Like everybody else in the world, I woke up this morning to find the US Federal Government has gone into shutdown, with all non-essential Federal workers on mandatory furlough until otherwise advised.
National parks, galleries, museums and zoos are closed until further notice. NASA, the Center for Disease Control and the IRS are all facing severe cutbacks, with only a skeleton staff in place. Federal loans for homebuyers and small businesses are stalled, garbage collection and parking enforcement in the Capitol is suspended and buying a gun just got harder, as the Bureau of Alcohol, Tobacco and Firearms is a non-essential service.
I’m no political junkie, but here’s how I understand the situation: the federal government has passed a law that says all Americans MUST buy health insurance or face a fine, and that law has been upheld by the Supreme Court. This law is referred to as Obamacare. Lots of people love it, lots of people hate it, but it IS the law, and it goes into effect today. The government shut down has nothing to do with trying to prevent the passage of a healthcare bill. The bill has been passed. It’s the law.
So what is the shutdown about? I think it’s straight-up posturing. Shutting down the government is a Very Bad Thing™ and whoever ends up getting the blame is probably not going to be re-elected. If the Republicans can stick the Democrats with the responsibility for the shut-down, they have pretty much annihilated Hilary’s chances in 2016.
Personally, I think it’s going to go the other way, and the Republicans are gonna get stuck with the shitty end of this stick, but we shall see. The fight, as I understand it, is over whether the implementation of the law should be delayed or not. And tacked onto that delay measure was some bullshit about companies being allowed to decide if the insurance plan employees are paying for should fund preventative health measures like birth control.
This is a war of ideology: is healthcare a fundamental right that all citizens should be guaranteed or should it be something you choose to have or not have? I’ve lived under all different regimes:
China – fully funded national healthcare with a robust black market providing private care
England – National Health Service with some private sector health providers
Australia – separate private and public systems
Canada – fully funded national healthcare with very little private healthcare available
USA – total fucking mess
For me it comes down to economic efficiency. A national healthcare system is just a more efficient way of spending healthcare dollars. National healthcare systems piss Americans off in particular because they are also progressive –they redistribute the resources of the rich to the poor. But they’re only moderately progressive. Nothing to get all up in arms about, if you ask me.
Using data on expenditures and life expectancy by income quintile from the Canadian health care system, I find that universal, publicly-funded health insurance is modestly redistributive. Putting $1 of tax funds into the public health insurance system effectively channels between $0.23 and $0.26 toward the lowest income quintile people, and about $0.50 to the bottom two income quintiles.
Health Care Financing, Efficiency, and Equity
http://www.nber.org/papers/w13881.pdf?new_window=1
Most of the media commentary on the shutdown focuses on these differences in ideology. FoxNews frames the conversation as one about a “critical spending bill”, and paints the Republicans as the good guys trying to “woo” the recalcitrant Democrats into negotiation.
CNN focuses on all the workers who won’t be getting paid and blames the Republicans for hating Obamacare.
http://www.cnn.com/2013/10/01/politics/government-shutdown/index.html?hpt=hp_t1
blah blah blah
There is one curious exception to the overall coverage, however. Both Slate’s Double XX blog and Jezebel have identified the battle as being not over a fundamental ideological difference about personal responsibility, but as a targeted example of misogyny.
The government has shut down because someone hates women.
Here’s where it gets tricky: almost ALL of the senior branch of the government is comprised of men.
The braying ladies can’t blame ALL men for this debacle, or they would end up blaming the men they count on to do the tricky, difficult job of governing for them.
Hmmmm.
What to do, what to do?
I know! Let’s focus on that one provision that allows companies to decide whether or not to fund particular preventative health measures and make the argument ALL ABOUT THAT, because that way, we can blame Republican men and save “our” men from criticism.
And they say that in 2013 women still don’t have any power. Behold, the US government, steward of the most powerful and wealthy country in the world, is about to be brought to its knees by a group of post-fertile conservatives who, more than anything, fear a loosening of their demographic’s grip over the choices of sexually active women. In fact, conservatives hate sluts so much that at midnight to night, they’re going to shut down the government over it.
http://jezebel.com/whos-really-to-blame-for-the-looming-government-shutdo-1426895790
Shutdown Looming, Republicans Spent the Weekend Trying to Cut off Your Contraception Access
Amanda Marcotte
The amendment reflects an extremely creepy view of the employer-employee relationship, in which apparently your boss’ beliefs and views are supposed to be in the mix when you’re making personal decisions about how you have sex and procreate.
This is not the first time Republicans have tried to hold our government and economy hostage with their misogynist obsessions—in a 2011 spending bill, the GOP threatened to cut off family planning subsidies for places like Planned Parenthood.
Here’s theFrisky, deploying the same tactic, helpfully illustrated with a white male Republican looking suitably grim. You just feel his lady-hate.
Congressional Republicans Willing To Let Government Shutdown Over Birth Control In Obamacare
What’s more important: letting your boss refuse to cover your birth control pills in your health care plan or the jobs of 800,000 federal workers? You guessed right — it’s your boss’s input on your family planning decisions! Oh, Lord, I just can’t anymore with Republicans.
Seriously. Are we in need of any more proof that feminism is deeply narcissistic? Not every debate is about women. Not everything is a “feminist” issue. Not everything is about meeeeeeeeeee!
How many ounces of human compassion do you need to realize that a lot of families are about to suffer with no money coming in to support them? No matter where you fall in the debate about healthcare, how hard is it to understand that almost a million people will not be getting paychecks for the foreseeable future?
Seriously, feminists.
Shut up.
You’re embarrassing yourselves.
You’re embarrassing everyone.
Lots of love,
JB
judgybitch 
For ‘England’ read UK. The United Kingdom is more than England, it is…………………
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For the record, John Boehner is an Orange American, not white…..
As to the solipsism of feminists, is it really any surprise. Last time I checked employer health care didn’t cover condoms so why should it cover birth control pills? Even up here in Soviet Canuckastan our national healthcare doesn’t cover BC pills I don’t think and private extended medical you get from employers only covers it if all prescriptions are covered under your plan.
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“For me it comes down to economic efficiency. A national healthcare system is just a more efficient way of spending healthcare dollars. National healthcare systems piss Americans off in particular because they are also progressive –they redistribute the resources of the rich to the poor. But they’re only moderately progressive. Nothing to get all up in arms about, if you ask me.”
Let me get this right. You’re telling me that the United States Government is capable of being -efficient-?
Having the USG determine whether or not I get treatment doesn’t sit too well either. And if you think it’s not going to come down to that, you’re not thinking, period(sorry to be so harsh…)
I’m a combat vet, and dirt poor. I get my care from the VA, which is essentially Obamacare on a small scale. And it sucks. It sucks with the suck of a thousand thousand Dysons.
And, while we’re on the subject of government issue healthcare, I’m sure they would -never- deny, delay, or otherwise screw with your health care on political or idelogical grounds, I mean look at the IRS, they’ve never abused their power to screw over a group of people who’s politics they didn’t like….
and finally.. being in favor of obamacare, means you’re in favor of modern slavery.
WTF, right?
here’s how it breaks down.
When any service or good becomes a right to possess, The government has an obligation to provide. If you have a ‘right’ to healthcare, Then the USG has an obligation to use force to provide it. This force will take the form of fines, and jail time. And, at some point, if there are not enough surgeons in ohio, surgeons from florida will be forced to move to ohio.
Or, you know, we can just pick who gets the care, cause there’s not enough care to go around.
And I’m sure malpractice will be handled smoothly. It’ll be just like trying to sue a DA for malicious prosecution, easy right?”
There are a lot more arguments against nationalized healthcare. And they’re all very good ones.
I love your work, but I really think you missed the shot on this one.
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I would agree that we have devolved (again) to the point where nationalized (i.e., not individual-controlled) healthcare is the only choice. It is the logical outcome of our political system–now before you think “socialism,” I will join you and put that Ph.D. student hat on. What kind of citizenry wants to be taken care of by the government? What kind of government wants to control (or, meh, “redistribute”) the resources used to take care of the citizenry?
You can Google it, I’ll wait.
Here’s the only hint you need: in the last two sentences of the longer paragraph above, change “citizenry” to “peasantry,” and change “government” to “aristocracy.”
Feudalism. That’s the danger here. Not socialism. Barack Obama isn’t detached and arrogant—he’s exactly the kind of lord/aristocrat that most of us wanted.
Full credit if your answer was: proper peasants want to be taken care of and are willing to turn over labor/wealth (these days, often in the form of debt, credit cards, or student loans) if they at least get a minimum level of looking after.
(Everything else is too scary, and what if I fail? I’d hate to have to learn, it’s hard; or grow to become a better human being. I mean, even though my step-mom and teachers told me every day how special I was, I still shit my pants from time to time.)
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I guess it’s all a matter of perspective. As a Canadian with universal healthcare, I couldn’t imagine not having it.
Just for understanding sake, the Fed government doesn’t run healthcare, the Provinces do. All the fed does is transfer tax money to the provinces to fund it and ensure a certain service level is maintained in the provinces. SO someone in say Quebec isn’t getting better or worse level of care as someone in Alberta.
As to doctor shortages, they provinces use incentives, not force. There was a shortage of general care doctors in remote northern areas for example. What they did was offer forgiveness of a large percentage of newly graduating doctor’s student loans if they agreed to practice in a remote area for 5 years after graduation.
There are a ton of arguments for national healthcare as well, and they are all very good ones.
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The government shutdown is the same old same old; they’re out of money and the party-not-currently-in-power balks at raising the debt ceiling again. The Ds did it to the Rs (remember Senator Obama’s posturing on how raising the debt ceiling was “unpatriotic?”) and now the Rs are doing it to the Ds. *yawn* It hardly matters, now that mandatory spending exceeds revenue anyway.
But the very thought that the government can be more efficient spending our health care dollars is preposterous. The problem with our system are third party party payers. Just imagine if we implemented the Affordable Car Act, which meant you only spent a copay for oil changes and the prices of cars was regulated. Will driving become less expensive, or more expensive? How about the Affordable Food Act? The Affordable Cell Phone Act? The mind reels. A combination of publicly subsidized health care plus actual free market health care (which we don’t actually have) would work wonders, if we’d just try it.
And a comment on the Canadian system. Do a little Googling and find out where the largest for-profit hospitals in the US are located. You may be surprised at the answer.
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The problem, as I see it, is this:
We have a huge health care problem in this country. Not the care itself (which is generally fairly good), but the paying for it. It’s tied to our jobs (so if we get too sick to work, we lose it, to say nothing of losing the income to pay for the premiums). It’s for-profit (so there’s incentive for the companies to find every loophole they can to avoid paying for the things they should be paying for). There are more.
So, Obama comes into office in a time where everyone agrees this is a HUGE PROBLEM, and starts off in conciliatory mode by scrapping what most on the left wanted (a single payer system) in favor of a hodge-podge cobbled together predominantly from ideas *that had previously been put forth by people on the right*.
And in true “party is more important than our constituents” fashion, the right wing IMMEDIATELY back-pedaled. They were focused on their goal of “doing whatever we can to deny Obama a second term” (how’d that work out for ya?). And so they dragged their feet and obstructed and didn’t really throw out anything even moderately helpful until very late in the process… and the hodge-podge passed, far less than what we need, but at least a step in the right direction (preventing lifetime caps on coverage, so people with really nasty diseases don’t end up screwed half way through treatment, preventing pre-existing condition exclusions, to keep companies from retroactively deciding that something SHOULDN’T have been covered, and denying the claim, etc).
And ever since, the GOP spin machine has been in full fetter. “Death panels”, “Socialist take-over of health care”, “Biggest tax increase ever” and other all out lies. Plus, voting 40 some times to repeal the thing, in symbolic votes they KNEW would never become law, while avoiding do any other real work.
