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Tilting at Windmills

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April 15, 2008
By: Kevin Drum

"SICK AROUND THE WORLD"....If you've been looking for the more serious, more substantive, more balanced version of Michael Moore's Sicko — and who hasn't? — you're in luck. It's called "Sick Around the World" and it airs tonight on PBS at 9 pm. Jon Cohn reviews it here:

"Sick Around the World" isn't afraid to talk about the problems in other countries. In England, the film notes, patients frequently wait for elective services; in Germany, physicians are unhappy that they don't get paid more; in Japan, the government's hyper-aggressive price controls have led to chronic underfunding. And yet the new film also puts these drawbacks in their rightful context. Every system the film portrays has its problems, but overall each one seems to deliver a better total package than the one in the U.S.

The most interesting case study is probably Taiwan. A few years ago, when Taiwan decided to revamp its health care system, it studied other countries to determine which system might work best. Its conclusion? A single-payer system — one in which the government insures everybody directly — made the most sense.

Virtually alone among health care commentators in the U.S. — a category that includes me — Paul Krugman has been touting Taiwan for a while. The film makes it easy to see why. Today, the people of Taiwan have guaranteed access to health care — and, according to the film, it's very good health care. There are no chronic waiting lists, like you find in Britain, and the care is very advanced. Among other things, Taiwan is among the world leaders in establishing electronic medical records — an innovation that should significantly improve care by keeping doctors and nurses better informed about patient histories and, no less important, avoiding potentially dangerous drug interactions.

Critics of national healthcare are always able to come up with reasons why the success of systems in other countries doesn't mean they'd work here. The Japanese are healthier than us. Belgium is smaller than us. Sweden is more homogeneous than us. Germans are more willing to pay higher taxes than us. Etc. Etc. It's always something.

But the opposite is true too. National healthcare, it turns out, is pretty effective in big countries (Germany, Japan), diverse countries (France, Britain), tax-phobic countries (Switzerland), and countries with health profiles similar to ours (Canada, Britain). And as Jon says, even warts and all, each one seems to deliver a better total package than the jury-rigged, pseudo-private mish-mash that we have here. So tell your skeptic friends to tune in tonight and watch the show. Maybe they'll start to understand that we can, indeed, do better if we put our minds to it.

Kevin Drum 7:26 PM Permalink | Trackbacks | Comments (28)

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Comments

"socialist" is among the most popular and effective smears members of one of the two political parties can use.

single-payer won't happen in the US unless without a huge crisis - something like the Depression - which completely upsets the current system.

Posted by: cleek on April 15, 2008 at 7:32 PM | PERMALINK

single-payer won't happen in the US unless without a huge crisis - something like the Depression - which completely upsets the current system.

Be careful what you wish for! An economic downturn is on the menu for the near future!

Posted by: troglodyte on April 15, 2008 at 7:38 PM | PERMALINK

frankly, while i'd really like single-payer, universal, etc. healthcare, i could do without a Depression.

Posted by: cleek on April 15, 2008 at 7:41 PM | PERMALINK

I lived in Taiwan for a number of years and it is certainly the case that, on the whole, medical coverage is far superior to that in many advanced western countries. For those living in large cities (which is the majority of the population), access to quality advanced care was unbelievably fast and affordable. I must add a single caveat however: Taiwan might not be the best test-case scenario for a U.S. medical system. The density of the population means that, despite relying on relatively fewer large, well-staffed medical centers to care for their people, Taiwan isn't confronting the challenges that guaranteeing that same level of care across a geographic space as large as the U.S. would entail. This is not a knock on their system, just a recognition of a particular difficulty in attempting to replicate its success in the States.

Posted by: gert on April 15, 2008 at 7:46 PM | PERMALINK

The US is the best! We can spend 2x what anyone else does for worse outcomes!

USA!

Posted by: John McCain: More of the Same on April 15, 2008 at 7:53 PM | PERMALINK

And as Jon says, even warts and all, each one seems to deliver a better total package than the jury-rigged, pseudo-private mish-mash that we have here.

