Paul Krugman: Health Care Terror

Paul Krugman discusses how the "medical-industrial complex and its political allies have used scare tactics" to prevent Americans from making health care available to all:

Health Care Terror, by Paul Krugman, Commentary, NY Times: These days terrorism is the first refuge of scoundrels. So when British authorities announced that a ring of Muslim doctors working for the National Health Service was behind the recent failed bomb plot, we should have known what was coming.

“National healthcare: Breeding ground for terror?” read the on-screen headline, as the Fox News host Neil Cavuto and the commentator Jerry Bowyer solemnly discussed how universal health care promotes terrorism.

While this was crass even by the standards of Bush-era political discourse, Fox was following in a long tradition. For more than 60 years, the medical-industrial complex and its political allies have used scare tactics to prevent America from following its conscience and making access to health care a right for all its citizens.

I say conscience, because the health care issue is, most of all, about morality.

That’s what we learn from the overwhelming response to Michael Moore’s “Sicko.” Health care reformers should, by all means, address the anxieties of middle-class Americans, their ... fear of finding themselves uninsured or ... den[ied] coverage when they need it most. But reformers shouldn’t focus only on self-interest. They should also appeal to Americans’ sense of decency and humanity.

What outrages people who see “Sicko” is the sheer cruelty and injustice of the American health care system — sick people who can’t pay their hospital bills literally dumped on the sidewalk, a child who dies because an emergency room that isn’t a participant in her mother’s health plan won’t treat her, hard-working Americans driven into humiliating poverty by medical bills.

“Sicko” is a powerful call to action — but ... defenders of the status quo  ...[are] very good at fending off reform by finding new ways to scare us.

These scare tactics have often included over-the-top claims about the dangers of government insurance. “Sicko” plays part of a recording Ronald Reagan once made for the American Medical Association, warning that .... the program now known as Medicare ... would lead to totalitarianism...

Mainly, though, the big-money interests with a stake in the present system want you to believe that universal health care would lead to a crushing tax burden and lousy medical care.

Now, every wealthy country except the United States already has some form of universal care. Citizens ... pay extra taxes as a result — but they make up for that through savings on insurance premiums and out-of-pocket medical costs. The overall cost of health care ... is much lower...

Meanwhile, every available indicator says that in terms of quality, access to needed care and health outcomes, the U.S. health care system does worse, not better, than other advanced countries. ...

All of which raises the question Mr. Moore asks at the beginning of “Sicko”: who are we?

“We have always known that heedless self-interest was bad morals; we know now that it is bad economics.” So declared F.D.R. in 1937, in words that apply perfectly to health care today. This isn’t one of those cases where we face painful tradeoffs — here, doing the right thing is also cost-efficient. Universal health care would save thousands of American lives each year, while actually saving money.

So this is a test. The only things standing in the way of universal health care are the fear-mongering and influence-buying of interest groups. If we can’t overcome those forces here, there’s not much hope for America’s future.

_________________________
Previous (7/6) column: Paul Krugman: Sacrifice Is for Suckers
Next (7/13) column: Paul Krugman: An Unjustified Privilege

Comments

[evagrius]

You don't need health care in order to live. :)

[anne]

http://www.yale.edu/lawweb/avalon/presiden/inaug/froos2.htm

January 20, 1937

The Second Inaugural Address
By Franklin Roosevelt

When four years ago we met to inaugurate a President, the Republic, single-minded in anxiety, stood in spirit here. We dedicated ourselves to the fulfillment of a vision — to speed the time when there would be for all the people that security and peace essential to the pursuit of happiness. We of the Republic pledged ourselves to drive from the temple of our ancient faith those who had profaned it; to end by action, tireless and unafraid, the stagnation and despair of that day. We did those first things first.

Our covenant with ourselves did not stop there. Instinctively we recognized a deeper need — the need to find through government the instrument of our united purpose to solve for the individual the ever-rising problems of a complex civilization. Repeated attempts at their solution without the aid of government had left us baffled and bewildered. For, without that aid, we had been unable to create those moral controls over the services of science which are necessary to make science a useful servant instead of a ruthless master of mankind. To do this we knew that we must find practical controls over blind economic forces and blindly selfish men.

We of the Republic sensed the truth that democratic government has innate capacity to protect its people against disasters once considered inevitable, to solve problems once considered unsolvable. We would not admit that we could not find a way to master economic epidemics just as, after centuries of fatalistic suffering, we had found a way to master epidemics of disease. We refused to leave the problems of our common welfare to be solved by the winds of chance and the hurricanes of disaster.

In this we Americans were discovering no wholly new truth; we were writing a new chapter in our book of self-government.

This year marks the one hundred and fiftieth anniversary of the Constitutional Convention which made us a nation. At that Convention our forefathers found the way out of the chaos which followed the Revolutionary War; they created a strong government with powers of united action sufficient then and now to solve problems utterly beyond individual or local solution. A century and a half ago they established the Federal Government in order to promote the general welfare and secure the blessings of liberty to the American people.

Today we invoke those same powers of government to achieve the same objectives.

Four years of new experience have not belied our historic instinct. They hold out the clear hope that government within communities, government within the separate States, and government of the United States can do the things the times require, without yielding its democracy. Our tasks in the last four years did not force democracy to take a holiday.

Nearly all of us recognize that as intricacies of human relationships increase, so power to govern them also must increase— power to stop evil; power to do good. The essential democracy of our Nation and the safety of our people depend not upon the absence of power, but upon lodging it with those whom the people can change or continue at stated intervals through an honest and free system of elections. The Constitution of 1787 did not make our democracy impotent.

In fact, in these last four years, we have made the exercise of all power more democratic; for we have begun to bring private autocratic powers into their proper subordination to the public's government. The legend that they were invincible — above and beyond the processes of a democracy — has been shattered. They have been challenged and beaten.

Our progress out of the depression is obvious. But that is not all that you and I mean by the new order of things. Our pledge was not merely to do a patchwork job with second-hand materials. By using the new materials of social justice we have undertaken to erect on the old foundations a more enduring structure for the better use of future generations.

In that purpose we have been helped by achievements of mind and spirit. Old truths have been relearned; untruths have been unlearned. We have always known that heedless self-interest was bad morals; we know now that it is bad economics. Out of the collapse of a prosperity whose builders boasted their practicality has come the conviction that in the long run economic morality pays. We are beginning to wipe out the line that divides the practical from the ideal; and in so doing we are fashioning an instrument of unimagined power for the establishment of a morally better world....

[anne]

Paul Krugman is reading of Franklin Roosevelt, as am I. Notice also that Mark Thoma understood and taught of this theme at once. We are many of us understanding. My sister and I separately noticed the warm nodding laughing clapping response to Michael Moore's fine film.

