Questions for Americans: Socialised Health Care


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The Exchange

Sorry if the term "banging on" came cross as me being upset or offended, which isn't the case. It's more that your a priori attachment to libertarianism seems to blind you to the basic fact that the UK system is much cheaper, despite the problems inherent in a single-payer state system (excess bureaucracy and waste, for example) which you cite. You also don't seem to appreciate that while a payment of a health insurance premium may not be a tax, it effectively has the same impact if that payment is coming out of a consumer's pocket - the state's (i.e. the citizens') liabilities for healthcare will fall if payments for it are reduced, irrespective if that payment is an insurance premium or a tax. Less money is less money, and it puts more money back in the pocket of the consumer either way. So quoting the various liabilities you mention is somewhat missing the point as one would hope that a reform that reduces the cost of healthcare (moot that this is on the table, of course) would actually reduce those liabilities.

As I said, I don't suggest that I would agree with your stance on principle but there are other factors which mean that a purely market-led solution will not always work in all circumstances. I don't suggest setting up an NHS in the US as it would be very disruptive, but something clearly needs to be done. And that something will probably need significant action by the state no matter what happens.


Aubrey the Malformed wrote:

Sorry if the term "banging on" came cross as me being upset or offended, which isn't the case. It's more that your a priori attachment to libertarianism seems to blind you to the basic fact that the UK system is much cheaper, despite the problems inherent in a single-payer state system (excess bureaucracy and waste, for example) which you cite. You also don't seem to appreciate that while a payment of a health insurance premium may not be a tax, it effectively has the same impact if that payment is coming out of a consumer's pocket - the state's (i.e. the citizens') liabilities for healthcare will fall if payments for it are reduced, irrespective if that payment is an insurance premium or a tax. Less money is less money, and it puts more money back in the pocket of the consumer either way. So quoting the various liabilities you mention is somewhat missing the point as one would hope that a reform that reduces the cost of healthcare (moot that this is on the table, of course) would actually reduce those liabilities.

As I said, I don't suggest that I would agree with your stance on principle but there are other factors which mean that a purely market-led solution will not always work in all circumstances. I don't suggest setting up an NHS in the US as it would be very disruptive, but something clearly needs to be done. And that something will probably need significant action by the state no matter what happens.

To add to this argument, a proportions of the saving made could be used to help clear the deficite which you are so morally opposed to.


Patrick, I accept that in some arguments the sides have to agree to disagree. No hard feelings chum, as far as health care debates go, you're relatively rational compared to others on the "anti" side I've talked with. Perhaps it is because you at least recognize that some measure of reform is needed, even if you don't quite like the current proposals.

A few things (hopefully you're still reading):

First, several insurance companies ARE non-profit. A good public option would grant us more than simple non-profit status though. Because it would automatically conform to all of the regulations currently being proposed (I've listed them before, will re-list at request) it will give a competitive incentive to the other private insurance plans to also institute the regulations. What does this mean? It means less will have to be spent on enforcing the new regulations, since the private insurance companies will have an incentive to adopt them.

Second, this quote:

Patrick Curtin wrote:
EDIT: I also think that if Congress and President Obama feel their health insurance will be so great that they should be obligated to participate in it, giving up the nice plan they enjoy as a perk ATM. But, we know how that goes.

suggests you STILL aren't really getting what the current health care proposals are about.

First, no one will be obligated to participate in the public health plan. It will simply be an option (note how it is always called the public option?) along with many (MANY!) more private plans. Anyone in the public option will be so because they chose to be there, for whatever reason.

Second, the option is there only for people buying health care in the individual insurance market (the health care exchange being proposed). People who get employer based health care won't have it open to them, and other than having their health care regulated (again, eight points, listed earlier) won't see any effect here.

Finally, I've seen some talk about Massachusetts thrown around here. This link dispels some of the characterizations of how the system is currently doing. For those who don't want to bother clicking, here's the tl;dr for you.

It worked. It has been a success. If national health-care reform has a similar effect, it will be wildly successful.


David Fryer wrote:


Never mind of course that, as was mentioned earlier in the thread, that 60% of those who are currently uninsured are already eligable for coverage under existing government insurance programs, and that, according to the President, another 6% would not be covered because of the immigration status. Of those that are left, many of those are uninsured by choice because they believe they have better things to spend ther money on. Also ignore the fact that for all the stated efficency of Medicare, it is millions, if not billions, of dollars in debt right now.

While some people may go without health insurance by choice, I'm sure many more choose to go without simply because our individual insurance market is horribly, horrendously broken.

Anyway, we already guarantee treatment at an ER, which is terribly expensive, inflicting even more financial damage on those who are already having trouble, as well as costing the hospitals money for treatment they never get payment for. Mandatory health insurance would help alleviate both of these issues, and the increased risk pool would help drive down the costs for those who already have insurance. Seems like a good deal to me. (obviously, duh)


From the Demonization thread:

pres man wrote:

Which just happen to be national issues ...

And actually I do not. I often times like some of the Dems ideas, but not all of them. Unfortunately in politics you either get the whole thing or nothing. Take the healthcare debate. I support the idea of covering all americans but I don't want to see a government insurance program. Instead I want to see mandatory issurance. The National Dems don't want that idea, either take the government insurance or shut up. It is not me who is not open.

Pres, I believe current health care reform does have a mandate for health care insurance (I assume that is what you were saying). I'm not sure where you have the idea that you take the government insurance or shut up; the current proposal simply creates a public health insurance plan that those buying health care on the individual market can choose. There will be many (MANY!) more private insurance plans, and they will cover many (MANY!) more individuals.

