Smithers MINNEAPOLIS

The issue her is the third-party payor (mostly employers) that creates a choke point in the marketplace.

Allowing people to shop for health insurance like they do for car insurance will go a long way towards allowing the market to bring a correction.

Actually you’ve got it backwards. Health insurance probably couldn’t succeed in the free market, or else they’d only get sick people signing up.

The problem with insurance is adverse selection. That’s why everyone’s required to have minimum car insurance. Soon (we can only hope), everyone will be required to buy health insurance, or else a national system will be put into place.

From what I’ve read and heard, national health care sounds pretty good.

Really, do the rich deserve more health than the poor? The moral argument for free markets–that stuff should go to those who work for it–breaks down when you’re talking about basic needs and inalienable rights.

Shoot, sign me up for a 17 week wait for gall bladder surgery, or for my mom’s cancer to be left untreated because she dared to get her own Avastin when the national health plan wouldn’t get it for her. (my gallbladder, my mom’s cancer, Canadian and English healthcare rules…would leave me disabled and my mom dead…that’s government “healthcare” for you)

The solution isn’t more government, it’s getting government OUT of the equation where possible and letting people see the costs of their own decisions.

are you actually disabled and your mother dead because of government healthcare? or are you speculating? i’m confused…

Having worked in an ER and having seen patient’s transported to a different facility because of no coverage or “wrong” coverage and having to wait to treat a patient or get a test completed based on what an insurance claims adjuster says, please bring a socialized medicine program in like Europe or Canada has.

Yea, all those Canadians flooding across the border to get US health care. I havent seen it. Spare us the anecdotal garbage about the quality of care in England or Canada. At least they dont have 1 in 6 without insurance. How about getting those services without insurance here? Have fun going into bankruptcy.

By the way, youre mom would have to go into the state pool in MN due to her preexisting condition. She’d be declined by all insurers in this state due to cancer history.

I had gallbladder surgery last year here within a week of my first trouble. In Canada, the wait is an average of 17 weeks. My mom had Avastin on her second round of chemo for colon cancer here; England does not cover this drug, and left a woman to die when she dared to pay for it herself.

The woman was an employee of Britian’s health service no less.

So when I merge my family’s recent health issues with the known limitations of government funded health insurance, I not surprisingly figure out that it wouldn’t be good.

Another example; a friend of mine had her first C section in Germany. When she had her second in the U.S. the ob/gyn asked her “who did this to you?”

My wife has had four C sections.

Our system here isn’t perfect, to be sure. Making it a government system (more than it already is), though, would be disastrous. If we have to do something, we could start by eliminating the antitrust exemption in the HMO Act (Author Teddy Kennedy) and change the insurance model from company-paid to employee-paid.

Eric, Canadians coming here for care (as well as Britons and others) isn’t “anecdotal.” It’s statistical, and in some cases, it’s the policy of Canadian provinces to send people (including expectant mothers) to the U.S. because the national system doesn’t have enough maternity wards.

(in a nation with a plunging birthrate, not enough maternity wards….scary, huh?)

And no, my mom, like other mature adults, had a job at the time, and wouldn’t have fallen onto MNCare. You’re batting 0, Eric.

Do the uninsured get Avastin? How long do they wait for gallbladder surgery?

I honestly don’t know the answers to these, but I find your anecdotes unconvincing at best.

my mom, like other mature adults, had a job at the time, and wouldn’t have fallen onto MNCare.

So…increase in unemployment is the result of an increase in the number of immature adults?

…isn’t “anecdotal.”

It’s also a result of not spending nearly as much on health care. Canada spends roughly 10% of GDP on health care, compared to 16% US.

Canada’s recently vowed to increase spending on health care, specifically to decrease wait times.

One problem with comparing average wait times for procedures between the US and Canada is that for a significant portion of US residents (those without adequate insurance) the wait time for their procedures is effectively infinite. They are not considered in calculations of ‘average’ wait time.

CBC article from last year:
http://www.cbc.ca/health/story/2007/10/15/waittime s-fraser.html

As of the article wait times in Canada had risen 90%+ over the last 14 years. So they are aware of it, and probably working on the problem.

National Health in Briton is also aware of having wait times and actively tries to correct the issue.

On the flip side. Briton has better preventative medicine then the U.S. The ability to see you g.p. when ever you want, and not have your insurer question why (and potentially not pay) has shown that people are more willing to go and and get minor issues checked out.

U.S. medicine is more geared towards the catastrophic case, but is not as good on the day to day preventative side (e.g. diet, check ups, etc.)

