THE BOOK--Playing The Percentages In Baseball

There are two things that I will never understand no matter how long I live in the United States.  1) Why people like Ronald Reagan; 2) Why people like the health care system here.

At least on #2, the veneer is starting to crack - polls just 3 or 4 years ago showed the vast majority of Americans thought the US Health Care system was the best in the world; it was 45% last year; and it’s now at 15%.  The irony is that most Americans with private insurance are dissatisfied with their own health care (Medicare satisfaction is much higher).  But people still like the guy who took solar panels off the White House…

At any rate, spending 20% of GDP on the health care industry is unsustainable and crowds out productive activities.  But as long as the belief that only patients, the health insurance companies and, on some rare occasions, doctors should be in charge of determining medical treatment persists, the system won’t get fixed.

I am by no means an expert, but i had around 20 folks working for me in Toronto 2 years back.  Each one of them hated the healthcare system - despised it.  Not the money aspect, the quality.  And not just the fact that they had to wait weeks and even months - the fact that many good Canadian doctors were leaving the country to work in the US.

Help me - does Canadian HC work or no?

Lou, how can you have 20 people all working for you, and each one of them having to wait weeks or months for services? Exactly what is it that would cause such a huge number of people in one spot require health care of a non-clinic kind?

Your story sounds like an extreme exagerration.  And if it’s not, then it’s surely an extreme data point.

The wait times are big for some clinics, and small for others.  It’s first-come first-served, so, you take your chances.

The wait times for certain specialized (non-critical) treatments can also be big (weeks, even months).  That’s what happens when you make healthcare so affordable and readily available: people actually USE their services. 

This is unlike in the US where those without insurance will delay and wait for extreme situations.  Like me.  I have the most basic plan I could get (200$ a month), and I get very little for it.  Where in Canada I would go see the doctor whenever I wanted, here I wait.  Sometimes I get pretty sick, and then I decide to go.  Sometimes I wait it out, and not go.  Shouldn’t this count against “wait” times?  I may not be waiting at the doctor’s office, but I’m waiting to go.

I believe that the crappy Canadian health care system was responsible for my father’s death.  That was my doctor’s opinion too, after the read the file.

Tango, how much of your family’s well-being would you trade for a 15% saving?

Comparing the two systems only by how much they cost is like saying the Yankees are dumb for paying millions of dollars for Derek Jeter, when they could have John McDonald for 1/20 the price.

Communism doesn’t work in theory, and it doesn’t work in practice.  The problem with the health system is that the 90% of the public doesn’t use the expensive part, so how can they know how good it is?  And even if they DO use it ... how do they know whether it’s any good or not?  A 1963 Oldsmobile looks like a miracle if you’ve never seen a car before.

Tango here makes the kind of argument that he’d rip apart if somebody else made it about baseball.

You can’t introduce one data point and then say it’s representative.

What about the 15% of the people who receive NO medical care?  Surely, at least a few of them lost loved ones as well, didn’t they?

And yes, how could any single person know anything.  They can’t.  YOU can’t. I can’t.

Therefore, we can’t argue it at that level.

The issue of the 15% of people who receive no medical care is different from the issue of which system delivers more value for the money.

By that defintion, a system of soup kitchens is better than a system of supermarkets, because (a) soup kitchens are cheaper, and (b) Whole Foods caters only to people with money, while soup kitchens will feed anyone.

Three separate issues:

a) universal access
b) value for money
c) general level of care
d) ability to opt out if the universal system screws up

I don’t think you can mix them up.

I’m in favor of the Canadian system for (a).  I don’t know about (b).  But I think (c) is substandard.  And I think the fact that (d) is illegal is an abomination.

The American system denies care to the poor (which is (a)).  The Canadian system denies it to the middle-class and up (which is (c)), and lets you sit and suffer for months (which is (d)).  Whether the crappy Canadian system is cheap or overpriced (which is (b)) is something I couldn’t tell you.  It’s 30% cheaper (15% less cost, and 15% more people covered), but is it more than 30% worse?  I doubt it, personally, but I have no evidence.

Anyway, if I were an American with a good health-care plan from my employer, I would be disappointed that so many poor people are uninsured.  But, for my selfish self, I think I’d be glad I had my plan and not the Canadian one.

i am admittedly not well versed in the ways of either system, though i live in the US, so don’t jump all over me if i say something ignorant, but is there a way to cover everyone on a basic level but also allow people to still pay for better service?  i would think ideally you’d cover everyone up to a point, and then after that have a different system where the more money you have, the better your healthcare is (if you choose to spend it on healthcare that is).

in the US we already guarantee coverage for the very young, the very old and for veterans, or something like that, right?  and no one can be refused emergency treatment?  so thats a good start.  i also know that the more people involved in covering the risk of medical treatment, the cheaper it will be for everyone.  so compulsory medical coverage makes sense on some level, the same way i appreciate the fact that people are compelled to purchase collision insurance if they own a care (or is it accident?  whatever it is for if you hit someone else). 

