How To Die In Sweden
Walter Williams writes in the WT of waiting lists just to get on waiting lists for medical care in Britain, a national health care system that isn't much different in Canada, and how it works in a country whose national health care we don't often hear about -- Sweden:
Canadians have an option Britainers don't: proximity of American hospitals. In fact, the Canadian government spends more than $1 billion each year for Canadians to receive medical treatment in our country. I wonder how much money the U.S. government spends for Americans to be treated in Canada."OK, Williams," you say, "Sweden is the world's socialist wonder." Sven R. Larson tells about some of Sweden's problems in "Lesson from Sweden's Universal Health System: Tales from the Health-care Crypt," published in the Journal of American Physicians and Surgeons (spring 2008). Mr. D., a Gothenburg multiple sclerosis patient, was prescribed a new drug. His doctor's request was denied because the drug was 33 percent more expensive than the older medicine. Mr. D. offered to pay for the medicine himself but was prevented from doing so. The bureaucrats said it would set a bad precedent and lead to unequal access to medicine.
Malmo, with its 280,000 residents, is Sweden's third-largest city. To see a physician, a patient must go to one of two local clinics before they can see a specialist. The clinics have security guards to keep patients from getting unruly as they wait hours to see a doctor. The guards also prevent new patients from entering the clinic when the waiting room is considered full. Uppsala, a city of 200,000 people, has only one mammography specialist. Sweden's National Cancer Foundation reports that in a few years most Swedish women will have no access to mammography.
Dr. Olle Stendahl, a professor of medicine at Linkoping University, pointed out a side effect of government-run medicine: its impact on innovation. He said, "In our budget-government health care there is no room for curious, young physicians and other professionals to challenge established views. New knowledge is not attractive but typically considered a problem [that brings] increased costs and disturbances in today's slimmed-down health care."
These are just a few of the problems of Sweden's single-payer government-run health care system. I wonder how many Americans would like a system that would, as in the case of Mr. D. of Gothenburg, prohibit private purchase of your own medicine if the government refused paying.
We have problems in our health care system but most of them are a result of too much government. More than 50 percent of health care expenditures in our country are made by government. Government health care advocates might say they will avoid the horrors of other government-run systems. Don't believe them.
The American Association of Physicians and Surgeons, who published Sven Larson's paper, is a group of liberty-oriented doctors and health care practitioners who haven't sold their members down the socialist river as have other medical associations. They deserve our thanks for being a major player in the '90s defeat of "Hillary care."
People will say, "That won't happen here in America," because we've had a capitalism-ish system. But, the Obama administration makes no bones about their desire for wealth redistribution in the name of fairness (not that the Republicans were ever the "small government" types they claim to be). So, we really can't say how far this will go. Also, innovation is surely going to be a problem if government is running the show, just for starters, because innovators are likely to shy away from becoming part of a vast medi-bureaucracy.
And regarding who we do take care of -- who I think we should take care of -- the mentally ill, the homeless, and others who truly can't help themselves. But, I think we need to encourage people to behave responsibly. Can't afford health care for two children? Have one -- or none.
More on Sweden's health care here, by David Hogberg, Ph.D., a senior policy analyst at the National Center for Public Policy Research:
While Sweden is a first world country, its health care system - at least in regards to access - is closer to the third world. Because the health care system is heavily-funded and operated by the government, the system is plagued with waiting lists for surgery. Those waiting lists increase patients' anxiety, pain and risk of death.Sweden's health care system offers two lessons for the policymakers of the United States. The first is that a single-payer system is not the answer to the problems faced as Americans. Sweden's system does not hold down costs and results in rationing of care. The second lesson is that market-oriented reforms must permit the market to work. Specifically, government should not protect health care providers that fail to provide patients with a quality service from going out of business.
When the United States chooses to reform its health care system, reform should lead to improvement. Reforming along the lines of Sweden would only make our system worse.
Gee Amy, I know you keep posting these articles saying how terrible health care is in the UK, but I look around and I don't see what you do. Private health care may be better than nationalised - or maybe not - people do disagree. There's room for different opinions. But the way you describe it, only the mad or the bad would opt for nationalised health care. Which leaves the question of why so many people in the UK do just that. They can't all be mad or bad.
I think it's more complex than you make it out to be.
Norman at March 23, 2009 5:24 AM
Norman -
The people of the UK have been living under socialism for so long that they have simply resigned themselves to it.
When I read stories about a man denied surgery to fix a broken ankle because he is a smoker, I have to conclude that there is something horribly wrong with the system.
brian at March 23, 2009 5:49 AM
All the innovation and high-tech gizmos are pretty useless for the huge bulk of people who can't afford them.
The best solution has to lie somewhere in between.
NicoleK at March 23, 2009 6:01 AM
And as far as I can remember, there are TONS of people who want to go to Canada from here for cheaper drugs... didn't they have to pass a bunch of laws forbidding them from doing so?
NicoleK at March 23, 2009 6:02 AM
I agree with both Norman and Nicole.
The reason I don't participate much on these threads is because I see flaws in both ways.
I agree that insurance needs to be separated from employment but I don't think insurance is the entire answer. All that results in is your insurance provider (instead of the government) having too much say over what your choices are. Six of one and half a dozen of the other if you ask me.
The reason these horror stories fail to impress is because I have insurance -- and with insurance I have had to wait six months for a primary physician. And, if I fall ill broke between pay days, I can't go because I don't have the GD copay. My insurance decides what they will and will not cover, not me. If I were to fall ill and miss payments because of it, they'd cancel it and I'd be left in the uninsured bag's without even the pitiful coverage they give. Prescription coverage is indeciperable at best with all available drugs being slotted into one of three categories and how much you pay depending on the insurance company's arbitrary placement thereof. I hate my insurance but I carry it because it's the best option I have unless I pay so much for it, I'm better off paying out of pocket and holding my breath against anything catestrophic (we're talking at least as much as I do in rent).
So, I'll concur with Nicole, that we need something in between. And, frankly, between the current nightmare and socialized, I'd choose the socialized. Big deal. I have to wait now. And then hope the insurance will cover.
T's Grammy at March 23, 2009 6:57 AM
Nicole - when you go to Canada to buy drugs "cheaper", you are stealing from the taxpayers of the nation of Canada. Canada has lower prices on drugs for two reasons - first, they are government subsidized. Second, they have price control laws.
That's right, we pay higher prices here in the states so that the Canadians can free-ride on our innovations.
T's G - Here's the critical difference that you miss. If you had no insurance at all, you could certainly work out a payment schedule with your physician. Even with insurance, if you are denied a procedure, you can still get it if you can come to an agreement on payment for those services.
Under a socialist system, if the government says "die", that's the only option you have. Whether you are dirt poor, or the richest man in the world, you don't get to determine your fate. Because it wouldn't be "fair".
When governments enforce fairness, you get "The Great Leap Forward".
Oh, and if we end up with a government-funded healthcare system, it will probably cost me between 500 and 1000 dollars per month in additional taxes. For a family that makes 250,000 a year, they could be looking at 25-30 grand a year in additional taxes.
Yes, that means increasing the income tax by ten percentage points.
And no, you wouldn't get the money you are currently having deducted from your pre-tax pay back in your check. The government will grab that too.
And all this so they can tell you you aren't worth saving.
Not just no, but FUCK NO!
brian at March 23, 2009 7:05 AM
Amy Alkon
http://www.advicegoddess.com/archives/2009/03/23/how_to_die_in_s.html#comment-1639804">comment from brianA friend in France -- American married to a French woman -- started doing really well over there, making in the neighborhood of 200,000eu (working his ass off like an American), and told me he paid 65 percent of his income in taxes. Just because you can't tell what taxpayer funded health care will cost you (and your kids and grandchildren) doesn't mean you aren't paying big for it. I pay, as a just-turned 45-year-old woman, around $300 for Kaiser Permanente HMO, and get pretty good care. I sometimes have to fight for better care, but I don't have to go to my senator -- I just work the system a little within Kaiser. But, do you think I could get government health care that's anywhere near as good for $300?
Amy Alkon at March 23, 2009 7:15 AM
All the innovation and high-tech gizmos are pretty useless for the huge bulk of people who can't afford them.
This is one of the fallacies that is common whenever individuals are looking at new technologies.
