Home » Off Topic » Off topic: Single payer health care

Off topic: Single payer health care

Here I was recently treated to an interesting display of Darwinist logic.

A commenter demanded that I provide proof that in a single-payer health system like Canada’s, older people are being abandoned to die. Another suggested I just shut up about it.

Sorry. Go here for how bad it can get.

It’s a matter of simple logic, really. Sarah Palin’s death panels are alive and well in Canada because we have a single government payer health system.

I don’t care what you think of Palin. But this much I know is true:

If the government is the only entity permitted to open a new bed in a hospital, this is what happens: You have a 55 year-old high school math teacher (Old Lady Smith*) and a 75 year-old retired high school math teacher (Old Lady Jones).

Who gets the bed? Who gets shunted off to die somewhere?

The obvious solution is more beds. But if only the government can pay …

The big problem with single payer government systems is that everyone is into government’s pocket for anything from an Olympic skating pavilion to new benches in the public park.

Only a few people have serious core health care issues, and they are usually diverse. So the lobby is small, fragmented, largely unheard.

Hey, if you can figure that one out, you are smarter than some of our commenters/trolls/ex-trolls.

The last time I took a politics test, I flunked “right wingness”, which is fine with me. I am talking about a practical issue. In Canada, Old Lady Jones isn’t legally allowed to just make her own arrangements, assuming she wants to be 85 or so before she pegs out.

I was intrigued by the difficulty some Darwinists had understanding her problem (= she needs a hospital bed but can’t legally pay for one), when it is a matter of simple logic.

Maybe they overdosed on “natural selection” and “the mind is an illusion created by neurons”?

*No, Old Lady Smith is not old by my standards, but that is how the teens on whom she forces algebra regard her. They can’t believe she ever had a life, even if she has a husband and six kids, which pretty much guarantees you would have a life.

Meanwhile, “Now, class, please turn to page 63 …. Factorials.”

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65 Responses to Off topic: Single payer health care

  1. A commenter demanded that I provide proof that in a single-payer health system like Canada’s, older people are being abandoned to die. Another suggested I just shut up about it.

    Sorry. Go here for how bad it can get.

    The link describes a case where an old lady receives care, and is not “abandoned to die”. Yes, the standard of care given was way below what we might expect, but it does nothing to answer the question asked.

  2. I also participated in this discussion.

    When you say one person suggested you shut up I guess you are referring to Nakashima’s comment #2 which finished with “Mrs O’Leary – please stop. Please.” I was rather surprised by this as he is one of the politest and most logical posters on this forum. I suspect there was something missing from the comment. Nevertheless it is hardly the same as “shut up”.

    As to the other comment. Is it bad form to ask for proof of what you assert?

    Meanwhile you appear to be saying it is illegal in Canada for anyone to provide healthcare except the government. The Wikipedia entry seems to be saying something different. Is it wrong?

  3. Frankly, I don’t understand the position of people who don’t want a national health care system. In France and in most of Europe anyway, this is so common that when we hear about countries that don’t have one, we usually think about Africa or Bangladesh…
    Regarding your Old ladies, if it was in France, they would have had beds, both of them. And then, back to their home, they would have had nurse taking care of them. Free of charge.
    Now, private hospital and clinics do exists. This is if you want 3 stars menu and your own room and can afford it.
    On the other hand, if your “old” ladies don’t have insurances in your country, what happen to them? Are they left to die?

  4. Kyrilluk at 3, I am describing Canada, not France. So is Blazing Cat Fur.

    Can we send all our old ladies to France? Please provide details.

    In an earlier post, I had suggested sending them to Graceland, but remember, I ain’t nothin’ but a houn’ dog and I don’t even get Graceland.

    Core health services (“doctors don’t keep you alive; we nurses do”*) are a government monopoly in Canada, but that makes them difficult to fund, in light of other demands. Non-core services can be bought privately (= tummy tucks and boob jobs).

    *I am impressed and moved by the quality of our paramedics but saddened by the difficulty of providing enough longer term care beds. If you come off a highway accident in Canada, you will get the best care in the world. I have seen the gurneys lined up in rows in the emerg after a blizzard, with all the injured tucked into wrapware. The problem is what happens if you need longer term care.

    While we are here, my point about Graceland in the post that prompted the “shut up” response was this: A prosperous, stable democracy like Canada should have the following type of problem: It turns out – counterfactually in this particular case – that the government spent $60 million gratifying the wishes of elderly ladies to visit Graceland (recreational therapy?). Is that a wise use of public funds? Doubtless, a big hoo-haw would ensue in Parliament, with eloquence on both sides.

    Voting Granny off the Island is an entirely different type of question. It is a core ethical question.

  5. Voting Granny off the Island is an entirely different type of question. It is a core ethical question.

    And we are still waiting to see you substantiate the claim that the Canadian government does this.

  6. Heinrich, I do not have much more time to spend on this question, so let me repeat one more time before the program ends: All a government need do is be the only provider of health care services in a country where everyone who isn’t sick or isn’t close to anyone who is wants roads, bridges, Olympic bids, soccer bubbles, firearms control, conservation education, etc.

    A relative in medicine once put it to me like this: People are transferred to progressively poorer care.

    If you live in a country where this has never been a problem, please send your formula for producing wealth out of thin air to me privately.

  7. Mr Frank,

    My remarks were printed in their totality. I simply found it difficult to express my feelings at such a serious topic, which I felt had been admirably and compassionately dealt with in the OP, subjected to non sequitur, shameless “First!” and “Me too!” -ism, and lame humor.

    Mrs O’Leary writes in a style that is inimitably her own. I have found her reportage quite clear. The flow of ideas in her opinion OP somewhat less so, whether or not I agree with her position. As a ‘white box’ commenter, I feel she is sometimes writing to quickly to organize her allusions well. I admit I have commented on her style previously. I just found this contrast of OP and comment quite painful. That wasn’t ‘shut up’, that was ‘think twice and write once’, an allusion to Norm Abram.

  8. “Frankly, I don’t understand the position of people who don’t want a national health care system.”

    Read: Frankly, I don’t understand the position of people who don’t want their money confiscated by the government bureaucrats so they can do with it what they please.

  9. Here I was recently treated to an interesting display of Darwinist logic.

    A commenter demanded that I provide proof that in a single-payer health system like Canada’s, older people are being abandoned to die.