however, i still think the overall best way to incentivize medical care industry to operate at increasingly higher standards and increasing levels of efficiency is allow for people to pay for the quality of care they receive.  there is a reason rich people form all over the world fly into america for specialized and costly treatments, no?  does not the overall welfare of the society benefit from competition for these rich people’s money when they get sick?

the main tension in the polemic seems to derive from the concept of greater coverage but lower quality vs less coverage and higher quality, with the cost varying completely on how the system is regulated at what point on the policy spectrum you commit to.  i certainly don’t know the answer, but i would like to see as many people get the best care possible.  so basically whatever that is i am for it.  so yeah, whatever thats worth then.

Phil,

“The American system denies care to the poor (which is (a)).  The Canadian system denies it to the middle-class and up (which is (c)), and lets you sit and suffer for months (which is (d)).”

I think you’ve missed some of the subtleties of the American system.

1) The American system provides care to the very poor through Medicaid (pregnant women, children and disabled people are covered to higher incomes.)

2) The American system provides care to people over 65 regardless of income through Medicare.

3) The VA provides care to veterans (depends on length of service and income); the IHS provides care to aboriginal people.

Pretty much everybody else is denied care - the insured, for the most part, aren’t that much better off than the uninsured, particularly if they have a serious illness.  But even on basic things, there’s an effort to pass so much of the cost on to the consumer that it results in denial of care.  There might be waiting lists in Canada for knee surgery; in the US, there are no waiting lists because people can’t afford to have surgery.  The only exceptions, of course, are seniors, who are covered by universal single-payer government-run insurance. 

A small number of people do have very good health insurance.  I’ve never met them - no one my age has it.  And, unlike Canada, I pay for services that I can’t use: 2.4% of my pay goes to Medicare, which I’m not eligible for until 2042.

On b) I can tell you from using both systems that the Canadian system gets better value for your money.  Basic things cost more than twice as much in California as Manitoba, but it doesn’t go to higher doctor salaries.

As for d) it’s a mirage in the US.  You’ll pay 50-100% out-of-pocket if you stray from approved providers.  If you want that deal in Canada, you can just go to the US.

The American system benefits the elderly and high-income people who work for large corporations.  Everybody else is at the mercy of the underwriters.  A system that benefits 1% of the working-age population at the expense of the others is not something to relish.  Even a majority of the few remaining Republicans want the system reformed.

I think several of the responses here re-affirm my original point.  The American health care system is so screwed up that you can’t possibly understand or justify it if you haven’t spent your entire life in the US. 

The macro performance of the US public health system is terrible.  Only the Danes with their horrendous drinking problem approach it on mortality.  The micro performance of the health care system is terrible too: a huge number of people are at risk of bankruptcy at any given time because benefits are tied to employment, if they’re available at all.

The irony is that everybody recognizes that the elderly need access to health care.  They are simply too expensive from an actuarial standpoint to allow the free market to determine their costs.  The demagoguery around extending such a system to everyone in the country is an attempt to privilege the corporations that sell health insurance, not an attempt to ensure that people can get good care.  It’s simply not a good idea to put 20% of your GDP into an unproductive activity.

Hawerchuk/8:

You and I have a different definition of “denied”.  If you can afford health insurance, and you choose not to buy it, you are not “denied”. 

There are some people in the US who are poor and can’t afford health care.  It’s bad that they don’t get it.  For those people, I don’t mind the term “denied”.  But the middle class is not “denied” if they can afford it but choose not to buy it.

“Passing on the cost to the consumer” is not denying care, any more than the fact that my grocery store wants me to pay for milk means that they are “denying” me milk.

Also: if the Ontario government makes me wait a year for surgery, that’s par for the course.  If my insurer in the US makes me wait a year for surgery, there will be a multi-million dollar lawsuit. 

In the US, While I’m filing the lawsuit, I can at least borrow money and have the surgery done elsewhere.  In Canada, while I’m waiting, I can’t do anything except suffer or die.  Well, I suppose I can go to the US, like Robert Bourassa and Jean Chretien did.  Assuming my doctor doesn’t have a moral problem helping me do that.

Further: it’s not the case that there are no waiting lists because many people can’t afford surgery.  There are few 800HP sports cars sold in the US, because most people can’t afford them.  But if demand arose, supply would quickly arise to fill the demand.  Same for surgeries.  I’ll bet you there are hardly any waiting lists in the US even for cheap procedures.  An MRI costs, what, $500?  Very affordable.  Canadians have to wait for months because the government refuses to increase supply.

We both agree that the US system is badly in need of reform.  That doesn’t make the Canadian system any better.  It’s not a zero-sum game where if the US system has 100 tons of sh*t and the Canadian system has 99 tons of sh*t, that makes the Canadian system holy and worthy.