I remember a few years back when the existence of CAT (CT) Scanners, MRI's, PET scanners and Gamma Knife was rare and you had trouble finding them. Now, most medium size facilities have a CT and MRI. For that matter, you can find MRI machines in some of your local malls.
The same thing happens with computers -- the brand new top of the line computer is still in the $2K+ range. But you can find a decent, serviceable computer new, for less than $500 and if you were to go used, you can get one at $150 or less.
New technology will always cost more. That it will always stay high is false.
Jim P. at March 23, 2009 7:20 AM
Amy Alkon
http://www.advicegoddess.com/archives/2009/03/23/how_to_die_in_s.html#comment-1639806">comment from Jim P.The free market system also means there's competition -- if I needed an MRI and didn't have Kaiser, I'd negotiate to bring the price down.
Amy Alkon at March 23, 2009 7:35 AM
One reason drugs are cheaper in Canada in elsewhere is that we Americans are picking up the slack. The government-run health care in Canada negotiates a way-below-cost deal with the drug companies (who must comply under the implicit threat of having their patents revoked). In this way, Canada et al. keep prices down. Of course, the drug companies can't make money this way, so they keep the prices high here, so in effect we are funding the world's cheap drugs. If the US were to adopt the Canadian system, the free ride would end, at which point one of two things will occur: a) Everyone will pay full-price for drugs. b) Everyone will pay below-cost, which will force the drug companies to end all innovation and new-drug research (which is horrendously expensive and made more so by the FDA), which of course will harm us all in the long run. I put my money on choice B.
kishke at March 23, 2009 7:43 AM
Kishke -
Daschle and others have said that "B" is precisely their goal. All this research is expensive. If Americans would just learn to accept "hopeless diagnoses" like their European betters, then we wouldn't have to worry about medical research and could use that money to buy votes.
And of course the best medical care money can buy - for the ruling class.
You proles just go die somewhere that we can't see you, OK?
brian at March 23, 2009 7:49 AM
T's Grammy,
Personally, I'd change providers and also move. All of my family get in to see a doctor same day if it's an emergency or usually in one to two weeks if scheduled, at our discretion. The longest wait for an MRI was 4 weeks, but it was also a low priority given it was my aging shoulder. I could have pushed it up by two weeks if I had pressed.
We negotiate with any medical provider to make payments, or reduce charges if not covered by insurance. I have a child who has gone through horrendous scoliosis surgery and now type I diabetes, all in thirteen months. Every medical provider has worked with us on the bills.
Ariel at March 23, 2009 7:58 AM
And of course the best medical care money can buy - for the ruling class.
Absolutely. No one imagines for a moment that Brown, and Blair before him, would wait on line for whatever procedure they might need.
kishke at March 23, 2009 8:18 AM
Brian - "When I read stories about a man denied surgery to fix a broken ankle because he is a smoker, I have to conclude that there is something horribly wrong with the system." - the NHS in the UK is the world's largest employer, after Indian Rail and Chinese Army. There will be things going wrong, every day. They hit the headlines. The millions of people who receive good treatment every day don't hit the headlines. I don't think your conclusion is entirely sound. I'm not saying there is nothing wrong, just that it is not sound to conclude that there is "something horribly wrong with the system" in a fundamental way. Using your reasoning you could say that any large system was horribly wrong. Do you not think you could find an equivalent horror story from any country of your choosing?
Free market advocates make a big deal out of each individual paying their own way. But the whole point of insurance is that some people pay more into the scheme than they get back in benefits, and conversely. We insure to average the risk. So even in the free market scheme, there are plenty people who do not pay their own way. Free market advocates are arguing for each individual to pay their own insurance, not their medical bills. But no-one argues that orphans, for example, should pay their own medical insurance. So even the most hardened free-market advocate takes quite a socialised position when it comes to paying for medical care.
There is a difference between a national insurance scheme paying for the health service, and the government running the health service. I'm happier with the former than the latter. The advantages of a national insurance scheme are that everyone who is earning is obliged to join, so everyone can claim the benefits when necessary. There can be no opting-out, and it's big enough to carry people who honestly can't afford to pay - such as children, chronically ill, etc. The disadvantages are that it attracts freeloading, and it can be difficult to keep the administration efficient. I don't think lack of choice is a disadvantage. I don't want choice: I just want a health service that works.
Having a government run the health service is a bad idea, IMO. Having a government run anything at all is a bad idea. They government should stick to governing.
Norman at March 23, 2009 8:21 AM
Aren't there 45 million Americans without health care coverage? As in 45,000,000 human beings whose access to critical care is dependant on the size of their savings?
That's ridiculous.
Socialized medicine has a multitude of problems, but denying lifesaving care to someone because they currently don't have a great job and a steady income isn't one of them.
Canadian at March 23, 2009 8:24 AM
Aren't there 45 million Americans without health care coverage?
It depends how you count. There are about 10 million who don't have health insurance because they're illegal immigrants and work in the black market. An unknown number of people choose to spend their money on toys instead of health care. Approximately 300 million want more/better than they have now.
Pseudonym at March 23, 2009 8:42 AM
Hey Canuck, no one is denied lifesaving care in the US. By law, hospitals must treat everyone who walks in the door. Even illegal aliens and legal aliens like you Canadians who schedule your US vacations around getting treated in our hospitals. Imagine how overwhelmed your system would be without the US providing all that extra care.
As others have stated, you canucks are riding on our backs for cheaper drugs too. Why don't you just say thank you to all of us Americans and go back to watching hockey. And thank the US for Hockey too. Without American cites, Canada couldn't support a league. The "Original 6" was 2/3's American.
And of the 45 million with insurance greater than 50% of them can afford insurance but choose not to buy it. That leaves less than 9% without insurance because they can't afford it.
sean at March 23, 2009 8:43 AM
Amy Alkon
http://www.advicegoddess.com/archives/2009/03/23/how_to_die_in_s.html#comment-1639821">comment from CanadianAgain, I pay a little over $300 a month for care out of my Kaiser HMO. Directly. No employer subsidizing me. Direct-deducted from my checking account. Also, I got into Kaiser -- started paying in -- at a rate of about $125 in my 20s...I didn't wait to turn 45 and then say, "Gee, I hope somebody will take me on." I've paid into the system for a long time, and now, at an age when I'm more vulnerable (though very healthy), I'm not looking to get somebody to take me on when it's more risky to their company. And I have the fullest care through Kaiser -- I could pay substantially less, but I want to be covered to the fullest degree in case I get cancer or some other debilitating illness.
So...the bottom-line question in all of the above is...how much of the health care crisis of all those uninsured Americans is/was caused by them putting their prioritie$ elsewhere?
Sure, some of this was caused by the ridiculous way we tie health care to employment when few have lifelong careers anymore.
But, I know a number of people who are in their 20s and decided they'd rather have iPods and other toys and chance that they won't need hospitalization. One, in particular, who comments here, lost that gamble - and ended up with over $10,000 in hospital bills (maybe more, from memory here) after he needed an operation (appendicitis, if I remember correctly).
Again, slightly over $300 at 45 for health care -- top of the line plan at an HMO -- well, if that's unaffordable to you, you need to work on a few things in your life. And FYI, health insurance has always come first for me...right up there with paying my rent. I'd go without a cell phone, eat beans out of a can, cancel all but basic phone service, go without TV, and more before I'd go without health insurance. How many people think to prioritize that way?
Also, I didn't get a dog until my late 30s because I needed to be able to afford any eventuality. How many people are that careful about financial planning before they have kids? A good deal of the problem in this country is a problem of priorities and lack of personal responsibility. And while I'll pay for a homeless guy to get preventive care so he doesn't lose a toe, if you want an iPod instead of paying for health insurance...fuck you, don't expect me to pick up the pieces when you get a big bill from a hospital for uninsured care.
Amy Alkon at March 23, 2009 8:46 AM
Canadian - I'd buy your argument if you could show me one instance of someone being denied emergency care in the US for lack of insurance that isn't the act of an incompetent clerk rather than a systemic failure to care.
As far a socialized medicine caring for people - in Canada you are more likely to die of heart disease than you are to get a bypass. And if you happen to get sick towards the end of the year, you are more likely to be shipped to the US for care.
If the US goes socialized, where will you send the patients your system can't care for?
I think you and I both know why your system can't care for a pregnant woman in Alberta, but we have sufficient NICU beds in one of our most sparsely populated states to deliver quadruplets.