    It was I who requested evidence showing that the elderly were being denied treatment because money was not available to pay for it. If it read like a demand then I apologize as that was not my intention.

    The case you cite of Blazing Cat Fur’s mother, as described, is disgraceful and she should certainly have complained loudly and vigorously about such poor treatment. But I have read of similar cases under both the British and the US systems. While it is no justification, these are all human systems which are prone to all-too-human failings.

    Darwinism, if it comes into this at all, surely applies to the Anerican system where you have a multitude of private care providers all competing to see who can be the fittest in terms of earning the most money or, at least, earning enough to enable them to survive.

    Sarah Palin’s reference to “death panels” was an exercise in political hyperbole. I do not know whether she really believes that such panels would be an outcome of the proposed healthcare reforms and I do not believe it has been helpful to the discussion but I can make allowance for it on the grounds of being part of the knockabout political debate.

    However, a few weeks ago, I caught the tail-end of some sort of meeting about these reforms broadcast from a hall in South Dakota. One of the panelists was a lady who is apparently the president and CEO of some sort of think-tank on the West Coast. Asked about the British system she claimed that if patients are a certain age or older and the cost of proposed treatment is above a certain amount it will be denied. Even worse she alleged that if the patients raised the money to pay for private treatment they would lose all their benefits in the UK.

    The British friend I was watching this with was appalled because these claims are completely untrue. Coming from someone like Sarah Palin they might have been excused on the grounds of ignorance but this was someone with a strong academic background who would be expected to know better.

    Like all healthcare systems, the British National Health Service has a duty to make the best use it can of a limited budget. The role of the National Institute for Clinical Excellence (NICE) is to review all the available treatments for a given condition and decide, based on all the available evidence, which is the most cost-effective. It will then draw up and publish guidelines on what treatments are recommended, based on that review.

    Although the legal status of the guidelines is a little murky and they are regarded as government policy, they are not mandatory. Doctors can ignore them if, in their clinical judgement, a different course of action is preferable. They may be required to justify that decision of problems arise later but they are not legally bound to follow the guidelines.

    Furthermore, if a patient’s request for a particular treatment is declined by the NHS and they elect to purchase the treatment from the private sector, they do not automatically lose all entitlements to benefits or treatments under the NHS.

    I do not doubt Blazing Cat Fur’s account of the disgraceful treatment her mother received. It, and others like it from different countries, are evidence that healthcare systems around the world are facing very real problems. Perhaps there have been suggestions that treatment for the elderly be scaled back though some misguided notion of what the phrase “survival of the fittest” actually means. But I know of no evolutionist who would suggest “Granny” be denied treatment or “voted off the island” in order to save money.

  10. O’Leary@4

    Are you kidding about the $ so million for recreational therapy? Surely that is not happening.

  11. Gods iPod @8 –

    “Frankly, I don’t understand the position of people who don’t want a national health care system.”

    Read: Frankly, I don’t understand the position of people who don’t want their money confiscated by the government bureaucrats so they can do with it what they please.

    (glad to see you have been un-banned, BTW)

    I can’t speak for Kyrilluk, but I also have difficulty understanding an attitude. It seems deeply uncaring: how else are you going to ensure that everyone in your country has access to health care? Or don’t you worry about the poor and needy?

  12. Seversky at 9: “The case you cite of Blazing Cat Fur’s mother, as described, is disgraceful and she should certainly have complained loudly and vigorously about such poor treatment.”

    Um, yeah. Try doing that when you are really sick. I remember a time, about twelve years ago, when I was so sick that the Resident simply coughed the numbers into the phone to the Clinician – trying to keep me from hearing them, so as not to alarm me – and advised me NOT to leave the hospital.
    Complaining loudly and vigorously won’t DO anything if there are no alternatives.

    Heinrich, 11: Re poor and needy: I’m one. I live on the kindness of strangers, and regularly rid my Inbox of hate, without ever bothering to follow it up.* So? All I know is, I want more options than the government gives me now.

    *Purely for information: I live in the few blocks between 53 Command and 54 Command of the local police force, and in Canada we do take assaults on women very seriously. It is second in line from “Officer down.” I am quite sure that no one reading our blog needs this information, of course, it is merely idle conversational chatter on my part, prompted by the receipt of certain e-mails.

  13. #4

    Core health services (”doctors don’t keep you alive; we nurses do”*) are a government monopoly in Canada, but that makes them difficult to fund, in light of other demands. Non-core services can be bought privately (= tummy tucks and boob jobs).

    Please can I confirm what you mean by this as it seems most extraordinary and also appears to conflict with the Wikipedia entry on the subject. Are you saying that no party other than the government is allowed to offer core health services throughout the country?

    #9

    As a UK citizen who has had to make extensive use of the NHS (for my relatives) I would like to confirm what Seversky says.

  14. Mark Frank, at 13, I am not going to do your research for you, but check the Canada Health Act, okay?

    Golly, if you could find me a better private deal, I’d love it.

  15. To say I’m a tad disappointed in this post is an understatement. As someone who is involved in the seniors community (I’m a pastor) I can safely say that I have NEVER seen this kind of “death panel” type stuff. I’ve seen the medical system make mistakes, yes. However, bottom line, it just plain works here in Saskatchewan and I have no trouble recommending our system to our southern neighbours.

  16. Heinrich — It seems deeply uncaring: how else are you going to ensure that everyone in your country has access to health care?

    Everybody in the U.S. has access to health care via emergency rooms. It’s by far not the most efficient, or inexpensive, way but it is still a far more compassionate means of “rationing” than is done in Europe i.e. make them stand in line and hope some of them die off before its time to treat them.

    What is missed in the health care debate is that it is not governments (or insurance company bureaucracies, for the matter) that provide “health care” but doctors, nurses, pharmacists etc. and lack of health care will certainly occur if talented people decide to stop entering these professions due to lack of compensation or a general desire to avoid aggravation.

    Those with false compassion turn away from reality (and the work that is entailed in alleviating suffering). Those with real compassion face it despite the ugliness.

  17. jhaugan15, if it works in Saskatchewan (a province of Canada, and I am proud to say my own birth province), great.

    I never had anything against the system in principle, except that I think we are better to have more players on the ice when we face a serious opponent like old age expenses in a society where longevity is normal.

    Ontario (the Canadian province in which I live) gets way more immigrants/migrants than Saskatchewan does.

