On Tuesday, July 10, President Bush addressed a crowd in Cleveland, Ohio at the Intercontinental Hotel Cleveland.The White House website characterized the address as a call "on Congress to Act to fund Vital Priorities" (see the link to the site and the text of the entire speech--bottom of this post).
Here is what the President said, in part, about health care:
“Let me talk about health care, since it's fresh on my mind. The objective has got to be to make sure America is the best place in the world to get health care, that we're the most innovative country, that we encourage doctors to stay in practice, that we are robust in the funding of research, and that patients get good, quality care at a reasonable cost. The immediate goal is to make sure there are more people on private insurance plans. I mean, people have access to health care in America. After all, you just go to an emergency room” [emphasis mine, LJ].
In his speech, the President goes on to argue against expanding almost any version of our public health care system that might eventually lead to a comprehensive, national health coverage plan, including coverage for children just above the national poverty line. This is understandable given his political ideology.
Now, we can legitimately debate the particulars of universal coverage and how to achieve that goal. The President's comments in the speech provide several "jumping off" points for such a debate. I respect the fact that the subject is complex and that numerous special interests are involved and have combined to make the entire issue a political quagmire for everyone. Future posts here will likely get at some of those issues and points for debate, as have several of my previous posts.
For today though, my attention is riveted on the remark the President made that actually reveals his perspective on what health care actually means, what it entails.
"I mean, people have access to health care in America. After all, you just go to an emergency room.”
I expect that any physician, hospital administrator or public health official who heard that statement must have been shocked, stunned, terrified and thoroughly amazed all at once!
For the President of the United States to equate health care with a visit to an emergency room demonstrates just how serious our national public health crisis really is. No wonder we are now spending over 15% of our annual Gross Domestic Product on health care related costs, while achieving so little return on our investment in quality public health outcomes when compared to other industrialized nations.
One of the President's major concerns as expressed later in the Cleveland address is how to best use our funds to achieve the maximum in public health quality and benefit. How such a concern squares with his placing the ERs of America in the default position for the nation's uninsured escapes me. Everyone knows that the emergency department is one of the most expensive health care venues available and is designed to be a station of last resort, or the first stop in an acute emergency situation.
Scroll back on this site to just last Thursday, July 12 ("A Medical Home"). That brief essay pointed out the extremely positive impact of a reliable medical home on minority health outcomes and clearly documented racially informed disparities.
In the same speech in Cleveland, the President vowed to veto a bipartisan plan to expand the Children's Health Insurance Program to more adequately care for the health of all of America's children. Members of his own party expressed shock at his threat, given the fact that the President had not had a chance to review the legislation.
There is a lot wrong here.
But, in my view, we can trace it all back to the simple-minded misconception that everyone already has health care. I mean, after all, anyone can go to the emergency room when they need to see a doctor.
45 comments:
That idea and comment is a complete joke.
Not surprising. But completely infuriating.
Larry,
I really cannot believe he said that. About 6 months ago, I took my 18 month old daughter to the ER at Children's Hospital on a Saturday night around 10 pm. It was a horrific scene. There were people everywhere, including the floor. The line to check-in, not for triage, just to check-in was about 40 people deep, and the whole place was wall to wall sick, crying, coughing children with sad, sleepy, distraught parents.
I spend about 90 seconds taking in this scene, I thanked God that I had a choice, and I walked back out, drove across town to Presbyterian, and my daughter was in triage in less than ten minutes.
The truly frieghtening thing for me was that I sincerely felt that if my duaghter and I had stayed at Children's ER long enough for her to be seen by a doctor, she could very likely have gotten sicker while we were there. I didn't want to touch anything, or even breathe, really. That is a public health crisis, and our children deserve better.
LB
LB, very well said.
The US health care system definitely has its issues. There is no doubt about that.
And there is all ready universal coverage for those in poverty. And its working pretty well for them.
Most americans in the middle and upper classes have health insurance as well, and good insurance.
So who doesn't have health insurance?
I'd recommend watching this video.
http://www.youtube.com/watch?v=uKCWbq18bNk
That being said, there are many problems with single payer systems across the globe. One of the biggest ones is in Canada, where it is illegal to purchase health care on your own. You must go through the government system. This means everyone gets the same crappy care. Rationing happens, due to no controls on supply. Many people tell horror stories of being on waiting lists for surgeries or MRIs... and many even come across the border to the US to get necessary procedures so as to not have to wait months upon months, or even years. Britain, although private medicine is allowed, is having similar problems.
The biggest reason that health care cost has skyrocketed is not because of greedy insurance companies, but because the system as it is is currently flawed. When the government started offering tax benefits to companies that paid for health insurance for employees, that became the main way people paid for health care. Rather than receiving a larger salary, tax free dollars go to pay for their health insurance. But because health insurance is no longer for catastrophic occurances, but for every day issues, demand has risen considerably, and consumers aren't encouraged to shop around for the doctor that offers the best prices. Add to that the extra cost that doctors have trying to navigate massive insurance stuff in order to get paid, and you'll see why costs have continued to rise.
If I were czar of the country (hehe) I would get rid of group insurance, and make individual insurance mandatory. I would give credits to the poor to pay for catastrophic coverage, as well as donated an amount of money into an HSA (health savings account) every year to pay for doctors visits and medicine. For the non poor, you also make it law that every person have individual catastrophic coverage, and continue to make donations into HSAs tax free (as they currently are.
