Editore"s Note
Tilting at Windmills

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April 11, 2007
By: Kevin Drum

HEALTHCARE IN NOT-AMERICA....Jon Cohn writes about America vs. the world when it comes to healthcare:

Look at Japan. It has universal health care. It also has more CT scanners and MRIs, per person, than the United States....On a per capita basis the French get more physician office visits and more drugs than their American counterparts....The Germans get almost as much time as the French.

....Cannon, Gratzer, Tanner, and others have all seized on the survival rates for cancers — particularly breast cancer and prostate cancer. In those two cases, Americans diagnosed with those diseases are significantly more likely to live than Europeans diagnosed with them....[Some caveats follow.]....But, even if that were true, it's hard to read the data as indictment of universal health care when the U.S. survival rate on other ailments isn't so superior. The Swedes are more likely than Americans to survive a diagnosis of cervical, ovarian, or skin cancer; the French are more likely to survive stomach cancer, Hodgkins disease, and non-Hodgkins lymphoma. Aussies, Brits, and Canadians do better on liver and kidney transplants.

Good stuff. And yet, it still leaves me with the unsettled feeling that all we're doing here is showing that we can cherry pick data just as well as the Heritage Foundation can. After all, every system does some things well and some things poorly, and it's not that hard to make any point you want if you only show a tiny portion of the data. (For example, here's a handy rule of thumb: any time a healthcare article starts nattering on about hip replacement waiting times in Canada, just stop reading. The authors are cherry picking so egregiously it's a wonder their fingers haven't fallen off.)

It's always struck me that one of the big obstacles in the way of universal healthcare in America is that it's so easy to scare Americans about healthcare in other countries. Basically, Americans just have no clue what healthcare is like elsewhere and assume that, say, in France, it's only barely better than it is in the third world. (Did you know that French-speaking Canadians sometimes have to wait a year for hip replacements?!?) But despite the damage this widespread fear does to the cause, almost no one ever writes about what foreign healthcare looks like to the actual people who use it. A full-scale book looking at healthcare in other countries, warts and all, would be great. Even a long magazine article about healthcare in one country would be great. But for some reason, very little like that really seems to exist. Just a scattering of OECD studies stuffed with charts and footnotes.

I'm not sure why. Is it too hard? Too expensive? Or what? In any case, demystifying healthcare in other advanced countries sure seems like it would help out the pro-universal healthcare cause in America. So consider this a job from the assignment desk.

Kevin Drum 1:55 PM Permalink | Trackbacks | Comments (128)

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Comments

So why don't you write the book?

Posted by: Pat on April 11, 2007 at 2:42 PM | PERMALINK

Pat: I'm both too lazy and too ignorant. I want someone with real talent to do it.

Posted by: Kevin Drum on April 11, 2007 at 2:45 PM | PERMALINK

Universal healthcare is unamerican. I, like tens of millions of Americans, choose not to have health insurance because it's a ripoff: It's like betting against yourself. I should not have that right taken away from me.

Posted by: Al on April 11, 2007 at 2:47 PM | PERMALINK

The current health care system in America should stay: it is the only hope the rest of the world has that America will finally collapse and stop its wars of aggression.

Posted by: Dicksknee on April 11, 2007 at 2:48 PM | PERMALINK

If we can find just one anecdote saying somewhere outside the U.S. had a bad experience with health care, that means we shouldn't change anything here. And the best part is: the anecdote doesn't have to be true!

Posted by: Gore/Edwards 08 on April 11, 2007 at 2:49 PM | PERMALINK

Kevin,

Have you ever considered the possibility that universal healthcare in the United States might only be a net benefit to those who need it but don't already have coverage?

Posted by: Yancey Ward on April 11, 2007 at 2:50 PM | PERMALINK

People like Al should have the right to opt out of treatment but. as with every other tax, no right to opt out of paying for the system. If Al has no underage children or home schools the ones he has does he have the right not to pay for schools? I think not.

Posted by: fyreflye on April 11, 2007 at 2:53 PM | PERMALINK

One statistic that really leaps out at you, though, is how much more we PAY per capita for our maybe-better-maybe-worse-maybe-not-much-different health care.

Also, I think debating the QUALITY of health care is a red herring. What we should be debating is its COST. That would shift the debate from single-provider to single-payer, which is a much less disruptive shift, is much easier to implement, and is much more politically palatable.

Posted by: bleh on April 11, 2007 at 2:54 PM | PERMALINK

There was an article in the New Yorker a while back, by (IIRC) Malcolm Gladwell, about medical care in France. It was primarily about his (and his son's) personal experience with the French system when they lived in Paris, but along the way it took a broader look.

Unless someone else can put their finger on it right away, I'll have a look for it when I get a moment.

Posted by: Austin Ham on April 11, 2007 at 2:57 PM | PERMALINK

Wrt Yancey's suggestion (charmingly made with no evidence at all) I can say that there are plenty of benefits to single-payer even for someone with health insurance. When I was a poor student in Australia, with universal coverage, I had better health care options than I have in the US as a rich professor with a pretty high level of coverage. I had more choices of doctors, especially on weekends, shorter waiting lists, lower co-pays, fewer out of pocket expenses, etc etc. Australian health care isn't great, but it's much better than what the middle class get here with full coverage. And it is, all things considered, much cheaper.

Posted by: Brian Weatherson on April 11, 2007 at 3:01 PM | PERMALINK

I think rather than cherry-picking statistics we should rely on urban-legendish anecdotes.

Like, a friend of a friend of mine broke his arm while on vacation in France. He went to the clinic, went through the drill of x-rays, setting, and so on, and at his last visit brought along his insurance paperwork to allow the French clinic to charge his American insurer for the costs of the treatment (which in the US would be well into 4 figures).

Ze French docteur stared imperiously down his enormous nose (adapted to the sniffing of steenky cheese) at ze forms, and told ze patient to take ze silly paperwork aways. "I am sorree sir, we haf no-one here to fill zese sings out. I cannot charge your silly insurance company."

I have heard this story several times, so it must be true. I have also witnessed a similar incident, without ze zees because the Quebecois pronounce the "th" as "d", and without the condecension because the Quebecois are nice, after the late-night emergency-room staff at Jeffrey Hale Hospital in Quebec (ville) sewed my father's finger back together. "We have no way of charging you."

Posted by: Marcus Sitz on April 11, 2007 at 3:02 PM | PERMALINK

I think that data describing whether an average person, rather than just those who've already been diagnosed, survive a particular disease would be much more elucidating; it would acknowledge that some countries do better prevention, and healthful lifestyle promotion et cetera.

Posted by: jhm on April 11, 2007 at 3:02 PM | PERMALINK

I like the healthcare in Canada because others get taken care of, not because I need it. It is a moral issue, not political one.

Posted by: Bob M on April 11, 2007 at 3:02 PM | PERMALINK

As a bi-coastal Aussi-Seppo I know that Universals better and would save lives but you can't take this part of the state in isolation from the rest.
Giving more power and resources to the state can only be done responsibly if there is a dramatic decline in the military-entertainment sector of the state.
So long as 'Tax-and-spend' statists don't get this linkage so long as they should wander in the wilderness. It would be criminally irresponsible to advocate the slightest increase in fascist USSA power - criminal. ( Hi to all Vichy's reading)
Why don't you learn some politics for dummies you political jerk-off artist?
Politics 101 - power corrupts.

Posted by: professor rat on April 11, 2007 at 3:03 PM | PERMALINK

Uh, Kevin? "[some caveats follow]"? The section you left out describes how European and Japanese don't live any longer on average than USians despite the US having the higher rates of early prostate/breast cancer detection! That is a bit of an important point, and I suspect the Radicals will have already started going to town with their pretzel logic by the time I get this posted as a result.

Cranky

Posted by: Cranky Observer on April 11, 2007 at 3:03 PM | PERMALINK

Bleh says: "I think debating the QUALITY of health care is a red herring. What we should be debating is its COST. That would shift the debate from single-provider to single-payer, which is a much less disruptive shift, is much easier to implement, and is much more politically palatable."

Why? We absolutely should talk about quality--because who says it's better here than elsewhere?

Posted by: Chocolate Thunder on April 11, 2007 at 3:12 PM | PERMALINK

Want a personal anecdote? I'm happt to oblige.

When visiting my sister and her family in a small Provence town near Nice, France in June 2001, I suffered a seperated shoulder. I had the best medical care provided at a Nice hospital, and it didn't cost me a dime, even though I was not a French citizen. They weren't even willing to bill my insurance carrier.

Contrast this to last year, when I had a bout with skin cancer that required outpatient surgery and five weeks of intensive radiation therapy. My out-of-pocket expenses, after the insurance carrier told me what it would pay for, eventually ran close to $10,000.

Health care in industrialized countries like France and Japan is cheaper per capita than in the U.S., the quality is superior and the patients have on average better outcomes.

Americans, on the other hand, live with the risk and fear that every asset they've worked so hard for can be lost, simply by virtue of an ill-timed major illness or accident either to oneself or a family member. And thanks to the 109th Congress' bankruptcy "reform", they can no longer use such protections as a financial umbrella against asset seizure by hospitals, etc.

Unfettered access to basic health care is either a fundamental American birthright, or it's a fungible commodity subject to sale or trade in a so-called "free market" that is increasingly showing all the hallmarks of being an insurance carriers' business cartel. The stark choice here is really as simple as that.

I've said it before on similar posts, and will say it again: What price or cost are you willing to assess your own peace of mind?

Posted by: Donald from Hawaii on April 11, 2007 at 3:13 PM | PERMALINK

Ok, I'll chip in with 2 cents (but those are universal cents). As a Canadian, I find the general health service very good although I confess that I don't understand how they distinguish what can be privatized and what can't (more on that later).

However, I have not had any bad experiences in waiting for services. When I need an appointment with my Dr I make an appointment as far in advance as I can, but on 1 or 2 occasions I have had to go in on an emergency basis and I was taken right in (maybe an hour wait). I have never had a problem with waiting at hospital emergency for care.

Most things are covered by our universal system but there are things that are not covered and I also have health insurance from my employer that covers things like eye glasses and drugs. My cost for this (for my family) is about $28 a month.

We (my family and I) try to live a healthy lifestyle so perhaps we are not typical. My mother suffered a number of problems when she was about 60 and essentially spent 2 years in hospitals and we were very glad that we could focus on her instead of trying to raise money for the bills.

My one bad experience is with my youngest daughter. She is 2 1/2 and is not talking yet so we are on a waiting list to see a speech pathologist. While this would be covered by our health care system, there are private speech pathologists that I could take her to and I am investigating this right now. They are, of course, not covered by the public system but maybe be partially covered through my work supplementary health. I don't know why there are private speech pathologists but other aspects of health care are not privatized. Hey, I am just a user, not a health policy maker.

Anyway, that should kick all the Als, Normans and Egbert into gear and the stories about how someone had to wait 3 months before they could get someone to sew their head back on should kick in.

Posted by: Yelling in the fog on April 11, 2007 at 3:22 PM | PERMALINK

And yet, it still leaves me with the unsettled feeling that all we're doing here is showing that we can cherry pick data just as well as the Heritage Foundation can.

Broken record here. Can you pick better cherries than:


  • Expected lifespan

  • Infant mortality rate

  • Percentage of life in ill health

  • Cost

We lose on all those metrics, to about 20 other countries. What metrics are better than these?

