Rebutting socialized medicine – international edition

3 blogs tackle the issue of socialized medicine.

On Canada and its health care woes, Abducens Nucleus blog (bonus points for a clever and funny blog title):

Because health care is largely free in Canada, demand is likely to exceed supply. It’s just human nature. Thus, waiting lists become the principal way of rationing medical care and holding down spending. And after 16 years of tracking growing waiting lists, the Fraser Institute observes that the problem is probably not a temporary one that can be fixed with a little more money or time. They note that provinces with higher spending per capita do not experience shorter wait times.

Just as we saw in the old Soviet system with its long lines for food and basic services, government central planning does not efficiently match supply with demand. And human beings will always seek more of something that is free. As one free market advocate states, “Long waits and widespread denial of needed care are a permanent and necessary part of government-run systems.”

Covering France is the Health Care BS blog, “French health care for the US? merci, non”, regarding the WHO’s rankings of health care systems (France is no. 1, US is no. 37) and how they take into account “fairness in financing”:

This dubious standard deliberately stacks the deck in favor of government-run health care systems. When it is removed, the ranking changes dramatically.


So, once again, the evangelists of socialized medicine are trying to pass off a sow’s ear as a silk purse. Aucune vente.

And finally, for our English-speaking friends across the ocean, InsureBlog has an anecdote about what happens “when bureaucrats take a perfectly reasonable goal (sensitivity to folks’ beliefs) and take it to absurd lengths”:

“HOSPITAL staff in the Lothians* have been told not to eat at their desks to avoid offending Muslim colleagues during Ramadan. NHS Lothian has advised doctors and other health workers not to have working lunches during the 30-day fast, which begins next month.”

Well said, folks. And let it be known that I am not arguing that our health care system in the US is perfect. It’s not, but if we are serious about lowering health care costs and improving accessibility (without infringing on our personal liberties by having some government bureaucrat tell you what procedures/medicines you may or may not have), there are much better alternatives than socialized medicine.

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10 Comments

  1. Jamelle said,

    August 13, 2007 at 9:07 pm

    With regards to waiting times. Two things:

    1. Any health care system must have rationing, it just depends on how you go about it. In the United States we limit care by cost. If you can’t afford it, then you don’t get it.

    2. Wait times in the United States are as long, if not longer, than wait times in Canada.

    With regards to everything else:

    “Socialized medicine” or in language that isn’t a tautology, universal health care isn’t “bad” by virtue of it being public. Countries with universal coverage systems have much better health outcomes than the United States and pay less per capita for it. Even in the U.S., our two government-run health programs – the VA and Medicare – report cheaper costs and better outcomes than private health care. It’s cool disagree, but don’t paint universal health care as being some boogieman.

    It isn’t.

  2. pulasthi said,

    August 14, 2007 at 2:20 pm

    yeah this is great. i love it

  3. Lily said,

    August 14, 2007 at 4:44 pm

    In response to Jamelle, a few (ok, more than a few) points:

    1. If you’re going to call limiting care by cost a form of rationing (which is fine), then every consumer good in this country is essentially “rationed.” Our groceries, our clothes, our cars, our houses – if you can’t afford it, you don’t get it. But in reality even people who need clothes and groceries and can’t afford it still get them, and you don’t necessarily need the government to provide these things. Many private charities – soup kitchens, food pantries, Salvation Army, Goodwill, etc – fill this gap. The same used to be the case before government started taking over health care – there were private organizations that helped provide care for people. My guess is that you would have more of these private charities if people had more money to give – and people have more money when they are taxed less, and people who are taxed less tend to reinvest their money which creates more jobs…thus even more money in our economy and more people who can afford things such as health care.

    2. Wait times in the US are likely not perfect, but do you have numbers/sources to back up that claim? I wouldn’t mind taking a look if you could find it. Even if wait times here were the same as in Canada, there is clearly no argument then that a “socialized” system is any better than what we have (in terms of wait times), even if it no worse. Thus there must be something else than can be changed to improve access in this regard. I would argue that it is easier for the private market to respond to such demands than a government monopoly. We just need to be careful not to put so many regulations in place such that innovation is hindered. For example, ‘minute-clinics’ are starting to take off, which is great. Patients who don’t have a lot of time to wait, don’t want to call in advance to make an appointment, or don’t have a lot of money for a full-service physician can utilize these clinics. The problems begin to arise when we restrict who can provide care – for instance, by requiring these clinics to have a physician on staff (supervising the nurses who usually are in charge) we may defeat their purpose and make them useless (or at least no better than the other alternatives).