Kirth Gersen wrote:

Have those "geniuses" in Washington decided that a Swiss-style system (private care, privately managed but held to a government-mandated system of uniform regulation) cannot work? If the Dems have taken that off the table (as maybe a workable compromise), then more fool them. One party is as bad as the other.

While the Swiss system is currently completely private, with government mandates and regulations, my understanding is that at its outset, it looked much like the current proposals in Congress, including a public health insurance plan. It was only recently that they dismantled their public plan when it became obvious it was no longer needed.


Patrick Curtin wrote:
As it is, I think I am going to have to leave this conversation. Obviously I am 'banging on' and annoying folks, so be it. We shall see what the future holds, for August is...

Just checking in from work, so I don't have time to respond to your points, but I wanted to mention that I think you are argueing a largely understandable case on financial issues. The financial concerns in this reform are, indeed, extreme. It is not possible to seriously consider reform without making long term argument that often extend decades into the future, which is all rather unconvincing considering the difficulty of such predictions.

It's good to have someone reminding folks of the costs. I just don't happen to find it a convincing argument for two reasons: 1) moral imperative and 2) long term financial security. I hope to find the time later today to come back and address your points one-by-one, but I'm trying to get ready for a business trip and may not have time. If not, I'll certainly give you a response next week.

Don't disengage just because folks disagree...


David Marks wrote:
While the Swiss system is currently completely private, with government mandates and regulations, my understanding is that at its outset, it looked much like the current proposals in Congress, including a public health insurance plan. It was only recently that they dismantled their public plan when it became obvious it was no longer needed.

Sadly, I have no information about this. The understanding I have is that the reforms were largely one-shot, and that matches how most big things in Switzerland are done: years and years of debate, formulation, and false starts, and then suddenly there is enough consensus to push a whole large package through. No idea on the public option. But I'll ask around and try to find more information when I get back.


David Marks wrote:
stuff

Sorry David, I wasn't as clear as I could have been. I mean if you don't want the public option in the plan, then you are being told to shut up, even if you want other things that are in the plan. Hopefully that clears up the confusion.


pres man wrote:
David Marks wrote:
stuff
Sorry David, I wasn't as clear as I could have been. I mean if you don't want the public option in the plan, then you are being told to shut up, even if you want other things that are in the plan. Hopefully that clears up the confusion.

Your posts do seem to confuse me more than others pres. I think it is your short stature and inexplicable hammer wielding that does it. :P

Thanks for the clarification. :)


David Marks wrote:
First, no one will be obligated to participate in the public health plan. It will simply be an option (note how it is always called the public option?) along with many (MANY!) more private plans. Anyone in the public option will be so because they chose to be there, for whatever reason.

My guess is the thinking is due to statements like this.

Scarab Sages

Once again, for your reading pleasure:

The History of the Public Option


b j wrote:

Sarcasm tags should NEVER be used. Period.

As to separation of church and state, we have a private health system now, with the exception of Medicare and Medicaid there is no state involvement. Almost every major city has at least one church owned MAJOR hospital. Over 600 hospitals in the US are owned by the Catholic church. About 1 in five people treated get treatment at a catholic owned facility each year. If the Gov. can replace them, fine go for it. Whether or not churches should own and run hospitals is completely moot at this point, because they do. We have to take that into consideration when reforming health care. Due to federal laws regarding emergency medicine, these hospitals would have to shut down their OB/GYN departments AND their ER's, or they could be required to provide abortions. The Bishops have said they would simply ignore the laws, and push a constitutional show down, or just lock the doors. Either way the losers are the patients.

This whole thing seems like foolishness. If Catholic hospitals are a major player in the system then write something into the legislation exempting them from having to provide abortions. In fact even that is probably not necessary.

As it stands no system is going to have it so that every hospital can provide every service - thats just not possible even for things that are not political hot potatoes. If one needs a service that hospital X does not provide then you go to hospital Y. If these hospitals don't hire people capable of doing abortions and don't install the facilities for doing them then people who want abortions will go to places that do in fact have such facilities. Same deal with cancer if hospital X does not have a cancer ward then people have to use hospital Y.


Valegrim wrote:

I dont consider the VA as a model to hold up as "exceedlingly" exceptional; to me it is mearly adequate. The problem that I have seen is not so much in the care; but the excessive time that you spend at VA. Really, now I only know about 3 people who go there fairly regularly; but as they need drivers; to take them I or someone else has to take nearly the entire day off; a good 6 hours or so; granted it takes 25 minutes to drive there; but, I find the amount of time spent there is exceedingly long. To me that is a great organizational problem that should be managed and executed differently.

Also, the general American populous could really use some enhancement to their general medical knowledge other than some bogus health class that you get in middle school which is really all about birth control, std's and a bit on dental stuff; least that was what mine was. I know about 15 nurses and about 3 doctors; which granted isnt much; but I have been listening to them for years, as well as a few administrators and it seems their position is that since people have health care; they come in for any slight little thing; slivers; headache; an hour worth of symptoms of sniffles thus completely abusing the care that is available.

So riddle me this: If we give free or very inexpensive health care that we few of the working population have to fund, how are we ever going to actually use the care provided if the system gets even more swamped by even more people who go in for advanced care who dont need it?