My rule of thumb for measurement, is to first count bodies. Death usually matters most.

Posted by: dr2chase on April 11, 2007 at 3:23 PM | PERMALINK

Corporate executives with tennis elbow do not want to have to wait for treatment while others with more serious injuries who need medical care so they can go back to work receive care first.

This is what drives the 'Canadians have to wait years for surgery' propaganda theme.

Posted by: Brojo on April 11, 2007 at 3:24 PM | PERMALINK

> Americans, on the other hand, live with the
> risk and fear that every asset they've worked
> so hard for can be lost, simply by virtue of
> an ill-timed major illness or accident either
> to oneself or a family member

If one were cynical, one could observe that France has high rates of locally-owned small businesses. The economic powers that control the US have been telling US citizens for 20 years that they must live with economic uncertainty and be prepared to be fired and/or retrain at an instant's notice - but at the same time they have made it almost impossible for 40-50 somethings who do get fired to set up their own businesses rather than begging for another corporate job at 1/3 the pay. Ya think there might be a connection?

Cranky

Posted by: Cranky Observer on April 11, 2007 at 3:24 PM | PERMALINK

No personal experience with health care outside the United States, but I do have several Europeans in my social group and have met a wider variety of nationalities through work and university. One thing stands out to me.

I have a never met a single person from outside the United States - insured or not, wealth or not - that prefers American health care.

Not one. Ever.

Posted by: William on April 11, 2007 at 3:26 PM | PERMALINK

"Americans, on the other hand, live with the risk and fear that every asset they've worked so hard for can be lost, simply by virtue of an ill-timed major illness or accident either to oneself or a family member."

If Dick Cheney were on our side, this would get us universal health care. The mushroom cloud of total ruin due to a freak medical emergency. Cheney would scare every American into supporting universal care.

I felt the chill of it recently, in what by many measures would count as a minor incident. My son in college vomited violently in a class building, tore his esophagus in doing so, passed out in a pool of blood, got taken by ambulance to the hospital a mile or two away, found to have lost an enormous amount of blood, spent three-four days there, briefly in ICU. The costs were enormous, but thank God, most covered. But I couldn't focus on his serious health condition, thinking stupid stuff like -- is the hospital on our plan?, the specialists?, etc. etc. And then the statments come in -- thousands and thousands of dollars. The ambulance alone costs $1500! And the insurance isn't paying! Negotiations etc.

What if it had been a really, really serious injury?

Just give me the French model, please. You're sick, you get treated, it doesn't cost much. Please.

Posted by: David in NY on April 11, 2007 at 3:27 PM | PERMALINK

David in NY: You are so right. My eyes were openedwhen I got strep throat in Burgundy-the doctor made a hotel call, gave me a thorough exam, and charged 27 dollars for the visit. The medicines at the pharmacy came to 23 dollars:J'aime la France!

Posted by: beth on April 11, 2007 at 3:33 PM | PERMALINK
And yet, it still leaves me with the unsettled feeling that all we're doing here is showing that we can cherry pick data just as well as the Heritage Foundation can.

First, WTF is up with "we" here? Are you Cohn's secret co-author? Are you on the editorial board of the New Republic? Do you have some other undisclosed connection to the article?

Second, the point of what you excerpt (the particularly repellantly-designed registration wall killed any desire I had to go to the source article itself) seems to be that the traditional cherry picked responses to the broad measures demonstrating the superiority of universal systems are easily matched by equal-but-opposite points, which, while perhaps not the best strictly logical response, seems to be a good way of neutralizing the effect of those irrational responses, which aren't, anyhow, a strictly logical rebuttal of the broader arguments for universal healthcare. So it seems to be that you are right about what Cohn is showing, but wrong in your suggestion that there is something undesirable about showing that.

Posted by: cmdicely on April 11, 2007 at 3:33 PM | PERMALINK

I always found the whole 'YOU HAVE TO WAIT A YEAR FOR SUCH AND SUCH!' argument against nationalized medicine. Don't you have the same kind of waitlists here in America? Hell, it can be even worse, depending on whether or not you can afford express treatment or not.

Posted by: Kryptik on April 11, 2007 at 3:34 PM | PERMALINK

Yelling in the fog -- my Canadian niece didn't speak until she was three and then started, no problem. Hope you're as lucky.

Posted by: David in NY on April 11, 2007 at 3:34 PM | PERMALINK

I'd like to chime in about Canadian healthcare. Canadians do a great job providing healthcare to everyone and we should really try to emulate that part of their plan. However, the quality of care, the quality of the facilities would be familiar only to low-income Americans who have to rely on City or County hospitals.

I lived in Vancouver for three years, during that time my daughter was hospitalized three times for fairly minor issues at a regional children's hospital. I'm glad I didn't have to worry about bills and paperwork because I had my hands full making sure my child received meals (they frequently forgot to bring them), had clean sheets on the bed (I had to change them myself) and was getting the care the doctors said they were going to provide (I was mislead regarding her care multiple times). It became very clear to me that I was being told certain tests would be run when the staff had no intention of running them. For example, I was told almost hourly over the course of a week that my child would be getting an ultrasound and that the machine should be up anytime. I was even told this as we checked out of the facility.

I won't go into details about the low quality of the hospital staff at all level. Let's just say I won't ever complain about Kaiser again.

The Canadians have access nailed, but our system still provides the best quality care in the world.

Posted by: bellhop68 on April 11, 2007 at 3:37 PM | PERMALINK

"David in NY: You are so right. My eyes were openedwhen I got strep throat in Burgundy-the doctor made a hotel call, gave me a thorough exam, and charged 27 dollars for the visit. The medicines at the pharmacy came to 23 dollars:J'aime la France!"

Amazing, isn't it, Beth? I had the same experience a couple of times -- once my wife sprouted an allergy to a medicine she had just begun taking just as we were to set off on a twelve-day hiking trip. $15 for a doctor's visit (this was 20 years ago), a few bucks for a prescription, a couple of days' rest, and that was it. Great.

Posted by: David in NY on April 11, 2007 at 3:39 PM | PERMALINK

Folks - can we PLEASE keep in mind the distinction between single-PROVIDOR (in which the Drs actually are govt employees and so far NOBODY is proposing that) with single-PAYER, in which the care "should" be the same the only difference being that the govt pays the Drs.

Let's just keep that in mind. Big Insurers/HMOs who would cease to exist for the most part in single-payer like to muddy the water by screaming "socialized medicine" ie the Drs will become lazy low-quality govt employees.

That ain't what we're talking about. The Drs. just get paid by someone else, probably significant more quickly, and do not have HMO-interference in their decisions.

Posted by: smott on April 11, 2007 at 3:45 PM | PERMALINK

UHC as seen through the eyes as being a driver to small business self-ownership is where we'll make the major breakthrough.

Posted by: Karmakin on April 11, 2007 at 3:45 PM | PERMALINK

As long as we are anectdoting . . .

I lived in the UK for 6 months with three small children. When the (almost inevitable) ear infection came I took them to the local doctor.

Sure, it wasn't fancy, and they didn't have every piece of equipment in every single room, but my kid was seen within the hour and we got the prescription for antibiotics after that. They apologized prfusely about making me pay, but it cost about 20 US dollars for the Dr and 4 US dollars for the prescription, which was less than their copay.

It was so low I didn't bother claiming it with my US medical insurance.

Granted this was 15 years ago but since then my mother-in-law broke her femur while on a cruise in Sweden. She was in hospital about two weeks, with surgery to set the bone, before she flew back. All of her healthcare in Sweden was free, paid for by Swedeish taxes.

We Americans are SO willfully ingorant it makes me sick sometimes.

Posted by: Tripp on April 11, 2007 at 3:53 PM | PERMALINK

Brian Weatherson,

Of course, your experience is just another anecdote, necessarily cherry-picked because it is your personal experience. For example, compare your anecdote to Bellhop68's about Canadian healthcare.

I asked my question for a reason. An assumption underlying a lot of the argument for universal care in the United States is that it would be better for Americans as a whole. What is the evidence supporting this assertion? I don't doubt that some would benefit, but it need not be true that we are collectively better off. Using stats like life expectancy and infant mortality still don't answer the question because Americans are different from the French or the Japanese in many more ways than just the healthcare system.

To put the question in another way, why do you think there is such resistance to universal healthcare? Do you think is just because Americans are ignorant? Or is it more likely that a good number of them realize that universal healthcare may mean that they personally get somewhat worse care than before?

Posted by: Yancey Ward on April 11, 2007 at 3:56 PM | PERMALINK

Nah I think the break through comes when Big Business gets behind it...which is finally starting to happen as the global economy pressures the bottom line...

Posted by: smott on April 11, 2007 at 3:57 PM | PERMALINK

um, I got sick once and like, went to the doctor and he was, like, take these like pills, like and i like got better but didn't pay for it because like i didn't have money, so like the doctor was like cool with it so like what's the problem with this urban legend anecdotal cherry-picking stuff anyway?

Posted by: beavis on April 11, 2007 at 4:04 PM | PERMALINK

Kevin,

There is no mystery here. It been well established that Americans get the most expensive health care in the world (some of them, the ones with insurance) and don't get significantly better outcomes than anywhere else. Here is the Kaiser Family Foundation study from a couple of years ago. Costs have only risen in the US in the last couple of years, so the discrepencies have only widened.

Posted by: Melanie on April 11, 2007 at 4:04 PM | PERMALINK

bellhop, many observers would actually give France the palm for best care in the world. If the Canadians (or Brits) chose to spend the same % of GDP on health care as the high-spending French do (let alone the even higher-spending US!) they too could combine access with an unsurpassed standard of care. The US is unique in providing lack of access (and a poor standard of care for the non-well-heeled) at by far the highest per capita cost in the world. That's simply indefensible, as hard as some people try.

Posted by: Steve LaBonne on April 11, 2007 at 4:05 PM | PERMALINK

Comparing the US medical services system with the systems in other countries -- eg. France, Canada, Japan, Germany, the UK, Australia -- is comparing apples and oranges, because the US system serves an entirely different purpose from the systems that those countries have.

The purpose of the universal single-payer nonprofit medical services systems in those countries is to efficiently and effectively deliver medical services to people who need them, thereby promoting and protecting the health and well-being of the entire population.

The purpose of the private, for-profit medical services system in the USA is to enrich and empower America's already ultra-rich and ultra-powerful corporate ruling class, by sucking up as much money as possible and concentrating it in the hands of the rich and powerful.

That's why a universal single-payer nonprofit medical services system is and always will be "off the table" in the USA.

Posted by: SecularAnimist on April 11, 2007 at 4:05 PM | PERMALINK

mhr is right! Cubans leave Cuba because of universal health care -- it has nothing to do with Castro, embargos or anything else.

So why don't we tell the HMOs to move to Cuba and leave the Cubans alone.

Oh, mhr is just a troll.

Never mind.

Posted by: Dicksknee on April 11, 2007 at 4:06 PM | PERMALINK
To put the question in another way, why do you think there is such resistance to universal healthcare?

"Such" as what? Universal healthcare has been supported by large national majorities in polls for years. It is opposed principally by the health insurance industry, which has lots and lots of money and narrow concentrated interest in its ability to extract profits from the inefficiencies in the status quo system, and lavishly funds utterly dishonest scare campaigns with no rational nexus with the actual substance of the proposed policy anytime an actual policy is in danger of being implemented to fulfill that broad public demand.

