Pharyngula

Posted by: Rog | August 13, 2009 7:58 AM

Not only is Hawking British, but he has said himself that the NHS has saved his life. Talk about an own goal !

Posted by: Harry | August 13, 2009 8:02 AM

"The stories of people dying on a waiting list or being denied altogether read like a horror movie script."

This is not something I recognise from here in the UK. Our experience of the service is that it is brilliant when most needed. What rationing there may be is not obvious at point of use but if this is the case I prefer it to one where those that can afford insurance get treated well and the rest get whatever free treatmetn they can.

Posted by: MosesZD | August 13, 2009 8:04 AM

Yeah, I saw the same thing. And as qwerty points out, the correction doesn't correct the main error. I'd should also point out that, here in America, Dr. Hawking would probably be dead, or warehoused away in some "home," already unless his parents were rich enough to deal with his issues.

Posted by: Evolving Squid | August 13, 2009 8:06 AM

People do, however, die on waiting lists here in Canada.

On the flip side, one person getting a medical problem can bankrupt an entire family in the US. Assuming they have enough assets to afford health care at all and don't just die from lack of financial resources. I'm not convinced either of those are improvements over dying on a waiting list.

Posted by: Meh | August 13, 2009 8:07 AM

There was an interesting article in the Guardian the other day looking at some of the claims circulating in the US about the NHS standard of care. A useful resource for correcting those factual inaccuracies when you come across them...

Posted by: Naked Bunny with a Whip | August 13, 2009 8:10 AM

Thank goodness healthcare in the US isn't rationed at all. With our private-insurance scheme, everybody has full access to medical care. (Band-Aids and whiskey are considered medical care, right?)

Posted by: Aquaria | August 13, 2009 8:13 AM

People such as scientist Stephen Hawking wouldn't have a chance in the UK, where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless

He's alive there, and he would probably be alive here. He'd probably have had health insurance, and qualify for SSI, etc.

Now if he was just some schmuck who worked at McDonalds--DEAD DEAD DEAD. long ago.

I'd love to have a US version of the NHS.

Oh, and I love the stupid argument people make about how doing anything to get the government involved in our health care would take us down the road to socialism.

I have to hold back the laughter as I ask them if they're seriously calling Japan a socialized country, since it has a public health plan.

JAPAN! Socialist! BWAHAHAHAHAHA!

They don't get it. They don't understand how all we're doing is making health care a government service, not that we're all going to be wearing the hammer and sickle and goosestepping past flags of Lenin at Red Square, or whatever warped vision they have of public health care.

Posted by: Thomas Theobald | August 13, 2009 8:16 AM

The fuckwittery is astonishing.

It really is this exact issue which makes me so torn about ever returning to the USA - either to contribute and fight back the dumb shits, or give the place up as lost and watch the floundering safely from Europe.

Just astonishing.

T

Posted by: MrrKAT from Finland, EU | August 13, 2009 8:18 AM

If all this tells knowlege level of that business paper, then please stop ordering or reading that paper that tells falsehoods - and drags all to big depression due to pure stupidity and fact-laziness.

Posted by: Feynmaniac | August 13, 2009 8:24 AM

The Guardian

We say his life is far from worthless, as they do at Addenbrooke's hospital, Cambridge, where Professor Hawking, who has motor neurone disease, was treated for chest problems in April. As indeed does he. "I wouldn't be here today if it were not for the NHS," he told us. "I have received a large amount of high-quality treatment without which I would not have survived." [Emphasis added]

Here's hoping the NHS keeps you going for a long time Prof. Hawking.

Posted by: SEF | August 13, 2009 8:28 AM

Stephen Hawking gets rushed into the local NHS hospital (a moderately famous one) whenever his condition gets too serious for his home care to handle (which unfortunately has been something making the news just a little too frequently these days). So far though, he is, as PZ says (and presumably as a result of that NHS hospital's staff's reality-based, evidence-based, science-based work), decidedly not dead.

Posted by: Lee Brimmicombe-Wood | August 13, 2009 8:32 AM

"The stories of people dying on a waiting list or being denied altogether read like a horror movie script."

This does not resemble the NHS that has served myself and my family through injury and severe illness, including cancer treatments. Though you can find anecdotal accounts of the service failing individuals, it serves the great mass of British citizens well. And where care is rationed, it is either of non-critical procedures or expensive new treatments.

As has been noted, private health care is allowed in the UK. I've had coverage for many years through my employer. So we get the best of the US private system for those who can afford it, and socialized care for those who cannot.

These charlatans are broadcasting a distorted message. There is the whiff of evil about what they say.

Posted by: Stephen Wells | August 13, 2009 8:33 AM

This neatly demonstrates the way the 99% of the opposition to health care reform in the USA is coming from people who have _no fucking clue_ what an actual health care system looks like.

Posted by: Knockgoats | August 13, 2009 8:34 AM

This is why Sarah Palin's hyperbolic comments about Obama's "death panels" were not particularly helpful. - Walton [my emphasis]

How about telling the plain truth for once, Walton? They were outright, deliberate, wicked, lies.

What we're seeing in the lie-campaign of the US private medical industry and its Republican stooges is real capitalism, rather than Walton's fantasy version. Threaten powerful private interests, and there are no lengths to which they will not go. We see exactly the same, of course, in the AGW-denialist campaign of the fossil fuel lobby, just as we have over decades with the tobacco lobby.

Posted by: Damian | August 13, 2009 8:35 AM

As others have pointed out, Stephen Hawking wasn't able to afford his own private health insurance for the majority of his life. He became famous more than 20 years after being diagnosed. So the reason that he is still alive, despite being given 5 (yes, five) years to live, is because of the NHS.

And in any case, private health insurance isn't that expensive in the UK. My mother and father have it, and they're not wealthy by any standards. There probably is an unfairness in that you are still expected to pay the same amount of tax, despite using your private insurance for certain operations, but very few people actually complain. And they have even commented that the service is actually no better, anyway.

As a woman on Ed Brayton's blog mentioned, she has been getting more than £30,000 worth of medical care from the NHS, each year, and without a single mention of the cost from anyone. She said that she has no complaints at all, only praise about the care that she has received, despite never actually paying in to the system the amount that she has received. And that is how it should be.

Posted by: Steve LaBonne | August 13, 2009 8:39 AM

It really is this exact issue which makes me so torn about ever returning to the USA - either to contribute and fight back the dumb shits, or give the place up as lost and watch the floundering safely from Europe.

STAY WHERE YOU ARE. I am dead serious about this. We're beyond help. I don't think any power on earth can prevent the US from going down the tubes over the coming decades; so much of the population has been successfully kept ignorant of reality, then systematically misinformed, to make a functioning democracy, or even more or less realistic policy-making to address the country's multiple and deep problems, possible any longer. I hope my daughter (now a high school senior) will find a way to make a life in a civilized country after college. I would do the same if I were young enough to start over from scratch.

Posted by: Walton | August 13, 2009 8:40 AM

Knockgoats,

Yes, British citizens are perfectly free to pay for private medical treatment, as to some extent are Canadian citizens (though some provinces, until a recent Supreme Court decision, banned private insurance from covering the same treatments as the public system). But neither Brits nor Canadians have the right to opt out of paying for the public system. In the case of the UK, we fund the NHS through our taxes whether we use it or not.

However, as I have explicitly recognised, Obama is not proposing a compulsory single-payer plan, but merely a government-run insurance option. As long as it remains optional, I don't see anything wrong with this suggestion. I also support his plan to provide tax subsidies so that insurance is more affordable; helping the poorest people in a society is a legitimate use of tax money.

I am criticising Sarah Palin's hyperbole about "death panels" because, in the end, any healthcare plan, public or private, has to ration care. Yes, Obama's public plan will not fund every treatment - but neither do existing private insurance companies or HMOs. As long as people have the right to opt out and pay for private treatment, all the talk about "death panels" and "rationing" is nothing more than rhetoric.

Posted by: Stuart | August 13, 2009 8:41 AM

#3 - he might well be a millionaire now, but his condition started in the 1970's when he was a relatively unknown scientist. Not that just being a scientist makes your rich, writing a best selling book does and he didn't do that until 1988

There are no 'foundations' which provide medical treatment (and no need for them of course as we have the NHS), day to day care, yes

Posted by: BdN | August 13, 2009 8:46 AM

Walton:

This is why Sarah Palin's hyperbolic comments about Obama's "death panels" were not particularly helpful. If Obama wanted to introduce a Canadian-style compulsory single-payer system, or a British-style socialised healthcare system, then she would have a point.

Errr.... as Michelle R pointed out, our system may be far from being perfect, but I was not aware that we had death panels over here... Of course, with a socialist like Stephan Harper, (or Jean Charest for the locals)who knows!!!

Posted by: Simon Scott | August 13, 2009 8:51 AM

Thanks for the laugh PZ, that was some serious foot-bullets there :D

Posted by: Eye of Horus | August 13, 2009 8:53 AM

I think our NHS is amazing. My grandmother, who was 84, received a heart operation. I was very surprised to find out that the NHS would fund this operation . Unfortunately my grandma died roughly 2 weeks after the operation after contracting an infection, but I have nothing but praise for the NHS and the doctors who performed the surgery despite her age. It was always going to be a risky operation, even for someone of a much younger age, but they still did it to try and improve her quality of life.

Posted by: Jeff S | August 13, 2009 8:59 AM

I get the republicans with money support and spread these lies, but why do the non-rich buy into it?

Are they really that dumb?

My mom (who I think voted for Obama, she implied as much but I never asked out of fear) sent me some stupid forward email yesterday about a picture of a sign placed on some highway that says

"Now we know that CHANGE =
MORE Debt, More Taxes, More Welfare, More Regulation, More Government, More Wasteful Spending, More CORRUPTION. Thanks, Mr. President"

Not only is it inaccurate and untrue, not only does it think more regulation is a bad thing where we are currently in a horrible global recession because of a lack of regulation, BUT it blames our current president for all the problems caused by the last administration. I remember when idiots like Romney were doing this before Obama was in office 100 days, but this is just getting to the point of ridiculousness.

It makes my head hurt that people can be so dumb. They lie, lie, lie, lie, lie. Its all they do. Its making me sick and angry, and now I have to lay down.

People need to wake up.

Posted by: Matt Penfold | August 13, 2009 9:01 AM

The NHS trains effectively all UK doctors and most nurses - so you use it even if you go private. It is also available as a backup if the private treatment causes a problem the hospital is not equipped to cope with; without that, private insurance would be considerably more expensive.

It is not unknown for NHS hospitals that are near private hospitals to get patients transferred over on a Friday afternoon. The most likely reason is that the private consultant knows the patient is likely to require attention over the weekend, and would rather the NHS took care of the patient rather than have to abandon a game of golf.

Posted by: Liveliest Crib | August 13, 2009 9:02 AM

Harry @ 4:

What rationing there may be is not obvious at point of use but if this is the case I prefer it to one where those that can afford insurance get treated well and the rest get whatever free treatmetn they can.

You give the American system too much credit. People who can afford out-of-pocket expenses are treated well. People who can afford insurance policies must constantly fight their insurance companies, which routinely deny coverage on grounds they know are baseless in the hopes that patients will give up the fight, and just try to pay the bill. People who cannot afford insurance use emergency rooms as their source of primary care, relying on Hippocratic ethics for treatment prior to payment, but placing them in credit-ruining debt forever.

Walton @ 11:

[Rationing] isn't in itself an argument against national healthcare; because as I've pointed out before, care is rationed in any system.