At this point, health care would be more consumer driven. When people are spending money that they've earned, they are more likely to look at cost of minor medical issues (doctors visits, medicine, etc) and they still have a high deducable plan to cover major illness and hospitalization. This will drive down cost, and will do away with massive bureaucracy at insurance companies, as well as providing as little interference from the government as possible.Because we all know that, while the government can provide some security, in doing so it always takes away liberty.
as usual, young Justin is still living in his fantasy world . . .
Universal health care IS the way to go!! We are the only "civilized" country without it. Sadly, it is about the insurance companies getting richer and richer.
Don't know where to begin, Justin!
Let's start at the top--"it's working pretty well for them"--referring to the poor. When's the last time you were in a public hospital? Notice the crowds? Feel like your doc's office or the medical home Larry wrote of a few days back? Wonder if the overcrowding explains something of the disparities in health outcomes for the poor?
There are 47 million uninsured Americans today. Maybe we are waking up to the fact that "most" is not good enough.
As to Canada and any of the other nations with universal coverage, Google health outcomes and compare the US to any other developed nation. You will find that we are dead last in most public health categories.
We have the best system in the world if you have money.
The reports on Canada's system, as well as others, being inadequate, etc. are largely rhetoric inspired by special interests in the US who don't want change due to concerns of financial self-interest.
Tax benefits to companies that provided health coverage was a compromise to hold off the inevitable business cry for a universal, single-payer system against the interests of the those who stand to lose from such a new approach. The admin savings alone annually would amount to $45 billion in a switch to a Medicare type system for everyone instead of private insurance that profits the insurance companies.
But, you didn't address Larry's main point here at all. He invites debate about the details.
What about the President's understanding or the lack thereof???
Ben K.
Tulsa
My two cents worth.... Grant works on a contract basis, so we don't have health insurance through an employer. We do have the ability to look around and buy insurance. So, here's what I found out our family of five could buy: a basic plan with an office visit copay and presciption card with a reasonable deductable and an 80/20 type plan for about $1000 a month. Give me a break. My kids don't even get sick very often and that didn't include dental. We opted for a $300 a month emergency plan with about a $5000 deductable that we will very likely never use. So, we send away $300 a month and then pay about $600 every six months to have our teeth cleaned and $60 for a sick visit to the Dr. Throw in the yearly female preventive stuff and that's another $300 or so. So, I wait and wait if my kids are sick so I don't have to fork out the money and the cost of a prescription and we are very middle class folks. I have gotten to the point where I just level with our doctor and tell him I want samples or the least expensive medicines. Who am I trying to impress?! :) There is something definitely wrong.
I think about how much it is really a cyclical issue. Uninsured people in poverty typically do not have diets that are healthy enough and often have other problems that exaggerate health concerns. Then add in a mentality which makes it difficult to assess whether a trip to the Dr. is really necessary. What a mess. CLEARY these are generalizations which may not even be fair, but suffice it to say that if my family has big problems in the health insurance/medical care arena, what must people in poverty be dealing with?
I am truly interested in hearing some real solutions. I am weary of hearing one side of the aisle screaming the ills of universal healthcare with nothing to back it up, yet I'm equally weary of the other side painting universal healthcare as the end all be all. If it was that great, seems like we'd have given it a try. Surely there is a middle of the road solution. I tend to be a middle of the road kind of gal on most issues, though! I'll be checking back to see if someone has a good middle ground with real meat that is a proven solution. I'd be in favor!
Sorry to change the subject but Jeremy from Central Dallas Ministries suggested i bring my concerns to this blog community that cares about the plight of the poor and oppressed. I need wisdom and advice. I'm a young preacher in a small Church in New Mexico. We have a large population of poor and over the last several weeks i have been working closely with some homeless individuals. Every situation is so different, and our city has little-to-none to offer the homeless and poor. I'm at a loss on how best to act redemptively in the lives of these individuals and how best to lead a congregation into intentional ministry to the poor and homeless. I've read most of Ruby Payne's info which has been very helpful but i need practical advice on how to work within or around the system to best help many of these individuals. What resources would you recommend that would be helpful in understanding how to practically and purposefully help those broken by poverty and homelessness. You can email me at charlton@grantscofc.org. Thanks.
Have you seen Michael Moore's film, Sicko?
Would love to hear your thoughts.
Haven't seen it, but have been told I must.
Belinda
Learn how to argue. Seriously. Your debating techniques are the same as that of Sean Hannity (thought you argue a different side). All you do is say "Person A. is stupid" then "my solution is the best and if you don't agree, you must be stupid" and then you offer some reasoning based on your own stereotypes of the people being discussed "republicans are just bad people" or "health insurance companies are just greedy" etc.
If you learn how to have a discussion rather than just make blanket statements that aren't backed up with fact at all, your opinion would be much more value. As for now, you are just an echo chamber for John Edwards, or whichever left wing demagogue you choose to worship at the time, and honestly, I'm sick and tired of your pedantic thoughts.
Anonymous that spoke after BPB
"when was the last time you were in a public hospital...."
Look, I'm just going by what Michael Moore has been saying on his tour to promote Sicko. Moore says, we all ready have a socialized program called medicare and medicaid and it works fine, so why shouldn't we just make it a system for the entire US. If Medicare sucks for people, why in God's name would we want that for everyone?
"As to Canada"
You still refuse to answer the question. Canada is facing massive shortages of services. Surely the rich and powerful don't get delays because they have power to lobby the government bureaucrats to change the waiting lists, but there are plenty of stories of people having major health issues because of rationed care in Canada, as well as Britain. In fact, a girl I went to high school with told me her grandfather, who is British, almost died because he had to wait on a treatment in Britain that would have been done here immediately.