Truth is, in Canada, wait times are the cost that the system charges to keep people from abusing the system. You do need to force the people using the system for trivialities and none life threatening issues to pay something or you'll end up with the system being flooded by people with minor ailments of no real regard. So, In Canada, if I want a doctor to remove a sliver he'll do it but I'm going to cool my heels in a waiting room for 6 to 12 hours first.

That wait time blows such chunks that I rarely see a doctor despite the fact that it costs me nothing and I simply have to flash my health card (were someone writes the number down) in order to access the system. Now that said wait times to see a GP are generally not so bad presuming you have a family doctor - then you just make an appointment and the doctor sees you but ER visits are long boring affairs.


Patrick Curtin wrote:


I guess it all boils down to the 'small' amount of waste and inequality. I have always found the implications of founding massive social programs with no secured funding an interesting take on things. Once again, I think this is a philisophical difference. I don't think that government delivers the services we are asking of it in a cost-concious well-organized manner. You seem to think it does. We disagree EOS.

Just as a clarification: I am arguing against my own self-interest on this one. I am making very little money, and a signifigant percentage of my pay goes towards health care insurance. If this passes as the Dems want, I win. Yippee. My children lose, but I'm sure they'll get used to the inevitable massive tax increases 'down the line', given time.

Or, Perhaps, they'll win. As it stands Americans pay far more then any other western state for healthcare and, worse yet, they also have one of the fastest rising costs. The status quo would seem to indicate that there situation will just get worse if something is not done. The rest of us are going to have to dole out more money - our systems are underfunded. Its only in America that real cost savings are actually possible because your already paying such a high price.

Beyond this it sort of perplexes me that your so anti-government in this regards. Historically America has been extraordinary good at really big projects. World Wars have been won based on America's ability to mobilize resources in a manner that no one else can compete with. So I don't think its really true that America is incapable of managing this sort of thing. Historically they've been able to do so better then anyone else.

Bureaucracy itself is not necessarily a bad thing. Most of the current Asian Tigers and Japan have become rich due to programs that, ultimately extend from very good bureaucratic over site. It seems like a very pessimistic view of America to presume that the rest of the western world can manage such programs but Americans are to incompetent and corrupt to manage what the rest of the western world has pulled off.

Personally I think its something of a self fulfilling situation. Everyone in America loathes pencil pushers so no one with any brains or self esteem becomes a pencil pusher which results in a bunch of lousy unmotivated pencil pushers.


Heh. My friend from Scotland just told me she's going to print up a T-shirt that says
"I SURVIVED THE EUROPEAN SOCIALIST DEATH PANELS (And All I Got Was This Lousy T-Shirt)."


Well, I have had a day to get my annoyance under control. I will post once more then I will have to excuse myself from the debate before I pop a gasket and have to use this country's broken healthcare system.

Aubrey the Malformed wrote:
But please stop saying how a centrally-funded system will lead to waste and bureaucracy when it clear that it is much, much worse in the US, especially when you consider that we have universal care and you don't.

This is why I decided to bow out of the conversation. I was asked nicely to stop saying centrally-funded systems will lead to waste and bureaucracy. Ergo, I really don't have much more to say about the matter. I never claimed that centrally-funded systems wouldn't work, or that they wouldn't do what they promised. My problem is the cost, the government taking over a large section of our lives, etc. etc. Our debt worries me. Obviously China can't foreclose on us, but being in theirs or anyone else's debt leaves us vulnerable to many political things. All they have to say is they are unwilling to buy any more debt from us and we are screwed.

David Marks wrote:


suggests you STILL aren't really getting what the current health care proposals are about.

First, no one will be obligated to participate in the public health plan. It will simply be an option (note how it is always called the public option?) along with many (MANY!) more private plans. Anyone in the public option will be so because they chose to be there, for whatever reason.

I'll be obligated. I'll have no choice. My employer will drop me like a hot potato once a public option is available. Ah well, I'll have more money for Paizo goodies, right? Why worry about tomorrrow when people are sick today! I've got a gold card with a $20,000 credit limit, as long as I can pay the minimum I can live like a king! ... For a while ...

Also, I LIVE in Massachusetts. I see on the ground what is going on in this state. That article you linked misrepresented the numbers. The $88 mil cost is the annual increase. There's also a lot of unintended consequences. Our state is being kept afloat by stimulus money, a federal 'bailout' if you will. We still had to increase our sales tax by 25%. Almost everyone my age or younger has left the state for states down South. Many business have fled as well. Tax revenues are down despite massive tax hikes. Yet I am stuck here because of family healthcare issues. Ironic, no?

Jeremy Mac Donald wrote:
Beyond this it sort of perplexes me that your so anti-government in this regards. Historically America has been extraordinary good at really big projects. World Wars have been won based on America's ability to mobilize resources in a manner that no one else can compete with. So I don't think its really true that America is incapable of managing this sort of thing. Historically they've been able to do so better then anyone else.

Americans work well when pressed. Americans can scramble together and put the shoulder to the wheel when times are tough. Americans also have a streak of self-determinism in their nature. They like making their own descisions. But the 'pencil pushers' as you call them will proliferate. The pencil pushers will have a well-paid job and although I am sure many will work diligently, a number of them will coast, as there is no real threat of firing. Many in the know will also obtain these 'pencil-pushing' jobs for friends and family. I'm not a big fan of nepotism, as my state is rife with it.

Twings wrote:
Don't disengage just because folks disagree...

I enjoy debating issues. I just feel the tenor of this particular thread is getting a bit sour so I'm punching out before the lock. Enjoy folks, I'm outta here :)


Adventure Path Charter Subscriber
Patrick Curtin wrote:

My problem is the cost, the government taking over a large section of our lives, etc. etc.