So, cut to today, and the GOP is still DESPERATELY trying to paint this as a negative for Obama, and so they decided to play chicken with the economy, and then offered a “compromise” that really wasn’t one. It was a compromise along these lines: I decide I want a 50% raise from my company. They, obviously, are unlikely to give that to me unless I’ve changed positions or otherwise done something to merit it. So I kidnap two of the CEO’s children. He says “Look, the company just doesn’t have the budget to give you 50% more salary”, and I offer to “compromise” by agreeing to take a 35% raise and return ONE of his children.
We need to solve the health care problem in this nation. If that happens to redistribute a bit of wealth around, well, that’s what insurance does anyway, no? You pay into it when you’re healthy and hope you never need it, and if you are lucky and remain healthy, you pay more into the system than you get out of it. If you are unlucky and get sick, you take more out of it than you put in. Socialization of health care costs.
But somehow, when we want to make it larger scale, more efficient, and with less possibility of people being screwed, bankrupted, and possibly dying for lack of coverage, a significant part of our population feels too selfish to buy into it.
I don’t want it so my money can go to pay for someone else’s care. That happens, so what. I want it so that if next week I get diagnosed with a rare and expensive form of cancer, I don’t have to worry about being dropped from my coverage because I can no longer work and so I can’t stay on the policy, or because the COBRA costs are too high to pay without an income, or suddenly finding out that the insurance company retroactively goes back and decides that because I failed to report that I had a hangnail as a child, that therefore obviously that means I should never have been accepted for my policy, and they are not obligated to pay for my care. I want it so that if I draw the short end of the stick, health-wise, I don’t ALSO draw the short end financially and bureaucratically.
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Still claiming that if birth control isn’t free they won’t have “access”. Bunch of lying deadbeat gold-diggers
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“A national healthcare system is just a more efficient way of spending healthcare dollars”
Guh? That makes no sense.
Anyhow, I live in England, and as a young fit male I obviously haven’t used the NHS for pretty much ever. I’ve even forgotten who my GP is it’s been so long. I don’t really like the idea that my tax money (and it is a large amount of my tax money) is paying for the healthcare of smokers and fat people and hypochondriacs who go to the doctor every time they sneeze.
Also feminists suck.
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uh ok. I just did and the most northern one is in Philly at #23. Most are down south in Texas and Florida. So, not sure what your point was?
http://www.beckershospitalreview.com/lists/50-largest-for-profit-hospitals-in-america-2013.html
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Oh, and I should point out, without a single payer system, the “requirement to buy” that so many right and libertarian people have such a problem with is absolutely necessary in order to do away with pre-existing-condition limitations.
Because imagine you did away with those limitations but didn’t require everyone to have coverage. What would happen?
All of the 20-somethings would say “What the hell? Why should I pay hundreds of dollars a month for something I probably don’t need. I’m not going to get insurance. If I get sick, I’ll get insurance.” And our system would absolutely collapse, because it RELIES on the healthy paying into it to cover the sick. Insurance companies don’t magically multiply money, you can’t take in premiums only from the people who need more health care funding than the premiums they pay, any more than you can pour ten gallons of gasoline out of a 5 gallon can.
I’m so sick of the caricature of those who support a single payer system as “wanting something from the government”. I don’t want something from the government, I know I’m going to be paying for it, and if you can find a way for me to pay for that same thing without being at their mercy to decide whether or not to pay my claim if I get sick, and without having to worry about losing coverage just at the moment I need it most because I can’t work any more and lose my company plan and am not earning enough to pay the COBRA premiums.
Find a solution that allows all of that, and I’m all for it. So far, the only one I’ve seen that seems workable and doesn’t add in as many large problems as it fixes is a single payer system, which works very well (in spite of the horror stories which are incredibly picked-and-chosen) in quite a number of countries in the world.
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This is one of the most annoying parts. As a person who paid full cost for contraception for a long time before getting coverage, there is a huge difference between access and free. If the coverage does not cover birth control, that doesn’t take it away from you. That just means you have to pay for it yourself. You don’t have a fundamental right to have other people pay for you.
Now personally, I am strongly in favour of governments paying for contraception and sterilization as well. People who don’t want children usually do a poor job of raising them (speaking from my years of work with children of awful parents). I think it is strongly in a country’s interest to help prevent the creation of additional unwanted children wherever possible, and I will happily pay into taxes to support that (instead of paying for the much more expensive consequences later) long before I’d pay for any other kind of organized health care.
But not having it paid for doesn’t mean you don’t have access.
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Sorry, if you get a rare and expensive form of cancer it probably means it probably means it’s time to die. Can’t win all the time. At least you didn’t choke to death on a hot dog.
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America – total fucking mess
And how. I’m just not sure that bringing the people responsible for making it a total fucking mess further into the system is going to fix it. I guess we’ll find out, eh?
That being said, I would point out one thing – out of this total fucking mess that we currently have came almost every major medical advance in the last 50 years. So we’re doing something right, I think.
National healthcare systems piss Americans off in particular because they are also progressive –they redistribute the resources of the rich to the poor. But they’re only moderately progressive. Nothing to get all up in arms about, if you ask me.
That isn’t the problem with me (above and beyond the problem I have with anything that the government pays for, which is the lack of voluntary association). Not by a long shot. The problem with me is that there seems to be some cognitive dissonance when it comes to health care that people just aren’t willing to address. Goes a little something like so:
1. Why is it perfectly acceptable for someone to be in debt for thirty years paying for a house (and in fact, is actually considered a desirable condition by most Americans) and yet, a person being in debt for 5 to 10 years to pay for necessary health care related expenses is just simply beyond the pale? Why are we getting so pearl-clutchy about people having to *GASP* pay for services that they used?. I read a comment on a Cracked.com article about a guy who robbed a bank so he could get thrown in jail to get his health care for free (as opposed to just, you know, paying for it), and the commenter said that the article made him sad and that it reminded him of his Dad, who was still paying for a minor surgery he had 5 years ago and would be for the next few years (he indicated that the cost was $25 k or so). Why does that make him sad? I absolutely, positively DO NOT understand why people think that a person paying for their own healthcare is such a fucking tragedy. Is it the fact that health problems don’t distribute proportionately, so some folks are going to get the short straw and pay more (like me?) Is it because health problems disproportionately affect the poor, who are less capable of paying their own way? Isn’t there some way to fix that problem without nationalizing an entire 1/6th of the economy?
2. Why won’t anyone address the fundamental issues with freedom that are associated with a fully nationalized system? Right now, if I’m “denied” treatment, all that means is that my insurance company won’t pay for it. I can still get it if I pay, and there are a lot of ways to get something paid for on installment plans and so forth (and charities and kickstarter/gofundme/whatever else campaigns, and , and, and, and…. Once the system goes nationalized, unless it allows for a private market to co-exist in tandem with the public one (which is rare-ish and difficult) and you get denied – guess what? You get to spend the next however many years appealing the decision to bureaucrat bean counters who don’t give a fuck about you and are more interested in ‘bending the cost curve” than helping you, until you die or give up.
3. You can tell me that the Canadian model is so much better than the US model, but I’ve a lot of Canadian friends, and they don’t come across the border for healthcare ALL THE TIME because their NHS is totally fucking super awesome, you guys. I needed an MRI 3 years ago. I had one 5 days later. My buddy who lives in Edmonton needed an MRI at around the same time. His wait was 5 months, and for some reason they sent him to Vancouver to get it, so he had to take 3 days off work to make the travel. I don’t know the particulars of why/where/what etc, but that’s the truth of it.
4. Why are we perpetuating a system where there is no competition? Why put it in the hands of bureaucrats to beat down the hospital to the “approved” cost of service X, when we could turn the free market loose on it and drive the cost of service X without needing to pay all those bureaucrats? When I got my MRI, they billed me 5,400 bucks or something for it. I later found out that there was an outfit in my town where I could have gotten the same MRI for 1,200. How is that possible? In a free market, where prices are driven by demand, supply, and competition, there is no way that one hospital would get away with charging that much, and I would have never used them. But there was no way for me to know beforehand, and THAT IS A FEATURE, NOT A BUG. It is a result of the cronyist system we have right now. Post prices. Allow shopping around. Hell, set up folks that will do the shopping FOR YOU so you don’t have to. It isn’t that hard.
5. Consider insurance. We call it insurance, but it isn’t anything of the sort. Your car insurance doesn’t pay for tires, brakes, gas, oil changes, and car washes, yet your health insurance pays for routine maintenance things all the time. Do you really, truly think that you would get a better deal on tires for your car if you paid for them through your insurance company? Do you really think that buying tires for your car would be easier somehow if you had to do it through your insurance company all the time? What we have isn’t insurance. Going back to true “insurance” in health care would drive the costs down, massively.
Anyway, I could go on, but my point is that it seems like people have only one solution to this problem (get the government to fix it) when I’m of the opinion that we could have a way better system by going other routes. For instance, we don’t need the government to run the restaurant industry in order to get good food, and my guess is that bringing them in wouldn’t improve it a lick.
Personally, I think it’s going to go the other way, and the Republicans are gonna get stuck with the shitty end of this stick, but we shall see.
Good. Couldn’t have happened to a nicer group of bastards. Except maybe if it happened to both sides. Whenever the democrats and republicans go to battle with each other, I look at it in the same way that I look at the communists and the Nazis going to war – which do you want to win?
I’m rooting for winter.
But I want to make one point, and that point needs to stick in the brains of anyone reading this, because it is a point that will cause all of you to stop and think about the logic of doing things through government:
There are people who think that birth control is a horrible sin. You might disagree with those people. I know that I do. That being said, they see it as an affront to their God and would rather not have any hand in helping other people pay for it. THEY AREN’T TRYING TO STOP YOU FROM DOING IT, just trying to keep themselves from being forced to pfinance the activity. This is their goddamned right as a human being, whether you disagree with their opinion or not. You should not be forced to participate in something that you see as morally repugnant.
However, the public funding aspect of Obamacare forces these people to pay for other people’s healthcare choices. All of them. If they do not, they will be fined. If they don’t pay the fine, they will eventually be arrested. If they resist arrest, they will be killed.
Whether you agree with those people or not, unless you’re a horrible person, you have to accept their right to have that opinion. If you accept their right to have that opinion, and yet are all for implementing a plan that will eventually kill them if they don’t go against their moral guidelines and comply, what kind of person does that make you?
Freedom is the answer here. To the extent that our healthcare market is screwed up, it is to the extent that our government has gotten involved and changed the paradigm of how the market worked. I think that by returning healthcare to as close to a free market system as we can, and then creating a system by which true insurance plans are created for those who can’t afford them, and health savings is allowed tax free to pay for regular care, we’ll have the best healthcare system on Earth.
But we won’t even try it. We’re pushing for stable stagnation instead of uncertain greatness.
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So you won’t be at the mercy of the government to decide to pay the claim if you’re sick?
You’re jumping out of the frying pan and into the fire. At least you can sue an insurance company for breach of contract.
Gonna sue the government, champ?
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I doubt it’s worth it, because most women have strong personal incentives for not having unplanned kids, and the ones that don’t aren’t going use contraception anyway. Mandatory abortions or sterilization would certainly be effective, but that’s not on the table. In any case there is apparently an urgent need to import bums from Latin America to pad the labor market due to the poor supply of native babies, wanted or not, who would at least speak English.
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There is just something about mixing up a profit incentive with healthcare that makes me queasy. Competition is an unparalleled way to introduce innovation and force constant improvement, which is why the US has the most advanced medical systems in the world.
But the idea that someone stands to make a profit off a kid with cancer just feels …. wrong.
You know, I might be a lot more comfortable with the idea of a national healthcare system for children, and then adults are on their own, except for adults who are dealing with the ramifications of childhood disease. Someone with CF for example, would always have coverage.
That’s how I lean when it comes the the welfare state. We should NEVER punish children for having idiot parents. It wasn’t their choice, obviously. And we should NOT hand cash to parents and just hope they will spend it on kids. Kids should be fed and clothed and receive medical treatment at school, and their parents can figure their own shit out.