You offer no counter arguments to my solutions, nor do you offer any counterpoints to the problems I showed with a universal care system.
I think the president is a joke, for many reasons. I think he is right to try and steer away from Government control of health care. Whether its because health insurance companies are lobbying him or not is irrelevant. There are ways to give health insurance to everyone that will lower cost, create a more aware consumer, keep rationing from occurring, keep our freedoms intact, and use tax dollars for those who can't afford, and its not the universal (read socialized) medicine of the left.
Check out freemarketcure.com please.
Larry, what do you think of Justin's plan? I've generally favored the single payer system, but his sounds like it could work if (and this is one of the larger ifs in existence) adequate funding were provided to assist the poor in purchasing insurance. I don't know if most of the rest of us have the background to analyze it effectively.
Charles, at the end of the day isn't that what Medicare and Medicaid do, with the added benefit of cutting out a much more expensive middle man? The subsidy to support the poor in buying insurance is not necessary if we expand Medicare or CHIP-like programs for all. Certainly, there would be a fee to be paid by everyone who could pay some, but it would be less expensive than private insurance and the drug benefit costs could be reduced due to the scale of purchasing.
Justin, your answer to Anonymous is curious. You quote Michael Moore about Sicko, but then poo, poo the universal health plans of nations like Canada which I understand Moore clearly champions. Can you have it both ways?
I am completely for universal healthcare for a variety of reasons: it is more cost effective, we spends more per capita than any other industrialized nation on health care yet are at the bottom in rankings of health outcomes, premiums increase much faster than inflation every year, 47 million Americans are unisured (shamefully this includes children), etc.
Of course socialized medicine is not perfect, nothing is. But the problems are largely over exaggerated (Canada and Great Britian's system do not make any list of the best socilaized mediceine programs, but unfortunately Americans hear and know the most about their programs) The problems in socialized medicine are shared more fairly among all citizens. Under our system the problems mainly affect the unemployed, self employed, the working poor and working classes.
I think the major benefit that comes from the U.S. dragging its feet in moving to socialized medicine is that we can study and learn from the programs of every othe rindustrialized nation (we are the ONLY one that does not have it) and make our program the best there is. We can make our health care system the best for all Americans not just for rich Americans.
Why do any of us bother to quote stats for Justin? Probably because he refuses to hear.
Everyone has the capability to tell truths sometimes. I don't think that Moore is completely falsifiying the problems with the US healthcare system. I do think that he's makes the Canadian system look better than it is.
I think Charles was looking for a response from you to my plan for health care. I'd like to hear it too. Do you see any flaws in it? It still includes coverage for everyone, it will cut out vast amounts of bureaucracy by having people use actual dollars for check ups and medicines, and it will lower costs for everyone because when people are using their own money, they are more likely to shop around and find the best doctors with the best prices. This competition will drive down cost, as well as increase the quality of care.
Has anyone watched that video about who the uninsured are in this country? It might suprise you.
And as for stats that talk about the savings the single payer would provide, the cost does not include the politicians and bureaucrats that run the system.
Tell ya what, since no one ever reads the links that I've posted, I'll just post ten debunked myths about single payer systems
from freemarketcure.com
Myth No. 1: Everyone has access to health care a single-payer system.
Everyone in a single-payer system has health insurance, not necessarily health care.
While the government in a single-payer system will pay for everyone's health care, it limits the access to health care. In a single-payer system, citizens often believe that "the government" is paying for their health care. When people perceive that someone else is paying for something, they tend to over-use it. In a single-payer health care system, people over-use health care. This puts strain on government health care budgets, and to contain costs governments must ration care.
Governments in a single-payer system ration care using waiting lists for surgery and diagnostic procedures and by canceling surgeries. As the Canadian Supreme Court said upon ruling unconstitutional a Quebec law that banned private health care, "access to a waiting list is not access to health care." [
Myth No. 2: Claims of rationing are exaggerated.
Jonathan Cohn, author of Sick, wrote that the "stories about [rationing in] Canada are wildly exaggerated." Yet advocates of single-payer never say what they mean by "exaggerated."
The fact is that people often suffering great pain and anxiety while they spend months on a waiting list for surgery. Others spend months waiting for a surgery, only to have it cancelled, after which they will spend even more time waiting for another surgery. Sometimes people even die while on the waiting list.
Media in foreign nations are full of stories about people suffer while on a waiting list. In Canada, Diane Gorsuch twice had heart surgery cancelled; she suffered a fatal heart attack before her third surgery. In Great Britain, Mavis Skeet had her cancer surgery cancelled four times before her cancer was determined to have become inoperable. In Australia, eight-year-old Kyle Inglis has lost 50 percent of his hearing while waiting nearly 11 months for an operation to remove a tumor in his ear. Kyle is one of over 1,000 children waiting over 600 days for ear, nose and throat surgery in Warnbro, a suburb in Western Australia.
These are not mere anecdotes. Much academic literature has examined the impact of waiting lists on health. A study in the Canadian Medical Association Journal found that 50 people died while on a wait list for cardiac catheterization in Ontario. A study of Swedish patients on a wait list for heart surgery found that the "risk of death increases significantly with waiting time." In a 2000 article in the journal Clinical Oncology, British researchers studying 29 lung cancer patients waiting for treatment further found that about 20 percent "of potentially curable patients became incurable on the waiting list."
