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The coming health care fight - questions for the left
Posted by: McQ on Thursday, December 27, 2007

Dovetailing nicely with my reference to some Iowans wanting to know how government is going to "fix" their life, we have this from the Boston Globe:
The stark difference between the parties is reflected in the findings of a Boston Globe poll of likely voters in the Jan. 8 New Hampshire presidential primary - 80 percent of Democrats polled say providing health coverage is government's responsibility; only 30 percent of Republicans agree. Moreover, it explains the dramatically divergent healthcare proposals of the candidates - Democrats would move toward universal coverage and a larger government role; Republicans generally favor tax incentives to expand private insurance and restrain costs through market forces.
It is an attitude which is becoming more and more pervasive on the left (and, with 30% of NH Republicans agreeing, not unknown on the right).

My question to the left is why is government the instrument of choice when it comes to your personal life? Is it the fact that after years and years of paying it lip-service you've finally internalized the "radical egalitarian" ideology which puts "fairness" over practicality, liberty and freedom of choice and leads to hugely inefficient centralized bureaucratic systems which were a hallmark of such "egalitarian" regimes as the USSR?

I for one can't imagine, regardless of how poor I may think our present health care system is (and, for the record, I don't think it is poor at all) that government intervention or control would somehow make it better? Why do you?

What is it that drives the left to consider the government to be the best choice to deliver health care? Have you thought past the point of government control to attempt to understand how it will effect physicans, other health care providers, hospitals, pharma and health care technology? For instance, how will it provide the incentive for innovation if it essentially removes the incentive of profit from the mix? And how about the level of care provided?

Since we're talking about infinite want/need (with few barriers to preclude seeking satisfaction of those wants/needs) meeting the finite resources of health care provision, how will the government choose to ration health care? Because it will.

Did you know that 5% of the population spends nearly 60% of the health care dollars (and 10% spend 70%). In fact, .5% spend 25%. How do we address these numbers through government? Is this where government will choose to begin rationing care? (Stats from "Health Care Reform Now! A Prescription for Change" by George Halvorson, pg. 2, Jossey-Bass,2007)

Did you know we have 50% of our population spending only 3% of our health care dollars (with 15% spending zero dollars per year)? Of course these are the people who will end up footing the bill for that 10% above. And with 15% spending nothing on health care it certainly brings to the fore the question of why those people may not have health insurance or see any need for it (I also find it interesting that taking the highest number of "uninsured" bandied about, 45 million, just happens to be about 15% of the population.).

However, under a universal government program, it will just be another in a long line of choices they'll no longer have, won't it?

I'd love to see some of our more left leaning commenters weigh in on these questions. Why is the so-called "party of choice" - i.e. the Democrats - preparing to take yet another choice away from the people by mandating government controlled health care?

More importantly, why do you think it is government's responsibility to provide it?
 
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I’d also suggest our universal health care advocates read this article:

Moral Health Care vs. “Universal Health Care”

One of the authors (Paul Hsieh, who publishes geekpress.com) is a physician and the other is a lawyer.
 
Written By: Billy Hollis
URL: http://
I ran into an article last night on AOL that dealt with retirement. The writer of the article was
naming what she thought were the 10 worst places to retire. This section of the article really caught my eye. It deals with Austin, Texas. Here is the section describing why Austin might not be the best place to retire:

Austin, Texas: Hard Time Getting a Doctor who Takes Medicare.
The rate Medicare pays doctors is so low that many are refusing to take new Medicare patients. That used to be a problem primarily for rural areas, but now it’s spreading to cities. Nationwide the number of family doctors taking new Medicare patients declined from 84% in 2000 to 76% in 2003, according to the American Academy of Family Physicians.

A 2006 Texas Medical Association survey found that only 43% of Austin doctors would take new Medicare patients. (The numbers aren’t much better in Denver, where a 2001 survey by the Denver Medical Society and the HealthOne Alliance Foundation found only 40% of doctors were open to new Medicare patients.)


Here is a link to the article

http://money.aol.com/retirement/worst-places-to-retire


I’ve often wondered how the government would be able to force Doctors to work for a specific fee, and what they would do if the Physicians refused? Would they make it illegal to refuse? Wouldn’t this possibly increase the odds that fewer people might want to go into medicine? Sure, you can negotiate, but what if Physicians decide it’s just not worth it? What do you do then?

Start importing Doctors from other countries that will work cheaper? What happens when they decide it’s not worth it?

Whenever I start to consider Universal Health Care, I always remind myself that government didn’t end poverty, government hasn’t closed the test gaps, social security isn’t looking so rosy, all which lead me to believe that Universal health care may turn out quite as well as some hope it will.

 
Written By: autot
URL: http://
"The state is that great fiction by which everyone attempts to live at the expense of everyone else."

(Frederick Bastiat)

It’s just exactly that simple, Bruce.
 
Written By: Billy Beck
URL: http://www.two—four.net/weblog.php
You posed a significant number of questions, many of which had to do with an errant premise.

The collectivists destruction of the health care system is simply another form of taking power. It has nothing to do with increasing the quality or delivery of health care.

As Rand clearly stated, "Why do you think that "life" is their goal?"
 
Written By: blackwing1
URL: http://
From different items i have read, basicly Great Britian imports a large number of their doctors. The exact same thing could happen here under this so called universial system.
 
Written By: navyvet
URL: http://www.yahoo.com
some of our more left leaning commenters weigh in on these questions.

Your left-leaning commenters, huh? Like, both of them?

It seems like no one wants to play, probably because we’re bored with all the fair and open-minded debate.

If you’re actually looking to hear empirical and logical responses to your questions, you might have to take some further effort, like guest posting on a left-leaning health care blogsite.

My money’s on you not really asking questions, just pushing the bogus frames out in question format to your like-minded audience and taking the silence as some imaginary admission of defeat by the entire global community.


But leaving all that cynicism aside, you’re not going to have smart, informed leftists leaving detailed answers to your questions, because they don’t read Q & O.

Questions like these probably aren’t going to increase my interest in untangling and looking up answers, either:

Is it the fact that after years and years of paying it lip-service you’ve finally internalized the "radical egalitarian" ideology which puts "fairness" over practicality, liberty and freedom of choice and leads to hugely inefficient centralized bureaucratic systems which were a hallmark of such "egalitarian" regimes as the USSR?

It’s probably not because we love the USSR and want to enslave Americans. I mean, what do we have here? Your ideological conviction that ’liberty’ and ’practicality’ are in conflict with ’fairness’ and that all moral people will therefore let poor people die of curable diseases on the street?

Of course, if someone’s running a sex club that creates traffic in your residential area, then who suddenly because the advocates of "fairness" over "freedom of choice"?

People aren’t interested in being free to catch any debilitating disease of their choice and then exercising their freedom to suffer and die at its hands, or cut out cancerous limbs with steak knives on their kitchen floors.
Your ideological hand-waving at this general level is literally useless in discussing actual problems.