And I hope it goes without saying that I do not consider the disabled or mentally ill to be examples of “welfare”. That’s social security. No one chooses to be schizophrenic or have Down Syndrome.
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Hmmm. I’m sorry, have I missed a huge rash of people on Medicare having coverage denied for things that should be covered?
You’re blowing smoke. There are TANGIBLE examples of people being screwed by the insurance companies, there aren’t many (that I’m aware of) of Medicare doing the same thing, so thank you for playing.
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The trouble with private healthcare is that it is never really private. You still have a federally funded system to take care of all the people who don’t have insurance but still need attention. It’s economically inefficient because the vast majority of healthy people who use the system judiciously are paying into a private system that subtracts a profit from their premiums being paid AND you still get to pay for all the noninsured, too.
A nationalized system would collect ALL the healthcare dollars including the profit and distribute them across the population. This guy cost $1 MILLION dollars of public money AND you had to pay for your own health care on top of that.
http://www.reportingonhealth.org/resources/lessons/million-dollar-homeless-patient
So yeah, I think a national system is definitely gonna be more cost effective.
Are there other considerations? Yes. But a national system will be cheaper than running both a private and public system.
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I guess it’s all a matter of perspective. As a Canadian with universal healthcare, I couldn’t imagine not having it.
Then my guess is that you probably should remove yourself from the discussion if you can’t even imagine another system that would work just fine. Because there are a lot of other options, and our government isn’t NEARLY as friendly as yours. The Canadian provincial governments are downright cuddly compared to the American Fed. Also, 350 million people vs, what? 80 million? Totally different discussion. Comparing the two countries is like apples and oranges.
Just for understanding sake, the Fed government doesn’t run healthcare, the Provinces do. All the fed does is transfer tax money to the provinces to fund it and ensure a certain service level is maintained in the provinces. SO someone in say Quebec isn’t getting better or worse level of care as someone in Alberta.
And if we went to a system where the Fed gave back tax money to the individual states to deal with the problem as they see fit, I’d be all for it, for a lot of reasons – competition between the states, escape being possible in the instance of an unfair or burdensome system, choice to the consumer… Etc, etc, etc. But we’re talking a federal system. I’ve worked closely with our federal government in several cases. They are bastard coated bastards with a creamy bastard filling, and I DO NOT WANT them to have the deciding vote on my healthcare options, because they don’t give two hot shits about me.
As to doctor shortages, they provinces use incentives, not force. There was a shortage of general care doctors in remote northern areas for example. What they did was offer forgiveness of a large percentage of newly graduating doctor’s student loans if they agreed to practice in a remote area for 5 years after graduation.
So all of the folks in northern areas had less experienced, less capable, less competent doctors. Good fix. You know, as opposed to paying them more, as a free market would, and drawing a wide range of docs for the folks up there, for many different reasons.
There are a ton of arguments for national healthcare as well, and they are all very good ones.
Sure. There are always two sides to any debate. The only problem is that I feel like I’m the only one debating another side. All I get are folks saying “NATIONAL HEALTHCARE!” and other folks saying “NO!” but not offering any ideas of their own (because something needs done, make no mistake). There really isn’t another side being discussed, and that frustrates me to no end (can you tell?)
There is another side. That other side is to free up the market and stay out of provision all together, decouple from employment, create insurance plans that are INSURNACE, instead of human warranties, create HS accounts for folks to fund routine care tax free, and create a tax regime that will fund insurance and HS accounts for those unable to pay for them on a group basis, at the state level. By my best estimate over at my place, this will reduce costs by 15 to 20 percent over a nationalized system, and by a huge margin over what we have today.
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Medicare has a higher claim denial rate than most private insurers: http://healthblog.ncpa.org/who-denies-the-highest-percent-of-claims-medicare/
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Mmmm, poor wording on my part. I should have said “largest number of hospital beds per capita.” There’s an odd concentration up in ND and SD, serving (among others) Canadians who can’t get what they need from their own system. Anecdotal data: relatives up north who work in such hospitals and have fairly scathing opinions of Canadian health care have affected my opinion here.
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tecnically, you are correct the feds dont run health care. However, in practice all the money given to provinces for health care comes with numerous conditions on how it is to be spent. That is the reason alberta for the longest time did not accept fed money for healthcare.
as for doctor shortages we still have them. the incentive is there but people are not taking it as much as necessary. the incentives are not just for north it is all rural communities too as we dont have enough gps for these communities.
almost every healthcare system sucks but nationalizing it doesnt make it better overall. the wait times are ridiculous and rationing is a valid concern.
If our system was as optimal as people suggest our politicians and wealthy would not travel to the states to pay for private medical attention.
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Right, but the choice isn’t pay for their healthcare or not, it’s pay for their healthcare AND pay for your own healthcare (plus a profit) on top of that. Uninsured people still get healthcare through the welfare state (Medicaid and Medicare in the US), which you get to pay for with your taxes and then pay for your own healthcare on top of that.
Take out the profit incentive and pool ALL the money you are paying and it’s going to be a lot cheaper to deliver healthcare.
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The same argument could be made if you replace health care with law enforcement. It comes down to how you see health in a society. Is it an individual responsibility, that everyone should just need to plan for, or is it a social good, like law and order?
I’ll agree, there are arguments for both sides. Disease control and prevention is easily a public good, but health care also covers incidents of human stupidity, which people are right to not want to pay for. If you look at life-threatening conditions, you may say that you don’t want people to choose between loosing everything they have or dying, at the same time, a lot of conditions are not life-threatening.
But I disagree it’s as simple as wealth redistribution and feudalism, unless your political views are anarchist, and you consider all forms of government-run societies as feudal in nature.
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Nope, folks aren’t being denied care, but medicare denies payment to the hospitals and doctors after the care has been provided all the time. To the point to where lots of docs won’t even work with medicare patients anymore because it is killing them financially.
Couple that with the fact that it take 90 to 120 days to get their money, and more and more docs are refusing to deal with medicare.
So, no, no one is being denied care. But the docs providing it aren’t getting paid, and are refusing to work with the system, meaning that –
Oh, wait, holy shit, people on medicare are seeing drastically reduced choice in their healthcare options, and are being denied care!
No, YOU thanks for playing…
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i should also add the national everybody is covered system leads to significant problems for emergency rooms. as every parent with a kid goes to emergency for everything and people got there because it is typically quicker then clinics.
i have advocated for years that some sort of user fee needs to be in place to prevent these people from wasting precious doctor time.
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Thanks for the link. You proved my point.
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Makes too much sense. I’m gonna go read some jezebel now to balance it out.
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1) Because people PLAN for their house. They (hopefully, not always, but that’s another story) choose a house in their price range. You don’t get to choose whether you get sick, and you don’t get to choose how expensive the illness you get is, and clearly most people agree with this, or medical insurance wouldn’t be a thing, and everyone would just pay as they go.
2) Does this happen with Medicare? No. If Medicare won’t pay for something, you then have the option of paying out of pocket for it. That might not be true under some systems (my understanding of the GB health system, for example), but under a single-payer plan like Medicare, there’s no reason I couldn’t go choose to pay out of pocket for a treatment I wanted that the payer wouldn’t pay for.
3) In any large system, you’ll be able to pick and choose the worst cases. I have numerous friends in Canada, and by and large, they wouldn’t trade what they have for what we have, and by and large they DON’T end up with the bogeyman horror stories we’re told here are common, the long drives, the long waits, the rationed care. For the most part, their experience with health care is the same as ours in terms of appointments and scheduling and tests and the like, the only difference is that they know they’ve paid for it in their taxes, so they don’t have to worry about whether they’re going to be able to feed the kids this month because they need an MRI.
4) There are so very many reasons why free markets do not behave at the macro level the way logic dictates that they do at the micro level. And I’m not going to have that argument again, because although YOU might not be this sort of libertarian, I’m very sick and tired of having any behavior that comes out of a free market model DEFINED as being “the way markets should operate”. If it’s a negative, it’s a negative, you don’t just get to redefine it as a positive. But that’s a whole different discussion for another time.
And you can say we don’t need the government in the restaurant industry, but in fact they’re already there, which is a large part of why you don’t run the risk of getting sick most of the time when you go to a restaurant. Places get shut down if they have roaches or aren’t properly cleaned or don’t keep their food at safe storage temperatures or use it past the freshness dates. And those regulations weren’t put into place because someone WANTED them there, they were put into place because the free market WASN’T keeping people from getting sick.
Finally, as to the funding, would you agree that it was within your company’s rights to dictate what you could spend your salary on? Obviously, the first step would be “We find abortion morally repugnant, so we are enjoining you from ever getting an abortion with funds we paid you.” Next, maybe it would be “We find homosexuality morally repugnant, so you are legally prevented from spending your salary money on anything that supports the same-sex cause.” And it’s a slippery slope from that to “Hey, you work for Macy’s. You are enjoined from buying any product which Macy’s sells from any of Macy’s competitors.”
Benefits are the same way. Now, I’m not sure how I feel about the whole “you have to pay for my birth control” thing, and similarly I sort of feel like abortion that is not medically necessary shouldn’t be covered any more than surgery which is elective and not medically necessary generally isn’t covered. But I don’t think the way to attack that is on the grounds of “I should get an exemption, because I find it morally repugnant”, the way to attack that is to say “Hey, that really shouldn’t be a requirement for ANYONE.” And maybe you’ll win and maybe you won’t, but this whole business about special exceptions for certain people… that just leads to more red tape and more of the things anti-government people love to point at as “the problem”.
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The “a single system is more efficient” argument used to be the standard line Marxists would use to criticize free markets. They were wrong then too.
Competition (which we don’t have now) drives down prices. If you want coverage for the uninsurable, then have an assigned risk pool wherein medically uninsurable people are *assigned* to an insurance company and the government helps pay for their premiums. Everyone else buys the policies they want (if they want) and it’s all good. No need to force everyone into a One-Size-Fits-Nobody system that *will* be inefficient and respond to political rather than medical/individual/market priorities.
Plus, monopsony buyers tend to drive suppliers out of business by refusing to cover the providers costs. Lots of doctors won’t accept Medicare because it doesn’t pay enough. Pharmaceuticals companies gouge Americans because Socialized medical systems abroad threaten to steal the pharmas intellectual property rights unless they can buy the drugs at slightly above *manufacturing* cost, which doesn’t cover development of the drugs that make it to market, let alone the costs of drugs that *didn’t* make it to market.
If we’re stuck with an income tax, then letting individuals deduct the cost of their own insurance, like employers are allowed to do, would also be helpful (though there we get back into social engineering).
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Not just Medicare and Medicaid, JB, also emergency rooms which are legally bound to treat emergency cases whether they can pay or not.
That’s part of why an aspirin at the ER costs $50 and why the wait can be so very long when you get there, they have to make up for the people using the ER for not-really-emergency care because they don’t have insurance or the money to pay the bill.
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So, is anybody interested in some data indicative of healthcare quality in developed countries (among other possible factors, like differences in lifestyle)?
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“Take out the profit incentive and pool ALL the money you are paying and it’s going to be a lot cheaper to deliver healthcare”
Where do people get this idea from? Seriously I’d love to know.
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I get my brainwashing liquid from The Economist!
http://www.economist.com/blogs/democracyinamerica/2013/07/high-cost-health-care-0
😛
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That’s like going for a jog and following it up with doing a line of coke.
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It is interesting as study after study up here shows a miniscule number of Canadians who actually go to the US explicitly for medical care.
Given the number of Snowbirds who winter in Florida or Arizona there is always going to be a certain percentage of Canadians using US healthcare, but they didn’t go there JUST to say get heart surgery.
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There is just something about mixing up a profit incentive with healthcare that makes me queasy.
Sorry, but this isn’t about the feeling in your gut, its about the best way to provide care for sick people. And you said it yourself:
Competition is an unparalleled way to introduce innovation and force constant improvement, which is why the US has the most advanced medical systems in the world.