Frontline had and excellent report detailing the pros and cons of various national systems, old and new. (http://www.pbs.org/wgbh/pages/frontline/sickaroun dtheworld/)

In general the conclusion was that we could most likely take the better parts of what is out there and fashion our own system that would work for us.

Free market, imo, is a bad idea because that makes health care all about profit. In that case you will see just as many refusals to operate on people as anecdotes conservatives can come up with detailing the evils of other systems.

For profit, in insurance and hosptitals, would quickly lead to companies following actuarial tables to a tee. Have cancer? What type? How old are you? What’s your current income level. Nope, we’d loose money, move along.

Don’t believe it could happen? Ask a young boy in Florida why he was taken off a transplant list. The hospital needs to watch costs and make a profit. Since he was a foster child they decided he would not receive adequate follow up care and there fore wasn’t worth it. (http://www.miamiherald.com/news/florida/story/596 995.html) That’s where a for profit system will lead.

pcomeau - thanks for the substantive post.

Re: Canada in general..
I believe life expectancy, too, in Canada is higher than in the US. I don’t have the figure off hand.

Your rail against the “free market” is ridiculous because none of the cases that you brought up is in a true “free market”. In the economic way of thinking, any service that is offered has constraints. There is not a infinity of any service, otherwise everyone would have good health, enough food, enough gas, enough airlines to use at their disposal. The study of economics is how scarce, constrained resources get allocated. It’s pretty simple, do you want to have a government, with a limited number of people making decisions for everybody without knowing their situation? Or would you rather have an allocation system based on each person doing the best they can for their own situation? The main way to do this is through the exchange of something of value. Over the years, money has become the tool of exchange. To obtain a scarce resource, you give up something of value. When we give that right up to a government, we decide that there are a few of us who are smarter than the rest and can make decisions concerning our lives for us. Instead of having a unit of exchange decide whether or not I get that kidney transplant, I now have to let someone else decide whether or not I get to get that transplant. I’d rather have more control over my life, the rest of you apparently think that a government is smarter than yourselves…

example. My brother has lived in Norway for the last 15 years. My ex-wife and a norwegian friend of his were both diagnosed with MS at the same time. She got copaxone and other med’s, he got put in a line. She still has MS but it has been liveable. He got worse and died. Over simplification I know, but it happens. It leads one to think, what if? What if he would’ve had the same access to medical care, the “opportunity”, would he have been better off? We’ll never know will we…

When we give that right up to a government, we decide that there are a few of us who are smarter than the rest and can make decisions concerning our lives for us.

So participate in democracy much?

Instead of having a unit of exchange decide whether or not I get that kidney transplant, I now have to let someone else decide whether or not I get to get that transplant.

So by that I infer you’d want to gut the insurance system (private or public) and leave paying for health care out of our own pockets to for profit providers?

Cool… Poor will die, preventative medicine will go out the window, only the rich will get service.

Again… if you go to a pure pay as you go system with profit as the only motive hospitals, insurers, etc. will make the decision for you as to whether or not you need the surgery.

Transplants, open heart, any big ticket surgery. I guarantee the Florida case will become the norm.

The MS anecdote just bolsters, imo, that the U.S. is good at catastrophic situations. (friend of mine has MS, I had open heart, on it goes.)

But just looking at one system and it’s faults does nothing for the discussion. Japan has decent health care, great technolgy (you can ask for an MRI at the drop of a hat), no waiting, etc. Downside? Hospitals are operating at a loss because the government constrains how much they can charge.

England? You get waiting lines, but great preventative medicine.

So again the “I have a an who did stories” are just anecdotes. They don’t really speak to the overall effacacy of the system.

Also the assumption that all we could do is copy some other countries system and/or government screws things up 100% of the time is silly.

Drinking water, sewage, road systems, etc. seem to do o.k. At the very least I don’t think privatizing those systems would improve them. So I don’t see why it’s an automatic that government run health care = a loss.

Here’s the list of life expectancies by country:
http://en.wikipedia.org/wiki/List_of_countries_by_ life_expectancy

You’ll note that France, Canada, Spain, Norway, and damn near everyone else all have higher life expectancies than the US. That’s not proof of anything, though.

You want proof, check Sherry Glied’s NBER working paper “Health Care Financing, Efficiency, and Equity”. She finds that there’s no relationship between a nation’s financing system and the efficiency of health care, but there is an equity relationship.
http://www.nber.org/papers/w13881

I’m just a hack here, but Sherry Glied knows wassup.

Well, I will concede that one “benefit” of socialized medicine is that you know **** well that you’ve got to take care of yourself, ’cause (as even pcomeau notes) wait lines are out of hand in them.