I mean, seriously. Do you think the answers are somehow different from "leftists don’t want people to get sick and die without help for no reason?" Let’s see, other stock answers, ... they don’t believe in the various negative consequences you speculate on and/or don’t consider them important.. the "party of choice" thinks that more people are bothered more seriously by wanting health care and not having it than will be bothered by not wanting health care and being mandated to have it... anything here that’s not blindingly obvious reasons why people would do these things?

I mean, do you really want to seriously study this at all? What kind of answers do you think you’re going to get from your freak*ng blog? Why don’t you go read some research and policy papers by health-care reform advocates? I mean, this lame, generalist answer to your lame, ideological questions is probably the best thing you’re going to get.


 
Written By: glasnost
URL: http://
Ten years ago, I’d have said yes let’s go for it. Maybe single payer, maybe something like what Germany has, or the Clinton Administration proposed in the early nineties (or we could go back to the Nixon proposal of the 1970s). However, even as the country has moved closer and closer to embracing such a system, I’m having my doubts. At the very least, we have to be careful what we construct, it’s hard to dismantle something once its built. First, we are not France or Germany. We have nearly three times the population of those two states combined, covering a large area of geography. The idea of one centralized government agency being able to coordinate such a policy efficiently and without fraud is simply not credible. And though states like Massachusetts are experimenting with state insurance, most states cannot afford such coverages, states are almost universally strapped for funds. Perhaps a different approach would work better.

The President in 2009 should call a Health Summit of leading hospitals, the AMA, insurance companies, patient advocates and other interested parties to try to craft a way to achieve the goal of assuring health care for all Americans without financially strapping the poor or creating a gigantic government agency. The President should lay down a challenge: The American people want quality heath care, affordable, and available to everyone. Many want a national health care plan, and Congress will take that issue up. But perhaps you stakeholders can come up with an alternative that may be more effective and which will be transparent and can be assessed.

If nothing useful comes out of the summit, the fall back position would be to focus on helping states develop their own plan, as well as a formula to free up some federal funds to aid states, with states given a lot of latitude on how they go about things (though not on how much funding they can get). The idea here is that small bureaucracies at the state level will be more effective than a massive federal bureaucracy, and as different states try different things, it will provide a wealth of data about what works and doesn’t work. It’s messier to figure out than simply creating a federal system, and the funding issues could be really tricky. The best bet is to see whether or not, given the public shift towards wanting major reform in the health industry, the relevant players can’t themselves figure out a plan they can make work with government only involved in assuring transparency and assessing that the plan does as promised.
 
Written By: Scott Erb
URL: http://faculty.umf.maine.edu/~erb/blog.htm
I see the Glasnost Fish Market is running a special today on red herrings.
 
Written By: Steverino
URL: http://
The some European countries ration care now by excluding older people from expensive measures such as bypass surgery and yet their government health systems are still going bankrupt. And that is with the US shouldering their major defense obligations freeing more of their budgets for social programs. Hey, the elderly are non-contributing members of society and are not paying their way say some European pundits. I have yet to hear of anyone asking our candidates for President, who want government health care, how they are going to keep from following the same path of rationing that we see in other socialized medicine programs.

After all of the concern expressed about the 17 year old, Krikor Sarkisyan, who died after being denied a liver transplant by her health insurer, Cigna HealCare, considered an experimental procedure by some because since she had leukemia and the known counter effects of each post-operative medical treatment (facts left out in many news reports I heard), why isn’t this a question to candidates and why isn’t the media comparing that situation to ones in England or Germany to see how it might have been handled? When 80 percent of Democrats (30% of Republicans) polled say providing health coverage is government’s responsibility, we would appear to be headed in that direction, especially if a Democrat is elected. At least the Sarkisyan family can sue to penalize the insurance company and in-effect correct the situation for the next person; try that with the government. And does anyone, who doesn’t live in a void, believe that government bean counters are better than the private ones.

While I disagree with the end product of what Mr. Erb’s proposes, it is better than I have heard from presidential candidates.
 
Written By: AMR
URL: http://
But leaving all that cynicism aside, you’re not going to have smart, informed leftists leaving detailed answers to your questions, because they don’t read Q & O.
And Glasnost certainly proves it...
 
Written By: shark
URL: http://
So tell me again why I sacrificed for over 5 years of College for two degrees, because I’m not seeing it anymore.

Tell me again why I work 50+ hrs a week at my 40/hr week job, because I’m not seeing it anymore.
 
Written By: jpm100
URL: http://
I offer this not to agree with the Democratic conclusions, but to clarify the arguments.

While there’s certainly quite a lot of anecdotal evidence for/against any given system, and various nations excel or fall behind in various statistical areas, it’s very hard to get around the fact that other major, developed nations have some form of universal health care, and they are not, in fact, falling apart. In fact, even the much-maligned Canadian health care system fares quite competitively with the US across a wide variety of areas. And they do it for far less.

Despite Righty claims about the inability of government to control costs, other health care systems have lower per-person expenditures. Yet, their outcomes and waiting times are generally better than those in the US. I’m quite sure we could trade anecdotes and niche statistics about each system for days on end, but it’s hard to see how most among those systems can be considered "worse" than the US system.

This is not an argument between free market health care and government health care. It’s an argument between two versions of government designed and structured health care systems that incorporate both government intervention and market components. Unfortunately, the system we have right now is pretty much the worst combination. It’s hard to see how this is better than, for example, the French system.

There are very real economic reasons why our system is very inefficient, and why that inefficiency creates cascading additional problems. It’s time we stopped denying that very clear fact and started thinking about better alternatives that cope with some of those inefficiencies and problems. Merely repeating anecdotes about Canada or only noticing statistics that the US excels is a good recipe for losing.
 
Written By: Jon Henke
URL: http://
My money’s on you not really asking questions, just pushing the bogus frames out in question format to your like-minded audience and taking the silence as some imaginary admission of defeat by the entire global community.
Not sure why you’re quoting Kos’ mission statement here.
The idea of one centralized government agency being able to coordinate such a policy efficiently and without fraud is simply not credible.
Quite simply the smartest thing Scotty has ever said, in the classroom or otherwise.
I mean, this lame, generalist answer to your lame, ideological questions is probably the best thing you’re going to get.
Translation: I got nothing, people. I’m a professional heckler.

The money quote from Henke’s link:
Practice liability is greatly diminished by a tort-averse legal system, and medical schools, although extremely competitive to enter, are tuition-free. Thus, French physicians enter their careers with little if any debt and pay much lower malpractice insurance premiums.

Lessee, which industry lobbyists will we have to overcome to make this possible? Uh, too numerous to count.
Call me crazy, but I kinda like the current system. I take care of myself and keep my healthcare costs low. Something catastrophic happens and one of two things occur: a) my insurance covers it or b) my insurance maybe doesnt cover it or it does and I die anyway. Oh well, had to happen someday in some way. At least I didnt shovel my problems on to someone else to pay for them. "Must go to hospital and get magic pill". Guess what, doctors aren’t geniuses, you know. They can’t and don’t save everyone. The practice of medicine has not usurped the 1st law of life: no one gets out alive. This seems another example of perfect being the enemy of good. How is it that we’ve become convinced that you can’t exist without round-the-clock access to a team of physicians? If you can’t see through the medical industry by now, you’ve got other, more pressing issues.