Indeed. The real question is how, i.e. on what basis? In the U.S., there are two criteria: (1) Can the patient afford to pay out of pocket?; and if not, (2) would it be more profitable to the company providing the insurance policy make more money by denying the patient care?

~~~~~~~~~~~~~~~~

As for the non-apology offered by the imbecilic magazine, I'm surprised they even acknowledged Hawking's nationality. Of course, it's never too late for the American press to make his country of origin into the latest distraction.

A controversy over a brilliant scientist's citizenship has erupted as Kenyan national, Barack Obama continues to plot your grandmother's death with health care reform. Some people say that renowned physicist Stephen Hawking is British, while others maintain that his amazing survival of Lou Gehrig's disease is due to his being an American, where he receives the best care in the world thanks to our refusal to bow to Soviet-style socialized medicine and baby eating. With us today is a far-left professor who says you are stupid to think Hawking is not an American, four other people who claim to have PhD's and who argue that the scientist lives right here, and Glen Beck, who says he can prove that Hawking is actually a moron so who cares anyway. Glen, we'll start with you . . .

Posted by: Rynaldo | August 13, 2009 9:04 AM

It's true that the health care system here in Canada is far from perfect. There have been plenty of news stories about wasteful spending and limited resources. Still, I have to prefer a system that is designed to provide health care to those that need it, not just those that can afford it. When my daughter suffered a mild concussion I found out that I had neglected to renew her health card (the card that allows access to the government health care system). Without a valid card, the hospital would have charged me thousands of dollars for tests and her overnight stay. Fortunately, I was able to quickly get to a government services office and renew the card on the spot so there were no hospital bills. As much as I might grumble and complain about my high taxes there are some things that all of us should contribute towards and universal health care is one of them.

Posted by: SEF | August 13, 2009 9:05 AM

The stories of people dying on a waiting list ...

... are unfortunately true. I know this not merely from being in the UK but also from working in hospitals, including on the relevant data! But this truth tends to apply under relatively specific circumstances.

For example, there is always a shortage of donated organs for transplant operations. It's hardly surprising that many people waiting for heart, lung or kidney transplants don't get one in time. Though they do get free dialysis and similar while they are waiting. They don't get no help at all as would typically be the case for the uninsured in the US.

The cause of the bottleneck and long waiting list is that too few people arrange to donate their organs and, equally importantly, to tell their families that they want to do so. Meanwhile, it turns out (ie recently made the outrage news!) that some private foreign patients have been getting some of the donated UK organs. That parasitic private health-care system again.

Another example is hip replacements. That operation used to be extremely long and require a lot of donated blood. These were relatively unavoidable limitations on the rate at which the operations could be carried out. Meanwhile, the sort of people who needed the operation tended to be fairly old. So it's hardly surprising that many of them died (I think it was around two thirds!) before they reached the head of the (approx. 3 year) virtual queue, especially with the additional quality-of-life-destroying problem of being house-bound while waiting.

However, since then (in the 80s), the technique of the operation has been improved :- less blood is required and it may (I'm unsure here) have become faster too. So, if the throughput is faster the waiting list could well be shorter - but the patients will still inevitably mostly be old and quite likely to die.

People don't simply die while on all waiting lists.

Posted by: midwifetoad | August 13, 2009 9:09 AM

There are no 'foundations' which provide medical treatment (and no need for them of course as we have the NHS), day to day care, yes

Day today care that is necessary for a person to remain alive is medical care. Quibbles about terminology are disingenuous.

My father spent his last two years in nursing care. Most of it was not covered by Medicare, nor by the private insurance he had been careful to maintain. Most of his care was paid for out of pocket. Fortunately he had spent a lifetime saving money. He used it all.

I'm kind of curious how this fits in to the proposed plan. Does anybody know? Even if they know, will it become reality in a system that changes from day to day?

I could go for nationally subsidised catastrophic health insurance. I could even be persuaded to consider a single payer system for catastrophic health care.

What I oppose is micromanagement of routine medicine and procedures that could be paid for out of pocket with medical savings.

But speaking of catastrophic care, I found myself last summer in NYC with a strangulating hernia. I managed to walk in to Presbyterian hospital and was admitted within 15 minutes, with no health insurance. I was on the operating table in under two hours from the time I walked in. It was near midnight on a Sunday.

I have bills to pay, but the Hospital consolidated all of them and agreed to a monthly payment I can afford. It's about one-fourth of what I had once paid for health insurance.

They say hard cases make bad law, and I think focusing on Hawking is silly. The opposition to the currently proposed national plan is really based on the track record of the federal government screwing up nearly everything it tries to micromanage. I say micromanage, because several thousand pages that no one has read would not be necessary unless it intends to manage every detail of health care. Would you buy an insurance policy that had two thousand pages of fine print?

Posted by: TomatoPaste | August 13, 2009 9:15 AM

I presently live in the UK (Scotland) and the healthcare here is AMAZING! Yes there are waiting lists when your condition isn't life threatening but whatever the case you are treated.

I also lived for 12 years in France and there it's even better!!

In both countries you pay a part of your salary for social security and healthcare, and you can also get complimentary private insurance (and I do through my employer) for things like better dental and occular. But I don't trust them.

A good friend of mine had a baby boy who had a terrible condition and spent his first six months in hospital and then passed away. BUPA - a private health insurer over here - refused to pay the £1.5 million bill over some stupid technicality so the NHS had to deal with it :/

Another friend of mine has had five pacemakers put in, for free, on the NHS. He is alive thanks to them. A private insurer would have probably found some way to wriggle out of it - at about £50,000 a piece I'm sure of it.

The ease of mind that comes with knowing you don't have to worry about paying for medical emergencies is something I would never give away for some capitalist ideal. Ever.

Posted by: Liveliest Crib | August 13, 2009 9:17 AM

midwifetoad @ 54:

. . . the track record of the federal government screwing up nearly everything it tries to micromanage. . . .

Such as?

Posted by: SEF | August 13, 2009 9:26 AM

NB It's not just private doctors/consultants in the UK who neglect their job to play golf. Too many NHS-employed ones were visibly skiving off too (while I was there to see the evidence of it, anyway) - and it generally was for golf!

Posted by: WhatBlueDot | August 13, 2009 9:35 AM

Thanks for that. I needed a good pick-me-up this morning.

Posted by: Thoughtful Guy | August 13, 2009 9:43 AM

We'll probably never has as good a health care system as they do in Canada, France and Britain. The idiots in opposition refuse to let it happen. Even if lawmakers do manage to get something passed, it will be so filled with compromises that it will be ineffective.

Posted by: Kemist | August 13, 2009 9:48 AM

People do, however, die on waiting lists here in Canada.

So I've heard. But I've never actually seen anybody die on a waiting list, except on transplants lists. Or from medical errors, which happen everywhere.

It also depends where you live. Rural regions have less services than big cities, but that is also true of private systems since it's far less profitable to have a big high-tech specialized hospital in a 500-people town than in a metropolitan area.

People may wait long times for things like orthopedic surgery, since that is, for some reason, a specialty that is shunned by med students. Dermatology services are also problematic for non-emergencies, but that is mainly because the private sector is more lucrative for them (botox injections). Another problem we have is a lack of family doctors, another specialty which is shunned by med students.

All those problems cannot be solved with a private system, and some would be or are made worse by the existence of a private sector.

Posted by: Susan | August 13, 2009 9:48 AM

I cannot understand how even those people can be so brainwashed, so inured against their own self-interest

It could be that many of them are covered by Medicare (although you'd think they'd have some consideration for their children and grandchildren). I've ceased being surprised by the mobs egged on by Beck, etc., but U.S. companies of every size are being dragged down by the cost of providing health care benefits to their employees... you'd think they would be using their own lobbyists to pressure Congress to change the situation, but I've seen nothing like that yet.

Posted by: midwifetoad | August 13, 2009 9:51 AM

You can help the parents avoid malnutrition, crib dead, and all sorts of problems. Furthermore it identifies potential problems with the children early on.

This translates into massive savings on health care, and in fact it is a bonus to the children into adulthood.

I worked as a family counsellor for seven years in children's protective services. My father was a state health officer for 29 years. He established things like county health clinics, and worked with visiting nurses. I know all about good intentions. I've lived them.

What I don't see coming out of Washington is an evolutionary approach. What I see is top down design, with not much intelligence evident.

What you get from efforts like this are unworkable systems that lead to cheating, shuffling of funds, dishonest bookkeeping, and the inability to track results. You will get systems that cannot deal with differing costs in different locations.

Now if congress wants me to get on board, all they have to do is make it mandatory that elected officials and government employes will be limited to the public plan. As it is, the rich and powerful will continue to have superior care and superior options.

And if "day to day" care isn't included, it will have little or no impact on people going bankrupt over medical bills. The fact is that uninsured people already do get emergency care, includung expensive surgery. It's the after care that breaks you.

Posted by: Knockgoats | August 13, 2009 10:00 AM

The opposition to the currently proposed national plan is really based on the track record of the federal government screwing up nearly everything it tries to micromanage. - midwifetoad

Crap. It's based on the fact that it would threaten the profits of the private health sector.

Posted by: MosesZD | August 13, 2009 10:02 AM

Posted by: Evolving Squid | August 13, 2009 8:06 AM

People do, however, die on waiting lists here in Canada.

People die on waiting lists here, too. Hell, a few years ago I was presenting stroke-like symptoms (lost virtually all the motor control and feeling in my left hand and arm) and they scheduled my visit with my Doctor for two weeks down the road!

I eventually got them to see me with only a TWO DAY delay.

I ended up having a viral infection of the left brachial plexus which killed a lot of nerves (most of which have grown back though there is some modest partial muscular paralysis/atrophy regarding my index finger). So it wasn't a stroke. But, Christ, it could of been! Especially as I am borderline to high-blood pressure and am in the elevated risk pool.

And yet, having this in my files, they made me wait!

Then, after I saw the doctor, I had to wait three weeks for some very painful nerve conductivity test. And even though that ruled out a stroke and spinal damage, they still made me take a goddamn MRI three-or-four weeks after that... Even though it was completely unnecessary (though they could bill it), just like when they tried to MRI my wife because she had a MINOR shoulder-strain.

So I don't want to hear about "waiting lists." I've been on plenty of them.

I also don't want to hear about "select your own doctor." Getting a doctor can be an ordeal. Last time I had to get a private-practice physician first I had to go down the BCBS "approved list" which my (then) current doctor wasn't on. Then I had to call them and find out who was taking new patients -- MOST WERE NOT.

Then I finally got a doctor and he moved! Now I just go to the local teaching hospital and am seen by a resident as part of their Internal Medicine program. So far they haven't been too stupid.

I also don't want to hear about "rationing." I have had the insurance company DENY care for my daughter's heart murmur. Those tests to see how it is progressing were, apparently, not cost effective for such a small murmur.

We also had a run-in when she was born. The doctor wanted to keep her another day. And wouldn't release her. However, the insurance company was "fuck you, you only get two days in the hospital, so get out."

We paid out of pocket. It cost about $5,000...

So, honestly, there's a lot of shit I don't want to hear about having experienced the glories of the American system. "A+ coverage" people such as myself who, suddenly, find that A+ coverage ain't exactly the A+ they're supposed to be getting with those $14K a year premiums they pay...

And for significant parts of the population in those countries, it's a shit load better in France, Germany, etc., than what they get here -- preventable death by lack of care.

So, really, I don't want here about "waiting lists." Or countries with different systems have "problems." We have all their problems, and more, while paying 40% more and only covering about 3/4ths of our population.

Posted by: Lee Brimmicombe-Wood | August 13, 2009 10:05 AM

I will happily go on the record as an Englishman who would not trade my health care system for the American one.

That said, I must admit that I'm moving shortly to Sweden where I'm sure I shall I shall succumb to the excesses of their socialized system.

Posted by: Soren | August 13, 2009 10:05 AM

Midwifetoad:

Why did you cite my reply in yours?

We agree that health insurance should cover more than emergency medicine.

So I guess we must agree that it is a good idea to help new parents, in order to improve the quality of life of the infants, and reduce the overall costs of the health care system?

I told the story of my mothers sister above. Rheumatism is not an emergency, but it sure does affect your quality of life, if you cannot walk and cannot use your hands. Health insurance must cover all necessary expenses, for as long as the patient is sick to be of any use. And cover a patient who've had ovarian cancer and breast cancer when she has another outbreak of ovarian cancer. And all this must be regardless of how much money the person has, or if he/she is employed.

Posted by: Feynmaniac | August 13, 2009 10:11 AM

This is almost as bad as:

At a recent town-hall meeting in suburban Simpsonville, a man stood up and told Rep. Robert Inglis (R-S.C.) to “keep your government hands off my Medicare.” [Emphasis added]

Posted by: Kemist | August 13, 2009 10:13 AM

Of all the friends and family I have, not a single one would trade their system for ours.

I wouldn't. I won't even put one toe on your side of the border without iron-clad insurance papers, and those only cover emergency health care plus transportation back home.

Have you noticed that none of those retired canadians living in the US have given up their canadian passports and will return home in a hurry if they are ever diagnosed with something bad ?

FYI, our health care systems are province-level administrated. That means that each province (state) has autonomy in its health care laws, and that there may be differences in the cost of some medical acts according to state, and so you may have to pay something (the difference in cost) if you receive care outside your province of residence. To get access to a state's system, the only requirement is that you be considered as a permanent resident.

And we won't even check your medical history. One of my friends, an Indian, got her permanent residency during her chemotherapy for ovarian cancer. I accompanied her to the border to get her papers.

Posted by: NoFear | August 13, 2009 10:17 AM

It is so annoying that the large majority of religious or ultra right wing articles/essays/blogs on the net don't allow comments. It is understandable though, they don't want their lies blatantly open to exposure by a swarm of informed individuals. I so wanted to comment on that article.

Posted by: David Marjanović, OM | August 13, 2009 10:21 AM

Right wing americans are insane when it comes to this issue. Are they really that insular that they don't understand what goes on in other countries where there is universal healthcare?

Fucking yes. Ignorance and the Dunning-Kruger effect are among the strongest forces in the universe.

----------------

Comment 33 sounds like a good idea to me.

Posted by: T. Bruce McNeely | August 13, 2009 10:27 AM

Midwife toad:
But speaking of catastrophic care, I found myself last summer in NYC with a strangulating hernia. I managed to walk in to Presbyterian hospital and was admitted within 15 minutes, with no health insurance. I was on the operating table in under two hours from the time I walked in. It was near midnight on a Sunday.

And pretty much the exact scenario would have happened in Canada. Immediate surgery is the standard of care for a strangulated hernia. If you had been a Canadian resident, almost the entire cost would have been covered. If you had been an American visiting without insurance, you would have had to pay out-of-pocket, but I guarantee that the charges would have been much less, So what is your point?

Posted by: midwifetoad | August 13, 2009 10:31 AM

Why did you cite my reply in yours?

Possibly it was a mistake. I'm not sure. The mechanics of this blog do not make dialog easy. By the time I respond to something, thirty people have made my response obsolete.

There is something deeply wrong with politics when something as massive as this requires such haste. I don't know the facts, because I haven't read the bill, but I do have an aversion to major political actions that seem to have a panic quality to them, as if the politions want to pass the bill before people have a chance to read and debate the contents.

I would hope that a really good piece of legislation would gain favor with time, rather than the reverse. A system that subsidised catastrophic care and exempted medical savings from taxes would get my attention. For ordinary care I prefer out of pocket.

I'm not really buying the "optional" bit. Once we start down this road, the private insurers will be nationalized. Within a decade or two.

Posted by: SEF | August 13, 2009 10:34 AM

It's like we're a third-world country when it comes to keeping our citizens healthy.

Today's midday news in the UK had an item whose tone was exactly that - treating the US as a horribly backward third world country, where British medical personnel had gone over to sort out the health problems of its unwanted* peasantry!

It completely paralleled the sort of coverage you'd get of missions to african and asian countries, where those in government couldn't care less about the "little" people (other than how many of them they can get away with killing while stealing the international aid resources intended for them).

* ie unwanted by the only-in-it-for-the-money US private insurance system, hospitals and medical staff.

Posted by: Steve LaBonne | August 13, 2009 10:37 AM

There is something deeply wrong with politics when something as massive as this requires such haste.

Haste? we've been trying to do this since the fucking Truman Administration.

I don't know the facts...

Obviously. Stop wanking so much- you'll go blind.

Posted by: Jeroen Metselaar | August 13, 2009 10:39 AM

Just a squeak from The Netherlands. We have a kind of hybrid between an NHS and a free insurance market. I am not saying it is perfect but over all it functions quite well.

I experienced how well things run last week. I had some symptoms, called my physician. He was on holiday but had left the number. I called, got an appointment a grand total of three(3) hours later. He requested some blood tests and give me a completed form.

Next morning I went to the lab (no appointment needed), handed over the form had my blood sampled. Yesterday the doctor called me for a consult over the phone. He prescribed me something that I could pick up at my pharmacist that afternoon. All as simple as that.

All through the proceedings the only administrative hassle I had was showing my insurance pass and my I.D. (fraud does happen) I never had to pay anything, all bills go straight to the nice people at my insurance company.

Waiting lists happen. The solution is to keep whoever runs the health care responsible. One way we got rid of the worst of them is to give a patient the right to shop around for care if local resources are insufficient. This extends beyond our borders.

The big advantage of the US is that as late adopter of a general health care system they can study all solutions around the world (don't forget Cuba!) and have a good look at all the weak and strong points.

Posted by: Liveliest Crib | August 13, 2009 10:39 AM

mikecbraun @ 73:

We wait here in America, too . . .

The American right wing's modus operandi is projection. There's a very simply formula to apply:

If an American right wing politican/pundit condemns something, s/he is currently engaged in that something; if s/he warns against something, it is because she knows s/he would implement that something if s/he were in charge.

The health care "debate" is no exception.

Waiting lists on which people die? Already happening, and corrupt right wingers would ensure that they and their families are bumped to the front of those lines if they were in charge.

Death panels whose bureaucrats would callously decide whose life is worth the expense of saving it? Already happening under the current system, and precisely how the right wingers would go about handling government-run care (perhaps making the callous decisions along lines of a patient's party loyalty).

Incompetence and wasteful spending? Our system is already the most wasteful of the developed world, and government is always incompetent when they are in charge. (That's their fundamental scam. They rail against government as inevitably incompetent, then take over and fuck everything up, and say, "Told ya so.")

Government encroachment on basic freedoms? Need I really elaborate on that one?

Posted by: foolfodder | August 13, 2009 10:44 AM

http://news.bbc.co.uk/1/hi/world/americas/7420744.stm

http://twitterfall.com/?trend=%23welovethenhs

Posted by: Knockgoats | August 13, 2009 10:46 AM

In the commercial media, the best bet is Sky News. - Walton

That's Lie News - brought to us by none other than Rupert Murdoch, proprietor of Faux News.

Posted by: alex | August 13, 2009 10:55 AM

7. Free spectacles (I'd love to know how the optician figured out the prescription)

Most modern eye tests are started using an autorefractor, which basically shines light into the eye, and works out if it's focused correctly, and if not, then derives what the corrections are.

After the autorefractor is done, then usually the optician will try to improve the prescription by using objective tests (which line can you read) or subjective tests (which looks clearer), but you can also use a retinoscope to improve the autorefractor's prescription, this uses the same principle but as it's operated by a human, it's usually more accurate.

Both the autorefractor and the retinoscope don't require any feedback from the subject, and can therefore be used on disabled or otherwise non-communicative patients.

Posted by: J Myers | August 13, 2009 11:02 AM

Palin's "Obama death panel" was the lowest though.

The first time she said it, or the second time?

Posted by: Spiro Keat | August 13, 2009 11:03 AM

A common occurrence with private operations here in the UK, is that if a private operation goes wrong, the patient is immediately transferred to an NHS ITU ward.

This of course helps to save the insurance companies from having to build, staff and maintain their own ITU services.

Posted by: bsk | August 13, 2009 11:04 AM

Editorials like these in financial publications are all too common. Being a finance grad student, this always makes me cringe. Sometimes I wonder if I'm the only scientifically-minded person in the whole profession :/

Posted by: Susan | August 13, 2009 11:16 AM

There is something deeply wrong with politics when something as massive as this requires such haste.

You may be slow, but I'm having no trouble keeping up with the developments. Read the news. Watch those who are actually informed (and not alarmist) dissect it. These discussions have been going on for decades. I certainly wish our government took this much time making a decision about bombing another country back into the dark ages.

Posted by: stogoe | August 13, 2009 11:23 AM

With our private-insurance scheme, everybody has full access to medical care. (Band-Aids and whiskey are considered medical care, right?)

We have full access to whiskey?! Why didn't anyone tell me?

Posted by: Pierce R. Butler | August 13, 2009 11:25 AM

Kel @ # 27: Right wing americans are insane when it comes to this issue.

How many issues can you name on which they display sanity?

Liveliest Crib @ # 58: midwifetoad @ 54:

. . . the track record of the federal government screwing up nearly everything it tries to micromanage. . . .

Such as?

Wars, hurricane preparedness & relief, schools, anti-terrorism, financial regulation... - just where were you between January 2001 & January 2009?

Steve La Bonne @ # 71: Why do you think that, uniquely among the industrialized countries, Americans are so stupid that they would be incapable of doing a decent job running a national health care system?

Maybe because he sees that, uniquely among the industrialized countries, large numbers of Americans are rioting against any improvement whatsoever in their health care management?

Posted by: David Marjanović, OM | August 13, 2009 11:29 AM

What I don't see coming out of Washington is an evolutionary approach. What I see is top down design, with not much intelligence evident.

What you get from efforts like this are unworkable systems that lead to cheating, shuffling of funds, dishonest bookkeeping, and the inability to track results. You will get systems that cannot deal with differing costs in different locations.

Then why

the fuck

does it work in almost every other halfway industrialized country in the world? Is there something in the water in DC?

Comment 71 has already said it, but it can't be said often enough.

I also don't want to hear about "select your own doctor."

Yeah. Over here, you have complete freedom. In the USA, your health insurance or lack of one chooses for you.

Posted by: Rick R | August 13, 2009 11:32 AM

Andrew @ #91-"Yikes, my first post here and it's a great long tirade. Hell of a way to delurk, eh?"

I thought your post was grand, just grand.

Posted by: Tasha | August 13, 2009 11:45 AM

Having moved from Canada (socialized medicine)to the US, I have to say that, in my experience, US healthcare is better, even for the poor. Because I was pregnant when we moved here, I couldn't get private insurance (pre-existing condition, meh!). On our state's version of public medicine, I received better care here than on Canada's "medicine for all" version with my previous pregnancy.

Don't know what the solution to the insurance problems are here, but going totally socialized is a step backwards in terms of quality of care. People do die on waiting lists. Finding a family doctor is impossible (everyone just goes to walk in clinics)because there aren't enough doctors (the government keeps the cost of healthcare down by artificially capping the number of graduates allowed from medical school). There is NO choice...you get what you get in terms of what doctor you see, waiting lists even for appointments are horribly long and you are just grateful that you finally get an MRI after waiting 18 months. Just the Kaiser in the city (never mind all the other hospitals, etc in the area) where I live has more MRI's than than the entire city of 700,000 people in Canada where we moved from.

And...the kicker is that it is illegal to provide medicine outside of the socialized setting, so even if a doctor wanted to open a private, fee based clinic for those who wanted faster, better service, they aren't allowed to. So *everyone* gets horrible service.

Maybe some sort of two-tiered system would work, where private and public medicine co-exist.

Posted by: Bernard Bumner | August 13, 2009 11:49 AM

What's with all the comments about how "right-wingers" are evil, corrupt people who cynically broadcast propaganda to their legions of brainwashed sheep-like followers? Some of you seem to think modern-day America is like a bad sci-fi movie.

Really, have you actually watched any of the videos of Sarah Palin's lies, the outright propaganda of Republican politicians as they purposely spread mistruths, or the mobs shouting down reformists as they try to make their case in town hall meetings?