    You are likely right to recommend your system to US states that resemble Saskatchewan. But what about those that are more like Ontario?

    All I am saying is, give people a choice, a chance.

    We do it NOW for stuff we don’t think matters (tummy tucks, boob jobs). What about stuff that does?

  18. Not an expert on any health care system other than what I have personally observed, I will pass on the following comments I have heard from others. Namely, that on minor care and emergency care, Canada, Britain, France are superb. It is on the long term high cost treatments that they are less than optimal. In other words how long would it take to get care for what is considered serious health care and how much would be provided. And how much does age factor in to those decisions.

    I will give an example of an elderly friend who is recovering from cancer in the New York area. After the diagnosis of colon cancer on August 9th two years ago the operation took place just 18 days later on August 27th (would have been sooner but the friend wanted to spend a week on vacation that had been planned), chemo started on September 24 after Pet scans and Cat scans. Seven months later the chemo ended and since that time there has been 4 Cat Scans, an MRI and another Pet scan. All tests were scheduled and completed within a week of the Doctor’s prescriptions. Some of these major tests could have happened the next day if the friend decided to do so. The above individual was on Medicare.

    This is common in the US and I have had people tell me this would never happen this fast in Canada and the UK. Now I have no personal experience with either medical system but have observed how fast the US system responds to emergencies and to long term medical needs. It is fairly rapid.

    The problem in the US is that the system is too good and cost associated with it has become run away. A lot of the costs is due to legal concerns as each health care giver must appear completely concerned about all possibilities or else they might get sued. Thus, a lot of the care is excessive but done to CYA. We were on a cruise once and our table had a doctor from the UK medical system and he mocked the US system as overly protective and described a story of a friend who got sick on a transatlantic flight and the excessive care and tests he got from what proved to be a minor incident. The reason the friend got all this attention was due to the fear of not providing for every contingency would lead to a law suit.

    All the recommendations for new health care in the US would not eliminate this fear as tort lawyers are the number one contributor to the Democrat party and Obama received $48 million in campaign contributions in 2008 from lawyers.

    Here is a youtube video by a Congressman in Michigan on the healthcare approach now being taken by the Democrats in the US. The public option has nothing to do with providing better care.

    http://www.youtube.com/watch?v=G44NCvNDLfc

  19. #14

    I did a bit more reading. To my amazement it is theoretically true. It is apparently illegal to offer private core health services in Canada. It is the only country in the world where this is the case. I apologise for doubting you.

    I also understand this is breaking down in practice and many institutions are offering private core services in contravention of the law and this is being quietly ignored. So you may be alright.

    If not, move to – well anywhere else.

  20. @O’Leary: “Kyrilluk at 3, I am describing Canada, not France. So is Blazing Cat Fur.Can we send all our old ladies to France? Please provide details.”
    Don’t worry, little canadian, american old ladies are already coming to France to benefit from our generous healthcare system.
    But my comment was more about what you said in your post:”If the government is the only entity permitted to open a new bed in a hospital, this is what happens: You have a 55 year-old high school math teacher (Old Lady Smith*) and a 75 year-old retired high school math teacher (Old Lady Jones).
    Who gets the bed? Who gets shunted off to die somewhere?”
    I was only mentioning the fact that countries around the world, France among them, have already answer your worries.
    You worry seems to be that the government may end up by choosing who it’s going to treat who it’s not going to help. Somehow, in the country like France or even England, this is not happening. So why should it happen in Canada or even in the USA?

  21. “It seems deeply uncaring: how else are you going to ensure that everyone in your country has access to health care? Or don’t you worry about the poor and needy?”

    I do not think this is accurate. The US is known for the quality of its health care. People come here from all over the world for it. Nobody from the US is running to Canada for health care.

    Being uninsured does not mean one does not get medical care. It means that one has to pay for it yourself or get public assistance if you cannot afford the cost of the medical care. Medicaid takes care of most poor but some people fall through the cracks.

    Many want what is call catastrophic care, that is care that would take care of high cost problems. I have seen some who have such policies with as much as $10,000 deductibles. In other words they pay for first $10,000. The insurance is cheap but handles any real problems such as cancer or other major conditions that would bankrupt the individual. They figure it is cost effective to have such a policy.

    Such policies may be eliminated by the currently discussed legislation.

  22. From what I understand the forbidding of private health care in Canada is eroding since a recent Supreme Court decision there a few years ago. I only know this because my wife works with Canadian drug companies in deploying their sales forces and some of their selling decisions have been based on this recent change.

  23. The US is known for the quality of its health care.

    Sure, we have great health care, if you can afford it. But a lousy health care delivery system.

    I guess I really don’t get the opposition to government bureaucrats making health care funding decisions when those of us who have health insurance have corporate bureaucrats making those decisions for us today.

    I know all the platitudes about the market providing better and more cost effective services. But having experienced the private insurance market, I don’t think the American insurance industry lives up to that ideal. My wife and I are lucky (I think) to both have employer provided insurance. But, like most people we don’t have any credible options beyond our employer-provided health insurance don’t. Many companies don’t let you opt out of the plan and even if you could, try buying health insurance as an individual that costs anywhere as low near what an employer plan does. It doesn’t happen. Most folks are already in a de facto single payer system because they can’t afford to buy insurance privately.

    Even if an individual could buy insurance at prices competitive with group plans, how does he decide which plan is the best? Markets work best when consumers have access to information about the products and if there is anything health insurance companies don’t like to share, it is information. Try it sometime.

    The hospital bill totalled $21,000. Her insurance (primary) paid $13,000. The remaining balance was submitted to my insurance company who refused to pay anything because their “allowable” charge for the surgery was $8,000 and the primary already paid more than that. So, what does it really cost to provide the surgery? $21,000? $13,000? $8,000? Same hospital, same doctor, 2 plans, 3 different prices. Requests to be sent the plan documents so that I could determine what service the company was obligated to provide were rebuffed. If they sent me any documentation at all, it was essentially a marketing brochure. In short, I was never able to get enough information to know which insurance company really had the better plan and even if they were actually living up to the contractual obligations within the plan. And you might ask yourself what a person without insurance would pay for that surgery? I’ll give you one guess and it isn’t $13,000 or $8,000

    The American health insurance market is a byzantine nightmare that works to ensure that any factor that actually helps consumers make decisions is clouded in a fog of obfuscation. Adam Smith wouldn’t recognize it.