 
Written By: Rob
URL: http://
Jon, that link you posted on the French system was discussed here months ago. Basically, the scoring method for evaluating the best system was heavily weighted toward cost. Aside from cost, the US was at or near the top of every other category. You can draw your own conclusions from it, but one valid conclusion would be, "You get what you pay for."

In software engineering, there’s an old Iron Rule: Of speed, cost, and effectiveness, you can pick only two.

 
Written By: Steverino
URL: http://
There are very real economic reasons why our system is very inefficient, and why that inefficiency creates cascading additional problems. It’s time we stopped denying that very clear fact and started thinking about better alternatives that cope with some of those inefficiencies and problems. Merely repeating anecdotes about Canada or only noticing statistics that the US excels is a good recipe for losing.
In the past year I’ve become quite acquainted with how the health care system works (and no, not because of any health problems — sorry to disappoint some of you!) It is a mess. It is a mess especially in areas where governmental regulations, both state and federal, intervene. It also is structured in a way that hurts those who are self-paying; they have higher bills, collection agencies go after them, and while there are numerous write offs, that’s only done at the end of a long process.

The system is dysfunctional, and it is very regulated. There are odd situations where in certain circumstances a hospital doesn’t get paid if a patient lives, but does if the patient dies (nice financial incentive to work hard to save the patient’s life!), and if a patient gets sick or gets infected at a hospital, the hospital often won’t be paid at all. The more I learn about the labyrinth of regulations and efforts by the government to save costs, the clearer it is that we’re not talking about a private system at this time, and as the population gets older, and health problems increase for the young due to life style issues, we are looking down the road at a potential melt down. I don’t think it’s something that government can get out of either — too many people do rely on medicare and medicaid for service, and it’s not realistic to argue that they should just be dumped and somehow charity would compensate.

I’m not sure what can be done but there are reasons to distrust governmental regulations, as well as reasons to talk about real reform. Just going for a big government program like the left often does, or claiming the market will do just fine like the right often does really dodges the problem.
 
Written By: Scott Erb
URL: http://faculty.umf.maine.edu/~erb/blog.htm
Two words: Euthanize. Boomers.

That should kick things off nicely.
 
Written By: Rob
URL: http://
I’m not sure what can be done but there are reasons to distrust governmental regulations, as well as reasons to talk about real reform. Just going for a big government program like the left often does, or claiming the market will do just fine like the right often does really dodges the problem.
Well, doctor, you’ve really cornered the market here. Eventually, one side wins out and there will be casualties. Either way, bad, bad things will happen to people and will be brushed aside by the bureaucrats. This is the law of unintended consequences at work. We’re experiencing this today as a result of managed healthcare and a runaway tort system. And what exactly is "the problem", as you’ve defined it here? Is it that people experience pain? Bankruptcy? Chicken pox? What exactly are you hoping to achieve with said reform? Are you looking for a truly egalitarian system? Because that ship set sail long, long ago... it was called the "Mayflower".
 
Written By: Rob
URL: http://
There are very real economic reasons why our system is very inefficient, and why that inefficiency creates cascading additional problems. It’s time we stopped denying that very clear fact and started thinking about better alternatives that cope with some of those inefficiencies and problems.
While there may indeed be inefficiencies and problems with which we must cope, the question here is why government is the answer.

I’ve been doing some reading lately and, as the stats I cited indicate, it would seem that given what we know about how health care is historically consumed, we could address it at that point.

The same George Halvorson I cited goes on to point out the the vast bulk of our health care dollars are spent on about 5 chronic diseases. In fact, about 70% of our hc dollars go toward fighting them. They are diabetes, congestive heart failure, coronary artery disease, asthma and depression. From these all manner of acute care complications flow.

The key point in all of this is the people getting the most expensive and heaviest level of care in the US today usually have "comorbidities" (two or more of those 5 chronic diseases) along with an additional acute disease to complicate the situation.

It is that situation which has to be addressed in any effort to corral rising hc costs.

Without going into all the why’s and wherefores, a better solution for all would be to "think systemically" about the care we deliver for those 5 diseases and then, as Halvorson says, "act systemically" to improve the "quality, outcomes, consistency and cost of that care".

That does not have to come from or involve government.
 
Written By: McQ
URL: http://www.qando.net/blog
...the vast bulk of our health care dollars are spent on about 5 chronic diseases.

...

...a better solution for all would be to "think systemically" about the care we deliver for those 5 diseases....

That does not have to come from or involve government.
And in fact, the innovation in fighting those diseases is not coming from government. The market leader in disease management and preventative care focused on diabetes and heart disease happens to be one of my clients. They are now moving into European markets, because the state-based systems there are in the Dark Ages on that kind of innovation.

This illustrates one of the main problems I have with government-run or government-dominated systems, which is comparative lack of innovation. Anyone who seriously believes a bureaucratic, government-run system will innovate anywhere near as fast as a free-market based alternative must be smoking crack.

I think it’s short-sighted and selfish to wish on our grandchildren a system that doesn’t innovate at the speed of a free market system. Think of what we have that our grandparents didn’t at the same age. Then think what could be available to our grandchildren, if innovation is allowed to proceed without the heavy hand of bureaucracy constantly stifling it. In fact, with advances in genetic engineering, the pace of unfettered innovation is likely to increase, which makes the cost of slowing it down even greater.
 
Written By: Billy Hollis
URL: http://
Living in Canada, I am very familiar with our "universal" (over 10% of Canadians don’t have doctors) healthcare system. It’s terrible. The govt RATIONS healthcare resources; shortage of equipment, ridiculously long waiting lists, and drugs drugs—lots of drugs to keep you doped up to alleviate your pain while you wait for a year or two for your operation.

The US would be crazy to let the govt control their healthcare. Almost everybody in Canada has had a relation, acquaintance, or relative of an acquaintance has a nightmare story. Are you unaware of the busloads of Canadians who go on "health tours" to the US? Check out the ratio of American vs Canadian patients in a bordering northern US state.

Where the hell are we going to go for healthcare if the US adopts our system?

And although Canada’s national media tries to keep a lid on it, I can assure Mr Henke that he would get more than his fill of "anecdotes" from local medias (sometimes you have to go to public to prevent death).
 
Written By: Mr Kennedy
URL: http://
While there may indeed be inefficiencies and problems with which we must cope, the question here is why government is the answer.
Why is government the answer to mass public education? I’d rather we had other options, too, but they’re not being proposed or meeting with sufficient public interest.

In the meantime, we already have a government health care system with all the economic problems of third-party payer, plus a wide variety of other problems (lack of portability, perverse incentives, cartels, etc). We’re not debating free market VS government health care. We’re debating two government-enabled health care systems.