Competition for what? Answer that question (okay, the answer is PROFIT), and you’ll know why THE ONLY healthcare system that I want to be a part of is the one where the doc makes a shit ton of money off of saving my life, and researchers make a shit ton of money off of coming up with that next new drug. The world needs at least one free market healthcare system.
But the idea that someone stands to make a profit off a kid with cancer just feels …. wrong.
It may “feel” wrong, but it creates all the right incentives for that kid to get the best care possible, and which would you rather? You “feel” good about it, or the kid gets the best care possible? Feminists “feel”. Rationalists look at something that makes them uncomfortable and logically explain to themselves why even though it seems unpalatable, it is the best option.
I’ve said it before and I’ll say it again – people who don’t know you don’t care about you. They cannot. It is contrary to the wiring of humanity. It is how docs can have patients die on them all the time and not turn into raving basket cases. It is how kids die every day in places like Somalia and I’m not turned into a steaming pile of jelly like I was when my friend’s daughter died a while back.
You want to motivate your doc? Throw something in for him. Make there be more of a benefit to him if you live, or at least if he gives you the best care available. Otherwise, he’s going to try hard to give a shit about you and fall short. He has to, for his own sanity.
To the remainder of your comments about kids, the indigent, and the mentally ill, I want to make sure that wasn’t a jab at my heartless libertarian cred. I’ve never once said that I was against public funding for healthcare services for those that have no insurance of their own. We don’t have to nationalize our healthcare system to take care of what amounts to something like 5 to 10 million people in a population of over 300 million.
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Given that I’m currently pursuing a doctorate in INNOVATION, I understand that pulling the primary motivator to innovate out of a system is going to have some ill-effects.
I don’t know the answer to this question, but if doctors and big pharma are motivated by profit, why can’t we just make sure they are paid very well collectively? Fund the shit out of research, out of a pooled source of income.
My comments about kids were no jab. Just thinking aloud.
We don’t have to nationalize our healthcare system to take care of what amounts to something like 5 to 10 million people in a population of over 300 million.
Good point.
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Does this happen with Medicare? No.
Read my response above. it happens all the fucking time. So often that docs the nation over are refusing to work with them.
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I suppose my relative’s experience is like customer service; they never see the Canadians who are satisfied with their health care. Point taken.
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Because people PLAN for their house. They (hopefully, not always, but that’s another story) choose a house in their price range. You don’t get to choose whether you get sick, and you don’t get to choose how expensive the illness you get is, and clearly most people agree with this, or medical insurance wouldn’t be a thing, and everyone would just pay as they go.
That’s not what I’m saying, and you know it (or you’re being purposely obtuse). Insurance is important. You should have it. You shouldn’t plan to “pay as you go”.
Your point on it being planned for is likewise just as incoherent as thinking paying for healthcare is somehow pitiful and sad. I don’t plan for the engine in my truck to blow up. To replace the engine in my truck would be $15,000, similar to the cost of the referenced guy’s Dad’s surgery. When it does, no one cries for me. No one says it makes them sad. No one goes on internet forums and screams about how unfair the system is because I had to pay to unexpectedly replace the engine in my truck.
And any claims that healthcare is “different” just because it is will fall on deaf ears. There are all sorts of necessary services that we would die without that no one seems to think is beyond the fucking pale if we have to pay for them. Food. Water. Shelter. So on and so forth…
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There are so very many reasons why free markets do not behave at the macro level the way logic dictates that they do at the micro level.
provide examples. i get people making this argument to me all the time but they’ve never, ever been able to provide an example of what they are saying happens all the time.
The fact that you say medicare doesn’t deny claims means that you’re woefully uninformed on this entire subject, and only looking at data that confirms your beliefs, so i’m going to go out on a limb here and guess that you aren’t going to be able to provide examples. You’re seeming like you’re more in the JB category here where you’re “feeling” your way through this rather than thinking it.
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And you can say we don’t need the government in the restaurant industry, but in fact they’re already there, which is a large part of why you don’t run the risk of getting sick most of the time when you go to a restaurant. Places get shut down if they have roaches or aren’t properly cleaned or don’t keep their food at safe storage temperatures or use it past the freshness dates. And those regulations weren’t put into place because someone WANTED them there, they were put into place because the free market WASN’T keeping people from getting sick.
Oh, yeah, totally. Restaurants would absolutely be in the business of making people sick all the time if it wasn’t for the super-competent government inspectors that make sure they are doig their jobs right. You know, because making your customers sick is totally good business practice, and restaurants that make customers sick would totally stay in business. Thank fucking God for the government saving us from THAT.
Jesus, man, do you even listen to yourself?
I got sick from a restaurant about this time last year and missed a bird hunt that I’d been planning for 3 months. Funny thing, that. It had been inspected by the government inspector only two days prior.
Amazingly enough, that restaurant is no longer in business. No, the government didn’t shut it down. They gave it A ratings right up until it shut down from lack of business because they’d gained a reputation for making customers sick.
Finally, as to the funding, would you agree that it was within your company’s rights to dictate what you could spend your salary on? Obviously, the first step would be “We find abortion morally repugnant, so we are enjoining you from ever getting an abortion with funds we paid you.” Next, maybe it would be “We find homosexuality morally repugnant, so you are legally prevented from spending your salary money on anything that supports the same-sex cause.” And it’s a slippery slope from that to “Hey, you work for Macy’s. You are enjoined from buying any product which Macy’s sells from any of Macy’s competitors.”
That isn’t even in the same realm of what we’re talking about here. It is a horrible comparison. I’m talking about forcing people against their will to pay for something they find repugnant. You’re talking about voluntary employment contracts and terms of employment that you don’t have to agree to if you don’t like it.
Benefits are the same way.
No, they aren’t. Especially if you de-couple them from employment as I advocate and continue to advocate.
Now, I’m not sure how I feel about the whole “you have to pay for my birth control” thing, and similarly I sort of feel like abortion that is not medically necessary shouldn’t be covered any more than surgery which is elective and not medically necessary generally isn’t covered. But I don’t think the way to attack that is on the grounds of “I should get an exemption, because I find it morally repugnant”, the way to attack that is to say “Hey, that really shouldn’t be a requirement for ANYONE.” And maybe you’ll win and maybe you won’t, but this whole business about special exceptions for certain people… that just leads to more red tape and more of the things anti-government people love to point at as “the problem”.
NO, it leads to a perfectly reasonable argument as to why the government shouldn’t be involved at all!
Are you dense?
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Eh, I don’t really see how that has anything to do with healthcare. We have a lot more violent crime down here in America. How do they account for that? We have a lot more occupational deaths here in America. How do they account for that? We have a lot more immigrants from Mexico coming in that haven’t had real good health care and might be sick here in America. How do they account for that?
Besides, no one that I’ve seen is arguing for the status quo. We need to do something. I’m just of the opinion that stifling innovation and crushing competition in the industry is a good idea. America is really the last developed nation on Earth that still has a bit of competition and profit motivation left in its health industry.
No surprise that America is where all the new drugs, methods, procedures, plans, and so forth have come from in the last 50 years (or almost all).
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Way to answer a different question. Your assertion was that with a nationalized health care plan (which, by the way, is not at all what the ACA is at this point) you lost the option that you have under private health insurance to pay for something out of pocket if the insurance doesn’t cover it.
And I asked if that happens under Medicare. And you say “all the fucking time.” So I’d like to you point me to some examples where someone on Medicare was prohibited from paying out of pocket for something Medicare wouldn’t cover (other than by lack of personal net worth to afford it, which would be a problem with private insurace, too). I’ll be astounded if you can find even one example.
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You started with asking why is it ok and no one gets upset when someone goes into debt for years to pay for a house, but they get upset when someone has to go into debt to pay for health insurance. I answered a difference there.
I have said before, if you can come up with a way to make private insurance work well without screwing people in service to the shareholders and the bottom line, I’m willing to listen. I’m even willing to give your “Free Market” solution a try, if you’re willing to also have a safety net for people if it turns out the free market doesn’t really solve all of the problems you say it will.
The difference between your truck and your body is that you can always buy a new truck. If you’re short on money, you can buy a used one. It won’t be great, but it’ll get the job done, get you where you need to go, and you’re not suddenly completely out of luck if it dies entirely. Sure, it’s a pain and it costs some money, but you aren’t permanently screwed.
With health insurance, as long as it remains the way it is, if you get too sick to work and lose your income, you lose your ability to pay your premiums, and now you lose your insurance at the time when you most need it. There’s something inherently wrong about a system that’s set up so that you pay for something that if you REALLY need it, will have all sorts of barriers in your way to keeping it.
Health IS different from every other thing you’ve mentioned. Food, water and shelter are more or less fixed costs. You don’t suddenly one day get a diagnosis that says “Oh, you now have to eat a pound of gold every day or you’ll starve to death”. And if you have a catastrophe and lose your house, you don’t lose the ability to PAY your house insurance premium just at the time where you need your homeowners insurance to pony up.
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/For me it comes down to economic efficiency. A national healthcare system is just a more efficient way of spending healthcare dollars.
My buddy Pareto would disagree. None of it really matters, though, because who’s going to pay for it? 90% of all jobs created since 2009 are part-time. It might be possible if structural costs were lower (ie, less stringent requirements for med schools → more docs → seeing a doctor is cheaper), but a lot of the cost of healthcare is the cost of price controls, rations, and grants of monopoly, and the interests that benefit from these distortions are entrenched (as shown by insurance companies getting a massive subsidy from the government).
The point about feminists making everything about them was very interesting. It seems a lot of feminism can be analysed as narcissism, and especially trying to maintain some image for a false self. Good article. Thank you!
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I like the idea of having private healthcare for those that can afford it. It would be much the same as toll roads (407 ETR). I pay money to take that road and not only do I get the service I pay for, I take one car off the regular roads thus reducing congestion. I can still take the regular roads if I wish.
This topic is taboo in Canada where I waited 13 hours in the ER with a burst appendix waiting for an operating room. I was also unceremoniously turfed the next day while still bleeding from my incisions. If I had driven to Buffalo, I would have had much better service covered under my ‘Out of Province’ insurance.
Let’s not even get started on the Court case of doctors wanting the right to unilaterally end life when they see fit.
http://www.ctvnews.ca/health/health-headlines/fight-over-when-doctors-can-end-life-sustaining-treatment-heads-to-court-1.1071336
It is all par for the course when you consider a good to be a right with no consideration as to how it will be paid for. People now-a-days even forget that freedom has to be paid for in blood.
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OK, here’s a good example of how “free markets” can be subverted, and if you say “well, that’s how they’re supposed to work” then you lose the argument that free markets will make everything better, because you’re defining a sub-optimal outcome as optimal, which doesn’t work.
In college, my friends and I were pretty evenly divided into the “Coke people” and the “Pepsi people”. We each sort of privately considered our cola of choice to be the best and couldn’t really understand how the other side could drink that “sewer water”.
So one day, we decided to do a blind taste test. Not double blind, maybe not scientifically valid, but it was good enough for us. So we bought some Coke, some Pepsi, and some RC Cola as a control.
And guess what, the RC Cola (which cost about 20% less than the other two) won the taste test. Almost universally, we preferred its taste over the big two.
And yet within a fairly short period, the Coke people were back to drinking solely Coke, the Pepsi people were back to drinking solely Pepsi, and I (as the lone guy still sticking with the RC Cola) being looked at kind of funny when I’d grab the RC on a shopping run.
For free markets to really work optimally, there has to be good access to information, a reliable filter to determine which is true and which is crap, and the time to actually go through all of that information.
Another example: Right now, there are a batch of people wanting to boycott Barilla pasta because of some homophobic thing or other that the CEO of the company said. I have been too busy to get the details. A few months back, it was Chick-Fil-A. Until last week, we didn’t know about Barilla. So how do I know, when I grab that box of Prince pasta thinking I’m making a statement to Barilla that I’m not also funding a company that, say, makes their pasta in sweatshops, or provides major funding for white supremacist groups, or uses substandard ingredients in their pasta?
