Matthew Holt does the definitive takedown of the health care jingoists that I’m too lazy to make myself:
But there is a much simpler way to get the free marketeers off the topic. It’s been known for a while that the U.S. is not as good at dealing with reducing foot amputation for diabetics as the Australians, Finns or Canadians. It’s nowhere near as good at keeping heart attack victims alive as the Danes, the Swiss or the Icelanders. But this doesn’t have to be an argument in which the universal health care proponents have to defend the evils of socialized medicine. Nope, the only question you need to ask the free marketeers is, “Why are you so happy to have a health care system that kills so many more people who have heart attacks, and amputates the feet of so many more diabetics?”
If they can’t defend that, they should exit the topic. And I won’t even rub it in by pointing out the new study that compares Canadian and American outcomes on 25 different measures and shows that on balance we do worse on more types of treatment and better on fewer here in the U.S than in Canada. (Oops, just did!).
Add to that: Ask the free marketeers to explain why they feel comfortable with a financing system that causes at least 25% of all the nation’s bankruptcies. Or, one might also ask why they espouse even greater cost sharing even though it’s been shown yet again this week that increased payment at the point of care reduces people’s likelihood of following their doctor’s advice?
Ow, ow, ow. It hurts.
So here in Massachusetts, will we use the reform ferment of the new health care law to actually demand better quality care? It sure seems like MA of all states would be in a good position to do so. But going forward, we need to jettison the old, smelly baggage that the “free market” is going to magically solve our problems. If we want Chapter 58 to work, I’m convinced that there will be a heavier role for government, in the form of subsidies on the demand side, and more regulation on the supply side. And that will be a good thing, on balance.
just don’t have the juice that they used to.
those balls that used to go out of the park so easily, are getting caught on the warning track more and more often these days.
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each week more and more people are realizing that all of this die-waiting-for-bypass-surgery rhetoric is mostly claptrap promulgated by people whose dividend check might get smaller if every american had equal access to affordable, quality healthcare.
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our job is to educate. and to replace the scare-mongering fantasies of the special interests with the real life facts of everyday people.
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and let’s try to do in a way that’s not . . . “rubbing it in.”
Hi Charley,
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I didn’t find the Holt thing definitive, but I did enjoy following the links.
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He was responding to a book review, written by David Gratzer, a Canadian-born-and-raised physician. Gratzer recently wrote a book that is CRITICAL of the US health care system.
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Yet he makes this point:
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The whole book review is a short read
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Now I’d agree with Holt that Gratzer is cherry-picking a couple examples. But then Holt does the EXACT SAME thing in the diabetic example.
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The truth is that these comparisons are hard.
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I think BMG Gary’s long-held point holds up: most Americans WITH private health insurance do not want to trade it in. If you’re a diabetic with health insurance, you’d probably rather be treated by an American doctor than one in any other nation.
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The main driver of the amputation disparity is a culture where we more people who, even when they know they have diabetes, pig out and remain really really fat.
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Your “smelly baggage” is perhaps a bit on the straw man side. Today’s Wall Street Journal editorial page (!) praises gov’t intervention on the supply side of the Drug Prescription benefit. Few of the free marketeers are holding onto the idea of “magically solving our problems” when it comes to health care.
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Instead, mostly the question is between those who want free market with gov’t regulation (which you seem to favor a la Chapter 58), and those who believe in gov’t provided universal health care, which AnnEM favors.
not government “provided”.
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one could say that healthcare in the uk is government provided since the doctors and hospitals are in effort employees of the gov. but the universal plans put forth in the usa retain our system of private and private care providers.
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i.e. not gummint run !!
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Universal government-guaranteed health care is not a problem, it’s how it’s set up that can be.
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Having had worked during college for a member of the British House of Commons, I became all too aware of the problems the British have with their National Health Service. Doctors, nurses, and other staff aren’t paid enough, there aren’t enough to go around, and they’re overworked. This staffing crisis has lead to rationing by way of extraordinarily long waiting lists for specialized care. Many doctors and nurses are leaving Britain for European Union and Commonwealth countries where it’s easy to relocate and the pay and working conditions are better. The real reason why the NHS is so broken has to do with the way that Britain’s unitary centralized state and funding mechanisms operate. Reform is slow and top-down and local governments have limited ability to innovate and fund alternatives. The debate over reform has been largely limited to tweaking the NHS or scrapping it entirely for an American-style private/non-profit owned system. Average Brits dislike both. Real reform would only come from actual reform of the British polity, but that’s too radical or academic to grasp.
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As for Canada, the federal government guarantees portability of care provided by each of the provincial governments. The government negotiates pay rates with private providers. The state itself doesn’t provide the health care, but “contracts out” to private/non-profit providers. The Canadian system emphasizes prevention, sort of like regular maintenance for your car. It’s far cheaper to do regular check-ups and minor repairs than wait for it to break down. A big problem is that there seems to be too few specialists, which creates waiting lists. Canadians can still choose freely which hospitals and doctors to see.
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It’s specialization where the U.S. excels. Specialists rake in more money that primary care doctors, and our mentality as a nation has been on fixing larger health care issues and not going in for preventative care. Heck, even co-pays for regular check-ups with some private plans deter Americans from getting them done, which leads to larger health problems down the road. We also have rationing by waiting times here because larger numbers have to see specialists to take care of problems which could’ve been better managed earlier through preventative care. And because our market-driven system favors specialization over prevention, we do have the best specialists in the world, which is why foreign VIPs come here for specialized care. They sure as hell don’t come here for a “turn and cough” physical!
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But I digress. I guess the point of this rambling comment is that universal health care provided (but not necessarily delivered by) the government isn’t the problem. Establishing a system with the proper priorities and funding mechanisms to provide that care are the problems to tackle.
Why do people that constantly witness and gripe about the utter incompetence of government and government workers think that involvement of government and those same workers will bring about a better healthcare system than what we have now? Certainly the system we have now is not able to keep up with the needs of the population. I’ve not seen government make a bad situation better, but to institutionalize the bad system to make it the norm. Will we see the day when a note from a politician can get you to the head of the line? Is that progress? I suppose it depends upon whether you have any political friends or not.
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As for the whole Massachusetts initiative, I’m reminded of the “healthcare package” passed during the Dukakis administration. That was just a hoax to get Dukakis elected as president. This “healthcare package” seems to be for the purpose of the last governor’s presidential aspirations. Suckered again?
…in the US, it isn’t so much an issue of the health care delivery system as it is an issue of the health care financing system. I recognize that the two are somewhat inter-related (the latter controls the former), but it is important to separate the two, to some degree.
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BTW, thanks for the link to the relevant link http://www.cbsnews.c… which is spot on. Relevant point:
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Why the difference? The big reason is that private insurance in this country has squeezed inpatient time to the bare minimum, while universal coverage in France has preserved longer periods for convalescence – just as it has in other countries. The Germans get almost as much time as the French.
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As I’ve mentioned before, in 2000 my spouse was diagnosed with a DVT (deep vein thrombosis) here in Munich. He spent a week in the local hospital. They stuck him with some sort of high-powered blood thinner (don’t remember the name–Heparin?) that was injected into his abdomen, and monitored his progress. A year or two later, on a conservative US web site, one of the US conservative commenters mentioned that he had just been diagnosed with a DVT. The doctors just gave him the things to jab himself with (Heparin), and he was virtually on his own on an outpatient basis. No monitoring. Why wasn’t he admitted to the hospital? Financing issues, obviously.