This is a point that has always mystified me about libertarian viewpoints. You don't want the government getting so involved, but you're OK with corporations doing so. They're no less faceless and, worse, are beholden to shareholders, not by, of, and for the people. The government may be pretty slow to react as a mass, but it has proven to be susceptible to grassroots organizing and individual congressmen are pretty responsive to constituent problems with government services. It helps explain the huge incumbency rate they have.

I start to wonder if the real distrust and fear libertarians have is for the people around them who may vote differently...

Debt worries, well, those I can understand.


Adventure Path Charter Subscriber
Jeremy Mac Donald wrote:

If Catholic hospitals are a major player in the system then write something into the legislation exempting them from having to provide abortions. In fact even that is probably not necessary.

Catholic hospitals are a major player in the field, very much so, and increasingly so as well. We're not really to that point yet, but there may come a time when the only hospital services in a reasonable area are Catholic.

But, from a freedom of choice standpoint, where the choice must be free is in the patient to whom the health care belongs. I can support any requirement for insurance to not be so tied to Catholic providers that a patient cannot receive good birth control options.


Bill Dunn wrote:
This is a point that has always mystified me about libertarian viewpoints. You don't want the government getting so involved, but you're OK with corporations doing so. They're no less faceless and, worse, are beholden to shareholders, not by, of, and for the people.

Minimize the power of government and you are maximizing the power of unaccountable, immortal, private tyrannies against which you have neither protection nor influence. I mean, who's going to protect you? The government? The same one just enfeebled?

This is why we do mixed economies.


Bill Dunn wrote:
Patrick Curtin wrote:

My problem is the cost, the government taking over a large section of our lives, etc. etc.

This is a point that has always mystified me about libertarian viewpoints. You don't want the government getting so involved, but you're OK with corporations doing so. They're no less faceless and, worse, are beholden to shareholders, not by, of, and for the people. The government may be pretty slow to react as a mass, but it has proven to be susceptible to grassroots organizing and individual congressmen are pretty responsive to constituent problems with government services. It helps explain the huge incumbency rate they have.

I start to wonder if the real distrust and fear libertarians have is for the people around them who may vote differently...

Debt worries, well, those I can understand.

Your point is taken but keep in mind corporations exist as they are because the government has written laws favorable to their existence. For example they don't pay inheritance tax and owners have significant protections from liability.

Also keep in mind that the insurance corporations that control half of the medical spending in the United States exist only because of the government HMO Act of 1976. If you take away that law, HMOs would disappear, they can only exist because the law is structured to allow them to exist, at least for now.


I haven't read this thread, so at the risk of repeating what someone else has said.

If long wait times are a problem, there is a solution. Pay your doctor yourself.

Do you show up at a dining establishment for lunch and have to wait until dinner to be served? If you do that place isn't going to be open for long, or it is so popular and exclusive you really are paying for the privilege of eating there. Many businesses which want your money won't make you wait, because you are the customer.

Who is the customer from the doctor's perspective? It isn't you. You aren't paying him. It is the third party which is the customer. Doesn't matter if that third party is an insurance company or the government. The doctor will make sure they get served, because they pay.

You will just have to wait.

And the service your third party payer wants? They want their forms filled out to make sure both you and the doctor are not ripping them off. So the forms are important, not your health.

I know what goes on in hospital lounges for staff, they are talking about their customers, not their patients. They are talking about this form and that form, filling out A, B, and C.

I live in the US, and I have largely given up* on the legal cartel which is known as medicine in this country. If I show up they are largely interested in hooking me up with some drugs that they can charge to their customer. Lower my cholesterol, treat possible diabetes, etc. I have ended up going online, diagnosing my health condition and treating myself several times.

*There are exceptions. When it comes to trauma the US is close to the top if not top. Liam Neeson's wife would have gotten a medevac chopper instead of a 3 hour drive if she had suffered her accident in the US. Why no medevac chopper like the US? Because in Canada with socialized medicine a medevac chopper is an expense, so no medical helicopter system in Quebec. In the US, people try to make money with the half of the medical spending(the other half is government spending) in private hands. So the US has a medical helicopter system, because rich people can pay to be flown when their life is on the line. RIP Natasha Richardson.

Likewise for MRI machines. You can't charge medical consumers in Canada for anything, so an MRI machine is purely a decision of cost. Best to keep costs as low as possible. The medical workers will decide how many MRI machines they will need, and they know the money available has to be spread across their salaries and the new equipment. Who do you think they are going to look out for?

An MRI machine in the US can be a source of income, you can make a profit. Thus a county in the US which has 80,000 residents has as many MRI machines as Montreal does, a population of several million.

Shocking as it may be, someone trying to make a profit treating your sickness is often of benefit to you.

I listened to one guy who lived under socialized medicine in the old Soviet Union. He was kidnapped and forced to stay in a hospital for a month. Why? Deaths in hospitals were too high, the Politburo demanded that hospitals reduce their death rate. Of course, the hospitals had no means or resources or money to do this. So they made sure the sick people were taken out to the streets and healthy people were brought in.

Viola, the death rate was lowered. Once they showed death rates were down, he was free to go.

So in short, the US medical system is already half socialized, and Obama wants to make it 100%. It really is too late to complain about socialism now, it was too late when Bush got his drug prescription plan passed, it was too late when the HMO Act of 1976 passed. That ship has sailed.