Another example: When I was in high school, and Bubble Yum bubble gum was a new brand, I remember it was “common knowledge” that Bubble Yum had been found to contain spiders eggs, and that there had been at least one instance of a child biting into a piece and finding a mouth full of baby spiders. It was, of course, complete BS.
Now, imagine that Hubba Bubba had in fact that very problem. To get out in front of it, they start a viral marketing campaign convincing everyone that it is Bubble Yum that has the problem. Eventually it blows over.
Now, when it comes out that in fact it is Hubba Bubba that has the problem, how do most people react? Either with brand confusion, saying “Oh, that’s old news, it wasn’t true” and dismissing it, or saying “Oh, well, I guess they all do it” and dismissing it, or saying “Yeah, fool me once, shame on you, it wasn’t true last time, why should I believe it this time?”
When someone has the monetary equivalent of a bullhorn, they can control (to some extent) the information flow, and the free market does not work as it should.
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No, just not brainwashed by libertarian ideals that really won’t work in the real world any better than pure socialism will.
The best place to be on most issues is somewhere in the middle, and buying into a “pure free market capitalist” system has as many issues as buying into a “pure socialist” system.
But I do find it funny that you misunderstand and misrepresent much of what I say and then accuse ME of being dense.
I’m done with you. Have the last word.
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You keep saying this, but show me some actual proof that all or even the majority of the major new medical procedures of the last 50 years were discovered by for profit hospitals and companies in the US.
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Why?
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When you have an Universal, first come first served system, this bogs down the MRIs. If they do an MRI on a knee and the next patient needs an ankle scan, the machine needs to be adjusted between patients. Private MRI clinics can do all the ankles in one day and adjust the machine for knees the next day. They have an incentive to efficiency and profit.
The best way to lower medical bills and tuition is to get the government out of the business of paying exorbitant fees.
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So you won’t be at the mercy of the government to decide to pay the claim if you’re sick?
The Affordable Care Act is not about government determining your treatment or deciding to pay a claim if you’re sick and get treatment. It’s about making mostly private insurance available for everyone in a way that reduces premiums and removes the worst excesses of the insurance system (denial of coverage for preexisting conditions and dropping patients’ coverage when they get sick). Yes, the Federal government will provide a small subsidy for people who make less than a determined level of income, but it’s hardly a wholesale redistribution of wealth.
The government isn’t deciding; the insurance company you choose is deciding.
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The trouble with private healthcare is that it is never really private
This is an argument for less government, not more.
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But the idea that someone stands to make a profit off a kid with cancer just feels …. wrong.
So a doctor is supposed to get a bachelors, go to med school, do residency all for free just so you can feel better?
They earn their dough and there isn’t such a thing as a free lunch.
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The idea of profit incentive raising prices runs against basic economic theory and common sense though (as long as you also have competition). Competition encourages low prices, then profit encourages low expenditure (efficiency). The key is the second word – “incentive” – what incentive to keep costs low would profit be replaced with I wonder? A gun to the head?
I think the problem with healthcare though, is that you’re not in a position to negotiate the price if you have something urgent and/or life threatening, so hospitals don’t really compete with one another very much. You go to the nearest hospital not the cheapest. So basically it’s lack of competition not profit incentive. Problem is, nationalizing something really isn’t a solution to a lack of competition.
Perhaps the answer would be something like to nationalize the urgent care (heart attacks, bullet wounds etc….), and privatize all the the other stuff, (hip replacements, prescription drugs etc…)?
Although I still completely fail to see how everyone putting their money into a pot in the middle, and then using that to pay for everyone could possibly make things cheaper. All that would do is redistribute money from healthy people to unhealthy people, from young to old, and from men to women.
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I’m not saying doctors shouldn’t be paid, but rather than their motivation should not be to charge more for their services than they cost: it’s the profit motive that feels wrong.
It feels better to think that doctors get paid a certain amount and it costs what it costs and that’s all there is too it. If a complication arises, the doctor doesn’t need to cover the cost of that from his fees – the national healthcare system picks up that slack.
Yeah, yeah, I know this is all about how I feel but healthcare really does seem different to me than any other service or good.
It’s a basic necessity.
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Assuming that you trust governmental sources at least somewhat, a better measure here.
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Perhaps, but let’s look a little deeper at why Medicare has a high claim-denial rate. the study breaks it down a bit:
*incorrect/invalid information submitted in support of claim.
* need for service not substantiated.
* service not covered
* incorrect/invalid coding
* separate billing not allowed for bundled procedures.
* service covered under other insurance/payment plan
That looks to me suspiciously like an effort to cut down on fraud and efforts to bilk the government. Many of those denied claims can also be amended, refiled, or appealed. The study doesn’t seem to take that into account.
The next highest, Aetna, denied 66% of claims because the service/procedure was already covered by a claim that was already paid.
Perhaps Medicare is just doing it’s job right…
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Holy crap. We are still here. The world didn’t end. They aren’t sending children to the mines. I guess my eeevyeel plan to use the tears of children to polish my monocle will have to wait.
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Indeed, the main problem with “healthcare” is that insurers and hospitals engage in radical cost-shifting, only partly because of treatment of the uninsured. The oft-repeated Republican mantra that “everyone has healthcare because you can go to the emergency room!” is part of the problem: it leads to cost-masking, poorer outcomes, sicker people, and is the most inefficient way to deliver health care possible.
When’s the last time you could comparison shop for a hospital procedure. If you have insurance you mostly don’t have to, since your insurance company will never be paying the “billed” costs; they’ve already negotiated a reduction.
If everyone is covered in the same system, whether that’s universal insurance or a single-payer system, it goes a long way toward ending cost-shifting, increasing transparency in pricing and costs, and generally will bring the rate of inflation in medical care down to more reasonable levels.
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Then there is the growing phenomenon of “medical tourism” on the part of Americans. They’re increasingly going overseas for treatment, either at the behest of their employer (to reduce costs) or their insurance companies. Costa Rica is one destination. I was talking to a friend a couple of weeks ago who has undergone several knee surgeries on both joints and is still hobbling in pain. She needs knee replacement surgery, but her insurance won’t allow it because she’s too “young.” She’s been exploring the option of going to India to have the procedure; they have a high success rate and cost about 25% of having it done here.
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According to this study, 1.6 million Americans traveled abroad last year for medical treatment. By contrast, inbound medical tourism is expected to show slow growth to over 500,000 annually by 2017. So apparently more Americans are going abroad than Canadians are coming here…
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If there was competitioniinthe market they wouldn’t be able to charge more without losing business and market share. You know this.
Stop letting feelings cloud your judgement you’re way smarter than this.
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Yeah but the discussion has devolved into single payer discussion. I’m not really talking about obamacare at this point.
Sorry for the lack of clarification.
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The post to which I responded with the linked study read as follows:
Hmmm. I’m sorry, have I missed a huge rash of people on Medicare having coverage denied for things that should be covered?
You’re blowing smoke. There are TANGIBLE examples of people being screwed by the insurance companies, there aren’t many (that I’m aware of) of Medicare doing the same thing, so thank you for playing.
The private insurers have lower rates of claim denials and, based on a quick perusal of the report, do so for similar reasons to Medicare. I don’t see the case for anyone claiming that Medicare is better than private insurance, especially given how I keep hearing that doctors are refusing to take Medicare more and more. Haven’t heard that about private insurance.
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Not living up to the terms of a labyrinth bureaucracy that purposely puts onerous perfection requirements on these businesses in order to deny claims?
You aren’t helping your case here.
I’ve worked with the feds. This is par for the course with them.
Docs are refusing to work with them over this. I think it runs deeper than just bad paperwork.
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Canadian population: 34,994,000
U.S. population: 313,914,040
% Canadians going to U.S. for medical care: 1.4
% of Americans going abroad for medical care: 0.5
So on a percentage basis (using your numbers which, granted, are not for the same year, and one is a projection), roughly three times as many Canadians seek medical care in the U.S.as Americans going abroad for the same reason..
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The health care mess in this country has more to do with government intervention than not.
Government said, “Old people shall have free medical care.”
And old people said, “Sure, why do I care that you’re charging the government $5000 for a hearing aid, I’m not paying for it, and I won’t be around to pay off the debt in the system, win-win for me.”
And the medical industry said, “Well, we can’t charge people differently, so Joe Poorman must also pay $5000 for his medical widget.”
And Joe Poorman said, “WTF is this shit? I’m not paying it.”
And the medical industry said, “Well, then we’re not treating you.”
And the government said, “You shall treat all people regardless of their ability to pay you.”
And the medical industry said, “Well, we have to recoup costs from deadbeats who don’t pay us, so we’ll charge even more for those who care about their credit rating and can pay.”
And Joe Middle-Class said, “WTF is this shit? I can’t pay this, why should I suffer so much if I’m a taxpayer?”
And the government said, “Oh, very well, free medical care for everyone.”
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The 500,000 number is for all foreign nationals coming to the U.S. for medical treatment, not just Canadians, though they are presumably included.
In fact, this study looking specifically at the issue of Canadians traveling to the U.S. specifically for medical treatment found
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Medicare reimbursement requirements are really no more onerous than that of many other private insurers. It’s also something of a myth that doctors are refusing to participate in Medicare. Yes, more doctors left the program in 2012 than did in 2009, but over the same period, the total number of doctors in the program increased by some 30,000. So much for docs refusing to work with them. See here and here.
Most doctors complaints over Medicare aren’t about paperwork, they’re about reimbursement rates, and the uncertainty that Congress can change them at any time.
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Geez. The government shutdown had nothing to do with healthcare. It has to do with a small group of Republican radicals in the House wanting to make a political statement and stamp their feet because they’re generally not getting their way. The laundry list of demands for voting a continuing resolution (essentially spending authority) to fund the government (in absence of a budget). This isn’t even the debt ceiling fight, that comes next. Essentially this cabal insisted that the entire Tea Party agenda be approved by the Senate and President or they’d walk off in a huff.
It sounds to me that they’re acting like feminists. Can be get back to bashing feminists now…?
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It isn’t my place to prove it. You’re the one questioning. Feel free to disprove.
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And yet within a fairly short period, the Coke people were back to drinking solely Coke, the Pepsi people were back to drinking solely Pepsi, and I (as the lone guy still sticking with the RC Cola) being looked at kind of funny when I’d grab the RC on a shopping run.
Maybe they had different reasons for liking Coke the best. You’re making my point for me. Your desire for top down control is causing you to think that because they liked the taste of RC the best, that RC is the best choice for them. THAT ISN’T YOUR CHOICE TO MAKE. If they want to drink Coke even if they don’t like the taste as much as RC, it doesn’t matter why, and it is absolutely none of your business as to why. You see one factor – taste, and you want to make a decision for everyone based on the one factor that is important for you.
I see a bunch of different factors, each of which is validly influencing the decision of which soda to drink, none of which you’ll give any merit because the only thing that matters to you is taste. Get my point?
For free markets to really work optimally, there has to be good access to information, a reliable filter to determine which is true and which is crap, and the time to actually go through all of that information.
The internets. What more do I need to say?
Or are you just concerned that people will make choices that you wouldn’t make, based on deciding factors that you wouldn’t use to make your decision, such as in your soda example?
So how do I know, when I grab that box of Prince pasta thinking I’m making a statement to Barilla that I’m not also funding a company that, say, makes their pasta in sweatshops, or provides major funding for white supremacist groups, or uses substandard ingredients in their pasta?
If it’s important to you you’ll take 5 minutes to Google it. If it isn’t, you won’t. That’s the entire point of the free market – people get to make their own decisions based on whatever criteria is important to them.
Your alternative is letting people just be ignorant and making decisions for them by proxy. That doesn’t sound any better to me, especially because the only thing that is important to you is taste, and it is obvious that there are other things to other people that are more important than just taste, and you are having a hard time grokking that.
Now, when it comes out that in fact it is Hubba Bubba that has the problem, how do most people react?
I doubt that this would ever happen in today’s society due mainly to the unfettered free flow of information that we now all have at our fingertips.