On a moral basis, I’d prefer the European system, where everyone is covered but you can buy something better if you think it’s appropriate.  Nobody dies because of lack of money, and nobody dies because the government threatens to throw them in jail if they try paying for something that the government plan is denying them.

Phil,

“If you can afford health insurance, and you choose not to buy it, you are not “denied”.”

So I buy the one health insurance policy offered by my employer (this is typical).  Something happens to me.  I’m in line for what would cost $30k worth of treatment under Medicare.  But my insurer has weaker negotiated rates, so it costs $60k.  But the treatment I need is outside their network.  So I have to pay $30k out of pocket in a single year.

Most people can’t afford that.  Period.  And you can’t know in advance what your expenses are going to be.  That’s why there are medical bankruptcies in the US.  Call it “denial,” call it “rationing” - it’s the same thing.  It’s not a matter of people being unwilling to purchase affordable health care.

I do not accept this notion that if someone can spend any percentage of their income and net worth on medical treatment it’s not denial of service.

There is certainly a reduction in waiting lists because people are unwilling to pay US market rates for surgery.  There’s also more supply due to higher reimbursement rates.

“We both agree that the US system is badly in need of reform.  That doesn’t make the Canadian system any better.”

They’re uncorrelated, certainly, and nothing absolves the Canadian system of its own problems.  But I think the problems you outlined - denial of care to the poor, denial of care to the middle class, poor value for money, and lack of access to an external system - are worse in the US system.  The ideal system - which is neither the Canadian one nor the American one - depends on what percentage of its income the public is willing to pay into it.

I think both countries could learn from South Korea’s system. Health insurance through most companies for people employed at 50% the cost (about $50 a month). I’ll have to check about the unemployed. You pay a small fee to see the doctor. You pay some of the fee when you need to stay in the hospital.

You pay more when you need more, but you pay less than half of the total price and procedures are much cheaper than they would cost in the US.

"The “efficiency” of the private enterprises in “competition” with each other to keep costs low while still turning a profit (the American way)”

Maybe in some people’s idealized versions of America, but this doesn’t describe the American health care system at all; we have Medicare, Medicaid, tax subsidies to employers, various regulations regarding insurance, the AMA.  I’m not going to say a completely laissez-faire health care system would be efficient, since I have no idea, but it’s basically a strawman as it’ll never happen.  Also, there are plenty of successful universal systems that allow private enterprise, see Singapore and Denmark.

Palin is an idiot, however, and I see no reason why Canada should “dismantle” its health care system.

FYI, people, especially Americans, need to understand that health insurance != free health care.  It’d certainly help the debate if we kept discussions of subsidies and discussions of insurance separate.  My point is that many employer-provided insurance plans cover things that really should not be covered.  There is really nothing risky about paying $200 every year for eyeglass frames, so why does my insurance cover this?  Why should insurance cover routine medical check-ups?  If you say so that the poor can receive it, then you’ve missed my point and need a better understanding of why we have insurance in the first place.

"Pretty much everybody else is denied care - the insured, for the most part, aren’t that much better off than the uninsured, particularly if they have a serious illness.  But even on basic things, there’s an effort to pass so much of the cost on to the consumer that it results in denial of care.  There might be waiting lists in Canada for knee surgery; in the US, there are no waiting lists because people can’t afford to have surgery.”

You make several good points, but this paragraph is completely wrong.  First, the insured are way better off than the uninsured, especially for high-cost treatment.  Health outcomes for the insured are comparable or exceed outcomes of peer Western nations.  Second, the US has the problem of overconsumption of health care, not underconsumption.  After all, almost everyone agrees the problem with the American system is the soaring cost of care; and no, it’s not just 1% of the working-class who consumes all that care.  That’s a pretty ridiculous number.

Phil/6, great summary.  If you’re not a teacher or professor, you should be.

Why do we care what Palin has to say?  In all honestly, and I mean this without exaggeration: we’d be more informed and have a better discussion listening to a well-read 6th grader.

Phil,

You are very uniformed about Canadian health care. It is not substandard.  Long wait time are the are not the norm.

If the medical condition is life threatening that person does jump the queue. I give the example of my 65 year old mother who just today was informed she needed a knee replacement. The surgery is scheduled for January 15th.  I don’t think a one and a half month wait for that type of surgery is extreme. And this is in a mid-sized city of 165,000 in Northern Ontario - far enough away from the larger centers around Toronto.

In fact I can’t think of one instance where a relative or family member was denied prompt care for a serious illness.

"First, the insured are way better off than the uninsured, especially for high-cost treatment.  Health outcomes for the insured are comparable or exceed outcomes of peer Western nations.”

I’d hope so!  At any rate, you can’t cherry-pick your population to make them healthier and give them access to better medical care.