Socialized medicine keeps people from going into the medical professions because they will never make enough to pay their student loans off, or have a decent life on the government payroll.
And unless Obama plans to force people to go to medical school at gunpoint, I don't see how the US will do any better than Canada or the UK. Hell, overzealous attorneys and stupid juries are already causing a shortage in the OB/Gyn field. Turns out that these doctors would rather retire than pay a half a million a year for malpractice insurance when the mother sues the doctor because her baby is born with Down's.
And that's the final nail in the Socialized coffin - there's no recourse for truly botched procedures. The doctors all become employees of the state, and are granted complete immunity. Which means that there's no longer any way to weed out the incompetent.
Not just no. FUCK NO!
brian at March 23, 2009 8:47 AM
This is recent. The famous actress Natasha Richardson bumped her head in a minor fall while skiing. She developed an increasing headache and serious symptoms that required emergency treatment. She died from a subdural hematoma, bleeding beneath the tough membrane surrounding the brain. It seems that Montreal does not have fast transportation to a primary hospital, even near a ski area. Why not? Patients are a cost to the system.
Begging for Medical Care
Andrew_M_Garland at March 23, 2009 9:44 AM
Andrew -
If Natasha Richardson had not refused care on site at the time of the accident, she would be alive today.
Everyone involved said as much.
Let's bash failed systems for systemic failure, not for human error.
brian at March 23, 2009 9:59 AM
"And that's the final nail in the Socialized coffin - there's no recourse for truly botched procedures. The doctors all become employees of the state, and are granted complete immunity. Which means that there's no longer any way to weed out the incompetent"
You're talking absolute BS there Brian, at least as far as the UK is concerned. GPs and Consultants alike are just as liable for civil suits as private Drs in your system. They receive no more protection from the 'State' than your quacks do from their employers.
Try getting a US quack to admit liability - I feel very confident that you'll have a much harder time getting past his/her retained legal team than you'll have obtaining medical records with an FOI request in this country.
And getting him or her struck off is just as unlikely as being successful in pursuing a complaint to that conclusion with the GMC over here - quacks on both sides of the pond like to swim together.
Nevertheless, and just to undermine your point further, there have been many record-breaking payouts to the victims of botched procedures over here. Some of the Drs were sacked, some were 'retrained,' and some got off with a slap on the wrist, but none enjoyed "complete immunity" from their actions
(however much they'd have liked it).
James H at March 23, 2009 10:02 AM
James - I did not say that your system had complete immunity, although I had expected it.
But if we have such a system here? You're damn right complete immunity will be a part of it.
You try holding a U.S. government employee responsible for negligence. You cannot. They have immunity.
Oh, and doctor's licensing records and complaints are public record here, you don't need an FOIA request. And if they are an AMA member, looking them up is even easier.
Government-run healthcare systems combine the efficiency of the Department of Motor Vehicles with the compassion of the Internal Revenue Service and the attention to detail of the Department of Homeland Security.
There's no way that it works out better then the current bodge we have now. We should be concentrating on putting transparency and competition into the system. Giving it all to the government ensures that it becomes completely opaque.
brian at March 23, 2009 10:17 AM
To Brian,
You have my reference to information. Please supply yours.
Richardson was 3.5 hours away from the appropriate hospital, from the time of the 2nd call to Canadian 911. There was no helicopter service. So, you know that she would be alive?
Further, do you rush to the hospital each time you bump your head, or do you wait for real symptoms?
I think the lack of quick transportation to a major hospital IS a systemic failure, for a busy ski area.
Andrew_M_Garland at March 23, 2009 10:27 AM
Anecdotal judgments about medical care are subject to "surviver bias", literally. A small fraction of younger people need expert medical care, the rest can get along with only average or delayed care.
Those who are confined to their apartments, or who are dead, are not around to spread the word that care is bad. Just like auto accidents are not a problem until you are in one.
It is easy in this situation to run a bad system, cut costs by cutting services, and gain votes. Why would people appoint politicians to judge their medical care? Why are they happier with this promise: Your care may be bad, but at least we aren't allowing anyone else to buy better care. Take that you rich people!
USA Healthcare is First - Infant Mortality is Low
easyopinions.blogspot.com/search/label/Healthcare
More information about healthcare.
Andrew_M_Garland at March 23, 2009 10:31 AM
>>You have my reference to information. Please supply yours.
Andrew,
The UK Press were reporting yesterday pretty much what Brian said.
The following (from UK middlebrow tabloid, the Daily Mail) is from an extremely experienced reporter/US correspondent on that paper - which is why I trusted this report:
‘If she had listened to Danush [ski instructor who helped Richardson], who grew up in the Quebec mountains and has been a ski pro for 14 years, she would have been at the local hospital, which has a CT scanner, within 30 minutes.But it was nearly four hours before she got there and they discovered her brain injury.They immediately sent her on to Montreal, but that’s an hour away and by the time she got there it was too late.
Jody Tresidder at March 23, 2009 10:41 AM
Andrew - the fact that she had time to get to Manhattan to die kind of puts the lie to your assertion.
See here. She fell at 12:43. No attempt to get medical attention was sought until nearly three hours later.
It was suggested to her to go get checked out at the ski slope. She refused. When she complained of a headache, once again she refused treatment.
To attempt to place the blame for her death on the lack of a medevac chopper is grasping at straws.
If she had gotten on that ambulance at the base of the mountain at 1 PM, she could have been in Quebec by 4. And she'd still be breathing today.
brian at March 23, 2009 10:42 AM
Like with all things, one's views on health care depends a lot on one's political views.
I, for one, have TONS of evidence of ENORMOUS problems with the Canadian health care system. Its very nature breeds inefficiency. Yet once one gets past the [often] long waits then the actual care by the nurses & doctors et al is supposed to be superb.
SOME PERSONAL STORIES ...
I pay $52 per month for health care here in British Columbia. If I didn't make sufficient income then this fee would be waived. I'm in good health so haven't had to use the medical system for years. But if I did get sick then I'd have to try to find a personal GP, which is exceedingly difficult these days. Another option would be to walk into a local clinic which operates with a pool of doctors in rotation. My third option would be to walk into the Emergency of any local hospital. In the latter two cases you're guaranteed a multi-hour wait (note: 4 - 10 hrs isn't unheard of) almost all the time. Even with a personal GP you usually still have to wait.
My mom's in the hospital right now. Thankfully there was a bed available for her. If there wasn't then she'd be on a waiting list for who knows how long.
A good friend of mine, John, had some major heart problems for years. When it got so severe he went to his GP simply to get an appointment for a heart specialist. Then he waited and waited and waited. His wife morbidly joked that only time would tell whether she would sit in on an appointment with the specialist or with a funeral director. Eventually John did get into the specialist after 8 months. By that point things were so serious that he was immediately scheduled for surgery. And all that wait was simply to get a pacemaker installed. He's now doing better.
The father of a close friend of mine has been suffering with different types of cancer for a few years. While waiting for surgery for his stomach cancer, he started getting blurry vision. Only at the insistence of his daughter screaming at the medical officials to give him an MRI was one done. It turned out he had a brain tumor. Thankfully space was available within a week to have an operation to remove it. All went well. But if there had been many others in line then he would have had to wait & wait & wait.
SOME INTERESTING FACTS ...
Because of the crazy rules preventing one from paying for private medical care here in Canada, it's actually easier to take one's dog in for an MRI than to get one for a human.
The powers at be refuse to share the costs of one's medical treatment with the patients. I've advocated for years that a bill should be presented to each patient, albeit with the costs waived. But the hospitals have no real cost controls per say so they don't actually know what it costs to treat each patient. Let's be clear: if costs are not closely monitored then inefficiencies and corruption are certain to result.
I have heard before, but don't have this confirmed, that there are more MRIs in the City of Philadelphia than in the entire country of Canada.
SUMMARY
Things are slowly changing for the positive here in Canada with more of a mixture of private and public health care. The fact is that competition improves things, no matter how much the public sector health care unions are in denial of this fact. In my province currently between 40 - 50% of all taxes go towards health care. This number keeps on increasing. The fear is that one day it will consume 70% or even 80% of the budget.
I have no specific advice for my American friends but the notion that health care is peachy keen here in Canada is a myth that only the likes of Michael Moore and other Obamunists will buy into.