When someone has the monetary equivalent of a bullhorn, they can control (to some extent) the information flow,
To a very limited extent, and not for very long.
and the free market does not work as it should.
It does, though. It always has and always does, despite the naysayers bringing up examples of “failures” like you did above.
Just because people make a decision that you woulnd’t make, for reasons that you don’t understand, does not mean the market has failed. It just means that you didn’t get your way.
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I’m even willing to give your “Free Market” solution a try, if you’re willing to also have a safety net for people if it turns out the free market doesn’t really solve all of the problems you say it will.
You’re not serious, right? In no less than three places in this comment thread alone I’ve advocated for a safety net for folks that get left behind due to mental illness, poverty, and so forth. How many more times do I need to do it? Three more?
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Okay, I will.
I’ve advocated for a safety net for the poor, indolent, mentally ill, and so forth numerous times in this comment thread.
How that translates into me advocating for a “pure free market” I truly can’t understand.
It is you, friend, who are misunderstanding and misrepresenting. I’ve understood you perfectly.
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Okay, you’re right.
Again…
Sigh…
I’ve fallen short of the ideal this week. Forgive me?
I’m out… Peace my homies……
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Oh yeah, one more thing…
WINTER!!! WInter!!! Winter!!! Winter!!!!
(Reference my comment above about nazis vs. communists and who I’m rooting for in the battle to come….)
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The internets. What more do I need to say?
Yes, the product of a Federal government program.
Unfortunately, it has few filters to determine what information is true and what information is crap. I don’t care what decisions people make, but will note decisions based on facts are usually better than decisions based on internet opinion posing as fact, of which there is a lot.
Google isn’t always the best answer…
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Yes, the product of a Federal government program.
Ehhh…
Well…
Kind of. Sort of.
Maybe, I guess you could make that argument.
But if you really think that the only reason that it exists today is because of the feds….
ARPANET perfected some of the technologies that were needed to make the internet work, but the private sector was getting there, too. This is just one case where the government beat them to the punch, spending money to create something that would have been created basically for free by the market if they hadn’t. Money spent so that they could establish control over it – or try to – and have a justified claim to that establishment…
But yeah, I’ll concede that the modern internet is here because of a federal program, as long as you concede that it didn’t really need to be in order to exist.
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“Winter is coming…”
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I know a direwolf when I see one….
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it has few filters to determine what information is true and what information is crap. I don’t care what decisions people make, but will note decisions based on facts are usually better than decisions based on internet opinion posing as fact, of which there is a lot.
Despite this imperfection, I still maintain that allowing people to make their own informed choices is better than making choices for them, or else everyone will be forced to drink RC because it tastes better to some federale, and all consideration of any other factor will be ignored because it isn’t what is important to that federale.
My system of personal, individual choice is far less flawed than any attempt at “one size fits all” because it will likely be more aptly called “one size fits few, and only the most politically connected and wealthy, at that.”
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You understand that link didn’t change anything about my previous analysis, right?
Just because heart disease and cancer are the #1 causes of death in America doesn’t mean that America isn’t pushed over the brink on the first index you posted by higher rates of violent crime and occupational hazards. Perhaps heart disease and cancer are the #1 causes of death in the other countries, too, and the only reason America still has a higher early death rate is still because of those other factors?
Do you understand what I’m saying?
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I see what you did there….
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Actually DARPA is a pretty cool DOD department.
It’s possible that the private market could have come up with something maybe approximating the internet as we know it, but it would be a radically different place, much more closed off, segmented, and controlled. And much more expensive.
ARPANET laid out the standard protocols that largely are still the backbone of the internet. A whole bunch of geeks, SF fans, and Deadheads in universities around the world contributed the original tools that made it grow, like Archie and Gopher. And of course the Web, as we know it, was created by Tim Berners Lee, while he was working at CERN in Switzerland–another government entity.
So, actually, no, I don’t concede anything. I think the way the internet and web developed out of government programs and grassroots efforts were very significant factors in the generally free internet we know today. Had it been developed privately, it would be a completely different animal…
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hiLiam October 1, 2013 at 17:46
Actually, in the 90’s, Hilary did get a law passed which means any doctor who provides medical care for cash that should be paid by Medicare, GOES TO JAIL! It’s the law. And, has been for years. As I remember it, any doctor who gives service for cash for what should be Medicare is prohibited to supply any Medicare service within one year. I am surprised you are unaware of this. It was widely publicized at the time.
As far as all the glowing opinions on the Obamacare, the truth is large numbers of doctors are saying they will do one of two things.
1. Retire or otherwise cease practice.
2. Go into totally private practice, on a pay-in-advance basis. There are already doctors doing this, and the numbers are expected to grow rapidly. If you want in their private plan, you pay so much a year/month, and when you need to see a doctor, no additional charge, except for meds and tests. It may even include house calls, to avoid the expense of an office, which can break a doctor. Especially with the paperwork requirements of even private insurance companies.
Here in Mexico, that horribly expensive knee surgery that athletes need runs about $300 for the MRI, and less than $3000 for the surgery. This would involve a first-rate surgeon of the type who works on million dollar athletes. When I asked about US prices, I was told the MRI alone would run more than the surgery here. And, the surgery might well be between $50.000 and 100,000 dollars.
So, just south of the border you can still get all the medical care you want. One of the best hospitals (in the world) is in Guadalajara, and when I still flew I sometimes talked to Canadians who waited for anything that could wait until they got to GDL.
Some years ago, when my now 7 year old grandson was a baby, on a Thursday he started with a fever and vomiting. This was in McAllen. The doctor said he could squeeze him in on Monday! I called a medical student I know who said it was most likely roseola. Sure enough on Saturday he got the rash on his back and the fever broke.
In Mexico, even in rural Mexico, if your kid gets sick on Thursday, you drive to a doctor’s office or house and ring the bell even at 2 am. And, he sees your kid.
My daughter same week, same day his rash broke, got a terrible headache. Same medical student said it was most likely viral meningitis, she got from her son. Monday I drove her to a doctor, who decided it was encephalitis, because for reasons known only to her, she declined to tell them her son had roseola. (Though it isn’t likely they would have figured it out anyway.)
As a result, she spent two days in the hospital, and their co-pay for this was several thousand dollars. Due to her being recalcitrant about my request she tell him about the roseola, I had no sympathy.
Two years ago, I was concerned about my wife’s osteoporosis. We drove an hour to a small private lab, and for $33 each they did x-ray bone density tests for us.
Obamacare will be forcing lots of people to Mexico for medical care. I realize American doctors want you to think Mexican doctors and hospitals are pure crap. That is not true, though of course there will be stupid doctors in Mexico. In Mexico, if a patient dies, instead of an insurance company paying the family, and the doctor shouting, “NEXT!!!”. there is an investigation as to whether the doctor committed mal practice. If so, he loses his license and will probably go to jail. This protocol requires the doctor to make the decision when the doctor enters his office whether he has the capacity to treat that problem. If he clearly does not, the law requires him to send the patient to a higher level medical agency, and not even attempt to treat him. If the patient dies he had darned well better did while being transporting.
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Because making sure that they are paid well collectively will not work. If they are all paid well, might just as well head to the golf course. If someone has to decide who is paid well, that will be done through lobbying and political connections.
If you have not watched it already, watch Ben Carson’s talk (just google it). Here is a man who went from nothing (single parent family in Detroit, custodial mother with a 3rd grade education) to the head of pediatric neurology at Johns Hopkins. Exactlt the sort you want takign care of a sick kid with cancer. He made a boatload of money, and is spending it to address the problenms if improved education for those who are like he was.
Now imagine the same scenario under any kind of National Health Care.
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See, this is just your fear of not having a guiding hand; a top-down control scheme that drives the end goal and makes sure everything turns out in the end. You’re just having trouble imagining a system that works without someone flipping the switches and turning the knobs in the control room. What we have today is the free-market internet. Very little of ARPANET still exists, and to the extent that it does, it is very much not necessary to the continued existence of the internet.
I don’t know where you get the idea that the free market would have created a disjointed, hard to use system (because it’s the system we have right now), but it’s the same argument that I get when people tell me that the free market could never build a system of roads that made any sense at all.
But it did. Many times throughout history. In fact, if you live in the western US (and many parts of the east, too), a goodly amount of the roads that you drive on were laid out by the free market originally, and by golly, they seem to work just fine. Granted, they are now maintained by the government (and I actually think that is okay in this case).
The idea that the free market would build roads that were incoherent and dead-ended is the same as thinking that because respective states build their own roads that they would all dead end at the state line. It is the same train of thought that goes into assuming that the internet wouldn’t have been coherent if not for the guiding hand of the government. And it’s dead wrong. There would be no benefit to the road builders if the road didn’t go anywhere, just as there would be no benefit to the internet builders if no one used it because it sucked and was too expensive.
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I’ll keep it simple. Find the percentage of deaths due to a specific cause in relation to hospitalizations due to the same cause. Less deaths per 100 hospitalizations means better healthcare in that specific area of expertise, right?
The surest method of reducing premature deaths caused by cancer is to raise the frequency of health checks screening for early stages of cancer. How to ensure compliance with screening regimes if each checkup were to be paid directly from your pocket? Not all people are equally risk-averse. Some are misinformed. Some professions require handling carcinogens for a living. The risk rises for decades after exposure, in some cases the DNA damage is inherited. How would you sort this mess, then?
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As a Canadian I can imagine any other health care system as being better than what we have in Canada. It is an expensive and inefficient system that rewards bureaucrats. Patients are the last on the list of concerns.
I have had TWO surgeries this past year after waiting ONE year for the surgeries. The stay in the hospital was fine, but the waste was horrible to watch and god forbid that you don’t have someone to advocate for you (HINT – never enter a Canadian hospital without a family member or good friend who will take the staff to task on your behalf). Confusion reigned in several areas – yes there are good staff trying to do a good job, but the highly expensive system doesn’t really allow them to.
As for Obamacare – I can’t understand why subsidies were just not provided to low income individuals who couldn’t afford health insurance (not people who could afford it but decided not to purchase insurance). That would leave individuals free to purchase whatever type of insurance they wanted – for some it would a basic package with a high deductible if they had no big health issues or others they could buy a Cadillac package if they cared to. Just provide the government with a policy to get the subsidy. Instead you have a government deciding what you WILL purchase (and what 58 year old woman needs contraceptives???? even a 20 year can afford birth control pills for the cost of two Starbucks coffees per month!) And you have more and more government bureaucrats NOT providing direct health care but administering stuff – gee just like Canada!
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That annoys me too, and it reminds me of the Sandra Fluke nonsense.
Most birth control pills cost less than $20 a month, and condoms aren’t all that expensive either.
He’ll, how about splitting it with your boyfriend – the girl pays for her own pills and her guy buys the rubbers? That’s what I always did, and I don’t recall it being any great financial burden on either me or him.
The sense of entitlement on that issue is galling.
I guess the parallel getting away from the feminism crap would be any other over-the-counter drug. Should the taxpayers also be on the hook for aspirin and Tylenol for people’s hangovers? If I want to eat a bunch of spicy foods, should the Feds cover my Pepto-Bismal? Where is it supposed to end?
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damn good thing too. seems like it’s the only thing that can convince people to actually work on shit they should’ve been doing during the summer when they could’ve been comfortable. should see if we can get it to last as long, might do everyone some good
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Yeah my dad is a vet too and we had to take him to the VA hospital because he was in severe pain. It was super fun watching my dad sit in agony for 6 hour waiting for a doctor.
Obamacare is going to suck.
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i see organized religion as morally repugnant, and as such, i really don’t want to cover for all the religious buildings and areas that are tax exempt. that’s basically your argument, just a different topic at it’s focus that a lot of people disagree with (largely due to said religion). if i have to help them keep their building, then they can help with my less expensive healthcare.