[Tim Worstall]

A little over the top, surely? The US has health care for all. It might be highly variable, inequitable, but health care it has. Health insurance for all it does not have.

[Jeffrey Dach MD]

What is the real solution, if Michael Moore’s government sponsored universal health care is not the answer?

The crux of the "SICKO" documentary is the disconnect between our expectations and the reality of health care. We are expecting compassionate care from another human being, and instead we get a faceless corporation. The person behind the desk or window is an agent of a health care corporation, which is not a human being, whose primary goal is to increase corporate profit.

This is America, and corporate profit is good, the profit motive forming the basis America’s greatness. The basic problem is that a corporation is not a human being. Therein lies the fallacy of replacing a corporation with a government agency, neither of which is a human being, when what we really want is a human being to deliver compassionate health care, and assist in serious health care decisions.

Review of "SICKO", by Jeffrey Dach MD

http://jeffreydach.com/2007/07/08/sicko--michael-moore-and-the-crisis-in-health-care-by-jeffrey-dach-md.aspx

Jeffrey Dach MD
http://www.drdach.com/

[Jeffrey Dach MD]

Review of "SICKO", by Jeffrey Dach MD

Jeffrey Dach MD

[anne]

There was this weekend a public television portrayal of the closing off of enrollment of eligible children in Georgia to federal-state health care insurance. What is a person to do when the Republican Governor of Georgia is telling us how angry he is about being accused of being insensitive to the needs of children, when he is being wildly insensitive to the needs of children?

What can a parent in Georgia do to save a diabetic child? Well call a Congressman, and cry and beg for gifts locally. Of course, the responsible Republican Congressman from Georgia essentially answered beg, since evidently the progam to insure the health of children in Georgia is being "mis-used" elsewhere and besides "where is parent responsibility?"

Remember, then, when Mark Thoma portrayed the policy disaster raising infant mortality rates through the South and focusing on Mississippi. There is evidently tragedy to come.

[anne]

"The US has health care for all."

Like, say, the pregnant women in Mississippi and Georgia who have no health care, and for whom there is tragedy on tragedy. A lot under the top, surely surely surely.

[anne]

http://www.cbpp.org/6-21-07bud.htm

We have a President and Congressional supporters who are asking for an increase in the defense budget, apart from the lunatic spending for Iraq, of $43.1 billion and an increase of $3.1 billion for international programs, but a cut of $16.4 billion for domestic social benefit program like, say, health care for children already eligible for government health care coverage.

So, $43.1 billion more for the military and $3.1 billion more for international affairs, and 16.$ billion less for our social benefit needs.

Democrats are offering even more for the military an a little less for international affairs, but $5.1 billion more for social benefit spending which will include meeting the health care needs of 6 million children.

The President has vowed a veto.

[real person from the real world]

Medical associations limit the ability of applicants to get into medical school, and then hospitals must import doctors and nurses from other countries. US companies claim they cannot find qualified applicaants for tech jobs, and import techies, while local colleges (like the large one I went to) are now suffering a bust of tech students. The medical associations set costs for medical procedures, and keep doctor's fees high. The same drugs we buy in the US are much cheaper in Canada, but the Industry claims they should be limited because they are not safe, yet US pharma buys the drugs from the same 3rd world countries it claims are not safe. Economists talk about supply and demand, but how can supply adjust to demand when it is continually influenced by entities persuing their own narrow interests to make as much money as possible regardless of how they do it? Fear mongers complain that US grade schools are not performing as well as other countries, yet so many foreigners of the 3rd world long fervently to come to the US to go to college. Education, Inc., teams up with financial interests to milk as much money out of US students as possible, while the gov't subsidizes foreign students generously. Two services vital to any strong economy, education and healthcare, need to be disconnected from the for profit business sector and profit motive.

[save_the_rustbelt]

"...Medical associations limit the ability of applicants to get into medical school,..."

That is a myth that has been around for decades.

Medical school seats are limited because, well, the American taxpayer does not want to pay for medical school seats - imports are easier.

[save_the-rustbelt]

Every PhD I know gets crazy whenever anyone presents an argument with "anecdotal evidence," yet Krugman is all ga-ga over this goofy polemic film by someone with absolutely no credentials to evaluate healthcare.

Of course Krugman pronounced the VA as our state-of-the-art because he sat in his office and read some reports that said so.

I can produce anecdotes too, but it is unlikely anyone would listen, as I actually know what I am talking about.

There are problems, Krugman and Moore will not lead us to a fix.

[anne]

Forgive me, I have made an important mistake. The number of children according to the Congressional Budget Office who are eligible for government health care insurance but who are not covered is "9" million. I have mistakenly used the number 6 million.

http://www.cbpp.org/5-10-07health.htm

[anne]

"SiCKO" was of course a brilliant film, and as with the health care ideas that have been described by Paul Krugman in column on column for several years * , we have fine workable ideas for health care insurance reform that are continually dealt with by the insurace industry with successful campaigns of fear and deception

* All of these Paul Krugman health care columns and others since Mark Thoma has been publishing are on this blog.

[anne]

Not to worry though, Georgia's Governor told the mother to call her Congressional Representative while the Georgia Congressional Representative told the mother not to bother with the calling. Me, I have all sorts of health care coverage but I was truly scared.

"Paul Krugman discusses how the 'medical-industrial complex and its political allies have used scare tactics' to prevent Americans from making health care available to all"

Thank you Paul Krugman and Mark Thoma and Michael Moore....

[anne]

http://www.nytimes.com/2007/04/22/health/22infant.html?ex=1334894400&en=5d5d40b319346648&ei=5090&partner=rssuserland&emc=rss

April 22, 2007

In Turnabout, Infant Deaths Climb in South
By ERIK ECKHOLM

HOLLANDALE, Miss. — For decades, Mississippi and neighboring states with large black populations and expanses of enduring poverty made steady progress in reducing infant death. But, in what health experts call an ominous portent, progress has stalled and in recent years the death rate has risen in Mississippi and several other states.

The setbacks have raised questions about the impact of cuts in welfare and Medicaid and of poor access to doctors, and, many doctors say, the growing epidemics of obesity, diabetes and hypertension among potential mothers, some of whom tip the scales here at 300 to 400 pounds.

"I don't think the rise is a fluke, and it's a disturbing trend, not only in Mississippi but throughout the Southeast," said Dr. Christina Glick, a neonatologist in Jackson, Miss., and past president of the National Perinatal Association.

To the shock of Mississippi officials, who in 2004 had seen the infant mortality rate — defined as deaths by the age of 1 year per thousand live births — fall to 9.7, the rate jumped sharply in 2005, to 11.4. The national average in 2003, the last year for which data have been compiled, was 6.9. Smaller rises also occurred in 2005 in Alabama, North Carolina and Tennessee. Louisiana and South Carolina saw rises in 2004 and have not yet reported on 2005.