Myth No. 3: A single-payer system would save money on administrative costs.
Single-payer advocates often claim that the U.S. private sector health care system is wasteful, spending far more on administrative costs than do government-run single-payer systems. According to single-payer advocates David Himmelstein and Steffie Woolhandler, "Streamlining administrative overhead to Canadian levels would save approximately $286.0 billion in 2003, $6,940 for each of the 41.2 million Americans who were uninsured as of 2001."
Yet comparisons of private sector administrative costs with those of government are misleading. Many government administrative expenses are excluded in such comparisons, such as what it costs employers and government to collect the taxes needed to fund the single-payer system, and the salaries of politicians and their staff members who set government health-care policy (the salary costs of executives and boards of directors who set company policy are included in private sector administrative costs).
But even if the U.S. would save money on administrative costs by switching to a single-payer system, the savings would prove temporary. The main cause of rising health care costs is not administrative costs, but over-use of health care. A single-payer system would not solve that problem. Indeed, it would make it worse.
Myth No. 4: Single-payer will provide fair and quality care for everyone.
Leftist Dave Zweifel claims that the U.S. "could make the system so much more fair by enacting a national single-payer health plan." Jonathan Cohn, when asked why he had faith that the government could run the health care system for all when it didn't do it very well for the poor, responded, "My answer is that they do it, and do it well, abroad."
Well, no they don't. According to Canada's Fraser Institute:
... a profusion of research reveals that cardiovascular surgery queues are routinely jumped by the famous and politically-connected, that suburban and rural residents confront barriers to access not encountered by their urban counterparts, and that low-income Canadians have less access to specialists, particularly cardiovascular ones, are less likely to utilize diagnostic imaging, and have lower cardiovascular and cancer survival rates than their higher-income neighbours.
It isn't much better in Great Britain. Take a look at the Saga 'Good Hospital Guide' for British hospitals. Compare the ones in Inner London, which tend to be in wealthier areas, to the ones in Outer London, which tend to be in poorer areas. You'll notice that in general, the ones in Inner London have more doctors and nurses per bed, shorter wait times for MRIs and hip replacements, and lower mortality ratios. [
Myth No. 5: A single-payer system will leave medical decisions to a patients and his or her doctor.
According to Physicians for a National Health Program (PNHP), a group pushing for a single-payer system in the U.S.:
There is a myth that, with national health insurance, the government will be making the medical decisions. But in a publicly-financed, universal health care system medical decisions are left to the patient and doctor, as they should be. This is true even in the countries like the UK and Spain that have socialized medicine.
Yet PNHP seems to be talking out of both sides of its mouth. Here is how PNHP addresses the question of how to keep doctors from doing too many procedures in a single-payer system:
[Doing too many procedures] is a problem in systems that reimburse physicians on a fee-for-service basis. In today's health system, another problem is physicians doing too little for patients. So the real question is, "how do we discourage both overcare and undercare"? One approach is to compare physicians' use of tests and procedures to their peers with similar patients. A physician who is "off the curve" will stand out. Another way is to set spending targets for each specialty. This encourages doctors to be prudent stewards and to make sure their colleagues are as well, because any doctor doing unnecessary procedures will be taking money away from other physicians in the same specialty.
In practice what this will mean is medical decisions will be left up to you and your doctor as long as your doctor isn't doing too many (or too few) procedures and is within a spending target.
The truth is that single-payer systems often interfere with treatment decisions. For example, most single-payer systems have bureaucracies that delay the approval of new drugs, preventing patients from using them. Alice Mahon, a former member of the British parliament, needed the drug Lucentis to slow her macular degeneration. Because of delays due to the National Health Service not yet having approved Lucentis at the time of her diagnosis, Mahon lost much of the sight in her left eye.
In 1999, Canadian patient Daniel Smith, a cystic fibrosis sufferer, and his doctors agreed that he needed a lung transplant. But his surgery was cancelled by administrators because an open hospital bed could not be found.
So much for medical decisions being left to patients and their doctors. [Back to Top]
Myth No. 6: Single-payer systems achieve better health outcomes.
Most single-payer advocates point to life expectancy and infant mortality as evidence that single-payer systems produce better health outcomes than the U.S. And, indeed, the U.S. has lower life expectancy and higher infant mortality than many nations with a single-payer system.
The problem is that life expectancy and infant mortality tell us very little about the quality of a health care system. Life expectancy is determined by a host of factors over which a health care system has little control, such as genetics, crime rate, gross domestic product per capita, diet, sanitation, and literacy rate.
The primary reason is that the U.S. has lower life expectancy is that we are ethnically a far more diverse nation than most other industrialized nations. Factors associated with different ethnic backgrounds -- culture, diet, etc. -- can have a substantial impact on life expectancy.
A good deal of the lower life expectancy rate in the U.S. is accounted for by the difference in life expectancy of African-Americans versus other populations in the United States. Life expectancy for African-Americans is about 72.3 years, while for whites it is about 77.7 years. What accounts for the difference? Numerous scholars have investigated this question. The most prevalent explanations are differences in income and personal risk factors. For example, one study found that about one-third of the difference between white and African-American life expectancies in the United States was accounted for by income; another third was accounted for by personal risk factors such as obesity, blood pressure, alcohol intake, diabetes, cholesterol concentration, and smoking and the final third was due to unexplained factors.