“Second, the US has the problem of overconsumption of health care, not underconsumption.  After all, almost everyone agrees the problem with the American system is the soaring cost of care; and no, it’s not just 1% of the working-class who consumes all that care.  That’s a pretty ridiculous number.”

Show me where I wrote that 1% of any group consumes all care.  What I wrote was that the system benefits 1% of the working-age population.  The system directs most of the public benefits to the elderly. 

The system also privileges a small number of high-income workers with a regressive employer tax break.  But the vast majority of people - even those who have insurance - are at risk of bankruptcy if they have a serious illness.

Just because the health care system here is not optimal (it’s nowhere near optimal in Canada too), does not mean it should be scrapped for the socialist system of Canada and much of Europe.  There is a lot of waste and fraud within the US health care system that has nothing to do with what kind of “system” we use.  Reform “yes”, socialized medicine “no”.
vr, Xei

And...Frank puts and end to the thread…

The best way to help people is to keep prices low, and jobs available. And the best way to do that is to keep the government out.

The idea that the US has a free market is one of the biggest, most damaging myths that exists today. Health Care is not private in the US, it is heavily regulated. Any criticism of the US health care system should be about how the government limits consumer choice, drives down competition, drives up barriers to entry, and gives power to special interests through governmental influence in the market.

If you want an example of an actual free market look at Hong Kong or Singapore.

Re: wait times

I work for the med school of a large university in Toronto and went to a mini-conference on wait times hosted here in the summer.  The problems we have come in two main forms: wait times for “quality of life” surgeries like joint replacements/cataracts, and wait times for imaging, usually CT or MRI. 

Basically the Ministry of Health tries to optimize services so there is little inefficient down time with unused resources, and this causes wait times for many procedures.  For the most part these wait times don’t cause a change in health care outcomes, as unpleasant as they might be.  The exceptions are the two categories mentioned above, especially MRIs, where we’re short on technicians and to a certain extent money for the machines.  People aren’t dying while they wait for treatment, as hyperbolists would have you believe.  This wasn’t always the case, but has improved drastically in the last 10 years. 

In general I would say that Canada can’t match the quality and immediacy of care that the top level of American medicine provides - the focus is on efficiency of the system.  Even with the additional slightly wasteful layer of government bureaucracy, I think it is overall a more cost-effective system. 

Regarding Phil’s points in #6 -
a) universal access - this is the main point in favour of our system

b) value for money - Canada spends $3900 per capita per year on health care, Americans spend $7300, if I remember correctly.

c) general level of care - I don’t see how this issue can be separated from a).  The level of care for insured Americans might be slightly better than that of Canadians but does that slight advantage make up for the disadvantages experienced by the uninsured?

d) ability to opt out if the universal system screws up - we usually “opt out” of the governing party if they screw health care up too badly, but many people want a private option in addition to the public system.  Most private health care is illegal, with a few exceptions - rehab facilities are the most common.  I would support legalizing private care on top of our current system - I don’t really buy the theory that it would drain the public system; it’s just not bad enough that very many people would pay for an alternative.  Anyone moving to the private system would just reduce the burden on the public.

In summary, I favour a universal single-payer system with private delivery (current system) with an additional prviate layer on top.

Generally Ian I agree with some of your points , I do however have a few observations .

“Even with the additional slightly wasteful layer of government bureaucracy, I think it is overall a more cost-effective system.”

My understanding is that administrative costs in the U.S are in the order of 15-20% of total costs, ( everything needs to be billed and accounted for-right down to how many kleenexes a given patient uses)in the single payer Canadian system only 5% of costs are associated with bureaucracy. 

One problem with “opting out”, and going for a private care option , and you do touch on this with the use of MRI facilities, is the shortage of trained technicians to run the machines. Generally speaking in all health care fields a severe shortage of manpower is the norm. Expanding private care options would exacerbate this issue. Essentially we have only so many radiologists who can read and interpret these tests, most of them would follow the money to the private system. What then happens to the public system? Costs overall must go up to compete.

Health care is a very complex issue, ( much more complicated than ascribing value to baseball players ). My experience has been that acute care treatment in either country is comparable, in fact if anything it’s better overall in Canada. The difference is that if you want , as Ian aptly describes it, quality of life surgeries such as a knee replacement-you’re better of in America with these caveats;

- you have a job with health care benefits ( and a good HMO).

-you’re not going to lose this job anytime soon and they won’t can you because of the knee.

- you live in a large urban area with lots of orthopods.

Basically your better off in Canada overall , unless you have a bum knee or are filthy 7 figure rich.