Go away, watch them, and then think about why people might draw those conclusions.

Posted by: Carl Fink | August 13, 2009 11:52 AM

Please cite an example of someone "pretending it would be horrible for poor children to get medical treatment."

Posted by: Rick R | August 13, 2009 11:55 AM

Walton, being insufferably arrogant and even more clueless than usual, said- "Some of you seem to think modern-day America is like a bad sci-fi movie."

"The fact that someone is "right-wing" or "left-wing", or otherwise holds a political opinion different from your own, does not make them intrinsically evil or stupid."

No. But in case you haven't noticed, the screaming, frothing-at-the-mouth idiots disrupting town hall meetings, whipping up the base with tales of "death squads", hanging politicians in fucking effigy because their heads have been crammed full of scaremongering CRAP from their talking-head gods are all on the RIGHT, you clueless idiot.
If that's "reasoned political discourse" in what passes for your mind, then please- FUCK RIGHT OFF.

Posted by: Knockgoats | August 13, 2009 11:59 AM

What's with all the comments about how "right-wingers" are evil, corrupt people who cynically broadcast propaganda to their legions of brainwashed sheep-like followers?
- Walton

Simple observation, Walton, simple observation.

On our state's version of public medicine, I received better care here than on Canada's "medicine for all" version with my previous pregnancy.

Don't know what the solution to the insurance problems are here, but going totally socialized is a step backwards in terms of quality of care. - Tasha

Tasha, you do realise that what you got in the USA was socialized medicine, no? That's what Medicaid, Medicare and the VA are.

Posted by: MrFire | August 13, 2009 12:00 PM

Having moved from Canada (socialized medicine)to the US, I have to say that, in my experience, US healthcare is better, even for the poor. Because I was pregnant when we moved here, I couldn't get private insurance (pre-existing condition, meh!). On our state's version of public medicine, I received better care here than on Canada's "medicine for all" version with my previous pregnancy.

Tasha - so I understand you correctly, are you saying that you received public medicine in the U.S. that was better than the public medicine you received in Canada, and that private medicine in the U.S. failed you completely?

Posted by: Walton | August 13, 2009 12:09 PM

Knockgoats:

What's with all the comments about how "right-wingers" are evil, corrupt people who cynically broadcast propaganda to their legions of brainwashed sheep-like followers? - Walton

Simple observation, Walton, simple observation.

Well, if I'm an evil, cynical, corrupt propaganda artist, then I'm very bad at it: I can assure you that no health insurance consortium or sinister conservative conspiracy has paid me any money whatsoever to express my opinions on the internet. Nor do I have any legions of sheep-like followers. Indeed, I have nothing at stake whatsoever on any of these issues. All I'm doing is looking at the evidence from an external perspective, and expressing the point of view which makes sense to me.

Posted by: Walton | August 13, 2009 12:12 PM

Tasha - so I understand you correctly, are you saying that you received public medicine in the U.S. that was better than the public medicine you received in Canada, and that private medicine in the U.S. failed you completely?

As I understand it, the point she was trying to make is that socialised medicine for all, without a substantial private sector to take the strain off the public system, leads to long waiting lists, substandard care and limited choice. Thankfully, Obama isn't proposing such a system.

Posted by: Mark | August 13, 2009 12:18 PM

Anyone who believes the reform proposals floating around Capitol Hill right now will save anyone money (the primary motivation behind reform) is smoking crack. Based on history, cost estimates for Gov't programs are woefully optimistic. A bit of research on Medicare, for example, reveals that when congress debated the program in 1967, the Ways and Means committee estimated its costs at $12 billion annually by 1990. Actual cost? $110 billion, a nearly ten-fold increase.

Right now, as we debate this, the Medicare program (according to its Board of Trustees) has an unfunded liability of $36 trillion. Yes, I typed trillion. Does anyone believe this program is sustainable? Obviously not President Obama; he may not be saying it, but Medicare's pending doom is one of the reasons he's pushing for reform.

Other Gov't-funded health care initiatives like Medicaid, SCHIP, etc., have a similar history of grossly optimistic cost estimates. In fact, this scenario repeats nearly universally for Gov't-sponsored/managed programs.

It seems to me if our Gov't was serious about controlling healthcare costs, it would rein in Medicare, Medicaid and SCHIP costs first.

We can debate the relative moral rightness of the details 'till our fingers bleed, but in the end it has to be paid for. I'll lend my support to the idea of Gov't-run health care (in the US) when our Gov't demonstrates an ability to manage and control costs of its current programs.

And the we-need-Gov't-regulation-because-the-'free market'-system-had-its-chance-and-blew-it crowd needs to Google 'free market.' If we had a free market system, big Pharma, doctors, hospitals and insurers would be competing with each other by looking for ways to provide goods and services at a reduced cost, or providing improved goods and services at the same cost. They don't do that. Why? Because it costs money to develop better or cheaper goods and services, and the potential return on investment is much greater for producers and providers to simply lobby congress for change in legislation that might provide them a market advantage.

This is the very definition of a regulated, not a free market, and it leads to all kinds of bad things, not the least of which is corrupt politicians pandering to those with the most cash. BTW, you pay for those lobbying costs every time you visit your doctor or the pharmacy.

Also BTW, the same is (mostly) true for our financial markets. Every time someone loses money we demand laws to 'protect' us. Who gets protected by the law? Why those with the most cash. Can you say TARP? Be careful what you wish for.

We haven't had a true free market system in the US in quite some time...

Posted by: Knockgoats | August 13, 2009 12:21 PM

So, Walton, how do you explain that the USA, with its largely private system, spends a far larger proportion of its GDP on health care than any other rich country, for outcomes that are at best, relatively poor in terms of life expectancy and infant mortality? Bear in mind also that medical costs are the leading cause of personal bankruptcies in the USA.

Posted by: Matt Penfold | August 13, 2009 12:23 PM

Mark,

So basically you are admitting although other countries have forms of socialised healthcare that are both affordable and provide good care, no one in the US is capable of doing so. You have a very low opinion of you fellow countrymen.

Posted by: Matt Penfold | August 13, 2009 12:27 PM

Knockgoats, I refer you to Mark's post at #138 above, which is spot on, and far more eloquent and informed than anything I could have written on the subject.

Mark's post is so full of holes it is pathetic.

A good part of the reason Medicaid and the like cost so much in the US is because private healthcare costs so much.

I note you also share Mark's view that Americans are too stupid to run a socialised healthcare system.

Posted by: Tasha | August 13, 2009 12:30 PM

Matt,

I stand corrected. My recollection was that it was illegal (we moved to the US 5 years ago). I just googled it and discovered that while private practice is technically not illegal, the reality is that there was a large disincentive to privately practice, and that some aspects were illegal, at least at the time I lived there (ie extra billing in some provinces)

But I stand by everything else I wrote...having experienced Medicare (for my pregnancy) here and socialized medicine in Canada, the state where I live now does "low cost care" better than Canada (where low cost IS standard care). Maybe because there is more choice here? I don't pretend to know why...but I'm glad that we have choices here. I'd like more choice actually...giving anyone a monopoly on healthcare (even the government) is not a good idea, IMHO.

Posted by: Matt Penfold | August 13, 2009 12:31 PM

I'd just like to say I love the post office. Show me a private company that will deliver an object thousands of miles in two days for pocket change, I Dare You. Show me a private company that delivers anywhere in the US for the same flat rate - I Dare You.

The Post Office beats UPS, hands down.

I would just add that here in the UK the Royal Mail has never had any problems finding my house. The same cannot be said of courier companies, more than one of which has failed to deliver because they claimed they could not work out where I lived.

Posted by: Walton | August 13, 2009 12:35 PM

But I stand by everything else I wrote...having experienced Medicare (for my pregnancy) here

Don't you mean Medicaid? I'm not American, but I thought Medicare was only available to those over 65.

Posted by: PVA | August 13, 2009 12:37 PM

someone asked if americans know nothing about how health care is provided in other countries. i think the answer to that is obvious but let me share an anecdote that shows how clueless americans can be about the rest of the world.

i was filling my car at a station in Canada along with another american family. the gent was absolutely furious because he couldn't figure out what he was paying for the petrol. he exclaimed "I don't understand why they have to use the metric system, NO ONE ELSE DOES." (emphasis mine)

i despair of my country.

Posted by: Mark | August 13, 2009 12:39 PM

The USPS is an example of a well-run Gov't program? Ooookay, if you say so...

http://www.businessweek.com/bwdaily/dnflash/content/aug2009/db2009087_477965.htm

Posted by: Matt Penfold | August 13, 2009 12:42 PM

Mark,

How much does it cost to send a letter in the US ?

How many courier companies will deliver anywhere within the US for the same price ?

Simple questions. Can you answer them ?

Posted by: Matt Penfold | August 13, 2009 12:46 PM

Exactly. I'm an external observer with no investment (financial or emotional) in the issue, and nothing to gain or lose either way, so I can look at the facts coldly and rationally. Isn't that a good thing?

Walton,

You are on record as admitting you freeload. You do not think you should have to pay taxes towards healthcare, but you refuse to stop using the NHS. You also refuse to pay for the full cost of your education, relying on the taxpayer to subsidize you. Yet you would seek to deny such an education to those who cannot afford it because being the selfish arsehole you are, you do not see why you should have to pay for other people's education. You are quite willing to take, but would refuse to give were you given half a chance.

Posted by: Hypatia's Daughter | August 13, 2009 12:47 PM

I was born & gave birth to my 3 kids in Canada; moved to the US when I was 43.
My 81 yr old mother, who lives in Ontario, went on full time dialysis last year, paid for By OHIP.
My husband has excellent health insurance through his work. (They are a European company & I suspect they wanted their American workers to have the same level of care as their European counterparts.)
I sliced open my finger on a powersaw last year and went to the ER for 8 stitches. A month later I got a bill for $750 from the ER physician. Our insurance paid half. I got dunning letters for the other half from the ER doctor, who handed it over to a collection agency after 3 letters. Apparently, the ER doctors had opted out of taking insurance several months previous. Our insurance SHOULD have paid it all, but their records kept insisting he had been fully paid because they did not realize he was on out-of service physician. I paid it and we are still waiting to be reimbursed.
Then we got a letter last Dec telling us, due to a breakdown in negotiations between our insurer and the local hospital group, we might no longer be able to get our visits (except emergencies) covered. Our local hospital is 1 mile away - the closest in-group hospital is over 35 miles away............ fortunately, it was resolved.
When my daughter lived in the US (she now lives in Canada & works for OHIP), she could not find a physician within 40 miles of her home/work place who would accept her insurance and was taking new patients. She finally had to go to an out-group dr and pay out of her own pocket.
I have a good friend who has been a diabetic since his teens. He has worked for small companies who would not put him on the company insurance plan because the costs would be too high - pre-existing condition.
Another friend, who is self-employed, pays over $1,500/month for insurance because his wife had a mild heart attack seven years ago - pre-existing condition.
#54 midwifetoad
It is great that the hospital consolidated your debt and gave you easy payments. However, don't get sick again. If you have a stroke, cancer,heart disease - you will be in debt until you die. I have a neighbour who had an aneurysm several years ago. She had insurance which covered 90% of her treatment. Sounds good, but her 10% was over $93,000. She had another one last year.

Posted by: Matt Penfold | August 13, 2009 12:48 PM

Sorry, its extremely reasonable to be skeptical of the US Federal Government's capacity to fuck up health care. Ample precedent exists. One doesnt have to be a raging bible thumping conservative to see the holes in the logic: "England does it, so it will work here too!".

Yea... right...

What is it with you people.

Do you really think America is such an incompetent country ? Only that is what you are admitting. Every other Western country manages some form of universal healthcare. Yet the US is unable to do so because there is no one in the US with the ability to manage such a system.

Posted by: DCP | August 13, 2009 12:49 PM

@152 - off-topic

it's anecdote time? ok, here we go:
I was once asked by an American whether Europe even has electricity.
Then, on an unrelated occassion, I was flatly told by a different American that "Germany doesn't have the Internet!"

The punchline? I was talking to both of them... over the Internet... while being in Germany.

Go USA!

Posted by: Lyle Raymond | August 13, 2009 12:51 PM

I think the health care debate is entirely a matter of political ideology, not objective reality. I must admit I was a bit offended that Mr. Meyers chose the wording "OUR health care opponents," since I am a rationalist and do not identify with the crowd supporting Obama's plan.

Posted by: Matt Penfold | August 13, 2009 12:51 PM

I have to ask Mark and Drj. IS the American military also incompetent ?

Posted by: Matt Penfold | August 13, 2009 12:55 PM

Matt@158, your questions are meaningless. Current USPS delivery charges are not enough -- they are in the red and begging congress for more money.

Ok, you refuse to answer. I rather though you would. They were such simple questions as well, but apparently beyond you.

Posted by: Scott from Oregon | August 13, 2009 12:57 PM

One never ceases to be amazed at the usefulness of well meaning fools.

National healthcare "debate" doesn't seem to include those who want collective health care BUT NOT BY USING A CENTRALIZED, UNCANNILY UNHEALTHY "stsate" to do it.

It never seems to get discussed during these "debates", but the entity y'all want to give massive amounts of money and power to is the SAME ENTITY that bombed the shit out of brown-skinned people these last forty years or so.

It is the same entity that amassed a huge fortune for those who were able to sidle up next to its power structure, and stole from the communities where you live and work.

It is the same entity that pollutes the globe and burns up worldly resources at an alarming rate SIMPLY TO SUPPORT THOSE who are able to sidle up to its power structure.

It is the same entity that lets in the corporate insiders through the back door, makes secret deals, and proudly proclaims out the front balcony to the ignorant (though useful) masses that the "state" is all about the welfare of "the people".

Good lord!

Something like 12 TRILLION gets heaped upon the taxpayer by the state in covered losses for the 1%ers, and y'all want to give them more power and control?

The mind cannot stop boggling...

Posted by: drj | August 13, 2009 12:59 PM

What is it with you people.

Do you really think America is such an incompetent country ? Only that is what you are admitting.

In a number of ways, yes. In all capacities, no, of course not. I am not saying we are ALL incompetent.

Every other Western country manages some form of universal healthcare. Yet the US is unable to do so because there is no one in the US with the ability to manage such a system.

Look no further than military medicine... of which my family has much experience.

Yes, there is ample evidence that social medicine can produce decent medical systems, in other countries, in other governments. However, there is also ample evidence to suggest that our government manages its current health programs with near incompetence, and in an unsustainable manner.

To not seriously consider the very real possibility that our government might actually make a bad situation worse, is criminally irresponsible and stupid.

Posted by: Matt Penfold | August 13, 2009 1:06 PM

In a number of ways, yes. In all capacities, no, of course not. I am not saying we are ALL incompetent.

You are saying that there is no American capable of running a universal healthcare scheme. This despite the fact every other Western country manages to do so. You clearly have a very low opinion of the ability of your fellow countrymen to manage.

How about taking a look at how other countries manage their schemes. Do you not think the US has anything to learn from other countries ? Why not get managers in from other countries to run the scheme for you, if no American is up to the job ? I know that might be a bit embarrassing, but then having European charities that provide healthcare to the third world seeing a need for their services in the US must be embarrassing as well.

Or will you have to admit that the US is so broken there is no solution possible ?

Posted by: Bobber | August 13, 2009 1:07 PM

Jose at #143: Well said, sir, well said.

Posted by: amphiox | August 13, 2009 1:08 PM

Tasha, all that means is that you were unlucky in Canada and lucky in the U.S with regards to the quality of the medical care you received. It is an anecdote and it means nothing with respect to the overall quality of either health care system.

What does mean something are verifiable outcome measures of quality, and in the case of pregnancy care, that would include things like infant and maternal mortality rates. These are better, significantly (for some measures by a factor approaching 2) in Canada than in the U.S, and even better in some European nations.

It is an ethical embarrassment that the United States, demonstrably capable of providing, in individual cases, the best medical care in the world (as evidenced by the fact that people are sent to the United States from other first world countries throughout the world to receive top quality specialized care not available in their home countries), and yet as population health outcome measures that struggle to stay on par with those of Cuba.

Posted by: Mark | August 13, 2009 1:12 PM

BlueIndependent@163, inflation was largely under control when Reagan took office in 1980 -- the congressional committee would only have had to look three years into the future to plan. Do you not think they included inflation in their estimates? If not, you merely bolster my argument of US Gov't incompetence.

Besides, many financial analyses have already shown actual costs far outstripped estimates even corrected for the unusually high inflation rates of the '70s -- the actuary who worked the original estimates for the committee even admits it.

Try not to put words in my mouth; you're not very good at it. I don't argue the current system is good. In fact, I pretty clearly stated I believe it to be bad and getting worse. I just don't agree with you that the Gov't can solve the problems.

Additionally, I never argued for a laissez faire free market system. I merely pointed out that blaming free market values for the current situation doesn't make sense because we don't, in fact, currently have a free market system.

Posted by: David Marjanović, OM | August 13, 2009 1:13 PM

There is something deeply wrong with politics when something as massive as this requires such haste.

"Haste"? It's overdue by a fucking century.

I'm not really buying the "optional" bit. Once we start down this road, the private insurers will be nationalized. Within a decade or two.

Then why the fuck has this still not happened in Germany?!?

You are making stuff up based on your ignorance.

Wars, hurricane preparedness & relief, schools, anti-terrorism, financial regulation... - just where were you between January 2001 & January 2009?

Is that "the federal government", or is it just the Busheviki?

What's with all the comments about how "right-wingers" are evil, corrupt people who cynically broadcast propaganda to their legions of brainwashed sheep-like followers? Some of you seem to think modern-day America is like a bad sci-fi movie.

Well, yes. :-|

Methinks you identify too much with the US right-wingers. I'm not sure on how many issues you'd really count as right-wing in the US. I mean, you're not as glaring a case as Schwarzenegger who believes he's a Republican just because he'd fit into Austria's conservative party*, but still...

* Death penalty excepted.

After all, we all want the same thing: a system which allows doctors, nurses, pharmacists, and researchers to operate to the best of their ability in delivering medical care to patients.

You want that; we want that; but the US health insurance industry, and its lobby in Congress, does not.

"England does it, so it will work here too!".

Everyone does it. Every country that isn't in the Third World. Except the USA.

Posted by: drj | August 13, 2009 1:16 PM

You are saying that there is no American capable of running a universal healthcare scheme. This despite the fact every other Western country manages to do so. You clearly have a very low opinion of the ability of your fellow countrymen to manage.

The needs and circumstances of the US are quite unique in regards to other western nations - both in size, and regarding the health needs of the citizens - Maybe its that good ol' Amurcan elitism speaking, but our medical program will have to be - by many orders of magnitude - the biggest most diverse social medical program in existence. These are not trivial points.

You say I must think we are all incompetent - quite frankly, I think I simply respect the magnitude of the task.

Posted by: Steve LaBonne | August 13, 2009 1:19 PM

Britain has the lowest cancer survival rate in Western Europe(much lower than the US)

Another bit of lying right-wing mythology (which you got straight out of the lying right-wing Brit media; in this case, the Torygraph which made a big to-do about it). "Survival rates" are completely meaningless. The US rate is severely skewed by our obsession for early screening of prostate cancer, which detects lots of small, slow-growing tumors for which no treatment is even indicated; this vastly inflates the number of "patients" who "survive". The meaningful numbers are MORTALITY rates from cancer. Guess what? The UK's is substantially LOWER than ours and one of the lowest in Europe. http://www.nationmaster.com/graph/hea_dea_fro_can-health-death-from-cancer

Posted by: Rev. BigDumbChimp | August 13, 2009 1:21 PM

I'm not really buying the "optional" bit. Once we start down this road, the private insurers will be nationalized. Within a decade or two.

Posted by: Mark | August 13, 2009 1:23 PM

Matt @ 176 says: "You are saying that there is no American capable of running a universal healthcare scheme. This despite the fact every other Western country manages to do so. You clearly have a very low opinion of the ability of your fellow countrymen to manage."

Again, you are very bad at speaking for me. I believe there are MANY Americans capable of running a universal healthcare scheme, I just don't believe any currently work for our Gov't.

I do believe we have much to learn from other countries, especially in regard to managing costs.

I don't have a low opinion of my countrymen to manage, just my Gov't. It has proven itself incompetent many times over.

Posted by: Steve LaBonne | August 13, 2009 1:24 PM

Maybe its that good ol' Amurcan elitism speaking

No, just good old American ovine ignorance and mental laziness. Britain, France and Germany are not exactly small, homogeneous, pastoral countries, you know. (Or perhaps you don't know.)

Posted by: Mena | August 13, 2009 1:28 PM

Does it look like there is a lot of astroturfing against health care going on to anyone else? I have spent large chunks of time in Saskatchewan (Tommy Douglas Land, where Keifer Sutherland's commie grandpa forced socialized medicine on the poor unsuspecting population) and I don't think that I have heard more complaining about the quality and cost of it there than I have here. Quite the opposite. Remember that Canada is still the place where old and infirm people have to send away to or visit so that they can afford medications that they need to live. Medications that were made here but are half the cost due to their government not allowing profiteering and gouging. Evuuulllll!

Posted by: Matt Penfold | August 13, 2009 1:31 PM

A

gain, you are very bad at speaking for me. I believe there are MANY Americans capable of running a universal healthcare scheme, I just don't believe any currently work for our Gov't.

I do believe we have much to learn from other countries, especially in regard to managing costs.

I don't have a low opinion of my countrymen to manage, just my Gov't. It has proven itself incompetent many times over.

It is not as though American business has always managed well either. Do you think those in charge of GM would do a better job ? Or how about those in charge of banks ?

Hmm, perhaps not.

Posted by: amphiox | August 13, 2009 1:33 PM

I trained and worked in the Canadian Health Care system. I am not aware of any cases where patients "died on the waiting list", wherein being on the waiting list had any substantial contribution to the subsequent death, relative to someone with the same condition who was not on any waiting list.

People in Canada who present acutely with serious life-threatening diagnoses get treated, IMMEDIATELY. They will always in fact bump in ahead of people on waiting lists for medical resources such as physician time, tests, surgeries, etc.

And unavailability of resources such as physicians, ICU beds, ORs also does not factor into it. People with serious life-threatening diagnoses who need immediate treatment that is unavailable in a timely fashion in Canada due to resource constraints get sent elsewhere, another Canadian province, or if necessary out of country, usually to the nearest U.S. hospital, as quickly as possible, and all bills are paid for by the Canadian government.

Waiting lists are primarily for non-urgent conditions, and quality of life procedures.

Cases you may hear with unfavorable outcomes and long waits are almost always secondary to one or more of the following factors:

1. Misdiagnosis - the serious condition was missed and the patient place on a waiting list on the presumption that they did not need urgent care. This kind of situation will occur regardless of the nature of the system.

2. Lack of diagnosis - the patient doesn't find a physician and doesn't present to acute care until the condition is very advanced and difficult or impossible to treat. But I fail to see any substantial difference in a case where a person cannot get in to see a physician because of a long waiting list and a case where a person cannot see a physician because of lack of insurance. If anything, the numbers show that this situation occurs more frequently in the U.S. than in countries with universal health systems.

3. Unexpected deterioration - a patient on a waiting list for a non-life threatening condition (say waiting for a knee replacement surgery) develops a serious, rare complication or deterioration. In most of these cases if the patient presents to acute care and is accurately diagnosed they will receive immediate treatment, but the diagnosis can be missed, or the complication particularly severe and rapid, or the patient may fail to recognize the urgency of the new symptoms, believing he has a non-urgent chronic condition. But again, this situation is not something that the specific nature of any health care system is going to have any impact on.

4. Distance - it does occur with some frequency in Canada that a patient develops a life-threatening condition in a remote location far away from the needed medical care, (often trauma, but things like stroke, heart attack etc also), and is physically unable to get to the medical facility in time. But this is the unavoidable reality of Canada's geography, with its huge expanses of sparsely populated territory, and is unrelated to anything the health care system can do, and is the same for remote areas of the U.S.

There are other factors of course, and just because I haven't personally experienced or heard of or read of cases doesn't mean they don't exist. But if you look at each individual case separately and analyze it, you will almost always find that the root cause of the unfavorable outcome had nothing at all to do with single-payer nature of the Canadian healthcare system, or the concept of universal access.