Jury-rigged? Isn't it actually jerry-rigged (as distinct from improperly influencing a verdict)?

But then again, I see a lot of people, even those who I would expect to know better (like Kevin) saying "jury-rigged," so maybe it's a distinction that doesn't matter.

Posted by: Karl on April 15, 2008 at 8:34 PM | PERMALINK

No, it's "jury-rigged". You're thinking of "jerry-built".

Posted by: Will on April 15, 2008 at 9:14 PM | PERMALINK

I'm watching the PBS show now but think I'll turn it off. I'm in CA and bored with you characters lost in your ideology, have fun who cares.

For me up here separated from you in the middle of North America in 1965 when we started, and we only started then, to go to go universal health care. Shit I come from a large Irish catholic family and we, I was only a dumb kid, went broke as a family having too many kids.

What on earth is wrong with you characters? ideology ideology ideology. Please keep it, it makes you much less completive and you seem to have fools - bitter people that just love to stay idiots.

Posted by: geoff on April 15, 2008 at 9:28 PM | PERMALINK

Karl is right. It's definately Jerry rigged.

Posted by: Pat on April 15, 2008 at 10:04 PM | PERMALINK

The density of the population means that, despite relying on relatively fewer large, well-staffed medical centers to care for their people, Taiwan isn't confronting the challenges that guaranteeing that same level of care across a geographic space as large as the U.S. would entail. This is not a knock on their system, just a recognition of a particular difficulty in attempting to replicate its success in the States.

Except you know? We don't do this now. Do you think the quality of care is the same in rural America as it is in dense cities? Ever been to a large hospital in say Knoxville or Nashville or Des Moines -- and witnessed all the people practically living in the waiting rooms because they've driven so far to be at the hospital with their loved ones?

Have you had a family member in Iowa or Wyoming that couldn't get to her doctor because the "closest" doctor was in the county seat or maybe even the next county over, and she couldn't make the drive herself?

I agree that delivery care across the U.S. is going to be a problem -- because it already IS a problem. Except now, no one has any guarantees that they'll even get it, if they can get to it.

Posted by: Christopher / Inaudible Nonsense on April 15, 2008 at 10:19 PM | PERMALINK

In England, the film notes, patients frequently wait for elective services

So let me see. I had shoulder surgery for arthritis a few years ago. Put in for an appointment in November, had surgery in February. Schedule a physical with my GP? Wait's about 6-12 weeks for an appointment. Ophthalmologist? 6 months, easy.

Nope. No waiting for elective procedures or anything here. Yay private insurance.

Posted by: DrBB on April 15, 2008 at 10:42 PM | PERMALINK

My gut says that the only way that there will be serious reform of the US health insurance system is if a rich, famous, white person dies in a very public way due to a lack of insurance. Say, Paris Hilton contracts a particularly nasty and unpronounceable terminal disease while filming her latest porn video (can that girl manage to take her clothes off without a camera in the room?). And, for some reason, she's unable to afford care- which is, I think you'll agree, unlikely for the average rich person.

Barring something dramatic + public, inertia says that we'll stay with some variation on our current mess.

And, whenever in doubt, bet on inertia.

-Z

Posted by: Zorro on April 15, 2008 at 11:10 PM | PERMALINK

Here's what I've discovered after years of discussing this stuff with "skeptics" and non-skeptics alike.


There are two types of people who can't be counted on to reliably support healthcare reform:
Group 1 (the majority) They know there's a problem, and would like to see it solved, in a vague way, kind of like we'd all like to see a man on Mars: of course we're for it, but it isn't a pressing issue, and as soon as we think it will cost us, our support evaporates. Maybe a show like this might help to firm up those people -- until the "Harry & Louise" ads come along and scare the shit out them.