@hawerchuk - so, like i said, im far from an expert on this topic, but there are plenty of people int he US who have quality health insurance who arent veterans, young or old.  its pretty much everyone with a job.  if you work for yourself or work part time or for whatever reason arent in a situation where youre employer covers the cost, then yes, you get screwed, and thats is the least appealing (most repulsive) aspect i can think of regrading the US system.

but you dont have to be super rich or work for a massive company to get excellent healthcare in the US.  my friend is 26 and for the past several years hes worked for a non profit in DC.  a very small one.  he gets all his medical costs covered, including his co-pays.  hes never paid a cent from his post tax salary to anything related to medicine or healthcare. most other peopl ei know from my generation to my parents who are salaried employees have at least ‘decent’ insurance. 

i am defintiely in the reform group, and think the US needs to find a effective way to cover everyone.  how everything past the basic level i think is much less clear cut.

When I used to work full-time, or my wife as a teacher, we got great coverage.  Yes, when SOMEONE ELSE is paying (the employer), we love health care.

When I’m paying out of pocket 100% of the premiums (750$ a month, after-tax, for 3 people), then it’s not so good.  And, that is the MINIMUM coverage I could get.  After that, it’s 40$ co-pay, plus 2500$ per person deductible.  I’m sure we pay at least 12,000$, if not more, for our medical care.  And we’re healthy.

So, we WANT someone else to pay… when it’s the employer, it’s fine. When it’s the government, it’s… not fine?  And yet, all those countries who do have the government pay, none of those countries are saying “stop the government from paying for me”.

Somehow my previous comment went into the ether.

@kendynamo - the question you have to ask before you decide that someone has “quality” health insurance is whether it has a risk of bankruptcy.  Just 0.09% of the age 20-44 population is being treated for cancer at any given time, so a typical plan, which covers 60% of major medical expenses does not put 99.91% of its users at risk.  Indeed, the median American consumes $650 of medical expenses a year.

But the medical underwriters have reduced their costs by essentially forcing consumers to take on a massive hidden financial risk.  That’s not how insurance is supposed to work.  Imagine if you bought a car insurance policy that offered $1 million liability...unless there was an accident where someone was seriously injured, in which case you had to pay 40% of the settlement out-of-pocket.  It’s illegal for car insurance companies to operate this way.  Why the same thing in the medical field is considered “quality” is beyond me.

Tango,
It’s important to note that employers don’t really pay for health coverage. It is part of our compensation as employees and it’s quid-pro-quo. When you have government-run and funded health care, it’s not quid pro quo.

Is it immoral for a poor person to break in to someone’s else home and steal? Almost everyone would say so. Government-run welfare of any kind is the same thing, except you have a third party involved doing the stealing. I’d make an exception only for those who cannot possibly be expected to provide for themselves (children, legitimately disabled). But that’s it. The foundation of free countries as originally articulated by the Enlightenment thinkers is the preservation of life, liberty and property. No one has a right to someone else’s property even if it is for society’s benefit.

I would imagine you would have better coverage in a universal health care system than you would otherwise. And if you think the role of government is to make everyone as prosperous as possible, you would probably be wise to advocate for that (maybe). But if you think the role of the government is limited to preserving the people’s rights and keeping us free, you come to a different answer.

Phil,

Everyone takes it for granted that it’s part of your compensation package.  It’s not like you are asked: do you want 100,000$ or do you want 85,000$ + health insurance (some people are actually offered that deal).  I’d prefer it that they did make it opt-out, with dollar benefit.

***

“The foundation of free countries as originally articulated by the Enlightenment thinkers is the preservation of life, liberty and propert”

I don’t really care what they originally said frankly.

***

If you note the start of this thread, Canadians across the country were asked to name the best Canadian ever.  They voted for the guy that was the father of universal health care.  Does that mean anything?

If you go to countries with universal health care, and ask them if they would prefer to give that up, what do you think they would say?

The important point is this: what Americans are contemplating is not some theoretical framework in which it’s difficult to establish the impact across a broad group of people.  What they are contemplating has been enacted around the world already.

The SMARTEST thing for them to do is to look at what has happened in all the other countries, and take the best of what they have.  The test cases are there.  Reality has been implemented.  By being one of the last countries to do this, they should be the ones best positioned to take advantage of making the fewest mistakes.

Instead, what you have is the same scare tactics that were used by all the opponents in those countries when this was being discussed.  History repeats itself.

Universal health care is an inevitability.  Those who are there just kicking and screaming are part of the problem.

Tango - To me, popular opinion means absolutely nothing on this issue or any other. Some of the worst ideas in history have had popular opinion on their side.

We’re on different sides of the fence here. You think government’s job is to try and make life better for its people. My belief is that government exists only to protect people’s rights and nothing more.

"We’re on different sides of the fence here. “

Not that there’s anything wrong with that.

@Phil D

“My belief is that government exists only to protect people’s rights and nothing more.”

Section 7 of the Canadian Charter of Rights and Freedoms guarantees the right to life, liberty and the security of person.  The Canadian Supreme Court has ruled that this guarantees access to health care.

