Obamacare's Russian Grandfather
Yuri N. Maltsev writes at Mises about what Soviet medicine teaches us:
These goals were similar to the ones declared by Mr. Obama and Ms. Pelosi -- attractive and humane goals of universal coverage and low costs. What's not to like?The system had many decades to work, but widespread apathy and low quality of work paralyzed the healthcare system. In the depths of the socialist experiment, healthcare institutions in Russia were at least a hundred years behind the average US level. Moreover, the filth, odors, cats roaming the halls, drunken medical personnel, and absence of soap and cleaning supplies added to an overall impression of hopelessness and frustration that paralyzed the system. According to official Russian estimates, 78 percent of all AIDS victims in Russia contracted the virus through dirty needles or HIV-tainted blood in the state-run hospitals.
Irresponsibility, expressed by the popular Russian saying "They pretend they are paying us and we pretend we are working," resulted in appalling quality of service, widespread corruption, and extensive loss of life. My friend, a famous neurosurgeon in today's Russia, received a monthly salary of 150 rubles -- one-third of the average bus driver's salary.
...Not surprisingly, government bureaucrats and Communist Party officials, as early as 1921 (three years after Lenin's socialization of medicine), realized that the egalitarian system of healthcare was good only for their personal interest as providers, managers, and rationers -- but not as private users of the system.
So, as in all countries with socialized medicine, a two-tier system was created: one for the "gray masses" and the other, with a completely different level of service, for the bureaucrats and their intellectual servants. In the USSR, it was often the case that while workers and peasants were dying in the state hospitals, the medicine and equipment that could save their lives was sitting unused in the nomenklatura system.
...Socialized medical systems have not served to raise general health or living standards anywhere. In fact, both analytical reasoning and empirical evidence point to the opposite conclusion. But the dismal failure of socialized medicine to raise people's health and longevity has not affected its appeal for politicians, administrators, and their intellectual servants in search of absolute power and total control.
It's crony communism -- which is kind of how all communism turns out.
Oh, and something to remember:
I should make it clear that the United States has one of the highest rates of the industrialized world only because it counts all dead infants, including premature babies, which is where most of the fatalities occur.Most countries do not count premature-infant deaths. Some don't count any deaths that occur in the first 72 hours. Some countries don't even count any deaths from the first two weeks of life. In Cuba, which boasts a very low infant-mortality rate, infants are only registered when they are several months old, thereby leaving out of the official statistics all infant deaths that take place within the first several months of life.
> Most countries do not count premature-infant deaths. Some don't count any deaths that occur in the first 72 hours. Some countries don't even count any deaths from the first two weeks of life. In Cuba, which boasts a very low infant-mortality rate, infants are only registered when they are several months old, thereby leaving out of the official statistics all infant deaths that take place within the first several months of life.
The more I read about cross-country data collection, the more I realize that the topic is deeply deeply fraught with problems.
There are careful researchers and good studies, of course, but it's stunningly easy to go far down a road and not realize that all of your data analysis is flawed because - at root - you're comparing apples to oranges.
I read once that part of the reason that Japan has such a low murder rate and such a high suicide rate is that when a men despairs about his job and kills his wife, then himself, this is marked as two suicides. I'm not sure if that's still true, but even if it has changed, the point remains: it's all too easy to pick up some statistics and use them without asking really stupid naive questions - because we're all so deeply embedded in our own cultures that it doesn't even occur to us that something simple might be done differently.
From statistics about meat consumption per person (which ignore the fact that in country X everyone raises and slaughters their own chickens, which don't show up in any official figures) to high school graduation rates (which ignore the fact that in country Y there is a two-track system with trade schools) to infant mortality (which ignore details you note above), and on and on and on, it's REALLY hard to get these things right.
In the end, sometimes numbers just aren't commensurable, no matter how much tweaking you're willing to do. If country Q lumps rape and assaults together into a single crime figure, it might be effectively impossible to tease them apart and compare them to country R.
TJIC at June 26, 2012 7:49 AM
Do not spread fishy rumors, you are nearing thoughtcrime:
http://blog.ivman.com/wp-content/FishyRumors.jpg
Stinky the Clown at June 26, 2012 9:09 AM
I'm not sure I see the similarity between Obamacare and Soviet Health Care.
I grew up as a Kaiser Kid in which my health care was pretty much free, and paid for by one of the biggest capitalists of the 20th century, who understood that having healthy workers meant more productivity and ultimately profit for him.
And the health care was uniformly top quality for everyone and had well cared for patients and near as I could tell very happy doctors and nurses (as could be measured by the low turnover).
There are aspects of Obamacare I dislike (the individual mandate, the role of insurance companies, and the tie-in to employers) but it seems just as reasonable, if not more so, to compare Obamacare to the health care system of Henry J. Kaiser than it does to the Soviet system of medicine.
jerry at June 26, 2012 10:22 AM
definition of socialism incorporates two criteria: The first is that socialism entails the public provision of non-public goods. The second is the use of central planning to implement that policy. Obamcare is socialist, Kaiser isn't, as he paid for it from non-public money.
Stinky the Clown at June 26, 2012 11:10 AM
Furthermore, Obamacare cannot work without the individual mandate.