We need to stop defending our current system, because it’s simply not substantively better than many other countries systems by most measurements. If we’re defending this system, we’ll lose. And we’ll deserve to lose, because we’re defending a system that is the product of regulatory capture, the cartelization of health care suppliers and various other government induced flaws. If we’re going to have a flawed government system, there are better systems available.

If we’re going to have something better than that, we’d better start working on something besides defending the current morass.
 
Written By: Jon Henke
URL: http://
Why is government the answer to mass public education?
Because it decided it was the answer (by selling the public a bill of goods) and took control.
If we’re going to have something better than that, we’d better start working on something besides defending the current morass.
I’m not sure to which "morass" you’re referring, but most people I talk to are not displeased by their own health care or its cost.

However:
And we’ll deserve to lose, because we’re defending a system that is the product of regulatory capture, the cartelization of health care suppliers and various other government induced flaws. If we’re going to have a flawed government system, there are better systems available.
If it’s down to a matter of choosing the lesser of many evils, I’d agree - not that any government system is good enough that I’d want it, but that some may be better than others. But I’m not yet willing to concede that ground yet.

So I’d prefer answers to the questions posed.
 
Written By: McQ
URL: http://www.qando.net/blog
Because it decided it was the answer (by selling the public a bill of goods) and took control.
I’m all ears as to alternative systems. But it’s been a function of government for a very long time and across the developed world. If there’s a way to get equivalent or superior results, I’m sure people will line up to support it. Where is that alternative?
I’m not sure to which "morass" you’re referring, but most people I talk to are not displeased by their own health care or its cost.
Prehaps. And some statistics will even substantiate your anecdotal data - many people are satisfied with their health care. Yet, majorities are dissatisfied with overall health care costs, believe we need fundamental changes in our health care system and want universal health care. Of course, there are reasons people don’t express dissatisfaction with their health care costs. Among others, (a) the older people who tend to consume a large portion of our health care are not actually paying a significant portion of their health care, and (b) most of the rest of us have other forms of third party payer health coverage - so we don’t really have the slightest clue what we’re paying. Until it screws us out of a job, etc.
So I’d prefer answers to the questions posed.
It seems like an odd question. Or at least, an outdated one. Perhaps it would have been useful to resolve that question before we voted to have the government design the system. But were quite a lot of decades past that point, so it seems about as relevant as asking the Left to defend government involvement in education, or dozens of other areas. Why would they bother to defend a position they’ve already won? It’s an interesting philosophical question, but here in reality we’re just haggling over the price now.

From a libertarian standpoint, we can only make progress by creating systems that facilitate more freedom, more choice and the emergence of market alternatives. (e.g., school vouchers, HSA’s, health care service differentiation, etc)
 
Written By: Jon Henke
URL: http://
Well, doctor, you’ve really cornered the market here. Eventually, one side wins out and there will be casualties. Either way, bad, bad things will happen to people and will be brushed aside by the bureaucrats. This is the law of unintended consequences at work. We’re experiencing this today as a result of managed healthcare and a runaway tort system. And what exactly is "the problem", as you’ve defined it here? Is it that people experience pain? Bankruptcy? Chicken pox? What exactly are you hoping to achieve with said reform? Are you looking for a truly egalitarian system? Because that ship set sail long, long ago... it was called the "Mayflower".
I agree with a lot of what you say. Again, having someone close to me directly involved in the business end of hospital work and hearing about the dysfunctional nature of especially government (but also private insurance) regulations and programs certainly shows government to be a huge part of the problem. Also, I agree that our propensity to sue and legitate is a huge problem as well. I’m not well versed enough in all this to really know what the solution is. If we all lived healthier lifestyles things would be a lot better, but that doesn’t seem to be happening.

I’m a pragmatist on issues like this, not an ideologue. Government is going to be involved no matter what one wants because that’s the way our political culture and system is operating. Moreover, as in Europe, an aging population is bringing tremendous challenges. Much of the growth in cost in the past years is due to pharmaceuticals — and (here comes an unsubstantiated biased assertion, so I plead guilty in advance) it seems to me we have a baby bomber generation who is still hooked on drugs — now legal drugs they hope will make them feel like 25 at age 60, trying to cure ever ailment with a pill. I can’t believe all these pharmaceuticals are worth the cost. But again, that’s just a gut reaction.
 
Written By: Scott Erb
URL: http://faculty.umf.maine.edu/~erb/blog.htm
Jon Henke’s answer is the polite, objective-sounding, impersonal set of assertions I’d have given if I wasn’t obviously succumbing to bitterness and futility.

There’s no difference betweeen his useful, clear answer and my irritated rant in terms of the resulting effect on the ’debate’, though.

It’s possible to have a discussion about a metric and the methodology used to achieve it, about specific examples of evidence. But posts asking people, "why do you want all these bad things to happen?" or "why do you want to use x to achieve y"? are going to get the same kinds of platitudes in response as were started with.

And that’s all John’s answer is, just like mine - a set of platitudes. More logical, more polite, more clearly focused on the issue at hand, but still assertions, springing from nothing, dismissable with a hand wave.

Here’s how:

it’s very hard to get around the fact that other major, developed nations have some form of universal health care, and they are not, in fact, falling apart.
Response: sure they are. quote mark steyn, GDP growth comparisons, British prostate cancer survival rates...
Yet, their outcomes and waiting times are generally better than those in the US.


Response: of course they’re not! Anecdotal story about Canada here.

It’s impossible to get any casual observer to agree on the basic facts, Jon. There’s an infinite supply of manufactured contrary-sounding data points, half-truths, and speculation. Sure, impartial, exhaustive studies can lead people to a rough range of similar conclusions - the same way you’ve arrived at it - but no one you’re talking to is doing that. Look how many stories have been run on this very website fundamentally disagreeing with your basic premises!
Sure, everyone has the right to believe whatever they want. But what makes you think anyone’s going to disinvest in there contrary opinions because you state that you believe something different, or link to a few studies?
I’m not sure to which "morass" you’re referring, but most people I talk to are not displeased by their own health care or its cost.
Ta da! Case in Point. This boils down to "I don’t believe you". There’s no agreement on premises. And there’s no way of reaching it. Even if you point out something like "hey, veterans’ health care is both the most heavily subsidized and european-like piece of our system, and you’re happy with it, which both disproves your fears about making the system more like your health care and suggests that your experiences are not in any way like the experiences of median American citizens". What’s the snappy comeback to that? How can we choose just one?


Here, a few more examples:
The market leader in disease management and preventative care focused on diabetes and heart disease happens to be one of my clients. They are now moving into European markets, because the state-based systems there are in the Dark Ages on that kind of innovation
Here’s a link documenting how the German health care system is obtaining smart-card medical ID systems that probably won’t show up in the US for another decade but might save 100,000 lives. every year.

Does this mean, just because I’ve provided an example of European medical systems being well ahead of the US technologically, that I’m going to change anyone’s mind that "government-run" systems create medical systems in the "Dark Ages"? Of course not, anymore than I’d change my mind if Billy had provided evidence to demonstrate that whatever his company is pushing is useful, relevant and Europeans don’t have it. The anecdotes butt heads as futilely as the antelopes.