    3. I would also take issue with your statement that “countries with universal coverage systems have much better health outcomes than the United States.” Which specific health outcomes? My guess (and I could be wrong) is that you are referring to life-expectancy and infant mortality rates. For life-expectancy, there is far more that affects this outcome than health care usage, including genetic and behavioral factors (i.e. diet, smoking, etc). Life-expectancy must also take into account accidental deaths (traffic accidents, etc) and homicides. I have heard it said (can’t find the source right now) that once these deaths are controlled for, the life-expectancy in the US increases and is higher than other developed countries. For infant mortality rates, I refer to a chapter from the book “Healthy Competition” (Cannon and Tanner, 2005), which points out several things. First, the US tends to include very low-birth-weight infants in its measures, which other nations exclude. Second, when comparing infants of the same birth-weight across countries, US babies have better outcomes (i.e. are more likely to survive).

    4. Regarding the VA and Medicare having cheaper costs and better outcomes – again, to which outcomes are you referring? In regard to cheaper costs – are you referring to administrative costs? (this is the usual argument) I would point out a couple things: First, I bet that if you talked to the veterans at Walter Reed, they would disagree with your statement about better outcomes. Second, of course Medicare is going to have lower administrative costs – they don’t have to market themselves, and they use employers, the IRS, and the Social Security Administration to collect and process their fees (see http://www.cahi.org/cahi_contents/resources/pdf/CAHI_Medicare_Admin_Final_Publication.pdf). Also, it is my understanding that Medicare fraud is a significant problem, so perhaps it wouldn’t hurt them to spend a bit more on administrative oversight in order to provide for a more efficient use of resources. And finally, the growth and promised benefits of Medicare are simply unsustainable. Again from “Healthy Competition,” to cover Medicare’s future unfunded liabilities, “the federal government would have to deposit approximately $68.4 trillion in an interest-bearing account…that sum is larger than the combined GDPs of all the nations on earth.” This is scary and needs to be addressed, but no politician wants to go near it, because it would require either increasing taxes or decreasing benefits.

    5. To me, universal health care (and by this, I mean government single-payer) is a ‘boogieman.’ History has shown us time and time again that a state-run monopoly is inefficient and produces poor outcomes for the population. This is the point the first blog, Abducens Nucleus, was making. When given the choice between a private system and a government system, I choose private. It’s not that I don’t want to help poor people – I do – but I think a freer market has done more to help the poor than any government program ever will (and no, our current health care system is not a free market). The US population continues to provide more private charity than any other country, and likely will continue to do so as long as our government doesn’t tax us into oblivion. If you prefer the government to collect your money and redistribute it to the poor through its program, go right ahead. Write the government a check. Just don’t force me to do the same.

    In short, I disagree with your viewpoints, but I appreciate that you have taken the time to comment on my blog and share your thoughts. I welcome and encourage your future comments, as I’m sure we have a lot to learn from each other.

  4. Jamelle said,

    August 14, 2007 at 5:35 pm

    Ah, I wish I had time to totally respond, but I will say this with regards to the terrifying Medicare liability.

    That is being driven largely by the rapid increase in health care costs. Regardless of the cause of said costs, I do think that there are perfectly sensible market based solutions for reducing health care costs. On the same token, I do think that the government should be responsible for providing basic health insurance to all of its citizens.

    And, you’re welcome. I have so far enjoyed reading your blog.

  5. 68.9 said,

    August 14, 2007 at 8:22 pm

    “History has shown us time and time again that a state-run monopoly is inefficient and produces poor outcomes for the population.”

    please show me this historical data. i seriously doubt this claim and many health population scholars, etc would also. take a look at population/lifestyle indicators in EU and Canada and compare with USA. across the board you will find the USA lagging behind. you appear to be suggesting the existence of a two-tier system. perhaps you should visit india before you start applauding such a system ~ in which the government purported delivers ‘basic’ (btw how do you define ‘basic’?) care to the populace and then a second tier exists for addition services on a fee-for-service basis. i know practising clinicians in india; they hate the system and many want to (and do) come to canada.

    the problem with the canadian system is that the docs have a payment structure that invites corruption ~ fee-for-service. and that a vast majority of the health care and hospital workers are unionized and this drives up the wages, of course, and that’s what eats up a lot of $. as far as supply and demand, i’m afraid that exists world wide. it takes many, many years to produce competent, experienced and trustworthy clinicians. and the system sucks them up faster than it churns them out. and simply put, we’re failing to entice really competent people into these roles.