Robert W. (Vancouver, BC) at March 23, 2009 11:03 AM
New technology will always cost more. That it will always stay high is false.
Posted by: Jim P. at March 23, 2009 7:20 AM
-------------------
Hahaha, no to the second part. Of course, how long it stays high, usually artificially depends on many factors. Demand and competition for a product leads to innovation to improve it, to sell more models/equipment and thus make more money (unless you're say GM or Chrysler).
Look at the Blue Ray vs HDDVD example. Both format's players were expensive for years, mostly because people had no real need/desire for them so manufacturers kept them high to stay solvent on them. More folks get newer tvs that can show off the high res video, more get interested. Even more get interested as prices on content and players drop.
Funny thing though, prices on players/content were still high for a long time, on a product that most had no use for compared to dvd quality (and older tvs). Then Microsoft etc. gave up on HDDVD and Sony wins this round in the format wars. Did blueray players drop in price? HDDVD players did, not surprisingly as stores clear out the leftover "junk". Sadly, most producers/stores raised prices up 50-150 bucks on blue ray players that had been cheaper months earlier. Its been oh at least a year now and we're now seeing basic intro players finally hitting the $150-200 area, far too late IMHO to make much more of an impact given the economy.
Sio at March 23, 2009 11:08 AM
I like my insurance. I like the care we get. It was a major factor in where DH chose to work. I don't see why we should have to give it up and accept lower just because some people rather spend their money elsewhere. The truly poor have medicaid. The rest need to lose the cell phones and prioritize better.
You think the financial crisis is bad, what with Obama laughing all the way through an interview about it? Wait till you see him laughing about people dying while waiting years for government healthcare to get around to healing them. .
momof3 at March 23, 2009 11:08 AM
I am very happy with my healthcare in France. It seems to combine the good old socialist "from each according to their ability" with a nice capitalist free market system where the patient decides where to go. I don't pay more than Amy per month, and am given total choice on what kind of practicioner I want to go to, (although I may pay more based on my decisions).
liz at March 23, 2009 1:03 PM
According to wikipedia the cost of the UK's NHS for 2008/9 was £94 thousand million. There are about 26 million taxpayers in the UK, so that works out at £300 per month per taxpayer. That's $435 USD at today's rates. Anyone corroborate these figures? Are there comparable figures for other countries?
I think the German scheme is interesting - everyone must have medical insurance, but you can choose between insurers. It's a bit like saying if you drive a car you must have at least third party insurance. The insurers must provide a certain basic level of cover, but beyond that, they can specialise or offer special deals or whatever. It worked fine for me.
I asked my lodger, who hails from the US, for her opinion on socialised health care. She's agin it, and is in fact agin medical insurance. She pays cash and avoids going to the doctor until she is dying. She'd vote against the German scheme.
Gotta go - the cat wants to ly withe keyjnqwlwe pooooooooooooooooooo
Norman at March 23, 2009 2:22 PM
"Aren't there 45 million Americans without health care coverage? As in 45,000,000 human beings whose access to critical care is dependant on the size of their savings?
That's ridiculous."
No, it's false - as has been shown above - but the real rub here is the assumption that because someone draws a breath, the are entitled to the work of others.
This is just one end of the "bone" representing medical care. The other end consists of deciding what treatments the patient gets.
Someone has to decide, and the patient cannot be that person if the power to summon money and assets is involved.
So far as the government's concerned, I have to ask everyone to take their anti-psychotic medicines; you're not about to accept public housing and you can't stand the IRS, BATFE or a bunch of other obnoxious agencies, and they represent the state of the arts in government services.
Radwaste at March 23, 2009 3:40 PM
> Which leaves the question of
> why so many people in the
> UK do just that.
People will always support systems that give them something for nothing.
And when people come come from cultures that have lost their vitality anyway, you wouldn't expect enthusiasm for independent responsibility.
Norman, you don't offend simply for offering the first comment to disagree with the direction of Amy's argument... You also lose points for being incoherent and distracted in rebuttal. "There's room for disagreement" about serving the flesh of retard children as fast food, too.
> All the innovation and high-tech gizmos
> are pretty useless for the huge bulk
> of people who can't afford them.
If you could live your life under a 1967 standard of care at 1967 prices, would you do it? Of course you wouldn't, and it would be immoral to let you try.
> One reason drugs are cheaper in Canada
> in elsewhere is that we Americans
> are picking up the slack.
Furthermore, Canada would never have entertained the fantasy of socialized medicine if they'd had to pay market price for defending their vast coastline, let alone their southern border. It's amazing what you can do with a national budget when the United States picks up the tab for your security... Amazing, but not miraculous.
> But the whole point of insurance
> is that some people pay more
> into the scheme than they get
> back in benefits, and
> conversely.
That's just the craziest-shit thing you've ever said, Martin. There's no second prize. It clearly exposes, with a circus spotlight under a high-top tent, the socialist rot at the core of your thinking.
Insurance pools risk. That's all it does. Again, again, again: Insurance does not create value. When people buy insurance, they're not looking to do something grand for the whole community: All they want is some assurance that a few unlikely outcomes will be made to go away when they occur. If at the start of the venture you tell anyone they're going to "pay more into the scheme than they get back", then there's no way they're going to participate.
That you could say so without shame proves that all you want to do is take money from some people and give it to others.
> I don't want choice: I just want
> a health service that works.
You imagine these matters aren't contingent. They are.
> But, I know a number of people
> who are in their 20s and decided
> they'd rather have iPods and
> other toys and chance that they
> won't need hospitalization.
We have a guy like that right here on the blog! And he's actually in his late 30's!
(Hi Brian!)
> I am very happy with my
> healthcare in France.
As noted above, some of us think of your arrangement as a gift from the United States taxpayer. Times are getting tight over here.... Good luck Over There.
Crid [cridcridatgmail] at March 23, 2009 4:14 PM
Sorry, I meant "retarded", not "retard". (Always thought that was a loathsome taunt.)
But anyway... I trust y'all to have discerned the satiric intent.
Crid [cridcridatgmail] at March 23, 2009 4:15 PM
To Brian,
You wrote: "If Natasha Richardson had not refused care on site at the time of the accident, she would be alive today. Everyone involved said as much."
I would appreciate the link to information that says or implies that. I don't think her actions killed her, or that she definitely would have lived. Faster treatment might have made a difference.
You wrote: "Andrew - the fact that she had time to get to Manhattan to die kind of puts the lie to your assertion."
That phrase is a strange one. The "kind of" is too weak, and the "puts the lie" seems too strong. Are you accusing me of LYING about an assertion?
Is this my assertion that you mean? (If not, please advise me which one.) Andrew: "I think the lack of quick transportation to a major hospital IS a systemic failure, for a busy ski area."
This is from the above link you gave to me, to
People Magazine:
Did Richardson die in Manhattan?
Technically, yes:
Andrew_M_Garland at March 23, 2009 4:28 PM
Not accusing YOU of lying, accusing the doctors who wish to assign sole blame on Canada's "antiquated medical evacuation system" of prevaricating, if not outright lying.
Lying is a common method used by bureaucrats to get their budgets increased.
And while their evac system played a small part in her demise, her refusal of medical care and the subsequent delay was the largest contributing factor after the knock on the bean.
The times tell the story, Andrew. By the time she got medical attention and got to the hospital, it was three hours after the initial incident. It was a less than three hour trip to Quebec. If she was still alive at 4 PM at the chalet, then she probably would have been alive at 3 PM when she arrived in Montreal.
Like I said - if you are going to make an argument against socialized medicine, there are many to be made. I just thing this is not a hill worth defending.
brian at March 23, 2009 5:34 PM
We have become a nation of weenies. Only a generation or two ago, teenagers would routinely marry. Yes, marry. After 16 parental consent was not needed in most states, but 14 to 16-year-olds had to get it. My firm's outside acct. marriued her BF at 15 -- no big deal in the 1940s in Los Angeles.
In Japan the age of consent is 14. As it should be. Why should the state criminalize the most natural behavior in the world?
i-hole at March 23, 2009 5:42 PM
Because the State is run by morons who never grew up, and figure that everyone is as immature as they are.
