Professor Bainbridge...on law, politics, religion, culture & food

"You end up either waiting in line or having a government bureaucrat deny your request for treatment.”

If your request for treatment is going to be denied, I doubt you’re any better off from having it denied by a bureaucrat at a private insurance carrier than a bureaucrat working for the government.

Being in health-care, I’ve NEVER seen one person in the places I’ve worked at been denied any service.

Never worked in Canada, huh?

This is not a good development for the Dems.  Doesn’t Sen. Obama (D-Buyer’s Remorse) already have at least three positions staked out on the issue of health care?

Nope, not good news at all.

Jay Reding writes: “Universal health care has a basic and fatal flaw, you can’t simultaneously reduce the cost of a service and increase access to it.”

The UHC advocate typically replies by claiming that while demand for services will go up, the cost of treatment will go down; if we all go to the doctor for the slightest sniffle, then we will avoid the extremely-expensive medical treatments for severe end-stage diseases.  As though the high cost of health care is due to epidemics of typhoid fever and smallpox sweeping the nation, instead of lifestyle diseases and simple old age.  If you’re dim enough to believe that eating like a pig won’t lead to obesity and diabetes and joint problems, then no amount of doctor’s visits is going to cure you; and I’d like to see the doctor who can counsel you against growing old!

Much is made of the fact that Americans pay more for health care, per capita, than any other nation.  This is inappropriately averaging the elderly Americans in with the rest of us.  Americans above the age of 55 spend almost $8000 a year per-capita; if you move the bar to 65+, it increases to more than ten thousand dollars each.  Under 65 is two to three thousand dollars each.  And--heigh ho--once you hit 65 you get Medicare, which is basically how most UHC advocates imagine the system working.

Paying for a thing empowers you.  You have the money, you have the power to “take your business elsewhere”.  This is why service in the private sector is often pretty good.  Not always, but poor service is punished when people can choose.

In a public system, there is a perverse reward for poor service.  Controlling expense is an overriding goal, and putting barriers between users of the service and the service itself helps to accomplish that.  Poor service helps by discouraging usage and thereby controlling costs.

Unfortunately, our current system does really work like a private sector service.  Most people really can’t “take their business elsewhere”.  They are stuck, pretty much, with the health plan offered by their employer.  They pay for their health care, but indirectly, and so their satisfaction with the services is less important to the providers.  In fact, the third party payer system introduces other problems, too.  In particular, the high cost of health care is due, in part, to this system.  If I am a provider, and have to look you in the eye as I give you a bill that comes directly out of your pocket, then my bill will have some connection with reality.  If, on the other hand, the bill is being paid by a third party, I can charge whatever the payer will pay.  Thus you have podiatrists charging $800.00 to spend 15 minutes making a plaster impression of a foot, among other silly things.

I doubt that most Americans would be happy with a fully socialist model, such as the British National Health Service.  In a public health service, patients are not customers, but users of services.  Certainly one will find caring and idealistic providers in any system, but the basic dynamic in a public system is to try and decrease costs, and to do so by limiting services.  Any thing that serves to discourage utilization helps to decrease costs.  So, poor service is, perversely, rewarded.  Anyone who has worked in a VA hospital will recognize this dynamic (yes, there are wonderful people working in VA hospitals, but again, the theme underlying the whole enterprise is to find ways to limit or deny services).

When my wife found a lump in her breast at the age of 23, she was told it was benign. She had the option to have the surgery that week or wait. She chose to have it immediately and it was found to cancerous. Two masectomy’s and a year of chemo later, she has had some of the best medical care, this world could possibly provide.
In countries like England, Canada and France, she would have been put in a line to wait for surgery, because it was technically an ‘elective’ surgery. In that case, she may not be around today.
Don’t force your beauracratic ‘health care’down our throats, we don’t want it.

<I doubt that most Americans would be happy with a fully socialist model, such as the British National Health Service.>

This is a misrepresentation. The NHS is for the poor, it’s like the VA without the V.  Can you imagine the Queen going to an NHS hospital?  Perish the thought.  But don’t worry, here is a flourishing private sector.  She goes to the Humana.

<In countries like England, Canada and France, she would have been put in a line to wait for surgery, because it was technically an ‘elective’ surgery.>

Another misrepresentation, in my view.  Where there is doubt, and the stakes are high, the NHS might well provide the same choice.  The NHS is generally good at critical care and not so good at the other stuff, e.g dentistry.  I only use private dentists because NHS dentists seem semi-skilled, possibly because of an incentive to mediocrity that the NHS seems to provide.  Interestingly, private dentists in the UK have always been more expensive than US dentists, imo.  If true, this may be because you can scratch a living as an NHS dentist without breaking sweat.  In the US, dentists have to make a choice: be good or starve.