The role of the insurance companies and employers is simply to keep the costs hidden until the ultimate collapse of the semi-private health care system Obamacare creates so that it can be replaced with a full-blown single-payer government-run socialized health care system which will be uniformly awful for everyone.
But at least we'll finally be equal.
brian at June 26, 2012 2:21 PM
>>which will be uniformly awful for everyone.
Except for our government overlords who will deem it necessary that their healthcare be better, "For the good of the nation."
Assholio at June 26, 2012 3:18 PM
brian & Assholio both hit the bullseye. Govt overloards (the "nomenklutura" in academic jargon) ALWAYS live better. Witness the long line of lefty Presidents& D.C. bureaucrats/cabinet officers(of which Clinton and Obama are just the most prominent) swearing allegiance to public education who send/sent their little darlin's to the most expensive, exclusive, finest private schools available citing their "special needs" Right.. While simultaneously dooming working blacks to see their children atrophy in failing public schools because voucher programs that would allow them to escape are killed by the left in the name of the very people who would be helped by the flexiblity & choice vouchers provide. Obamacare will be NO different. Remember the female Canadian MP who was a steadfast defender (and designer)of their Nat Healthcare system who flew to LA within hours of being diagnosed with breast cancer in order to get proper & timely treatment--leaving not so fortunate fellow Canadians to languish on the treatment waiting lists? Whaat??? Obamacare a two-tier system? Nobody here but us chickens!
virgil xenophon at June 26, 2012 4:26 PM
If they had changed the law, so that if you self-pay and don't use your employer's insurance you got a tax credit of X% of your income up to $x max, you would see so many advertisements for private health insurance on TV that Geico, Aflac and Progressive would not have a chance to advertise.
That they didn't go to the free market system, tells me they are about control more than healthcare.
A government that respects your liberty encourages you to make the right decision but allows you to fail. A government that doesn't respect your liberty makes you ask permission for your liberty.
We're about 36 hours out from the SCOTUS decision at this point. I hope it is a full dump.
Jim P. at June 26, 2012 6:35 PM
Health care for Canadians is also two-tiered (as it is for Europeans with socialist health care systems): one tier for ordinary Canadians, called the Canadian health care system; and another tier for politicians, high level government officials and the wealthy, called the American health care system.
I've worked in six different hospitals in the Pacific Northwest over the past 16 years. There were Canadian patients in all of them on every day that I went to work. The first two patients I ever took care of, while I was still in college, were both Canadians. They were there to have surgery that was life saving, that was not available to them in Canada, or not available soon enough to save their lives.
I've read surveys in which people in different countries were asked how satisfied they were with their health care systems. The results were compared to the responses of Americans who were generally less satisfied with the health care they get here.
But the fact is, people who've grown up in countries with government controlled, socialist health care systems have no idea what excellent, state of the art health care is... except for the hundreds of thousands of Europeans, Asians, Latin Americans and Canadians who are rich enough to come to the U.S.A. for health care when they really need it.
And most Americans who've grown up in this country that spends more per person on health care than any other country, have no idea how backward, inefficient, underfunded and inaccessible government controlled, socialist health care systems can be, especially when the rich and powerful can get their health care somewhere else.
Ken R at June 27, 2012 5:06 AM
It's pretty ridiculous to compare socialized medicine in 1st world countries to the communist medical system; and Obamacare doesn't even meet that bar (it isn’t a single payer system).
If the writer were to do an honest comparison he would compare the system we have in place in the U.S. with socialized medicine in Europe; With special attention being paid to the healthcare system in the England. Which considering the similarities in our governments, economy, and culture would present a reasonable point of comparison. If he would have done that he would have found that European countries similar to ours with socialized medicine: pay less for healthcare, have better outcomes, and their citizens overwhelmingly support the healthcare system that they have in place.
This isn’t to say that I think socialized medicine is the right answer for the United States, only that we should have an honest debate instead of using misleading hyperbole.
As a side note I have received care under: the civilian U.S. system; Socialized medicine provided by the U.S. government (military healthcare & V.A. healthcare); European socialized medical treatment (both Spanish & Italian healthcare); and for a couple of months I was on Medicaid which is similar to the Canadian system (the government paying for healthcare that the private sector provides).
I have to say that the healthcare provided by the European socialist system was: fast, efficient, provided good quality care, and was less expensive (yes I paid more than the sticker price for it though taxes). From what I have seen the quality of care under socialized medicine over there was basically the same as it is here, and I got to see a doctor much faster and easier. Granted I didn’t have any major surgery or anything, but from what I could see their healthcare system is quite good.
On the other hand the worst quality of care I have received is from U.S. socialized medicine (medical care provided directly by the government via the U.S. military). To me this may suggest that although other countries can be good at providing healthcare though the government; the U.S. government may be bad at it. Or these programs may just be underfunded. I’m not sure which is the case. Medical care though Medicaid was equal to medical care under the civilian U.S. healthcare system.
These are just my personal experiences, but the care I received under 1st world “socialized” medical systems is much different than the claims I’ve been hearing about the quality of care from conservative pundants.
Mike Hunter at June 27, 2012 9:49 AM
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