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If Only We Had Socialized Medicine!
Then people paying for their health care (through their taxes) can get healthcare as shitty as the people getting a free ride! James Christopher reviews Michael Moore's film Sicko in the Times of London:

He travels to London to show off the beauty and brilliance of the British National Health Service. He talks to an unstressed doctor who has a four bedroom house in Greenwich and a £100,000 salary from the NHS. He films empty waiting rooms and happy, care-free health workers. He even talks to Tony Benn about how this wonderful marvel came into existence in 1948.

What he hasn’t done is lie in a corridor all night at the Royal Free watching his severed toe disintegrate in a plastic cup of melted ice. I have. I’ve spent more hours than I care to remember in NHS hospitals vainly waiting for stitches or praying for the arrival of a midwife. There are no such traumas in Moore’s rose-tinted vision of our glorious NHS.

How uncommon is this? Apparently, not uncommon at all. Here's Jackie Danicki's Brit boyfriend Antoine's recent experience with their NHS (National Health Insurance) -- a repeat of an experience he'd gone through not long before:

Antoine has been at the hospital since this morning, waiting to be admitted for an ailment I won’t disclose, except to say that it is very painful and that the doctors aren’t sure yet exactly what they are dealing with, though it could be something very serious. They want to keep him overnight at least one night, possibly more. Now, at 10.30PM in London, he is STILL waiting for a bed.

Considering how many of my loved ones they’ve killed or otherwise injured, I’m not sure if I’ve ever been more upset with the farce that is the National Health Service than I am right now. The next American who tells me how wonderful socialised healthcare would be for the US might just get more of an earful than I can usually be bothered to produce.

UPDATE: I spoke to Antoine at 11.30PM London time and they still hadn’t got him in a bed, though at least the nurses helped by bitching to him about what a horribly run hospital they work in and providing some comic relief. He texted me at quarter past midnight and said they’d finally found him a bed.

If you think that experience is an anomaly, here are many more, just on Jackie's blog.

Michael Cannon, director of health policy studies at Cato, asks a few questions nobody else is asking at Tech Central Station, and then comes up with this, about how disconnected American workers are from their workplace-paid healthcare dollars:

They could start with the fact that federal laws have created a health care system where patients are too often spending someone else's money when they purchase medical care. On average, third-parties pay for 86 cents out of every dollar of medical care American patients receive. That's about the same share as under Canada's socialized health care system.

As a result, U.S. patients demand too much medical care and pay too little attention to whether that care is cost-effective. Is it any wonder health insurance premiums are skyrocketing, our uninsured rate is too high, and quality is less than it should be?

There's a lesson here for those who want to cover the uninsured: focus on the incentives facing the 250 million Americans who have health insurance, not on the estimated 47 million who don't. If the federal government stopped encouraging people with health insurance to be less careful consumers, then coverage would be more affordable, the number of people without coverage would shrink, and the quality of care would improve.

That's why the most important reforms would allow workers to control the health care dollars that their employers currently control. If workers are allowed to own those dollars, 180 million Americans would start making more cost-conscious decisions about their health insurance and their medical care. President Bush's proposal to give all taxpayers a standard deduction for health insurance is one such reform. Another would allow workers to take all their health benefits as a cash contribution into a health savings account.

Of course, I'm against workplace paid health insurance altogether, which discriminates against the single person on behalf of the guy who's got a wife and six kids on the work healthcare dole. I pay for my own healthcare through Kaiser. It really isn't a big deal. And I'm 43 and it's $235 a month, and I didn't get denied health care because I was smart enough and responsible enough to have it ever since I got out of college. I was with Oxford in New York, and I've been with Kaiser ever since my last "real job," in my late 20s. It's not the Cadillac of healthcare, but it's adequate, and I'm pretty much paying Ford Focus prices.

Oh yeah, and for anybody (like Bill Maher in the video below or an American friend of mine living in France) who waxes poetic about French health care, a story I've told before: The expat friend, who's married to a French woman, was bragging about his "free" health care. I reminded him that, moments before, he'd been complaing about paying...get this...65 percent of his income in taxes. That's not free health care, that's extraordinarily expensive health care.

review link via Samizdata

Posted by aalkon at May 28, 2007 10:08 AM


I absolutely agree that we should not have employer paid healthcare.... (Because it's bad to demand this overhead of some companies and not of others, especially when most of the rest of the world does not burden employers with these costs.)