The Exchange

NPC Dave wrote:
Liam Neeson's wife would have gotten a medevac chopper instead of a 3 hour drive if she had suffered her accident in the US. Why no medevac chopper like the US? Because in Canada with socialized medicine a medevac chopper is an expense, so no medical helicopter system in Quebec. In the US, people try to make money with the half of the medical spending(the other half is government spending) in private hands. So the US has a medical helicopter system, because rich people can pay to be flown when their life is on the line. RIP Natasha Richardson.

That's balls, I'm afraid. The ambulance showed up promptly, but she felt OK and sent them away. Arguably what killed her was British stiff upper lip.


Patrick Curtin wrote:

I'll be obligated. I'll have no choice. My employer will drop me like a hot potato once a public option is available. Ah well, I'll have more money for Paizo goodies, right? Why worry about tomorrrow when people are sick today! I've got a gold card with a $20,000 credit limit, as long as I can pay the minimum I can live like a king! ... For a while ...

Also, I LIVE in Massachusetts. I see on the ground what is going on in this state. That article you linked misrepresented the numbers. The $88 mil cost is the annual increase. There's also a lot of unintended consequences. Our state is being kept afloat by stimulus money, a federal 'bailout' if you will. We still had to increase our sales tax by 25%. Almost everyone my age or younger has left the state for states down South. Many business have fled as well. Tax revenues are down despite massive tax hikes. Yet I am stuck here because of family healthcare issues. Ironic, no?

Again, I'd say don't go away. But anyhow, even IF your employer drops your job based health care, that still doesn't mean you'll be forced onto the public option. It's an option, one of many plans that will be available through the public exchanges. You will still be 100% free to choose a private plan if you would so want. Would a chart help? Have a chart.

As for the Massachusetts angle, I would assume the Bostonian journalists also live there as well. Most states (all of them?) are being kept afloat because of Federal stimulus money, as tax revenues are down everywhere (recessions suck, ya know?) I wouldn't expect Massachusetts to be any more immune to those macroeconomic trends than any other state.


pres man wrote:
My guess is the thinking is due to statements like this.

Sorry pres, youtube is blocked here at work (shh, don't tell on me.) Transcript? Description? Anyone?

I'll try to remember to watch this when I get home and see if I can respond for you ...

Aberzombie wrote:

Once again, for your reading pleasure:

The History of the Public Option

My zomblee friend, I'm not sure that it is much of a secret that the public option is a compromise between what most liberals truly would like with what conservatives want. Our system is broken and we want reform, even if that means having to accept something other than the best possible outcome. Don't let the perfect become the enemy of the good, and all that.

The larger the pool of payees into an insurance system the better. Think of the Fire Department. Everyone pays taxes to supply their Fire Department, even though most people will never have a house burn down on them. The "free" money from those people helps make sure the Fire Department has enough money to handle the property of those people who do have fires. The larger the base of people paying into the system, the more risk can be diluted and spread over all of them.


Jeremy Mac Donald wrote:


This whole thing seems like foolishness. If Catholic hospitals are a major player in the system then write something into the legislation exempting them from having to provide abortions. In fact even that is probably not necessary.

As it stands no system is going to have it so that every hospital can provide every service - thats just not possible even for things that are not political hot potatoes. If one needs a service that hospital X does not provide then you go to hospital Y. If these hospitals don't hire people capable of doing abortions and don't install the facilities for doing them then people who want abortions will go to places that do in fact have such facilities. Same deal with cancer if hospital X does not have a cancer ward then people have to use hospital Y.

This whole thing is wholly tangential to current health care reforms, but that said:

The whole problem is in some areas of America, finding a place that will perform abortions can be very difficult to do. South Dakota, for example, only has one in the entire state.

That said, the government is not allowed to spend any public money on providing abortions, and nothing in the current health care reform would change that status of that law.


Regarding wait times, even they aren't inherent to government health care. Try this link out.

Here's a little taste:

Five Myths About Health Care in the Rest of the World wrote:
In Japan, waiting times are so short that most patients don’t bother to make an appointment. One Thursday morning in Tokyo, I called the prestigious orthopedic clinic at Keio University Hospital to schedule a consultation about my aching shoulder. “Why don’t you just drop by?” the receptionist said. That same afternoon, I was in the surgeon’s office. Dr. Nakamichi recommended an operation. “When could we do it?” I asked. The doctor checked his computer and said, “Tomorrow would be pretty difficult. Perhaps some day next week?”

Have I mentioned we pay 50% more per person than the Japanese do? And they have universal coverage? And better outcomes?

I mentioned earlier about how one of the more quixotic effects of our terrible health care system is that it is sometimes better to bankrupt yourself so that you can qualify for health care: This story reflects that precisely.


Please come back Patrick. Seriously. We need more than one side to debate, and you are among the most rational people I've met on the side opposing mine. It's not just refreshing to find someone who doesn't start screaming and throwing things when one espouses their opinion- I'd be willing to say it's a necessity.


Again, not sure why I'm bothering to interject -

The problems with these 'debates' are the limits on the sustaining arguments. ie. Where do you draw the line?

Unfortunately, each side has to take it on faith what the plan would actually shape up to be. Blogger A says that it would cover people in the country illegally, Politician B says it won't. Politician C says it would cost this much, GAO says it will cost that. Politician D says that private choices will still be available, and Politician E says they won't. There is nothing in this initiative that will leave this country's health care system as it is, private or public. It will change things. How much is TBD.