Or, for another example:
Without going into all the why’s and wherefores, a better solution for all would be to "think systemically" about the care we deliver for those 5 diseases and then, as Halvorson says, "act systemically" to improve the "quality, outcomes, consistency and cost of that care".

That does not have to come from or involve government
And one would say: there’s no other entity that can act systemically change doctors’ current incentives to maximize costs. Market ’competition’ is self-evidently failing to change the situation - because medical care situations are individually unique and consumers have no idea how much any kind of beginning-to-end treatment could cost, should cost or will end up costing, and because unlike midsize consumer goods, consumers are willing to spend unlimited amounts of money to solve serious medical problems. So no one has any incentives to control costs except the insurance companies, and the way insurance comnpanies control costs, by disallowing coverage, has no direct effect on quantity or cost of services delivered, anymore than credit card payment disputes act as cost control on consumer purchasing habits.

How many objections can be raised to the above argument? Ten? One hundred? Shall we provide examples of hospital patients choosing one hosptial over another one? Voluntary industry associations adopting self-enforced codes of behavior? Assertions of all the reasons hospitals have to control costs?
With infinite resources, time, and persistence to track down every one of these mental escape routes, there might be some kind of consensus, but ad hoc virtual dinner-table talk doesn’t stand a chance.
From a libertarian standpoint, we can only make progress by creating systems that facilitate more freedom, more choice and the emergence of market alternatives. (e.g., school vouchers, HSA’s, health care service differentiation, etc)
Gee, how about... publicly pooled insurance plans, available to everyone, that are left to compete to with the private insurance sector? That instantly! expands the field of competition and lets all the "government-plans-are-doomed" theorists test their beliefs against real-world outcomes! That’s just what you’re looking for! Expanded choices! So I guess you’ll be voting for Democratic presidential candidates, because they’re actually offering the opportunity to expand choice in that manner. Meanwhile, HSA’s won’t do a darn thing to control costs, or help poor people achieve better health outcomes - goals which are mutually reinforcing - and I’d be surprised if you bothered to disagree, Jon. They’re just another way of making more income available to plow into the broken system.


 
Written By: glasnost
URL: http://
Forgot to close that underline tag, huh? Anyway, Jon:

You don’t buy supply-side economics. You’re a skeptic on the Iraq War. You don’t buy the Republicans’ approach to immigration. You want people to look at genuine solutions to health care problems that you admit empirically exist. You accept the scientific consensus that global warming is real.

Sometimes I have trouble understanding why you work for Republicans, Jon. They don’t agree with you on any of these things.
 
Written By: glasnost
URL: http://
why do you think it is government’s responsibility to provide it
Because if we wait for a profit-motivated corporation to do it we’ll all be dead? No, seriously. I’m not the kind of liberal who reflexively wants the government to do everything, but there are some big problems that contain no motive for profit-driven business to fix. That’s where our big dumb government steps in.
 
Written By: Oliver Willis
URL: http://www.oliverwillis.com
Gee, how about... publicly pooled insurance plans, available to everyone, that are left to compete to with the private insurance sector? That instantly! expands the field of competition and lets all the "government-plans-are-doomed" theorists test their beliefs against real-world outcomes! That’s just what you’re looking for! Expanded choices! So I guess you’ll be voting for Democratic presidential candidates, because they’re actually offering the opportunity to expand choice in that manner. Meanwhile, HSA’s won’t do a darn thing to control costs, or help poor people achieve better health outcomes - goals which are mutually reinforcing - and I’d be surprised if you bothered to disagree, Jon. They’re just another way of making more income available to plow into the broken system.
I haven’t studied the issue well enough to venture into a serious debate on any of those items. It’s a bit difficult to see how publicly pooled insurance plans would really be a step forward. Couldn’t anybody set that up tomorrow? If so, why haven’t they? It seems to me that it would be less of an insurance pool, and more of a price control mechanism - an entity capable of undercutting competitors by legislative fiat, not due to an improved business model. But actuarial realities are not malleable by legislation. Imagine if the government were to go into the car-making business. Could they undercut existing manufacturers? Of course they could. Would it improve things? Perhaps anecdotally or in the very short term. Hey, anybody can assume the current platform, tweak it to make it slightly better for the consumer and then declare victory. But I very seriously doubt anybody here would really argue that government production of autos would be ultimately beneficial. So, while I dislike our current, non-market system, I’m also skeptical of the long-term consequences of government intervention.

I’m not really persuaded that HSA’s are the answer, either, but they’re not just some way to get more money. The value is that it allows people to bear the cost of their health care decisions, and to ration accordingly.

I’d offer a few basic changes:

1. We should stop enabling the AMA and (to a lesser extent) nursing cartels that limit the supply of medical practitioners, and require absurdly unnecessary licensing requirements. There should be more gradation in health care provision.

2. We should de-link health care from employment. The employer health care subsidy should end, and health care expenditures should come from pre-tax income for individuals.

3. We shouldn’t have ’insurance’ for basic medical services. If it covers every medical service, it’s not "insurance". Insurance should be limited to unusual expenses, and individuals should pay for the costs of routine work.
Sometimes I have trouble understanding why you work for Republicans, Jon. They don’t agree with you on any of these things.
What makes you think I agree with the Democrats on those things? I don’t have a viable third choice, so I prioritize and go where I have a chance of making progress on my priorities.
 
Written By: Jon Henke
URL: http://
Because if we wait for a profit-motivated corporation to do it we’ll all be dead? No, seriously.
That’s the kind of anecdotal evidence I think is so flimsy when I see it from the Right. Are there perverse incentives? Of course. There are perverse incentives in government-designed health care, too.

But it’s plainly absurd to suggest that the profit motive would lead corporations to kill their customers in a market situation as a matter of policy. There are a variety of reasons that happened, but "the free market" isn’t one of them.

Now, to get Cigna to change their policy, it took a little sunlight, some protestors and a single tragic consequence. How often does the government change it’s policy based on a bit of sunlight, a few protestors or a tragic consequence?

Indeed, the same thing happens every day in this country as a result of the FCC not approving drugs. Can 150 protestors and a bit of publicity get a drug or procedure approved at the FCC? If not, why are you more concerned about Cigna’s rejection of a treatment than you are about the FCC’s rejection of/delay on a drug or treatment?
 
Written By: Jon Henke
URL: http://
Universal Coverage and the Rising Cost of Health Care are two different beasts (though related in that the rising cost of health scares many people into thinking that maybe we need the government to offer universal coverage.)

I think some of the mandatory universal coverage plans that have a subsidy at some income levels while retaining the private market would be acceptable to many Republicans. This is essentially a question of money, really. We already pay for Medicaid and S-chip so we could roll all these programs into one big subsidy set-up. At the same time, we could make health insurance portable and de-linked from employment.