  24. Oops. The fifth paragraph was supposed to start with a mention of a surgery my wife had earlier this year. Note to self: proofread first.

  25. #18

    Jerry

    Anecdotes are lousy evidence but for what it is worth I have a number of relevant experiences.

    My wife was diagnosed with bowel cancer in November 2007 and offered an operation the following week. She was assigned a specialist cancer nurse before the operation and afterwards whom she could contact by telephone for advice and guidance at any time (usually she had to leave a message and got the call returned with a few hours). This service is available to this day. In the week or two following the operation she was visited several times at home by the GP and stoma nurse. I have lost count of the number of follow up tests since that time, including MRI and CAT scans, and I believe some of them will continue indefinitely. She has thankfully made a full recovery. All free and on the NHS.

    Her experience was not all good. There was a shortage of non-critical beds the night before the operation so she had to take the “gut purging” drugs herself at home the night before. I drove her in in the morning. Immediately after the operation she was on a ward of six patients (The NHS rarely provides private rooms – but you can pay for them) and the nurses were clearly rushed and of mixed quality. On at least one occasion after the operation we had to wait 2 hours after the scheduled time to see the specialist and then only got see a junior doctor.

    Nevertheless the overall service was free, timely and successful. It would have been possible to pay for private room and private consultations which would no doubt have been more timely (although quite possibly with the same doctor!)

    My father got terminal lung cancer in 2001. The care from diagnosis through to his eventual death was if anything even better.

    In the 1980s we had our first child in Atlanta and our second in London. I won’t go into details but the care in Atlanta, paid for by my employer, fell well short of the NHS maternity care in London. In fact we felt severely let down by the care in Atlanta – although this may have been partly because we did not understand the system.

    You can maybe understand why I am quite passionate about this subject.

  26. @Jerry 21:”The US is known for the quality of its health care. People come here from all over the world for it.”
    Probably from Africa or poorer part of the world. Certainly not from Europe.

  27. Personally I feel that this is unfair that some children are suffering because their parents can’t afford to pay for their medical bills.
    I don’t believe that the state should be everywhere but I think that healthcare and education is the basic minimum that each person in a rich country should have.
    France is a very atheistic country but healthcare program are much more developed than in America. I always wondered why. I think this is because people are atheist and therefore consider this life as being very important. They think that the state should take the place of God (“l’etat providence”) and care for people. Maybe the religious in America consider that the poor deserve to be poor because God punished them.
    We all pay taxes. It’s part of our life. What better use of these taxes can be make if it save one person??

  28. “Maybe the religious in America consider that the poor deserve to be poor because God punished them.”

    One of the more stupidest statements I have seen in awhile. You are reading too much nonsense.

  29. “Anecdotes are lousy evidence”

    Not necessarily. If enough of the same appear then they constitute evidence especially if they are repeated experiences by the same person. My experience is that people like to dwell on horror stories and health care is a prime example. It is seldom part of any conversation I have had in the last few years so t he anecdotal evidence adds up. In all the health care harangues in the US in the last several months we have had only a few rare cases of abominable care as examples.

    Obama keeps on talking about a broken system but all I see is a remarkable system. The problem is not bad health care but the excessive cost for it. Each year we invent new treatments and new drugs and everybody wants it.

    I can cite any number of experiences of people being given over care here in the US due to the fear of litigation. That is the problem, not poor care. And too many options.

  30. This is from a website I just found

    http://www.ncpa.org/pub/ba649

    Maybe someone should check its accuracy.

    Fact No. 1:  Americans have better survival rates than Europeans for common cancers.  Breast cancer mortality is 52 percent higher in Germany than in the United States, and 88 percent higher in the United Kingdom.  Prostate cancer mortality is 604 percent higher in the U.K. and 457 percent higher in Norway.  The mortality rate for colorectal cancer among British men and women is about 40 percent higher.

    Fact No. 2:  Americans have lower cancer mortality rates than Canadians.  Breast cancer mortality is 9 percent higher, prostate cancer is 184 percent higher and colon cancer mortality among men is about 10 percent higher than in the United States.

    Fact No. 3:  Americans have better access to treatment for chronic diseases than patients in other developed countries.  Some 56 percent of Americans who could benefit are taking statins, which reduce cholesterol and protect against heart disease.  By comparison, of those patients who could benefit from these drugs, only 36 percent of the Dutch, 29 percent of the Swiss, 26 percent of Germans, 23 percent of Britons and 17 percent of Italians receive them. 

     Fact No. 4:  Americans have better access to preventive cancer screening than Canadians. Take the proportion of the appropriate-age population groups who have received recommended tests for breast, cervical, prostate and colon cancer:
    • Nine of 10 middle-aged American women (89 percent) have had a mammogram, compared to less than three-fourths of Canadians (72 percent).
    • Nearly all American women (96 percent) have had a pap smear, compared to less than 90 percent of Canadians.
    • More than half of American men (54 percent) have had a PSA test, compared to less than 1 in 6 Canadians (16 percent).
    • Nearly one-third of Americans (30 percent) have had a colonoscopy, compared with less than 1 in 20 Canadians (5 percent).

    Fact No. 5:  Lower income Americans are in better health than comparable Canadians.  Twice as many American seniors with below-median incomes self-report “excellent” health compared to Canadian seniors (11.7 percent versus 5.8 percent).  Conversely, white Canadian young adults with below-median incomes are 20 percent more likely than lower income Americans to describe their health as “fair or poor.”

    No. 6:  Americans spend less time waiting for care than patients in Canada and the U.K.  Canadian and British patients wait about twice as long – sometimes more than a year – to see a specialist, to have elective surgery like hip replacements or to get radiation treatment for cancer.[6]  All told, 827,429 people are waiting for some type of procedure in Canada.  In England, nearly 1.8 million people are waiting for a hospital admission or outpatient treatment.

    Fact No. 7:  People in countries with more government control of health care are highly dissatisfied and believe reform is needed.   More than 70 percent of German, Canadian, Australian, New Zealand and British adults say their health system needs either “fundamental change” or “complete rebuilding.”

    Fact No. 8:  Americans are more satisfied with the care they receive than Canadians.  When asked about their own health care instead of the “health care system,” more than half of Americans (51.3 percent) are very satisfied with their health care services, compared to only 41.5 percent of Canadians; a lower proportion of Americans are dissatisfied (6.8 percent) than Canadians (8.5 percent).