Whether the rises continue or not, federal officials say, rates have stagnated in the Deep South at levels well above the national average....

[anne]

http://www.nytimes.com/2007/04/26/opinion/l26south.html

Infant Deaths: Shame of a Nation

To the Editor:

"In Turnabout, Infant Deaths Climb in South":

When my colleagues and I started a community health center in the Mississippi Delta in the 1960s, we estimated the actual black infant mortality rate in our area at nearly 60 per thousand live births.

The causes were abysmal poverty, wide unemployment, crumbling shacks, outright malnutrition, contaminated water and lack of transportation.

We addressed those problems, in addition to providing desperately needed medical care. The infant mortality rate dropped sharply.

Those causes persist, now worsened by deep cuts in Medicaid and welfare.

The consequence of shredding the social safety net is more dead black (and white) babies. No health service can overcome the effects of social policies that devastate the lives of the poor.

This is not just a health problem; it is a measure of our moral commitment to a fair chance for survival. We should be enraged, and ashamed, that these preventable excess deaths continue, and increase, among us.

H. Jack Geiger, M.D.
Brooklyn, April 25, 2007
The writer was a founding member and national coordinator of the Medical Committee for Human Rights.

[anne]

Mark Thoma:

"Paul Krugman discusses how the 'medical-industrial complex and its political allies have used scare tactics' to prevent Americans from making health care available to all...."

Precisely, of course. Precisely like the crying begging Georgia mother whose child has Type I diabetes and for whom a day with no insulin treatment is a day that will end in death. Precisely like the mother and child who are suddenly shut off from the Georgia health care system, and for whom $900 a month is an impossible cost.

Notice how well I am writing.

[Mickey]

"These scare tactics have often included over-the-top claims about the dangers of government insurance. “Sicko” plays part of a recording Ronald Reagan once made for the American Medical Association, warning that .... the program now known as Medicare ... would lead to totalitarianism..."

HE WAS RIGHT.

[evagrius]

Send news tip to FOXNews.com

SUBMIT FOXNEWS.COM HOME > HEALTH

U.S. Trails Others in Health Care Satisfaction
Friday, October 29, 2004

By Todd Zwillich

E-MAIL STORY PRINTER FRIENDLY VERSION
Americans are more dissatisfied than citizens of other nations with their basic health care (search) even while paying more of their own money for treatment, a five-nation survey released Thursday notes.

The study shows that people in the U.S. face longer wait times to see doctors and have more trouble getting care on evenings or weekends than do people in other industrialized countries. At the same time, Americans were more likely to receive advice on disease prevention and self-care than others.

One-third of Americans told pollsters that the U.S. health care system should be completely rebuilt, far more than residents of Australia, Canada, New Zealand, or the U.K. Just 16 percent of Americans said that the U.S. health care system needs only minor changes, the lowest number expressing approval among the countries surveyed.

“In no country is the majority of adults satisfied,” says Cathy Schoen, a vice president at the Commonwealth Fund (search), a nonprofit group that conducted surveys of some 7,000 patients in the five countries.

(Story continues below)

Where Do the Candidates Stand on Health Care? Get Health News Delivered to You Learn the Latest on Medicare Reform The U.S. is the only industrialized country that does not offer government-sponsored health coverage for all citizens. Proponents of market-driven health care often point to long wait times for services in other countries when warning of the dangers of a government-run system.

Sixty percent of patients in New Zealand told researchers that they were able to get a same-day appointment with a doctor when sick, nearly double the 33 percent of Americans who got such speedy care. Only Canada scored lower, with 27 percent saying they could get same-day attention. Americans were also the most likely to have difficulty getting care on nights, weekends, or holidays without going to an emergency room.

Four in 10 U.S. adults told researchers that they had gone without needed care because of the cost, including skipping prescriptions, avoiding going to the doctor, or skipping a recommended test or treatment.

Meanwhile, 26 percent of Americans surveyed said that they had faced more than $1,000 in out-of-pocket health care costs in the last year, compared with 14 percent of Australians, and 4 percent of Britons.

“The U.S. stands out as the patients the most exposed to medical bills,” Schoen says.

A Silver Lining in American Health Care

The results seemed to discourage American officials, though they say they were heartened by other figures showing that U.S. patients were the most likely to receive several forms of preventive care, including Pap smear tests.

Eighty-six percent of American women respondents between 50 and 64 years of age said they got a mammogram (search) in the past three years, six points higher than in Australia and nine higher than in the U.K.

“We’ll take good news where we can get it,” says Carolyn M. Clancy, MD, director of the U.S. Agency for Healthcare Research and Quality. “The other findings are clearly of concern,” she says.

Clancy stresses that government officials have been actively pushing programs to promote preventive medicine, pointing to the Medicare reforms passed last year that will add preventive care and chronic disease management to the program’s list of paid services for seniors.

Though their countries generally outperformed the U.S., officials from the survey’s other nations also acknowledged it as proof that their government must do more to promote primary health care and better medical information technology.

John Hutton, a British Member of Parliament and the Minister of State for Health, says, “When they tell us a message, I think we should listen to it.”

By Todd Zwillich, reviewed by Brunilda Nazario, MD

SOURCES: “The Commonwealth Fund 2004 International Health Policy Survey of Primary Care in Five Countries,” Commonwealth Fund, Oct. 28, 2004. Cathy Schoen, vice president, Commonwealth Fund. Carolyn M. Clancy, MD, director, Agency for Healthcare Research and Quality. The Honorable John Hutton, MP.

[evagrius]

NPR on "Sicko".

http://www.npr.org/templates/story/story.php?storyId=11285514

[Depressed and Disgusted]

I live in Missouri, which the Republicans have made into a test bed for cutting Medicaide. Almost 100,000 people have lost their eligibility under the new (as of last year) regime.

One legislator, told that this would kill people, replied "Everyone has to die sometime." But this is better than "job killing new taxes." Anything but that.

[anne]

"Precisely, of course. Precisely like the crying begging Georgia mother whose child has Type I diabetes and for whom a day with no insulin treatment is a day that will end in death. Precisely like the mother and child who are suddenly shut off from the Georgia health care system, and for whom $900 a month is an impossible cost."

Tra la, tra li....

[Holly W.]

I also saw the NOW segment on PBS about the diabetic girl in Georgia; the family had been able to pay for her insulin until her father was laid off from his job, at which point they no longer had the resources. The point of the story was that this is exactly the sort of situation for which we are supposed to have a safety net, and yet, because the safety net (SCHIP, the federal health program specifically for children) has been overwhelmed, this family was unable to get help when they needed it. They didn't expect to require it forever.