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The Canadian health care system is extremely competitive. Just not with private business. It is competitive based on health outcomes. In every region, you have several hospitals. If one hospital is not as efficient as the others, it is reviewed and management could be let go for someone else. In every province there are regional health authorities. If they are not as successful as the next, there will be a change in management. In Canada, there are ten provinces. Each compare health outcomes. If they fail, there is a change in leadership. These health outcomes are then compared to every nation. If those fail, there is a change in leadership.
To say there is no competition is myopic. You just need to look at it from a different angle.
In many ways, the American health system is driven by oligopolies that are too large to change. Thus, are they really competitive?
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ND and SD, right next to low populated provinces? I think that point needs a little more work.
The idea that mass amounts of Canadians go to the US to get health service is a myth. You can google the odd case. I can tell you cases of Americans receiving health care here. Each fuelled by the politicians in each nation.
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The biggest issue with the American health system is it is heavily hospital based. Hospitals are great for acute care. I break my leg, I want to go to the hospital. But they are very poor for chronic treatment. Mental health, addictions, CDPM, self management, etc. These are all emerging issues. The private sector is investing in the American hospitals because it is the money maker. But not necessarily the best place to treat people. The community is much more efficient, less expensive, and can provide better care for chronic issues.
Canada certainly does not have the best health care system, but many indicators and health outcomes show it is well ahead of the US. Canada still needs to invest more in its communities.
But furthermore, the privatization in the US creates barriers for patient flow. Moving through the health system is far more difficult and extremely ineffective. The coordinated approach of many other nations is much better for patient care.
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Profit is an amazing incentive.
However, so is improving health care for many people. Also, reduction of taxation and maximizing service.
Profit is one of the strongest deliverables out there. But to believe it is the only deliverable that motivates individuals is a little narrow minded.
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Why do you feel that it is your responsibility to save people from their own choices?
Also, you can’t argue that without adjusting for other externalities like higer violent crime that the data you posted is meaningless. There wasnt anything in your links about rates per hundred per mortality type.
You linked one graph saying americans die younger and one graph saying that the largest causes of death in America are heart disease and cancer. Neither proved or indicated in any way that our rates of heart disease and cancer were higher. You extrapolated that on your own, fallaciously.
No need t “make it simple.”
Also, you are assuming that I’m arguing for status quo. I’m very clearly not.
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This can not be said enough. JB…profits are never subtracted from revenues they are what is left over from operating costs. Doing so collapses your revenue stream very quickly in almost every conceivable business model. My sister used to work for the Nova Scotia department of health. They had a small bit of money left over one year in on area of operation. Which they promptly blew on buying new office furniture and other payoffs to vendors owned by friends. This type of behavior isn’t more valuable then the capital allocation signals sent by private sector profit.
The usa is a poor poor example of market forces at work in health care.
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The sheer amount of misinformation and low information in this post AND in the comment thread just has me shaking my head. Normally i agree and enjoy most of your conclusions, JB, but I feel you and many commenters simply do not have the necessary information to provide an informed conclusion.
I started writing out an explanation and simplification of all the factors involved, and realized after 40 minutes that I was writing a novel.
Suffice to say that a bookie, a doctor, and a patient walk into a bar. The actuarial tables tell the bookie what sort of odds he should give the patient that he won’t get sick or injured, and thus what sort of ‘bet’ each month would cover the payout… his tables are adjusted by the fact that the doctor might not necessarily need the entire payout, and that the patient might pay a couple of hundred dollars of the payout himself, the excess of which the bookie gets to keep.
The patient leaves, secure in the knowledge that he has made a fair bet. The bookie leaves, secure in the knowledge that the odds favor him making money. The doctor leaves, secure in the knowledge that he will get paid if he has to give the patient treatment.
Every single step that complicates this process adds a level of inefficiency. every ‘control’ other than the fact that a patient can choose a better bookie or a cheaper doctor, adds to the inefficiency. Every layer of bureaucracy can and will expect to take their ‘cut’ of the process, which invariably makes these things more expensive.
One of the things most often not discusses is the simple fact that America has, for a century, had nearly unfettered research driven solely by a free market. ‘generics’ are far cheaper than name-brand drugs, and a healthy level of competition among medial researchers has led to low prices for nearly every aspect of healthcare, both at home and abroad.
America has, for the last several decades, been THE choice for low-cost drugs and innovative treatment equipment. In a very real sense, the socialized healthcare programs of every developed nation has absolutely DEPENDED upon American suppliers, exporters, innovators, researchers, and producers. They have not once been required to actually become self-supporting, and the lack of market incentives under a socialized medical system has absolutely destroyed their ability to ever become self-sufficient.
People point to cheap imported knockoffs of drugs from indonesia, bangladesh, china, and taiwan and say “Look! we no longer need to rely on american innovation!’ but what they fail to realize is that the very forces that keep these knockoffs available and affordable are the market forces driving American research and development.
Not only do innovative treatments offer low-cost healthcare, but they ALSO prevent excessive damage in ‘long term care’ from an untreated condition.
Apparently no one has noticed the research-stifling provisions deeply imbedded into Obamacare, and instead of creating a real long term solution, the ACA simply adds another level to the healthcare pyramid… only this time, There is going to be no America injecting desperately-needed market forces into the pricing and research pyramid.
I really, really look forward to watching the ‘fabulously successful’ socialized medicine programs around the world collapse one by one as they are driven under by their inherent inefficiencies without getting propped up by the last bastion of free market. Thank goodness I work ‘under the table’ and have to pay only capital gains tax for my labor.
Oh, and I know a really good bookie that’s got me and my family covered.
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Hey, I never said it was the only incentive. I’ve just never heard the argument that removing profit incentive will lower prices/costs – well except maybe from stoned hippie douches. Profit is awesome.
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More relevant info.
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I’m for informed choices. But choices ignorant by design?
Information inequality breeds market failures. The more stratified society, the more information inequality in every market exchange. Delegating responsibility works only if the recipient is accountable.
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The American, oligopoly insurance based system is extremely bureaucratic with many silos and barriers for patients. One of the biggest mistakes when we discuss competitive industries is we assume perfect competition. Perfect competition rarely exists. Most of the time it is monopolistic competition. In the case of the American health care industry, it is oligopoly. Not only that, but the significant costs associated with new entrants discourages new competition. They would rather take advantage of their opportunity cost to go elsewhere.
You can say what you want about socialized medicine, but paper after paper on the World stage has it providing better patient care and life expectancy at a lower cost. They are not only more efficient, but more effective.
Free market is a wonderful thing. But it is silly to assume there is one answer to all questions.
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Perhaps heart disease and cancer are the #1 causes of death in the other countries, too, and the only reason America still has a higher early death rate is still because of those other factors?
Perhaps you haven’t noticed that you could have that answer already from here:
http://stats.oecd.org/
PYLL per 1000 population (both sexes) due to cancer in 2008 (A):
Australia 815.1
Canada 887.4
Finland 760.6
France 1 095.6
Germany 960.6
Israel 841.7
Japan 783.5
Mexico 741.6
Netherlands 1 048
New Zealand 947.3
Norway 834.9
Sweden 759.6
United Kingdom 933.2
United States 925.8
PYLL per 1000 population (both sexes) due to cardiovascular diseases in 2008 (B):
Australia 414.4
Canada 448.4
Finland 666.2
France 396.3
Germany 558.5
Israel 337.4
Japan 471.8
Mexico 748.7
Netherlands 438.2
New Zealand 546
Norway 384.3
Sweden 420.9
United Kingdom 586.1
United States 844.4
PYLL per 1000 population (both sexes) due to assault (I assume mostly armed) in 2008 (C):
Australia 35.2
Canada 59.4
Finland 64.2
France 19.9
Germany 15.8
Israel 61.8
Japan 13.2
Mexico 390.1
Netherlands 29.6
New Zealand 43.6
Norway 19.2
Sweden 25.3
United Kingdom 11.3
United States 210.3
Now an example of direct comparison between the US and New Zealand:
A+B C
United States 1770,2 210.3
New Zealand 1493,3 43.6
The difference between these countries is for both accounts as follows:
276,9 166,7
See?
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Sorry for not quoting the first sentence properly and for table spacing lost in copying.
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Eh, it’s for both heart failures and strokes, not only heart failures. And values are a hundred times lower – per 100 000 population, not 1 000.
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Anybody interested in checking cumulative costs of healthcare per capita in each of those countries after adjusting for purchasing power parity? It’s simple number crushing with a spreadsheet software.
Then it would be easy to establish “potential years of life earned” for “every” dollar spent on healthcare. I know, “an average citizen” is a fiction, but an useful fiction.
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It has something to do with healthcare.
Obamacare was never voted on in its final form, it was procedurally enacted as law. I see little morally wrong with using procedure to try to thwart something that the left did not have the courage to trust the system to enact.
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The way this public healthcare is planned in US is quite strange: or you buy the healthcare or you face a fine. It is like a compulsory private insurance. I understand why a lot of Americans are against it. It is surrealistic.
In Europe, the public healthcare works this way: from yout taxes, the Government takes an ammount to public healthcare. And, believe me, you always are going to pay a lot of taxes (with the “anti taxes” conservatives even MORE. Vg: Thatcher in UK or Rajoy in Spain) So, in that case, it is better to have a public healthcare than not, paying the SAME amount of taxes.
What the conservative Govermente is doing in Spain is the next thing: you pay MORE taxes and you have LESS public services. Surrealist, is not it?
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One of the major problems with the medical industry in the U.S. is that it’s *not* competitive. You won’t find me defending the kludge we currently (even before Obamacare) suffer under, but at the same time, I don’t see giving the Feds *more* control as being anything but a complete disaster. The one thing they’re good at is making services more expensive and less efficient.
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Under the Affordable Care Act, people are still free to purchase whatever type of insurance they want and can afford. The state insurance exchanges set up under the act offer comparison shopping among a variety of policies with a variety level of coverage and cost from a variety of private insurance providers. The government is in no way deciding what you will purchase.
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The Patient Protection and Affordable Care Act was indeed duly voted on and passed by both the House and Senate. You’re thinking of a later bill–The Health Care and Education Reconciliation Act–that dealt with some budgetary matters relating the ACA and since it involved budgetary matters was passed under the “reconciliation” procedure which only meant it was not subject to a potential fillibuster in the Senate. That bill, too, was duly voted on and passed by both the House and the Senate. So there’s nothing “morally wrong” going on…
And the current government shutdown still has nothing to do with healthcare. It’s a political stunt.
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See, this is just your fear of not having a guiding hand; a top-down control scheme that drives the end goal and makes sure everything turns out in the end. You’re just having trouble imagining a system that works without someone flipping the switches and turning the knobs in the control room.
Goober, please stop projecting your wild, nearly delusional, cartoon fantasies and fear of government on to me. It’s getting rather creepy.
I’ve never said that the free market hasn’t had a huge impact on the subsequent development of the internet and the Web. Private enterprise is almost completely responsible for the build-out of bandwidth, software, and hardware that make up the existing internet. Could the free market have come up with the internet without any help from any government entity? Possibly, but it would have taken a lot longer and been subject to more corporate control. In the early days of the web, some companies, notably AOL made an attempt to do so. They tried very hard and with much success to convince AOL users that AOL was the web. But those efforts were ultimately unsuccessful because of the nature of the open architecture designed–by government entities, private researchers, and universities–into the underlying internet.
I know you don’t like that this is an example of a government program that was not only successful, but a pivotal development. But it is.
As for roads, I think the Interstate Highway System–a government project–was pretty successful.
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Actually as you are the one making the assertion and using it to prop up your argument, it is your place to prove it.. Debate 101.
The fact you can’t speaks volumes.
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Hey JB,
I thought this post might have been an overstatement, as I have not heard a lot of the debate on NPR centered around women. BUT then, ahh I cringed today when I saw what my own SISTER had posted on facebook:
“Go girl.
http://www.upworthy.com/a-senator-bluntly-says-what-were-all-thinking-about-the-awful-and-obnoxious-government-shutdown?g=2&c=ufb1”
It’s a post about how the government shutdown is due to birth control arguments.