Which is the point, really; are we to assume that a bureaucrat in DC or Ottawa knows better than you do how important it is to you whether your gallbladder surgery is performed as soon as it’s practical, or rather four months later? Whether you’d like to take the risk and take Avastin for your colon cancer or not?

You know better, don’t you? Instead of further isolating patients from the cost of care, maybe it’s time to let people directly see the cost of what they’re getting–and pay it for things that are (Ken Cooper said something like 55% of the cost is here) avoidable.

(you want an anti-obesity and anti-smoking campaign? There you go!)

Which is the point, really; are we to assume that a bureaucrat in DC or Ottawa knows better than you do how important it is to you whether your gallbladder surgery is performed as soon as it’s practical, or rather four months later? Whether you’d like to take the risk and take Avastin for your colon cancer or not?

Under the current system, if an insurer decides one’s affliction was a pre-existing condition and that the insurer isn’t going to cover it. This scenario is happenning now. Today. And who’s suggesting that an elected official decide what affliction/disease/injury gets what priority?

You know better, don’t you?

Actually, no, I don’t. My doctor, who is trained in medicine does. The current system cuts the doctor out for those who don’t have insurance — again, the insurer is making decisions for you (likely based on profitability). What is the insurer’s training?

Instead of further isolating patients from the cost of care, maybe it’s time to let people directly see the cost of what they’re getting–and pay it for things… that are avoidable.

Sweet — agreed. We would do well to remember, however, that the effects of some of these negative bahaviors (like obesity or smoking) are not immediately recognizable, such as falling off your bike and braking your collar bone is. The connection between action now and effect later is not nearly as strong when you’re talking decades into the future. Don’t believe it? How long have cigarettes been known to cause cancer and a whole host of other maladies? Does it those who do from lighting up? Nevertheless, this is a seperate topic from whether our current health-care system is effective at providing us (US citizens) with good healthcare; which it is not.

Instead of further isolating patients from the cost of care, maybe it’s time to let people directly see the cost of what they’re getting–and pay it for things that are (Ken Cooper said something like 55% of the cost is here) avoidable.

I guess I don’t really have the patience to cite something here, but I’ve heard it said numerous times that the cost of a pack of cigarettes–when taking into account the cost of treating smoking related illnesses–should be between 5-7 dollars a pack. Are you advocated increased taxes (”fees” if you prefer) to offset this? Also, I again don’t have the patience, but I seem to recall you claiming that banning smoking on airplanes was an onerous burden that “the man” places on business. How does that work? We know smoking causes enormous health problems and costs. We know that those around smokers are also exposed to these same health risks and costs–even if they choose not to participate in the activity. You seem to be at once advocating that people pay for the cost of their choices, while at the same time you’re saying that we don’t have a right to regulate those behaviors so that others are not exposed to the effects/costs from the person making those choices…how does that work?

Also, would you mother, knowing the costs for her cancer treatment, actually have made different choices (you know, maybe remove the half of the cancer that is really bad now and chance it on the other half until it got really bad like I do at the mechanic)? Do you think it would be beneficial or non-beneficial to her recovery, when, ahead of time, she provides the checklist of her chosen treatments–according to the price menu–to the doctor, and he says: we have to wait for the credit check–and consult our charts on the likelihood that you’ll recover enough to work this off–to come through to know which of these you’re approved for? You don’t think she would have listened to her doctors instead of looking at a price chart? If she had been paying out-of-pocket, could she afford it, and what would be her financial situation now?

’cause (as even pcomeau notes) wait lines are out of hand in them.

Wow… way to change the context of what I wrote. Let’s see… Canadian wait lines are up, but they have recognized that fact and are trying to do something about it.

In the case of the British, wait lines have come down over the years. Again they recognized the problem and are dealing with it.

In no way does this indicate the systems are doing badly… Average life expectancy in those countries is still higher then ours.

If people pay attention, they know the cost of their care already. Most insurers send out an EOB (explanation of benefits) That shows total cost, and how much is covered by the insurer.

So again… I don’t see a problem with universal health care. Will it be perfect? No. But the current system isn’t that great either.

And please can we drop the my wife, brother, sister’s friend, father’s 2nd cousin’s college roommate’s best friend stories?

These stories are not data, just anecdotes. We all have them, and in reality they are emotional pleas. They get the discussion no where…

What needs to be done is get people to see health care as a national security crisis. figure out a way to reduce health care providers liabilities through licensing and reducing litigation costs. The reason health costs are so high is that overwhelming amount of spurious lawsuits of our litigious society.

Additionally, we need a real movement to improve awareness of health care and options. We definitely need a men’s health care movement that is as strong as women’s. Here in Wisconsin every hospital seems to be opening big shiny new women’s health center, yet none of them have a men’s health center. Which is a shame since the average guy sees a doctor for his immunizations for High School and then again when he hits the ER from his first heart attack or other major medical crisis.