About the only legitimate scenario of dying on a waiting list, where the waiting list is the direct contributor to death are organ transplant waiting lists. The bottleneck here is available organs. The nature of the healthcare system has nothing to do with this.

Posted by: pdferguson | August 13, 2009 1:39 PM

walton wrote:

As long as people have the right to opt out and pay for private treatment, all the talk about "death panels" and "rationing" is nothing more than rhetoric.

No, that isn't rhetoric. It's a concerted effort to derail the discussion through outright lies, to ignite fear and panic among people unable to see it for what it is. It is inflammatory and irresponsible statements like Palin's that have lead to disruptions of town hall meetings, threats against elected officials, and more. It is exactly the same thing we saw in the general election after Palin attacked Obama for "palling around with terrorists." The threats against Obama went through the roof and the conversation about issues ground to a halt. That's not rhetoric, it's far more sinister and harmful. It's Orwellian in its danger. Words matter, and terms like "death panel" are as heavily loaded as a hunting rifle. If anyone needed more proof that Palin herself is a terrorist with lipstick, this was it.

Posted by: Matt Penfold | August 13, 2009 1:40 PM

About the only legitimate scenario of dying on a waiting list, where the waiting list is the direct contributor to death are organ transplant waiting lists. The bottleneck here is available organs. The nature of the healthcare system has nothing to do with this.

There is an example I have seen cited about the UK of a patient dying waiting for cardio-vascular surgery. On investigation it has turned out the surgeons were aware of the severity of the patient's condition but the patient continued to smoke, and had refused offers of assistance in quitting. The surgeons felt that in such circumstances there little point in proceeding with the operation since it would have brought minimal benefit to the patient but carried a significant mortality risk.

Posted by: dean | August 13, 2009 1:43 PM

Here is a set of interesting statistics - not exactly "waiting lists", but in that vein.

http://blogs.consumerreports.org/health/2009/08/amenable-mortality-us-health-care-system-versus-other-countries-.html

Some snips: the information deals with

"the concept of "amenable mortality." Invented years ago in the United States and used worldwide by researchers ever since, it’s basically a body count of people who die for want of "timely and effective health care." "

There is a brief list of some items that are considered.

"Back in the mid-1990s, two British researchers measured amenable mortality in 19 industrialized countries. At the time, the U.S. ranked 15th out of the 19 (above*)."

Then this:

"Last year, the same two researchers published an update, in the January-February, 2008 issue of the scholarly journal Health Affairs. (You need a subscription to access the full article but can read a good summary of it here.) Sadly, the U.S. had by this time fallen to last place (right*).
"We got better by 4 percent, but the other countries got better by 16 percent, and the United Kingdom just blew right by us," says Cathy Schoen, M.S., senior vice president for research and evaluationof the Commonwealth Fund, a non-profit health care research organization."

The two references to "right" refer to displays in the original article.

Posted by: Mark | August 13, 2009 1:44 PM

Matt, Matt, Matt... *sigh* Where did I say we should put GM's senior management or the banking system in charge of health care reform?

Please listen carefully, I'll type slowly: I simply don't think our Gov't has proven itself capable of managing anything as complex, diverse and dynamic as the entire US healthcare industry -- especially when there is so much money involved.

I argue before we turn over such a responsibility to our Gov't, let it prove itself capable by managing costs for the programs it already administers.

Posted by: Cliff Hendroval | August 13, 2009 1:47 PM

the government keeps the cost of healthcare down by artificially capping the number of graduates allowed from medical school

I'm not an economist - I don't even play one on TV, like Ben Stein - but isn't this exactly backwards? Wouldn't you keep the price down by flooding the market?

Posted by: Steve LaBonne | August 13, 2009 1:48 PM

I argue before we turn over such a responsibility to our Gov't, let it prove itself capable by managing costs for the programs it already administers.

Like the VA medical system, which provides quality care FAR MORE efficiently than the private system? Or Medicare, which provides health insurance FAR MORE efficiently than private insurers do?

FAIL.

Posted by: Gregory Greenwood | August 13, 2009 1:52 PM

I posted this comment on the "I think We Sucessfully Poked Him With a Sharp Stick" thread;

"This is off topic I know, but I am beginning to wonder if the religious right in America is actually allergic to the truth. I have been following, with increasing bewilderment, the coverage of the Right's demonisation of the NHS as part of their campaign against President Obama's health care reforms.

I would be the first to admit that the UK health care system has problems. These problems are not small. They are big, honking, fill-the-horizon problems. For example, our cancer care leaves a lot to be desired and the situation with MRSA and Clostridium Deficile in our hospitals is a travesty. However, describing the NHS as "Orwellian" seems a bit strong.

Claiming that if Edward Kennedy lived in the UK he would be allowed die untreated from a brain tumour is, at best, wrong and at worst an outright lie. There are no automatic age limits at which you no longer receive health care in the UK. Further claims that anyone in the UK over the age of 59 is ineligible for treatment for heart disease is another calumny. My mother is a sufferer of heart disease and she is 65. Last time I checked she was still receiving a full regimen of medication.

The misrepresentation of the role of the National Institute for Clinical Excellence (NICE) is equally gross. NICE examins the cost effectiveness of certain drugs, along with a wide variety of other roles, but it does not exist to put a monetary value on peoples' lives.

The fact is that the UK spends less per head on healthcare but has a higher life expectancy than the US. The World Health Organisation ranks Britain's healthcare 18th in the world, while the US comes in 37th place.

I respect the fact that health care, and its potential socialisation, are contentious and emotive issues in the USA, but it would be appreciated if Republicans could refrain from innaccurate and prejorative characterisations of the NHS in pursuit of their domestic political goals.

I'm just waiting for one of them to claim that the NHS and its problems are a judgement from god on a sinful (and predominantly secular) people . . ."

So, now they have claimed that Stephen Hawking would be dead if he lived in the UK. That being the same Stephen Hawking who is probably the single most famous British scientist for a hundred years? And who is notably not dead. Or at least seems to be doing really well for a dead man. At least they retracted the statement eventually, but to even make it in the first place . . .

Verily doth the stupid burn mine eyes. Unfortunately, I live in the UK so I am probably ineligible for treatment because NICE is, obviously, run by evil socialist pixies. At least that seems to be the prevailing opinion among the American religious right.

head/desk.

Posted by: Matt Penfold | August 13, 2009 1:54 PM

I argue before we turn over such a responsibility to our Gov't, let it prove itself capable by managing costs for the programs it already administers.

Ok, I get you point. Does it extend to the American military ? You going to insist they be brought home until such time as they can be shown to be managed properly ?

Posted by: SEF | August 13, 2009 1:57 PM

here in the UK the Royal Mail has never had any problems finding my house.

Whereas, I find them to be somewhat unreliable on that count. They tend to deliver other people's stuff to me and, occasionally, my stuff to other people. When it's just other houses in the same road it's not so bad, just tedious. When it's unknown people in quite far distant locations (by UK standards!), it's more of a problem.

Posted by: Matt Penfold | August 13, 2009 1:59 PM

Your "clear inference" is beginning to sound a lot like the "You must hate America!" style rhetoric.

If it makes you feel better - I have doubts that any American, Frenchman, Englishman, Canadian, German, et al could successfully manage a functional socialized medical program in America.

So you now think the US is a failing state ? Only if it cannot provide healthcare to all of its citizens it can hardly be considered a developed country can it ?

You really do have a poor opinion of you country. It must be embarrassing for you to have to admit that the US is screwed.

Posted by: Damian | August 13, 2009 2:03 PM

No, Kate, the link that Steve Labonne provided refers to mortality rates, and the UK beats the USA by 70 people per 100,000. In other words, 70 more people die of cancer in the US per 100,000 than in the UK.

To be fair, that suffers from exactly the same problems as the link that you provided. It doesn't discuss the possible reasons, which are not always linked to poor care.

But that is why the link that you provided is so dishonest. It's more than 10 years old — and much has been done in the intervening period, including a new party in office that pumped a lot more money in the NHS — and there is no discussion of possible reasons, which is crucial, as it's not always linked to the quality of care.

Otherwise, rich people would never die early from cancer.

Posted by: Knockgoats | August 13, 2009 2:06 PM

It's not just the U.S. stats that Britain trails in:

http://www.telegraph.co.uk/news/uknews/1560849/UK-cancer-survival-rate-lowest-in-Europe.html - Kate

As has already been noted, survival rates don't tell you everything. The UK has a lower death rate from cancer than the US, or most European countries - see #188 and the link therefrom. Survival is measured from time of diagnosis - but that will mean you get higher survival rates if you diagnose earlier, even if this makes no difference to whether or when you die of the cancer. There may also, of course, be differences in the incidence of different cancers.

Can you honestly say that they don't ration care and have waiting lists in Britain? - Kate

Of course there's rationing - demand for healthcare seems to be more or less unlimited - but it is (at least in intention) rationing by clinical need, not by how much you can afford, so far as the NHS is concerned. Your link about the Swiss system doesn't go to WHO, do you have one to there? Your link does say Switzerland pays 11.6% of its GDP for health care, more than any other country but the USA (15.3%). The UK spends about 7.5% IIRC - and that's up quite a bit over the past decade. That's the biggest problem with the NHS - we just don't spend enough. The second biggest is the series of "market" reforms pushed through by successive governments, which have meant that much of the extra spending has gone into wasteful paper-pushing and target-chasing. However, waiting lists have come down enormously in the past few years - and you will get life-saving treatment fast.

Posted by: Matt Penfold | August 13, 2009 2:09 PM

Every time I hear politicians talk about prevention it scares me.

So policies aimed at reducing obesity, excessive alcohol consumption, tobacco use scare you ? How about encouraging people to wear seat-belts ? Does that scare you as well ?

Posted by: edivimo | August 13, 2009 2:12 PM

You know, I live in Costa Rica [CRI], a country in Central America of merely 4 million inhabitants with a "socialist" health-care system with the acronym CCSS (Caja Costarricense del Seguro Social). So if we compare rankings of health-care system between Costa Rica and USA:

Health-care ranking (index) --> [USA]36 (CRI)37
Healthy life expectancy (years) --> [USA]70.0 [CRI]66.7

Fairness in financial contribution (%) --> [USA]54-55 [CRI]64-65
Health expenditure per capita ($) --> [USA]6096 [CRI]592
Total Health Expenditures (%GDP) --> [USA]15.2 [CRI]7.1

Health Performance Rank (index) --> [USA]72 [CRI]25

So, we manage to expend less money, we're more fair and we're almost equal in the ranks (except life expectancy), implying a better health performance... something is wrong with the healt-care in USA.

Source: http://www.photius.com/rankings/healthranks.html
The Health expenditure per capita ($): http://hdrstats.undp.org/indicators/52.html

Posted by: Steve LaBonne | August 13, 2009 2:17 PM

It's astonishing how the poor middle and lower class citizens can always be counted upon to vote against their own best interests- usually out of fear and ignorance.

Don't forget racism. "I'm not paying for care for "those" people!"

Posted by: Walton | August 13, 2009 2:17 PM

Methinks you identify too much with the US right-wingers. I'm not sure on how many issues you'd really count as right-wing in the US. I mean, you're not as glaring a case as Schwarzenegger who believes he's a Republican just because he'd fit into Austria's conservative party*, but still...

Maybe true. My positions on social issues have become more liberal over time, and I would describe myself as pro-choice, pro-gay rights, pro-science, pro-drug legalisation, and pro-secular education. The less enlightened corners of the American right, such as those who frequent Conservapedia, would certainly label me a liberal. Nevertheless, my positions on taxation and the economy position me firmly on the right, even in the US political spectrum, when it comes to fiscal and economic issues.

Posted by: Steve LaBonne | August 13, 2009 2:22 PM

Google Britain Cancer Survival rates, almost all show lower ones than most Western countries.

Yet one more time, "survival" rates are nearly MEANINGLESS because philosophies on cancer screening and diagnosis differ greatly among countries. Rates of cancer incidence and mortality are both lower in the UK than in the US. And you are still an idiot.

Posted by: Mark | August 13, 2009 2:23 PM

MrFire @ 207 said: "So there could be a goverment capable of doing it, like in other countries, just not now?"

No, obviously there are other countries doing things better than us -- at least according to the criteria many are using for comparison.

MrFire said: "Or is America somehow incapable of ever having a government that can pull it off? From your use of "currently", I'm assuming the former."

No, I don't believe that. I believe other countries have hit on a formula that allows them to keep costs under control much more effectively than us. We need to study how they've done so and emulate.

To do so, however, would mean a committment to eschew our current legislative system of lobbyist influenced regulation. As long as lobbyists can manipulate the market by purchasing adventageous legislation, we will never control costs.

BTW, those who are saying Big Pharma and private insurance companies are behind the efforts to fight President Obama's reform effort are wrong. The Wall Street Journal reports the majority of health insurance companies "are still mostly on board with the president's effort to overhaul the U.S. health-care system." And the New York Times reports "The drug industry has already contributed millions of dollars to advertising campaigns for the health care overhaul through the advocacy groups like Healthy Economies Now and Families USA. It has spent about $1 million on similar advertisements under its own name."

Why, you ask? Simple, because they stand to gain a tremendous number of new customers. Insurance companies are especially happy because many of those new customers will be young and healthy people who currently opt out of insurance because... wait for it... they are young and healthy and don't need it!

MrFire said: "I'm also guessing you think that the same goverment branch would be more efficient if it were running privately."

Not necessarily. Again, it comes down to the way we govern ourselves. If a private company sees a way to take advantage of the legislature through graft, it will. They are, after all, in business to make money. As long as our market system makes it more worth their while to lobby congress than to improve their products and services, there gonna lobby. You gotta do what you gotta do to stay in business.

MrFire said: "I'm not trying to bait you here, I'm honestly trying to understand your point."

No offense taken, I hope I've cleared it up for you.

, no offense taken.

Posted by: edivimo | August 13, 2009 2:28 PM

"Everyone does it. Every country that isn't in the Third World. Except the USA."

¡My country (Costa Rica) is in the third world and does it too!

Repeating myself: something is wrong with the healt-care in USA.

Posted by: Matt Penfold | August 13, 2009 2:31 PM

No, obviously there are other countries doing things better than us -- at least according to the criteria many are using for comparison.

Criteria like paying less and getting more ?

Tell me, if the market is so effective, how come costs in the US are higher than in Europe and outcomes either much the same or worse ? Does that not indicate that the free market in healthcare in the US is not working very well ? And yet that is what you prefer to stick with ?

Posted by: Kate | August 13, 2009 2:35 PM

YOU say cancer survival rates are useless because they do not support your agenda! Calling me an idiot does nothing to support your assertions(I have an iq of 137). Media outlets all over Europe and North America do not seem to think they are useless.

Again, what proof do you have that Britain has a faster and more efficient system than Switzerland? If you think that you have more options and quicker care in Britain you are an idiot! If you had all the money in the world, would you rather be treated by the NHS or in the US with priivate care? If you think that you'd have faster treatment and more options under the NHS, you are an idiot!

Posted by: Steve LaBonne | August 13, 2009 2:38 PM

YOU say cancer survival rates are useless because they do not support your agenda!

No, I say it because it's known to be true. I already explained exactly why @ 188. Go read it. Idiot.

Posted by: Matt Penfold | August 13, 2009 2:40 PM

YOU say cancer survival rates are useless because they do not support your agenda! Calling me an idiot does nothing to support your assertions(I have an iq of 137). Media outlets all over Europe and North America do not seem to think they are useless.

Oh right, because media outlets know so much more about healthcare than the professionals in oncology and health statistics.

I suggest you have your IQ re-tested. There may have been a mistake on your previous test.

Posted by: Matt Penfold | August 13, 2009 2:43 PM

Kate,

I note you have not offered an explanation as to why the US healthcare system fares worse than the NHS in cancer prevention.

Posted by: Kate | August 13, 2009 2:46 PM

Can people on here not read the word Switzerland? I asked for proof that the NHS offers faster care and more patient choice than Britain. The WHO states that the Swiss have the timeliest care in Europe, as it says in my previous link! The rankings do not reflect quality, but health in general. Infant Mortality and Life Expectancy can be affected by many factors. In the U.S. for example, we have a high infant mortality among certain demographics because of poverty, obesity, and lack of education. If these stats are removed from the population, the rate goes way down. What I am refering to is quality and timeliness, not equal access. The U.S. has the best quality and quickest care for those who can afford it. Britain has equal access and cheaper care. Switzerland has the best of both worlds. Why do people on here keep attacking the US system, when I am advocating a Swiss model?!

Posted by: Steve LaBonne | August 13, 2009 2:48 PM

Depends on what you mean by 'quality care.' Have you ever visited a VA hospital?

You really are so stupid that you judge quality of care by hospital decor? (Although the big VA hospital in Cleveland is in fact undergoing a major and very impressive renovation, so visiting it will produce quite a different impression than you imagine.) Many NHS hospitals in the UK don't resemble 5-star hotels either, I'm told. Yet in both cases, the thing that matters- treating patients successfully- IS happening. http://www.washingtonmonthly.com/features/2005/0501.longman.html

Posted by: Bernard Bumner | August 13, 2009 2:52 PM

Britain has equal access and cheaper care. Switzerland has the best of both worlds. Why do people on here keep attacking the US system, when I am advocating a Swiss model?!

To be fair, many people are attacking your erroneous statements about the NHS.

However, people are attacking the US system, because you keep asking about it.

Also, you keep asking for us to prove something about the UK versus the Swiss system, but your link only provided lmited information on the economics of the system. What do you actually know about the quality of Swiss healthcare?

Posted by: Matt Bowman | August 13, 2009 2:53 PM

Matt Penfold @226 thanks for your smart ass comment in reference to my comment @223. No I'm not afraid of policies that reduce unhealthy behavior. I'm in favor of affordable policies and programs. About 2/3 of Americans are obese or overweight. So my point was that we need to make behavioral changes a major part of the effort to solve our health care problem, not just tests and screenings and then treatment, without any thought to why we are experiencing such high rates of disease in the first place.

I think you've said you're a Brit so you should know something about this—you can't solve dental problems with visits to the dental office alone. You have to brush your teeth and floss too. Right? How are you guys doing with your dental care nowadays? Better?

Posted by: Gregory Greenwood | August 13, 2009 2:54 PM

Kate;

"If you think that you have more options and quicker care in Britain you are an idiot! If you had all the money in the world, would you rather be treated by the NHS or in the US with private care? If you think that you'd have faster treatment and more options under the NHS, you are an idiot!"

You are comparing the NHS, that provides care free at the point of need to anyone no matter how little personal finance they may have, to American private care that, since it is private care, may well provide more comprehensive care and possess greater resources but on the downside is far too expensive for many poorer Americans to afford.

Imagine you did not have much money. Imagine if you were one of the millions of Americans with no health insurance and no chance of affording private care. In such a circumstance, would you not be glad of a system such as the NHS that provides all essential care irrespective of personal wealth?

Posted by: Kate | August 13, 2009 2:58 PM

I'll pit Dartmouth Hitchock up against an NHS hospital anyday!

Posted by: Karey | August 13, 2009 2:58 PM

Of course HMO's are happy with Obama's reform plan. The plan is doing nothing ot actually control costs. If it were going to bring costs down they'd be very against it, but as it stands its going to do nothing but cost us all more, and yes the HMO's will get more customers and get to keep charging everybody exorbitant rates, its a win for them.

Fact is nothing but a real single payer will control the costs. The only shot in hell we had of controlling costs while keeping the private system was if the national system provided competition to the private system, but the blue dogs had that part of the bill taken out, saying the national system had "an unfair advantage" over the private system with its ability to produce cheaper care. WTF, isn't that what we're f*cking trying to do here? Produce cheaper health care of equal quality? but no, thats "unfair".

Posted by: Matt Penfold | August 13, 2009 3:01 PM

Matt Penfold @226 thanks for your smart ass comment in reference to my comment

What was smart-arse about it ? You stated that talk of prevention scares you. Since all those things I mentioned would be part of any decent prevention program it follows that you are scared by such things.

Of course that may not have been what you meant to say. However it is not my fault you cannot express yourself clearly. Do not take your frustration at being inarticulate out on me.

So my point was that we need to make behavioral changes a major part of the effort to solve our health care problem, not just tests and screenings and then treatment, without any thought to why we are experiencing such high rates of disease in the first place.

That is NOT what you said. Again, if you do not say what you mean, do not blame us. However if you think things like routine blood pressure testing is a waste of time, make your case.

You are on record as opposing policies to reduce obesity etc., so you also seem to be contradicting yourself here.

Posted by: Kate | August 13, 2009 3:05 PM

Gregory,
I agree that there is more access when it comes to the NHS. That is why I support a Swiss model. Everyone is covered. People choose from private plans. No one pays more than 10% of their income, and poor people pay nothing. They have the timeliest care in Europe and the most patient choice.

Posted by: Steve LaBonne | August 13, 2009 3:11 PM

They have the timeliest care in Europe and the most patient choice.

And the highest costs.

Posted by: Steve LaBonne | August 13, 2009 3:16 PM

Karey, I don't like what's happening either- and was furious that single payer was ruled off the table from the outset- but I won't give up as long as there's a chance of passing something which is at least an incremental improvement and can be further improved later.On the other hand, I'm the first to agree that if what comes out is anything like the Senate Finance Committee bill is shaping up to be, it should be killed (as House Progressives have vowed to do- they better stick to their guns.)

Posted by: MrFire | August 13, 2009 3:22 PM

Matt @236:

Thanks for the elaborating on those questions; I think some of the points you make there are reasonable even if I have strong differences of opinion with you.

However, at least part of what you say at #247 is not reasonable:

And did you get the part about the $36 TRILLION deficit? 36 TRILLION! Our Gov't is only a bit less than $2 trillion over budget this year. Imagine if they included those unfunded Medicare mandates in the total...

I raised an objection to this in #175 using harsher language than I perhaps should have. It is COMPLETELY MISLEADING if not MADE UP.

Posted by: Rachel | August 13, 2009 3:28 PM

I am a US citizen working in health care in Canada. I have previously worked in hospitals in Virginia and Texas. I, too, have been sickened by the outright lies and fearmongering taking place in the US. I saw more people denied coverage in the States than I have in Canada (even people with insurance). Want to talk about rationing and ration boards? What are insurance companies?

Posted by: Steve LaBonne | August 13, 2009 3:29 PM

All the crap that Obama has been trying to push through has long been on offer all over the place. Sweden, Canada, Germany, Britain, France - you name it. So, given that immigration isn't too difficult, why don't the people who want this stuff just move?

Oh, right, it's just that fucking easy. Why don't you just put a gun to your useless head and pull the trigger?

Posted by: Mariana | August 13, 2009 3:32 PM

For what it's worth, I live in Brazil, and we do have government funded health care here. In theory, it's universal health care. In practice it does not work very well (it simply cannot handle the demand).
So what happens is that anyone who can afford private insurance has it. The difference between the US system and ours, is that a) private insurance is affordable by the lower middle classes and up (I know, it's not right, but it's an improvement compared to 15, 20 years ago), and b) private insurance is heavily regulated. You cannot be refused by an insurance company. What they can do is establish a "grace period" for your pre-existing conditions. And if they don't do that when you sign the contract, they can't later refuse coverage by citing something as a pre-existing condition, because a judge will just say "not specified in the contract, tough luck, you must cover it".

So, in sum, it's not a fantastic system, but I think we're in a better situation here, in general, than people in the US. I'm considering sending my teenage daughter abroad in an exchange program to an English-speaking country, but I've ruled out the US because even if I could afford health insurance for her while she's there, there's no guarantee that she'll be get medical care if she needs it, since it seems they can refuse it on any grounds they want. Maybe I'm misinformed, but that's the impression I get from the outside.

I guess what I'm saying is that people in the US might not be aware that people in a developing country like Brazil look at your health care system and think it's scary.

Posted by: Andrew Dennis | August 13, 2009 3:36 PM

Alex at 104, thanks for the info: I shall look up the technology with interest.

For the rest of you, my fiancee is now rehearsing with the other singers in her group, the little fella is sitting in, and occasionally banging his drum, oblivious to his moment of internet fame.

Posted by: MrFire | August 13, 2009 3:45 PM

Bad, bad day to advocate stupid ideas about socialized healthcare when I'm knocking around.

Why? Because I'll have to wade through 4 paragraphs of your insipid, unsubstantiated wanking?

What hubris.

Posted by: Karey | August 13, 2009 3:46 PM

A public option that doesn't compete at all with private options is a dead public option. It was the whole point of creating a public option and its gone. The republicans have already won and letting this bill pass just plays into their hands, making everyone buy in to the exorbitant rates the private system gets to charge us.

Posted by: Tom | August 13, 2009 4:06 PM