The mother also stated that they had asked for help from a church group, as well, who told them that $900 a month was out of the question. So non-government aid wasn't working for this family, either.

[anne]

D&D

I live in Missouri, which the Republicans have made into a test bed for cutting Medicaid. Almost 100,000 people have lost their eligibility under the new (as of last year) regime.

One legislator, told that this would kill people, replied "Everyone has to die sometime." ...

[Thank you; I thought Missouri was being hard pressed and would appreciate any reference possible.]

[anne]

Actually, I was bothered by the public television report in that the mothers needing health care insurance for their children were apologetic for their need. I would not be apologetic, and a needy mother should not be apologetic. We are quite the "family values" country.

Holly summarzes well.

[anne]

"Actually, I was bothered by the public television report in that the mothers needing health care insurance for their children were apologetic for their need. I would not be apologetic, and a needy mother should not be apologetic. We are quite the 'family values' country."

Yes; I am writing well. Tra la, tra li.

[save_the-rustbelt]

Americans went crazy when managed care companies tried to "manage care." Liberal politicians were screaming the loudest.

Wait until Americans encounter government rationing, they will really go ballistic.

Be careful what you wish for...........

[evagrius]

"Wait until Americans encounter government rationing, they will really go ballistic.

Be careful what you wish for..........."

As compared to health insurance company rationing?

[anne]

Ah, yes, there is the Republican threat of rationing, always Republican threats all the time. Scary Republicans, know just how to be scary. Ration, ration, ration. Soon there will be no health go round, when we Republicans let you all have your health care coverage. We are the scary rationing Republicans. Wooo, wooo.

Never a Republican rationing for the insane tragedy of war and occupation in Iraq or for the m ilitary. Ration health. Wooo, wooo.

[anne]

We can afford an additional $43 to $45 billion for the military, before the insane costs of Iraq, but insuring the health of millions of American children is un-affordable, completely utterly un-affordable, always forever un-affordable. Suppose we just ration children, tra la, tra li.

This child can be healthy, this child not; this child healthy, this one not, tra la.

[robertdfeinman]

Do we have the resources to treat everyone who needs treatment in the US? Yes.
Do we have enough money to pay for this treatment? Yes.

So why aren't we doing it? Priorities.

We have (implicitly) decided that others things need our money first. The most obvious is the war machine, but even before the current quagmires the military was always the first to the trough.

Just today there is an article about NYC planning to install millions of dollars worth of cameras in Manhattan. Not only will there be a capital cost involved but a permanent staff to monitor them. As with all "security" spending this is a dead weight on society. Even in the UK the elaborate "security" system has yet to prevent an attack. At best it has made finding the people easier afterward.

I'm willing to bet that if we took the money spent on useless "security" from concrete blockades to guards at office buildings and military standing around in railroad stations and transfered it to health care instead we would have adequate funds to solve the health problem.

People allow themselves to be scared into living in a police state. In the US it is especially telling since the threats are much less than in other parts of the world but our reaction has been so much greater. I've seen estimates that 9/11 caused a trillion dollars in military/police spending.

We always claimed that excessive militarism was the downfall of the USSR, is there a lesson to be learned from this?

[anne]

There is a wonderful fitness to an important article on public intimidation and humiliation over the right to health care insurance, drawing just the intimidation and attempt at humiliation. This is what has been done to fathers and mothers who struggle on behalf of their children, let alone struggle on their own behalf. They are psychologically smashed and slashed. I did not properly understand before.

Tra la, tra li.

[save_the_rustbelt]

"...As compared to health insurance company rationing?..."

Yes.

You ain't seen nothing yet, despite Anne's rambling.

And while Democrats talk a good game, in the bowels of policy development they are not all that different than the GOP. There is only so much money in any system.

[anne]

There is a wonderful fitness to an important article on public intimidation and humiliation over the right to health care insurance, drawing just the intimidation and attempt at humiliation. This is what has been done to fathers and mothers who struggle on behalf of their children, let alone struggle on their own behalf. They are psychologically smashed and slashed. I did not properly understand before, but I do now.

Tra la, tra li.

says...

Aren't Moore's films just another way of "scare tactic"?

[Holly W.]

STR has a point about "rationing." IMO, people will put up with all kinds of abuse if they think they have some control over it or some choices, i.e., "I can always switch to a different insurance company." Once you install a single-payor government system, there's no-one to switch to, and when people feel that matters are less in their control, they are likely to resent any withheld services more than they do now.

Personally, I don't feel this overrides the benefits of a single-payor system, especially since in most European countries people can always opt-out or buy supplemental insurance if they wish to and can afford it, but it's certainly a consideration we shouldn't ignore.

[evagrius]

Holly W.;

That's exactly right. The health care systems in France and Germany, I belive, are composed of levels of insurance and payment coverage, a mixture of government and private insurance.

The problem is that, in the U.S., people think of it as an all or nothing option.

It isn't and hasn't been that way in Europe.

[Holly W.]

Evagrius: The problem is that, in the U.S., people think of it as an all or nothing option. It isn't and hasn't been that way in Europe.

So maybe what we need to do is better educate Americans about the realities of the European system -- not the "socialism!" fear-mongering aspects, or the Michael Moore sugar-coated aspects, but the big picture, imperfect as it may be.

Since all the European countries and Canada have slightly different systems from each other, I keep wondering why we Americans can't take a practical look at them all and cherry pick the best features of each. Didn't we used to pride ourselves on having good old American know-how and can-do spirit? This seems like a perfect policy arena in which to apply those things.

[anne]

Ah; there was truth all through the Michael Moore film, as those from Jay Leno on, even to me, who have used health care systems in Europe understand. There only sugar coating was in the actual attractiveness of the health care systems from Italy to Norway to Spain.

[jean]

I no longer read ANY comments where tb participates. That person drags DOWN the discourse of this blog and lowers almost all other discourse. In fact I read this blog much less that ever since tb started 'participating'. Sorry, it used to be very interesting.

[Depressed and Disgusted]

"And while Democrats talk a good game, in the bowels of policy development they are not all that different than the GOP. There is only so much money in any system."

Only so much money in the system. All the more reason not to let insurance companies bleed it. All other systems are cheaper than ours. Who knows; perhaps we could pay for a nice new war from the savings and at the same time give Anne more to write about. :-)

"STR has a point about "rationing." IMO, people will put up with all kinds of abuse if they think they have some control over it or some choices, i.e., "I can always switch to a different insurance company." "

What alternate universe is this describing? People who get insurance through their employer, the vast majority of those who have it, have the company (and the coverage) their employer chooses.

Moreover, employers switch constantly. This is why we have little preventative care, much the cheapest kind. Famously, "Why should I spend money now to save my competitors money later?" In the current system this is economically rational, which is a major element in what's wrong with our system.

And TB is a troll. Ignore him completely.