It’s nice to think about pointing fingers at people and making them see the costs of their decisions, but it’s not as easy as all that. For example we are finding the link between cigarettes and cancer is tenuous at best. First clue: lung cancer was rare in the early twentieth century when smoking was hugely popular. Second, evidence is coming about that lung cancer is more likely caused by HPV, the same virus that causes the majority of uterus cancer — testing of tissue archived back forty years is showing this link to be true.

What needs to be made available is a path for people to lead healthy lives and have a personal doctor instead of waiting to go to the emergency room when the story has turned to tragedy. To do this, we need an army of GP’s, something that will take decades to deliver. As it is, we are understaffed for the current demand.

We need a new National Science movement, but unfortunately it’s no child left behind and no foreigner allowed to study — our education system is being gutted from both ends.

There’s a lot wrong with any healthcare system, but what needs to be done is for a long term commitment to making things better, something difficult to do when politicians like to make themselves look better in the short term by gutting programs to save a buck now when the real costs won’t be felt for many years after they have left office, like say Jesse Ventura did.

Ventura gutted the social safety net when the economy was strong and nobody noticed or cared. But now, when times are starting to get tough it’s not there and the cost of reestablishing it both in money and time is prohibitive.

As to the Canadian system, the Commonwealth Fund has done surveys in multiple countries and their results show that 12% of Canadians want their system rebuilt completely while 34% of Americans want theirs rebuilt. Seems to me that the anecdotal “evidence” that I always hear about the Canadian system is just that - anecdotal. Go look for yourself at http://www.commonwealthfund.org/surveys/.

I also might add that free market competition is leading to rising healthcare costs. Look at every friggin hospital in the Twin Cities. Within the past 5 years I can guarantee that ALL of them have made significant capital expenditures to add new facilities which may or may not have been needed, all to win market share and get more patients. We are now seeing a huge expansion of two children’s hospitals in Minneapolis. (There is another children’s hospital in St Paul) Is that necessary? Guess who’s paying for it through their healthcare dollars.

pcomeau, having experienced the gallbladder thing, I assure you that I’d have paid a little extra (and did in a way) to get it out in a timely manner. Never mind that it costs about the same whether you do things now, or four months from now.

Actually, waiting probably costs more, as you’ve got to monitor the situation to make sure it doesn’t get out of hand, and you’ve got two hospital admissions and all.

Not quite sure what you’re trying to get at with the cancer thing, though. No sane person leaves known cancerous areas in unless they won’t be able to survive the surgery/chemo/radiation, and yes, there were some sacrifices made in my family to make sure we could get the best care.

So here’s your choice; partial care for the uninsured, or partial/nonexistent care for all. What do you choose?

Not quite sure what you’re trying to get at with the cancer thing, though.
That was jim r’s post not mine… reread and redirect questions at him.

As for
So here’s your choice; partial care for the uninsured, or partial/nonexistent care for all. What do you choose?

Neither… Again my point is that our current system is good at hight ticket , catastrophic problems. But costs are too high and many can not afford the type of insurance that can cover that.

Our current system rarely pays or encourages for preventative medicine. Actuarial tables are based on age and ability to survive. Hospitals are having to act as for profit institutions, which means items like the boy in FL will become more common.

A state (federal level) regulated system could alleviate this and guarantee minimum care for those in need. I have no illusions that such system will be complex to implement, and that it won’t be perfect. I just don’t get this doom and gloom sense that government gets nothing right and somehow free enterprise will solve everything.

It’s really a false dichotomy as it will take both public and private to revamp the system.

pcomeau, agreed that a federal program could provide “minimal” care. Given, however, that my family already has better, and even the poor have that through Medicaid, why bother changing anything?

Reality here is that while a few “new” regulations might be necessary, the problems we have today derive mostly from government action, and thus can be fixed mostly by repealing those actions–starting with the fact that medical care expenses are out of taxed income when you pay, and out of pretax income when your employer pays.

You’re all just BSing. Go read that Glied paper and you will become enlightened.

What we’re arguing about is basically just how to pay for healthcare–just financing. It turns out, from ACTUAL data and ACTUAL research that there is no connection to efficiency, but that it DOES effect equity.

So, it seems to me that we can get a fairer society by switching to national healthcare. It’s no less efficient, but it’s a good deal fairer.

BTW (Bubba), I’d love to see who gets to decide what illnesses are “avoidable”. Are heart attacks avoidable? How about cancer? Fact is, nobody really knows much how avoidable those are.