So, the reason for the resistance there is that a narrow, entrenched oligopoly that is making a fortune at everyone else's expense in the status quo is quite understandably devoted to defending its position.

Posted by: cmdicely on April 11, 2007 at 4:10 PM | PERMALINK

"Or is it more likely that a good number of them realize that universal healthcare may mean that they personally get somewhat worse care than before?"

Why would that be true, Yancey? I mean, leaving aside the folks who gladly self-insure because they've got an extra million or so lying around in case of an emergency. (They can always take their money somewhere to get care, I'm sure.) But take the ordinary person with an HMO or similar plan from work. What makes you think universal healthcare would be worse for them? What evidence do you have?

Posted by: David in NY on April 11, 2007 at 4:12 PM | PERMALINK

Donald from Hawaii:

I have heard the "injury in France, no charge" story so many times, with a couple of elements in common, that I always figured it was urban legend.

What are the common elements?

(1) Orthopedist involvement (I've heard broken arm, broken wrist, broken leg);

(2) South of France

You check out on both counts, except that it happened to you! You're famous! Or at least the kernel of an urban legend!

Posted by: Marcus Sitz on April 11, 2007 at 4:14 PM | PERMALINK

The diagnosis rate for both prostate and breast cancer is directly related to screening rates. The US standard of care involves far more testing for, and detection of, early stage cancers. As the majority of these cancers are slow-growing and will likely never cause a problem for the patient, US survival rates for these health outcomes will exceed those in nation's with lower screening rates. The question shouldn't be about survival but quality adjusted life years. Under our system many Americans receive unnecessary treatment, and live with unnecessary side adverse side effects, that reduce QALYs.

Posted by: Dris on April 11, 2007 at 4:14 PM | PERMALINK

Yancey Ward wrote: "To put the question in another way, why do you think there is such resistance to universal healthcare? Do you think is just because Americans are ignorant? "

What is your evidence that "there is such resistance to universal healthcare" by "Americans"?

Opinion polls do not support your suggestion that Americans in general are "resistant" to universal, single-payer, nonprofit health care:

"Washington Post-ABC News Poll: Health Care," October 20, 2003:

Which would you prefer - (the current health insurance system in the United States, in which most people get their health insurance from private employers, but some people have no insurance); or (a universal health insurance program, in which everyone is covered under a program like Medicare that's run by the government and financed by taxpayers?)

32% - Current
62% - Universal
2% - No opinion

That's an approximately 2-to-1 preference for "a universal health insurance program, in which everyone is covered under a program like Medicare that's run by the government and financed by taxpayers".

Of course, the ultra-rich corporate elites who actually rule America are "resistant" to universal single-payer nonprofit health care, since they are getting richer and richer every day from the current for-profit system.

Yancey Ward wrote: "Or is it more likely that a good number of them realize that universal healthcare may mean that they personally get somewhat worse care than before?"

You have offered no evidence that anyone in America would "personally get somewhat worse care than before" under a universal single-payer nonprofit health care system. You are just regurgitating a scripted right-wing talking point.

Nonetheless, the same opinion poll I cited above asked two related questions, and even if a universal single-payer nonprofit health care system resulted in limiting choices of doctors, or waiting lists for certain treatments, the majority of the 62 percent of respondents who supported a universal single-payer nonprofit health care system still supported it, even if it limited their choice of doctors or put people on waiting lists for non-emergency treatments:

Would you support or oppose a universal health insurance program if it limited your own choice of doctors?

56% - Support
42% - Oppose
2% - No opinion

Would you support or oppose a universal health insurance program if it meant there were waiting lists for some non-emergency treatments?

63% - Support
34% - Oppose
3% - No opinion

You are really bringing nothing at all to this discussion, except regurgitation of right-wing talking points and the dittohead's bizarre and baseless conviction that the majority of Americans agree with lunatic fringe right-wing extremist dogma.

Posted by: SecularAnimist on April 11, 2007 at 4:22 PM | PERMALINK

Ezra Klein did a great series on his blog a couple years back providing a pretty thorough overview of what's going on in other countries:
http://ezraklein.typepad.com/blog/health_of_nations/index.html

Posted by: Steve on April 11, 2007 at 4:25 PM | PERMALINK

Discussing the quality of Universal Health care is like a starving man refusing a burger because it's not a Turnador Rossini.The entire debate is one big Red herring after another.

Posted by: Nancy pelosi's mom Norma on April 11, 2007 at 4:30 PM | PERMALINK

To put the question in another way, why do you think there is such resistance to universal healthcare? Do you think is just because Americans are ignorant? Or is it more likely that a good number of them realize that universal healthcare may mean that they personally get somewhat worse care than before?

I'm sure Yancey omitted the possibility that there's been a decades-long PR campaign against it by people who are ideologically opposed the idea, and organizations that have a financial incentive to see it doesn't happen, strictly by accident. Why, even as ideologically opposed as ol' Yancey is, in his ruggedly individualistic way, to have deliberately presented a false choice like that would be intellectually dishonest.

Posted by: Gregory on April 11, 2007 at 4:32 PM | PERMALINK

I have heard the "injury in France, no charge" story so many times, with a couple of elements in common, that I always figured it was urban legend.

marcus sitz,

That is a very odd criterion for an being considered an urban legend.

The story of my Mother in law's broken leg with no charge is true. It really happened. I've spoken to the people involved and they, being staunch Republicans, would have no need to lie. I noticed that they weren't Republican enough to pay.

Isn't that odd. Support the status quo of squeezing the poor yet suckle off the foreign freebies. Now you know they are Republicans.

Posted by: Tripp on April 11, 2007 at 4:48 PM | PERMALINK

Cuba has universal health care and every year hundreds of Cubans climb into little boats headed for Florida to escape it.

Best. mhr comment. Ever.

Posted by: Alek Hidell on April 11, 2007 at 4:50 PM | PERMALINK

Can anyone name a very major difference between Japan and the U.S.? Can anyone list the other countries that would benefit if we established UHC here?

(I hope this question isn't too annoying.)

Posted by: TLB on April 11, 2007 at 4:51 PM | PERMALINK

Kevin, Have you ever considered the possibility that universal healthcare in the United States might only be a net benefit to those who need it but don't already have coverage? Posted by: Yancey Ward

Who do you think is paying now indirectly for the uninsured?

Posted by: JeffII on April 11, 2007 at 4:59 PM | PERMALINK
Can anyone name a very major difference between Japan and the U.S.?

They have an Emporer, and we don't.

Their flag has a sun, ours has a bunch of stars.

They have a lot higher population density.

Can anyone list the other countries that would benefit if we established UHC here?

Pretty much all of them, as a lot of our destructive policy approaches with harms here and abroad are only made possible by overreactions to fear and insecurity in the US public, and UHC would deal reduce that fear and uncertainty and thereby make those policies less likely to be implemented.

Posted by: cmdicely on April 11, 2007 at 5:00 PM | PERMALINK

Last summer the wife and I visited Paris. We had to go to the emergency room.

We had to wait about 5 minutes. There was only one other patient in the ER, a man with an obvious bleed from his upper arm (stab wound, perhaps). They apologized to us for the long delay.

Oh, we did have to pay via credit card up front. And got billed later for the ultrasound. They couldn't bill our insurance.

Posted by: VOR on April 11, 2007 at 5:02 PM | PERMALINK

Can anyone name a very major difference between Japan and the U.S.? (I hope this question isn't too annoying.) Posted by: TLB

Not annoying, just vague. Having lived in Japan for seven years, and helping write a study on the Japanese pharmaceutical industry in grad school, I could offer some perspective.

Posted by: JeffII on April 11, 2007 at 5:04 PM | PERMALINK

Tripp,

Was your Mother-in-law in the South of France?

Just kidding...

I absolutely don't insist that this is an U.L. After all, I was there for a similar incident with my father, in Quebec. And there is another incident I can think of...my brother-in-law's discovery, while in Paris, of a bee-sting allergy. That one involved the Gallic equivalent of a 911 call, paramedics climbing 8 flights of stairs, significant costs on the system --- and no discussion of a bill. Somehow the punk survived into Christianist wingnuttery and I'm sure he has forgotten what how the cheese-eating socialists saved his life once.

The story I tell about the French doctor laughing at the American patient who wants to pay his bill can be qualified as an urban legend: it didn't happen to me, I can't cite a source, and I may possibly have embellished the account here and there ... but note how many first-person versions of the story are out there, and they line up with One Important Fact: the French have managed to cut the enormous self-serving insurance bureaucracy out of the action.

Posted by: Marcus Sitz on April 11, 2007 at 5:05 PM | PERMALINK

I have a friend who was in japan a few years ago on vacation and got strep-throat or something. He was directed to a clinic where he waited a bit while they found the doctor that spoke some english, gave him some medication and sent him on his way. They didn't charge a dime.

Posted by: jefff on April 11, 2007 at 5:10 PM | PERMALINK

Marcus Sitz: "You check out on both counts, except that it happened to you! You're famous! Or at least the kernel of an urban legend!"

I would hazard to guess, having no statistics at immediate hand that would support or debunk my estimation, that most Americans who are forced to seek out medical care whilst traveling overseas are usually compelled by some sort of personal injury to their extremities, i.e., a severe cut or a broken bone. That might account for the inordinate amount of orthopedic care mentioned anectdotally.

This is hardly myth or "urban legend" as you so snidely termed it, as though you're calling me out as a liar. If you'd like specifics about where I visit when in Provence, my sister lives in the village of Biot, about 16 km northwest of Nice. Her in-laws are the owners/operators of that village's only hotel along with the adjoining restaurant.

And apparently unlike you -- who seem more than perfectly willing to carry the water on this particular issue for the nation's wealthy and well-heeled corpoate class, as though you were some ingratiating galley slave -- I've been following this closely for years both personally and professionally, and I'd have to say that your gross and unsubstantive generalizations about such anecdotes are exactly that: Gross and unsubstantive generalizations.

Posted by: Donald from Hawaii on April 11, 2007 at 5:11 PM | PERMALINK

>> Can anyone name a very major
>> difference between Japan and the U.S.?

> They have an Emporer, and we don't.

Are you absolutely sure about that? I am not, anymore...

Cranky

Posted by: Cranky Observer on April 11, 2007 at 5:17 PM | PERMALINK

The article here:

http://www.ajph.org/cgi/reprint/93/1/31.pdf

published in the American Journal of Public Health, gives a pretty good, non-anecdotal account of what makes France's system better than most others. Neither too technical, nor too fluffy. Pretty convincing, it seems to me.

Posted by: JD on April 11, 2007 at 5:18 PM | PERMALINK

I think the scoffers at the "urban legends" of good, cheap care in other countries are missing the point (unless they mean that we, who have had this experience, are all liars). Nobody, ever, has a story about getting quick, free or low cost, medical care in the United States. It's stunning to so many of us because getting care in places like France is so easy and so cheap.

I think one of the most pleasant things there is that you don't have the experience people have in hospitals here -- being directed initially to the billing office, waiting a half-hour or 45 minutes to be seen by a clerk who takes down all one's personal and insurance information, and only then being treated.