Fiscal driver - US cannot afford it.
Compassion driver - we need to find a way.
Trust the gov't to do it? - track record is poor.
Trust the gov't to do it economically? - even worse.
Fast track it? - scary, at best

Trying to match a system with countries a fraction of our size, or a fraction of our population? Apples and oranges.

Ramrodding an immediate/fast-track solution to a complex and long-vested problem is a recipe for screw ups.

Fix ridiculous prescription costs? Should be easy, and have a good/immediate impact. A pill mfrd by Company A should not cost $1 in Mexico, $2 in Canada, and $20 in the US.

Tort Reform? Yes, needed.

Could our system be better? Hell, yes.

Take more than 60 days to develop a plan that will impact everyone in this country for the remainder of their lives? You'd think we were worth it.


Aubrey the Malformed wrote:
NPC Dave wrote:
Liam Neeson's wife would have gotten a medevac chopper instead of a 3 hour drive if she had suffered her accident in the US. Why no medevac chopper like the US? Because in Canada with socialized medicine a medevac chopper is an expense, so no medical helicopter system in Quebec. In the US, people try to make money with the half of the medical spending(the other half is government spending) in private hands. So the US has a medical helicopter system, because rich people can pay to be flown when their life is on the line. RIP Natasha Richardson.
That's balls, I'm afraid. The ambulance showed up promptly, but she felt OK and sent them away. Arguably what killed her was British stiff upper lip.

Not balls.

Yes, she did send away the ambulance. But no matter how prompt it is, that is still a 3 hour drive to a hospital that can help her. Even if she had gotten in right away, 3 hours may still have been too long.

Without knowing how much time she had, you and I can't know for sure if her declining the ambulance at first mattered. What we do know is that she had limited time to get medical attention before she would die. In such circumstances, a helicopter will save valuable time.

The USA has a medical helicopter system, because a medical helicopter system can be profitable and make money. Quebec does not have a medical helicopter system, because the medical system is socialist and you can't make people pay to use a medical helicopter system.


NPC Dave wrote:

I haven't read this thread, so at the risk of repeating what someone else has said.

Maybe you should try reading the thread as it might allow you to become part of the conversation instead of just bombarding people with your points without reference to what has gone before.

NPC Dave wrote:


Who is the customer from the doctor's perspective? It isn't you. You aren't paying him. It is the third party which is the customer. Doesn't matter if that third party is an insurance company or the government. The doctor will make sure they get served, because they pay.

You will just have to wait.

And the service your third party payer wants? They want their forms filled out to make sure both you and the doctor are not ripping them off. So the forms are important, not your health.

Probably to some extent this is true but your solution seems to be - only expect good service if you show up holding $10,000 dollars in your hand so you can physically cover your treatments in cash. I actually seriously doubt even the very rich do that so I don't see how one gets around this issue.

NPC Dave wrote:


I know what goes on in hospital lounges for staff, they are talking about their customers, not their patients. They are talking about this form and that form, filling out A, B, and C.

Quite possibly, but I think you may underestimate just how routine forms and such are in Canada's system. One of the areas we save a lot of money is basically in administration. No convincing insurance companies that, yes this really was a necessary precautionary procedure or dealing with lots of different organizations. Its just basic forms, created by the Canadian Medical association, and 99% of these forms for treatment are stamped and filed by the administration basically without a second look. Essentially the system is so routine that its fast and easy. You have to be involved in a lot of unusual practices, as a doctor, before your files start raising red flags and the administration decides to do some serous poking around into your affairs. So technically the government is standing over you but in reality the government takes a very hands off approach to the whole thing. You treat your patients as you see fit and so long as you stay with the overall regulations you'll practically never deal with the administration that pays your patients fees directly.

NPC Dave wrote:


*There are exceptions. When it comes to trauma the US is close to the top if not top. Liam Neeson's wife would have gotten a medevac chopper instead of a 3 hour drive if she had suffered her accident in the US. Why no medevac chopper like the US? Because in Canada with socialized medicine a medevac chopper is an expense, so no medical helicopter system in Quebec.

Semantic games - Quebec maintains a couple of airplanes with a full suite of medical systems on board. They could do surgery in the air if they had too.

The reality of the case are that she waved off treatment since she had just bonked her head on the beginners hill. Its not normally a life threatening event.

NPC Dave wrote:


Likewise for MRI machines. You can't charge medical consumers in Canada for anything...

This actually depends on province. In Quebec (but not Ontario) you could set up a private practice. You'd just not then be allowed to participate in the government system. You can't have both - its one or the other, this was done when the system was being set up because of fears that doctors would try and get people to use the private system and only offer the public system if they could not get them to use the private system. However almost no one in Quebec sets up private for profit establishments because its hard to find customers. Its brutally difficult to compete when the state offers the same service for free.

NPC Dave wrote:


I listened to one guy who lived under socialized medicine in the old Soviet Union. He was kidnapped and forced to stay in a hospital for a month. Why? Deaths in hospitals were too high, the Politburo demanded that hospitals reduce their death rate. Of course, the hospitals had no means or resources or money to do this. So they made sure the sick people were taken out to the streets and healthy people were brought in.

Viola, the death rate was lowered. Once they showed death rates were down, he was free to go.

Blatant fear mongering.


Adventure Path Charter Subscriber
NPC Dave wrote:


The USA has a medical helicopter system, because a medical helicopter system can be profitable and make money. Quebec does not have a medical helicopter system, because the medical system is socialist and you can't make people pay to use a medical helicopter system.