Hence the extension of adolescence into the early thirties.
brian at March 23, 2009 8:13 PM
1)To Pseudonym & Radwaste - I was wrong. I'll admit that. There aren't 45 million uninsured people currently in the states, there are actually 46.6 million uninsured people in the states as of 2006 (U.S. Census Bureau. Income, Poverty, and Health Insurance Coveragein the United States: 2005. Suitland, MD: U.S. Census Bureau; 2006.) and the number is expected to rise to 56 million by 2013. And I'm going to hazard a guess that the 10 million uninsured illegal immigrants that were mentioned earlier probably didn't make it into the census data, what with it being an official census and them being people who wish to illegally remain in the states.
2)And the reason that 46.6 million people are uninsured isn't because all 46.6 million people prefer buying ipods and big macs to getting insurance to cover their kids Ventolin (though I admit those who do are an obnoxious minority), it's because of a complex variety reasons, most of which aren't the "fault" of the uninsured person (i.e. Layoffs and difficulty finding new coverage due to risk factors, a change from unionized (and insured) to clerical and service industry (and uninsured) job opportunities, increasing copayment costs). Frankly, as a student with a lovely loan, I would have trouble scraping up 300$ a month for insurance. It's probably because I like eating and sleeping in an apartment and paying tuition too much.
3) For the record, I'd just like to say that my favorite argument against socialized medicine thus far was the vaguely cited example of the German man who was denied surgery because he smoked. This is awesome because a) it's hearsay and SO MANY people smoke in Europe that I sincerely doubt that it's the full story and b)aren't people denied the insurance necessary to pay for cancer drugs if they don't have the insurance to begin with? That's gotta be pretty fatal.
4)I'm actually not a jackass. I just feel really strongly that healthcare should be considered an inalienable human right and that no one should be denied it on any grounds.
5)I reference my work!:
U. Sarpel, B.C. Vladeck, C.M.Divino and P.E. Klotman, "Fact and Fiction: Debunking Myths in the US Healthcare System" Annals of Surgery, Vol. 247:4, April 2008.
I do believe "Annals of Surgery" is a peer reviewed journal. Also, it's not a blog.
Canadian at March 23, 2009 9:50 PM
http://www.city-journal.org/html/13_2_oh_to_be.html
> I'm actually not a jackass. I just
> feel really strongly that
> healthcare should be considered
> an inalienable human right
Well, that suggests a kind of aggressive jack-assedness.
"Healthcare" is an incredibly nuanced and detailed thing. It happens in a particular context that takes generations to put in motion... A context of education and hard work and stability and decency and fulfilled responsibility —including mutually fulfilled responsibilities between the caregivers and the cared-for. Whether the treatment succeeds or whether the time's come for all care to fail, there will be consequences for providing the service.
When you say it "should be considered an inalienable human right", it sounds like you've done some very incomplete arithmetic, relying on fantasy where you ought to be counting on logic.
Yes, good care is a remarkable thing! But so is food, and plenty of people go hungry. So it literacy, but plenty don't read, and a disturbingly large number don't see the point. To simply daydream of a plentiful time where endless expenditures are given to anyone who (in Raddy's excellent phrase) merely draws a breath is to discount the fulfillment of responsibility that occurs when medical care actually goes well.
The entirety of this article is relevant here, but pay attention to the last anecdote in particular.
You don't get brownie points as a decent guy just because you want the little people to have free stuff, or paternalistically dream of managing their protection.
Crid [cridcridatgmail] at March 24, 2009 1:43 AM
Canadian, what remains wrong about your assertions is not a number, but a premise. When you say, "As in 45,000,000 human beings whose access to critical care is dependant on the size of their savings," that just is not true. Fix that.
You've mistaken critical care for maintenance, and for the presence of some magical force to dispel cost.
Some people, again schizophrenic in being completely unable to accept governmental bungling in other areas of performance, imagine that "government" is that magical force.
It's not.
The key to affordable health care is not government, but in making health care cheaper. This means removing everyone possible who is not a doctor or a patient from treatment decisions. Always remember the term, "affordable".
Right now, "insurance" - merely a cost pool, not a prevention measure - costs a bunch and removes much of the decision process from the patient. People put up with this because the current setup allows the use of advanced technology on those who are members of a program; providers put up with this because they can count on being paid.
They could still do that if the patient had a "medical credit card" for routine care.
Radwaste at March 24, 2009 2:32 AM
One more thing, about, "I just feel really strongly that healthcare should be considered an inalienable human right and that no one should be denied it on any grounds.":
Sometimes a fast Internet connection makes people think things are "free". Nothing is.
Radwaste at March 24, 2009 2:42 AM
"If at the start of the venture you tell anyone they're going to "pay more into the scheme than they get back", then there's no way they're going to participate"
Maybe not, but it doesn't make the statement itself untrue. Insurers don't offer policies based on generosity - they're out to make as much money as they can.
Amy may be very happy with Kaiser, but if someone in Kaiser had decided to turn a quick profit on the back of some fancy-looking CDOs, and the organisation had gone down the toilet as a result, where would she be now?
She's fit and healthy, and one assumes that another provider would take her on, but what if that wasn't the case?
Let's assume she had suffered back problems, or had treatment already for Angina through Kaiser. In those circumstances, the chance of a new insurer covering anything related to her heart or spine would be pretty slim.
One heart attack later, and she's STILL paying 3,600 dollars per annum but now she's also got to find the money for the CAT scans, drugs etc on top.
I'd be the last person to pretend that the NHS doesn't have problems, but it was designed as a safety net and it does that job pretty well.
Several of you have commented on the amount of kit (MRI scanners etc) that US hospitals and clinics have in place. You seem to be arguing that this is an example of efficiency and good service. I would suggest it's the opposite. Your system has a lot of built-in waste and redundancy that ours doesn't, and you're paying for that kit one way or another. Ever looked at your bill and wondered why you'd been subjected to a scan, even though your condition probably didn't warrant it? Your insurance company certainly has.
James H at March 24, 2009 4:11 AM
And your system keeps sending people to our country because of a lack of capacity.
When a kid in Malaysia needs some cutting edge surgery to save him from some obscure condition, where does he get sent? Certainly not Canada.
Then you ARE a jackass. Because "universal" healthcare systems are nothing but systems for denying care on arbitrary and capricious grounds.
Look, it's really simple. Any commerce system in which there is no connection between cost and price is going to collapse due to overuse.
Until the actual consumers of medical care start to pay the actual price of care, and have the ability to comparison shop, prices won't come down.
If you make everything look "free", then the emergency rooms will be even more overloaded than they already are with people who can't be bothered to call a GP or go to a walk-in clinic. We see this already in many cities in the US. It's gotten bad enough in London where they've made a rule that once you're in the building a doctor has to see you in four hours. You might want to look in to how well that's worked out.
Which means that you expect ME to cough up that $300 a month for you on top of the $300 I'm coughing up for me.
Not just no. FUCK NO!
brian at March 24, 2009 4:50 AM
Brian - "When a kid in Malaysia needs some cutting edge surgery to save him from some obscure condition, where does he get sent? Certainly not Canada." I don't know about Canada, but sometimes they end up in the UK.
Norman at March 24, 2009 6:30 AM
Only sometimes, Norman.
The bulk of them come here. Why? Because we have the very best medical system in the world.
And if the socialists get their way, that will no longer be true.
I've just got this feeling in my gut that this is how the greens are finally gonna get their population control fantasies fulfilled.
It can't possibly be lost on them that just controlling the number of children born is a piss-poor way of handling population growth. A government-run care-denial system is the perfect way to cull the elderly from the herd before they get too expensive, so that the too-few children being born will actually be able to labor sufficiently to have anything resembling an economy.
Kill your grandparents. FOR THE CHILDREN!
brian at March 24, 2009 6:49 AM
Brian, kids in Malaysia get sent all over the place. They don't only go to the US. Most Western nations have random Malaysian kids or the equivalent in their hospitals. Even Arab sheiks often go to Europe instead.
Also, Brian, people who don't have insurance often end up using the emergency room as their PCP. People who DO have insurance sometimes go to the doctor for every little thing, because they want to get their money's worth.
On a different note, I read an article, I forget where, that said that most insurance companies and hospitals started out as non-profits, and somewhere around the 80s they switched over. That makes a lot of sense to me... the problem with for-profits is there is the tendency to give you as little service for the highest price they can get away with. What do you all think about a non-profit insurance company? Would you sign up?