Posted by: David in NY on April 11, 2007 at 5:19 PM | PERMALINK

Can anyone name a very major difference between Japan and the U.S.?

Following up on Chris Dicely's excellent list, I'd like to add that Japan has Godzilla while we only have corporate monsters.

I would prefer Godzilla.

Speaking of corporate monsters, Halliburton has just finished one project helping our "archenemy" Iran but has quietly signed a new contract to help Iran develop their its natural gas fields.

Aiding and abetting the enemy, tsk tsk.

Pretty much all of them, as a lot of our destructive policy approaches with harms here and abroad are only made possible by overreactions to fear and insecurity in the US public, and UHC would deal reduce that fear and uncertainty and thereby make those policies less likely to be implemented.

Good observation. Ironically the trillion plus dollars we'll have spent grinding down our army in Iraq for nothing could have gone a long way towards implenting a much-needed UHC plan.

Ah well, you go to hell with the Republican governments you have, not the Republican governments you want.

Posted by: trex on April 11, 2007 at 5:21 PM | PERMALINK

> They have an Emporer, and we don't.

Are you absolutely sure about that? I am not, anymore... Posted by: Cranky Observer

In a sense, both wrong and right.

The Japanese emperor is a virtual prisoner of this evil institution called the Imperial Household Agency. Whereas the British royals can do pretty much whatever they want (their restrictions are typically those of self-restraint appropriate to royalty), the members of the Japanese imperial family, though still revered by much of the general populace, can hardly go to the bathroom without the permission of the IHA. In many ways, it's not so different from the days of the shogunate - titular royalty with no power whatsoever.

Over the last six years, Shrub has been "commanding" an army and has been allowed to pretty much whatever the hell he wants to. Our "emperor" trumps theirs currently.

Posted by: JeffII on April 11, 2007 at 5:26 PM | PERMALINK

A single payor system won't change the excess cost growth issue in the US,at least not right away. Hospitals,for example, don't know what to charge for a procedure or test because the answer is it depends. The multitude of insurers,including the Medis, negotiate rates for DRGs and so they and the hospitals do the "cost" dance every year, further complicated by the SMSA factors, rural vs. urban and so on.
I have tried on several occasions to price a liver test my wife needs (cholesterol medicine) at various hospitals and literally could not get an answer. It always ended up that since we were insured, why did I care?
Hospitals here (Midwest-Urban)aren't very well run.Quite a few need to close,but won't.

Posted by: TJM on April 11, 2007 at 5:27 PM | PERMALINK

Donald from Hawaii!

No offense! I've been telling the story for years, because I think it is basically true... and now you (and others) come along to tell me to take the "basically" out of the story...

If there is a liar in this story it is me, not you ...

... and if the big shots are looking for a water carrier, it will have to be someone other than me: I like the French system, have lived with the French system, I have also lived with and liked the Canadian system, and think that the American system is absurd and horribly expensive.

There is another common element in all of these stories (which does not make them UL, nonono): American patient goes to the emergency room and GETS SEEN IN A REASONABLE AMOUNT OF TIME. Why is that? I went into the emergency room in San Francisco a few years ago, with chest pain (pleurisy, thank you very much), and I did get seen immediately...but only because the triage nurse boosted me in front of the line of people who needed to see a medic, but maybe not that instant. Funny: in France, and in Canada, and in all those other countries with universal coverage of some sort, the emergency room gets used for emergencies, rather than for primary care for the uninsured.

Posted by: Marcus Sitz on April 11, 2007 at 5:30 PM | PERMALINK
A single payor system won't change the excess cost growth issue in the US,at least not right away.

Well, cutting out insurer profits will cut out a big chunk of the costs in the short-term. Cutting out the diversity of different eligibility and reimbursement systems will, too.

Not having different pools of people with access to different sets of providers based on which insurance carrier and plan they have will also spur economy.

Posted by: cmdicely on April 11, 2007 at 5:36 PM | PERMALINK

The ONLY system LIMITING CHOICE of Dr's is the AMERICAN SYSTEM.
If there is one universal payer system with limits to choice please name it and provide links, just some proof. I keep reading it over and over again but can't see any proof. So please step up to the plate.

Name names, not just allegations.

Posted by: Renate on April 11, 2007 at 5:49 PM | PERMALINK

So, the reason for the resistance there is that a narrow, entrenched oligopoly that is making a fortune at everyone else's expense in the status quo is quite understandably devoted to defending its position.

cmdicely: I want radical reform of our healthcare sector as much as the next person, but I think statements like yours make it harder to achieve. Sure, the insurance industry opposes changes to the status quo it thinks would adversely affect its profits. But large numbers of Americans, too, oppose changes to the status quo. Generally speaking, when the American public wants something from the government (prescription benefits, the mortgage interest deduction, etc.), politicians manage to give it to them. They're good like that.

A far better strategy would be to face the reality that building political consensus for UHC has so far not been possible, and figure out why this is, and what we can do about it.

Posted by: Jasper on April 11, 2007 at 5:50 PM | PERMALINK

A collection of anecdotes is data! "Nobody, ever, has a story about getting quick, free or low cost, medical care in the United States. It's stunning to so many of us because getting care in places like France is so easy and so cheap."

Years before I met my wife she had a bike accident on the Blue Ridge Parkway, went over the handlebars and broke her jaws. Fortunately someone drove by, picked her up and took her to a hospital. She walks up to the admission desk, bleeding and trying to hold her face together with both hands. The nice lady at the desk told her she had to fill out the forms, or at least tell her what insurance she had before they could help her.

This wouldn't happen virtually anywhere else in the world. No one would insist an injured person has to explain how they're going to pay before they can stop the bleeding or relieve the pain. When I read the idiotic comments from rightwing trolls about waiting for hip replacements or prostate cancer recovery rates (neither of which they understand or care about) it drives me crazy.

My wife's stepfather, who was a millionaire, got on a ferry in Canada, had some heart problems and ended up in a Canadian hospital. The care he got there was as good as any he got at home.

It doesn't have to be like this.

Posted by: SteveH on April 11, 2007 at 5:53 PM | PERMALINK

cmdicely, you may be right, but try to quantify it. Let's assume that insurers spend 20% on overhead and Medicare (and Medicaid) spends 3%. Since the Medis are about 60% of expenditures, you're looking at 7.8% savings or about 1 years cost growth. I suppose it's a start but it's not much.

Posted by: TJM on April 11, 2007 at 6:03 PM | PERMALINK

Ho ho ho ho ho ho! Those "liberals" shure have a sense of humor.

Anywho, Japan is an island, while the U.S. is connected to Mexico, and indirectly to Central and South America. The crooks who run those countries would love it if we established UHC here, almost certainly encouraging even more of their populace to head here for the benefits.

Obviously, that's a vital issue when it comes to UHC, yet few want to discuss it. If they don't want to discuss such a vital issue - or handwave or smear it away - should anyone trust anything they say?

Posted by: TLB on April 11, 2007 at 6:07 PM | PERMALINK
Let's assume that insurers spend 20% on overhead and Medicare (and Medicaid) spends 3%. Since the Medis are about 60% of expenditures, you're looking at 7.8% savings or about 1 years cost growth.

The myriad of record keeping expenses imposed by the mixed public/private system (and the diversity of public systems designed to plug different gaps in the private provision of health care) increase the cost of the public components as well as the private components.

Having a single single-payor system would reduce cost even among those parts of the system that are currently public.

Posted by: cmdicely on April 11, 2007 at 6:07 PM | PERMALINK

I don't doubt that some would benefit, but it need not be true that we are collectively better off. Using stats like life expectancy and infant mortality still don't answer the question.

yancey, i love you dearly, but this is dumb. what ELSE could anyone possibly cite as a measure of better overall health outcomes than those statistics? why aren't they good enough to answer the question? what exactly would it take to convince you? are you seriously arguing that these statistics are useless?

because Americans are different from the French or the Japanese in many more ways than just the healthcare system.

yeah, we speak English and they speak French and Japanese respectively.

To put the question in another way, why do you think there is such resistance to universal healthcare?

universal health care has popular support as others in this thread have shown.

Do you think is just because Americans are ignorant? Or is it more likely that a good number of them realize that universal healthcare may mean that they personally get somewhat worse care than before?

i suspect that they know that a good universal system would require higher taxes. i don't think it's a fear about quality of care, but about high taxes.

Posted by: spacebaby on April 11, 2007 at 6:08 PM | PERMALINK

Generally speaking, when the American public wants something from the government (prescription benefits, the mortgage interest deduction, etc.), politicians manage to give it to them. They're good like that.

Yeah, which is why the American public said get out of Iraq and we're out. Oh, wait....

Posted by: Stefan on April 11, 2007 at 6:13 PM | PERMALINK

I think the best book on the subject is not on this subject at all -- that's Paul Starr's _the Social Transformation of American Medicine_. He lays bare the history of how we got here, thereby serving the same purpose -- things were not always the way they are now, and what we have now would be optimal only by accident.

Utilization patterns in Japan are so radically different from the US that it's hard to make useful comparisons -- there's no primary care per se, and hospital lengths of stay are dramatically larger than in any other OECD nation. Although not a summary article, the "discussion" section of http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1388212 provides some data and citations.

It's an interesting phenomenon that we Americans on the whole believe that we live in the best of all possible countries, and that the institutions we have are the best of all possible institutions, and therefore we have little or nothing to learn from experiences in other countries; indeed, we tend to believe that other countries are strange and should adopt our institutions. Whether one is talking about our stance towards speech (compared with, for example, the UK, where these rights are markedly different), drug policy (e.g. the Netherlands), or health care (any other industrialized nation), there is essentially no room in our political or social discourse to suggest that we might be able to improve things by adopting practices observed elsewhere. It's, by definition, "unAmerican" and that trumps all else.

Posted by: s_kawachi on April 11, 2007 at 6:15 PM | PERMALINK
Generally speaking, when the American public wants something from the government (prescription benefits, the mortgage interest deduction, etc.), politicians manage to give it to them.

The second of your examples didn't have any wealthy, concentrated entrenched opposition, and the second opposition is something that was demanded for many years before a half-hearted, industry handout that resembled the public demand in vague outline was provided.

It certainly does not prove your point that the failure of government to immediately provide something is prima facie evidence that there isn't broad public support for it.

A far better strategy would be to face the reality that building political consensus for UHC has so far not been possible, and figure out why this is, and what we can do about it.

Er, if by "political consensus" you mean only the passage of a law, that's true, I've acknowledged the reality, and I've pointed out why it is true.

As for what we can do, its simple: understand (1) that the vast majority of people are already on the side of UHC and why, as, e.g., the polling data SecularAnimist points to illustrates, (2) understand how the narrow opposition has responded in the past to specific proposals and is likely to in the future, and (3) prepare to hit back hard against FUD with facts, and recognize that a well-funded campaign is going to be needed, because that's what's going to be behind the other sides lies.

What we don't need to do is pretend we're starting from a worse position than we, in fact, are.

Posted by: cmdicely on April 11, 2007 at 6:15 PM | PERMALINK

TJM

US spends about 4-5% of GDP on healthcare administration, Canada and UK c. 1%.

Per citizen, recalling that US GDP per head is quite a bit higher, this is obviously a bigger number.