There are a few problems with this analysis.

1) Not all cases are triaged as needing immediate flight to a hospital with a medical helicopter even if such services exist.

2) A casual Google search will find that Medflight, a well-known set of medical helicopter services, are often not-for-profit. There are enough different "medflight" results that I can't be sure they all are. So profitability is not an issue.

3) Other parts of Canada DO have medical helicopter services, even if Quebec does not.

The problem does not lie with the medical system being socialist. It lies with Quebec not choosing to have a medical helicopter system. Too MUCH free market, perhaps? The free market may make certain choices possible, but it doesn't necessarily make them likely.


David Marks wrote:
pres man wrote:
My guess is the thinking is due to statements like this.

Sorry pres, youtube is blocked here at work (shh, don't tell on me.) Transcript? Description? Anyone?

I'll try to remember to watch this when I get home and see if I can respond for you ...

If you read Aberzombie's link, you get the jist of it. The video is of some Dem politicians (Prez Obama, Barney Frank, and someone else). The Prez is shown saying that the government option isn't a trojan horse for the single payer. He is then shown saying the employer health insurance isn't likely to be able to go away for some time 5, 10, 20 years (as in the option will lead to it going away). He is then shown where has said he is a supporter of the single payer option.

So when he says it isn't a trojan horse, is he being truthful? Is other comments seem to indicate he at least doesn't believe he himself is.

The Barney Frank and the other politican are more of the same, basically telling single payer proponents that the government option plan is the way to trojan horse in single payer in the long run.

It is because of these comments that some people see Government Option = Single Payer, because the Democratic politicians have said it is. They then turn around say, no it isn't. So who are they lying to? The single payer proponents or the single payer opponents?

politician: Government Option won't lead to single payer.
Opponent of Single Payer: Good!
Proponent of Single Payer: Damn you!
*politician turns to Pro*
politician: Don't worry, I am lying to them, it will.
Pro: Oh, ok, cool.
Opp: Hey, I heard that!
*politician turns to Opp*
politician: Hey, look, I'm just tricking them so they will shut up.
Opp: Oh, alright then.
Pro: Hello! I'm right here, I can hear you!
*politician turns to Pro*
politician: Believe me, I'm hoodwinking them, we're going to get it.
Pro: If you say so, I'm not sure.
Opp: G$% d#%n it! You just said ...(and so on)


And that's different from any other politician in history discussing any other issue you'd care to name... how, excatly?


Kirth Gersen wrote:
And that's different from any other politician in history discussing any other issue you'd care to name... how, excatly?

I agree, but I was trying to show why some people think that Government Option = Single Payer, since Single Payer isn't in the bills. I was saying, the reason is, is because the same politican that say it isn't going to lead to it have also said it will.

I agree, politicans are two(or more)-faced, so you can't believe most of what they say.


Kirth Gersen wrote:
And that's different from any other politician in history discussing any other issue you'd care to name... how, excatly?

Which should be, in itself, enough to cause concern. Natural reaction, yes?


NPC Dave wrote:


Not balls.

Yes, she did send away the ambulance. But no matter how prompt it is, that is still a 3 hour drive to a hospital that can help her. Even if she had gotten in right away, 3 hours may still have been too long.

Without knowing how much time she had, you and I can't know for sure if her declining the ambulance at first mattered. What we do know is that she had limited time to get medical attention before she would die. In such circumstances, a helicopter will save valuable time.

The USA has a medical helicopter system, because a medical helicopter system can be profitable and make money. Quebec does not have a medical helicopter system, because the medical system is socialist and you can't make people pay to use a medical helicopter system.

The Quebec Government maintains modified Challanger 601's for medivac.

Here is a picture of one.


Adventure Path Charter Subscriber
pres man wrote:


If you read Aberzombie's link, you get the jist of it. The video is of some Dem politicians (Prez Obama, Barney Frank, and someone else). The Prez is shown saying that the government option isn't a trojan horse for the single payer. He is then shown saying the employer health insurance isn't likely to be able to go away for some time 5, 10, 20 years (as in the option will lead to it going away). He is then shown where has said he is a supporter of the single payer option.

So when he says it isn't a trojan horse, is he being truthful? Is other comments seem to indicate he at least doesn't believe he himself is.

<snip>

Different politicians can certainly have different end goals for policy initiatives. But to assert that it's a trojan horse in any case is misleading. To become a single payor system, a public options as currently proposed would require additional legislation - which could be voted up or down when it comes up.

Even if some politicians do view a public option as a first step toward a single payor system, there's nothing wrong with incrementalism. And there's nothing wrong with implementing steps toward a single payor system, finding they are working well enough, and stopping there.


First off, again, I was trying to help David Marks understand why some people see it that way despite the exact language missing from the legislation. The reason is both logical and simple, the reason some people think that way is because some of the people most responsible for the legislation are saying it is going to work that way. Don't blame me, blame those politicians for making those statements. This isn't some "conservative conspiracy", this taking the words coming out of some Dem's mouths at face value.

Bill Dunn wrote:
Different politicians can certainly have different end goals for policy initiatives.

Some politicians seem to have conflicting end goals with themselves.

Bill Dunn wrote:
But to assert that it's a trojan horse in any case is misleading. To become a single payor system, a public options as currently proposed would require additional legislation - which could be voted up or down when it comes up.

To be "de jure" sure, "de facto", not necessarily.

Bill Dunn wrote:
Even if some politicians do view a public option as a first step toward a single payor system, there's nothing wrong with incrementalism. And there's nothing wrong with implementing steps toward a single payor system, finding they are working well enough, and stopping there.