    Fact No. 9:  Americans have much better access to important new technologies like medical imaging than patients in Canada or the U.K.  Maligned as a waste by economists and policymakers naïve to actual medical practice, an overwhelming majority of leading American physicians identified computerized tomography (CT) and magnetic resonance imaging (MRI) as the most important medical innovations for improving patient care during the previous decade.   The United States has 34 CT scanners per million Americans, compared to 12 in Canada and eight in Britain.  The United States has nearly 27 MRI machines per million compared to about 6 per million in Canada and Britain.

    Fact No. 10:  Americans are responsible for the vast majority of all health care innovations.  The top five U.S. hospitals conduct more clinical trials than all the hospitals in any other single developed country. Since the mid-1970s, the Nobel Prize in medicine or physiology has gone to American residents more often than recipients from all other countries combined.  In only five of the past 34 years did a scientist living in America not win or share in the prize.   Most important recent medical innovations were developed in the United States.

    So please shove your complaints about health care in the US up something. It is a political game being played here and has nothing to do with the quality of health care.

  31. If it is the reality of cost we are concerned about, it seems like a no-brainer to be rid of a for-profit system that drains 30% of the health care dollars to corporate profits. Not that people shouldn’t have that option if they want it…

    And speaking of aggravation! Having thousands of plans and endless paperwork, confusion about whether something will or will not be covered and often being refused, going through red tape and just plain denials!

    And Jerry, if no one is going to Canada for health care how come they had to make it illegal for people to cross the border to buy their less price gouging pharmaceuticals? Oh, and while I am at it, another major reason for the high cost of health care in the US is the outrageous price of pharmaceuticals…which I believe the government would help to control.

    I have purchased catastrophic care myself, but it is very, very hard to find.

    And boy do I want to corroborate what Hummus man says. It is amazingly difficult, which is to say, impossible, to get any particular health deliverer to tell you the cost. I can give many examples, from myself and others. They WILL NOT tell you the price. My daughter, a young uninsured, was at a clinic for some reason, and said that she had no insurance and wanted to know what her visit would cost. They could not say!!! She said, how come when I leave here shortly I will be given a bill, but you can’t let me know now, before I go in? I mean, this sort of example can be multiplied many times over. Why people tolerate it, when it would not be tolerated by any other service industry, is beyond me.

  32. Whenever the cancer argument comes up, I can’t help but feel that if it weren’t cancer, there’d be something else the US system would happen to do better at. The question is, if our (I’m a USan) radically different system is the best in the world, why aren’t all our numbers like the cancer ones?

    (All defenders of our system, and all opponents of UHC, have no choice but to call ours the best in the world, because it’s the only one like it. Or is there a private healthcare system that gets better outcomes than American ones?)

  33. “And Jerry, if no one is going to Canada for health care how come they had to make it illegal for people to cross the border to buy their less price gouging pharmaceuticals”

    A little economics for you. If I make something, I have the right to charge anything I want and you have the right not to buy. The same company makes the drugs in both places and it probably comes from the same factory. In socialist medical organizations such as in Canada, the price is negotiated by the agency in charge in the government with the manufacturer. The manufacturer agrees to the price for Canada only. Canada gets a lower price since the drug companies depend upon the US’s free market society to fund the cost of developing drugs so that Canada can get lower prices. If the US became as controlled as most countries the new drug market would not dry up but it would slow down considerably. Essentially the US is funding a lot of the health care cost of countries around the world because of the drug prices charged here.

    But if that annoys people, the restriction of it will inhibit research and innovation as price controls have done for ever. Drug companies often have to pay billions in legal fees for drugs developed so drug research will slow up considerably unless they are assured of making a profit.

    Most health care givers have going prices but know that if someone does not have insurance they will probably not be able to pay it. Even if one has insurance the insurance company may balk at the price and will only pay a percentage on the posted price. So the actual price is often a lot less but is not published when it has to be negotiated for both insurance companies as well as for non insurance holders. Essentially the people with the better insurance programs are subsidizing those with lesser programs because the insurance pays the posted price. So the those who have the great programs such as people from unions with great plans are paying for the poor. Some doctors will not accept certain insurance companies because of what they will pay. The premier breast cancer surgeon in my area will not take most insurance unless the patient is willing to pay an extra fee.

    It is the same way in universities in the US. Those who pay full tuition are subsidizing a large percentage of the student body who receive aid or essentially a lower tuition. My wife raised money for her university and was told that 2/3 of the student body pay less than full tuition. So those paying full tuition as I did for my children are subsidizing most of the students.

    Also if you bought the argument that the insurance company is making too much money, the solution is not a government option. The option is more competition. It has worked for thousands of years. Government bureaucrats have never been efficient at anything except at getting more in the budget for the following year.

  34. Jerry,

    “If I make something, I have the right to charge anything I want and you have the right not to buy.”

    I’m sorry but I can’t remember who the Christians are here, so this argument might be irrelevant… At least we can say that this approach is not about anything moral written in the heart, nor about compassion or the art of healing.

    I have a hard time being too concerned about the pharmaceutical companies profits, since I read that of the 500 wealthiest corporations in the world, the top ten are all pharmaceuticals. So I also read where there was this chemo drug, and all chemo drugs are amazingly expensive, but this one had been around a while at a certain level of price, when it was found to have some efficacy in another type of cancer, breast I think, and so they jacked up the price to two or three times what it had been before. Asked about justifying that, they answered that now the drug was more valuable.

    Look, I don’t want to praise Michael Moore’s new documentary which I haven’t seen, but I saw an interview and he said capitalism as it is currently constructed is “anti-Jesus.” See, the drug company is perfectly within their rights to charge thousands of dollars for a bag of chemicals, even though the people who buy it are in fear for their lives and often entire families are bankrupted, insurance or no, with the expenses of cancer treatment. People have to mortgage their homes after losing their life savings and that sort of thing, and I just wonder, knowing that this is common – even for those with “good” insurance – I just wonder what Jesus would have to say about that pharmaceutical company’s decision?

  35. #30

    Jerry you are quoting from a highly politically motivated article that has been selective and often misleading in its use of statistics.