Infant mortality is also impacted by many of the same factors that affect life expectancy -- genetics, GDP per capita, diet, etc. -- all of which are factors beyond the control of a health care system. Another factor that makes U.S. infant mortality rates higher than other nations is that we have far more pregnant women living alone; in other nations pregnant women are more likely to be either be married or living with a partner. Pregnant women in such households are more likely to receive prenatal care than pregnant women living on their own.
Perhaps the biggest drawback of infant mortality is that it is measured too inconsistently across nations to be a useful measure. Under United Nations' guidelines, countries are supposed to count any infant showing any sign of life as a "live birth." While the United States follows that guideline, many other nations do not. For example, Switzerland does not count any infant born measuring less than 12 inches, while France and Belgium do not count any infant born prior to 26 weeks. In short, many other nations exclude many high-risk infants from their infant mortality statistics, making their infant mortality numbers look better than they really are.
In areas where a health care system does have an impact, such as treating disease, the U.S. outperforms single-payer systems. For example, the U.S. has a higher five-year survival rate for victims of heart attacks than Canada, due to the fact that we do more bypass surgeries and angioplasties in the U.S. Hospitals in the U.S. also commit fewer errors than hospitals in countries with single-payer systems like Australia, Canada, New Zealand, and the United Kingdom.
Myth No. 7: The U.S. systems also engages in rationing - 18,000 people die each year due to lack of insurance.
According to PNHP, "Rationing in U.S. health care is based on income: if you can afford care you get it, if you can't, you don't. A recent study by the prestigious Institute of Medicine found that 18,000 Americans die every year because they don't have health insurance."
The Institute of Medicine study purporting to show that 18,000 people die each year due to a lack of health insurance is actually a "meta-analysis," a study that summarizes the results of other studies. Yet many of the studies the Institute relied on have some rather odd results. One study in the New England Journal of Medicine found that women with private insurance were more likely to survive breast cancer than those uninsured. However, data in the study also showed that those who were uninsured had a higher survival rate than women covered by Medicaid. This suggests that factors other than health insurance, like education and income, were at play in determining breast cancer survival.
Furthermore, everyone in the U.S. can get care regardless of income. In 1986 the U.S. Congress passed the Emergency Medical Treatment and Active Labor Act. This requires emergency rooms to treat any person who shows up seeking medical treatment, regardless of their ability to pay
Myth No. 8: A single-payer system will not hamper medical research.
The PNHP claims:
Medical research does not disappear under universal health care system. Many famous discoveries have been made in countries that have national health care systems. Laparoscopic gallbladder removal was pioneered in Canada. The CT scan was invented in England. The new treatment to cure juvenile diabetics by transplanting pancreatic cells was developed in Canada.
While it is true that medical research will not "disappear," it will surely decline. Consider what has happened to pharmaceutical research in single-payer systems, where the government imposes price controls on prescription drugs. A study (PDF) conducted by U.S. Commerce Department found that drug price controls in other nations reduced annual investment in pharmaceuticals by $5-8 billion, resulting in 3 to 4 fewer drugs being launched each year. The Boston Consulting Group found (PDF) an even bigger effect of price controls, showing a loss of $17-22 billion annually in pharmaceutical research resulting in the loss of 10 to 13 new drug launches.
In a free market, producers make a profit by providing services that consumers find useful. Profits also act as a signal to research - research dollars go toward services that make more profit. This is desirable because services that make more profit are the ones that consumers find most useful. Medical services that make profit -- i.e., the ones that patients find most useful -- will attract more research dollars.
In a single-payer system, government sets the prices for medical services. Since government is not good at setting prices, it inevitably over-pays for some services. Research dollars will go not necessarily toward the services that patients find most useful but toward the services that government over-pays since those will be the ones that will be most profitable.
Myth No. 9: Single-payer will save money because patients will seek care earlier (since they will no longer face financial barriers to health care) when it is easier and more affordable to treat diseases.
This assumes that patients will be able to get access to health care easily in a single-payer system. But as nations with single-payer have shown, even the most basic health care, like routine doctors visits, are rationed. According to a report by Statistics Canada:
* Despite the fact that most individuals had a regular family doctor, almost one in five individuals of those who required routine care experienced difficulties accessing care. The rates were significantly lower in Saskatchewan (12%), Alberta (13%) and British Columbia (12%), and significantly higher in Newfoundland and Labrador (20%) and Quebec (19%).
* The top two barriers to receiving routine or on-going care were difficulties getting an appointment, and long waits for an appointment.
* Overall, 16% of Canadians who had required health information or advice indicated that they had experienced difficulties accessing care. The rates were significantly lower in Saskatchewan (13%) and Alberta (13%), and significantly higher in Ontario (18%).
Seeking care earlier will make little difference if patients have trouble getting a routine appointment with a doctor
Myth No. 10: The free market in health care has failed in the U.S.
What has failed in the U.S. is government micromanagement of the health care system. Over the past 40 years government's role in the health care system has continually expanded, from programs like Medicare, Medicaid and SCHIP, to regulations like HIPPA and COBRA. Like most government interventions, it has only made the problem worse.
The fact is we do not have a free market in health care in the U.S. Ask yourself: How many markets in the U.S. do you get a tax break for buying a product, but only if you buy it through your employer, as we do with health insurance? In how many markets are you prohibited from purchasing a product out of state, as we are with health insurance? In how many markets are employers prohibited from providing bonuses to employees for improving quality and productivity, as hospitals are prevented from doing with doctors? If government policy inhibited other markets that way, those markets would be dysfunctional too.