The 5th and 14th amendments to the US Constitution guarantee the same rights. 

One of the rights that the government protects for the elderly in the US is access to health care regardless of their ability to pay.  There are no credible legal challenges to the existence of Medicare that I know of, so I would imagine that it would be found constitutional on the basis of guaranteed rights.

@tango - phil points it out and i see you acknowledge it but there is a huge fundamental difference between employer paid insurance, which really is employee paid, and government paid.  if its part of your compensation, then you are incentivized to get a better job so you can get better insurance.  if its all paid by the government, then you are stuck with whatever level of care the government limit is.  just because they take the dollar amount for healhcare out of your paycheck before you can cash it doesnt mean you havent paid for it.  and isnt that the fundamental part of this debate?  whether its the government or private citizens deciding how they are paying and what theyre getting?

that’s why, without getting into the details since ive never looked up the numbers or anything, i’m saying i agree with setting a minimum coverage for country.  a healthier society is more productive one and a benefit to everyone.  but just like education in the US, if you want to pay for better healthcare, you should be able to.  if everyone get the same coverage, then the average level of care would go down, no?  yes, many people would get level of care below average, maybe far below, it’ll depend on how much of the costs will go to the government (ie from taxes) and how much to the private citizens, but i think its more important that people have the ability to pay more and get more than it is for everyone having the right to equal care.  i can understand if people disagree though.  and i can certainly see needing to overhaul how the insurance companies work and anything to increase efficiency in the industry.

@hawechuk - sorry man, you lost me in those numbers.  i still dont see how no one in the US has ‘quality’ health coverage tho.  i guess it all depends on how you define ‘quality’ of course, but still, i know lots people in the US in all sorts of age ranges and all sorts of levels of health and very large portion of them are happy with the health care they receive.  not everyone, of course, and there is obviously room for improvement and i have no problem with overhauling the current system, but the reason you see so much resistance, i think anyway, is that people ARE receiving quality care and are naturally skeptical that they will be better off with any change.

and i think we can at least all agree that the US’s legislatives are doing a piss poor job educating their constituents about what kind changes theyre advocating and what the results will be.

"i agree with setting a minimum coverage for country.  a healthier society is more productive one and a benefit to everyone.  but just like education in the US, if you want to pay for better healthcare, you should be able to. “

I agree.

***

It also doesn’t help that people want to make this an immigration issue as well.  They want to make it an issue, period, and will latch on to whatever.

Hawerchuk,
Here’s the 5th amendment.

“No person shall be held to answer for a capital, or otherwise infamous crime, unless on presentment or indictment of a Grand Jury, except in cases arising in the land or naval forces, or in the Militia, when in actual service in time of War or public danger; nor shall any person be subject for the same offense to be twice put in jeopardy of life or limb; nor shall be compelled in any criminal case to be a witness against himself, nor be deprived of life, liberty, or property, without due process of law; nor shall private property be taken for public use, without just compensation.”

Sorry, I don’t how see how that guarantees anyone the right to free health care. If anything, the last phrase is prima facie evidence that it’s unconstitutional: taking my private property by force to pay for someone else’s health care.

Here’s the relevant part of the 14th amendment, excluding the parts about voting rights and such:

“All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.”

Again, I don’t see in there any guarantee of womb-to-tomb care, provided by the State if one cannot provide it for himself.

"I don’t how see how that guarantees anyone the right to free health care.”

First of all, who gets free health care?  Every single person pays into the system in some way.  What Tango supports is that everyone pays into the system, and when they get sick, they get what they need.

Second, your viewpoint is not one that even the Republicans support.  Maybe Ron Paul.  Eliminating a successful universal single-payer medical system for the elderly simply is not going to happen.  And there’s no justification for depriving millions of non-elderly Americans of access to the same.

@kendynamo

“you lost me in those numbers...i know lots people in the US in all sorts of age ranges and all sorts of levels of health and very large portion of them are happy with the health care they receive.”

Insurance policies are designed to limit the insurer’s risk. 

1-in-1000 people aged 20-44 have cancer in a given year. 

Most insurance policies limit coverage for expensive cancer treatments to 60%.

So perhaps 1-in-2000 or 1-in-3000 people who get cancer are at risk of bankruptcy each year.

You don’t know 3000 people.  Odds are that no one you know has experienced the downside risk.

And even though it’s a rare insured person who experiences the downside risk of their insurance, under 50% of non-elderly Americans are presently satisfied with their health insurance.

“the reason you see so much resistance, i think anyway, is that people ARE receiving quality care and are naturally skeptical that they will be better off with any change.”

Beyond the demagoguery on this issue, there is a significant partisan divide on this issue.  Democratic voters support health care reform in large numbers; Republican voters don’t, but they do appear to support the notion of single-payer universal health insurance in the form of Medicare. 