After that, we might differ....

and I didn't get denied health care because I was smart enough and responsible enough to have it ever since I got out of college.

I am not sure I understand this statement. I think it's the case that many people just cannot afford health insurance, regardless of when they started. Also, it seems like you are demanding that people begin paying into insurance as soon as they are 18 or else you are okay with them being rejected for it. But if that's the case, that people that may want it in their middle age or elder years or when they have kids need to get on it at 18, then it really isn't an optional "insurance", it's more of your annual health insurance tax.

I don't want to read more into your statement than you mean. In a sense, I just don't understand how we can have a system that either turns people away or gives them unaffordable rates "merely" because they haven't participated up to that point.

I grant you if I were an "insurance" company, I would hate those people and not want to exclude them. And as another participant in the system I would be pretty damned upset with them too.

But I'm not sure that society should really expect every 18-21 year old to have the same preferences or wisdom that you had and the resources to pay for that or else risk at any time later on, never being able to enter the system. Or if we do expect that, than why not just call it a tax.

France certainly demands an enormous amount in taxes, but most of it, does not go to healthcare. Per capita, French healthcare is roughly $3,000 per person compared to our per capita cost of $5,700 per person.

Our health care industry of a bazillion people making sure doctors don't spend too much requiring a bazillion more people hired at the doctor's office to fill out the paperwork for the first bazillion to read, and then another bazillion people making sure that everything is kept private has enormous overhead. And basically, not a single one of those people provide any productive efforts towards making anyone better. They are just there to fill out paperwork, keep lawyers happy, and satisfy all the different arcane rules between plans.

I think that's why that if we had a single payer plan, not employer related, we could provide coverage for a lot more people at a whole lot less money. We would have the time to have people really focus on the real health care cost drivers, the malpractice, the emergency care, the paperwork, the drugs, and things like that.

Oh well, we aren't going to solve this here....

Posted by: jerry at May 28, 2007 8:08 AM

I am not sure I understand this statement. I think it's the case that many people just cannot afford health insurance, regardless of when they started.

I couldn't afford health insurance some of that time -- when I was starting out as a writer -- but I had it anyway, out of a sense of personal responsibility. I was biking and rollerskating all over New York at the time. What if something happened to me from that, or what if I had some disease. Would my parents be forced to mortgage their house to pay for my care? (Not that they necessarily would, as they're big on "you made your bed..." etc.)

Speaking of beds, when I say I "couldn't afford it," I was sleeping on a door at the time...propped up on two milk crates...because I couldn't afford a bed. But, I paid my rent and I paid my health insurance, and I ate a lot of baked beans.

Posted by: Amy Alkon at May 28, 2007 8:26 AM

I hate this sort of anecdotal reporting. Everyone has a horror stiry, no matter the system. I can tell you about waiting nine mon ths for my son to see a doctor at Kaiser, or how my husband had to wait so lonbg for kidney stone treatment he passed them before his appointment came up, or being made to wait an entire day for my son to have emergency stitches because the hospital had no surgeons- but it would all be irrelevant. As it is, people are simply happier overall with socialized medicine when compared to our 'insurance companies take all' system, and it seems the only way to argbue that is through anecdote, which is really a cheap, ineffective way to argue, for both Moore and his critics.

Posted by: Jennifer Emick at May 28, 2007 10:33 AM

Jennifer, there are waits even at Cedars Sinai, which is a pretty great hospital. But, they just don't compare to the waits in Canada or England -- months or years for an operation, for example.

I, too, had to fight at Kaiser for care. It's not perfect, but I'd rather decide how much of my income I'd like to pay for care and get the care that comes with my investment than paying for everybody to get care and getting care dumbed down onto a mass scale. I could have Blue Cross -- but it's a lot of money and I choose not to spend it. Of course, because I pay for my own care, it's not coming out of some giant "pot" at some vast workplace where I'm subsidizing people who overprocreate, I'm careful with my dollars.