The solution to our health care problems is to reduce the role of government, not increase it by switching to a single-payer system.
so in conlusion. I do not believe that our current system is perfect. But I do think the solution lies in freedom and not the savior government.
wow... that was totally unnecessary... I got all excited that there was a big discussion... more like a monologue, though...
Not cool when someone takes someone else's material and barfs it onto another blog in a cheap effort for "real" discussion.
Justin, in most cases I'd likely remove so much "comment" and simply ask the one who posted it to put it up on their own blog. Since it's you and we have so much history :), I'll not do that. Not sure when I'll ever find the time to answer all that you posted, but let me just say every point has really good counter points.
For now, let me just point out what everyone has admitted: the most efficient (in terms of admin costs) health insurance plans in history are Medicare, Medicaid and the VA health benefit. If memory serves me correctly it is something less than 2%. The savings annually would be over $45 billion. I'll try to get back to the long list you put up later.
It was not my intention to spam anything. But no one seems to want to read any links I've posted to, and most if not all the points ya'll raised were addressed above.
Like, I posted a video that discusses who the uninsured in america are, and I'm quite certain no one watched it.
I've asked people to check out freemarketcure.com (which acknowledges a problem, but proposes a different solution) but no one wants to do that either, which is why I ended up posting that entire article.
I know you're busy Larry, but if you truely want debate over the issue, and not a bunch of liberal dittoheads that just spout the talking points about health care
"canada's system works fine"
"45 million uninsured people in the country"
"45 billion in savings" (that's without the cost of administration, collecting taxes, etc. and also that's assuming that the demand for health care stays static. add to that demand legalized new citizens from central america, people who will go to the doctor more often when they aren't paying for it, and that number might not be the same)
No one addresses the rationing that takes place in these countries, or that part of the reason our ranking in health care has to do with things other than insurance. Bad diets (won't change) poverty and crime (government's been spending a boatload on this too, and it hasn't improved, race (which plays a factor in many health issues, drug and alcohol abuse, etc. These are thing that contribute to our lower ranking that will not be changed by having a single payer system.
I just wish someone on here would be intellectually honest enough to look at the other side and admit for just a second that maybe those who are against government run health care are against it for legitimate reasons, and not just becuase they hate poor people or are greedy and rich.
that is the problem of our culture... the challenge of saying something succinctly and effectively so that people will listen... cuz they're definitely not gonna read copy and pasted material.
well sometimes I feel like they don't read what I say that isn't copy and pasted either.
Justin, I assume you are claiming here that your sources are all objective and without "ditto head" right wing leanings? Come on, man.
I am going to answer your points and I have read the other side. Just a bit of background: for the past 10 years I have been working, almost daily, with a major health care system here in Dallas. They are our partners in medical delivery to our inner city community. We serve only the uninsured. The folks inside the system--the doctors and administrators--who are trying to hold this system together agree with most of what I say and present here. I am not coming out of a vaccum.
Fact: the exotic benefits of health care in the US, the really costly precedures and medicines go to those who can pay for it. Thus, health care is a commodity to be bought and sold in our system.
The impact of this on public health data, both morbidity and mortality is obvious in our stats as a nation compared to others.
Fact: I don't go to the doctor more often jsut because I have health insurance; I do go for preventive checkups, as do our patients at our clinci because we are educating about moving away from accute approaches to preventive strategies which saves money for everyone.
Now to the 'myths"--
Myth No. 1: Everyone has access to health care a single-payer system.
There are waiting lists now, even for me in the private payor system. The differecnce is people with coverage don't have to face the choice of paying the rent or going to the doctor. The notion that "someone else is paying" will not be true for a single payor system. Those folks who are covered will pay something just like we do now for Medicare. The poor will be covered by Medicaid. The notion that the gov't would just pick up the tab for everyone is not true in any country with a single payor system. It is true that the efficiencies and public health outcomes are better than here.
Myth No. 2: Claims of rationing are exaggerated.
The fact here is you are (or better, your source) using anecdotes. The hard data tells a much different story.
You want to talk about death rates? Let's look at the mortality rates per 1,000 persons who are uninsured in this country and how they fare in trying to get care via the ER as our President suggest. Those numbers will bury you, my friend. Why don't you look into that?
Myth No. 3: A single-payer system would save money on administrative costs.
This is most ridiculous of all these "myths." The comparisons are fair, every objective analyst agrees with this. To suggest a comparison that brings politicians into the mix is absurd. One-to-one comparisons reveal huge savings. It is a fact.
Who is over using health care? Those who can afford insurance? The cost of health care is rising because so many people don't have insurance--they grow sicker before seeing a doc, and they use the ER as their port of entry to the American system, driving costs up for everyone--you have heard of cost-shifting, right?
Myth No. 4: Single-payer will provide fair and quality care for everyone.
So, you are saying the current system that forces millions of people into the ERs is fairer than, again, the antecdotal examples--fit for People magazine--indicate? People may always find ways to beat the system, but what we have now is not fair at all.
Myth No. 5: A single-payer system will leave medical decisions to a patients and his or her doctor.
Again, how is this different from what we have now with managed care? I would bet you that doctors and patients who have Medicaid and Medicare compare more favorably in this regard than thsoe covered by private insurance.
Myth No. 6: Single-payer systems achieve better health outcomes.
Some of the factors you mention are worthy of debate, and we have had those debates here.
There are unique factors in the US and our culture.
But to say that nations with single payor systems don't also have the diversity in their nations, is not true.