Perhaps I'm naive and stupid, but I'm finding it hard to see how dying on a waiting list for an oversubscribed public service is somehow worse than dying without there even being a public service to apply for, or how careful rationing of scarce things like that service in order to at least try to ensure fairness and equality would be a bad idea. Maybe if I were sufficiently wealthy to actually be able to pay for private healthcare and still have enough left over to live on afterwards, it would give me a different perspective.

Posted by: Ed Courtenay | August 13, 2009 4:07 PM

My mother was diagnosed with a brain tumour (Meningioma) in 1989; within a week the tumour itself had been removed by one of the top brain surgeons in Europe at the time.

On the NHS.

For free.

Twenty years later, she's still with us. She's had numerous operations on her face to help correct the partial paralysis that was caused by the removal of the meningioma. She has also had a completely unconnected condition dealt with - a full hip replacement - earlier this year.

For free.

On the NHS.

My daughter was born with a squint in her left eye, which was operated on (and corrected successfully) earlier this year.

For free.

On the NHS.

If you have a medical need, in 99.9% of cases the system works.

Posted by: Steve LaBonne | August 13, 2009 4:18 PM

Just a minor correction: If you're ABLE to pay for it, you have the best care in the world.

Not even that much is true. "Quality. In a comparison with five other countries, the Commonwealth Fund ranked the United States first in providing the “right care” for a given condition as defined by standard clinical guidelines and gave it especially high marks for preventive care, like Pap smears and mammograms to detect early-stage cancers, and blood tests and cholesterol checks for hypertensive patients. But we scored poorly in coordinating the care of chronically ill patients, in protecting the safety of patients, and in meeting their needs and preferences, which drove our overall quality rating down to last place. American doctors and hospitals kill patients through surgical and medical mistakes more often than their counterparts in other industrialized nations."
http://www.nytimes.com/2007/08/12/opinion/12sun1.html

Posted by: DCP | August 13, 2009 4:19 PM

All the crap that Obama has been trying to push through has long been on offer all over the place. Sweden, Canada, Germany, Britain, France - you name it. So, given that immigration isn't too difficult, why don't the people who want this stuff just move?

Of course! It's fucking easy to immigrate to foreign nations if you are poor and uneducated! Which is exactly what countries like Sweden, Canada, Germany, Britain and France want, right?

Posted by: JeffreyD | August 13, 2009 4:34 PM

Walton, I am with Patricia at #169, I believe you would benefit from counseling. No joke, not an insult, just seek out someone for a little discussion on your issues. Offer still on for a drink, but afraid you need much more personal contact and on an ongoing basis.

Ciao

Posted by: Gregory Greenwood | August 13, 2009 4:49 PM

Kate;

Would you mind expl;aining the Swiss system to me in greater detail? I do not know much about Swiss healthcare, but from what you say it sounds like a hybrid system that makes use of insurance paired with some kind of government support. Would this be a fair assessment?

Posted by: B.T. Murtagh | August 13, 2009 4:58 PM

Andrew Dennis at #87,

May I please quote your entire post, with attribution, on my own blog and in correspondence with some healthcare opponents? Pretty please?

Posted by: Canuck | August 13, 2009 4:58 PM

Patricia,
I've heard a bit of Rush on the interwebs. He's so impossibly crazy that I just don't know why anyone bothers to listen to him, much less believe the garbage that comes out of his mouth.

I recall reading somewhere recently that there has been some research done that indicates that people who are hard right wing are, in general, more fearful than those on the left. And it appears to be something in the brian development. If that's true then it's not at all peculiar that Rush and his devotees are the way they are. They are afraid, and they likely construct boogymen because they need them.

Come to think of it, the US has done that as a nation for the last century or more. There always needs to be a vilified "other" against whom y'all do battle (with "battle" having a wide latitude; military, economic, etc.). Follow a timeline back and see if you can find anything other than a very short gap in the presence of some foreign deamon.

Posted by: amsp | August 13, 2009 5:05 PM

I live in Sweden, a country with free health care, and I have to say that the US system based on insurance not only seems like total lunacy but bordering on barbaric. The insurance companies must be laughing their asses off seeing people not lamenting outrageous medical costs, but actually opposing this reform! I guess that fat lobbying budget was a good idea after all.. jeeesh O-O

Posted by: Atros | August 13, 2009 5:11 PM

Got into an argument with a staunch republican on this subject today, and he claimed that Germany and Sweden are going broke due to their socialized health care systems, and were looking to get out from under them. No sources cited, but can anybody here give an up or down on this, and maybe where this came from?

Posted by: Walton | August 13, 2009 5:15 PM

Atros @#304: I believe Swedish governments in recent years have had to reduce taxes and slim down the amount of government spending (which had become ridiculous; at one point the Swedish government controlled 60% of the economy, IIRC). But that's not primarily caused by healthcare costs, as far as I know. "Going broke" is a bit of an exaggeration.

Posted by: Chris | August 13, 2009 5:22 PM

* ie unwanted by the only-in-it-for-the-money US private insurance system, hospitals and **administrative** staff.

Fixed.

Also: as Islander said in 289, able to pay is more important than willing to pay. I've had patients ask me exactly how much the test that's going to diagnose their heart ailment will cost($500), then grumble about it, then get into their brand-spanking-new Aston Martin DB9. Mostly, those who are *able* to pay, are the least *willing* to pay, at least in SoCal.

Posted by: Heidi | August 13, 2009 5:44 PM

@Cimourdain: Are you really as evil as your posts indicate? You sound like Ebenezer Scrooge saying that the poor should get on with dying and decrease the surplus population.

If "socialized" healthcare is so bad, then why doesn't anyone who has it want to trade "up" to the US system? You know, the one where I waited at the ER with my daughter last year for 6 hours before being seen? She had been bitten by her cat and had developed a raging infection that required IV antibiotics. Six hours after we got to the ER. Go USA! (This was in a city of ~20K people in central Massachusetts, in case that is important to anyone's demographics.)

Posted by: DCP | August 13, 2009 5:45 PM

Got into an argument with a staunch republican on this subject today, and he claimed that Germany and Sweden are going broke due to their socialized health care systems, and were looking to get out from under them. No sources cited, but can anybody here give an up or down on this, and maybe where this came from?

Going broke? If the system couldn't adapt to the current situation, then yes, at least in the long run. Wanting to get out from under them? Hell, no!

Let's take a quick and a bit simplified look a the German situation: Due to low birthrates the ration of young people to old people is not very good.
That basically means that fewer young people have to pay for the health care of a lot more old people than a few generations before.
This means that the insurances cannot sustain the same level of coverage like before. Therefore some changes were introduced in the last years.

While every essential thing(blood-pressure pills etc.) is still completely covered, unnecessary things (like aspirin) are not.
You also have to fork over a copayment of 10€ once a quarter year if you go to see a doctor. Furthermore if you stay at a hospital you have to pay for up to three weeks (or so) 10€/day. After that time period it's totally free.
Other than that public insurances still tend to cover things like gym fees if you are too fat (because that's way cheaper than treating you for fat-related diseases later on.).

Well that's everything that comes to my mind right now.

Posted by: Alan Kellogg | August 13, 2009 6:04 PM

gaypaganunitarianagnostic, #311

But with insurance your premiums go to pay for people who can't afford medical care. That's thing, you can get medical care should you need it regardless of ability to pay. Others will be found to cover the expense of treating you. Insurance, public and private, is a formalization of this practice.

Posted by: Mark | August 13, 2009 6:21 PM

Anri @ 241, no, we'll put YOU in charge of writing them until 2012, when President Obama's plan is to go into effect.

Posted by: Andreas | August 13, 2009 6:36 PM

Socialized health care will of course lead to higher taxes but this extra burden is surely less than insurence premiums.

Posted by: amsp | August 13, 2009 6:45 PM

Alan Kellogg @ 315: So you're saying that you have more faith in an insurance corporation who's sole interest is profit to judge IF you are entitled to health care when you need it, than a democratically elected government who has nothing to gain from denying it's population medical care?? I've had enough experience with insurance companies when it comes to stupid material things to know that no way in hell would I be comfortable letting them handle something like my medical care thank you very much. The thing is maybe we pay a little more in taxes than you guys but at least we are never denied treatment, being bankrupted for having surgery, or have to rationalize if going to the doctor or buying that medicine is REALLY necessary just because we're tight on cash at the moment. I don't know about you, but I sleep better at night this way. Like some lady from Brazil said in an earlier post, if developing countries think the US medical system is scary it might a good idea to reevaluate things, just a thought.

Posted by: BlueIndependent | August 13, 2009 6:49 PM

The conservative fear-mongering on what a single payer system in the US would look like are based on 30 year old caricatures. There are two major problems with how conservatives cast the proposals for health care reform in the US:

1) Their descriptions of what they call "socialized medicine" are based on models that are nearly non-existent across the globe, and especially in countries rated higher than ours on health care.
2) Their assumptions of how well the US system works are based on the logical capitalist conlusions taken from soviet example decades ago.

The conservatives' conjuring of soviet imagery is essentially a total strawman formulation that no longer exists. Putting aside the fact that such an argument essentially proves their total lack of faith in the American system of government, such obtuse imagery cannot be found in any country whose health system is rated higher than ours. The UK is the only western country that has government doctors and hospitals, and even that is a very small portion of their current system. Canada, Japan, France, etc. do not have government-employed health care professionals. What most Western countries now have is a single payer system where the government provides the health plan for all citizens, paid for through taxes. Citizens then go seek care essentially the same way they do in the US. There are no bread line-style marches like the images of Soviet Russia conservatives like to conjur up as the justification to reject everything they don't expressly support.

The current facts do not support the conservative formulation of how bad proposed reforms would make things. The conservative framing, based on what is known about our system and that of our peer nations, is largely wrong. I can go to an urgent care clinic right now and not be admitted for a couple hours. Emergency rooms at hospitals are often packed with people waiting for an entire day to be seen for serious problems. I had to take my wife to one last year and had to wait an hour to get in. And in fact, a few years ago under Bush the conservative answer to the question of health care reform was that everyone technically already had insurance, and that they should just go to an emergency room. Such a "solution" is laughable because A) many who do go to emergency rooms for care of any sort are likely already unable to pay for coverage and end up in a lot of debt for even a few hours of care, or go bankrupt; and B) the same conservatives proposing emergency rooms as a good stop-gap are the same ones complaining that some people are stealing taxpayer funds that are spent on government-run insurance programs and are getting free care.

Our system needs to be reformed now. I have several individuals in health care in my family, and regardless of political stripe they came around - years ago no less - to the fact that our largely private system isn't working. To bolster the need for change, we know that companies like Cigna made choices on who to cover based on certain factors, the "murder by spreadsheet" that has amde the news. We know that families are denied care for their children. We know about the "pre-existing condition" clauses that many companies take in order to get out of paying for specific line items. I fell under such a clause once a few years ago when I was only a few months from a kidney stone event. The individual health insurance I purchased expressly said they wouldn't cover any future occurences for a 24 month period and priced the deductible so absurdly high that I would have to pay out of pocket if it ever happened again. Thankfully it didn't. And add all of this to the fact that so many of the drugs in the US cost so much more than they do in other countries. Seniors go bankrupt trying to pay for meds they need to live. And conservatives want to scream horror about "death panels"; how is pricing a drug at $1k/month for a senior *not* damn close to a "death panel".

The mostly privatized system is beginning to fall apart because it's more focused on profits than care. If they aren't going to provide health care, or if I have to wrestle them to the ground for my child for months to get them to do their job because I paid my money already, how can anyone honestly describe that as a system that "works"? It's certainly not the case that everyone has to wrestle to get them to pay all the time, but if they are doing it with a family with a child that needs medicine or a procedure, that's when I call foul. A child is not responsible for a birth defect or a "pre-existing condition", and should not be punished indirectly through their parents because they are born the way they are.

Health care is a right, not a privilege. It's time our thinking changes and advances, rather than reducing one more part of our humanity to a spreadsheet on an account's computer screen.

Posted by: Liveliest Crib | August 13, 2009 6:58 PM

Pierce R. Butler @ 313:

Lacking health insurance, I can't say this with certified certainty, but I self-diagnose my # 116 as a clear case of tongue-in-cheek.

My apologies. It's a Poe thing. Since I've heard true believing Busheviks tell me in all seriousness that Hurricane Katrina proves that government programs do not work, I often cannot tell when someone is kidding. ;)

I agree that there will be many problems with whatever plan manages to get through the House, the Senate, the conference committees and is finally signed by the president.

And yes, our D/R party duopoly is just awful. (I think the D actually stands for Dirt, and the R actually stands for Rubbish.) The Republican Party is essentially the Sociopathic Party, in the game just to win elections, and gain power. The elections and the power are the ends, not the means to the ends. And the Democrats? They're really just the Futile and Tenuous Coalition of Non-Sociopaths. So, it's difficult for anything to get done.

What we really need is electoral reform, but I won't derail the thread with that. :)

Posted by: DCP | August 13, 2009 7:29 PM

@ Mena

Yes, I'm still in Germany. As far as I know people will get the bill(s) and then forward these to their respective insurance companies, who then proceed to evaluate whether they cover the costs or not.

But please keep in mind that I'm by no means sure about that. I could tell you how it works if you got private insurance and are a Beamter (civil servant; somewhat of a special employment with the state. They, like judges and soldiers, get Beihilfe; which basically covers a lot of the copayments. It's kind of complicated.)

Nonetheless, I could ask around how it works if you're covered by public insurance. You would have to wait until tomorrow, though, 'cause it's about 1:30am local time.

Posted by: Mena | August 13, 2009 7:41 PM

DCP, I think that I wasn't very good at explaining myself. This is the US system that I'm talking about. It's a total mess for all sorts of reasons, including the fact that you never know how much anything costs until you get another bill long after the fact. It's usually something that looks like someone just pulled a bunch of random numbers out of thin air to see how much they can get away with.
Have a good night!

Posted by: Last Hussar | August 13, 2009 8:07 PM

[q]BlueIndependent@163, inflation was largely under control when Reagan took office in 1980 -- the congressional committee would only have had to look three years into the future to plan. Do you not think they included inflation in their estimates? If not, you merely bolster my argument of US Gov't incompetence.[/q] surely that is an arguement of Republican incompetence.

Cimourdain

Bad, bad day to advocate stupid ideas about socialized healthcare...

Well thats ok, because nobody is. They are repeatedly pointing out that the UK ranks 18th to the US 35th. And trying to explain why cancer survival rates are a false statistic if the intervention is unneeded.

Of course, now that you are an expert on health care ('my freinds father'- my dads an electrical engineer- is it genetic, or is it just a virus like you have?) you will be in a position to explain when all those private Doctors are going to pay back the costs of their training.

Did you not wonder why so many consultants still do NHS work when they earn so much more privately. BECAUSE THEY RELY ON THE NHS TO KEEP THEM UP TO DATE. By staying with the NHS for part of the time they get trained free, because thats what employers do. When they carry out private operations it is often using exactly the same theatre and staff as the public option would have done, with all that taxpayer funded training. Private payment is often just jumping the queue.

Where the private sector gets involved it is oftenjust the cherrypicked profitable ops. Oddly enough BUPA doesn't offer much in the way of insurance for long term schizophenia. And when it all goes wrong (hence unprofitable) it has already pointed out who picks up the expensive pieces.

Kate- Swiss system- which bit of 50% more (11% vs 7% of GDP) did you miss?

We can ignore Walton- he thinks Sky is unbiased. Clue- Proprietor Rupert Murdoch. Which other news network does he own?

Posted by: Andrew Dennis | August 13, 2009 8:52 PM

B. T. Murtagh @#298, be my guest.

Posted by: Alex Deam | August 13, 2009 9:29 PM

I believe Swedish governments in recent years have had to reduce taxes and slim down the amount of government spending (which had become ridiculous; at one point the Swedish government controlled 60% of the economy, IIRC).

Walton is not aware of the massive financial and real estate crisis (similar to the global one now) in Sweden in the 1990s. He does not realise that Sweden had to nationalize its banks to save his precious free market from ruin.

My positions on social issues have become more liberal over time, and I would describe myself as pro-choice, pro-gay rights, pro-science, pro-drug legalisation, and pro-secular education. The less enlightened corners of the American right, such as those who frequent Conservapedia, would certainly label me a liberal. Nevertheless, my positions on taxation and the economy position me firmly on the right, even in the US political spectrum, when it comes to fiscal and economic issues.

Walton is not aware that economics is a science and so advocating fiscal conservatism is like PZ advocating intelligent design.

By far the best source of British political news and opinion is Iain Dale's blog. In the commercial media, the best bet is Sky News.

Walton's student diary entry #1096:

*Got up, put on Sky News
*Eamonn Holmes is entertaining today
*Takes a copy of the Times from his college lodge
*Ah, isn't Michael Gove on fire as usual!
*Two lectures today, lecturers going on about some nonsense of the "law", but I never entered into this contract with the evil bureaucrats
*Made sure to grab my copy of the Sun on way back to college
*Nothing better than Murdoch titillation!
*Right, internet time for me
*Can't believe how moronic the Pharyngulites are being, they think democracy is a good thing??
*Angry, think I'll calm myself down by subscribing to the Wall Street Journal, meaning to for a long time, its free content was not enough freshwater school for my tastes!
*Aargh, no Daniel Hannan blog post today, how I miss his wit!
*Delivered Tory campaign leaflets round Oxford this evening, avoided socialist students protesting about Gaza in city centre, the filthy reds
*Back in room, completed "NO TAXATION WITH REPRESENTATION" banner, will unfurl outside local NHS hospital tomorrow
*If that doesn't work, well I shall go John Galt, and take my productive capitalist self out of society. I shall watch the motor of the world stop.
*Tried to watch BBC News at Ten before bed, but they kept reporting accurate facts challenging my world view. Switched off in disgust.
*Read Rand in bed. Scourged self for wickedness.

Reading this back, maybe Walton should get twitter instead?

But neither Brits nor Canadians have the right to opt out of paying for the public system. In the case of the UK, we fund the NHS through our taxes whether we use it or not.

Walton, in whatever you deem to be your utopian dream society, would you have no taxation?

Posted by: BCReason | August 13, 2009 9:43 PM

Let me tell you how bad the Canadian health care system is. (sarcasm)

My wife found a lump in her breast. Before the month was out she had all the diagnostic tests including a CAT scan and the lump removed surgically. We didn't have any unreasonable wait's. The procedures were done in a hospital so new you could still smell the paint with all new state of the art equipment. Then there were 3 months of radiation treatments to make sure the cancer was dead.

Total cost to us? About $50 bucks for parking at the hospital parking lot.

I think my wife is paying about $10 a month for her medication. Prescriptions are cheaper here because the government negotiates bulk rates from the pharmaceutical companies. Add an employer drug plan and your laughing.

Anyone who fights against socialized medicine must be on some pretty potent drugs or just plain STUPID!

Posted by: Samantha | August 13, 2009 9:52 PM

Tasha:

No wonder your health care was down the tubes. With as much respect as it's possible to say this: Alberta health care is the laughingstock of the rest of Canada. It's well known to be a terribly inefficient cross of socialized and not, with you get the care of a poor resident of a non-socialized system while paying like you're getting socialized care. Alberta is pretty much a member of the US in terms of social programs, giving them as little as they can within the bounds of Canadian expectation.

Most of what you brought up is not a consideration here in Ontario. You can choose to take your child to a pediatrician, if you can find one that has the space. Most of us do have a family doctor and can get in within two to three days. Walk-in clinics are primarily used by people who really want a rush on getting a prescription or just haven't taken the time to find a GP. You can choose your OBGYN and as long as they're willing to come in, you can have them there. It's only if your OBGYN is off-duty and won't come in that you won't get them there. My Mom had the same OBGYN for both me and my brother and he came in in the middle of the night to help deliver my brother. This is encouraged, although not forced. And waits in hospital emergency rooms are rarely more than an hour or two, although this does depend on whether there has been a recent catastrophe.

One interesting thing you said, though:

That's what I'm talking about when I say that choice is essential. She had the financial ability to get it done out of the country, but it should be a choice where you live. Not everyone has the financial ability to seek treatment out of the country, as my in-laws did.

You do realize that, under the current American health care situation, most of the people who don't have the finances your in-laws did don't get ANY care at all, never mind sub-standard care. Sure, your MIL had to go to the States because her Alberta medical care wasn't doing what she needed, but if she'd been just a little poorer and living in the States at the time, she might only have gotten just enough care to save her life... and then spent the rest of her life paying it off.

I can't say that Alberta health care was efficient or even right, but it is not typical of even the rest of Canada, never mind other socialized systems. Never mind the fact that she was even able to get SOME care without being bankrupted, which isn't the case for even some people WITH insurance in the States.

Posted by: VP | August 13, 2009 10:15 PM

Tom Fool @339: Silence, boy. You don't issue orders.

Posted by: Shaun Fletcher | August 13, 2009 11:42 PM

Tom Fool, who raised the issue of Professor Hawking's care? Was it proponents of this reform or its opponents?

Oops

Posted by: windy | August 14, 2009 1:19 AM

Which is why I think that we need to seriously look at a single-payer health insurance system.

Ironically, Obama initially tried that, and couldn't even find support for it from most of the people that *are* going to vote for the one that is currently in the works.

What, when did Obama try to push for a single payer system? When did this happen?

(Besides that famous 2003 video, but now he's disowning those ideas: "I have not said that I was a single-payer supporter." I hope Obama is not turning out to be the Chris Mooney of health care reform?)

Posted by: Joe Bob | August 14, 2009 4:01 AM

Any word on Generalissimo Francisco Franco?

Still dead.

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

Posted by: windy | August 14, 2009 5:53 AM

Adrian Mole, the next generation? (sans the working class background)

Posted by: kostas | August 14, 2009 7:24 AM

For people that want to know more about how health systems are organized worldwide, I have found this very well-researched paper from Cato spot-on regarding my experience with the greek system, so I assume it should give a fair overview of the other countries it also discusses (Switzerland, Canada, France, Germany, Britain, etc.)

Posted by: JBlilie | August 14, 2009 8:57 AM

Al Franken said it well a while back: Lying Liars.

http://www.amazon.com/Lies-Lying-Liars-Tell-Them/dp/141766388X/ref=sr_1_1?ie=UTF8&s=books&qid=1250254603&sr=8-1

More lies from the right wing:

http://www.timesonline.co.uk/tol/news/uk/article6795466.ece

Posted by: John | August 14, 2009 10:01 AM

Kate writes

In the U.S. for example, we have a high infant mortality among certain demographics because of poverty, obesity, and lack of education. If these stats are removed from the population, the rate goes way down.

That has to be one of the most offensive things I've read in quite some time, and to see why, let's take an analogy.

Imagine that there is a string of rapes in your town, and you are a bit worried. Someone says to you "Oh, but it's skewed by certain demographics. If we take out the women, the rate goes way down".

It is these very people who the scheme is proposed to help. Don't you understand this? These are the people suffering and dying at the moment. It is asinine to argue that the stats with them taken out mean anything at all.

Given that removal of these stats tends to mean removing very large sections of the black and hispanic communities, I think we can see exactly where you are coming from with this. Your post basically boils down to "If we only include whitey, and rich whitey at that, who, after all, are much more important, then everything is just dandy".

I know that many people would love to come out and argue from this point of view, but it is still sickening when they do.

You should be ashamed of yourself for posting such bilge.

Posted by: Walton | August 14, 2009 10:36 AM

John, I don't think Kate was saying that we should simply disregard the problems of the most disadvantaged sectors of the population. Rather, I think the point she was trying to make is that the US's poor health outcomes compared to other countries are due, in part, to high levels of obesity, poverty, poor nutrition and lack of health education among certain sectors of the population, not exclusively to lack of medical care. These are factors which will not be improved by reforming the health insurance industry. (I don't know whether this is true or not, since I haven't looked at the stats; this is merely my interpretation of what Kate was saying.)

Posted by: Gaz | August 14, 2009 11:03 AM

Daniel M

"He said (and this is the bit that had my jaw literally hit the floor)"

Literally? I hope you were in the UK when THAT happened - sounds like serious reconstructive work needed....

Posted by: Knockgoats | August 14, 2009 11:13 AM

Alex Deam@334,
You've been spying on Walton, haven't you?

Aargh, no Daniel Hannan blog post today, how I miss his wit!