    A few examples

    A common tactic is to quote how the US fares better on some statistic versus one or two other countries. For any given measure the US is unlikely to be bottom of the list so there will always be another country or two that does worse.

    The figure of 1.8 million waiting for inpatient or outpatient treatment in the UK sounds dramatic but is meaningless. It includes everyone who is waiting for anything for any length of time – even for one day for an ingrowing tail nail. The equivalent figure in the US will certainly be far higher – if it is available.

    The cancer mortality rates are a notorious deception. The US does better than many countries on some types of cancer but it looks far better because of the way cancer mortality rates are measured. A patient is classified as surviving cancer if they are still alive 5 years after initial diagnosis. The US policy is for very early diagnosis. The result is that more people live more than 5 years after diagnosis even if the treatment regimes are identical. The classic case is prostrate cancer. The PSA test is easy to administer and given earlier to more men in the US than most countries. The result is an apparent higher survival rate. However, even in the USA it is quite controversial as to whether the test gives a net benefit (see http://www.cancer.gov/cancerto.....ection/PSA).

    I find it very hard to get a non-political motivated comparison of health care systems. There are any number rating the US system very low but I am suspicious of such headlines. I stumbled across this presentation recently:

    http://internationalforum.bmj......0Gibis.pdf

    It is intended to assess the German system and so has no political axe to grind with respect to the US system. You will see that the figures for performance are very mixed. For example, the US does well on waiting time to see a specialist (but only marginally better than France and Germany) but rather poorly on efficiency and avoidable mortality rates (although admittedly these figures are rather old). Actually all the industrialised countries provide a pretty good service. The outstanding difference is that the US system is twice as expensive per capita as the rest.

  36. tribune7 @ 16 –

    Everybody in the U.S. has access to health care via emergency rooms. It’s by far not the most efficient, or inexpensive, way but it is still a far more compassionate means of “rationing” than is done in Europe i.e. make them stand in line and hope some of them die off before its time to treat them.

    Wow. So in the US, health care for the poor is rationed to emergency care.

    And they still have to pay.

    jerry @21 –

    “It seems deeply uncaring: how else are you going to ensure that everyone in your country has access to health care? Or don’t you worry about the poor and needy?”

    I do not think this is accurate. The US is known for the quality of its health care. People come here from all over the world for it. Nobody from the US is running to Canada for health care.

    If you have insurance, health care might be good. But…

    Being uninsured does not mean one does not get medical care. It means that one has to pay for it yourself or get public assistance if you cannot afford the cost of the medical care. Medicaid takes care of most poor but some people fall through the cracks.

    Health care is so expensive, the poor and needy can’t afford it. Medicaid should help, but I have a friend who is uninsured, and she would have to be earning less than her rent to qualify for it (this is in NYC). She has mental health problems, but no way of getting treatment, because she can’t afford in, and there aren’t many psychiatrists in ER. Because of this, she couldn’t work full-time. So she’s stuck.

  37. Heinrich –Wow. So in the US, health care for the poor is rationed to emergency care.

    Wow. So in Europe, health care for the middle class is rationed to every thing. The rich, of course, always can find a way right?

    And in your system they get the added benefit of feeling warm and holy while giving the shaft to everyone else.

    And they still have to pay.

    Nope. They are treated regardless.

  38. I have a hard time being too concerned about the pharmaceutical companies profits,

    As do I. I am concerned, however, about persons having an incentive to create, produce and distribute useful pharmaceutical products.

    The less profit (and more hurdles) the less incentive. I was this rather indisputable principle was universally recognized.

    I wish something else that was more recognized is that those inclined to enter government are often (maybe even mostly) motivated by a desire to rule than to serve.

    And/or to have an easy income, of course.

  39. 39

    As a Canadian I find it hard to reconcile Ms. O’Leary’s words with anything that I have experienced with regards to our health care system. Now, that is certainly only my experiences and not a scientific study, but her views seem to come from far out of right field.

    As someone mentioned above regarding France, in Canada if a person needs a bed they get a bed.

  40. Wow. So in Europe, health care for the middle class is rationed to every thing. The rich, of course, always can find a way right?

    I don’t think it’s done in that way. In any health system with finite resources there will be prioritisation. The problem is how it is done. In Europe it is (largely) by seriousness of the ailment, and cost effectiveness of treatment. In the US it is by income and current health (all those people being refused insurance because of pre-existing conditions).

    The important issue, I think, is how the prioritisation is done. The US system seems fundamentally unfair in the way the poor are refused help, unless they want to bankrupt themselves (hm, I guess it puts to bed any claim that the US is a Christian nation). Shouldn’t we be protecting the weak?

    And they still have to pay.

    Nope. They are treated regardless.

    Yep. They are treated, and then get sent the bill afterwards.

  41. It’s true that the poor are well treated, and so long as they intend to remain absolutely poor all their lives they should be OK. Because they do get a bill.
    But there are many millions of uninsured, like my lovely 24-year-old college grad daughter who are not going to be poor all their lives. If she has the bad luck to wrack up a large hospital bill, it will wreck her future. And of course she works. Lots of people work hard but don’t have insurance, and lots of people make 7 or 8 or 9 or 10 dollars an hour.

    Frankly, the pharmaceutical companies have the medical schools under their thumb, and work hard to diss anything but chemical drugs, all of which have side effects, many of them monstrous, and are not a route to health. Calling them by the word ‘therapy’ is disingenuous. They insidiously destroy health. and I really don’t buy that unless their are huge profits their will be no incentive for further research.
    All this fearmongering about having the govt take over health care. We have a very functional set of govt run programs that no one in their right minds would want to do without, or have to buy insurance for. Fire. Police. Post office. Roads.

  42. Marduk (#41)

    1. Ms. O’Leary’s first name is Denyse, not Denise.

    2. In written English, the names of countries and their residents are capitalized, as well as the names of important historical events and undertakings – for instance, “Europeans,” “Canadians,” “America,” “Manhattan Project” and “American,” to quote a few of the words you forgot to capitalize.

    3. I’ll borrow a phrase of yours. “Note that the most capitalistic nation is the one” that initiated the Manhattan Project.

    4. If any nation does eventually discover a “cure” for “human stupidity,” I wouldn’t mind betting that it won’t be an Old World country.

    5. Your phrase “engaged in empire” makes absolutely no sense. You can engage in empire-building, but not in “empire.” By the way, “empire” is a countable noun.