Providing health care plans for everyone certainly will not hurt our public health outcomes, including infant mortality, chronic asthma, diabetes, etc. No doubt, a big part of our problem here relates directly to poverty.
Myth No. 7: The U.S. systems also engages in rationing - 18,000 people die each year due to lack of insurance.
This is the weakest part of your argument--or, their's. They try to debunk solid research with distracting, statistical fine points, it sounds like.
The giveaway is the last paragraph! Sounds like the President's statement--here is what your sources said: "Furthermore, everyone in the U.S. can get care regardless of income. In 1986 the U.S. Congress passed the Emergency Medical Treatment and Active Labor Act. This requires emergency rooms to treat any person who shows up seeking medical treatment, regardless of their ability to pay."
Myth No. 8: A single-payer system will not hamper medical research.
We can at least debate this one in a rational manner. Again, though, I don't think we know what impact a change would have on research. Our research might actually take on a more consistent humanitarian motive, rather than researcht that is driven by the profit motive. Not all of our research to date has been valid, helpful or adequate--witness the number of popular drugs pulled from the market after negative health outcomes.
Myth No. 9: Single-payer will save money because patients will seek care earlier (since they will no longer face financial barriers to health care) when it is easier and more affordable to treat diseases.
If regular doctor's visits will be rationed, how can you say elsewhere that there will be over useage? Some planned protocol, call it rationing if you like, would likely not be a bad thing.
The Canadian stats look pretty good to me! I bet they compare favorably with the rates in the US among private insured, esp given the fact that you say we are so grossly over-using our health care benefits. Smoke and mirrors, Justin.
Myth No. 10: The free market in health care has failed in the U.S.
Blame Uncle Sam, right! Thank God for everyone of the programs mentioned in the unfair critique--all bring benefit to people, mostly the weak and marginalized. God bless America for not turning away.
Let me quote the conclusion here and take it apart in bits: "The fact is we do not have a free market in health care in the U.S." Thank God! Health care should not be a commodity to be traded like beef futures!
"Ask yourself: How many markets in the U.S. do you get a tax break for buying a product, but only if you buy it through your employer, as we do with health insurance?" The 401 K industry, along with other life insurance and retirement strategies.
"In how many markets are you prohibited from purchasing a product out of state, as we are with health insurance?" Single payor system would solve that one, wouldn't it?
"In how many markets are employers prohibited from providing bonuses to employees for improving quality and productivity, as hospitals are prevented from doing with doctors?" Not true. Here in Dallas, doctors enjoy incentive programs for performance improvement. This I know for a fact.
"If government policy inhibited other markets that way, those markets would be dysfunctional too.
The solution to our health care problems is to reduce the role of government, not increase it by switching to a single-payer system." Here we come to the ideological center of this entire, distorted diatribe! Objective material worthy of honest debate? Come on!
What we have here is an apologetic for the insurance industry.
Freedom is not the same as community or democracy, Justin. The good of the whole must trump the benefit to the individual in any rational, sustainable society. We just disagree. It is not that I am unwillling to look at your stuff. Your number one value seems to be "freedom." Mine is "community."
ER usage is ugly...
I was recently working on data for a nonprofit that provides medical care to low-income households. We found that patients at this nonprofit reduced their emergency room visits almost in half once they became patients.
Talk about a lot of savings...
Daniel, thanks for the feedback. This has been our experience as well. In fact, the growth of our medical work is directly related to the cost savings we have demonstrated by keeping people out of the ER and hospital with a preventive approach.
Ok, I can see relevant points that you make countering the arguments put forth by that website. But you must concede that there is no unbiased source in any of the data we are going to consume in this debate? Everyone has an agenda. And, the vast majority of politicians agendas is more power in their hands, and less in the hands of the American people. Is it fair to assume that some of those promoting this system are doing so in order to increase their power over the populous rather than for purely humanitarian reasons?
Onto fairness... exactly what constitutes fair in your mind, Larry? Its a pretty abstract concept (as are many concepts...) Does fair mean everyone receives the same thing no matter their behaviors? One might say its fair that one person who has worked hard their entire life receives plenty. Another might say its unfair because, at some point in time, this person may have gotten a leg up for some reason.
I guess it does come down to a difference in ideology. I think rather than talking about fairness, we should talk about justice. People have the right to be treated as human beings, regardless of their income, race, etc. And we can try to make the world just for these people. Justice meaning their rights are the same as mine or yours. But I have trouble with fairness, because even if you put all the worlds riches into a big pot, and doled it out equally, things would still not be "fair". Because some have different skills than others. Some are disabled. Some are lazy. Some aren't as smart as others. Because we aren't carbon copies, but living breathing things that can make our own decisions, and have a genetic makeup that is different, how can things ever be fair? I may be wrong, but I feel like we should strive for justice for those in the margins, we should help them when they are in need, and stand with them when there are powers working against them. But I don't think there is such thing as totally fair. And I definitely don't think human beings, especially those who have shown a penchant for desiring power, have the capability to determine that.
I thought I put forth a fairly decent plan, that involved government dollars and making sure people had a base to be able to get their health care needs met back in post 4. Is there something wrong with that?
Justin, thanks. The fairness thing came up only because that was the language used in Myth #10. I agree, life ain't fair and we should work for justice.
I come from a context where I see people suffering, waiting, be abused daily by a system that grades everything on the "wealth scale." I know that feeds my bias. But, I find comfort from my reading of the Bible wherein it is clear that God had a bias for the poor too.