The Rising Cost of Health Care is a different animal, and attempts to reduce the cost through large state actions like nationalizing health care could have serious unforeseen consequences. I think it would be wise to take it much slower in this area, relying on market and institutional/administrative reforms first before deciding to buy drugs via monopsony or what not. Look at the state’s results for different ideas, etc.

By the way, Jon, what’s stopping us from going to a fully private education system?

A. Tradition/History
B. Inertia/Bureaucratic interests
C. Unions

These are the exact reasons why we should be very, very, very careful with health care. If you decide to let it fall into state hands, you may never ever get to change it again. Look at the UK try to inject market forces into their system - why are they doing that if it works pretty much just like our system does but is cheaper?

You’ll also note the UK massively funded their health services in the past few years and did not get good results. Does this sound similar to the US public education system where money is lavished in some areas, but results do not improve either?






 
Written By: Harun
URL: http://
You posed a significant number of questions, many of which had to do with an errant premise.Despite Right claims about the inability of government to control costs, other health care systems have lower per-person expenditures.
And they’ve done that by rationing care (and I’m not so sure they’ve really "lowered cost" - check out the stats and tell me how much lower you can get for the 50% paying 3% of the health care dollars).

Rationing is a key point here - every system does it. What would you be willing to ration and how given the numbers on who gets the majority of HC expenditures and the 5 chronic diseases I mentioned?
 
Written By: McQ
URL: http://www.qando.net/blog
Rationing is a key point here - every system does it. What would you be willing to ration and how given the numbers on who gets the majority of HC expenditures and the 5 chronic diseases I mentioned?
True, but the problem we fear with government rationing is that either (a) people won’t get access to health care or (b) there will be little cost control as people consume as much health care as they want. But we already have those problems, due to our third party payment system. And it seems that some other countries - e.g., France - aren’t experiencing the major problems we fear from that kind of system.

Why not? The overall statistical evidence pretty clearly indicates that our current system has more problems with cost controls and access than do the various universal care systems.

That’s not to say they don’t have problems, but they are certainly not failures.
 
Written By: Jon Henke
URL: http://www.QandO.net
True, but the problem we fear with government rationing is that either (a) people won’t get access to health care or (b) there will be little cost control as people consume as much health care as they want. But we already have those problems, due to our third party payment system. And it seems that some other countries - e.g., France - aren’t experiencing the major problems we fear from that kind of system.
France is a country of 63 million, compared to one of 310 million. France has the highest tax rate in Europe (nearly 50% of GDP in 2005) and that has helped create an almost chronically stagnant economy along with inflexible budget items, such as health care, and pushed the budget deficit above the eurozone’s 3%-of-GDP limit in 2006. And unemployment remains near 9%. Not exactly the state of a affairs one wants to see here just to claim "we aren’t experiencing major problems" with a government run system.

I see no reason to settle for "minor" problems with a government run system because, as a commenter previously noted, once its done, there’s no turning back.

Frankly I want nothing to do with government run or administered health care, because once it is in place, the options and choices become few to none..

So your point that the market must do something is one I accept, but I’d remind you that one reason the market isn’t able to do much is again the result of government interference in the form of mandates for insurers. These preclude an ala carte "buy what you need" insurance policy and make insurance too expensive for most who would like to buy it privately.

The other, of course, has to do with the fact that insurance is employer based. I’ve noted many times that one of the first things which should be done is to get insurance away from employers and into the open market where those seeking health care insurance can shop for it (sans mandates) and thus purchase it as we do other insurance. For most that takes care of portability and pre-existing conditions.
Why not? The overall statistical evidence pretty clearly indicates that our current system has more problems with cost controls and access than do the various universal care systems.
Well that depends on how other systems choose to treat patients in similar medical situations and when and how much they’re willing to spend on that treatment doesn’t it? Cost containment doesn’t mean that the consumer is getting adequate or timely care, does it? Most likely it does mean that compared to us, patients not having the amount of money spent on them as we spend in similar cases. Depending on your point of view, it is certainly debatable as to whether that’s a good or bad thing.
That’s not to say they don’t have problems, but they are certainly not failures.
In the most basic sense of the word, I guess you’re right, but it sure does beg the question as to why so many of those with the means to do so in those countries seek medical care elsewhere (a large number of them doing so here).
 
Written By: McQ
URL: http://www.qando.net/blog
I’m not well versed enough in all this to really know what the solution is... I’m a pragmatist on issues like this, not an ideologue. Government is going to be involved no matter what one wants because that’s the way our political culture and system is operating. Moreover, as in Europe, an aging population is bringing tremendous challenges. Much of the growth in cost in the past years is due to pharmaceuticals — and (here comes an unsubstantiated biased assertion, so I plead guilty in advance) it seems to me we have a baby bomber generation who is still hooked on drugs — now legal drugs they hope will make them feel like 25 at age 60, trying to cure ever ailment with a pill. I can’t believe all these pharmaceuticals are worth the cost. But again, that’s just a gut reaction.
Sometimes gut reactions are worth paying attention to. Everything you say here are solid reasons to resist the boomer’s scorched-earth policy on our budget. Overtly or not, that’s what it is. We shouldn’t be looking for ways to ensure maximum boomer lifespans at the expense of every other budgetary need. Sounds like hyperbole, I know, until you look at the amount of money discussed. In terms of sheer numbers, they can swallow the country’s economy whole.
There’s an infinite supply of manufactured contrary-sounding data points, half-truths, and speculation... everyone has the right to believe whatever they want. But what makes you think anyone’s going to disinvest in there contrary opinions because you state that you believe something different, or link to a few studies?
You use up a lot of column inches to basically agree: we’re at an impasse. The right with their market forces and the left with their big government programs cannot reconcile. The last big compromise (managed care) only made things worse faster. The winner of the next go-round will be by attrition. My money’s on the left, only because their media machine is more entrenched and the public is more gullible than ever.
So I guess you’ll be voting for Democratic presidential candidates, because they’re actually offering the opportunity to expand choice in that manner.
That assumes you believe them. Just because they say they are during a campaign season doesn’t mean they will once in office. I simply can’t take a candidate, any candidate, at their word anymore. Their personal track record will have to suffice... as usual.
Because if we wait for a profit-motivated corporation to do it we’ll all be dead? No, seriously. I’m not the kind of liberal who reflexively wants the government to do everything, but there are some big problems that contain no motive for profit-driven business to fix. That’s where our big dumb government steps in.
Isn’t this what you’re speaking of, Glasnost? Post anecdotal link to somehow counter the other side, then broadbrush it with "we’ll all be dead"? Once again, Grady brings his entire site over in a coupla sentences. Brilliant... and yes, he is that kind of liberal.
I’d offer a few basic changes:

1. We should stop enabling the AMA and (to a lesser extent) nursing cartels that limit the supply of medical practitioners, and require absurdly unnecessary licensing requirements. There should be more gradation in health care provision.

2. We should de-link health care from employment. The employer health care subsidy should end, and health care expenditures should come from pre-tax income for individuals.