The "skeptics" (Group 2) , on the other hand, healthcare aren't interested in facts presented by a show like this. In fact, the problem is they aren't "skeptics" at all -- they're ideologues, programmed to oppose anything supported by the left. Even if you could get them to watch it (good luck!), the only things they would remember afterwards would be the high taxes in Germany, the waiting times in England, and the fact that the French are cheese eating surrender monkeys whose women don't shave under their arms. And besides, we kicked the Japs' asses in WWII, so what do they know?

The roadblock for healthcare reform, I'm coming to realize, isn't a lack of information, or knowledge The real problem healthcare reform faces is that the left supports it, which means a large segment of the population must be opposed to it for no other reason. Then the insurance companies turn on the money spigot to scare the comfortable middle, and it's over. This is going to be a long, hard war, and it probably won't end until things get nearer to a crisis. Too many people are too "polarized", too much money is invested in the current system, and these aren't the kind of people who are interested in reasoned debate.

Posted by: MG on April 15, 2008 at 11:29 PM | PERMALINK

Jury rigging refers to makeshift repairs or temporary contrivances, made with only the tools and materials that happen to be on hand. (Wikipedia)

jury-rigged Definition
jury-rigged (-rigd′)
adjective
rigged for temporary or emergency use
(yourdictionary.com/jury-rigged)

google the term and you will see that the choice is jerry-built or jury-rigged

Posted by: Scott on April 15, 2008 at 11:29 PM | PERMALINK

Having watched the show, it's clear that the difference between the nations featured and our own is one simple point: those countries want solutions that address the needs of the people while we look for solutions that address the needs of our health care companies. How incredible was it to see the conservative president of Switzerland state that the right to health care is no different than the right to education or legal representation? Because of this show I now believe that true universal health care in the US is possible. But I also believe none of the three presidential candidates are prepared to do what needs to be done.

Posted by: yocoolz on April 15, 2008 at 11:31 PM | PERMALINK

I'm not so sure I agree that single-payer won't happen without a crisis, or without some high-profile death due to lack of insurance. Instead, I think it'll be the steady accumulation of health atrocities and horror stories happening to each of us, and the people we love--and the advent of someone to offer us all a way to focus our individual outrage into a collective tidal wave that brings about change. I thought that "someone" might be John Edwards; at the moment I have no clue. Sadly, the only hope I have for real change is the fact that these horror stories continue piling up, and sooner or later something's gonna blow. Needs a catalyst, though.

Posted by: dougR on April 15, 2008 at 11:34 PM | PERMALINK

Just got done watching and here’s my take. First, Krugman is right and Obama wrong.

The four non-British, non-single payer countries all have mandates.

Second, they all have price caps.

Third, they all but Switzerland require insurance companies to be non-profits. (Switzerland allows supplemental policies to be unregulated.)

Read more at my blog.

Posted by: SocraticGadfly on April 15, 2008 at 11:36 PM | PERMALINK

OK, a couple things. First... More "serious, more substantive, more balanced" than Michael Moore. Do you have a specific problem with "Sicko"? I'd really like to hear it. It seems to be taken on faith that MM is somehow unfair, but I'd like to see some substantive arguments about that.

Second. I appreciated the show. But... there were these times that the reporter just inserted some...bias or personal opinion...I don't know what... but said things like, "which Americans might see as too socialistic"... or "which Americans might consider too much 'Big Brother' ..." and the like. Where does this come from? He didn't offer data, just strange "common perception"... or personal opinion... or some kind of way to achieve some "balance" where there really isn't any.

Posted by: dave on April 15, 2008 at 11:47 PM | PERMALINK

Dave, I would call Reid's comments "political analysis" rather than "personal opinion." First, note the "might." If this were straight-up opinion, he wouldn't have used that qualifier.

We can debate how accurate his analysis is (the first may be somewhat off the mark, or not; the "Big Brother" comment probably rings pretty close to true, on Taiwan's "smart cards"), but I'd prefer to start from the point of calling it "analysis" and not "opinion."