Not sure how many non-Brits (or even Brits) will know Mr. Hannan, who's been slagging off the NHS on Faux News. He's a weird Tory MEP (Member of the European Parliament) with his own blog and a planet-seized ego. Amusingly, Tory leaders in the UK, including the party leader himself, have rushed to repudiate his attack on the NHS, pledging not to dismantle it if they win the next election. As they probably will win, Mr. Hannan has done us in the UK a considerable favour, as these pledges will be difficult to wriggle out of. Thanks, Danny baby!

In the U.S. for example, we have a high infant mortality among certain demographics because of poverty, obesity, and lack of education. If these stats are removed from the population, the rate goes way down. - Kate

This does not directly address your claim, as it concerns the health of middle-aged men, but even when you compare non-Hispanic whites, Disease and Disadvantage in the United States and in England, those who have spent decades suffering under the socialistic NHS still come out considerably healthier than those enjoying the advantages of the profit-driven US system.

Posted by: Knockgoats | August 14, 2009 11:27 AM

Matt Penfold@359,
I'm not sure you're right here. Income inequality seems to be behind the international and US-state variation in obesity levels, for example (Wilkinson and Pickett, op.cit.). Rather, I'd say the US health-care system is a part of a pattern of high levels of inequality - and with the highly inefficient health system it has, even spending more than twice the amount per capita as the UK still leaves US health worse overall - and not just among the poor. Inequality seems to be bad for you even if you are near the top of the heap (Wilkinson and Pickett, op.cit.).

Posted by: Walton | August 14, 2009 11:45 AM

Knockgoats, you are obsessed... will you agree to stop going on about the Wilkinson and Pickett book in every other post if I promise to buy a copy? (Whether or not I actually read it, I'm perfectly happy for the authors to profit from my purchase... after all, in this awful capitalist system, even socialists actually have to sell books to the public in order to make a living.) :-)

Posted by: MrFire | August 14, 2009 12:31 PM

Mark @317:

Thanks again for the link. It is indeed grim reading. Upon hearing it from the horse's mouth, I humbly retract my assertion that $36 trillion is made up out of nothing.

However, I shall stand by my main point: it is still an entirely misleading number. $36 trillion represents the accumulated shortfall faced in 75 years' time if we do nothing. As such, it can't possibly be considered in the same stride as your other points, many of which are placed in the here-and-now, and are better-argued.

Medicare is undeniably in trouble if it remains as it is. But I don't believe you make a convincing case that the free market will do a better job:

If we had a free market system, big Pharma, doctors, hospitals and insurers would be competing with each other by looking for ways to provide goods and services at a reduced cost, or providing improved goods and services at the same cost.

When the goods and services are optional to me, I would agree. In the case of health insurance, I have no realistic choice. I either buy into a plan, or I gamble on never getting injured. Health insurance companies have me by the balls. Where is my freedom in that market?

They don't [look for ways to provide goods and services at a reduced cost, or provide improved goods and services at the same cost]. Why? Because it costs money to develop better or cheaper goods and services, and the potential return on investment is much greater for producers and providers to simply lobby congress for change in legislation that might provide them a market advantage.

It seems you are arguing that either congress should be more principled and stand up to insurance companies (hell yeah!), or that it should remove itself from the equation. What you don't explain is why less regulation is a better recipe for product quality. It's ironic that you mention TARP in the same comment, since even Allen Greenspan admits that deregulation was a major factor in the market collapse.

Additionally, I never argued for a laissez faire free market system.

This does not seem to square with your previous assertions (to wit: above you state that a 'true' free market system would yield better goods and services). However, I do find myself strongly in agreement when you say:

I believe other countries have hit on a formula that allows them to keep costs under control much more effectively than us. We need to study how they've done so and emulate.

To do so, however, would mean a committment to eschew our current legislative system of lobbyist influenced regulation. As long as lobbyists can manipulate the market by purchasing adventageous legislation, we will never control costs.

Posted by: Ema Nymton | August 14, 2009 1:40 PM

Wow.

Walton, you've got to be one of the dumbest individuals I've ever had the displeasure of reading.

I'm not being flippant. Your inability to reason is amazing--and incredible given your relatively strong ability to write (as evidenced by your posts here and your blog.)

Posted by: Ema Nymton | August 14, 2009 2:05 PM

Kate, your IQ might be 137, but your inability to understand basic logic--or parse what you read--suggest that you are, in fact, mentally deficient. Or, as you put it, a moron.

Posted by: Walton | August 14, 2009 2:37 PM

Knockgoats, I was kidding. I guess my attempt at witty banter fell flat. :-)

Ema Nymton: Where have I demonstrated an inability to reason? Healthcare reform is a complex field, where reasonable people can, and do, legitimately disagree with one another. In common with most people on this blog, I don't claim any special expertise in the field of health economics. I simply assess the situation as best I can in all the circumstances, and revise my opinion constantly.

And thanks for the comment on my writing ability, incidentally (though I realise you weren't intending to pay me a compliment).

(I was originally opposed to Obama's plan, but having looked at it in more detail, it seems sensible and reasonable. As I've made clear on this thread, I think the US conservative movement is rather overreacting to the fairly moderate reform package that Obama has proposed. The health reform bill is not a federal takeover of healthcare; it merely creates an optional public plan to operate alongside private alternatives.)

Posted by: MrFire | August 14, 2009 3:12 PM

Ema Nymton:

Awesome name.

Posted by: Ema Nymton | August 14, 2009 3:59 PM

Walton, you demonstrate such throughout your writing, here and on your own blog. And I did indeed mean to compliment your writing, just not your reasoning. To be fair, your lack of logical reasoning seems almost entirely due to a wholly unwarranted worshiping of free markets.

MrFire: Isn't it, though?

Posted by: MrFire | August 14, 2009 5:02 PM

A lot of these responses are drearily predictable.

A piece of trollspeak that is itself drearily predictable.

As it will be in the future, it was at the birth of Man

Quoting Kipling is great - as long as you actually have a point.

Like I say, if this stuff is so great, why not move to Europe?

I think you need to pay more attention to those drearily predictable responses.

Of course, the _problem_ is the one Orwell pointed out long ago - the left by and large has no sense of responsibility, or even causality. They want it three ways and none, always.

Be that as it may, you have no sense of coherency.

I'm charmed, looking at these debates, is that no one gives thought to the welfare of those providing the care. Go figure. Here's a tip: men willing to work under compulsion are unfit for elevator repairmen, let alone medicine.

After distilling off the crazy, I gather you think that NHS doctors are working under the state lash (if so, I think you mean "coercion", not "compulsion") and as such are either unable to provide quality service or are just inherently shit people. After having been treated by those doctors for twenty years, I cannot but conclude that you are unfit to provide any opinions on anything.

Thank you for the reading comprehension challenge, but seriously: do you share a padded cell with Dave Mabus?

Posted by: Robin Levett | August 14, 2009 5:37 PM

@Nothingworthwhiletoadd:

I'm not sure this is the most relevant place to ask but: I recall a year or so back a lot of the british papers (admittedly including the Daily Mail, which should have probably set off alarm bells) made a huge deal about how the NHS being so much worse than America health care due to MRSA and other super bugs being spread by sub-par sanitation.

Read Ben Goldacre's Bad Science; you will find that the scare was just that. He explains that he was called by a journalist friend to ask which laboratory everyone else used to get their results, because his carefully gathered swabs from NHS hospital doorhandles were coming up blank for MRSA etc. Turns out many, if not all, of the stories were based on results manufactured by someone operating out of his garden shed with no expertise and arguably even less ethics.

Posted by: Robin Levett | August 14, 2009 5:59 PM

@Cimourdain #375:

And what do you think Kipling was getting at? O worshipper of the Gods of the Market Place?

The rest of the post can be summarised as "pity the poor consultants on their six figure salaries earned on the back of their training in NHS hospitals".

Posted by: 'Tis Himself, Quel Dommage | August 14, 2009 6:42 PM

Reggie Greene / The Logistician #383

This bill, and virtually anything that might be done to improve our healthcare system, involves too much complexity with which we are emotionally motivated to deal. In addition, there are too many factions with entrenched economic and/or financial interests to permit it to become a true health initiative.

This is the problem. All too many people are shrieking at each other, generating way too much noise, for there to be a calm discussion of this important topic. I know where my prejudices lie, and I know where Walton's and Cimourdain's prejudices lie.

At my company I'm a member of a committee that's continually looking at health insurance providers. We want the company with the lowest price that doesn't screw over the patients. We've already eliminated a couple of insurance companies because they have a reputation for denying claims at the slightest provocation. It's quite hard to get an affordable insurance company that gives good service. We can find one or the other but the combination is getting more and more difficult to find.

Posted by: Tom Fool | August 14, 2009 10:18 PM

The author of this article made NO case for nationalized healthcare... just engaged in the typical tactic of attacking the opposition by finding an article that made an error. Defend national healthcare, Professor Myers, with REASONED arguments. You can't, can you? All you can do is engage in the typical name calling. I challenge you to name ONE GOVERNMENT PROGRAM that is run EFFICIENTLY and EFFECTIVELY.
Are those crickets I'm hearing?
And please try to address me without strawman arguments like "Sarah Palin is a liar," or "fundamentalist Christians are stupid," blah, blah, blah! You guys are boring, already. I would have expected more from supposedly "learned" members of academia," but alas, you are disingenuous, shrill, and intellectually vacuous.

Posted by: maureen brian | August 14, 2009 10:30 PM

Tell me, Tom Fool, why Professor Myers who is a teacher of biology at a small town in Minnesota should make the full case for nationalised health care when no-one - as far as I can see - is proposing any such thing.

You're in the wrong place if that is what you want to see - try some health economists.

And stop being so fucking aggressive, will you, as you are a guest at PZ's place not in a playpen until you finish your tantrum. Or maybe you are a 3-year-old!

Posted by: E.V. | August 14, 2009 10:37 PM

SO you think Enron, AIG, Haliburton, Blackwater (Xe) etc, ad nauseum, are going to have your interests at heart? Blow me.

Posted by: E.V. | August 14, 2009 10:40 PM

Libertard clean up on aisle 5.

Posted by: Tom Fool | August 14, 2009 10:50 PM

EV:
Oh yes, if we don't turn healthcare over to the government, Halliburton will take over! How stupid can you be? I thought this was the place to come to for "reasoned" discourse!
Who bailed out AIG, numb nuts? Obama! Yes, and so did Bush. They're two different sides of the same coin!
Oh, but whoops! That ruins 99% of the intellectual midgets' arguments on this forum, who want to continue making it a "right vs. left" debate.
Simpletons.

Posted by: E.V. | August 14, 2009 10:57 PM

No idiot. You asked if any government program worked and then ranted about $300 toilet seats and every non-medical program you could think of. I countered with mismanaged, greedy private corps, you moron, who are just as happy to rape and pillage the average Amerikan.
If you're style is to misrepresent everything then piss off asswipe, I'm sick of lying asswipes obnoxiously trolling for a fight.

Posted by: E.V. | August 14, 2009 10:59 PM

Why don't you address the SUBSTANCE of what I'm saying?

Posted by: Tom Fool | August 14, 2009 11:03 PM

Here's the substance: the government has no business running our healthcare system.
Tell me why I'm wrong. Simple and to the point.

Posted by: H.H. | August 14, 2009 11:09 PM

Tom Fool:

Tell me why I'm wrong. Simple and to the point.

Posted by: Tom Fool | August 14, 2009 11:17 PM

H.H.
Good for you for having the integrity to at least make an attempt at defending your argument. The problem is you say, "Because government is more efficient and cost effective at providing essential services like health care than for-profit companies."
You sure about that? You should research the current state of Medicare and Medicaid.
Also, Obama himself (unintentionally I'm sure) made the case at his Town Hall meeting that UPS and FedEX were more efficient than the Post Office.
Also, read John Mackey's op-Ed (the co-founder and CEO of Whole Foods) about what he has done with his employees and his take on a government plan. It's very well written and thought out.
http://online.wsj.com/article/SB10001424052970204251404574342170072865070.html

Posted by: Tom Fool | August 15, 2009 12:17 AM

Stanton,
Thank you, also, for asking a substantive question. I honestly wasn't trying to be a "troll," as other alleged.
Personally, I believe the government has a limited role in regulation. Your question, as I see it, has more to do with the government REGULATING certain aspects of healthcare... not RUNNING it.
Ironically, one of the concerns some people have expressed about nationalized healthcare is that the government would get involved in denying people with "familial dispositions" to certain illnesses (rationing). I. personally, haven't seen convincing evidence that that is the case. But it is noteworthy that BOTH sides of the debate have that concern

Posted by: Ema Nymton | August 15, 2009 1:23 AM

You're really not a very intelligent person, are you, Tom? In fact, it seems you recognize that fact. Good. And I'm sure your working hard to do the best you can, despite your obvious handicap.

Now, you posted a link to a piece by John Mackey. Obviously, your lack of intelligence kept you from being able to see what a steaming pile of shit that piece was. It's a laughably standard ALL REGULATION IS BAD spiel, with absolutely no connection to reality. Any actual issue with our health care in the US was ignored, as, of course, are the examples of every other modern nation. I'm sure he was rather embarrassed to put his name on it.

And this provides a learning opportunity for you, Tom. See, you're dumb--we agreed on that earlier. But your working hard to function in this society, and from reading Mackey's piece you can see a wonderful example of what poorly reasoned and written argument really is. I'm happy you had this experience, Tom. I'm sure you'll be the better for it.

Posted by: Tom Fool | August 15, 2009 3:00 AM

To quote Dan Aykroyd: Ema, you ignorant slut!
Not surprisingly, there is no substance to your claims, just more name calling and general disagreements based on your own biases and limited world experiences. How old are you anyway... 19... 20? You seem to have all the wisdom of one just on the cusp of legal drinking age.
Of Mackey's article, you say, "It's a laughably standard ALL REGULATION IS BAD spiel, with absolutely no connection to reality."
No connection to reality? How about the REALITY that is his health plan at Whole Foods? How about the REALITY that his employees really LIKE their health plan, thank you very much. How about the REALITY of a successful businessman who has real world experience in matters you have no clue about. Ever run a business, Ema? Ever had the burden of responsibility to meet a payroll? No, of course not! But no matter... you're SO much smarter than a guy like John Mackey.
Who is the truly unintelligent one here, babe? Grow up.

Posted by: Robin Levett | August 15, 2009 4:38 AM

@Tom Fool:

OK, so the employees of Whole Foods "really like" their plan (any evidence of that? - crickets).

Someone with a serious illness would just love paying $2,500 per year in health costs, wouldn't they (and what co-pay is there)?

What's that you say? Someone with that serious an illness wouldn't last very long in their job at Whole Foods? Oh dear, so they'll lose their job - and their ("great", albeit expensive)health insurance with it. And they find that no other health insurer will pick up the tab for that illness because it's a "pre-existing condition". Great scheme that, isn't it?

Posted by: Thunderbird5 | August 15, 2009 5:37 AM

I'm very late to this party - been working overtime. I'm an RN with over 20 years experience in the NHS, currently working as a senior community nurse in the rural SW of England. Most of my earlier gigs were in inner-city A&E (ER), although I did do a couple of contracts in hospitals in the USA (NY 1995/6 and FL 2003/4).

That second stint: I'd gone to the US for personal reasons but had to earn a living and went again with the NCLEX and a basic-grade contract in a Level 2 rather than illegal dishwashing. It had been a tough go in NY before but this one did me in. I was so ashamed to be a part of the injustice, cynicism, greed and humiliation being perpetrated upon those in need. I stuck it out (breaking the contract was not an option...) but I disgusted myself.

Insurance co. groupies, Republicans and generic shit-for-brains who ignorantly and self-destructively defend their cherished God-given freedom from medical socialism can henceforth rest happy in their $1000-a-night private patient rooms knowing that I'll never be back to infect either them or their compatriots with my universal-health-care-supporting, NHS-trained, trade-union-member, Nazi-esque presence ever again.

The NHS isn't perfect.

The US healthcare system is a fucking disgrace.

Posted by: djinn | August 15, 2009 9:48 AM

Tom Fool, Medicare has 3-4% overhead, compared with 20-50% for Health Insurance companies. Medicare is by every measure more cost effective.

Posted by: Mark | August 15, 2009 11:35 AM

Reggie Greene @383 said: "If either side of the debate has to work this hard arguing about something which theoretically should improve the lives of the masses of people, there's a big problem."

Amen! The problem (in my mind, at least) is the instant application of a label depending on the side taken. I, for instance, have been arguing largely against the various version of health care reform being bandied about Capitol Hill. I have been labeled, variously, a 'right-winger,' 'libertard,' 'stupid,' etc., etc. The fact is, none of these labels apply to me.

It would be nice if (at least here of all places) folks could set aside their prejudices and preconceived notions respond to the arguments. That is, after all, what PZ asks those poor, misguided, backward and superstitious religious folk to do, right? Set aside prejudices and preconceived notions and listen to argument?

For the record, I argue my position NOT because I don't favor reform, but because I don't agree with the reform ideas currently being offered by congress and backed by President Obama. I don't have a special hatred for Democrats or President Obama in particular, it's more a distrust of Gov't in general.

Before we entrust what could very well turn out to be the largest part of our economy -- not to mention our very physical well-being -- to that nebulous faction of our society we call "Government," we should fully understand its motives. Further, we must understand how it intends to finance and manage such a vitally important trust for ourselves and our posterity.

Posted by: Alex Deam | August 15, 2009 12:00 PM

How old are you anyway... 19... 20? You seem to have all the wisdom of one just on the cusp of legal drinking age.

Yes because 19 and 20 year olds can't possibly be smarter than fucktards such as yourself.

For starters, the debate isn't over BETTER national health care as we currently don't have national health care in the first place! It's about whether or not we even want such a thing and those of us who aren't immersed in the bubble world of academia see a government program as a disaster for our economy.

There's a whole world of difference between "national" health care, and "nationalized" health care. Or do you think the NFL is run by the US government?

Besides, for the nth time, NO-ONE IS PROPOSING NATIONALIZED HEALTH CARE! The bill that is proposing the most government intervention in US health care is H.R. 676, which would create something similar to Canada's single payer system. Nobody is prosing a system like the UK's NHS, nor is anyone proposing the full nationalization of US health care, commie-style, as people who babble about "death panels" have been wont to say people are.

Alex @ 334, thanks for littering the thread with unfunny adhominem crap.

While humour is of course a matter of personal taste, does one comment out of over 400 really count as "littering the thread", particularly when there are far more unproductive and inane comments on this thread than mine.

And since when does an attempt at satire get to be labelled an ad hominem? Do you know what an ad hominem actually is?

Our health-care is universal, mandatory, employer-based and highly regulated and state controlled.

"Mandatory"? You mean they gave you no choice and forced that rectal thermometer up your ass? Do state bureaucrats siphon Calpol into the mouths of helpless Greek children who have a cold? Are zimmer frame wielding pensioners defending themselves from a ruthless army of pen-pushers wanting to ram influenza vaccines into their arms?

"Employer-based" and "state controlled"? You mean the Greek government has nationalized all industries and you are living in some sort of Marxist paradise/hell (it can only be one of those two)?

"Highly regulated and state controlled"? You mean that "highly regulated" is not an inherent property of "state controlled" health care, and so mentioning the two terms alongside each other does not make the former term superfluous?

Alex Deam@334, You've been spying on Walton, haven't you?

Damn! You've found out my fiendish liberal pinko conspiracy to recommend government answers to all private problems, and so enforce the state's will and glare (kinda like Sauron) on all citizens, especially those who have seen the light, like Walton. As #377 correctly pointed out, Orwell was a socialist, but what people often forget (but what I think the Republicans haven't) is that 1984 wasn't satire, nor was it a warning, it was actually a manifesto, a blueprint for the future that Orwell wanted to see.

So yes, Sarah Palin was wrong to call Obama's plan "Orwellian", for the simple reason that Orwell would disapprove of it. He would be outraged that Obama does not want to spy on you or any other Americans (warrantless wiretapping aside of course).

Posted by: Mark | August 15, 2009 12:09 PM

Robin Levett @ 412 said: "Someone with a serious illness would just love paying $2,500 per year in health costs, wouldn't they (and what co-pay is there)?"

So how much is fair? Should it be a set amount, or one based on income? Would that be fair? For that matter, should individuals take ANY responsibility for their own health care costs?

The tragedy of an individual experiencing a serious illness almost always illicits an emotional response from those more fortunate. Believe me, I know; my oldest brother was recently diagnosed with small-cell lung cancer. We all would love to heal all sickness. Hell, why not eliminate hunger and poverty while we're at it? And because we feel so strongly about it, why stop at our borders? There's a whole WORLD of suffering out there we could if not end, at least seriously mitigate.

But there's always that nagging 'cost' issue. Someone must pay tribute at the altar of altruism.

I've found it effective, at least for me, to try and keep emotion out of arguments where difficult choices must be made.

Posted by: Mark | August 15, 2009 12:20 PM

'Tis Himself @ 421, great! Again, I haven't argued we SHOULD have completely unregulated free markets, simply that the idea free markets got us where we are is false. The sometimes inept fumblings, and sometimes calculated manipulations, of our legislature in what everyone believes is a free market is what got us here.

I believe before we hand off another huge chunk of control of our lives to these idiots, we get them under control. In that regard, hate them or love them, agree with their message or not, the folks yelling and screaming at the many town hall meetings around the country are certainly reminding our congress-critters they are not all powerful. Score another round for free speech!

Posted by: DingoJack | August 15, 2009 12:48 PM

Tom Fool et al. - Thought these figures& might help:
"In the US-based Commonwealth Fund's 2008 healthcare rankings of six top developed nations (Australia, Germany, Canada, New Zealand, United Kingdom and United States):
The United Kingdom ranks top overall - and ranks above the US in all but one measure - yet has the lowest healthcare spend per head of population.
The USA ranks sixth overall - ranking bottom on five of the nine measures along with having the lowest life-expectancy and highest infant mortality rates by far - despite spending more than twice what any other country spends on healthcare (and, at $6,102 vs. $2,546, almost three times the spend in the UK), per head of population."
Hope that's helpful for you. - DJ
*See here:http://scienceblogs.com/dispatches/2009/08/dumbass_quote_of_the_day_47.php#c1845439 @ Mark (#58).
I saw a really consise reoprt posted somewhere, but I can't seem to find it now. DAMN!

Posted by: Karey | August 15, 2009 12:51 PM

The free market can work in beautiful ways, sure. But you need regulation to protect the free market process sometimes. Corporations have only too much incentive to try and fix the market and you need regulation to keep the market working as it should, from them. These tired old arguments were made over the last 10-20 years by people saying the same things you say, that less regulaton=more better capitalism, and we are now sitting in a ruined economy because of it. Everything you have to say about how the market should work, is disproven by the current state of reality.

Posted by: E.V. | August 15, 2009 1:03 PM

Score another round for free speech!

Posted by: Mark | August 15, 2009 1:32 PM

Bobber @427 said: "You do know that what they are doing is (a) lying and (b) preventing the free speech of their representatives, let alone trying to prevent the reps from doing what the majority of their constituents want them to do. That's not free speech; that's attempted intimidation, and it has no place in democracy."

Methinks someone has been reading too many 'talking points' in party literature...

There's no question that some of the people opposing health care reform do so only because they wish to oppose the 'other party.' I've clearly stated I believe this to be part of the problem in finding solutions. It's also pretty clear that organizations such as Freedom Works are involved. Just as obvious is that many politically-motivated organizations working for the interests of Democrats have attended said meetings and made their opinions heard.

What you may NOT know, however, is that Big Pharma and most of the private insurance companies are FOR President Obama's plan -- mostly because it means they will get more customers. Therefore, stating catagorically the opposition 'has interests in the current for-profit' system is, at best, misleading, at worst, outright lying.

Speaking of lying, I'm sure there is much of it (or at least spinning) going on on both sides of the debate. But showing up and voicing an opinion is precisely the purpose of a so-called 'town hall meeting.' How is this interfering with free speech?

As far as interfering with the free speech of elected representatives... PUH-LEASE! Democrats hold the House, the Senate and the Executive. They have a bully pulpit from which they may broadcast their message any time they wish. In fact, House Speaker and Democrat Nancy Pelosi just ran an Op-Ed piece last week in USA Today -- only the paper with the largest circulation in the country. And what did she say? She accused anyone offering an opinion opposing hers and the Democrats of being 'un-American.'

Now exactly who was it you said was interfering with free speech? And you're surprised why when people get pissed and show up yelling and misbehaving at town hall meetings?

Let's face it, if Democrats truly wanted to push thru health care reform, they'd have little need for input, much less votes from Republicans.

Obviously, the Democrats aren't quite sure exactly which way the wind is blowing (i.e. the opinion of the 'majority of their constituents'), because if they were, health care reform would be a done deal, and we wouldn't be having a debate.

Posted by: Mark | August 15, 2009 1:42 PM

E.V. @ 430, again with the labels. By invoking Fox News you seek to imply a political affiliation. Trust me, if the Republicans had suggested approach (not as far-fetched as you might think) to health care reform like the current offerings on Capitol Hill I would have the same opinion.