I'm not sure I follow your arithmetic, and I accept the argument that if the US had single payer, it might not achieve 1% admin costs as opposed to 4% ie all of that gain might not be 'on the table'.

But this is the sort of magnitude of difference between the two systems.

The other factor is that medical people and providers to the medical system (drug and equipment companies etc.) are paid much less in Canada and the UK. Because there is one buyer, it has bargaining power, and it bargains *hard*.

Posted by: Valuethinker on April 11, 2007 at 6:18 PM | PERMALINK

OK, comparative anecdotes from an American, US vs. non-US:

1. Slipped and potentially damaged wrist in the UK: waited 1 1/2 hours in ER. Xray and exam, (wrist wasn't broken) no charge.

2. Ear infection in Australia: 1/2 hour wait in clinic, $30 doctor's visit, $10 for antibiotics.

3. Lost medicine in Canada: 45 minute wait at clinic, no problem getting a prescription, total cost about $25. My *copay* in the US is $35.

4. Grandmother has stroke while visiting Germany- ambulance, 1 1/2 weeks in hospital: total charge $900.

As compared to
1. Friend who was between insurance coverage for 2 months (COBRA doesn't always apply): got hit in the face. Visit to ER and repair of broken bone in face: $10,000, negotiated to $8000 because he could put it all at once on a credit card. Most people can't put that much on a CC, and would end up paying the full $10k.

2. Insured friend who was bleeding- a potential miscarriage- during pregnancy. Waited 3 hours at ER before seeing a doctor. (No choice of HMO hospital.)

3. Insured friend with severe chest pain. Waited 2 hours (the window for treatment to prevent permanent heart damage in a heart attack is 1 hour). He ended up phoning other ERs and leaving for one with a shorter wait. Total time before 1st blood test-- 3 hours. (Ended up being gallstones, the symptoms of which can mimic heart attacks.)

4. Friend with the high-risk California insurance-- $700/month, 20% copay, in her 30s. Got infected with the 'flesh eating' bacteria in her leg from working out in a gym. Hospitalized for a week, including time in the ICU. Her cost-- about $8000.

Luckily you can take money out of your retirement account to pay for medical expenses. For 2006, with over $16,000 in medical expenses, she sure doesn't have extra money to put into retirement.

Posted by: Kathryn from Sunnyvale on April 11, 2007 at 6:21 PM | PERMALINK

6 months ago I underwent a radical cyctoprostatectomy for bladder and prostate cancer. I have relatively good insurance as a retired teacher but dealing with the nightmare blizzard of bills you can't undrestand from people you never even met was insane.

It is long overdue for a single payer system.

We rarely, if ever, hear of the savings such a system would provide, only about the cost.

Take the fucking insurance companies out of the equation. They are bloodsucking bastards.

Posted by: angryspittle on April 11, 2007 at 6:21 PM | PERMALINK
Anywho, Japan is an island, while the U.S. is connected to Mexico, and indirectly to Central and South America. The crooks who run those countries would love it if we established UHC here, almost certainly encouraging even more of their populace to head here for the benefits.

Its not really all that unusual, and certainly not impossible, for countries with UHC to limit public benefits to citizens and legal residents, possibly with extensions to citizens of other countries with reciprocal agreements.

That being said, the governments of Mexico, etc., while they certainly don't mind the money coming back from emigrants, would probably prefer if their most productive and industrious and ambitious citizens would do more to contribute to the productive development of their own country rather than ours.

At any rate, certainly UHC would make the US a more attractive place to live, and increase immigration demand, and therefore the market-clearing price of immigration. But that shouldn't be a bad thing for the US; the problem with the status quo system is that it focuses on hard caps to immigration, rather than turning the demand into a source of benefit for the US public by capturing it: that could be changed, and would create an immigration system that is both more just, more effective at excluding the individuals who should be excluded, and more effective at serving the interests of Americans, despite a higher volume of legal immigration than in the status quo system.

But that's kind of tangential to UHC rather than central to it.

Posted by: cmdicely on April 11, 2007 at 6:25 PM | PERMALINK

Fucking insurance companies must have entire divisions simply to deny coverage on the first, second, and third efforts to get them to do what they promised.

Fuckers.

Posted by: angryspittle on April 11, 2007 at 6:25 PM | PERMALINK

Yes, Canadian medical employees are paid much lower wages than their American counterparts...which is why there are the nurse shortage is so much more acute in Canada than the US. You fail to mention that we are the Overtaxed Canadians. We like to brag about our health system to outsiders, but our media criticizes our healthcare system non-stop. I agree with the bellhop. We need to keep improving.

Posted by: Canadian Patriot on April 11, 2007 at 6:26 PM | PERMALINK

Jasper wrote: "But large numbers of Americans, too, oppose changes to the status quo."

What is your evidence for that assertion? Opinion polls such as the one I cited above show the opposite -- by nearly 2 to 1, respondents say they would prefer a universal single-payer nonprofit "Medicare for All" health care system.

Posted by: SecularAnimist on April 11, 2007 at 6:28 PM | PERMALINK

Kevin wrote: A full-scale book looking at healthcare in other countries, warts and all, would be great.

Although dated, there is an informative book that compares health care in the US, Germany, France and England. It's Lynn Payer's "Medicine and Culture."

For example, in the chapter on the US, she writes about how much more aggressive US medicine is compared to the other three countries: more invasive; surgeries performed more often; and when surgeries are performed across countries, the US surgeries themselves are more aggressive. The book does help to demystify health care across the four countries.

Posted by: Frank de Libero on April 11, 2007 at 6:28 PM | PERMALINK

Anywho, Japan is an island, while the U.S. is connected to Mexico, and indirectly to Central and South America. The crooks who run those countries would love it if we established UHC here, almost certainly encouraging even more of their populace to head here for the benefits.

Europe is connected to Asia and only a short hop from Africa, and despite its proximity to vast masses of uninsured Third World countries manages to maintain comprehensive health care systems. Try again.

Posted by: Stefan on April 11, 2007 at 6:36 PM | PERMALINK

Valuethinker:
>other factor is that medical people and
>providers to the medical system (drug and
>equipment companies etc.) are paid much less in
>Canada and the UK. Because there is one buyer,
>it has bargaining power, and it bargains *hard*.

Anderson et al make the same point in their 2003 article "It's the Prices, Stupid: Why the United States is So Different from Other Countries" (http://content.healthaffairs.org/cgi/content/abstract/22/3/89) unfortunately the full article is behind the subscription firewall. We spend more not because we get more care, but because the supply chain and providers are paid so much more.

They don't break apart the differences between primary and specialty care, nor do they analyze the factors that drive the US to have higher rates of particular surgical procedures (e.g. angioplasty) than anyone else, without matching improvements in cardiac mortality. Ayanian's recent piece in Circulation (http://circ.ahajournals.org/cgi/content/full/113/3/333#R9-172574) provides good summaries of recent work on the high rate of surgical treatment for coronary heart disease, despite evidence that improved use of beta blockers has equivalent effects in improving post-AMI mortality.

Posted by: s_kawachi on April 11, 2007 at 6:41 PM | PERMALINK

Utilization patterns in Japan are so radically different from the US that it's hard to make useful comparisons -- there's no primary care per se, and hospital lengths of stay are dramatically larger than in any other OECD nation. Posted by: s_kawachi

This is both positive and negative.

American medicine (or at least hospitals) want you gone as soon as you are "ambulatory." Not a bad thing as an increasing level of "secondary illness" and mortality in U.S. hospitals is the result of infection contracted in the hospital. I think most many people would rather be recuperating at home in their own bed than in a hospital. On the flip side, they practically through mothers and newborns out the door. If you have a good OB-GYN and or ped, he/she will authorize an extra day after delivery.

For the last twenty years or so, Japanese hospitals have had increasing problems with patients getting secondary infections from over long hospital stays and the general over/mis-use of antibiotics. Both the over long stays in hospitals and the declining efficacy of anti-biotics in Japan are a direct result of the national health system. In short, hospitals and doctors (who dispense prescription medicine) are gouging the government.

On the plus side in Japan, mothers and newborns typically spend five days in the hospital after delivery.

My limited experience with medicine in Japan has been positive, but Japanese society still has a long way to go, IMUHO, with how they treat patients with serious curable and incurable disease. A lot of old-school doctors still won't be honest with patients who are seriously ill about what is ailing them.

Posted by: JeffII on April 11, 2007 at 6:44 PM | PERMALINK

TLB:

Japan isn't "an island" any more than Hawaii is, it's a chain of islands that stretch for a couple of thousand islands from off the coast of Siberia almost to Taiwan.

It is already easy for Americans living near the northern border to "sneak" into Canada for free health care, and given that this option is within driving distance for more Americans than a similar option would be for Latin Americans -- in fact it would be easier for a Korean to sneak into southern Japan for medical care than it would be for most Latin Americans to sneak into a U.S. that offered universal coverage -- it's hard to see how this would be seen as a serious problem to anyone who wasn't already suffering serious delusions about a Latin American threat. Hell, think of all those Britons, Walloons, Dutch, Spaniards, Italians, Germans, etc. who could sneak into France...

s_kawachi:

Thanks for mentioning Starr's The Social Transformation of American Medicine, and the cite for Japanese health care. I only skimmed the article you referred to, but it seemed to refer mainly to pediatric care, not general care, when discussing the use of hospitals, the length of stay, etc. In addition, while there may not be a formal category of "general physicians" in Japan, the doctors who staff small clinics often function in just that capacity.

Interesting thoughts on American exceptionalism and our frequent unwillingness to borrow from, or even examine, systems that work well in other societies. I think U.S. News did a cover story on this a couple of years ago, and in fact, that's an occasional staple of news magazines: look how well country X does mass transit! look how well country Y does public education!

Oddly enough, these happy alternatives rarely involve turning away from public participation in social goods -- you just don't see stories that refer to the unbelievable successes achieved when a country privatizes its entire education system or does away with mass transit (or public health care)... because such successes simply don't exist.

Posted by: keith on April 11, 2007 at 6:51 PM | PERMALINK

JeffI:
>Both the over long stays in hospitals and the
>declining efficacy of anti-biotics in Japan are
>a direct result of the national health system.

or of the rules and culture embedded in this particular instantiation of national health, I would say. Yeah, clearly there are problems, and clearly there are bad ways of implementing single provider or single payor systems. I would just say that culturally Japan is so distinct from the US and Europe in the way disease is considered and treated that it makes for bad, or at least confusing, comparisons.

Posted by: s_kawachi on April 11, 2007 at 6:59 PM | PERMALINK

I'd like to know what "regional" hospital bellhop68 took her daughter to in Vancouver.
Certainly doesn't sound like the hospitals I
have visited in that city. Care has always been excellent and top notch, especially in comparison
with what I have received in the US.

Posted by: Optical Weenie on April 11, 2007 at 7:11 PM | PERMALINK

My favorite tale of right wing ridiculousness of health care argument is how almost every time I speak with my family (a bunch of right wing nuts) they end up listing off all the terrible things that have happened to them, their friends, and other family members that would happen if our health care system had universal coverage. The ridiculous part is that, being typically provincial right wingers, all their horror stories occur in the United States!

Posted by: jefff on April 11, 2007 at 7:11 PM | PERMALINK

Japan isn't "an island" any more than Hawaii is, it's a chain of islands that stretch for a couple of thousand islands from off the coast of Siberia almost to Taiwan.