    6. The total cost to the U.S. since 2001 of the wars in Iraq and Afghanistan is approximately $920 billion. See http://costofwar.com/. So much for propping up capitalism.

    7. Here’s one final thought on human stupidity: people who live in glass houses should not throw stones.

  43. But there are many millions of uninsured, like my lovely 24-year-old college grad daughter who are not going to be poor all their lives.

    So instead of, well, her paying for her own insurance — or you paying for it — you want the young married couple who is now doing the responsible thing by having their own insurance to start paying for her’s?

  44. Heinrich — In Europe it is (largely) by seriousness of the ailment, and cost effectiveness of treatment.

    It’s demand without supply. If you want treatment you have the “right” to it, but if the resources aren’t there you are not going get what you want/need no matter how much a “right” to it you have.

    And of course if the patient waits long enough he will not need treatment.

    Central planning never works for service provision and hoping for death is the worst form of rationing.

  45. Heinrich — (hm, I guess it puts to bed any claim that the US is a Christian nation). Shouldn’t we be protecting the weak?

    One of the problems with this debate is claims of moral superiority being substituted for thought.

    The motivations for the supporters of the various health care reforms seem to be solely a desire to feel warm and fuzzy and not solve a real problem.

    Putting ink on paper does not give you health care.

    I want health care for everybody. My objections to government-run systems (single payer or otherwise) is that centrally planned systems give you fewer doctors treating fewer patients per day i.e. less health care.

    The problem on which the bureaucrats and politicians concentrate is health insurance. A much better metric than the number of uninsured to use by those seriously concerned about the expansion of health care services would be the number of active doctors and the number of patients seen.

    And it puzzles me no end why nobody seems willing to question the motivations of politicians the way Obama questions the motivations of doctors.

  46. I want health care for everybody. My objections to government-run systems (single payer or otherwise) is that centrally planned systems give you fewer doctors treating fewer patients per day i.e. less health care.

    Many health care systems are not centrally planned: for example the German system is based on private health insurance, but access is guaranteed.

    There will never be a perfect solution, but you seem to prefer a high throughput of care, at the expense of a large number of your fellow Americans (15% uninsured, of which 8.9% are unable to get their costs covered – source). I wonder – how far would you allow inefficiencies to build in the system if it meant that treatment could be targetted at those who really need it?

  47. I want health care for everybody. My objections to government-run systems (single payer or otherwise) is that centrally planned systems give you fewer doctors treating fewer patients per day i.e. less health care.

    Doctors per 1000 people

    Germany: 3.4
    France: 3.37
    Sweden: 3.3
    Norway: 3.1
    Netherlands: 3.1
    Denmark: 2.9
    Australia: 2.5
    United States: 2.3
    New Zealand: 2.2
    United Kingdom: 2.2
    Canada: 2.1

    Nurses per 1000 people

    Netherlands: 13.4
    Switzerland: 10.7
    Australia: 10.7
    Norway: 10.3
    Canada: 9.9
    Germany: 9.6
    New Zealand: 9.6
    Denmark: 9.5
    Austria: 9.2
    Sweden: 8.8
    United Kingdom: 8.8
    United States: 8.1
    Japan: 7.8
    France: 6.7
    Italy: 5.2

    Source: http://www.nationmaster.com (edited to remove countries that are not comparable e.g. very small)

  48. Very good post, Mark Frank and I thank you.

    Under the Obama plan will the U.S. be more like Germany or France, or Canada and the U.K.? If anything, there is a real concern that what an Obama plan will do is cut back on the number of doctors/nurses. He certainly has done to address it. Everything Obama, Pelosi and Reid talk about involves containing costs, not providing service.

    And there is another integral part of the debate that goes along the number of doctors and that is their productivity. Here’s chart from nationmasters.com showing that U.S. doctors see significantly more patients (three times that of Sweden) than any other devolped nation other than Japan, which is off the chart.

    Can anybody enlighten us as to what the Japanese health care system is like? Nakashima-san are you there?

    And Mark, since Canada’s system doesn’t seem to be shining anywhere, is there any attempt to reform it to one more like Germany?

  49. Heinrich, maybe Germany’s system is fine and I shouldn’t be picking on it when I have Canada and U.K. in mind.

    The fear here is that the very good things in our system will be taken over and destroyed by fools and thieves.

  50. Oh, I thought they already had been!

  51. #47

    As I understand it, the Obama plan is to continue with privately provided health services but expand the scope of insurance and regulate it more. This is far more like Germany and France than the UK and Canada.

  52. #47 (cont)

    I am not sure that the number of consultations is a very useful measure of doctor productivity.What counts as a consultation? How long are they on average? How effective are they? Is a doctor who has many rather aimless consultations with a pregnant mother more productive than one who has one or two good ones?

    Actually I am not sure that number of doctors is a very good measure of a health system – but you raised it.

    What really counts is results and we have already seen how very hard it is to get a good measure of these. There is no evidence that the USA is outstanding compared to other industrialised nations and it is far more expensive.

  53. Mark Frank — Obama is talking everything including single payer, and it’s pretty clear that’s what he wants and the suspicion is that any reform will be a stepping stone towards that goal even it should not be obtained.

    Actually I am not sure that number of doctors (and consultations) is a very good measure of a health system

    They provide a far, far, far, far, far better starting point than the number of uninsured in determining the quality of medical care.

    And does anybody even consider what the purpose of insurance is? It’s not to fix the body/car/house but to make sure that the person who fixes the body/car/house gets paid. Once you look at it that way, the whole debate changes.

  54. The fear here is that the very good things in our system will be taken over and destroyed by fools and thieves. . . .Oh, I thought they already had been!

    Heinrich, the government yes. Health care not yet.

  55. And does anybody even consider what the purpose of insurance is? It’s not to fix the body/car/house but to make sure that the person who fixes the body/car/house gets paid.

    Surely the objective of a health system is to fix the body not to give the doctors a good salary? So if market driven insurance makes sure the doctor gets paid, but the body is not fixed, then something else is needed in addition to insurance.

  56. “So instead of, well, her paying for her own insurance — or you paying for it — you want the young married couple who is now doing the responsible thing by having their own insurance to start paying for her’s?”

    It simply isn’t affordable at all times of life for all people. I want a single payer, tax-based system, that she and I will pay into all our lives, but which if a person is between jobs or not fully employed at some time or other, does not mean they are out of luck if they need medical care.