    the other problem with the cdn system lies in the fact that now it is feeling the effects of all the cutbacks and closures of the 1990s and the population is only getting older, sicker, lazier and making worse and worse lifestyle choices. this costs. superbugs ~ cost. etc … and blah blah. global warming ~ costs. all these things that seem unrelated to health care, indeed impinge upon it. its complicated.

    as far as wait times ~ here they are months … perhaps years for some things. and that is the result of a number of effects all converging at once. people here have died waiting for surgery … treatment … even a simple diagnostic test. sure, you can pay to have that MRI … why should you, considering the income tax you’ve already paid? i agree with your sentiment ~ those tax dollars don’t necessarily get divided the way they need to for optimal health care delivery. still … the alternative seems worse to me. why should i have some piss ass insurance bean counter who knows jack sh1t about medicine, physiology, etc determine what treatment i should receive? BS to that! i barely trust any docs, let alone some dumb-ass with a business degree and an insurance license!

    health care delivery is the convergence of many factors. not just accessibilty… but many more things. and, its not a business venture ~ its an infrastructure.

    do charities really exist to provide health care at large, b/c citizens like you don’t believe its their responsibility to contribute to their society via payment of taxes? that’s laughable … and for your information a great many of the health care facilities here in canada were established by religious (i.e. charitable, if you like) organizations and continue to be operated by same … in conjunction with the health ministry.

    its easy for people to sit here and be armchair quarter backs and decide how health care should be run. its entirely another thing to have to actually work in said system … on the front lines or anywhere else. its never as simple as it seems.

    try working in a hospital … or on the street as a street nurse. your perspective may become wider … who knows.

    interesting discussion

  6. Lily said,

    August 14, 2007 at 11:51 pm

    Historical examples – Soviet Union (big one!)…but if you’re looking within the US, go no further than public education, the US postal service, and Amtrak, to name a few. I’m not suggesting a two-tier system. I would prefer an entirely private run system with fewer restrictions on the type of health insurance or other options citizens can choose from (among others). For instance, I would support being able to purchase insurance from other states, which is illegal right now. Or I would support removing ‘minimum coverage’ restrictions that force people to purchase insurance that covers services they will never use – all lobbied hard for by the insurance companies of course because it gives them bigger premiums (no surprise that they also lobby for individual or employer mandates). I would support pricing transparency so people actually have an idea of what they’re paying versus the quality they’re receiving. I would also change the current tax-incentives regarding employer-sponsored insurance (it favors wealthier individuals, while the poor receive no such tax-exemption for health care purchases). I don’t believe that fee-for-service is the only reimbursement option that should be used, particularly because (when financed by the US govt via Medicare) it manipulates markets, and you have physicians wasting resources on unnecessary services that pay more than other, more beneficial but time-consuming, care.

    I also find it interesting that you think complain about “some piss ass insurance bean counter” determining the care you receive, but you would welcome some bureaucrat who knows equally as much (or as little, if you prefer) as the insurance person. At least with an insurance company you have a contract, and have the option of switching companies (in a better system at least, if not tied by your employer) if they don’t meet your needs. Much easier than switching countries!

    As for responsibility to help others, that sounds a bit like a moral judgment, which is fine (or at least not bad, per se). I think I have a responsibility to help others, but is that fair to force my views onto you or others, who may or may not agree? You say yes, I say no (some people think all abortion is wrong, should they be allowed to impose those moral views on you?) . Thus my moral responsibility is shown through donations or volunteer work to local, national, and global groups. I think charities are capable of wonderful things, but perhaps I’m more optimistic about the ideals and abilities of my neighbors than you.

    As for the need to work in such a system before passing judgment, two points: First, I am a medical student and am thus embedded in such a system already. I see patients, I see the hospital, I see the paperwork, and the multitude of workers involved in the system. Second, does that really make me an expert? Who, in your view, would be considered an expert in such a system, and thus considered ‘worthy’ of contributing an opinion? I put my trust in the individual – only you know what is best for yourself, only I know what is best for myself (obviously there are distinctions made for minors or mentally ill). Until you can acknowledge that you do not know what is best for your neighbor (and likewise, that an insurance agent or government official does not know what is best for you), I’m afraid we will continue to disagree.