WTF? I'm pretty sure that when we flew to Hawaii last August (the four other times I've been there) that it over the Pacific Ocean, which surrounds the, wait, wait, islands of Hawaii. Ditto for the three dozen or so times I've flown to and from Japan.

-- in fact it would be easier for a Korean to sneak into southern Japan for medical care than it would be for most Latin Americans to sneak into a U.S. that offered universal coverage -- Posted by: keith

Not to be repetitious, but WTF? Japan has some of the strictest immigration laws in the world (unless you're a female "entertainer" from Russia or SE Asia, but I digress). Unless a S. Korean spoke flawless Japanese and had the "proper papers" (i.e. a national health card), he isn't going to fuck off to Japan to take advantage of the national health. Why would he when he has pretty much the same thing in S. Korea?

And BTW, that would be sneaking into western Japan from the Japanese perspective.

Moron.

Posted by: JeffII on April 11, 2007 at 7:16 PM | PERMALINK

keith -- yah, I just happened to have that article on Japan, as in my current work I'm using GIS to examine healthcare utilization and referral patterns, and had it nearby as a citation. I don't know of a general survey comparison of the US and Japan with respect to health and healthcare, which is where this blog started, I think...

Posted by: s_kawachi on April 11, 2007 at 7:25 PM | PERMALINK
WTF? I'm pretty sure that when we flew to Hawaii last August (the four other times I've been there) that it over the Pacific Ocean, which surrounds the, wait, wait, islands of Hawaii. Ditto for the three dozen or so times I've flown to and from Japan.

And this conflicts with the claim that Japan is not an island but instead a chain of islands just like Hawaii, how exactly?

I think you should be a little bit slower to call anyone else a moron.

Posted by: cmdicely on April 11, 2007 at 7:35 PM | PERMALINK

It certainly does not prove your point that the failure of government to immediately provide something is prima facie evidence that there isn't broad public support for it.

But I'm not making the point that the public doesn't support "universal healthcare." Why wouldn't they want some as important as "healthcare" to be "universal"? Of course they do.

The question is: do they support it enough to change the status quo enough to get it? So far, the evidence says "no."

The Hillarycare debacle wasn't about a bunch of rich executives getting together to derail the administration's proposal*. Rather, the debacle was about Americans' fear of changing the status quo, and the well-founded fear of politicians that they'd be punished by said Americans if they ignored their constitutents' wishes.

The fact is, the vast majority of Americans -- as in, like, 85% -- possess insurance coverage. A good portion of those who don't either can't vote (because they're not citizens) or are young enough to not worry much about their lack of coverage (else they'd forgo the new Jetta and plow the payments into monthly premiums). Lots of Americans are either perfectly happy with the deal they've got when it comes to health insurance, or are insufficiently unhappy to punish politicians who don't give them something different. Wonks like you and me and the people who typically come to blogs this Kevin's may not agree with our fellow Americans, and we may curse their ignorance of how much better citizens of other wealthy democracies have it (which is pretty much the point of Kevin's post), but we're in the minority. The quicker we realize this and come up with strategies that comport with this reality, the better.

*Side note: I rather think Bush's failure to privatize Social Security is prima facie evidence for my contention. Here we have a very similar situation but in reverse. The financial services industry -- like healthcare an absolutely vast, rich and powerful sector of the economy -- would have loved to get a crack at managing 100 million private Social Security accounts. But John Q. Voter thought otherwise. The folks in Congress -- and this includes Republicans -- know how to poll. And not surprisingly, they politely told Mr. Bush to jump in a lake.

Posted by: Jasper on April 11, 2007 at 7:41 PM | PERMALINK

Let me rephrase for time-wasting lefties: "Japan is an island country comprised of several islands, all of which are surrounded by large amounts of water, thus making that an 'island country' in the general sense as well as the figurative sense."

cmdicely says: Its not really all that unusual, and certainly not impossible, for countries with UHC to limit public benefits to citizens and legal residents

In the U.S. political sense it would be very difficult. Imagine a politician so limiting UHC. Why, I can hear Kevin Drum starting to cluck as I write this. The RacialPowerGroups would have a fit; HowardDean would start talking about ScapegoatingImmigrants, the NYT would write editorials, etc. etc. etc.

the governments of Mexico, etc., while they certainly don't mind the money coming back from emigrants, would probably prefer if their most productive and industrious and ambitious citizens would do more to contribute to the productive development of their own country rather than ours

I highly doubt that. The last thing they want are a bunch of troublemakers who'd demand reforms.

Regarding supply v. demand, there are billions of people who'd come here if they got the chance.

Posted by: Mr. Annoying aka TLB aka LonewackoDotCom on April 11, 2007 at 7:56 PM | PERMALINK

See my review in The Tyee of Differences That Matter, a comparison of the working poor in Seattle and Vancouver: http://thetyee.ca/Books/2007/02/13/Seattle/

The author, now a sociology professor at the University of British Columbia, compared the living and working conditions of hotel workers in the two cities, and found that Canadian social policies, including health care, made an enormous difference. If you've got be a low-income worker, Canada is where you should live. For that matter, it's where high-income workers should live, too: not just better health care, but more parks and community centers.

Posted by: Crawford Kilian on April 11, 2007 at 8:26 PM | PERMALINK

I think you should be a little bit slower to call anyone else a moron. Posted by: cmdicely

I feel shame. I will now commit seppeku. Would you be my "second"?

Posted by: JeffII on April 11, 2007 at 8:34 PM | PERMALINK

If there were pro-universal healthcare:

Thinktanks
Lobby groups
PACs
PR machines

then these kinds of things would happen. There is nothing driving a pro-universal healthcare agenda in Congress, there is nothing providing pro-universal health care research and nothing feeding pro-universal health care stories to a media that is happy to write up anyone's press releases as news because its cheaper than doing real news.

That's the way the game works in US politics. Its worse because even there though there is a strong progressive movement, there is no part of it with an obvious reason to focus on health care. So you get a strong general desire for universal health care from progressives, but no specific effort on it.

Posted by: swio on April 11, 2007 at 8:53 PM | PERMALINK
The Hillarycare debacle wasn't about a bunch of rich executives getting together to derail the administration's proposal

Yeah, actually, it was.

Though the Congressional Black Caucus, IIRC, played a role for reasons that had nothing to do with the policy at issue.

Posted by: cmdicely on April 11, 2007 at 8:58 PM | PERMALINK
In the U.S. political sense it would be very difficult.

In the US political sense, it would be very difficult not to limit UHC benefits to those legally resident in the US, the same way that all (at least, that I know of) federal direct benefits are currently limited (though the existing rules on emergency services being provided without regard to ability to pay would probably continue.)

Imagine a politician so limiting UHC. Why, I can hear Kevin Drum starting to cluck as I write this. The RacialPowerGroups would have a fit; HowardDean would start talking about ScapegoatingImmigrants, the NYT would write editorials, etc. etc. etc.

Your hysterical fantasies are not evidence of anything.

Posted by: cmdicely on April 11, 2007 at 9:04 PM | PERMALINK

Nice new diversion, the whole "can't have universal healthcare because Mexicans would steal it" claim. Now you've got people arguing about the difference between "island" and "islands". Good work, you've definitely earned your pay today. However, I feel a statistically-informed rant coming on:

If we could manage to run our health care system as well as either the 3rd (Swiss) or 4th (Norwegian) expensive systems in the world, we could provide health care for every single person in the US AND Mexico, and have money left over. (#2 is Monaco.)

Spain, also beats us on these metrics, spends less than one third as much per capita. If we ran our medical system as efficiently as Spain does, we could cover the entire hemisphere and have money left over. That deals with the island problem, don't you think? (This oversimplifies a little bit; there are in fact issues of sanitation that don't normally get charged to "health care" -- then again, we'd have money left over, we could spend some of the surplus on sewers and water in Sao Paolo).

And you can't claim that we wouldn't settle for only a Norwegian or Spanish level of care, because we've settled for less than that already -- they live longer, they're healthier, and fewer of their infants die. ("But Japan is an island nation".)

I don't think you trolls fully comprehend how atrocious our health care system is, or what incredible sums of money we spend. It's not just France that's better, or Canada, or Japan. It's: Andorra, Macau, Singapore, San Marino, Hong Kong, Japan, Switzerland, Sweden, Australia, Guernsey, Iceland, Canada, Cayman Islands, Italy, Gibraltar, France, Monaco, Liechtsenstein, Spain , Norway, Israel, Jersey, Faroe Islands, Aruba, Greece, Martinique, Austria, Virgin Islands, Malta, Netherlands, Luxembourg, Montserrat, New Zealand, German, Belgium, Saint Pierre and Miquelon, Guam, UK, Finland, Isle of Man, Puerto Rico , Jordan, Guadeloupe, Bosnia and Herzegovina, Bermuda, and Saint Helena. Life expectancy, we're #47. There's 46 different countries, whose citizens manage to live longer despite spending far less per capita on health care.

Perhaps you'd like to see how we do with infant mortality ("think of the children!"). We're worse than Hong Kong, Japan, Iceland, Finland, Norway, Malta, Czech Republic, Andorra, Germany, France, Macay, Denmark, Austria, Australia, Belgium, Liechtenstein, Guernsey, Canada, Luxembourg, Netherlands, Portugal, Gibraltar, Jersey, Ireland, Monaco, Greece, San Marino, New Zealand, Aruba, Isle of Man, Italy, and the Faroe Islands (we're apparently 6.4/1000, just ahead of Cuba at 6.45).

Here's another cherry-picked statistic -- probability of not reaching age 60. We're #25, just behind Albania. I hope I'm not insulting any Albanians, but I think this reflects very badly on our health care system.

And another cherry --
healthy life expectancy at birth, 67.6 years( #29), vs UK (69.6, #20), vs Spain (70.9, #9), vs Australia (71.6, #4), vs Japan (73.6, #1).

Yep, we're sicker, dying years early, killing thousands of babies through inferior health care, and spending double or triple for the privilege, but by God, we discovered Viagra.

Posted by: dr2chase on April 11, 2007 at 9:33 PM | PERMALINK

The mortality statistics, particularly the infant mortality stat is troubling as is the fact that half of US spending on pre-,post- and neo-natal care is for preemies. The urge to have more free care for children (Pa. is expanding their program) should realistically include free pre-,post- and neonatal care. Combine that with the Medis and it's getting closer to a single payor by default. maybe that's how to get there. Make it a fait accompli.

Posted by: TJM on April 11, 2007 at 10:17 PM | PERMALINK

cmdicely says: In the US political sense, it would be very difficult not to limit UHC benefits to those legally resident in the US.

I think I'm going to declare "loggerheads" at this point, because based on all the other giveaways to MexicanCitizens that the Dems push (such as allowing MexicanCitizens who are here illegally to take CollegeDiscounts from U.S. citizens - no really, they support that) I'm pretty sure that any UHC plan would as planned or as surreptiously designed would cover IllegalAliens. And, because of that, I'm going to have to say you must be high. You would probably disagree, thus the loggerheads.

Those who want to educate themselves about what the Dems are really up to can start here.

Perhaps the Dems should "do a Halliburton" and just move their HQ to MexicoCity.