[anne]

D&D

Agreed completely; and please do set down any useful links on Missouri's Medicaid cuts when possible.

[Holly W.]

People who get insurance through their employer, the vast majority of those who have it, have the company (and the coverage) their employer chooses.

Many large-ish employers do carry health insurance through more than one provider, and offer "open enrollment" once a year to people who want to switch plans. My sister-in-law and her husband went through three or four providers when they were getting fertility treatments -- each year they used up the allowable benefits from the insurer they had, and then switched to a new one. They now have two-year-old twins, so it did pay off in the end. (My brother-in-law works for an Ivy League university, so you can decide for yourself if that's 'an alternate universe') :-)

Under a single-payor system, no-one has this option of rotating through different insurers as they reach their benefit caps. I don't know if they have those same benefit caps in Europe, but I have to assume they do to keep costs in line.

[anne]

Holly

"My sister-in-law and her husband went through three or four providers when they were getting fertility treatments -- each year they used up the allowable benefits from the insurer they had, and then switched to a new one."

So, there was a lifetime benefit for the treatments that was used each year with a separate company until there was a success. That is interesting, and I wonder if fairly unique to fertility treatments. I think certain states have mandated allowance for such treatments. I wonder.

[anne]

But, this was more than 2 years ago....

http://www.latimes.com/news/nationworld/nation/la-na-medicaid24apr24,0,3416218.story?coll=la-home-headlines

April 24, 2005

Legislatures are looking to cut Medicaid or add fees. Missouri is poised to end the program, which many of the poor rely upon for care.
By Stephanie Simon - Los Angeles Times

SIKESTON, Mo. — Hundreds of thousands of poor people across the nation will lose their state-subsidized health insurance in the coming months as legislators scramble to hold down the enormous — and ever-escalating — cost of Medicaid.

Here in impoverished southeast Missouri, nurses at a family health clinic stash drug samples for patients they know won't be able to afford their prescriptions after their coverage is eliminated this summer. Doctors try to comfort waitresses, sales clerks and others who will soon lose coverage for medical, dental and mental healthcare.

'I don't know what cure to offer them,' Dr. Hameed Khaja said.

Lawmakers say they feel for those who will lose coverage. But they say also that they have no alternative.

Prenatal checkups, care in nursing homes and other health services for the poor and disabled account for more than 25% of total spending in many states. Medicaid is often a state's single biggest budget item, more expensive even than K-12 education. And the price of services, especially prescription drugs and skilled nursing for the elderly, continues to soar.

The federal government helps pay for Medicaid, but in the coming fiscal year, the federal contribution will drop by more than $1 billion because of changes in the cost-share formula. President Bush has warned of far deeper cuts to come; he aims to reduce federal spending on Medicaid by as much as $40 billion over the next decade....

[anne]

Here is a comprehensive set of statistics, I have had....

http://www.epi.org/content.cfm/bp175

September 28, 2006

Health Insurance Eroding for Working Families: Employer-provided coverage declines for fifth consecutive year
By Elise Gould

More Americans are uninsured because of the continued erosion in employer-provided health insurance, the most prominent form of U.S. health insurance. The number of people without health insurance grew significantly for the fifth year in a row. Nearly 46.6 million Americans were uninsured in 2005—up almost 7 million since 2000. The rate of those without insurance has grown 1.7 percentage points during this period, from 14.2% in 2000 to 15.9% in 2005.

The percent of people with employer-provided health insurance also fell for the fifth year in a row, 4.1 percentage points in total. Over 3 million fewer people of all ages had employer-provided insurance in 2005 than in 2000 as a result of rising health costs coupled with weak labor demand. However, this decline does not take into account population growth. As many as 9 million more people would have had employer-provided health insurance in 2005 if the coverage rate had remained at the 2000 level.

Because of these large declines in employer-provided health insurance, workers and their families have been falling into the ranks of the uninsured at alarming rates. There were almost 4 million more uninsured workers in 2005 than in 2000. While uninsured workers are disproportionately young, non-white, less educated, and low-wage, workers across the socio-economic spectrum have experienced losses in coverage. Men lost coverage at nearly twice the rate of women, as did non-Hispanic whites over blacks. Even the most highly educated and highest wage workers had lower rates of insurance coverage in 2005 than in 2000.

As with workers, the downward trend in employer-provided coverage for children continued into 2005. In the previous four years, children were less likely to become uninsured as public-sector health coverage expanded. This year that trend reversed and the number of uninsured children rose 361,000 to 8.3 million in 2005. This is the first time in seven years that the rate of uninsured children has increased.....

[Holly W.]

People who get insurance through their employer, the vast majority of those who have it, have the company (and the coverage) their employer chooses.

I wonder, too. We're all used to annual caps on health services (chiropractic, mental health, physical therapy, etc.), but the lifetime cap for fertility treatments seems awfully easy to reach very quickly. I know some states, such as MA and NJ, have mandated that insurers must cover fertility treatments, but I don't know to what extent those mandates go.

[Lafayette]

PK: They should also appeal to Americans’ sense of decency and humanity.

Yeah, right. Will the last person looking for a sense of decency and humanity in America's Health Care system please turn out the lights.

Sixteen more months ...

[anne]

I am going to ask about the fertility issue; but I remember the Catholic Bishops complaining strongly that fertility should be covered and think Massashusetts and Rhode Island were responsive. New Jersey? I did not know. There are large dedicated fertility clinics about. I have the sense that the treatments are highly expensive, but have not given the matter much thought.

[ECONOMISTA NON GRATA]

It's just incredible that we have gotten to this point. American coporations are the ruling class in this nation and there's nothing that we can do about it. They advertise and represent the revenue stream for the main-stream media... They will always act in their short term self interests and will always carry that agenda... The media will cooperate with the insurance companies because it is in their financial interests to do so. This will happen until the people can no longer bear these burdens, until they are desperate.

Having said that, why do we act so suprised....? Have we forgoten about Katrina...? Did we not set a fine example then.... Just look around you. Is this America...? Is this how we want to be defined...?

Nothing is going to happen in healthcare, it's only going to get worse for Americans. The system is designed to take everything away from you and your family.

We are too civil, too politicaly correct, servile peasants if you will. Until the day arrives that the powers that be, the government, the corporations, begin to fear the people, nothing will change....

You're all just a bunch of ungrateful slaves.... :-)

Best regards,

Econolicious

[anne]

There was a conversation at Church I partly gave attention about a fairly recent vaccine for "shingles" that is important for older people, but evidently is mostly uncovered by private insurance and not covered by Medicare. I know who to ask about the coverage process to find out how such coverage may or may not spread. I must ask.