  7. 68.9 said,

    August 15, 2007 at 6:11 am

    “Soviet Union (big one!)…but if you’re looking within the US, go no further than public education, the US postal service, and Amtrak”

    specifically i was looking to historical examples depicting state-run monopolies on health care … one cannot compare the delivery of transportation, education or postal services to that of health care. the soviet union is entirely its own volume of discussions.

    as a former nurse (RN) with nearly a decade of experience, i do believe i know what the current science tells us best practices are for care of individuals, including prevention and treatment of disease. indeed, i do know what is best for others, like it or not i have a parchment that tells me so … and at one point in time, even had a professional license. i have watched many, many people die. have seen many more suffer, bleed profusely and all those other things. its not just about paper and concepts and words on this screen. some piss ass insurance bean counter has no such knowledge or grasp of the clinical situation. yet s/he has direct involvement in clinical decision-making? sorry, i have a problem with that. indeed, here policy makers do not all have experience as health care professionals, they do not, however, engage directly in clinical decisions regarding patients. standards of care delivery in this country are based upon sound scientific study, not some insurance company’s bottom line.

    put simply, do you want the insurance underwriter, or the banker to build your house, or do you want the carpenters and other skilled workers who have received the appropriate training to carry out the task? that’s where i’m coming from.

    far be it from me to judge anyone’s worthiness wrt contributing to this discussion … however my many years of experience tell me the vast majority of people hold many erroneous views regarding health care. as for what you refer to as forcing of views ~ like it or not we share this planet … and we are social creatures that live in social groups. that means if we want to derive the benefits of said arrangement we contribute. its not a matter of forcing a POV on someone … its a matter of seeing basic human responsibility. typically charities represent a particular socio-political view. i do not believe deliver of health care should be subjected to any such views. (its certainly not doing africa any favours, is it, having so many christian charities there, who oppose birth control, delivering the majority of health care services!)

    at the risk of repeating myself … seeing the never ending paper work and the sea of health care workers does not make one an expert … seeing the carnage, suffering, and death does, though. also enduring the carnage and suffering does. my point was that those who have spent much time in a hospital … at the actual beside or in the bed (ie as pt) possess a wisdom that others, without these experiences, do not.

  8. Lily said,

    August 15, 2007 at 7:35 am

    Do you really know what’s best for someone? I admit that you have years of experience and thus knowledge that a patient doesn’t, but as I see it yours and my job is to pass that information on to the patient in order to help them decide their best course of treatment. In some instances there is obviously a set standard of care, but still that standard is recommended, not forced.

    In regards to policy makers not directly engaging in clinical decisions – this is false. They do this every day, when they decide which drugs are to be approved, which procedures reimbursed, and how much each procedure is reimbursed. This is also what the insurance company does…I fail to see a major difference between the two.

    I think we’ll have to agree to disagree regarding moral views versus social contracts. As for religious charities in Africa, I would agree that they hold some misguided views that they are imposing on others. I would not choose to support a charity that practices abstinence-only or that tries to convert people from their native religion. Unfortunately I don’t have a choice, as my government does and likely will continue to support them. There are plenty of non-religious charities that do work around the globe, and certainly there are religious charities that do good work as well.

  9. mposey said,

    August 17, 2007 at 9:20 am

    Janelle said:

    “Wait times in the United States are as long, if not longer, than wait times in Canada.”

    Where are you getting that from? Michael Moore’s scientific study where he went into a hospital waiting room and asked people how long they had been waiting?

    There is an actual factual study on waiting times in the U.S. vs. Canada (though I know that many of the Michael Moore zombies out there are allergic to facts and would rather have his showboating and dramatizing).

    “A Commonwealth Fund study of six highly industrialized countries, the U.S., and five nations with national health systems, Britain, Germany, Australia, New Zealand, and Canada, found waiting times were worse in the U.S. than in all the other countries except Canada.”

    The article is here:

    http://www.medicalnewstoday.com/articles/76295.php

    This is from a pro-socialized medicine article! So if you’re going to talk about wait times and socialized medicine, maybe you should rethink your use of Canada as an ideal.

  10. Erik said,

    April 15, 2008 at 5:43 pm

    mposey, that reference of yours that Canada had worse waiting times than the US was taken entirely out of context. It specifically mentioned that Canadian data was outdated. So you could be sure the US was behind all the other surveyed industrialized nations, except with Canada they had to provide some more indicators to show that Canada did in fact not have worse waiting times than the US:

    “And, most of the Canadian data so widely reported by the U.S. media is out of date, and misleading, according to PNHP and CNA/NNOC.

    In Canada, there are no waits for emergency surgeries, and the median time for non-emergency elective surgery has been dropping as a result of public pressure and increased funding so that it is now equal to or better than the U.S. in most areas, the organizations say. Statistics Canada’s latest figures show that median wait times for elective surgery in Canada is now three weeks. “


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