Posted by: The Annoying LonewackoDotCom on April 11, 2007 at 11:48 PM | PERMALINK

Ive lived in Japan for 9 years, I'll take US healthcare anyday of the week.

Posted by: usasamurai on April 12, 2007 at 12:16 AM | PERMALINK

"There is nothing driving a pro-universal healthcare agenda in Congress, there is nothing providing pro-universal health care research and nothing feeding pro-universal health care stories to a media that is happy to write up anyone's press releases as news because its cheaper than doing real news."

There is a group, PHNP, Physicians for a National Health Program, a nonprofit organization of 14,000 physicians, medical students and health professionals who support single-payer national health insurance. Lobbying, press releases, the whole works.
http://www.pnhp.org/

Posted by: ph on April 12, 2007 at 12:27 AM | PERMALINK

Lonewacko, I'm going to take your Mexico misdirection and ram it down your throat. Our health care is so wedged it is immoral, and so are you for defending it. This is not a game, this is people dying years early, this is thousands of dead babies.

You are looking at this the wrong way. The "giveaways" to the insurance industry, and lord knows what other inefficiencies exist in our system, are larger than what it would cost us to additionally cover Mexico, at no cost to Mexico or its citizens, even if we would only cut our costs to the level of the 3rd most-expensive health care, instead of the most expensive.

That is to say, the crap and inefficiency in our medical system, is stealing more money from us than all the Mexicans who ever even thought of crossing the border could. We could cover them in their own country, and STILL save money. It is possible, if we could manage to reach Spanish levels of efficiency, for us to cover the entire hemisphere. Do the math -- our current system "covers" 300 million people, but Spain's per capita cost is 3.2x lower. For the same money, we could cover almost a Billion people. The whole hemisphere's got about 940 Million people in it.

Posted by: dr2chase on April 12, 2007 at 12:36 AM | PERMALINK

Ive lived in Japan for 9 years, I'll take US healthcare anyday of the week.

Posted by: usasamurai on April 12, 2007 at 12:16 AM | PERMALINK

I assume you mean: "I'll take US health care anyday of the week with the superior health plan I am covered by."

Just wondering?

Posted by: notthere on April 12, 2007 at 1:21 AM | PERMALINK

I have a never met a single person from outside the United States - insured or not, wealth or not - that prefers American health care.

Not one. Ever.

Posted by: William on April 11, 2007 at 3:26 PM | PERMALINK

I'll ditto this.

Also never known any USian with experience who had a bad word for national health care; in the UK, Spain, France, and Denmark so far.

Obviously usasamurai above differs. Wonder how he would feel if he fell in that ditch between medicaid and a decent health plan.

Probably didn't like the suppositories.

Posted by: notthere on April 12, 2007 at 1:42 AM | PERMALINK

Hey, dr2chase - excellent post! A concisely substantive & trenchant deconstruction of several key myths used by Big Pharma & Big Insurance to alarm & dissuade Americans from healthcare reform.

The Australian system isn't perfect but it provides world-class, universal healthcare at a reasonable price (1.5% medicare levy on incomes > $25,000) while the superior outcomes you cited speak for themselves. 50% of Australians choose to augment their universal cover with private cover (heavily rebated by Govt) to ensure access to private rooms, dental, cosmetic & elective surgery without waiting lists etc. Even so, the rates for Australian private cover are 60-90% cheaper than those comparable in the US.

But arguably the best thing about the Aust. system is the universal availability of low cost medications through the Pharmaceutical Benefits Scheme. All medicines listed on PBS are subsidized to ensure most prescriptions cost $8-20, even less for pensioners & the disabled. As a single huge purchasing desk, PBS is able to negotiate ruthlessly with BigPharma to keep prices down. The readiness of PBS to list highly competitive "generic" medications acts as a further price lowering incentive: if the price differential between a generic & name-brand med becomes significant, the name brand is PBS delisted, thus becoming prohibitively (ie = to US pricing) expensive.

Americans are paying more than anyone in the world for a profoundly dysfunctional, appallingly inequitable healthcare system with provably mediocre outcomes, as dr2chase cited. It is a system in which the primary beneficiaries are BigPharma, BigInsurance & the wealthy. The expectation of its' exorbitant provision by (some) employers makes those US businesses less competitive while making workers needlessly, terrifyingly beholden to these employers. Americans are paying far too much, for far too little, to far too few. Given the high price & quality of US facilities & expertise, they deserve a great deal better.

Posted by: DanJoaquinOz on April 12, 2007 at 1:59 AM | PERMALINK

s_kawatchi

Thank you for some high quality information and insight.

I would say on the 'exceptionalism' of Americans that it is part of what defines America, and makes it a great country. It's pure of the enduring myth of America, and there are any number of institutions aligned to promote it.

*however* it means Americans can have trouble with the outside world, because they assume that people and institutions in other countries just aren't as good as they are, for example:

- a group of dirty, poor jungle guerillas defeat the technological preeminence of the US Army and military (Vietnam)

- an island nation (Cuba) invents and maintains a socialist state against militant US opposition (which some would say strengthens Castro's position), and reaches near first world levels of health care and literacy, on a GDP per capita probably less than 1/10th the US

- squirty Japanese car companies come to be the largest car companies in the world, overtaking the company which invented mass production (Ford) and the world's largest auto company (GM). They do this by making better, more reliable cars, that more customers want

- other nations develop and deploy working high speed train networks (Japan and France), effective nuclear power (France)

- other nations have better healthcare systems

General

The 'illegals using healthcare' is a red herring. Every country has tackled this, including Canada. You have a medical identity card, and an identification number.

The system ties back everything to your number. No number, no care.

There is doubtless fraud (all systems have fraud) but it's not a huge problem. The biggest problem in the EU is your eligibility for healthcare in *other* EU nations, and we have created a system to handle that, eg when travelling.

But most sensible people also buy travel insurance before they go on holiday. A Spanish or Italian hospital may not speak English, and an emergency flight back can be an expensive thing.

Posted by: Valuethinker on April 12, 2007 at 2:03 AM | PERMALINK

The argument for the US healthcare system, and in particular for US drug pricing, is that the high cost means a high level of technology and a high level of innovation.

ie the US is driving advances in medical technology, and the rest of the world is living off of that.

There is some evidence for this view. There is certainly advanced cancer treatment that you can only get in the US.

The problem is the social costs of the US system are making those benefits less and less accessible to the masses.

And in addition to achieve real gains in the number of healthy years enjoyed by the population, requires significant changes in *lifestyle*. Medicine, for all its wonders, is only a small part of that.

The big diseases and problems in the Western world are lifestyle-driven.

That is why Italians have a truly lousy healthcare system, but are among the world's healthiest people. They eat good food, have regular walking (at least in rural areas), spend time with their families, go home at lunch for a nap, avoid excessive indulgence.

Posted by: Valuethinker on April 12, 2007 at 2:08 AM | PERMALINK

A couple of remarks about Japan health care.

From the experience of a Japanese friend of mine the longer Japanese hospital stays were based on helping the patient learn how to deal with their disease. He had suffered both strokes and diabetes. When he was in for diabetes they used about a month to teach him about exercise and diet. Following that he could manage his diabetes on his own.

My impression was that the Japanese system was good at that level. On the other hand, the same person needed a triple bypass and he received that in the US as he suffered a heart attack while here on business. His doctor told him that if he had had that treated in Japan they would have done one artery at a time, letting him heal between each operation, because a triple bypass was not approved in Japan at that time.

On a separate tack, I frequently see pundits compare GM and Toyota saying that GM is bogged down paying high health care costs while Toyota employees get by with national health care. This is partly true. However, Toyota provides its employees with a better health care plan over and above what is provided by the national health care plan. So Toyota has some advantage but it is not black and white.

Caveat: I am not trained in medicine nor do I work in that field.

Posted by: JohnK on April 12, 2007 at 2:35 AM | PERMALINK

Jasper, you should note that Mrs. Clinton's health care proposal, when stripped of her name, had something like a 70% approval rate in polling.

I've been to the doctor in Japan for non-emergency surgery long ago: for some reason I decided to have a permanent blackhead thingy removed from the side of my nose. They were very apologetic that they had to charge for it since it was cosmetic surgery, but I decided to go for it anyway. I can't remember there being much of a wait to have it done and I think the cost was only a couple hundred dollars. The only minus that I can remember was that the hospital interior was particularly ugly and the procedure room was essentially a curtained-off cubicle.

Had kidney stones in India. Again, a very ugly hospital. I kept waiting for them to tell me how much it cost. I did have to pay for the medecine.

However, I'll put my current health care up against anything. Of course my wife is a nurse at the ER at Kaiser. Basically everything is covered with some insignificant co-pay and we get excellent service (of course, I've never had to go in while hordes of hammered-thumbs were waiting in the ER for bandaids.) Good thing we don't depend on my company: something like $50/month not including spouse, kids, vision or dental; Doctor visit co-pay, drug co-pay; then a $1200 deductible just to sweeten things.

Posted by: mcdruid on April 12, 2007 at 2:38 AM | PERMALINK

Most of the commonly established objective measures of healthcare do not favor the U.S.:

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

Doctors 1999/1000 pop
US: 2.7 OECD avg: 2.85

Specialists
US: 1.4 OECD avg: 1.56
(Australia & Canada do worse than us)

"Cherry-picking" numbers that buck this trend is difficult to do. Knee replacement (US 116/100000 vOECD 76/100000) is one number that does, hip replacement (US 102/100000, OECD 138/100000) does not.

Generally speaking, OECD countries have shorter waits to see primary physicians and shorter waits to see specialists, but I don't have the actual numbers on hand.

Posted by: mcdruid on April 12, 2007 at 2:50 AM | PERMALINK

Politics 101 - power corrupts.
Posted by: professor rat at 3:03 PM

Professor, are you ready to advance to Politics 102 - power doesn't disappear when you starve the democratic state; it just goes somewhere private where you the average citizen can't influence it?

PS guys, it's payer, emperor, and seppuku. Thank you.

Posted by: derek on April 12, 2007 at 3:41 AM | PERMALINK

bleh:One statistic that really leaps out at you, though, is how much more we PAY per capita for our maybe-better-maybe-worse-maybe-not-much-different health care.

This is the only area where we are clearly in 1st place:

PER CAPITA HEALTH EXPENDITURES, 2001
Great news! We're number 1!!!!!! (all in US dollars)

United States 4869
Switzerland 3288
Norway 3258
Luxembourg 2900
Canada 2743
Germany 2735
Iceland 2680
France 2588
Denmark 2520
Australia 2504

www.irdes.fr/ecosante/OCDE/411010.html

Posted by: Steve J. on April 12, 2007 at 4:23 AM | PERMALINK

Kevin: Basically, Americans just have no clue what healthcare is like elsewhere and assume that, say, in France, it's only barely better than it is in the third world.

There's also the ludicrous nationalism of BushBots: "We're #1" in everything.

Posted by: Steve J. on April 12, 2007 at 4:34 AM | PERMALINK

Something that Democrats and progressives need to face in this battle is that waiting times for many procedures are in fact longer -- much longer -- under national and single-payer systems.

Not all surgeries are equally urgent. Not all diseases have the same risk. With a finite pot of money and finite resources -- as well as differing levels of "doability" -- priorities have to be set. It can take several months in Europe, for instance, to have a hernia operation. That's because you can live with it. And you certainly don't see Terri Schiavo-like dramas under single-payer plans. Keeping people alive for years in a vegetative state is usually considered -- by doctors and patients alike -- as a gross misallocation of resources.