3. We shouldn’t have ’insurance’ for basic medical services. If it covers every medical service, it’s not "insurance". Insurance should be limited to unusual expenses, and individuals should pay for the costs of routine work.
Gee, this seems like a nice, easy way to start. Gradually cripple the special interests. Keep the word "mandate" out of all legislation. Real world tinkering, not wholesale blind sweeps. Seems reasoned and reasonable. Probably doesn’t have a chance in hell.

By the way, Jon, I really hope the FCC isn’t approving drugs nowadays.

 
Written By: Rob
URL: http://
Sometimes gut reactions are worth paying attention to. Everything you say here are solid reasons to resist the boomer’s scorched-earth policy on our budget. Overtly or not, that’s what it is. We shouldn’t be looking for ways to ensure maximum boomer lifespans at the expense of every other budgetary need. Sounds like hyperbole, I know, until you look at the amount of money discussed. In terms of sheer numbers, they can swallow the country’s economy whole.
Well they (and I’m a part of that generation — towards the end of the boom) have the votes so I guess that’s not surprising. But...I think states and the federal government will be facing a huge budget crisis in coming years as we are no longer able to finance an ever increasing debt (I explain some of the rational for that thinking in my response to McQ on the housing crisis post). Fiscal responsibility will be forced on us, and it will be painful for many people. I really think that’s coming, and I don’t think either party is looking at the problem directly. We live in interesting times.

 
Written By: Scott Erb
URL: http://faculty.umf.maine.edu/~erb/blog.htm
Rob, your list of suggestions should have a change: insurance should cover, and incentives should be created, to enhance screening. Early detection and treatment is usually far more cost effective than waiting until something unusual happens. That’s why, for instance, dental insurance almost always covers 100% of basic check ups (one in every six month time period).
 
Written By: Scott Erb
URL: http://faculty.umf.maine.edu/~erb/blog.htm
the federal government will be facing a huge budget crisis in coming years as we are no longer able to finance an ever increasing debt
Again, liberal talking points from the Reagan era. Outdated. But if you indeed truly believe this, why oh why would we undertake a shiny new massive government program? And I mean massive as in other massive govt programs look at it and go "dang, that’s freakin’ massive". Granted, we have a spending problem that needs redress, but the economy continues to grow at an impressive clip, the "nightly news" notwithstanding.
insurance should cover, and incentives should be created, to enhance screening. Early detection and treatment is usually far more cost effective than waiting until something unusual happens.
What? Is there an early detection problem that I haven’t heard about? We have the best cancer survival rate in the world (you wouldn’t know that from the WHO rankings) precisely because of early detection. Why incentivize something that seems to be working quite well? Again, that’s how we got in this mess...


 
Written By: Rob
URL: http://
Rob, I’m not arguing for a massive government program. As for early detection and screening, in general I’m convinced costs are lower the earlier you catch almost any kind of disease (survival rates say nothing about cost). I also disagree with you about optimism concerning the economy. High inflation, a declining dollar, and high debt (which really isn’t a ’liberal’ talking point, but one shared by fiscal conservatives of all stripes) is a huge problem. I go over this in the first comment in the discussion of housing.
 
Written By: Scott Erb
URL: http://faculty.umf.maine.edu/~erb/blog.htm
Government Healthcare will save Social Security.

Fewer people will be around to collect it.
 
Written By: John
URL: http://
It’s a bit difficult to see how publicly pooled insurance plans would really be a step forward. Couldn’t anybody set that up tomorrow?
If it was that easy, wouldn’t they have already done so? How exactly do you as a private citizen intend to set up something like that for several million people?
If so, why haven’t they? It seems to me that it would be less of an insurance pool, and more of a price control mechanism - an entity capable of undercutting competitors by legislative fiat, not due to an improved business model. But actuarial realities are not malleable by legislation. Imagine if the government were to go into the car-making business. Could they undercut existing manufacturers? Of course they could. Would it improve things? Perhaps anecdotally or in the very short term. Hey, anybody can assume the current platform, tweak it to make it slightly better for the consumer and then declare victory. But I very seriously doubt anybody here would really argue that government production of autos would be ultimately beneficial. So, while I dislike our current, non-market system, I’m also skeptical of the long-term consequences of government intervention.
You’re hand-waving away the fact that a government-administered pool system to *compete with* - not abolish - private insurance would bring competition to places that hardly have it now. The insurance market, from what I’ve seen, tends to one or two massive players per geographic region. Collusion and oligopolic behavior seems to be quite prevalent.

For that matter, while state monopolization of car production is probably a bad idea, I don’t know exactly how the sky would fall in if the government started selling cars, if they were competing evenly with private competition. A lack of competition led US oligopolies in Detroit to mimic all the obsolesence of state monopoly systems well into the eighties.

The value is that it allows people to bear the cost of their health care decisions, and to ration accordingly.

No one voluntarily rations with crippling or life-threatening diseases. And no one should have to. Whether or not it’s completely avoidable is one thing, whether it should be avoided to the greatest extent possible is another entirely.

Furthermore, you don’t save money by rationing health-care in many situations. You allow the health problems to get worse and spend more money fixing them later. You can’t attack health-care cost control from the demand side in any broad sense. It’s a disaster in the making.
1. We should stop enabling the AMA and (to a lesser extent) nursing cartels that limit the supply of medical practitioners, and require absurdly unnecessary licensing requirements. There should be more gradation in health care provision.

2. We should de-link health care from employment. The employer health care subsidy should end, and health care expenditures should come from pre-tax income for individuals.

3. We shouldn’t have ’insurance’ for basic medical services. If it covers every medical service, it’s not "insurance". Insurance should be limited to unusual expenses, and individuals should pay for the costs of routine work.
I agree with #1 and #3. Current Democratic plans are, in fact, trying to delink healthcare from employment - humanely - by setting up public, subsidized, affordable alternatives, without using the kind of shock therapy your suggestion seems to suggest. Making a de-link by fiat, wiping out the employer subsidy, etc, if employers stopped offering health-care (are you proposing to outlaw the offering of it?), would be instantly dumping thousands or tens of thousands of bills onto american families in midstream, with no corresponding income boost. All you’d get are families skipping care that makes later care more expensive, a drastic shrinkage in non-health-care expenditure, and an extremely bitter population.


Of course, you wouldn’t even know what Democratic plans actually are from rhetoric like this:
These are the exact reasons why we should be very, very, very careful with health care. If you decide to let it fall into state hands, you may never ever get to change it again.
I might become slightly less cynical if certain people - like most people here - would stop describing imaginary plans to abolish private insurance coverage and start describing the actual policies of the Democratic party. This whole debate is a giant freaking strawman. Heck, rich people can get private insurance in most European countries. Where are the propaganda bullet points coming from? Jon, do you have the magic wand? If you type the words, "There are no mainstream democratic plans to abolish private insurance coverage", will people suddenly get it?













