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March 23, 2005

POLICY: Yet another shoddy article on single payer

The major outlets of the SCLM (so called liberal media) tend to give lots of column inches to conservatives like William Safire, Debra Saunders, and now Tucker Carlson on NPR and you don't see the reciprocal placing of Michael Moore on Fox News or the Wall Street Journal. This week's wingnut is Jeff Jacoby writing in the Boston Globe about how single payer would suck.  There may be a valid conversation about the merits of single payer, but this ain't it. If the only people Jacoby can quote in his favor are the CDHP flacks at the NCPA and the appallingly biased Fraser Institute, he really needs to get a real education in this subject before he starts wasting column inches in a great newspaper.

Did he bother talking with anyone who knows something just across the Charles from Boston, like Bob Blendon or Marc Roberts at Harvard, both of whom are able to give an unbiased overview of the issues.  Did he even get America's leading single payer advocate Steffi Woolhandler to tell her side of the story? It was all a cab ride away.  Even Bill O'Reilly's had her on.

And he brought out a laundry list of where health care systems abroad are in trouble, and are resorting to rationing. No shit.  I can find him a much much longer list of bad things going on here, but why bother when the Wall Street Journal ran a whole series on rationing in the US in 2003.  Wasn't Jacoby reading his fellow travelers' stuff?  He never bothers to mention that the universal health care nations pay far less for their health care and get better population outcomes. Did he even know that?

This is a complex and difficult argument, but any rational analysis (like my rather good one about Canada!) shows that our system has at least as many problems as those abroad, and considerably more than those countries with a sensible public/private mix like France and Germany.

March 23, 2005 in Policy | Permalink


This would carry a lot more weight with me if you specifically rebutted Jacoby's points with facts and links of your own, instead of indulging in a lot of name- and place-dropping.

Posted by: Joan | Mar 29, 2005 2:08:42 PM

I'll give it a shot Joan, a Canadian living in the U.S. who got double cataract surgery done in Canada for about 25% of the U.S. cost, with no waiting. (paid cash - fought with my insurer for six months to get reimbursment).

"...rationing by waiting is pervasive, putting patients at risk and keeping them in pain.''

Like the rationing here done by affordability where those people without insurance wait until the last possible minute before finally going to the ER for emergency treatment. Or the uninsured people who can't afford elective surgery and so go without.

''Lives at Risk,'' now there's a fear mongering emotional title based on facts. ''Health Care in a Free Society.'', no it's not free and is paid for through the tax system, and everyone knows it.

"that it is more efficient, more equitable, and more affordable than American healthcare..."

Exactly right!

"The facts of socialized medicine aren't nearly as pretty as the myths."
"It is routinely claimed, for example, that single-payer systems ''guarantee'' every citizen the right to healthcare."

Having every "right" does not mean you get all you want right now. Do you get that in the U.S. system? Well at least the rich do.

"In reality, countries with nationalized systems invariably limit healthcare to control costs."

Well there's a novel concept, actually controlling costs, and in a so-called "socialized" country. We limmit healthcare here by ability to pay just like we limit accessability to Rolls-Royces.

"The result, of course, is ever-lengthening wait lists."

Yes there have been waiting lists but allocation is done by doctors, not by government, based on need, and not on ability to pay. When certain cancer treatment was causing patients to wait too long, the "guvmt" paid to have those patients travel to the U.S. to get prompt treatment until the problem could be fixed.

"Around 25 percent of patients undergoing elective surgery in Canada, Australia, and New Zealand -- and around 36 percent in Britain -- have to wait more than four months for a turn in the OR (The figure in the United States: 5 percent)."

Gee waiting for, notice the term, "elective", surgery where "need" is the determining factor. How about the U.S. system where there is about a 30% underutilization rate due to competeing providers and over supply.

"Lengthy waits are not trivial. Delays in Britain for colon cancer treatment are so protracted that 20 percent of cases considered curable at the time of diagnosis are incurable by the time of treatment. Last year a lawsuit was filed against 12 Quebec hospitals on behalf of 10,000 breast-cancer patients who had to wait more than eight weeks for radiation therapy. A ''right to healthcare?'' Socialized medicine guarantees only the right to stand in line -- and often to get sicker while you wait."

Ok so what about those people unable to afford that test the insurance won't pay for or the uninsured who can't pay anything that would pick up those same diseases here in the U.S. and save lives. Problems in those countries can be fixed by the ballot box as happens in Canada, ever try to deal with your insurer? Or maybe your congressman who takes bribes from the healthcare industry so that they get the legislation they want to keep their income stream going.

"But when you finally do get to the head of the line in a single-payer country, at least the quality of the care you receive will be top-notch, right?"
"Alas, wrong."