This will be a difficult thing for an instant-gratification culture like America to get its head around, and progressives who really want universal health care need to address it head-on instead of pretending it just isn't so.

Posted by: Elisha Sessions on April 12, 2007 at 11:30 AM | PERMALINK

Derek, who is probably no longer reading this, wrote:
>PS guys, it's payer, emperor, and seppuku. Thank you

Just to note that in legalese, a "payor" is someone legally obligated to reimburse someone else (the "payee"). It leaks over to medical/financial lit as health insurers are typically termed "payors" to reinforce their legal status.

While it is true that "single payer" is more commonly in use, its alternative can also be observed, e.g. from http://www.mainehealthcare.com/glossary.asp :

"Single-payor health care describes a system where one entity, usually the government, pays for covered health care costs. Single-payor health care systems are funded by tax dollars. Decisions about how much to spend on health care, where to spend it, and which procedures, drugs and treatments get covered are all made by the government.

"Although a single-payor system could conceivably be administered by a private company, most single-payor advocates favor the elimination of private health insurers."

The bills introduced into both the Maine and Kentucky legislatures, for example, both use "single payor" while California's SB 840 is termed "the Single Payer Bill"

& as for romanization of Japanese words like seppuku, well, in the US we typically follow the rules of Revised Hepburn, just like we used to use Wade-Giles (mostly) for Chinese, but this isn't really spelling as much as it is convention...and leads to odd mispronunciations of Japanese words following American orthography and pronunciation (e.g. loss of the dipthong "ai" in sa-mu-ra'i not to mention the rolled "r" sound). But I digress.

Posted by: s_kawachi on April 12, 2007 at 2:48 PM | PERMALINK

"Do you think is just because Americans are ignorant? Or is it more likely that a good number of them realize that universal healthcare may mean that they personally get somewhat worse care than before? "

Put me down for "ignorant." Or maybe "healthy."

Put you down for "ignorant" too if you think people actually "realize" rather than "fear" that they will get worse care under universal coverage.

Most Americans who really NEED healthcare, and especially those who have to PAY for it, realize our healthcare is crappy. It's so expensive as to be virtually unavailable for those whose employers don't pay for it, and employers are shedding paying for it as fast as they can.

How many times has someone you know been unable to make an appointment with a specialist because there isn't that kind of specialist in their "PPO"? I have had that happen several times, just in my extended family.

The underlying problem is that America is in love with "profit." America worships profit and sees it as the best solution for any problem. But the profit motive operates exactly against providing the best possible health care for the largest number of people.

So let me propose as a first step that only NON-profits can provide health insurance. Stop, immediately, letting non-profit health insurers switch to for-profit status. Make all for-profit health insurers switch to non-profit status, charging only what the service actually costs to provide. You can still pay nice, high salaries to top executives, but as non-profit executives, those salaries would be scrutinized publicly. You'd see single-payer soon enough as all the blood-sucking leeches of the health insurance industry dropped off the body politic.

As for personal anecdotes: While vacationing in the UK, hubby had a severe asthma attack. We were seen in the local clinic after about a 10 minute wait. He was given medicine free of charge, with an apology that since he was an American, they could not make the prescription refillable, as this particular medication was not approved by the FDA. There was no charge for the visit either.

Posted by: Cal Gal on April 12, 2007 at 2:52 PM | PERMALINK

read a story in NY Magazine about uninsured 20-somethings in NY. Something struck me as interesting. Their "anecdote" was of a guy who nearly had a burst appendix, went to the ER got a huge bill, couldn't pay it etc. At the end of the story, it turned out that the hospital realized he'd never be able to pay the bill so wrote it off and he no longer had a bill to pay. Partly as a result, although he still doesn't have insurance, he wonders if the next time he gets in a jam, he might have the bill written off again.

I can't even quite sort it out, but there's something seriously dysfunctional about that. At that point, let's scrap the current system and do it over.

Posted by: JMS on April 12, 2007 at 2:58 PM | PERMALINK

If anyone is still interested, the statistics that I think would be useful for comparing health-care systems.

Life expectancy at 65
Proportion of population with medical disability at age 55

The problem with life expectancy at birth as a measurement is that it makes premature births and accidents primary drivers of the comparison; neither is generally health-care related.

Posted by: SamChevre on April 12, 2007 at 3:43 PM | PERMALINK

Although I believe in universal coverage, I'm not convinced that the single-payer system is the best we can develop. I did some research (See my website, The Public Interest: www-the-pi.org) on European systems and found, for the most part, they are actually better for more people than our American system (no surprise), but they, too are beginning to feel the pinch of runaway healthcare costs.

This may lead some to say the focus should be on cost. But I suggest that a couple of strategy professors (Michael Porter & Elizabeth Teisberg) pegged the real problem -- we don't have results based on medical condition so we can't make informed decisions on which treatments (or lack of, for example, physical therapy is sometimes better for the patient than surgery, but it's not paid as well to providers -- a disincentive for providers to recommend therapy, etc.).

With results based on medical condition adjusted for risk (That just means you can't rank, 1-for-1 a doctor treating a very ill person with condition A to doctor treating a very healthy person with condition A; the doctor with the ill -- or senior -- patient needs to be handicapped for the results achieved).

Right now, a doctor can only compare his/her efforts with his/her own efforts! Maybe treatment of patient C went better than patient A. But a different doctor could be using a different teatment with much greater success -- and only that doctor knows it! When you think about it, this really doesn't make any sense.

We need results and we need to legislate them if we're to get them widely available in our lifetime. Our profs. would rather see voluntary results publishing (And actually, some groups have started with non-doctor specific results. A good step). But we can't wait. We need to get this legislation going now -- especially in MA (or CA) where healthcare is becoming mandatory this July.

If anyone can offer me advice on getting a referendum going on the subject, please let me know. Visit my blog & leave comments at: ww-the-pi.info. Thank you for your time -- Linda Bistany.

Posted by: Linda Bistany on April 12, 2007 at 4:06 PM | PERMALINK

JeffII,

If you're still reading, I'll assume that you're willing to take back calling me a "moron" because I correctly pointed out that neither Japan (where I lived for six years) nor Hawaii (where I've lived for seven years) is "an island."

As for sneaking into Japan, a regular ferry runs from Pusan to Kyushu, and if Koreans lacked good health care, it would not be difficult to take the ferry to Japan, find a Japanese-Korean whose health card they could borrow, and walk into a clinic to ask for service. The point isn't that Koreans do sneak into Japan for health care -- no more than Mexicans sneak into the U.S. The point is that they could get there more easily than someone from southern Mexico could get to the U.S., but they don't do so . . . and neither will Mexicans. Is that clear enough for you?

None of this has anything to do with immigartion laws. When I lived in Tokyo (I wasn't an immigrant), I had a bicycle accident that required stitches and a tetanus shot, the doctor who saw me didn't even ask for documentation until after he'd finished sewing me up -- he just assumed that anyone who walked into a clinic in Japan had Japanese health coverage. Maybe he was a "moron", too?

And one last thing. Nishi Nihon is also known as 西南 (as in 福岡市の西南学院大学), so it would be sneaking into southwestern Japan, right? right??

WTF? I'm pretty sure that when we flew to Hawaii last August (the four other times I've been there) that it over the Pacific Ocean, which surrounds the, wait, wait, islands of Hawaii. Ditto for the three dozen or so times I've flown to and from Japan.

Not to be repetitious, but WTF? Japan has some of the strictest immigration laws in the world (unless you're a female "entertainer" from Russia or SE Asia, but I digress). Unless a S. Korean spoke flawless Japanese and had the "proper papers" (i.e. a national health card), he isn't going to fuck off to Japan to take advantage of the national health. Why would he when he has pretty much the same thing in S. Korea?

And BTW, that would be sneaking into western Japan from the Japanese perspective.

Moron.

Posted by: JeffII on April 11, 2007 at 7:16 PM |

Posted by: keith on April 12, 2007 at 7:23 PM | PERMALINK


Life expectancy at 65
Proportion of population with medical disability at age 55


The problem with life expectancy at birth as a measurement is that it makes premature births and accidents primary drivers of the comparison; neither is generally health-care related.

I agree, but I don't find those numbers at my statistics dump of choice, nationmaster.com. I think the percentage of life in ill health (which is there) is also a good one. You should also dial the life expectancy threshold back a bit; a non-trivial chunk of our population dies before 65. Better to pick the age around where the accident rate starts to fall, say 30. (and I'd also like a statistical pony).

I don't think that the infant mortality rate is that big an influence; I tried to figure it out once, we have a difference of 4/1000, and I think it costs us about 1/3 of year in the expected lifespan (against a baseline of 80). Of course, this also assumes that it's not a healthcare problem, to have a infant mortality rate double what the best systems manage.

Posted by: dr2chase on April 12, 2007 at 7:33 PM | PERMALINK

If you're still reading, I'll assume that you're willing to take back calling me a "moron" because I correctly pointed out that neither Japan (where I lived for six years) nor Hawaii (where I've lived for seven years) is "an island."

No and yes. I read incorrectly, but you are still something of a moron and geographically and culturally challenged.

As for sneaking into Japan, a regular ferry runs from Pusan to Kyushu, and if Koreans lacked good health care, it would not be difficult to take the ferry to Japan, find a Japanese-Korean whose health card they could borrow, and walk into a clinic to ask for service. The point isn't that Koreans do sneak into Japan for health care -- no more than Mexicans sneak into the U.S. The point is that they could get there more easily than someone from southern Mexico could get to the U.S., but they don't do so . . . and neither will Mexicans. Is that clear enough for you?

Perfectly clear, but your elaboration is still a crappy comparison for the reasons I listed.

And one last thing. Nishi Nihon is also known as 西南 (as in 福岡市の西南学院大学), so it would be sneaking into southwestern Japan, right? right??

No. While the Japanese archipelago most assuredly runs in a north by northwest to southwest arc, the Japanese are somewhat geographically blinkered and still commonly think of the country, as you well know, as being divided on an east-west axis based on Tokyo. Kyushu, particularly where the ferries run to Busan (Shimonoseki and Fukuoka-shi), are almost due west of Tokyo.

Posted by: JeffII on April 12, 2007 at 8:03 PM | PERMALINK

Hi Kevin,

Have you looked here? It's a report from the World Health Organization, published in 2000:

http://www.who.int/whr/2000/en/

"This report examines and compares aspects of health systems around the world. It provides conceptual insights into the complex factors that explain how health systems perform, and offers practical advice on how to assess performance and achieve improvements with available resources."

http://www.who.int/whr/2000/media_centre/press_release/en/index.html

"The World Health Organization has carried out the first ever analysis of the world's health systems. Using five performance indicators to measure health systems in 191 member states, it finds that France provides the best overall health care followed among major countries by Italy, Spain, Oman, Austria and Japan."

Posted by: Poéthique on April 12, 2007 at 11:56 PM | PERMALINK

Anyone know of a good California blog? Kevin has gone over to the bright side of Right Coast time, and by the time we on the Left Coast get on, the threads are full of a**holes calling each other names.

Posted by: Cal Gal on April 14, 2007 at 12:09 AM | PERMALINK




 

 

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