What I don't understand is why I was paying $135 a month in 2000, and in 2001 I was paying $315, and in 2004 it was over $400... when I was in my 20s the whole time, had no health problems, and LOST weight. The initial jump I can see, I changed states, but why the subsequent jumps? It seems like an awfully steep increase.
NicoleK at March 24, 2009 6:51 AM
>>Brian, kids in Malaysia get sent all over the place. They don't only go to the US. Most Western nations have random Malaysian kids or the equivalent in their hospitals. Even Arab sheiks often go to Europe instead.
Spot on, NicoleK.
Brian is frequently sound on general facts at Amy's (even if he spins hard!). But he is totally out to lunch on several talking points here about "socialized" medicine in Europe (including the one you just explained). It's getting silly.
Jody Tresidder at March 24, 2009 7:08 AM
NicoleK
You never took Econ 101, did you.
On one side, we have the aggregate supply of medical care. The potential growth of this supply is limited by cost, credentials, regulations, and guilds.
On the other side, we have the aggregate demand for medical care. This is potentially infinite, as all demands are.
In a market system, prices are an indicator of relative availability of a resource. When's the last time you asked your doctor for a quote on a procedure? Do you even know the true cost of that last prescription you picked up?
If you have typical insurance, the answer is "no".
So what we have here is the classic case of too many dollars chasing too few goods. And you get inflation.
The cost of insurance is a proxy for this, but a poor proxy because the bulk of people with insurance don't even know how much they are paying for that!
And that's why your health insurance premiums go up at 3-10 times the rate of general inflation.
There is no scenario in which a government-run healthcare system improves this. The only thing it does is take away your ability to purchase care with your own cash when the government decides you're too expensive to care for.
HMO's are just one step removed from government-run health care. An organized system where care is denied to people based upon some bureaucrat's idea of who is worth saving.
I can think of no situation in which a government-run single-payer health care system is an improvement over what we have now.
The only way forward is complete transparency.
Jody - Please show me where uncooked statistics show any socialized health-care system to be superior to our not-even-remotely-free-market system. Statistics for infant mortality that leave out preemies and for life expectancy that leave out accidental and criminal deaths don't count.
brian at March 24, 2009 7:45 AM
>>Jody - Please show me where uncooked statistics show any socialized health-care system to be superior to our not-even-remotely-free-market system.
Brian,
Seriously - what's the point, oh wise cooking mentor:)
If I serve you "raw" data, you'll skewer them - then grill me.
If I serve you statistics that have been lightly marinated in my liberal juices, you'll declare them unpalatable.
Either way, I'll get roasted!
(And I'll probably fuck up a decimal point or three along the way!)
And, anyway, I did NOT claim one system is "superior" to another, and you know it. That substitution is NOT one I'll swallow!
Jody Tresidder at March 24, 2009 8:23 AM
"But he is totally out to lunch on several talking points here about "socialized" medicine in Europe (including the one you just explained). It's getting silly."
Perhaps Brian's Doctor is handing on some of the kickbacks she's just received from the Pfizer/A.N.Other pharmaceutical company Rep.
Maybe they're just handing out free samples of the product.
Either way, I like to know that my clinicians aren't prescribing unnecessary med's to me just because they'll get an extra crate of Scotch at Christmas for doing so.
Get rid of the venality and greed from private healthcare systems and you might have a system that benefits the policy-holders. As it stands, everyone from the insurer to the clinician has a stake in extracting the maximum amount of money from you whilst keeping their respective cost bases as low as possible.
That would be fine if they could show that their system worked better than ours, but infant mortality in the US is 6.3 deaths per 1000 whilst that of Canada and the UK is 4.8/1000. Sweden's is 3.2/1000.
Overall life expectancy in the States is lower than ours too (admittedly only slightly) at 78.06, against the UK's 78.7 years.
So we're less likely to die as a child, and we'll live longer overall. Hmm...
As for the argument that socialised medical systems don't innovate (a point made earlier in this thread), I'd ask you to remind me which country carried out the first full-face transplant? Which country carried out the first double arm transplant? Which country 'grew' the first test-tube baby?
The US has undoubtedly contributed a great deal to medicine, but it's not the only country that does. All three examples above are from different countries - all European, all operating under socialised medical systems.
James H at March 24, 2009 8:43 AM
You may not have explicitly made the claim, but you have advocated for centrally-managed single-payer health care. In the face of all the evidence that shows it to be absolutely useless.
Although I'm not willing to concede the point that there's a health-care crisis in the United States, for sake of argument, let's stipulate that such is the case.
What, therefore, should be done? Should we (a) try a system that has shown to be a failure everywhere it has ever been tried, or (b) try something new that might have a chance at working?
If you said (a), then you're letting ideology color your perspective. I've not heard a serious argument that socialized medicine is superior to the present hodge-podge that makes up the American medical landscape. Most of the arguments are of the class "well, sure it sucks, but everyone gets some". Gee, I think I'll have a plate of suck. NOT!
We know what things about the American experiments have failed. The primary thing being the idea of a central payment clearinghouse that hides the true costs of care from the consumer while simultaneously trying to force the prices of said care down by fiat.
The end result of that has been a decline in the number of doctors, doctors not taking new patients, and the cost and availability of care going in what most consider to be the "wrong" direction.
All a government system does is change the price forcing from semi-voluntary (i.e. the doctor can refuse patients who use a particularly odious insurance carrier) to compulsory. You will be paid $X and you will perform the procedure, or you will not be a doctor any more.
Tell me how that's an improvement.
In case you hadn't guessed, I'm an anti-Kenyesian. I'm a supply-sider, Chicago school of economics style.
If you want the price of medical care to come down, you need to increase the supply. The only way to do that is to make it worth while for someone to go to school for a dozen years, endure residency and internship, and undergo stringent licensing tests. You don't do that by holding a gun to someone's head and saying "You're going to be a doctor."
You do that by making it lucrative. And that is best done by having as few steps between producer and consumer as possible.
brian at March 24, 2009 8:51 AM
Cooked statistics. Europeans don't count preemies that die within X number of hours (24 I believe is the UK standard) as "live births". You draw one breath and die in the US and you get a birth certificate and a death certificate.
The US has a higher incidence of death from criminal activity, which is hardly a medical concern. We also have higher accidental death rates.
Let's look at REAL statistics that measure quality of care, shall we?
Like expected lifespan after cancer treatment, recovery after diagnosis of heart disease, etc.
I've already linked stats on those and others in the last argument we had here about this.
James, you need to understand that greed, for lack of a better word, is GOOD. Remove the, as you put it "venality and greed" from the system, and you get nothing at all. What motivation is there for a man to become a doctor when he can make better money and get more respect as a plumber with far less schooling?
brian at March 24, 2009 8:57 AM
>>What motivation is there for a man to become a doctor when he can make better money and get more respect as a plumber with far less schooling?
Brian,
That sentence is pathetic. Seriously.
It's just hyped up republican mumbling dripping with slanted suppositions, rhetorical whiffle and - atypical, for you - total gas baggery.
I'm outta here before I get any more British and wanky myself.
Jody Tresidder at March 24, 2009 9:04 AM
"You may not have explicitly made the claim, but you have advocated for centrally-managed single-payer health care. In the face of all the evidence that shows it to be absolutely useless."
What evidence? Which countries?
You haven't produced any evidence that "centrally-managed single-payer" systems are "absolutely useless."
All you (and Amy) have done is point up a few cases where the system hasn't worked well. I can (and have) pointed out a few similar examples that apply to private systems.
Doctors are well-rewarded as is. I would like them to be a little more focused on what will make me better, and a little less focused on what will make their wallets fatter.
Medicine has to be a vocation as well as a career, otherwise you end up with more of the types of quacks that will perform Octo-Mum style procedures, or 'endow' women with triple G breast impants (and to hell with the medical consequences of doing so).
James H at March 24, 2009 9:11 AM
James -
I give you Canada. A country where supply has been so constrained that THEY ANNUALLY SPEND 2 BILLION DOLLARS SENDING PEOPLE TO ANOTHER COUNTRY FOR CARE.
What part of that doesn't get through your thick mother fucking head?
Centrally-managed systems ALWAYS ALWAYS ALWAYS result in rationing.
You don't find that to be a problem, because at least EVERYONE gets fucked a little.
I find a system that has as its control factor the intentional harming of another person to be a Bad Thing.