[James Killus]

The first time I ever read about single-payer health care as a means of providing health care coverage that lowered administrative costs sufficiently to pay for universal coverage was in that left-wing radical publication The Readers Digest. That was in the late 1980s. Apparently someone at the RD hadn't gotten the memo that it would lead to totalitarianism, or that a government run single-payer system would be as bad as insurance company "rationing" (which consists of denying coverage to some at the outset, then denying coverage to others when the bills come due).

They also apparently didn't get the memo that told them that everyone gets health care because emergency rooms treat everyone, and no one pays for it, except that emergency rooms don't treat everyone, they charge $700 to refer you to someone who then gives you a $60 cortisone shot (true story), and you can't go to your ER to get your daily insulin or your chemotherapy or your heart medication.

As nearly as I can tell, the memo in question was written by someone in high school who had just had a marathon session of reading F. A. Hayek and Ayn Rand. Then he had a psychotic break and was put into a room where his every paranoid muttering was transcribed and then used as an outline for reports from the Hoover Institution, Heritage Foundation, and the AEI. Hey, it's a tragic story, but at least he got free health care out of the deal.

[billy]

save_the_rustbelt says..

You ain't seen nothing yet, despite Anne's rambling.

You guys should be aware that STR is someone who feeds off the current system. Ask him what he does for a living, and how the current racket let him gets his cushy packet.

[anne]

Darn, I realize that Holly and James raise an issue I did not properly think about. While I know that a number of public hospitals will treat any emergency case, what does that mean? Can the mother with the diabetic daughter take her to an emergency room for a rountine insulin injection? I would have thought the answer yes, since insulin is imperative. But, there was no evidence of that presented. Could even insulin be almost impossible to get, lacking insurance?

[anne]

Remember, there was a time when there were highly regarded non-profit health management groups as Kaiser, but Michael Moore sets the stage for the movement to private health management companies based essentially on rationing. Heck, the whole consumer based insurance movement of very high deductible policies is rationing based.

[Lafayette]

Apparently someone at the RD hadn't gotten the memo that it would lead to totalitarianism

So totalitarian that ten (all European) of the top fifteen global health care systems employ a single-payer (state) agency - that covers ALL citizens.

Yep, all fascist states ... including Germany. They're real comics over there at Fox News.

[evagrius]

"Could even insulin be almost impossible to get, lacking insurance?"

Diabetes is not considered a disability under SSI Disability rules. The reason? It can be controlled through
insulin shots.

The same reasoning is used with regards to cancer. If the cancer is treatable it is not considered a disability.

[Lafayette]

rdf: Even in the UK the elaborate "security" system has yet to prevent an attack. At best it has made finding the people easier afterward.

When installed, their justification was NEVER to prevent attacks. That notion is silly Hollywoodian, special effects, and all that.

They have been useful in detecting people who are felons and spotting crime in process, thereby triggering more quickly police intervention.

That's all, but compared to places that don't have them ... that's plenty.

France will be installing a new camera system, having been convinced by the British experience.

[Lafayette]

Apparently someone at the RD hadn't gotten the memo that it would lead to totalitarianism

So totalitarian that ten (all European) of the top fifteen global health care systems employ a single-payer (state) agency - that covers ALL citizens.

Yep, all fascist states ... including Germany. They're real comics over there at Fox News.

[anne]

So, no disability and no Medicaid. What then?

[Lafayette]

Pediatrics, November 2006.: Reija Klemetti, MHSc; Tiina Sevon; Mika Gissler, DrPhil, MSocSc; Elina Hemminki, MD:

Researchers tracked the health of 4,559 kids born between 1996 and 1999, including the type of delivery and the child's weight at birth. Because Finland has a national health care system, they were able to determine the number of kids who'd received medical care or disability payments for chronic conditions, including allergies, asthma, epilepsy, diabetes, diarrhea, arthritis, pneumonia, or psychological disorders. Researchers then compared the health of kids born via IVF with the health of those conceived naturally.

Compared with other moms, those who gave birth via IVF needed much more hospital care during pregnancy. IVF moms also had a higher rate of cesarean births.

Overall, most kids born via IVF were healthy. But compared with those conceived naturally, children born via IVF had a higher death rate, a higher rate of institutionalization for severe disabilities, and a higher percentage of child disabilities. IVF kids had a threefold increased risk of cerebral palsy and were more likely to have behavioral or emotional disorders, compared with kids conceived naturally. IVF kids were also more likely to require hospitalization.

[evagrius]

"So, no disability and no Medicaid. What then?"

Public health clinics, if available or the constant trips to ERs.

Either way, the taxpayer foots the large bill.

[James Killus]

I saw a story a while back about a Los Angeles County program (I think it was LA County) to provide such things as insulin to diabetics. It turns out that some ER nurses had noticed how expensive it was to treat the frequent diabetic comas, gangrene, etc., and figured it would be cheaper for the county to just give them their insulin.

We're probably well past the point where it would be cheaper to simply provide free basic medical coverage to everyone, but if we did that, someone would be getting something just because they needed it and we can't have that, can we? Besides, only government could bell that cat and it's much more important to funnel more money to the pharmaceutical industry.

Also, Democrats are just the same as Republicans and Michael Moore is fat.

[ken melvin]

Michael's conversation w/ Wolf at CNN:

http://www.crooksandliars.com/2007/07/09/michael-moore-demands-apology-from-wolf-blitzer/

[cm]

Holly, evagrius: "since in most European countries people can always opt-out"

Not in Germany, if you are employed (privately, not in the civil service) and your income is below the healthcare insurance cap. You can choose your insurer, but you have to stay in the public system. That is widely considered a flaw, as it allows precisely the highest payers to escape. In an attempt to mitigate the resulting adverse selection somewhat, once you opt out, you cannot get back in unless your income drops below the cap again for some period. (There is surely more complexity to it, and I don't know about the provisions for retirees, there is probably something to keep you from sneaking back in through the back door when your medical bills roll in and your private insurance jacks up rates.)

[german_reader]

It's really hard to understand how americans can accept such an inefficient mess in their health care system. Martin Wolf, chief economics commentator of the "Financial Times", a conservative by european standards, made recently an interesting comment upon the situation in the US:

"Some argue that the abiding problem of race is the reason the US does not have a welfare state... I have always been amused that the US even employs two different phrases: “social security” is for hard-working people, “like us”, while “welfare” is for idlers, “like them”."

blogs.ft.com/wolfforum/2007/06/harness-market-.html#comments

I think he is correct about what is going on in the United States. It may be a "melting pot", but it's an imperfect one. As long as the ruling white majority is relatively privileged in regard to income, health care, education or imprisonment, there will be no fundamental changes in the US-system. And it's really no surprise, that the most radical conservatives ( like this remarkable man in the white house ) come from the american south.

May be now, that the US health care system seems to be damaged to a degree, where it even threatens the economic welfare of the ( mostly white ) middle class and the competitiveness of large corporations ( GM, Ford ), there may be room for change.

