oh wow

Krugman weighs in on health care.

Why don’t you throw in Ira Magaziner as well?

Evan:

The goal of a health care system is to tend to the health needs of the community. However, health care systems do not operate on goodwill alone. The greatest problem is providing health care at an affordable price.

You might be falling victim to the “health care is a right” illusion, or you don’t grasp the idea of economics — whichever it is, what is your supposed goal of the health care system?

Has anyone ever asked George Bush whether he views health insurance (or all Republicans) as a carrot to get people to work?

I must be in a cynical mood this morning, because it seems that some policy decisions favoring our current healthcare/healthcare insurance system are designed with this as a central tenet.

Thats the inherent problem with pandering to the “health care is a right” crowd. It seems like a noble idea and everything, but it is just not feasible. Plain and simple: not feasible, not logical, not a good idea. Canada is the perfect example. Their health care system embraces all these noble ideas, and it is a complete flop. They recently had to pass legislation fining physicians and patients $20,000 for health care outside of the national network. You don’t have choices in a system like that. Over 35 and need a new liver: SOL in the national network, or pay an additional 40k as well as criminal charges for getting a new liver outside the national network.

I have said before that I believe the system should provide a low-level net of guaranteed support to all Americans concerning public health issues (vaccines, flu shots, education about health), but that the patient should be responsible for anything else. We have to draw a line somewhere, else we end up like Canada.

Health care advances are great, but just because they exist does not mean everyone is entitled to them. Should the government (taxpayers) be forced to shoulder the burden of $50,000 treatments? When the government decides it can only spend $X per year on health care, rationing ensues. What happened to providing for the health needs of the community? “Sorry, looks like you’ll have to wait 9 months for that hip replacement ma’am.”"Sorry, the government says that you’re over 35 and we can’t give you a kidney transplant, maybe you’ll live long enough to see your son graduate high school.”

Faced with scenarios like this, is it really in the best interests of the patients to switch to a national health care system?

Based on levels of thinking, you’re operating around the 2nd level. Also, you apparently don’t think preventative medicine has any bearing on community health…OK, doesn’t make sense, but OK.

You point out that countries with an economy 1/3 as strong as ours provide health care for free to their citizens. Yes, they do provide universal health care, point not debated. Now, rise up to the 3rd level of thinking, and inspect the health care systems. They are weak, wasteful systems which do not provide as much as you would like to believe. Again, look at Canada. They have a national health care system, its relatively inexpensive compared to ours. But you have to wait 2 months to see a PCP, 4 months to see a specialist, 4 months to undergo surgery, if you’re over 35 you can’t get an organ transplant, etc. etc.

This is the situation you face with nationalized health care: a broken, wholly ineffective system. In free-market systems you can get a hip replacement surgery within weeks. It takes 9 months in systems like Canada’s.

To go over the simple economic theory associated with it: health care costs money. There is no ceiling on how much is spent on health care, it is not something that you can “estimate” and fit into budget. Lets say the government decides to pay for everything. Cost is nothing to the subscriber (citizen) now. Patients go to the doctor for anything, lets say for arguments sake when they have a sore back, “just in case”. Doctors, even knowing its BS, but at the demand of the patient and not wanting to risk lawsuits, order an X-ray. As suspected, everything is ok, its just a pulled muscle, doc prescribes tylenol. The whole scenario was an expensive process, topping $1500. What does the patient care though? They’re not paying for it, the government is! Throw cases like that together, and the health care system triples in its cost the first year alone. (You may dismiss this as an unlikely scenario, but this is quite common. Look at the explosive cost of Medicare over the past 40 years).

So after year one, health care costs have tripled. The nation can’t afford that! You can’t just pass off trillions in expenses to taxpayers. So with their budget, the government is forced to ration the health care system and cut reimbursements to physicians. They become a national HMO, deciding who will go see a doctor, how quickly they can see that doctor, and if the government will pay for that operation they need. Physicians, forced into making 50k a year after 10 years of training, say “screw it” and find work where they can make more money and their talents are appreciated. No student is going to put themselves $200k in debt just to make $50k a year…so you face a shortage in physicians, and the “best and brightest” drop medicine because it is a poor career choice. Ever wonder why theres not a lot of foreign medical schools; why the most innovative medical research is done in the states?

So this is the great illusion of national health care. Sure, you can say the government will pay for everything, but you’re just going to end up with a broken, crappy, health system that patients skip the country to get out of.

The above rant was simplified a bit, as there is much more to expound upon, but I think the general point is made.

I am not familiar enough with the military health care system to make an adequate analysis.

Here are some sources for you though:
http://ff.org/centers/ccfsp/pdf/CCSFP-PP-Winter-03.pdf

http://www.medicalpost.com/mpcontent/article.jsp?content=/content/EXTRACT/RAWART/3734/09A.html

This one is a mammoth PDF file:
http://www.fraserinstitute.ca/admin/books/files/wyt.pdf

This list could go on and on, if you need more files, google “canada health care wait times”. Looking at the bleak health care system in Canada, and the fact that the US has about 10 times as many citizens, switching to a national system would spell disaster. Theres even some stats in those pages describing the exodus of over 10k physicians in the 90s, with that rate slowing to about 200-250 physicians/year now. Its irrefutable evidence to what I warn. Switch to a national system: face exorbitant costs, shortage of physicians, and ultimately the waiting times we see in Canada now. It is hardly a health care system to model after.

PRIMARY care is not the problem, and countries with socialized or single-payer systems usually do not have a problem meetimg that need.

SPECIALTY care is where the rubber meets the road.

That is where you start to see the deficiencies. Yes, that Canadian resident will see the primary doc the same day for her sniffles.

And since most people have either no health care issues or minor issues, most people will be “satisfied” with medical care under those systems.

Let that same Canadian (or Brit, etc.) develop a major illness, cancer, heart disease, etc…….then see how long she waits.

Since few people have major health care needs at any time, there are few people complaining about this at any time, hence “more people are satisfied” with those systems.

No, the current system is not the best system, but it is a great deal better than a single-payer system. The point of the original point was to point out why we need to shift away from anything resembling gov’t control and put the responsibility in the patient’s hands. No one said anything about keeping the status quo, just no one wants to start the downward spiral of a single-payer system. Theres a big difference.

So lemme get this straight.

We all agree that an ideal health care system should cover everyone? Is that right?

The government mandates that everyone has to buy car insurance to have an auto. That’s done by the power of the government.

How would you mandate that everyone has to have health insurance, Chris?

Chris, having lived in Canada and utilized that health system, and having family in Canada which continues to utilize that system, what can I say other than “stop making stuff up”?

Canadians won’t claim that their system is perfect – they know better. But the typical working class Canadian gets much better health care at a much lower overall cost than the typical working American.

The U.S. has the most expensive health care system in the world, in raw dollars or in per capita dollars, yet leaves about 47 million people uninsured and probably at least as many underinsured. Yet the claim is made that the socialized systems are ineffecient and wasteful? Why not punctuate your posts with “Darn that pesky evidence, I’ll believe what I want to!”