Read my post again. I applaud not necessarily the message these people are shouting at town hall meetings, but the fact that they've used a fundamental individual right to get the attention of our 'ruling class' -- the very purpose envisioned by those who originally conceived the idea of 'free speech.'

Believe it or not, I also applaud the Democrats for slowing things down (remember, President Obama originally wanted a bill to sign on his desk by the summer break) and engaging their constituents. Then again, it may just have been a case of collective 'look before you leap.' Many of these folks are up for reelection in 2010...

Posted by: Mark | August 15, 2009 2:41 PM

Matt @ 433: I didn't say I wanted the same access to the media as Nancy Pelosi. My post was in response to another's suggestion that an ordinary American showing up and voicing opinion at a town hall meeting might in any way, shape or form interfere with an elected official's ability to get their message heard.

But thanks for helping make my point :)

As for your other question, 'How would I provide health care coverage for all?' I would answer I'm not yet convinced that should be the goal.

One of the provisions of the plan being offered is that 'everyone' must be covered -- including millions of 'uninsured' Americans who are perfectly able to afford insurance -- even in our current broken system -- but choose not to. I understand the reason; the more people who share the risk, the cheaper it is for everyone. But that's just a way of spreading the pain. We're already doing that right now with Medicare, and it isn't working. Everyone who works (legitimately) in the US pays into Medicare, but only those old enough to retire actually get benefits. Despite this, Medicare teeters on the brink of insolvency -- talk about a Ponzi scheme!

This is why I have said that before I can get behind any government-run universal health care program, we have to get costs under control. That means the US Gov't must get costs for the current medical programs it runs under control. I'm a proof-is-in-the-pudding kinda guy (one of the reasons I like reading the Blog), and reining in costs for Medicare, Medicade, etc. would go far toward showing me my Gov't is capable of administering an even larger medical system.

One way we might do that is change the way our government legislates product liability. Think about this: It costs nearly $20 billion and 15 years to get a new drug approved by the Food and Drug Adminstration. A good thing? Probably, as long as it's administered honestly and fairly. But even after clearing this Herculean bureaucratic hurdle, even after 'proving' to our (your) government a new drug is safe and effective, the pharmaceutical company who brings said FDA-annointed drug to market is still subject to product liability lawsuits.

It seems to me we're hitting these companies with a double whammy. Wouldn't it make sense (and cost a whole helluva lot less) to choose one method of protection or the other? Either we trust the government to ensure the efficacy and safety of our drugs, or we trust the tort system to keep manufacturers honest. As it is, pharmaceutical companies must bear the cost of both the FDA approval process AND plan for the inevitable lawsuits. Is it any wonder new drugs cost so much?

Another thing we might consider is provider certification and access laws. Why should I have to visit an M.D., who spends nearly half his/her productive adulthood in school and must charge commensurately to recoup those education costs, when all I might need is an antibiotic for a mild infection? I'm not a doctor, but I know the difference between viral and bacterial infections. The average pharmacist knows which antibiotic is most effective against a given infection. But I can't go to the pharmacy, speak briefly with a pharmacist and walk out with an appropriate antibiotic. How much do you think this adds to overall healthcare costs in our country?

Whatever we do, however, I firmly believe any reform effort must start with cost control. Other countries have better health care at much lower costs than us. Why? What can we learn from them? I predict if we study carefully, we'll find we'll have to do much more than simply put everyone on a government-sponsored insurance plan.

If we're gonna do it, let's do it right the first time. After all the bank and auto bailouts, we may not have the money to make any more mistakes. The Chinese are already publicly voicing concerns about the level of debt our government carries. Could you have imagined 20 years ago -- hell even 10 years ago -- that we would give two shits what the Chinese thought about our national debt? Times have changed...

Posted by: Bobber | August 15, 2009 3:13 PM

'How would I provide health care coverage for all?' I would answer I'm not yet convinced that should be the goal.

...thus endeth the conversation.

Posted by: maureen brian | August 15, 2009 3:43 PM

I haven't been able to get into this site all day and was going to reply to Tom Fool @ 393 whose every sentence contains a lie or an assumption that I could refute.

Then I decided I had better things to do with my life.

So, I'd just like to say a big thank you to all the nutters - here and elsewhere - of the USAian persuasion. The lies that have been told about the NHS are so stupid and so blatant that we now have a situation where the population is aroused and no incoming government would dare undermine the NHS in any way, not even by neglect. They are under considerable pressure to make it even better than it now is! Thanks, guys!

(Yes, TF, I'm a Brit and the reason that I was posting at 3 in the morning our time is that my new medication is making me feel so much better that I'm having a little difficulty establishing a new sleep pattern - compounding the almost universal problems which we wrinklies experience with age. OK?)

Posted by: E.V. | August 15, 2009 5:24 PM

this SERVES the average American.

WTF?

Do you even know why we're in the current economic meltdown? (The whole Market & banks run amok from deregulation and Gordon Gecko's mantra, "greed is good!" thing?) So do you think the Republican's with their motto "I have mine, so pull yourself up by your own bootstraps... what, you can't afford boots? Not my problem, slacker" and the Libertarian default to Objectivism (See:Ayn Rand)is the answer?

I am apathetic.
Thread fatigue has set in.

I know that the current system is majorly fucked and I know Gov. programs always get fouled up by the mouthbreathers and goobers who end up staffing the bureaucratic gatekeeping positions.

I don't have the answers. I do know something has to change before it all runs off the cliff. Our next revolution won't be due to race or religion but to the inequality between the haves and have nots when the have nots realize there is nothing left to lose.
The previous administration has undermined and damaged what all other administrations had been able to sustain as a range within the status quo. We're seriously fucked.

If you think you have the answers I suggest you get off the blog and call your state senators with your proposals. You're not going to save the world arguing with Pharyngulites.

Posted by: Bobber | August 15, 2009 5:30 PM

Oh, and lest we forget: the plan isn't for the government to take over health care. It is for government to set up a competing, and in some cases, complementary plan. The proposal does not eliminate private health insurers.

I always thought free enterprisers LIKED competition. Whiners.

Posted by: Mark | August 15, 2009 7:23 PM

Bobber: I would argue access to personal transportation is as much a right as access to affordable healthcare. Do you think you can exercise your right to liberty and the pursuit of happiness in our society without a car a driver license?

Again, (*sigh*) I don't argue for no gov't intervention, I say we should debate the type and level of gov't intervention, with the default position being as little as possible. You say the goal is to provide health coverage for all; I say health care should be made available to all. Think about it.

I've already acknowledged some of the rhetoric political operatives are employing at the town hall meetings is specious, to say the least. And yes, there are some ignorant people out there making stupid statments. But isn't that what the town hall meetings are supposed to be for, so the legislators can hear people's fears and answer them? Again, the proponents of these reform plans have pretty much full-time access to all the news agencies; they can set the record straight whenever they want. A few yokels yelling at the local school won't change that fact.

BTW, I haven't heard you admit that the bad behavior and willful ignorance is occurring on both sides of the argument.

Somehow you've failed to pick on something during this discussion. I'm not Republican or Libertarian. Many of the people arguing against these proposals (or at least to slow down and THINK) aren't hard line Republicans either -- you know, those people you say didn't speak up when Bush got us into two stupid wars? (Where were you by the way? Out organizing war protests?) Many are swing voters, and THAT'S why congress put on the brakes and are listening; they know the swing is what wins elections.

And you must not be paying attention when you ask sarcastically, "These people are motivated over concerns over the national debt?" Who have you been debating? Have I used any of the silly arguments you mentioned? Haven't I expressed a concern over the fiscal realities of the situation? Hey, wake up! I am one of the people asking questions at the town hall meetings! Believe it or not, there are people with a few brain cells to rub together on the other side of the discussion. I'm one of the people congress and President Obama has to convince that the gov't can provide health care for everyone AND save money. So far, I'm not seeing it, and believe me, I'm far from alone. I have many friends and acquaintances -- both Republican AND Democrat -- who feel exactly as I do.

You say that if I "...believe these protesters confronting our represenatives are motivated purely by concern over our national debt, then you are ignorant, willfully or otherwise." If you think that statement is true, then you haven't been paying attention, willfully or otherwise.

Worry not, brother, your attention span will grow with maturity...

Posted by: Jeeves | August 15, 2009 8:49 PM

How much would it currently cost to get a medical insurance policy in the US for the following:

- All pre-existing medical conditions fully covered
- No co-pays or deductibles
- No limit on the amount paid for treatment/diagnostics per year
- No charge for prescription drugs/medical appliances

I'm truly interested as, currently under the UK's NHS, I receive all those things (I'm disabled and have just had the 26th major surgery of my life with many more likely in the future).

I work, and pay around $300/month in national insurance contributions. Would I be able to get a similar insurance policy in the States?

Posted by: Mark | August 16, 2009 12:54 AM

Bobber said: "...you're right to drive to the liquor store... my right to the medicines I need to survive..." No dude, your right to drive to work and earn a living. You know, so you can buy medical insurance? You DO drive to work, don't you?

You said: " ...it's not just "some ignorant people". It's people with positions of authority and access to millions via talk radio." Right, and everything proponents of health care reform say is the God's honest truth. Who's drinking koolaid?

You said: "I see one side offering solutions and attempting to inform voters in a reasoned way. I see another side trying to drum up fear and, yes, threats of violence in order to keep insurance companies rolling in money." Holy shit dude! Can you get more one sided? Listen, I was AT the town hall meeting in Saint Louis where six people were arrested, and they weren't the people arguing against health care reform. I was there and saw the ordinary folk (the ones there to complain) being turned away at the front door by Carnahan's organizers because the "hall is full," while the folks wearing union shirts were being let in the side door. If you can't see culpability on both sides of this debate you are truly in for a long, disappointing life.

You said: "You are implying that those others at the meetings are all worried about the same things you are - when you admit that they are NOT. ...and you have no call to claim I'm not paying attention." I can't help but chuckle. How many times have I said I acknowledge there idiots at these meetings getting loud and obnoxious? Pretty much every post I make I say it. Yet you still make the silly statement above. Listen carefully, I'm only gonna say this once more: Not everyone who opposes the health care reform bills being pushed is a looney. Yes, there are a few, just as there are on the other side of the debate. But those few looneys do not negate the justified concerns of the less bellicose majority. If you don't want me to imply you're not paying attention, then pay attention!

Why don't you conduct an informal poll. Ask everyone you know to list their top three concerns regarding health care reform. Be sure and ask people on both sides of the debate. I'm guessing you're gonna hear "cost" from the vast majority. Start with yourself: What are your top three concerns?

You seem to think this debate comes down to two sides: a)Those who believe we need health care reform at any cost, and b) Those who won't agree to health care reform at any cost. That just isn't the way it is.

Look, what you seem to have forgotten is the fact we both want health care reform. It's obvious to me at the rate health care costs are rising in this country the situation will soon be untenable. Where we differ is in the details.

I've pretty clearly stated my opinion I think we should start with controlling costs, then look at ways to increase the numbers of insured people because that's probably the best way to keep costs down over the long run. If that means new laws requiring the purchase of insurance (gov't or private), so be it.

If I'm hearing you correctly, you believe we should START with gov't-sponsored (read subsidized) health insurance, THEN look for ways to manage costs.

Going strictly from history, our gov't has been notoriously bad at estimating and managing program costs. For some reason (well, we both know the reason), costs always seem to exceed estimates. Do you really think President Obama and the current congress is going to be any different?

Given our government's current fiscal situation, I simply don't think we can give him the benefit of the doubt -- we can't afford to get this one wrong. We're already spending $1.8 trillion more than revenues this year, with an expected shortfall of some $3 trillion by the end of next year -- and that's before the proposed health care reform bills kick in. Trillion. With a T.

Put that number in perspective. Our government's entire budget for 2006 was roughly $1 trillion. That means whatever you paid in taxes is what you have to pay for every trillion our government spends. By the end of next year, our government will have spent three times what it did for the entire year in 2006 over and above its normal expenditures! And President Obama doesn't plan to get out of the red... ever as far as I can tell. How long will it take to pay this debt back? CAN we pay it back?

You think my bringing up our debt to China is scaremongering? Google US debt and China. The Chinese government HAS expressed concern about the fed (that's the US Federal Reserve Bank) printing so much money. That's were they're gettin money from lately, by the way; it's getting harder and harder to borrow. If the dollar drops (the inevitable consequence of artificially inflating the money supply), China's markers loose their value too. How far will they let their investment fall before doing something? What will they do? Do you know? Does President Obama? Does anyone? It's not scaremongering if it's the truth.

So what's the solution? I certainly don't know. But I do know when you're neck deep in debt you don't borrow (or print) a bunch more money to buy something you can't afford otherwise.

If I've missed the part where President Obama and the congress have explained how they're going to do this without spending money, please let me know. I hear President Obama say he's NOT going to raise taxes on those making less than $250 grand per year, while his advisors say you can never say never, and that nothing is off limits. Who do we believe?

Posted by: Alex Deam | August 16, 2009 4:57 AM

Right, and everything proponents of health care reform say is the God's honest truth.

There's a huge difference between any Democrats out there that might be telling a few porkies or adding some spin to their proposals, and Republicans scaremongering about "death panels" or talk show hosts comparing Obama to Hitler. All untruths were not created equal.

Holy shit dude! Can you get more one sided? Listen, I was AT the town hall meeting in Saint Louis where six people were arrested, and they weren't the people arguing against health care reform. I was there and saw the ordinary folk (the ones there to complain) being turned away at the front door by Carnahan's organizers because the "hall is full," while the folks wearing union shirts were being let in the side door. If you can't see culpability on both sides of this debate you are truly in for a long, disappointing life.

And you expect the rest of us here to know about your anecdote from Saint Louis, why?

Not everyone who opposes the health care reform bills being pushed is a looney. Yes, there are a few, just as there are on the other side of the debate.

Please point me to the left/liberal version of comparing Obama to Hitler, or claiming that Obama wants to kill your Grandma.

I've pretty clearly stated my opinion I think we should start with controlling costs, then look at ways to increase the numbers of insured people because that's probably the best way to keep costs down over the long run.

The main reason that there are 47 million uninsured is cost. You don't seem to realise that US health care currently costs twice as much for far fewer people in proportion to the size of the country compared to the rest of the developed world. Why you can't see that it's not impossible for health care costs to be lower with reforms and be universal, is beyond me.

Going strictly from history, our gov't has been notoriously bad at estimating and managing program costs. For some reason (well, we both know the reason), costs always seem to exceed estimates.

Are you sure? What about:

The estimated cost of compliance with the acid rain control provisions in the Clean Air Act of 1990 were much lower than EPA predicted. The “annual cost of the program was expected to be $2.7 billion — 4.0 billion.” Yet an EPA analysis a decade later determined that the actual cost of cutting sulfur emissions by 40 percent was substantially lower—“$1 to $2 billion per year, just one quarter of original EPA estimates.”

http://climateprogress.org/2009/06/22/cbo-stunner-waxman-markey-postage-stamp-a-day-low-income-families-efficiency-savings/

And what is it about health care is half as cheap around the developed world that you find so hard to understand? Maybe Congress will underestimate the cost. But in all likelihood, the cost will still be lower than currently.

Given our government's current fiscal situation, I simply don't think we can give him the benefit of the doubt -- we can't afford to get this one wrong. We're already spending $1.8 trillion more than revenues this year, with an expected shortfall of some $3 trillion by the end of next year -- and that's before the proposed health care reform bills kick in. Trillion. With a T.

Yes, and reform is designed to get costs DOWN.

Our government's entire budget for 2006 was roughly $1 trillion.

Try again. 2006 US budget was $2.66 trillion.

By the end of next year, our government will have spent three times what it did for the entire year in 2006 over and above its normal expenditures!

Since you got the 2006 figure wrong, this stat is clearly false.

But anyway, who's fault is the massive deficit? Not Obama's, that's for sure.

And if you knew anything about the 2010 budget, you'd know that less debt will be accrued next year than this year.

And President Obama doesn't plan to get out of the red... ever as far as I can tell.

Then you can't tell very far.

Google US debt and China. The Chinese government HAS expressed concern about the fed (that's the US Federal Reserve Bank) printing so much money. That's were they're gettin money from lately, by the way; it's getting harder and harder to borrow.

Debt and printing money are very very different things. Printing money doesn't add to the debt.

And China has not expressed concern over "printing money". It expressed concern over the value of US treasuries, a very different thing again. And that didn't seem to get much mention after you guys had the Strategic Economic dialogue or whatever it's called.

artificially inflating the money supply

Please explain what "naturally" inflating the money supply would entail? Leaves as greenbacks?

So what's the solution? I certainly don't know. But I do know when you're neck deep in debt you don't borrow (or print) a bunch more money to buy something you can't afford otherwise.

You have your own personal monetary printing press?

You have heard of Keynesian economics, haven't you? What makes sense to you when you're in debt doesn't make sense for society as a whole in a recession.

If I've missed the part where President Obama and the congress have explained how they're going to do this without spending money, please let me know. I hear President Obama say he's NOT going to raise taxes on those making less than $250 grand per year, while his advisors say you can never say never, and that nothing is off limits. Who do we believe?

Stop concern trolling and go actually look at what's being proposed.

Posted by: Robin Levett | August 16, 2009 6:30 AM

@Walton #453:

Erm... plenty of leftists compared Bush to Hitler, repeatedly, during Bush's presidency.

OK, then; name one. One caveat - make it a mainstream Dem figure, say a VP candidate or a headline speaker at a Dem national convention. Then set out the circumstances of the comparison; was it because of Bush's habit of riding roughshod over the USA Constitution when he felt it necessary, or because Bush was proposing major reform that would help the poorest segment of US society in a way that might hit major donors to the Dem party in the pocket?

Can you do that for me? Just to show how objective you are; we Brits are, after all, in favour of fair play.

Posted by: Robin Levett | August 16, 2009 1:59 PM

@Mark #455:

The bottom line is this: I think there is much to be gained by looking at other ways of accomplishing health care coverage for all without resorting to gov't-provided care.

How do you provide health coverage for someone who cannot even afford insurance without "resorting to gov't provided care"?

I've read your claims that the US government, uniquely in the Western world, is unable to run any programme effectively. Even if that is true, is that possibly because in refusing to commit the resources necessary to run anything properly the great American voter ensures it can only ever be run badly? The US spends more than twice as much per head of population as the UK with measurably worse outcomes in child mortality, life expectancy and even such things as cancer mortality; and that's with health care (outside emergency services) in private hands.

Posted by: Lareina | August 16, 2009 2:33 PM

One of my best friends gave birth to her firstborn son in England and then about 4 years later she gave birth to her second son in US. She said that the difference in health care was huge!
I'll take American health care in a capitalistic society any day over Rationed non-Care!

Posted by: Ema Nymton | August 16, 2009 4:23 PM

Wow, Lareina is a lying fuck who showed up to shit all over this thread! Nice to have you, Lareina!

Posted by: Walton | August 16, 2009 4:36 PM

OK, then; name one. One caveat - make it a mainstream Dem figure, say a VP candidate or a headline speaker at a Dem national convention.

While I can't think of a leading Democratic politician who openly compared Bush to Hitler, I would note that Michael Moore made a film, Fahrenheit 9/11, full of irresponsible conspiracy-mongering and outright lies - and subsequently became the guest of honour at the Democratic National Convention, and was seated next to Jimmy Carter. Not to mention all the nonsense about "how much did Bush know about 9/11?", nonsense which was inflamed by Howard Dean, among others.

Don't get me wrong. The likes of Limbaugh are no better. Indeed, from the perspective of an external observer, the overwhelming impression is that Rush Limbaugh and Michael Moore are exactly the same kind of person; they just picked different sides in the battle. But both are equally willing to lie, talk bullshit, and use irresponsible hyperbole when it suits their agendas. It's the dark side of partisan politics.

Obama, I believe, is an honourable man who would not stoop to that level. So are many leading Republicans. But in the end, the partisan warriors on both sides are equally culpable.

Posted by: Kim Beach | August 16, 2009 4:47 PM

Tasha said: "I can choose my personal doctor in the US. I was actually amazed when we moved and I could actually research doctors and have a choice. In Calgary (where we moved from), you get whoever is on call when you go to the walk-in clinic. Forget having a family doctor. You get who you get."

You can choose your personal doctor in Alberta still. Walk-in clinics are, by definition "you get whoever is on call." There is no restriction on who we choose as a family doctor, except that some are overbooked and are not taking new patients. But there are always others who are. "You get who you get" is not an accurate statement as far as choice goes, EXCEPT in the already cited example of the walk-in clinic. Incidentally, if you want to see your family doctor but can't get in right away, you can ask his nurse what day he/she is at the walk-in and see him/her that day. I've done that repeatedly and it's not always a long ordeal (and that's what novels are for). I find it a bit distressing that there are rumours flying around indicating that we don't have a choice of doctors up here. We do. We are free to research and choose who we want to offer us care. The *only* restriction on that is whether or not the doctor is taking new patients.

Posted by: Robin Levett | August 16, 2009 5:07 PM

@Walton:

While I can't think of a leading Democratic politician who openly compared Bush to Hitler...

to:

But in the end, the partisan warriors on both sides are equally culpable.

Hmm. Sarah Palin compares Obama to Hitler over health care reforms, you can't find any prominent Dem politician making an equivalent comparison - and yet they are "equally culpable".

Just give up, Walton - admit you're wrong and move on.

One other thing; on your blog you claim that"Some of this criticism is justified; in particular, survival rates for many cancers are lower in Britain than in the United States..."

Survival rates are a function of early diagnosis as much as quality of subsequent care. The US has a mania for early diagnosis of things like prostate cancer which wildly distort the figures. Compare cancer mortality, however, and guess which system comes out on top? The one which actually treats 100% and not 85% of its population, of course.

Posted by: Walton | August 16, 2009 5:27 PM

Survival rates are a function of early diagnosis as much as quality of subsequent care. The US has a mania for early diagnosis of things like prostate cancer which wildly distort the figures.

Maybe I'm misunderstanding you, since I'm not an oncologist. But surely if early diagnosis leads to more people surviving, then a "mania for early diagnosis" is a good thing?

Hmm. Sarah Palin compares Obama to Hitler over health care reforms, you can't find any prominent Dem politician making an equivalent comparison - and yet they are "equally culpable".

Did Palin compare Obama to Hitler? She did talk a lot of hyperbolic nonsense about "death panels", which I have repeatedly condemned here and on my own blog, but I can't find any Hitler comparisons.

Rush Limbaugh did compare Obama to Hitler, but, as I pointed out earlier, this is no different from Michael Moore comparing Bush to Hitler; both Limbaugh and Moore are equally given to wild hysteria and distortion, and both have egos significantly larger than their intellects.

Posted by: Robin Levett | August 16, 2009 6:15 PM

@Walton #468:

Maybe I'm misunderstanding you, since I'm not an oncologist. But surely if early diagnosis leads to more people surviving, then a "mania for early diagnosis" is a good thing?

It doesn't - it simply starts the clock ticking earlier. Survival rates are the percentage surviving for a given period - usually 5 years - from diagnosis. If you diagnose earlier, and then give exactly the same care at exactly the same time with exactly the same health outcome, you get a better result simply because the diagnosis was earlier.

Mortality rates tell you how many die of the disease - which is at least in part a function of the quality of care given - and cancer mortality is lower in the UK.

Did Palin compare Obama to Hitler? She did talk a lot of hyperbolic nonsense about "death panels", which I have repeatedly condemned here and on my own blog, but I can't find any Hitler comparisons.

Compartmentalisation is your friend. No, Palin didn't make that comparison in so many words. The reference to "death panels", however, was such a comparison; death panels deciding who lives or dies depending on their worth to society? Is that anything other than an allusion to Nazi eugenics?

Rush Limbaugh did compare Obama to Hitler, but, as I pointed out earlier, this is no different from Michael Moore comparing Bush to Hitler