Posted by: SocraticGadfly on April 15, 2008 at 11:56 PM | PERMALINK

google the term and you will see that the choice is jerry-built or jury-rigged

If by "the choice is," you meant that someone somewhere made a prescriptive pronouncement that jives with your personal preference of phrase, that's merely the stuff of school marms and old farts. Linguistically, it's as relevant as saying that it's wrong to end with a preposition or to split infinitives; that is, not at all.

Look at occurrences of the phrases and you'll see that either "jerry-rigged" or "jury-rigged" is possible, and that they mean the same thing, with the latter appearing to have the greater frequency. A quick search of New York Times articles for 1994-2006, for example, shows 68 instances of jerry-rigged and 251 of jury-rigged.

Posted by: phleabo on April 16, 2008 at 12:00 AM | PERMALINK

I'd like to offer a practical observation, if I may. As I understand them, neither Obama or Clinton are promising to cover undocumented workers in their proposed programs. Can either plan work without addressing that issue?

Posted by: Everett on April 16, 2008 at 12:03 AM | PERMALINK

Dirty little side note from history: 50-60 years ago, unions were among the main opponents of national health care. They figured they had negotiated their own high-quality health insurance plans through Churchillian blood, sweat, toil and tears, and, in essence, to hell with everybody else. Not the first nor the last time in history that American unions have been short-sighted and self-centered.

Posted by: SocraticGadfly on April 16, 2008 at 12:17 AM | PERMALINK

Good show! I think it complements Sicko well. I enjoyed Michael Moore's movie, but it was pretty obvious that the questioning was just a set up for his point. Unlike Moore, T.R. Reid doesn't act shocked and amazed when someone answers him exactly like he knew they would.

On the other hand, Sicko was a lot more entertaining and, I believe, provides a better introduction for the majority of people who aren't policy wonks and don't know much about health care systems.

Posted by: DevilDog on April 16, 2008 at 4:15 AM | PERMALINK

Socraticshitfly-60 years ago we also had politically supported seperate toilets and drinking fountains for black people so how is the union comment relavant to this discussion?

Posted by: Gandalf on April 16, 2008 at 9:12 AM | PERMALINK

"Socraticshitfly-60 years ago we also had politically supported seperate toilets and drinking fountains for black people so how is the union comment relavant to this discussion?"

Wow, someone needs to take their meds and then take a remedial reading comprehension class.

Unions have always acted selfishly (that's their perogative) and more often than no, very shortsightedly. Is that so different from every other self interested organization? No. But that is something to keep in mind when we look at the interest groups pushing for the next national healthcare plan.

Posted by: anon on April 16, 2008 at 11:00 AM | PERMALINK

"If you've been looking for the more serious, more substantive, more balanced version of Michael Moore's Sicko — and who hasn't?"

Was this absolutely necessary? I suspect its one of those lines that "centrists" use to show that they are not one of those dirty hippie wacked out Liberals. Their way of saying "See I'm one of you, I don't like Michael Moore either" to the wing-nut fringe so they won't get beat up.
Its akin to one of the lesser youngsters on the playground joining in the group beat down of some poor nerd, to show that they too are part of the group. Its kind of sickening.

Posted by: Henk on April 16, 2008 at 12:10 PM | PERMALINK

It's important to stress that Taiwan put its new system into place only a few years ago.

Here in the U.S. we are very apt to think that it's too late now--that such a sweeping change as single-payer would be undoable, because of the long-term entrenched interests that are opposed, and powerful.

But Taiwan did it. We've got to keep pointing that out.

Posted by: Nancy Irving on April 17, 2008 at 6:01 AM | PERMALINK

'If by "the choice is," you meant that someone somewhere made a prescriptive pronouncement that jives with your personal preference of phrase, that's merely the stuff of school marms and old farts.'

"[J]ives" should be "jibes."

(Schoolmarm/old fart)

Posted by: Nancy Irving on April 17, 2008 at 6:32 AM | PERMALINK




 

 

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