As Tango noted above: “Universal health care is an inevitability.  Those who are there just kicking and screaming are part of the problem. “

Hawerchuk,
Anywhere from 25 to 33% of Americans (depending on how and when you measure it) pay zero income tax. Some will pay other federal taxes (excise taxes, indirect taxes), but not enough to offset what they get back in various forms of social welfare. Those are the people who will receive health care paid for by someone else.

Secondly, I’m not advocating denying care to anyone. I’m saying you have to pay for it, like anything else. A shopkeeper who doesn’t let you have his merchandise for free isn’t denying it to you.

Phil - Not one adult American pays zero dollars in taxes in their lifetimes.  In addition to sales taxes, everyone who has ever had a job (which I believe is 100% of the non-disabled population) pays Social Security and Medicare taxes.  By your logic, no elderly people should have access to Medicare because the benefits they receive exceed their contributions. 

Do you believe that handicapped people who can’t work don’t have a right to use social services?  Or that disabled veterans who don’t work don’t have a right to use the VA?

Hawerchuk,
Clearly, there are many Americans whose receipts from social services exceed what they have paid in taxes. Medicare currently has $36.3 trillion in unfunded liabilities. You can think Medicare’s a good idea, but you better have a way to pay for it.

Not that I expect anyone to recall everything said in the thread, but I addressed the issue of disabled people before. Society/government should protect only those who truly cannot be expected to provide for themselves; namely, the disabled and children,

Why single out health care for the “free” handout?  Last year, the government stepped in to bail out the entire financial industry.  Every shareholder and employee of Goldman Sachs, to take one example, saw his net worth held intact with government money.  They tend to consider this an earned social benefit. 

Healthy people are a positive good in a society.  People who are really sick and really poor ultimately are a drag on society in many ways.  So which is a better social good, keeping Goldman Sachs alive or keeping citizens healthy?  Yeah, you can make a choice about that, but I don’t really think there’s a good argument for the one we’re currently funding. 

This year I received about $300 of health care for an auto accident, which was entirely not my fault.  My HMO had to bill my auto insurer which then billed the insurance company of the person who hit me.  The cost of the paperwork among the three companies exceeded the cost of the care I received.  Why is that a good system?

As Tango noted, the entire industrialized world has shown us how to provide universal health care, pay for it and have it cost less than what we pay here.

Phil/27

“Is it immoral for a poor person to break in to someone’s else home and steal? Almost everyone would say so. Government-run welfare of any kind is the same thing, except you have a third party involved doing the stealing.”

Are you talking about “welfare” or any governmental taxation?

Breadbaker @ 40 - You make a good point, though I doubt anyone who opposes universal health care will admit to supporting the bank bailouts (or even admit that they supported Bush.)

There’s a certain amount of cognitive dissonance in this country: defense gets a blank check without having to pay for it; the elderly get universal single-payer health care and prescription drug subsidies with only a cursory attempt to pay for it; and a health care reform bill that would pay for itself, primarily through user premiums, gets hung with the “welfare” tag.

If there was a real populist movement that wanted to end corporate welfare in every sector - banks, defense, energy, agriculture, health care - and focus on jobs and debt reduction, it would probably be the most popular thing in the country right now.  But we have no such thing - just a pseudo-populist movement that wants to smash the banks, but privilege the health insurance companies, defense contractors and oil companies.  I don’t think they’ll ever clear up that inconsistency.

Hawerchuk,
There is a such a movement which you described; it’s called libertarianism (or alternatively, Constitutionalism). Unfortunately, for those of us who are in this movement, it isn’t the biggest thing right now. And it’s also being corrupted by phony populists like Sarah Palin and Glenn Beck.

I don’t think libertarianism is a very compelling political philosophy at the moment.  According to the Cato Institute, libertarians voted 72-20 R in 2000, and 59-38 R in 2004 - even though GWB had, among other things, just passed Medicare Part D by a razor-thin margin and was promising unfunded wars.  I can’t find exit polls for 2008 that break down the libertarian vote, but the pre-election polls all lean R. 

So for all of the complaints about fiscal irresponsibility and foreign intervention, libertarians still vote for the party of corporate welfare and massive debt.

Health Expenditure Per Person:
Canada 3900$, US 7300$

Life Expectancy:
Canada 81, US 78

Infant Mortality Rate:
Canada 5, US 6.7

What does this tell you?

Dunno.  Could be a lot of things.

It could be that with health insurance, your life expectancy in Canada is 81 and in the US it’s 90.  It could be that if you take out murders, it’s 80 Canada and 84 in the US.  It could be that poor people without insurance don’t have access to the best care for premature births.  It could be that the US has more drug-addicted pregnant women whose babies don’t survive.

Per capita, Kenyans do a lot better than Canadians in marathons.  They must have REALLY good running shoes.