I asked for the context. Remember that Limbaugh is calling Obama a Nazi for trying to extend health care to the tens of millions of US citizens who can't currently afford it. What was the context of Moore's comparison?

Posted by: SimonC | August 16, 2009 7:19 PM

Alan @ 315: Fine. Stop using our roads, and our sewage systems, and our military, and our police, and our fire service, and our schools, and our science, and our medical research, you rugged individualist. I assume you won't be using any technological advances created by 'society', so if you can find a pharyngulite in your neighbourhood you can surrender your computer, TV, phone, air-con, medications and all the other stuff you didn't create 'ex nihilo'.
What? You actually got an education for free? Someone taught you to read and write? FOR FREE? Someone on Pharyngula actually paid for that. Can you please stop using OUR education against us, after all, we did pay for it. Wake up to reality - you ARE part of a community.

Posted by: Jadehawk, OM | August 16, 2009 7:42 PM

I won't respond to this thread because I promised myself to try to keep stress levels as low as possible, but this simply screams for highlighting:

I say if I must have it to live my life, enjoy liberty and pursue happiness, then it is a right ordained by the US Constitution.

And this includes the right to drive a car, but excludes the right not to die or go bankrupt from medical bills? WTF?

Posted by: Mark | August 16, 2009 8:18 PM

Robin Levett @456, I never said we wouldn't have to have some form of gov't provided care -- we do already. People can simply walk into any emergency room in the country, even if they have no money or health insurance. What I argue against is mandated, gov't provided health insurance for everyone.

And America isn't unique in the western world in its ability to fuck up a wet dream when it comes to efficiently administering large, expensive programs. I'm sure you can think of a few examples in your own country.

As far as whether people one side of the argument or the other are behaving badly, it seems the sum of your (and others') argument is 'our guys/gals lie and exaggerate less than yours.' Is that it? It's ok for the people on one side to lie and exaggerate as long as they do it less, and their intentions are better, than the other side.

I'm sure this is the same logic Nancy Pelosi used when she wrote her article in USA Today accusing those opposing health care reform of being un-American. This despite the fact that people getting loud and obnoxious and behaving badly to get political attention is one of the most time-honored American activities in our history.

I'm sure the King's men thought Sam Adams was loud and obnoxious when he got the Boston rowdies riled up a few hundred years ago. I'm sure many people in government at the time thought Martin Luther King was using his political power for un-American purposes. I'm sure Abbie Hoffman gave many people in the government fits with his hyperbole and civil disobedience.

And before anyone goes ballistic with indignity, no I don't compare the stature of those opposing health care reform with those I mentioned in the previous paragraph. I only draw comparisons in that those giants ALSO were thought to be rabble rousers behaving badly to get their political message heard -- an activity with a long and rich history in this country.

Some have mentioned the fact that certain members of the current adminstration have been called 'fascists' by a few of the more vocal and demonstrative opposers of health care reform. How did Nancy respond? By suggesting protesters were un-American. If I recall my history correctly, one of the keystone tenets of a Fascist regime is the suppression of opposing polical views.

I don't believe Nancy Pelosi is a Fascist, or a Nazi, but the irony of the situation makes me smile. One thinks she might do well to check out the wikipedia page on Fascism before she writes another Op-Ed condemning her fellow Americans for speaking out...

Posted by: Bobber | August 16, 2009 8:28 PM

I'm sure this is the same logic Nancy Pelosi used when she wrote her article in USA Today accusing those opposing health care reform of being un-American.

Liar. This is what she wrote. She invites debate - but not people preventing debate and using threats of violence to keep productive debate from occurring. You can oppose health care reform - but debate is democratic, not thuggery and intimidation, which is Fascistic. Which is why I won't engage you any longer - your posts have never addressed a question, you are only interested in pontificating.

We believe it is healthy for such a historic effort to be subject to so much scrutiny and debate. The failure of past attempts is a reminder that health insurance reform is a defining moment in our nation's history — it is well worth the time it takes to get it right. We are confident that we will get this right.

Already, three House committees have passed this critical legislation and over August, the two of us will work closely with those three committees to produce one strong piece of legislation that the House will approve in September.

In the meantime, as members of Congress spend time at home during August, they are talking with their constituents about reform. The dialogue between elected representatives and constituents is at the heart of our democracy and plays an integral role in assuring that the legislation we write reflects the genuine needs and concerns of the people we represent.

However, it is now evident that an ugly campaign is underway not merely to misrepresent the health insurance reform legislation, but to disrupt public meetings and prevent members of Congress and constituents from conducting a civil dialogue. These tactics have included hanging in effigy one Democratic member of Congress in Maryland and protesters holding a sign displaying a tombstone with the name of another congressman in Texas, where protesters also shouted "Just say no!" drowning out those who wanted to hold a substantive discussion.

These disruptions are occurring because opponents are afraid not just of differing views — but of the facts themselves. Drowning out opposing views is simply un-American. Drowning out the facts is how we failed at this task for decades.

Source: http://blogs.usatoday.com/oped/2009/08/unamerican-attacks-cant-derail-health-care-debate-.html

Posted by: Mark | August 16, 2009 8:52 PM

Bobber: Saying you welcome debate on the one hand while accusing those raising questions of being un-American is bit facetious don't you think?

Let's review. Nancy said:

"However, it is now evident that an ugly campaign is underway not merely to misrepresent the health insurance reform legislation, but to disrupt public meetings and prevent members of Congress and constituents from conducting a civil dialogue. These tactics have included hanging in effigy one Democratic member of Congress in Maryland and protesters holding a sign displaying a tombstone with the name of another congressman in Texas, where protesters also shouted "Just say no!" drowning out those who wanted to hold a substantive discussion."

How is this different from any of the many acts of civil disobedience and rowdy behavior proponents of one point of view or another have engaged in throughout American history? And she fails to mention that her supporters have engaged in the very same kinds of activities in attempting to 'drown out' the protesters. If you believe what she's saying here you're as big a hypocrite as she is.

"These disruptions are occurring because opponents are afraid not just of differing views — but of the facts themselves. Drowning out opposing views is simply un-American. Drowning out the facts is how we failed at this task for decades."

And again, her comment is supremely disengenous. I'll repeat, she has the bully pulpit from which to clarify all the misinformation and lies. She doesn't need to listen to any disrespectful outbursts, she can just call a press conference and clear things up for us.

You're arguments are getting shrill and thin, and you've resorted to insults to play to your audience in an effort bolster your weak position. You say I've not responded to a question, only pontificated. Go back and read the thread, nearly all my comments have been in response to questions or comments in opposition to me.

Your continuing harangue boils down to "our mouthpieces are nicer than yours," a silly and pointless argument at best. Perhaps it IS time for you to take your toys and go home.

Posted by: Bobber | August 16, 2009 9:05 PM

Go back and read the thread, nearly all my comments have been in response to questions or comments in opposition to me.

Answer these:

(a) Do you believe President Obama is a natural-born citizen of the United States?

(b) Do you think Bill O'Reilly and/or Lou Dobbs are honest and right most of the time?

(c) Do you think Martin Luther King, Sam Adams, and Abbie Hoffman would be FOR government-funded health care insurance for the masses, or against it? (Hint: it's not enough to be loud. You need to be loud for the right reasons.)

(d) Is it appropriate for death threats to be made to my congressman, Brad Miller, because instead of holding a general town meeting, he decided to set up individual meetings? Do you know that no one on the anti-health care reform side signed up for a meeting? Do you think it's because they couldn't make a public spectacle and get their faces on t.v., which is the tactic being used by these fringers to make their "movement" appear bigger than it is?

So, answer THOSE questions.

Posted by: Mark | August 16, 2009 10:52 PM

Bobber:

Question a) Irrelevent to this discussion. But if you insist, yes, I have enough faith in our gov't investigative services to get that right.

Question b) Again, irrelevent. My answer is I don't know, I don't listen to or read either one of them to have an opinion.

Question c) Three irrelevent in a row. My answer is I haven't a clue how they would feel about this issue today -- these are much different times than they lived in. If you are asking me if I think they would have been for President Obama's health care reform proposal in THEIR time, I would say 1) Sam Adams, no. 2) Abbie Hoffman and MLK, doubt it... not enough federal money then and too many more important issues. (And that lack of attention problem pops up again: I never said ALL opponents of President Obama's health care reform proposal are right, only that they are absolutely within their rights to voice their opinion. HINT: The fact that you don't agree with someone doesn't make them wrong.)

Question d) No, it's asinine and counterproductive to issue death threats, not to mention morally wrong and illegal. As for the rest of the questions under 'd,' I have no idea what you're talking about, so I can't respond. BTW, if you think Brad Miller would like to speak with me personally, I'd be happy to!

And 'Tis Himself, if you have read my comments, then you are as obtuse as Bobber (intentionally or not). Saying I oppose a universal, single-payer, gov't-mandated and sponsored health insurance system (at this time) is not the same as saying I don't believe everyone should have access to adequate health care. I've clarified this point time after time -- you tossing around inaccurate labels and insults won't change that fact.

Let me ask you a question: Do you live in America? If so, do you believe you and the people you know could live the lives you're living without access to private transporation? And if you don't live in American then shut the fuck up about driving as a priviledge, you know not of what you speak.

For the record, sigh, once again: I believe everyone should have adequate access to health care. I believe everyone DOES have access to health care in the US, it just costs too much. I believe the ideal of a single-payer system MAY prove to be the only approach to managing costs in the long run. And finally, I simply don't believe the current reform proposals being debated offer viable, long-term solutions to the current problem of too expensive health care in America.

Posted by: Walton | August 17, 2009 5:30 AM

I say if I must have it to live my life, enjoy liberty and pursue happiness, then it is a right ordained by the US Constitution.

I have to disagree with this. Rights do not entitle you to be given the things you need for free at the expense of other people. Rather, they define what other people may not do to you. The government may not lock you up without trial, inflict cruel or unusual punishment on you, steal your property, restrict your right to freedom of expression or of religion, or take away your guns.

I would therefore disagree with Mark: there is certainly no "right", on any level, to drive a car. Firstly, you must be able to afford to buy and operate a car for yourself; and, secondly, it is legitimate for the state to prevent you from driving unless you are competent to do so without endangering the lives and safety of others. Hence why driver licensing requirements, anti-drink-driving laws, and other such regulations are completely legitimate.

Re healthcare: I realise it will be unpopular in these parts to say this, but I do not believe there is, or ought to be, a "right" to healthcare. By this, I do not necessarily mean that the government should not provide healthcare; as I've said elsewhere, I think the government should provide healthcare to those who can't otherwise afford it. But what does it mean to claim that healthcare is a "right"? For the term "right to healthcare" to be meaningful, it would have to confer on every citizen the legal right to go to court and demand to be provided with healthcare. Clearly this would be highly impractical; the resources simply do not exist to provide everyone with all the healthcare they need.

So when we say that there is a "right" to healthcare, what we really mean is that our policy goal is for everyone to have access to healthcare. It is misleading, therefore, to describe it as a "right". It is not a fundamental, judicially-enforceable right of every individual, like the right to a fair trial or to freedom of expression. Rather, healthcare is something that we try, as far as resources allow, to provide to every individual. Hence why I wouldn't describe it as a right.

Posted by: Mark | August 17, 2009 8:22 AM

Walton: The discussion was about the right to drive, not the right to own. I said that given the dearth of public transportation and distances, personal transportation is a must in the US to live and prosper. In this regard, a license to drive should indeed be considered an individual right.

Bobber: I get it... People you agree with are GOOD, they are fighting the good fight -- everyone else should just shut the fuck up. You're sounding more like Nancy Pelosi all the time. Good on ya!

BTW, I haven't villified anyone as a liar; I'll leave the insightful character analyses to you.

Your continuing failed attempts to lump me with the loonies is as pathetic as your attempt to bait me with insult and innuendo. What I don't understand is why you keep trying. Perhaps you can't stand the thought that someone with whom you disagree might actually have a point worth listening to.

Despite your personal invective, I sincerely empathize with your financial situation; many of us are suffering through these trying times. I would ask this though: How would trading your car for free health care help if you couldn't drive to get to the doctor's office? And you think MY analogy is bullshit?

BTW, didn't you say you weren't going to engage me further (twice)? Isn't it about time? It seems like you need a break...

Posted by: Robin Levett | August 17, 2009 5:06 PM

@Mark #476:

I never said we wouldn't have to have some form of gov't provided care -- we do already. People can simply walk into any emergency room in the country, even if they have no money or health insurance. What I argue against is mandated, gov't provided health insurance for everyone.

Nobody is proposing what you now claim you argue against, but moving on: your comment to which I replied was:

The bottom line is this: I think there is much to be gained by looking at other ways of accomplishing health care coverage for all without resorting to gov't-provided care.

So you don't want to resort to government-provided health care; so how would you provide universal health coverage?

Emergency room care isn't the answer; it's the most expensive and least effective way of providing universal health coverage - waiting until a condition gets so bad that it is indeed an emergency guarantees that the victim is off work for longer, has a worse health outcome and has to have more care simply to keep him alive than earlier treatment would permit.

Again - how are you going to provide universal health coverage?

Posted by: Robin Levett | August 20, 2009 2:10 AM

@Mark:

...the best health care system will include the minimum government regulation to ensure consumer protections while allowing providers to compete in the market. This will bring costs down...

Ooookkaaayyy. Assume I'm not a libertarian, so this is not an articles of faith. Explain to me exactly how reducing government regulation reduces health care costs.

Posted by: Steve_C | August 20, 2009 10:36 AM

http://www.youtube.com/watch?v=nYlZiWK2Iy8

Barney Frank laying a smack down.

Posted by: Steve_C | August 20, 2009 2:53 PM

Well if they staffed up to deal with the backlog you guys would bitch about bigger government.

Those dealerships got a lot of business and NOW they're pulling out. We are talking about car salesmen... not the most forthright group in the marketplace.

Posted by: Robin Levett | August 24, 2009 2:41 AM

@Mark @493:

Sorry = trying to carry on too many on-line conversations, and to have a real life as well...

Just a couple of short points in the meantime; firstly, the high-deductible scheme you propose is already legal under US law - I've had Whole Foods Inc's scheme quoted at me.

Secondly, on deregulation. Insurers, even more than bank managers, are people who are quite happy to hire you an umbrella while the sun is shining, but only on terms that require its return when the first drop of rain falls (if we don't agree on that, then one of us isn't living in the real world); indeed, that's where they make their money. How does deregulation improve that position? Why was regulation imposed in the first place?

Posted by: Robin Levett | August 24, 2009 8:38 AM

@Mark #493:

It's no secret that a tremendous amount of waste in the current system can be traced to the number of unnecessary tests and procedures doctors prescribe.

Then there will be widely available validated figures for this waste to which you can provide a reference?

Oh, and here's why a high-deductible scheme isn't the win-win situation you claim.

What you are doing with such a scheme is having the members self-insure for the lowest slice of liability. They will still be paying the same global premium annually.

The eventual claimant who suffers serious ill-health will however have only a fraction of the amount of money in his HSA that is required to cover the deductible.

Why do I say that? Because all that premium that is being paid into individual HSAs isn't (as it would have been in the low-deductible scheme) available in the health insurer's funds to pay for his treatment; it's sitting in the HSAs of those members who haven't suffered the illness and have suffered from no insured risk.

The only way to avoid that position is to ensure that at all times your HSA contains enough money to cover the deductible. That means, however, that overall the group is spending far more money on healthcare than is necessary; everybody's HSA could then pay the deductible, but only a few are actually going to be called upon to do so, so there cash sitting around in HSAs that will never be used, and everybody has paid more per annum than under the low-deductible scheme.

As for the idea that an individual acting on his own has more incentive or market clout to bring down costs than does a health insurer; all I can ask is what colour the sky is in your world (here in the real world it's currently blue). If an individual can bring can bring down the cost of a given treatment (say one that's prescribed 10 million times per annum in the US) by a dollar, he can take it or leave it; only some will be motivated to make the effort. If the insurer can bring down that same cost by that same dollar, it can increase profits by $10 million; and a big insurer is in a position to dictate terms to healthcare providers.

Posted by: Robin Levett | August 26, 2009 2:44 AM

@Mark #501:

Just time for a quick one:

Assume I purchase a policy with a deductible of $5000. If I faithfully deposit $100 per month into an HSA I'll have enough to cover the deductible in around four years, less if I deposit more.

You are missing my point; the premium for that first $5,000 coverage will be very considerably more than $1,200 per annum. It cannot possibly be less, simply because of the way insurers and premiums work.

Again, if you have a serious illness within the first 4 years, you will not have the cash in the HSA to cover it. For $5,000 and if you're employed, that might not be a disaster - but $5,000 isn't a very high deductible.

More later - I have to go to work...

Posted by: Robin Levett | August 26, 2009 11:41 AM

@Mark #503:

Orszag's estimate isn't referenced at that URL - I've looked at a couple of transcripts of his evidence to congressional committees, but can't find it. Can you?

What I can find is (in his 21 June 2007 testimony) a concern that there isn't enough information (on comparative effectiveness of treatments) available to health insurers to enable them to limit the use of ineffective care. Without that information I can't see how the claim can be anything more than a guess, albeit informed.

Again, without a cite, I don't know what "tests and procedures" are referred to here; are the procedures diagnostic, or therapeutic?

What is clear is that high-deductible policies with HSAs created to cover the risk of paying the deductible will either be more expensive than low-deductible policies for the same cover, when all the HSA contributions are taken into account (because every member of the scheme creates his own pile of money to cover potential risk, rather then the insurer creating one such pool from premium income), or will provide less cover than the low-deductible policy, because any individual's HSA will not fully cover the potential outlay on deductible fully.

Your argument is that market forces exerted by the individual will be to reduce that potential outlay, because the member will be more careful with their own money; but it is far from clear that that reduction will reduce overall health expenditure sufficiently to overcome the inefficiency (in claims cover) introduced by the high-deductible policy. Your reliance upon Peter Orzag's guess suggests that you haven't actually considered this, but simply assumed that the market will provide.

One likely countervailing force is that once the deductible is high enough to cover the diagnostic tests now routinely carried out, the insurer will deny further cover unless all those tests are undergone, and will refuse cover to any member suffering complications arising from (its own definition of) undertreatment; on the basis that this will deter enough members with high value claims to make it financially worthwhile.

Posted by: Mark | August 27, 2009 1:37 PM

Here's another interesting idea:

http://www.nytimes.com/2009/08/26/business/economy/26leonhardt.html?_r=1&scp=2&sq=leonhardt&st=Search

Posted by: Robin Levett | August 28, 2009 11:37 AM

@Mark #505:

Another tidbit:

...preventative care actually INCREASED for users of consumer-driven plans

Whereas the study suggested:

This is likely due to the fact that most CDH plans provide commonly recognized preventive care with no charge to the participants. Several of the studies discussed increased messaging to CDH participants, which may account for some increased uptake in promoted preventive services.

...and goes on to point out that that is less generally the case with traditional plans.

Posted by: Mark | August 30, 2009 6:37 PM

Robin: I like the way you labeled the ideas I suggest 'libertarian,' the better to dismiss them out of hand.

If the per person healthcare costs in the US were brought down to (or below) those enjoyed by many European countries, wouldn't that make health care more accessible? If a person making $30,000 per year is currently paying roughly 1/6th of their income on health care, and we can reduce that fraction to 1/10th or 1/12th, doesn't that mean they can afford more or better health care?

The key, the ONLY key to sustaining long-term access to quality health care is keeping costs under control. This is true for a free-market as well as government-run systems. I simply do not believe my government, an organization which has demonstrated inept management capabilities for the majority of my adult life, can control costs.

BTW, have you seen the latest US deficit estimates? Apparently the previous estimates were a bit off -- like $2 trillion over the next ten years. I have no faith whatsoever in any cost projections coming from this administration.

Posted by: Mark | August 31, 2009 5:29 PM

Robin: Since the discussion is about health care it seemed relevent to be sure any stats used to quantify it are accurate, thus my post regarding longevity and infant mortality rates. What the data say about our society in general is another thing entirely, but it does point out that judging the relative efficacy of health care systems based on longevity and infant mortality provides skewed results unless corrected for a whole host of factors. Again, this is one of the reasons the WHO no longer ranks health care systems -- it's far too complex a problem.

Obviously, there are many different factors on which to rate the relative efficacy of health care systems. Which do we use? If cost is the only factor, then the US loses. Using other factors such as longevity, infant mortality and access don't provide a clear winner. I believe it is valid to say, health care in the US is expensive, but it's generally also very effective. Do people die due to untreated illness? Yes, just as in every country in the world. And just as in every other country in the world, they do so for many reasons other than availability of health care.

Regarding costs, I'm not sure how much more plainer I can put it. If the cost of health care goes down, it becomes more accessible by definition. If the cost of petrol in your country were to drop by 50% (for whatever reason), wouldn't you think that would make petrol more accessible to everyone?

You mention the numbers of people who can't obtain health care through their employers and those without jobs. Why IS health care insurance tied to employement in the US? Because that's the way unions like it; they pay tremendous sums of money to lobbyists to keep it that way. If health care insurance weren't tied to employment, it would be accessible whether one were working or not.

Part of the problem is who WANTS to be insured. Some estimates suggest that of the 50 or so million uninsured in the US, only 20% are uninsured by choice. That means 40 or so million are uninsured because they choose not to be, likely because they are young and healthy and choose to spend their money on something else. THAT probably has a great deal to do with cost of insurance, though likely little to do with overall cost per person since the uninsured have access to the ER just like everyone else. Part of Obama's plan is to get all those young, healthy folks on insurance plans to spread the cost. In effect, those young folks will be subsidizing older, sicker people. The right or the wrong of that is another discussion entirely, but I will say it seems there must be a balance between the individual needs of liberty and the collective needs of society.

As far as US medical research goes, you can post a link showing it is ineffective, and I can post another showing it not only is, but that countries around the world benefit greatly from it. There is a reason people around the world still come to the US for medical treatment; I've yet to hear about the droves of US citizens going outside the US for legitimate medical care they can't get in the US.

BTW, your link above doesn't say US medical research is ineffective, it says people outside of the medical community struggle to understand the benefit because it doesn't always directly result in cures. Research, however, as we both know, spawns a great many benefits not immediately obvious. I believe many here have made this point in support of greater government investment in science.

This discussion has provided an opportunity for me to clarify my thoughts about this subject, and I thank you for that. But the time involved, unfortunately, is becoming onerous. If you don't believe government regulation has an impact on US health care costs (administrators outnumber providers some two to one, estimates place administrative costs at some 30% of overall costs, the many billions spent annually on lobbying, etc.), then we are at an impasse. You are just as capable as I am to research the monetary impact of government regulation in the US healthcare system -- there are tens of thousands of pages regulating everything imaginable in the industry.

I don't say ALL government regulation is bad, it's just that the current volume of it provides easy opportunities for some to take unfair advantage in the market -- which many of our legislators are all to eager to provide for the right price.

For a good example of how well-intentioned government regulation skews market competition, read this:

http://www.latimes.com/business/la-fi-mattel28-2009aug28,0,2679974.story

Again Robin, I thank you for taking the time to discuss this. I must say, I'm impressed you've taken so much interest in the health care system of another country. Either you don't sleep much, or you have a great deal more free time than I do! Adios!