Perhaps americans finally become aware of how ineffective their health care system really is. A simple comparison of GDP shares or spending per capita reveals only a part of the truth. European societies on average are older than the United States. Germany for example has 50% more citizens above the age of 65. Older people in most cases are less healthy and therefore more expensive. Despite this demographic disadvantage most of Europe manages to cover nearly all of its citizens at less than half the price in the United States. And the results are often better.

Germany's health care system ( or the swiss ), far from being perfect, could be ( among others ) an interesting model for the United States. According to the most studies, it seems to be a good mixture between costs ( it's not the cheapest, but much cheaper than the US-system ), general coverage, availability, state-of-art"-treatment and individual choice ( very american ). It's based on a complex system of public and private insurance companies controlled by a general legal framework. Don't ask the average german, how it works. For a short summary you can look here:

http://www.medhunters.com/articles/healthcareInGermany.html

[anne]

There is no question for me but that race has been used to limit American sympathy for social service programs. Paul Krugman has written and spoken to the issue, and I must consider this further.

[Lafayette]

g_r: It's based on a complex system of public and private insurance companies controlled by a general legal framework.

And who mandates health care service pricing, the state or the insurance companies? Do the insurance companies negotiate pricing with the associations/unions of the various health care practitioners?

I think you will find that prices are fixed by the state based upon what is considered a fair return. That is the ONLY way that health care costs can be reasonably contained.

Very UN-AMERICAN, that.

says...

"I remember the Catholic Bishops complaining strongly that fertility should be covered"

I'm curious about that: what kind of fertility treatments? Certainly not IVF, that results in extra, discardable embryos.

[Holly W.]

Anne: Can the mother with the diabetic daughter take her to an emergency room for a rountine insulin injection?

The problem is, there is no such thing as a "routine" insulin injection. Yes, most diabetics have a rough schedule to follow, such as injections before meals. But they are also pricking their fingers and trying to monitor their physical condition all day long, and if their blood sugar increases too much for any reason, they need insulin now, not after a trip to and potentially several-hours-long wait at an emergency room. Therefore, diabetics generally carry insulin with them all the time, either in a pump, as the girl on NOW did, or in tiny bottles. That's why the family needed the cash to get insulin up front.

[anne]

Interesting, I do not know and never thought to pay attention to the techniques at issue, but Massachusetts and Rhode Island Bishops pushed hard and successfully to mandate inclusion of fertility coverage in insurance. I do not remember specific techniques being at issue, however. The point seemed coverage of fertility assistance.

[anne]

Thank you, Holly. That was explained to me too briefly last night, and of course the apparently young girl portrayed wore a monitor and had worn a monitor on a prom dress. I will learn more.

[Holly W.]

Thanks, cm. I was thinking "people can opt out if their income is high enough," but didn't write it out -- and your post provides more information than I knew, anyway.

[JRossi]

I'm a family physician who supports universal insurance because it would be more equitable and more efficient than the current system. But I'm worried than many people have unrealistic expectations about it. We will never have a system with universal easy access combined with reasonably priced first-class care from unhurried providers. We can have one of these things, maybe two, but never three. Some posters at this blog seem to think that we can just do it the way the Europeans do it. Wouldn't that be nice? But we can't get away with paying doctors and other health care workers what Europeans get--America's more materialistic and individualistic values would lead to shortages. And of course labor is the main component of health care costs. We can import more workers, but at the cost of lower technical and cultural competence. Maybe that's a tradeoff Americans are willing to make, but we'll squawk about it.
Universal health care, even under the best scenarios, will be characterized by local labor shortages, inconvenient wait times, and often rushed service. So-called concierge practices could proliferate, exacerbating shortages of primary care MDs in some locales. Some people who now have good insurance will see their service suffer. People now without insurance will benefit greatly.

[anne]

"And of course labor is the main component of health care costs."

Not so; the main component of health care costs is continually found to be administration. As far as I am concerned, physician and nure and technician salaries with broader health care insurance coverage should be and will be as unlimited as they are now.

[anne]

While we do not know what the results of the Massachusetts universal health care paln will be, I am completely sure salaries of health care workers will not be negatively effected. I also know, my access to doctors and service from doctors will not deteriorate.

[JRossi]

Anne, Perhaps I should have written that increased labor costs for clinical services (including the labor involved in producing and distributing drugs and medical devices)are the main driver of health care inflation. Your point, that cutting administrative costs would be a good thing, is certainly valid. But this would be a one-off savings and would not decrease the rate of increase of health care costs, which is really the main problem. And this rate of increase is mainly due to increased non-administrative services. Shooting the insurance guys would give many, including myself, a lot of glee, but it would not get us out of this mess.
You say that HCP salaries will be unlimited?! Well, if you were running for health care czar, I'd vote for you. But I'm not sure anyone else on this blog would.

[JRossi]

Anne, You are probably right that nominal salaries will not fall. Of course that main issue is whether salary increases keep up with inflation. I think your complete certainty on this matter is not shared by the health care community. And certainly your own personal access and service might not suffer in the short term. But the real issue is the longer-term changes in the health care labor market.

[anne]

J Rossi,

Know I always pay close attention to your arguments and am thinking, but in addition to wishing fiercely resist limit on helath servies providers income I would also, as you know, immediately move to minimal public college-medical school tuition using federal-state revenue sharing. I especially love the idea of students going to biological and health service fields, and encourage this fully (though I wish for education in general).

[anne]

J Rossi has several times raised the important issue of supply of health care service workers, an I share the concern but find such dramatic differences in looking at supply limits or abundances from Canada to Israel, from Norway to Japan to South Africa to Australia, that I can only ask that we now look to increasing interest in health care fields of study and in biology.

[anne]

Remember, we find dozens of American students a year who, with support even of a Republican Congress, have been going to Cuba for medical school given the tuition-free schooling. Supply issues are complex, are we are not doing nearly enough to think of how to increase study in the biology related subjects.

[JRossi]

Anne, I apologize for being so contrary today, but the number of students studying undergraduate biology really does not directly influence medical school enrollments. Basic freshman biology and chemistry, maybe with a little organic chemistry thrown in, are all that's really needed to start med school. Undergrad math and physics are required at some med schools but are in fact useless for medical studies.Med schools teach you all the basic science you need in the first two years, so undergraduate English and philosophy majors can and often do excel in medicine. One of the best docs I know started out as a sociology PhD! Th important factors are willingness to work hard and motivation, which is to some extent a function of anticipated rewards.
I don't know about nursing or other HC fields.

[cm]

There is little point discussing this with TB. Some such generalized views will change only (and often do) when their holder is on the receiving side of the shaft.