Ornery,
RE: “Where there is doubt, and the stakes are high, the NHS might well provide the same choice.”

I appreciate your post and it makes sense, but I don’t want to take that chance, ‘might’ is not good enough.
Plus, my wife’s aunt lives in Canada and she came to the U.S. when she got cancer because of the health care in Canada. There’s a reason cancer death rates are so much higher in those countries.

The Dude, a little evidence might be in order for that last claim. No one argues that the US probably has the best of health care world (if you need a rare surgery and the like) but it is the lagging bottom end that is most disturbing.

The figure of 47 million uninsured is misleading. If you take into account the fact that 90 million people every year go at least one month without insurance, that starts to look a little more staggering and makes one question the 57% number the professor quoted. Am I satisfied with my insurance simply because I have it? Cause that is a hell of a lot better than not.

Health care is America is in deep trouble. Ask any doctor. They will tell you flat out. Better yet ask any hospital administrator, CMS employee, healthcare policy analyst, insurance company CEO, anyone.

When will people like the dude realize they will hold back a solution because of the obvious myopia he has when he doesn’t realize he pays more for his insurance in the future because all these people aren’t covered. IT AFFECTS YOU.

Get smart people. Theres a much better way to do things and what we have is terrible, inefficient and grossly unfair (from both a human and a policy perspective). These better ways will involve the government and, yes, they will waste some money. But your money is being wasted by insurance companies and hospitals anyway and still 90 million people (and do you know how many of those are children?).

HEALTHCARE IS NOT A FREE MARKET, NEVER HAS BEEN AND NEVER WILL BE. Get over this Republicans, please. No one is trying to take away your private insurance but you believing that the government is only makes you a shill for insurance companies.

John, what makes you think it will be any better than the failing public school system? One can “opt out” and send one’s children to private school, but one still pays for the public system.

There are plenty of good teaches, good schools, and smart kids in the public school system. The problem is “the lagging bottom end”.

Oh:
“still 90 million people (and do you know how many of those are children?)”

Really?!? 1/3 of the US is uninsured? That seems very unlikely to me. Source?

As for how many of them are children - who cannot receive care if they need it - my guess is approximately 0%. If you dig deep enough, you may find several thousands, but out of 90 million, that is statistically 0%.

What we need is government sponsored not run health care.  Give everyone a medical credit card that allows you to choose the health insurance you want.  Each card would have the amount needed to buy a minimal policy so that everyone would be covered.. If you want a better policy, you pay the difference. This way the government doesn’t run health care. Private industry is better at preventing fraud and abuse.  Certain regulations and rights would have to
guaranteed to patients and doctors so it doesn’t become insurance companies raking everyone ofver the coals for profit.(more than they do now)

My source is the ex-CEO of a major health insurance company. I am currently a health policy graduate student who has worked for the hospitals and government health agencies. The 90 million number is accurate and once again, is the number of people who do not have insurance for one month or more during a year.

Mrsizer, statistically zero is not at all true. The number is over a million. And if it was 100 or 10 would that be OK with you? By the way, not attacking the substance of my argument and arguing about statistical significance is pretty weak. I hate to say it but, you sound like the Bush administration on global warming. Not proven, not proven, the evidence is shaky, the globe is warming, its getting a little warmer, maybe we should do something in 17 years…

Finally, public schools suck. I know, I used to be a public school teacher. So I can probably speak with a little more authority than most readers here. But the analogy fails in that there aren’t millions of 10 year old walking around during the day because there is no service for them.

John,

I think one criterion that should be considered before making major changes in our healthcare system is whether or not the changes will likely result in improved care for most people.  I have not lived in a country with a national health service, but as a pathologist I read journals from countries that do, I am not convinced that people in, say, the UK, receive better care.  The opposite, in fact.

And I’m not just talking about those with health insurance.  People without health insurance in the United States tend to get pretty good healthcare for acute problems.  Routine care, and preventative care is poor, however.  Often this is because people don’t take advantage of services available to them.  Medicaid will pay for pap smears, mammograms, and colonoscopies, for example.

In countries with socialist health care systems, by contrast, failure to provide both screening and treatment is often a consequence of arbitrary decisions made by the agencies delivering these services.  I can’t count the number of studies I’ve read coming from countries with socialist systems whose premise is that a particular service need not be offered because the results to do not justify the expenditure.  There is a good reason why cancer death rates are significantly higher in the UK than in the US, and lack of support for good screening programs is one of them.

Involving the government moreso than it has already involved itself in healthcare in the US may actually make care worse, overall, and for nearly everyone, not just those served by government sponsored programs.  I would bet on it, in fact.