I never said I rejected your plan; but it does seem like a plan designed to keep the insurance industry in the game when much of the cost of such a plan could be eliminated if we went straight to the process like Medicare does.
Would you do me a favor?
Please call your two U. S. Senators and ask them to support the Dream Act now. I'd be grateful to you!
Our nation has recognized that fair treatment involves not letting people die, as shown in the law that requires ERs to take in patients. I don't think anyone on this thread would disagree with society shouldering the burden of healing and saving the lives of people who have no other alternative.
What I find attractive about the single-payer model is it recognizes that health spending can reduce the life-saving ER bills so much as to reduce the overall cost. Even if it doesn't quite reach that threshold, isn't it worth some taxes to think of people not living in fear of what will happen to their bodies the next day? While we can't control people's emotions, this doesn't sound like too high a bar to reach.
I know this statement could be distorted to represent giving services like cosmetic surgery for free, but please give me credit for meaning reasonable checkups and treatment.
My only thought on medical research is that companies who spend more on advertising than R&D, and spend more time developing drugs that enhance higher-income lives (Viagra, anyone?) than lifesavers, well, I don't lose any sleep about those.
Justin and Larry and all other commenters, I appreciate all the thoughts that I've been able to sift through here.
"call senators to support the dream act"
Done.
I don't think there's a problem with people making a profit for providing a service. Profit, when in a non monopolistic situation, increases entry into a market, until that profit is spread out amongst different corporations. When profits increase, more companies enter into take part in that profit, which creates more jobs, and causes competition lowering cost.
I imagine you take issue with companies taking large profits, but those companies also provide jobs for those in the middle class, helping keep them out of poverty. I'm sure they would feel betrayed by someone who legislated away their job? Is that just?
I don't know. I don't trust the government as far as I can throw it. I trust corporations just a little bit more, if only because they are dependent on consumers rather than government, whose power, while it is supposed to come from the people, we all know continues to grow. And as government grows, it can be lobbied by corporations to offer corporate welfare, as it grows it starts pre emptive wars. And its not just the republicans that are power hungry. Its both parties.
I think when you take the power out of the governments hands, the corporations cannot work the system for their benefit, and the market has a chance to create the best care possible at the lowest cost.
And once again, christian doctors can offer charity (which might be illegal in a government system) the government still pays for the health care, but the consumer has more choice to determine what's best for them.
I appreciate your responding to me, though.
Justin, thanks for your support of the Dream Act! I really appreciate it.
Here's my problem with corporations as it relates to politics: who provides the big money that influences the political system to the negative?
I trust people, not markets, but people. We've all grown too cynical and satisfied and thus, uninvolved.
Thanks for being involved today. Your calls will help us get the Dream Act moving for kids like Monica and Jose.
I agree that corporations can influence the government badly. But would you not agree that giving the government the power of corporations could be equally bad, or worse?
If the government has a small reach, if it doesn't involve itself in policies not authorized by the constitution, but only protects the rights of individuals based on the constitution, corporations, rich people, no one, would be able to influence the government in negative ways, because they government's only job would be to protect people's rights when they are violated.
The larger we make government, the more power it possesses, the more government corruption that is possible. I trust people as well, I don't trust government. And if the Government allows people to be free to help people however they see fit, I think that we'll all be better off. I hate to throw the communist flag, but we've all seen what tyrannical governments who claimed to represent the people ended up doing. Absolute power corrupts, absolutely. What would be best, in my opinion, would be a government that protects individual rights... one that protects us from others who desire to harm and take advantage of us, but one that doesn't possess the ability to take advantage of us itself.
We are a long way from the fearful prospect you describe here. Frankly, most of our problems today have little, if anything to do with government, except as corporate America manipulates government and politics to its own interests. Government has many opportunities to protect us today, but I don't see that happening. It's all about money, greed and the accumulation of great wealth by the few.
I can hear you talking now about the "jobs that are created." But, that rings so hollow as labor dives, as jobs are outsourced and "off-shored" and as the middle class shrinks. I guess I'm living in a different world.
Seems like there's a lot more corruption in corporations than there is in government... I wonder why we turn a blind eye to all of the crap going on in the corporate world.
Government bad, corporate good... whatever... they're both prone to corrupt people. At least governments have elections -- people can keep it accountable. In corporate world, if no one finds out, then it didn't happen.
So naive...
"if no one finds out, then it didn't happen"
Does that principle not apply to government as well?
And sure, we have elections now, but with these new electronic voting machines, its only a matter of time before things start getting rigged. I'm not so sure that some Bush folks didn't rig the Ohio machines in 2004.
We elect businesses as well. Dollar votes are what its called. If you don't support wal mart, then don't shop there. If you don't support Citgo, don't shop there. When profits diminish because of dissatisfied customers, companies will change, and as long as we have a free press (which the government is supposed to protect, but is often the one who infringes that right. Also, with the internet, only government regulation can take control of content.) people will find out when bad stuff is going on. And good people, upon seeing a new market, will enter in.
Garner Mountain (a Bass Pro type place) is against corporate welfare. They won't take it. And either Bass Pro will stop taking it, or as the word gets out, people will change their shopping habits.
Government provides elections, sure. But what happens if they do away with them? They have the power and military might to do it. They continue to try and take away the right to bear arms, which makes it that much easier for them to remove the right to vote. And if the government is only protecting individual rights, then corporations can never enslave you. But the IRS and the government can.
Am I sounding like one of those nutjob conspiracy theorists?
pretty much... go outside and do something today... too much time indoors can be bad on the brain.
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