There’s a reason that Jean Chrétien went to Minnesota for medical care, and Robert Bourrassa went to Baltimore.  They obviously didn’t feel their lifespan would be maximized by getting treatment in Canada.

Two things are obvious:

-- if money is an object, people would rather have the Canadian system.

-- if money were no object, people would rather be treated in the US system.

Why not just agree that the US has better care for those who can afford it and that Canada has better care for those who can’t?  Why is there this need to decide which is “best” when obviously there are two conflicting definitions?

That you are trying to introduce facts in what clearly is a debate about the primary motivation of the constitution: look out for number 1, and don’t let the government try to tell you otherwise.

What makes America great ("the American dream") also is the reason that it is so despised (limited government involvement means that the haves and havenots will continue to be separated).

"Why not just agree that the US has better care for those who can afford it and that Canada has better care for those who can’t?  Why is there this need to decide which is “best” when obviously there are two conflicting definitions? “

Completely agree.

Indeed, I presume if you look at polls by income levels, I have no doubt that the people’s opinions on health care reform is directly linked.  The question then is how much influence do the rich people have in limiting the reform.

Basically, all these issues (immigration, abortion, drugs, etc) are all biased based on various demographics.  And, depending on the frequency of the demographics, that’ll tell you what the popular opinion is for that country.

Is there any issue that transcends a particular culture, that actually points to a level of right and wrong?  Murder, theft, and rape?  Is that pretty much it?

Phil/47

I think the point of this thread became quality vs access. I agree with you in the sense that we shouldn’t be picking one or the other, but we should be striving for both.

A lot of people who are for reform (and specifically universal coverage) believe health is a human right. However, no one’s arguing that it will or should be free.

You talk about people dying in waiting lines in Canada, but no mention of the 45,000 Americans who died last year because they had no health insurance. This is a serious problem and there needs to be a way to insure everyone, regardless of how much money they have.

The idea that competition leads to lower prices and better quality may work for hammers, but it does not work for medical treatment, due to necessity and urgency. Hence, instead of competition, private systems run on a worst-of-all-possible-worlds managed care system.

:The idea that gravity leads to acceleration may work for baseballs, but it does not work for people falling off roofs, due to necessity and urgency.:

[Editor’s note: not a deletable offense, but embarrassing kindergarten logic to see on my blog.  Highlight between the colons if you must.)

Phil B/47:

“if money were no object, people would rather be treated in the US system.”

Any evidence?

As an aside, I should note that the US spends more in private AND public health care money than do Canada and France. Much of that is research (97% of all health care research is public funded—sorry, I figured that number in 2006, and I didn’t bookmark that), but not all of that.

53/Charles:

>“Any evidence?”

Sure, but anecdotal.

Many Canadians go to the US for treatment—including our former Prime Minister and Premier of Quebec.  But I haven’t heard of any insured high-profile Americans coming to Canada.

There is one exception: Outside of Toronto, there is a world-class, world-famous hernia treatment center called the Shouldice Clinic.  It attracts patients from the Northern USA. 

Coincidentally, the Shouldice Clinic is the only private hospital legal in Canada.  It was explicitly granted an exemption to the law, presumably because it’s so good. 

Also: lots of Americans buy their drugs in Canada because it’s cheaper.  I haven’t heard of too many Americans coming to Canada for surgery, though.

Again, anecdotal.  If anyone has any actual numbers, please post.

Phil,

Here’s some analysis of Canadians crossing the border for medical treatment:

http://content.healthaffairs.org/cgi/content/long/21/3/19

One estimate they have is that the percentage of Canadians who intentionally sought cross-border treatment is 0.1% in the year surveyed.  So that’s 30,000 people nationwide if we accept the results of the survey.  Some of them did it on their own; some were sent by their local health ministries.

On the other hand, 11% of Americans have purchased prescription drugs from a foreign country.  Some of that comes from Mexico of course.

There are plenty of Americans who go to other countries for cheaper surgeries.  As crazy as it sounds, six million Americans supposedly do that!

http://www.cnn.com/2009/HEALTH/03/27/india.medical.travel/index.html

Hawerchuk, you’re changing the subject!

We know Americans go overseas for surgery, like to India where it’s really cheap.  The question is: do Americans come to Canada for surgery?

Since they do come for drugs, we know that they’re willing to travel when they get value for money.  So if they’re not coming HERE for surgery, that certainly tells you something.

And 30,000 people is a lot, a hell of a lot.  If someone offered you a free car, would you reject it to go to the US and pay full price?  You would, but *only if the other car was better*!  Thirty thousand people rejected that free car.  Including Chretien and Bourassa.

I don’t understand this reluctance to accept that the US has better health care (if you can afford it). 

But, if you like, post data on what percentage of medical breakthroughs/pioneerings come out of the US, and what percentage come out of Canada.  I mean, here in Canada we’re still bragging about discovering insulin ... in, what, 1920?