Well go find out how Americans compare to those countries in overall health. How come Canada is voted one of the best countries to live in year after year?

"Because the number of doctors in Canada is artificially restricted,"

Yes that's right because for each doc there needs to be a money stream to support them, and unlimited docs would would blow budgets. Do you think the number of lawyers in the U.S. should be restricted? I bet docs do.

"Consider another measure of medical quality: access to lifesaving technology. British scientists helped develop kidney dialysis in the 1960s, yet today Britons use dialysis at one-third the rate Americans do. If you need a coronary bypass, you are five times more likely to get it in the United States than in Canada (and eight times more likely than in Britain). Access to CT scanners? MRI machines? Lithotripsy units for treating kidney stones? Angioplasty? When it comes to one kind of high-tech medical procedure after another, the average American patient is far likelier to get treatment than his single-payer counterpart. That is why Americans often have a better chance at beating a condition -- such as prostate cancer, renal failure, or heart disease -- that would kill them elsewhere."

No there is not an MRI on every corner, but Canadians are not writhing in pain in bed at home either. And when Canadians come out of treatment they don't have to declare bankruptcy. They have no medical bills at a time in their lives when things are tough enough. If these statements were really true Canadians would be demanding the U.S. model. But they aren't.

"The Spectator, a British journal, summed up the issue in the headline of its Feb. 12 cover story: ''Die in Britain, survive in the US.''

How about - maybe survive in the U.S. but also broke and homeless in the U.S. due to health bills.

"The American healthcare system is far from perfect, as Goodman and his co-authors make amply clear. But more government control of that system -- and less private-sector choice -- will not make it better. As our friends in Canada, Britain, and other countries with national health insurance can attest, single-payer healthcare looks better on a bumper sticker than it does in real life."

That's why Canadians are crossing the border in droves to use the U.S. system, and pay for it as well. Yea, right. If the U.S. model is working, why are so many people demanding "more" government control not less. Do they really see this system correcting itself, not likely.

There is no perfect system, but the U.S. doesn't have a real system, other than a money making system. The best way I have noticed, from using both systems, is the single pay government run system.

Posted by: Peter | Apr 26, 2006 5:43:41 AM

The elephant in the room that is rarely mentioned in the public debate on medical care is that all of us (sadly, including myself) have far too high expectations of medical research and medical care. Because of our collective conceit and arrogance we have deceived ourselves into thinking that if we just throw enough money at medical research and medical care, we can have eternal life and happiness here on earth. Remember the cliché, “if we can put a man on the moon, we can do anything.” Of course, we know that this is absurd when we say it. But that is how we feel and that is how we behave and I must sadly admit that I am as much a part of the problem as anybody else. When something is wrong with me (or one my loved ones), I expect to have the leading-edge state of the art in medical treatment applied to fix it and I really do not care how much it costs. Because the about 300,000,000 of us feel this way, we have an impossible situation since the leading-edge state of the art treatments are increasing in cost considerably faster than inflation and the GDP. In the future, if everyone were to have leading-edge state of the art care, we would be living as impoverished slaves in an ultimately vain attempt to provide it. We have, in essence, defined “adequate” medical care for everyone to be leading-edge state of the art care for everyone.

Because of our ridiculously egalitarian attitudes on medical care, we will not let our leaders lead on this issue. The leaders are always going to be elites who have a sufficient combination of power, prestige, influence and money to be above any system that they propose or try to implement. Inevitably, if they or there loved ones need leading-edge state of the art medical care, they will be able to get it. Even if they cannot get in the USA, they will get it in Thailand or elsewhere. For instance, they would not have to wait in line for organ transplants because they could get them in desperately poor nations whose people will provide them to the highest bidder. When we realize this, we would mount unbearable opposition to their proposals and policies unless ALL of us could do the same thing. This would be the case whether the policies were capitalistic, socialistic or some combination thereof. Even in socialistic systems, the leaders and elites are above the system.

Obviously, all of us (including myself) must resign ourselves to the fact that in the future we will get sick, suffer and die and be knowingly denied leading-edge state of the art medical care that could extend our lives or improve our quality of life. This would be the case regardless of the nature of the system be it capitalistic, socialistic or whatever. However, our leaders and elites will be able get that leading-edge care for themselves and their loved ones. Hopefully, our envy of them on medical care would be no worse than in other areas of life such as housing, cars, food, clothes, entertainment and social status.

Posted by: Van Waldo | Feb 22, 2007 3:43:36 PM

By now we've learned of the horrific costs the government would impose on tax payers who already are satisfied with their healthcare. Keep the government out of my health care!

Posted by: Dave J | May 9, 2011 1:26:22 PM

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