Where I live, there are very few independent GPs any more. You know why? Costs. They have to pay astronomical amounts of money for malpractice insurance on account of over litigiousness. They have insane clerical overhead thanks to insurance companies and government regulations (google HIPAA). They get a break on both if they pool resources, so now you have some number of doctors operating in a shared practice. And with doctors pooling resources, they also end up sharing patients, so now you might have to wait to get your preferred doctor.
This isn't going to get better if we replace the HMOs with government, or if the government just mandates that everyone join and pay an HMO with the government kicking in to pay for those who can't afford it.
Just saying "Well, they'll all have access" isn't good enough. I don't think that giving everyone access to mediocre care is a suitable solution. Especially since I know that a far superior alternative exists. I also know that it won't be tried because it will take too much power and money out of government hands, and they don't like that much.
brian at March 24, 2009 9:25 AM
Canadian doctor salary (GP) average C$ 101,752.
Here.
Canadian plumbers don't get paid shit.
And I'm thinking that the numbers for that are "employees", because my plumber doesn't charge me $23 an hour.
But even Canada realizes that their supply problems come from not making the money. A good number of Canadian doctors practice in the US for that reason.
And you want to take that away in the name of fair access.
If you make the US medical system more like Canada's, where will the Canadians go for their care?
If you won't think of the Americans, won't you at least think of the Canadians.
Enough of this. I need to work.
brian at March 24, 2009 9:32 AM
"What part of that doesn't get through your thick mother fucking head?"
Go fuck yourself Brian. I am BRITISH. Not Canadian and not (thank fuck for the accidents of birth) a septic like you.
The Canadian system is, I am sure, a good example of a poorly run socialised care system. A lot of their problems stem from having a large landmass containing a very small population. Their system wouldn't be any better for them if it were privatised, as no private GP is going to want to work where he or she can't make a shit-load of cash, which would pretty much rule out coverage of 98.9% of Canada's landmass.
The venality inheritant in your system is what causes an awful lot of your system's problems. You pay 4x the rate that any other civilised country does for its drugs because your corrupt drug companies bribed your corrupt politicians to make it that way. They enacted primary legislation to do it.
Nothing to do with Canada, nothing to do with Europe - they're problems that YOUR country created for itself.
You don't like socialised medicine? - that's fine. Just try getting your big drug companies and large medical corporations to accept the kinds of changes that you want to make. They won't - I know it.
Why do I know it? Because THEY could change the system in a heartbeat (pardon the pun) by flexing their economic/lobbying muscle to get the legislation enacted.
Now ask yourself why they haven't and won't?
James H at March 24, 2009 9:44 AM
"inheritant" - inherant.
I also looked at the links for the infant mortality rates you left above.
It's unfortunate that the Dr that wrote the article didn't look more closely at how the WHO reports their statistics.
They factor in the differences in reporting standards before they publish.
James H at March 24, 2009 9:51 AM
Septic?
You limey bastard! You do understand that the only reason you and the Continentals (and the Canadians) even have the ability to try out this "Social Democracy" bullshit is because after World War II we were so sick of fighting Europe's wars that we offered to defend you at our expense from the USSR.
And the real reason we pay so much for medicine here?
Canada and other countries that have passed price controls. Now, maybe it's just me, but if I was Merck or Pfizer, I would tell Canada to go piss up a rope. Pay what the drug is worth, or no pills for you. But they sell the drugs - at or below cost in some cases - to the Canadians, and then make it up here where as I believe I mentioned the fucking costs are completely hidden from the average insurance-carrying twit.
To your final point, if people actually paid attention to what their politicians were doing, we wouldn't have had a housing bubble and subsequent collapse of the financial markets. That wasn't the result of greedy bankers operating in a vacuum. It was all orchestrated by the Congress of the United States of America.
We get shafted not because drug companies buy off Senators, but because senators can be bought. If those assholes in DC want to pass salary caps, they should start with themselves.
brian at March 24, 2009 10:12 AM
"If those assholes in DC want to pass salary caps, they should start with themselves"
Well we've finally found something to agree on (on this thread at least). There are enough assholes on both sides of the House (on both sides of the pond) to keep a good proctologist in clover for the rest of his or her life.
Whether you'd get the already apathetic to do something more constructive than whinge, even IF they were paying out of their own pocket, is debateable though.
Chin up though eh?!
James H at March 24, 2009 10:35 AM
It's funny how it's always Americans who are so eager to tell you why Canada's health care system stinks and it's always Canadians who are eager to tell you why the US system sucks....
The Cdn system is cheaper on a per capita basis (as a share of GDP - look it up); it works for me; it works for my family; and you never risk losing your health care just because the economy goes south.
So if you are afraid of the scary ol' S-word (socialism...shudder...how many who hate that word to their very core could even define it properly? It's like the great American shibboleth -- if you can say socialism without turning pale you ain't an american) then stick with your perfect system. No skin of my back...
scott at March 24, 2009 11:31 AM
Scott - nothing could be further from the truth.
When government receipts go down, rationing gets tighter, lines get longer, and treatments get abandoned.
And if you want to know why Americans are (rightly) anti-socialist and anti-communist, one of our founders summed it up nicely:
The government that is powerful enough to give you everything you want, is powerful enough to take everything you have.
brian at March 24, 2009 11:57 AM
Brian, your government is more than powerful enough to convince all of us that you never existed in the first place. And you still don't get health care.
"When government receipts go down, rationing gets tighter, lines get longer, and treatments get abandoned." This is some pseudo-economics and it doesn't hold in the Canadian health care context. Tax receipts may be off but transfers from the feds (who have to pay for the lion's share) to the provinces (who are the actual "Single User" and are actually responsible for providing the services) under the Canada Health Act are legislated and highly political. No politician will touch those. In fact, health transfers have been rising as a percentage of overall federal expenditures/transfer payments since...forever? (But so what? That doesn't mean it doesn't work. US defense spending has the same arc and I'd say the US is reasonably secure in the world.)
An aging population and the associated increased demands on the health system, together with a shortage of family doctors (note, not ALL types of doctors, but family doctors, which redirects patients with minor problems to general purpose facilities like hospital emergency rooms) are responsible for longer lines. There are a lot of possible solutions within the socialized model to fix these issues.
scott at March 24, 2009 12:46 PM
Scott -
Your model works right up until it doesn't.
It hits the wall when people start demanding more expensive treatments that Americans presently get. It hits another wall when the Canadian equivalent of the Federal Reserve can no longer print money to pay for services. It hits yet another wall when you hit the demographic tipping point of more people taking money out of the system than putting money in.
Socialism works, temporarily.
I'm interested in a long-term solution. Sustainable, if you will.
Your federal government and mine are both limited by the same thing - a finite number of taxpayers to fleece, and no place to go to get more money when the taxpayers run dry.
And when there's no more money to pay for services or to add capacity, what happens? Well, if you're Canadian, you go to the US.
If the US has gone to a similar system, you go to where, India?
You don't want to see the limitations inherent in the system because you view it as a point of personal pride that your nation is somehow superior to mine by virtue of having the government finance health care.
If the United States did not exist, or had the same health care regime as Canada, that woman from Alberta would have had four dead kids instead of four live ones.
Think about that before you advocate for socialism.
Socialism is a failure. Everywhere it has been tried, it has ultimately failed. Mao killed 40 million people, and China's still going capitalist. Stalin killed tens of millions. Socialism failed.
And now we're starting to hear the same arguments here that Stalin used. Only we're calling our bank executives "kulaks" instead of the farmers.
brian at March 24, 2009 1:02 PM
Brian...where to begin...?
"It hits the wall when people start demanding more expensive treatments that Americans presently get." Well that's been happening for ever and yet here we are, still plodding happily along with our sui generis system, and scarcely a mob to be seen on the lawns of Parliament demanding free rhinoplasty and post-stomach stapling skin tucks. But, you know, maybe next week...
"It hits another wall when the Canadian equivalent of the Federal Reserve can no longer print money to pay for services." It's called the Bank of Canada and it hasn't had to print money to pay for services in a long time. We've been in budget surplus here since the mid-90s. We're forecasting deficits for the next couple years to compensate for the economic implosion of our most important export market, but the numbers involved are still of a size that can be conceptualized (like, billions with a B) and our largest creditors aren't yet begging us to stop printing t-bills.