 
Written By: glasnost
URL: http://
By the way, Jon, I really hope the FCC isn’t approving drugs nowadays.
My bad. FDA.
the federal government will be facing a huge budget crisis in coming years as we are no longer able to finance an ever increasing debt
Again, liberal talking points from the Reagan era. Outdated.
The forthcoming major budget crisis is a liberal talking point? I could have sworn that the Right has been talking about the enormous, underfunded entitlement crush that’s coming. And we’re already running structural, not cyclical, deficits in the hundreds of billion of dollars...even after we throw in the $100b + surplus from Social Security. We are most definitely facing a major budget crisis in coming years. There’s no plausible way we can grow out of that.
If it was that easy, wouldn’t they have already done so? How exactly do you as a private citizen intend to set up something like that for several million people?
Um...how does any insurance company set up? In fact, people are already free to sign up. Why aren’t they? And if only a small percentage are responsible for most health care costs, why would I want to be in a pool with them?
You’re hand-waving away the fact that a government-administered pool system to *compete with* - not abolish - private insurance would bring competition to places that hardly have it now. The insurance market, from what I’ve seen, tends to one or two massive players per geographic region. Collusion and oligopolic behavior seems to be quite prevalent.
The government doesn’t "compete". And how would an insurance company compete with a non-profit that will be subsidized by tax dollars, doesn’t pay taxes, has no need to turn a profit, etc? You’re right about the cartelization of insurance, though. There’s no reason they should be limited by geographic reason, or unable to compete across state lines. None.
No one voluntarily rations with crippling or life-threatening diseases. And no one should have to.
While people can economize in ways that tend to prevent major illnesses or injuries, I agree that people don’t necessarily ration rationally. That’s why I said we should reserve insurance for major issues - catastrophic care, etc - rather than applying it to every routine thing.
I might become slightly less cynical if certain people - like most people here - would stop describing imaginary plans to abolish private insurance coverage and start describing the actual policies of the Democratic party. This whole debate is a giant freaking strawman. Heck, rich people can get private insurance in most European countries. Where are the propaganda bullet points coming from? Jon, do you have the magic wand? If you type the words, "There are no mainstream democratic plans to abolish private insurance coverage", will people suddenly get it?
Google around for "Medicare for All" or "Medicare or Everyone". Lots of Democrats advocate it. Quoting Ezra Klein: "The idea of a government takeover in health care turns folks off, at which point we have to explain that no, the government isn’t taking over health care, just all forms of health insurance, and no, that won’t change health services, and no, nothing will be different in this wholly new structure where everything is funded differently and there are no more insurance companies. It’s all quite counterintuitive. That’s why Medicare-for-All is such a great banner."

Rep. Stark. Kennedy and Dingell. They’ve proposed legislation with a lot of cosponsors.

 
Written By: Jon Henke
URL: http://
France is a country of 63 million, compared to one of 310 million. France has the highest tax rate in Europe (nearly 50% of GDP in 2005) and that has helped create an almost chronically stagnant economy along with inflexible budget items, such as health care, and pushed the budget deficit above the eurozone’s 3%-of-GDP limit in 2006. And unemployment remains near 9%. Not exactly the state of a affairs one wants to see here just to claim "we aren’t experiencing major problems" with a government run system.
I don’t think the population comparisons are particularly helpful to your case. It’s not really apparent why a larger population would have higher per-capita costs. As for the tax rate - yes, that’s an economic drag (though France isn’t doing quite so terrible as we’d sometimes like to think), but our much higher per capita spending on health care is more of a drag.

In any event, we’ve got two systems. In one, health care is paid for through taxes that are a drag on economic growth, but they spend less, have better access, shorter wait times and better outcomes. In another, health care spending is still a drag, but it sucks down a much larger percentage of income...and we still pay about half of it through the government.
I see no reason to settle for "minor" problems with a government run system because, as a commenter previously noted, once its done, there’s no turning back.
Again we passed that point many generations ago. There’s already no turning back. We’re debating among government-designed systems.
In the most basic sense of the word, I guess you’re right, but it sure does beg the question as to why so many of those with the means to do so in those countries seek medical care elsewhere (a large number of them doing so here).
I realize that happens, but wealthy people also go to other countries for such surgeries. I’d like to see research on that question that controls for overall wealth of a country, and other factors. One answer may be that a government system that essentially creates cartels will tend to cater to the high-dollar, specialty consumers. That’s not a free market, though.
 
Written By: Jon Henke
URL: http://
Glasnost,

I admire your passion and sincere belief that the Democratic Health Care policies might actually work and alleviate the problem.
But my problem is this. I don’t believe any of them will work. Why?
Maybe it’s just my life experience dealing with Government and, in my opinion, their belief that people are like computers, and if you just plug in the right software, the computer will do what you want it to do.

But people aren’t computers, and they don’t always act like you believe they will.
I the 60s I was told that Welfare was going to eradicate poverty. Well, it didn’t.
I’ve seen lord knows how many education policies, from integration to desegregation, to busing, to No Child Left Behind, and was told that these would equalize education and end the test gaps. Well, that hasn’t worked either.

And as for Social Security (which really galls me), I paid into the system for 32 years before becoming an instructor at a State Vocational/Technical School, and now I’ve been told that I won’t receive near what I would have received in Social Security Benefits, because I’ve been paying into a Teacher’s Retirement System, and will be receiving less. Why? I guess someone in the Government has decided that regardless of the fact that I paid exactly what I was supposed to pay, well, I really don’t need it, because I’ll have another pension coming in. Sound fair?
Play by the rules, and get what we decide you deserve. And that doesn’t even touch the financial strap it’s in.
As for Medicare, well, I guess I’ve posted my comments already.

My final thoughts are these. I hope your right, I really do, and I’m being sincere. I hope that if a Universal/Socialist/Health Care for all Program (whatever someone wants to call it) is put in place, that it’s just the best thing since sliced bread.

But from what I’ve seen in my life (and I could go on for days about some of the federal governments fine educational programs that I deal with that accomplish zilch), I just don’t have the faith anymore. I think it will be a financial disaster.
When it comes to dealing with people, the law of unintended consequences just always seems to pop up.

But again, if these policies are put in place, I hope you are right.
 
Written By: autot
URL: http://
I respect your skepticism, autot.

Social problems that aren’t emprically defined to begin with with always be around in some form until they *are* empirically defined. "Poverty" will never be ended, but I have a feeling there’s a lot less malnourishment - something that can be empirically defined - in this country than there was in 1950.

The government will never fix every aspect of anything, but there’s nothing that makes it special amongst all other types of organized groups of people that makes it impossible for their actions to improve society’s circumstances.


Jon:
Google around for "Medicare for All" or "Medicare or Everyone". Lots of Democrats advocate it
I’m genuinely surprised. Guess I was wrong. The plans of three major Democratic Presidential candidates, however, don’t look anything like this.

I hear the Fair Tax Act has a lot of cosponsors as well. So I guess neither are absolutely unheard of, but neither of them are what you’d call mainstream, or likely to come about.

So it’s fair to say that people blurring the debate between the realistic reform proposals "on the table", and that reform, are not helping people understand what’s going on and what the choices are.

 
Written By: glasnost
URL: http://

 
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