Unless you feel that is moving in the wrong direction. If I want to go up, it doesn't matter how slowing I go down, I am still going in the wrong direction.


The idea that health care in the socialized countries is less than what we receive here is laughable, as is the idea that the government bureaucracies are more inefficient or expensive. From the link I gave in my last post:

Five Myths About Health Care in the Rest of the World wrote:

U.S. health insurance companies have the highest administrative costs in the world; they spend roughly 20 cents of every dollar for nonmedical costs, such as paperwork, reviewing claims and marketing. France's health insurance industry, in contrast, covers everybody and spends about 4 percent on administration. Canada's universal insurance system, run by government bureaucrats, spends 6 percent on administration. In Taiwan, a leaner version of the Canadian model has administrative costs of 1.5 percent; one year, this figure ballooned to 2 percent, and the opposition parties savaged the government for wasting money.

The world champion at controlling medical costs is Japan, even though its aging population is a profligate consumer of medical care. On average, the Japanese go to the doctor 15 times a year, three times the U.S. rate. They have twice as many MRI scans and X-rays. Quality is high; life expectancy and recovery rates for major diseases are better than in the United States. And yet Japan spends about $3,400 per person annually on health care; the United States spends more than $7,000.

Go read the link, you'll like it.

pres, thanks for the transcript (although of course, I didn't see it until I got home anyway). My response would be that you're misconstruing what is being said here. Eliminating employer based health care does not have anything to do with the creation of a single payer system. A system could exist (and does, if I understand Switzerland's system correctly) where no one receives health insurance from their employer but still purchases private health insurance for themselves.

Employer based health care is a really bad idea, and we only have it by accident. Weaning ourselves off of this system is important, but people are naturally attached to a system so rooted in our system. This is wholly tangential to single payer though.

Glad I could clear that up. :)


Patrick Curtin wrote:


I will leave you with one last interesting article on the comparison of various countries debt-to-income ratios: >link<.

I've read this a couple of times and I'm still not certain I completely follow. Some of the graphs don't seem to have more then incidental relationships with the other graphs. I'm unclear why total GDP even matters for whats being discussed in this blog post.

That said it would seem that the author wants to convince people that the countries that have good social services are also the ones that are deeply in debt. In some cases I suppose that is true - though the way the blogger anthropomorphizes various nations seems very iffy. I don't, for a second, buy his argument that Europe is like a debtor thats run their credit cards up knowing they can thumb their noises at their creditors. Their creditors know what their doing when they lend them money and figure that their still a good risk even if the debt levels are high.

n any case I think that there seems to be some selective choosing of countries going on here. Japan is included and then explained away but I certainly noticed the lack of Canada on the list. Hence I went looking for another graph of net value per citizen and dug one up here.

Lots of the stats are pretty close but I note that Italy seems to change a lot in its placement. In any case if the argument is social welfare systems are money losers then I don't think the data supports it. Canada, like Japan, does extremely well so its certainly not social welfare systems that are the problem.


David Marks wrote:

pres, thanks for the transcript (although of course, I didn't see it until I got home anyway). My response would be that you're misconstruing what is being said here. Eliminating employer based health care does not have anything to do with the creation of a single payer system. A system could exist (and does, if I understand Switzerland's system correctly) where no one receives health insurance from their employer but still purchases private health insurance for themselves.

Employer based health care is a really bad idea, and we only have it by accident. Weaning ourselves off of this system is important, but people are naturally attached to a system so rooted in our system. This is wholly tangential to single payer though.

Glad I could clear that up. :)

Problem is, you are talking to the wrong people here. You need to go and talk to people like Rep. Frank. If you see some more of that video of him talking while walking he tells the interviewer that he is doing more to get to a single payer by pushing the government option then those people that are pushing for a single payer directly. So please go clear things up with Rep. Frank and others like him. Once everyone understands it on both sides, then things will be good.


pres man wrote:


Problem is, you are talking to the wrong people here. You need to go and talk to people like Rep. Frank. If you see some more of that video of him talking while walking he tells the interviewer that he is doing more to get to a single payer by pushing the government option then those people that are pushing for a single payer directly. So please go clear things up with Rep. Frank and others like him. Once everyone understands it on both sides, then things will be good.

Lol, point taken. I'll certainly concede that in many ways the Democrats have badly bungled how the entire health care reform package has been sold. Sadly, perhaps, message discipline has never been a trait for my "side".

Part of the problem, I think, is talked about here. I want single-payer, I've admitted it many times. It is understandable that some may see me saying that the current reform isn't single-payer but that I still favor it and assume I'm simply lying. I'd call that cynical, but it isn't wholly irrational.

Another part is, in some ways, that he IS doing work towards single-payer by advancing the public option. It isn't that the public option will lead to single-payer, but if it is popular and successful it would certainly make it easier for single-payer to pass someday. Of course, if it is a terrible idea that crashes and burns, it'll make single-payer dead in this country for at least a generation or two, if not more.

If I were the one selling the reform I'd hammer on the eight points which I posted earlier, since those are the ones that will affect the most people. The other changes will have far more beneficial affects on people's lives, but only for a much smaller share of the population, and predominantly among a share that isn't known for being very politically active. I suppose, however, that you advocate for legislation with the politicians you have, not the politicians you want, right?


I really don't want to wade into this .... I'm trying to restrain myself .... for the love of God, somebody help me .... =)

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