"It hits yet another wall when you hit the demographic tipping point of more people taking money out of the system than putting money in." Fair enough. I mentioned demographics as well. It's a challenge for all western countries irrespective of your medical system. There's a lot of aging and soon to be decrepit boomers out there waiting impatiently to retire to the waiting rooms of our nation's hospitals and hospices. But this too shall pass...
"Your federal government and mine are both limited by the same thing - a finite number of taxpayers to fleece, and no place to go to get more money when the taxpayers run dry." The enthusiasm with which said governments have embraced deficit financing (primarily funded from overseas sovereign creditors) suggests that this is not actually the case.
"And when there's no more money to pay for services or to add capacity, what happens? Well, if you're Canadian, you go to the US." Guess what, it's not free for Canadians to get health care in the US. It's more expensive to our system to send people there. But because we have wait time guarantees in this country, people are entitled to go south of the border to receive service in a timely manner if such service cannot be provided in Cda. (Or if the demand for a given service is too low in Cda to justify the front-end investment -- for instance, very rare disorders.) It's actually more expensive that way, but it also serves as a pressure-release valve on our system and provides revenue to yours. So what exactly is the problem?
"You don't want to see the limitations inherent in the system because you view it as a point of personal pride that your nation is somehow superior to mine by virtue of having the government finance health care." You shouldn't make comments about people's motivations because you can't prove it either way. And in this case, you are wrong. I said keep your system or don't, I don't care, but I don't want our system to change because it works for me and my family very well. All systems have limitations; we live in a finite world.
"Socialism is a failure. Everywhere it has been tried, it has ultimately failed. Mao killed 40 million people, and China's still going capitalist. Stalin killed tens of millions. Socialism failed." Both the examples you cite are communist and not socialist. I know the USSR called itself a union of socialist republics but names can be deceiving. Canada calls itself a Confederation and we are very much a federation. (look 'em all up if you want to know the differences.) Various types of socialism are working fine -- see: virtually all OECD countries.
And, I'm not piling on the US here, you guys are alright by me. But the US isn't exactly a perfectly open market either, it's just that the benefits are too often directed at small groups instead of the whole (see: US cotton farming, subsidies provided thereto).
scott at March 24, 2009 1:39 PM
Scott -
China's not interested in buying more debt, so deficit financing is probably coming to an end whether we want it to or not.
And the problem with what the left in this country wants to do is that the pressure relief valve your nation so often takes advantage of will be gone.
Socialism and Communism are two sides of the same coin. Both are systems that ultimately need to be propped up by force. What OECD countries have is "Social Democracy" which is not quite either. It's more of a really expensive club. Socialism and Communism involve the state telling you what to do and where and when. That level of coercion doesn't exist in the UK yet.
And you're correct, the US isn't an open market. I want it to be, however. I am firmly against all subsidies, as they distort the apparent value of whatever they support. If the US didn't have corn subsidies, we wouldn't be using high-fructose corn sweeteners, for one example.
There is no system for delivering medical care that will please everyone save Jesus personally laying on hands to cure everyone. And that's not likely to happen.
I know the limitations of the socialist model, and I don't like them. Those limitations don't appear in a truly open market solution.
Insurance is supposed to be about mitigating risk for uncommon occurrences. What we have here instead is a cost-spreading scheme to take the costs of standard maintenance and pass them off to others.
And whether that's done by the government or by HMOs, it distorts the market because the costs and the demand are divorced. You get overdemand/undersupply, and everything goes wonky.
brian at March 24, 2009 2:02 PM
"What OECD countries have is "Social Democracy"."
Ok, true about social democracy but isn't that what we are talking about here? I thought I was using the shorthand for this thread. We're not talking about the US importing Albania's health care system; we are talking about a soc/dem model.
Are you really worried about the US becoming literally a socialist country?? As opposed to soc/dem?? Cause if so, you can totally relax. It's not going to happen. If you pull as hard left as Cda (which ain't too far left frankly) in the next fifty years it will be utterly shocking.
"There is no system for delivering medical care that will please everyone save Jesus personally laying on hands to cure everyone."
LOL. Well I do like to end on a concilliatory note and now there's a statement I can agree with.
scott at March 24, 2009 2:31 PM
It would make this blog a lot easier to understand if everyone posted the name of their country at the start. Oops, I should have said:
(Scotland, UK) It would make this blog a lot easier to understand if everyone posted the name of their country at the start.
Norman at March 24, 2009 3:21 PM
I'm worried about America becoming a socialist nation, yes. With people in government openly talking about nationalizing industries, it's a concern.
I'm also worried about America becoming a social democracy. We're already most of the way there. A few more tweaks to the tax code, and we will effectively be a kleptocracy - where fewer than 50% of the population are actually contributing financially. Once we hit that tipping point, any realistic fiscal reform becomes impossible outside of a general strike.
And the John Galt movement is forming in this country.
brian at March 24, 2009 3:27 PM
Well, a Canadian friend who lives in America but is back in Canada visiting his sick mother just sent me this:
Amy Alkon at March 25, 2009 8:54 AM
Amy -- aren't you the person who coined the clever phrase "the plural of anecdote is not data"? If not, I've been citing you incorrectly.
scott at March 26, 2009 1:32 PM
"An unknown number of people choose to spend their money on toys instead of health care." That's way oversimplifying and definitely overgeneralizing. I'll just use the example I deal with day to day. I work in building management so I work closely with custodial. Supervisors (one day and one night) make roughly what I do; the bulk, thousands per year less. The company who holds the custodial contract in our building does "offer" health insurance. For $600 a month. Janitors not electing this insurance are not opting for toys instead; they are opting to be able to pay rent, buy food and pay the heat bill and buy a bus pass. Most of them do not own a car. They cannot afford to. Yet the good old US of A assumes they can pay $600 a month on medical needs?
"I pay $52 per month for health care here in British Columbia...I'd have to try to find a personal GP, which is exceedingly difficult these days. Another option would be to walk into a local clinic which operates with a pool of doctors in rotation. My third option would be to walk into the Emergency of any local hospital. In the latter two cases you're guaranteed a multi-hour wait (note: 4 - 10 hrs isn't unheard of) almost all the time. Even with a personal GP you usually still have to wait." Sounds exactly like my health insurance. And, for all of you who missed it, I can afford my employer-provided health insurance. I don't even want to think what I'd pay for privately bought at my age in my poor health.
As for the claims about any ER has to treat you whether you can afford it or not. Several arguments with that argument against doing something about our flawed healthcare system here in the US. First of all -- and most glaringly -- it's exactly the same kind of socialism you're arguing against when you argue against national health care. Secondly, it's true as to the immediate rushed to the hospital in the ambulence sense but not true thereafter. Any follow-up care has to be paid for. And, if you have any job at all or even no job, they can still come after you for the bill, including garnishing your pay no matter how meager and putting liens against bank accounts, tax refunds, etc. I know people who can't open a checking account for the liens immediately taken out of them so that they'll be emptied out by someone they owe as soon as any money is put in. They don't fill your scripts. They don't even care about how you get home from the hospital. When I couldn't walk, it was go home on the bus. If I hadn't been able to find someone (in the middle of the work day) to drive me home, I'd have had to choose between sitting in their waiting room until I could walk or trying to crawl to the bus stop, onto a bus, then the two blocks home from the stop.
I'm sorry but I think Amy and others are being delusional about optional insurance. If Amy did have that heart attack, I think she'd find her rates would go up. In fact, I do remember her being worried about her coverage thanks to those assholes at BofA. 20-some years of paying on time and they were threatening to cut her off if one monthly payment wasn't received by a certain day. Fortunately, she got it there and didn't need it but if she had missed the date due through no fault of her own due to BofA and had a heart attack or something (she does not seem like prime heart attack material but nothing's guaranteed that's why she puts such a high priority on her health insurance), she'd be screwed and that's fair how? Frankly, after reading that, if I ever do get private insurance, I'll never go with Kaiser who I don't choose anyway because you have to go to their facility instead of choosing your own doctor. And I note that her monthly premium has risen quite dramatically since her 20's. Unless she's had some major illness or injury she hasn't shared with us, they're raising her rates despite not having had major use of the coverage. Wonder what she'd now be paying if she had.
I really think the solution lies somewhere in between. We keep arguing socialized versus private insurance but the ideal solution should be something else. Not sure what but something affordable even to the working poor.
T's Grammy at March 27, 2009 11:16 AM
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