    I would be willing to have a public option, but I don’t see how insurance companies can really ever compete with a not-for-profit system, which is exactly what we should have. 30% overhead and our lives in the hands of faceless corporates whose eye is on the bottom line – that is worse than government any day.

    Oh, and I most certainly do question the motives of politicians – especially those whose campaigns have had significant contributions from the insurance companies.

  57. Mark Frank

    Surely the objective of a health system is to fix the body not to give the doctors a good salary?

    EXACTLY!!!

    Which is why insurance is a rather minor part of it. Which is why it is puzzling — unless you are a cynic about it, which is probably the most reasonable thing to be — that all Harry Reid, Nancy Pelosi and Obama are talking about is insurance.

  58. avocationist–It simply isn’t affordable at all times of life for all people.

    In many cases with young people — and I’m not saying your daughter falls into this category or judging her if she should since we were all that age once — it’s not a matter of affordability but priority.

    I mean she (or you) would be looking at $40 a month –at least for my zip code for a 24-year-old female. It wouldn’t be the greatest plan but it would save her from bankruptcy or life-long debt in the event of a serious event which is your concern.

    And it would still give her a lot more freedom in choosing her care than a single-payer plan.

    And if you want to cut the cost of private insurance even more you can push to end the the mandates states impose on insurance carriers in their coverage.

    If you are looking for a bare-bones policy to bail you out in the event of a catastrophe — which again is what you seem to want for your daughter –it would be nicer and cheaper to get one that doesn’t cover birth control, mammograms and alcoholism.

    And of course, if you do want those things an insurance company would be glad to include those in a policy.

    Or if you want government to cover those things, it would still be less damaging than a single-payer take over.

  59. The stuff some people say on here is rich. A government tax-payor healthcare system?

    Since when does anyone trust the government to do anything?

    The truth about government healthcare by one of Obama’s advisors…

    We will let you die

    “you young healthy people, you’re going to have to pay more”

    and

    “by the way, if you’re very old, we are not going to give you all that technology and all those drugs for the last couple of months of your life because its to expensive, so we’re going to let you die”

    These cretins are deciding who will live in die, because afterall, they’re smarter than us. My grandmother under their watch would have died several years early because she would not be allowed all that new technology.

  60. Listen to that video above as the young “liberals” clap when they hear grandma or grandpa can die.

  61. As for France, Canada,

    French healthcare, WHO says,
    “best in the world” nationalized healtchare system in deep debt. They don’t know how they’re going to pay for rising cost.

    Socialized debt

    Canadian care enslaves people?
    Government forced care, Seeking other solutions

    15,000 die in French heatwave disaster…

    No 1. healthcare in world lets 15,000 die

    Adverse events cause up to 24K deaths a year

    “The Canadian Adverse Events Study reports that “adverse events” in Canadian hospitals result in 9,000- 24,000 deaths every year (“Universal Problems…”). Nonlethal events keep Canadians in hospitals for a total of over a million extra days per year (“Universal Problems…”).”

    Tax rates of nations…

    In 2007, America’s average personal tax rate was 28.3 percent of the GDP compared to Canada’s 33.3 percent, Germany’s 36.2 percent, England’s 36.6 percent, and France’s 43.6 percent. Japan’s tax rate equals that of the United States, but its debt last year was 170 percent of its GDP, three times more than that of the United States (“Obama’s Health Care…”).*

    It appears that government healthcare does not solve anything. It merely forces a one-size fits all plan on everyone but the Political Masters of Society.

  62. 2004 report on waiting time in Canada…

    Waiting to die

  63. I propose several measures to alleviate America’s healtcare problems.

    1) Remove American Military from around the world, from all corners of the world. Let Europe, Japan, Taiwan, Phillipines and every other nation defend itself with their own military and their own money. Transfer all cost savings to cover current unfunded liabilities in medicare, medicaid and social security for the American people.

    2) Stop funding all other nations, mainly third world nations with medical care, food, medicine and water treatment. Transfer all savings to Americans. We’ve given trillions to the world. Its time we take care of our own people. And let the world take care of itself. Maybe Japan, China, Russia and Eurupe can do half of what America has done to save lives around the world?

    3) Stop Americans funding abortions around the world. Transfer money back to American poor for healthcare.

    4) Stop funding democrat donors favored projects, like George Soros’s investment in Petrobas, Brazil. Instead, provide low-cost loans for Americna projects, not Brazilian or other nations.

    5) Start charging more money or taxing all drugs and patents that America creates to all other nations. We own the majority of clinical studies, research, discoveries and medicines in the world. Yet, the American people pay more for their drugs than other nations like Canada. Canadians, French, Brits, Japanese should all have to pay the same as Americans. Any nation that copies our drugs illegaly shall be cutoff from the world by our stronger defenses as a result of not protecting the whole world from evil tyrants and communist.

    The rest is domestic and already known. We allow more competition in all states. For example, I can get a cheaper Humana plan, but a friend of mine cannot get it in another state. This is government controlled sanctions against Americans. We need to free our nation for competition, not limit it by government controls. And of course tort reform, where Mississippi and Texas are already seeing lower cost and more doctors flowing into their states.

    There, that should do it. Anyone else with ideas on how to save American lives and money? I think the world is grown up enough to take care of itself now, don’t you? Without the evil American empire?

    They can hire Obama after he finishes. If the world clamors so much for a marxist loving leader, they deserve it.

  64. #61

    French healthcare, WHO says,
    “best in the world” nationalized healtchare system in deep debt. They don’t know how they’re going to pay for rising cost.

    If France has a problem with the cost of its healthcare then where does that put the US? France spends 11% of GDP per capita on healthcare. US spends 16% of a higher GPD per capita. In France it is the government who has a problem paying. In the US it is individuals and employers and government.

    Healthcare costs money. It is no secret. The trick is to get as much as possible from that money and distribute the results equitablty.

  65. I mean she (or you) would be looking at $40 a month –at least for my zip code for a 24-year-old female.

    You know, something else I don’t think young people or their parents consider. The cost for insurance — probably through a mandated requirement to buy it — will rise considerably for the young under a single-payer plan since the criteria will no longer be based on risk but on the need to fund the system which will invariably increase since the market will not be there to constrain the inevitable growth in bureaucracy.

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