(Sidenote: I am beginning to fucking hate upworthy and it’s attempt to associate anything posted on their site with ‘good.’)
My question, most sincere, is:
What do I do as I see my sister, 23, turning into a bitter feminist-jezebel type something or other before my very eyes? It breaks my heart. She started crying one night because she thought “Blurred lines was sooo rapey.” Betty Freidan sits on our coffee table. I wish I were joking, but I’m not, I’m dead serious. Fuck fuck fuck. How do I fight back to my own flesh and blood? The very last thing I want is a bitter cat lady sister as I grow older. I want nieces and nephews and shit. It’s like once the brainwashing has set in from a dumbass liberal arts college of women studies, there is no going back. Or is it just a phase…? A phase that she’ll regret once she has passed the wall? Appreciate your thoughts, JB.
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I have never even discussed that the american healthcare as it stood was horribly flawed. However, I consider the socialization of medicine to be akin to shooting a sick man. Certainly it will cure the disease, but is it worth it?
paper after paper on the world stage has never dealt with the actual financial implications of not having a free-market alternative to socialized medicine.
Frankly, I am sick to death of pringing up the ‘shooting the patient’ problems with socialized healthcare, as well as the fact that implementation in the United states was both unconstitutional and illegal. On Facebook, on websites, I have hit my limit on trying to explain publicly-available information to nitwits that keep screaming about how their ‘feelings’ about obamacare justifies destroying the constitution and bill of rights. The information on every single aspect is a little disconnected, the flaws are egregious, and most articles focus on a single issue rather than taken in whole. It is unconstitutional, economically unsound, tyrannical, plagued with violation after violation of the bill of rights, medical and judicial ethics, privacy, self-determination, individuality, limitation and separation of powers, checks and balances, tax law, and even basic logic.
Or as Robert Heinlein said, “The greatest form of tyranny is to force a man to pay for something he does not want, merely because you think it would be good for him.”
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You are aware, are you not, that we have a whole section of our government dedicated to ensuring that laws do NOT violate the constitution, and that that group of nine men and women has collectively ruled the whole thing constitutional, right? So essentially, you’re using inflammatory and false rhetoric.
You’d have a lot more credibility if you stuck to facts rather than using the ever increasingly prevalent tactic of asserting that anything you don’t personally agree with is somehow unconstitutional.
http://www.theonion.com/articles/area-man-passionate-defender-of-what-he-imagines-c,2849/
Could very well be that the reason people don’t listen to you is that when you start with a demonstrably false assertion, it’s pretty easy to dismiss the rest of what you say as equally I’ll-informed.
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Stupid auto-correct. “Ill-informed”
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Read it yourself.
Unconstitutional and violates the seperation of powers- It was adjudged unconstitutional by the supreme court until it was called a ‘tax’. Tax bills have to be proposed in the House. Obamacare did not originate in the House of representatives. Unconstitutional and illegal. http://www.washingtontimes.com/news/2013/mar/31/obamacare-lawsuit-over-health-care-tax-will-test-c/?page=all
Enormous flaws and lies- the name is a misnomer. It dramatically increases taxes on the sector it is supposed to be assisting. for a single example: http://www.infowars.com/obamacare-fines-to-be-seized-from-bank-accounts/
The Bill of rights: Obamacare defies the first amendment, specifically on freedom of religion. As a ‘Tax’ it violates the ethics of the catholic and several other major churches, as their members are forced to pay for abortions, certain medical procedures, abortifacents(sic), and birth control. http://dailycaller.com/2012/01/04/obamacare-violates-my-first-amendment-rights/ and http://www.reformation21.org/articles/christians-in-conflict-over-obamacare.php
Medical and Judicial ethics: Obamacare puts your private medical records into the hands of the government. Doctor-patient confidentiality goes out the window. http://www.americanthinker.com/2013/09/patient_privacy_goes_out_the_window_and_into_the_obamacare_data_hub.html and of course judicial ethics and conflict of interest http://www.lifesitenews.com/news/kagans-participation-in-obamacare-taints-the-decision/
economic unsoundness and destruction of individual rights as well as self-determination http://www.policymic.com/articles/5487/how-obamacare-will-hurt-tax-payers-and-stop-the-economic-recovery
gods, I am so tired of doing basic google searches for people that cannot figure out how to do it themselves. How hard is it to understand that FORCING people to pay for services they DO NOT WANT is WRONG?
Even if 60% of american taxpayers supported obamacare (they do not. Huffpost and the likes try to say that 60% of AMERICANS support it, but completely ignore the fact that many of those are not taxpayers… of course non-taxpayers want ‘free stuff’ that other people are forced to pay for) is it right that 60% of the people can force the other 40% to do something against their will?
I totally support laws which tell people what they CAN NOT do, but laws that force people TO DO something are simply and clearly the very definition of ‘dictatorship’. If it is not prohibited it is mandatory. Do you really want to live in a country like that?
And please do not try to compare Obamacare to Canada or the UK healthcare. They are nothing alike. neither country FORCES people, at gunpoint, to buy insurance. And the average co-pay on Obama care is one thousand four hundred dollars. How much copay do the canucks and brits have? none? Hmmmm.
*Sigh* you can lead a horse to water….There are a lot of horses dying of dehydration in the middle of a lake right now.
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BTW, nice try at painting me with the ‘low information’ brush. I have sat here for nearly a week reading through the darned law, and at even halfway through I have noted dozens of potential slippery slopes, imbedded ‘government rights’ that are easily abused, state ‘incentive programs’ that literally pay states to violate the bill of rights on a technicality (just like child protective services, and everyone with a brain KNOWS how they abuse ‘federal contributions’), and insane levels of doublespeak that point to a single conclusion- Obamacare is the vehicle by which Obama turns our constitutional republic into Cambodia.
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If it walks like a duck and quacks like a duck…
I didn’t necessarily say you WERE low information, I said that your tendency to spew wild, inflammatory rhetoric and throw in things which are false makes you SEEM ill-informed.
Nothing you’ve said in response shows me that you’re anything but a troll, a hyper-partisan or a paranoid lunatic.
You, sir, are dangerous, and far more likely to be the sort of person who leads to the destruction of this nation than our President is.
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This is exactly like Canadian health care. I was in a car accident once, and I spent four hours in X-Ray strapped to a backboard in a c-collar, because there wasn’t a radiologist available on the weekend to run the scanner. This is not an aberration in the system.
Single-payer is horribly, horribly inefficient at all levels, and as healthcare is a government monopoly, there are no market controls. People that can afford it leave the country to get service for many health conditions.
As an aside, the federal Health Act should be at some basic level unconstitutional, because healthcare is constitutionally a provincial responsibility. No one has yet challenged it, which tells you something about the provinces.
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Minor correction there JB:
You said:
Not exactly. As this article points out, the nation has already gone through several shutdowns:
http://www.nationalreview.com/article/360142/government-shutdowns-history-charles-c-w-cooke
If anything, that was the idea behind the 10th amendment (or at least, one of them). Let the federal government shut down, most of our lives and concerns lay with the state we live in. (and if it gets to the point that fed shutdown is really bad for us all… well shows how far we’ve gone from the original constitutional vision, doesn’t it?)
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When the market signals that there is more consumer demand for cosmetic surgery (a Veblen good for the most part) than for treating life threatening conditions, then it becomes less of a straightforward issue.
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I have the same problem. I need new hips and knees and am too young to qualify. But Obamacare scares me more than the system we have in place now. I’m already anticipating the likelihood that I’m going to have the have my surgeries overseas just to afford them.
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FWIW my costs have only gone up as the ACA has continued to go into effect. My doctor and pharmacist are both swamped with piles of extra paperwork office visits (on the part of my doctor) that amount to little more than busywork to raise $$ for the implementation of the plan. My kids have already lost their doctor because he couldn’t afford to stay in private practice. I go to the doctor as little as possible to keep my costs down when I didn’t used to have to think of it nearly so much.
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I’m with you Goober. Industry of any kind is not motivated by touchy-feely sentiment- it’s motivated by profit. We have seen unprecedented advancements in medical care and technology over the last century because there has been money to made in such innovation.
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The thing is, “Obamacare” is primarily about getting people into private insurance, since there is no “government insurance” option. So if your doctors and pharmacists are getting more paperwork, I’d question whether it is because of government or insurance companies. It’s true that some insurance companies have been playing a little fast and loose in the run-up to full implementation, especially raising rates where they can, the truth is that they would have been doing that anyway and this just provides an excuse. Once fully phased in, it should reduce rates for everyone, since the playing field will have been leveled and there should be more competition in the insurance market.
That said, your insurance may actually end up providing incentives for getting surgeries overseas. In many cases, if not most, the level of care is equivalent for common procedures, such as knee and hip replacements, but the cost is significantly less. Which gets back to the main problem with American healthcare: costs, and cost-shifting, are so hidden from consumers that costs are vastly inflated.
Obamacare isn’t a complete answer, but it’s a step in the right direction…
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We’ll see. My experience so far has been all bad and I am not hopeful that it will get better.
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“National healthcare systems piss Americans off in particular because they are also progressive”
Nah. The entire government has been in the thrall of one branch of progressive or another for over a hundred years, and will probably remain so until they finish completely sucking the lifeblood out of the productive and crash the whole system. The only question about that is whether it’ll crash so hard we end up back in the Dark Ages.
No, the problem with this is that under the new law, it is a FELONY to provide any medical treatment which hasn’t been pre-approved by a panel of government bureaucrats, whether the government pays for it or not.
Have a medical condition for which the cheapest possible treatment isn’t really effective in your case? Tough luck…if your doctor gives you a more effective treatment, he risks going to prison for it.
Of course, it might take years for them to start openly using it to kill off the opposition. But what we can fight NOW is the requirement that every American citizen who isn’t already insured by their employer spend many thousands of dollars out of pocket every year for policies that are required to cover things many of them don’t want, but for actual medical _insurance_ (that is, coverage against unlikely events which would be financially crippling if they happened) are surprisingly useless.
Delaying it just delays the pain. They ought to let the whole thing go through, and then when we re-take the Senate next year, we kill it off wholesale. The more painful it is, the more the tiny remnant of mainstream Americans who aren’t yet against it will come over to our side.
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Hey JB – I love your blog and your writing!!
You should check out the crazies over at FreeJinger (www.freejingger.org) – they’ve been discussing you a lot lately, and I thought you might appreciate their ridiculous feminist nonsense. It really is quite hysterical!!
The owner of the site is “disabled” and hasn’t worked in 17+ years – when someone questioned this her response was basically “I’m not lazy! The government should pay for me!” – and that’s just the tip of the iceberg.
I really think you’d enjoy some of their conversation — in a JudgyBitch sort of way. 🙂
Keep up the awesome work – I am a longtime follower and always look forward to your new posts. 🙂
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Yeah, the freejingers are quite a hoot, aren’t they?
Apparently, I’m a Christian fundamentalist with a cheating husband I can barely stand and I make all these stories up.
Excellent reading comprehension, ladies.
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No, the problem with this is that under the new law, it is a FELONY to provide any medical treatment which hasn’t been pre-approved by a panel of government bureaucrats
Now that’s a rather outrageous–and preposterous–claim. Can you cite which section of the law provides for this? Or any reputable source for this false statement?
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No, they are “free” to purchase whatever type of health care they want, from a severely reduced menu of options (high deductible plans have been eliminated), that they can “afford”, knowing that the young are subsidizing the old. Technically you are correct in that the government is not deciding what you will purchase, BUT they are deciding that you will purchase (but it’s a “tax”), and they sure as hell are deciding what you won’t puchase.
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Wrong.
People are “free” (forced, but it’s okay, since it’s a “tax”) to purchase whatever they want, from a severely limited set of choices. All of these choices have mandated coverage, so as to ensure the least expensive subsidize the most expensive (there is no reason men and women should be the same price, under any actuarial model).
So, the gov’t is very much making purchasing decisions for you.
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