Posted by: Amy Alkon at May 28, 2007 10:57 AM

What I hear about Canada is that if you're an MP or or magistrate or whatever kind of funky government type they have up there, you get to cut in line. Basically, they're kicking their health care distribution back to the middle ages. But the thing about exotic diseases is that they don't just happen to exotic people. An American can manage his pennies as he sees fit, and when the shit hits the fan and he needs a doctor, his money's as green as anyone's, even the Governor's.

We should also note that the reason France can afford that health care --aside from the cheapness of its slow delivery and their high rate of taxes-- Is that for a generation or two, the protection of their international boundaries has been guaranteed by the American taxpayer. This has done much for socialist budgets across the Continent.

Next time I see her, I'll be sure and thank my retired mother on their behalf.

The thing about Maher and Stewart is this: They came to politics through comedy, and not vice versa. Their job is to get two hundred people in a studio audience to snicker loud enough to be heard on microphones.

Here's an important truth about comedy: You can't work more than five minutes a day without making fart jokes. At the bottom of that sixth minute, you're going to realize you have no more insights to offer in clever wording, and you're not going to have any new ones until you read tomorrow's papers and recharge. So you turn to the things that are always funny. You bring on the flatulence.

It's impossible to watch Maher and Stewart without wishing they'd skipped a joke or two to actually finish a thought, or think through the implications of one of their kindhearted presumptions... But they can't do that, because they know the implications are usually pretty shitty. And they're in the business of being funny in front of self-admiring hipsters.

If you went to lunch with Maher and Stewart at the Firehouse Cafe, you'd not be impressed with their perspectives. And you wouldn't laugh at their jokes either... Which would be kinda sad for you and absolutely devastating to them.

Posted by: Crid at May 28, 2007 12:11 PM

I apologize... "self-admiring hipsters" is redundant.

Anyway, love love love this blog post. The genius of America lies in finding and exploiting value, something our current arrangements prevent. As the selfish boomers move into the years of healthcare without the opportunity to express this brilliance, we can expect fireworks.

Posted by: Crid at May 28, 2007 12:32 PM

Jennifer, I agree that anecdotes are a poor way to argue. But your statement that people "are simply happier overall with socialized medicine" is just that. My own anecdote: when I lived in the UK, I was perfectly happy with the system. Of course, I never needed medical attention, so my opinion would have been meaningless.

As you say at the end of your post, one needn't accept such non-proofs. An objective comparison should not be difficult. Pick a representative set of treatments, compare the average waiting time for treatment, the average quality of the result, etc.

I am not aware of any such study, but surely one has been done? Anyone know of one?

Posted by: bradley13 at May 28, 2007 11:24 PM

More than with any other policy matter, health care may be the one where anecdotal argument carries the day. We can get all angry about that if we want....

Posted by: Crid at May 29, 2007 6:09 AM

Health insurance is the biggest fear scam in the world. (ok, slightly exaggerated) My husband freaked when I told him I was quitting my 9-5. He freaked only because of health insurance. Now, he is a REALLY smart guy, but it took forever to explain that I was paying $5000 a year to get a freaking pap smear once a year. I left the company and got high deductible coverage ($1500 per person per year) that is cheap- $270 a month for a family of four. I pay the doc $178 for the yearly visit now, our total bill for coverage is $3240, and I save nearly $1600 while keeping our assets covered.

It is, like Amy said, the responsible thing to do and almost anyone can afford it. You might call it "having your priorties straight." The families that say they can't afford medicine will often be the same ones with a car they can't afford, tv in every room, dinners out, and a bike for every kid.

Posted by: miche at May 29, 2007 11:19 AM

Just in case anybody needs it... I found pretty cheap, comprehensive insurance with Tonik by Blue Cross. I think there's an age cut off as it's designed for young people though. No deductible, 100 bucks a month, generic prescription coverage and a low copay, as well as emergency room coverage.

Posted by: Christina at May 29, 2007 12:06 PM

when I say I "couldn't afford it," I was sleeping on a door at the time...propped up on two milk crates...because I couldn't afford a bed. But, I paid my rent and I paid my health insurance, and I ate a lot of baked beans.

And this says good things about our society how?

Posted by: LYT at May 29, 2007 10:47 PM

And this says good things about our society how?

It says that (some) people are prepared to take care of their needs without stealing from you to do it.

Really, as much as you'll hear otherwise, it's not a novel concept.

Posted by: miche at May 30, 2007 12:19 AM

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