[anne]

Oh, I know you are right and I was fudging because I dearly love students studying biology for the sake of biology. Actually, though I value all of biology I love the idea of a background in evolutionary biology as what I would hope would be a humanizing experience.

Having told students of my family of cherry tree catbirds, I have been getting journal articles on birds in turn. What we have is an appreciation, a little appreciation of what a cheery whistling catbird who comes to you means to you.

[Holly W.]

JRossi: Universal health care, even under the best scenarios, will be characterized by local labor shortages, inconvenient wait times, and often rushed service.

And that sounds different from what many of us experience now, how? :-)

Seriously, I understand that many rural areas in the US have local doctor shortages, because even with the carrots held out to try to get people to practice there, it's just not that appealing to serve those locations. I'm not sure universal healthcare would change that one way or the other, but do you really think it would make it worse than it already is?

[anne]

Holly is pointing another instance of why the supply issue is so complex; urban, rural, but even urban concentration and dearth is found.

[David H]

The following is a letter I emailed to Mr. Krugman. Too bad he chose not to print and respond to it, perhaps because it would have embarassed him and/or he couldn't respond to it?

If Canada can serve as a model of universal health care, then it can be called "universal LACK of health care." See NY Times article dated 2/28/06, "Canada's Private Clinics Surge as Public System Falters." In Canada, people willingly pay private clinics for services they can get for
free. Other facts from the article: There are "1.4 million people in the province of Ontario alone without the services of a family doctor." That NY Times article is a must read.

Is that what we want?

I urge everyone to find the truth about univeral health care starting with the 2/28/06 NY Times article, instead of listening to ideologues who don't care about facts, just their own agenda.

[David H]

To elucidate on my prior post:

The NY Times article points out that there are tremendous waiting lists for every kind of care and a shortage of doctors. People have to wait months for cancer detection and treatment, and often people die on waiting lists.

Read the article.

[kthomas]

David H., thanks for the post. I'm a big fan of General Krugman, but I do love it when he is challenged.

Are you saying we don't have any problems in the US system, such as it is? Also, do you approve of FOX, among others, saying that a more socialized way of offering health care becomes a breeding ground for terrorists?

[Mark Thoma]

I see the waiting time issue has been raised, i.e. the article David H. references has this quote "This is a country in which dogs can get a hip replacement in under a week and in which humans can wait two to three years." Here's something I thought of posting, but didn't:A Handy Rule of ThumbWhen universal health care is raised as a possibility, one of the first arguments you often hear against it has to do with waiting times for hip replacement surgery in Canada. Here's something to bring up the next time you hear this argument. From Money Talks:Paul Krugman: One additional point I would like to get in: the example of wait times people use most often is hip replacements. But who pays for hip replacements in the U.S.? Medicare, usually. So it's not socialized medicine versus the private sector, it's two government insurance programs (Medicare vs. Medicare, actually, because that's what the Canadians call their system), one of which spends more money.Ezra Klein adds: It's fascinating how much more concerned conservative types are with a Canadian who had to wait 3 months for a hip replacement than with the 18,000 Americans who die each year because they lack access to quality medical care.Kevin Drum suggests:[H]ere's a handy rule of thumb: any time a healthcare article starts nattering on about hip replacement waiting times in Canada, just stop reading. The authors are cherry picking so egregiously it's a wonder their fingers haven't fallen off.

[David H]

kthomas:

You're funny. Of course there are problems.

Here's what I recommend. First, tort reform. The reason why healthcare and health insurance are unaffordable is because of outrageous malpractice awards, making malpractice insurance very high for doctors. In NY, a Democratic governor, Eliot Spitzer, cites the need for reform in this area, and indeed, the NY Insurance Department granted a rate hike of 14% for malpractice insurers, citing the need to keep them afloat. (It's no coincidence that John Edwards is a very wealthy man.)

Second, we do need some form of univeral care for those in the bottom rung of society.

[David H]

Further.

Malpractice insurance costs don't go away simply because we have universal health care. In that event, either doctors stop practicing because they can't afford the insurance any longer, or else the government foots the bill, meaning we pay through much higher taxes.

Free health care = more doctor visits = more malpractice suits = much higher taxes

[dogfacegeorge]

"The reason why healthcare and health insurance are unaffordable is because of outrageous malpractice awards"

Is this a self-evident truth, like the one about all men being created equal? If not, are we supposed to believe it simply because you say it's so?

[Holly W.]

The current issue of Businessweek has an article about waiting times in the US, and it's not pretty, either.

I remember reading an article in the Boston Globe a year or so ago about waiting times to see specialists in the US -- the times vary a great deal from city to city, so it seems to me that this can't be an issue that's easily distilled to private-versus-universal insurance systems. I expect the waiting time varies similarly by location in other countries, as well.

[Holly W.]

Free health care = more doctor visits ...

But for many workers, health care is essentially "free" since the bulk of their insurance bill is paid for by their employer. Do those folks just go to the doctor as often as they can?

One could also make an argument, I think, that when self-insured people fork over $1,000 a month for health insurance (and this is a typical price to cover a family), they may have even more incentive to go to the doctor frequently, since they have already "paid" for their visits via the premium, and they want to get their money's worth. This is equally valid psychology -- and yet I never hear anyone bring this up.

[JRossi]

Holly W.,
Regarding labor shortages, wait times, etc: I learn every day that these problems are already with us, but some (not all) advocates of universal insurance think that it will enter us into some kind of medical Shangri-La. My point, made in my first post, is that this will not happen. Realistic expectations might diminish future disappointment.

[dogfacegeorge]

And how can you pretend to be in a position to characterize a verdict as "outrageous"? Do you really believe that you know better than the twelve who actually heard and analyzed the evidence? Where do you get the ego?

[Holly W.]

Lafayette: I forgot to ask you about your statistics for IVF births. I assume that if one weeds out the multiple births resulting from more than one embryo implanting, the health issues mentioned probably disappear.

There is a movement in the US to try to encourage doctors to limit each attempt to one embryo -- it may take longer for couples to conceive, but the problems which result from multiples do seem to be serious enough to warrant trying to avoid so many twin and triplet pregnancies. (My sister-in-law thought a 25% chance of twins was "small", even though my husband told her he thought it was pretty high).

[JRossi]

A few more points. Malpractice is over-rated as a cause of macro HC inflation. The main drivers are an aging population and advancing expensive technology. Malpractice anecdotally causes MDs to leave certain areas, but this is controversial. A lot of docs probably cry malpractice when they really don't want to be a neurosurgeon in Medford OR anyway(real case). Free (at the point of service) health care will increase outpt visits but might decrease much much more expensive inpt stays. It's impossible to know the overall effect. I happen to believe (but cannot prove) that free HC will require some fairly explicit rationing, but of course we already have rationing by insurance status.