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April 08, 2008

Comments

kim

Apparently where health care is a right de jure, it's not one de facto. And here, where it's a right de facto, it's not one de jure. Hell yes, time for a change.
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Great Banana

I made this exact point in comments, but posted it in the wrong thread. I'm always a day late and a dollar short.

PeterUK

"Let's Move Hillary From Ohio To England".

This would put a strain on Anglo=American relations to say the least.
We have a government full of left wing loonies as it is.

GMax

Just set her up somewheres in Scotland. She will fit right in, although she may constitute the rightwing of the Scottish laborites...

MayBee

GB- I saw it and sgree with your comment completely.

Great Banana

I think what people pushing "universal" health care forget, is that no matter what, there is always going to be different levels of care.

The question is, who decides on the different levels of care? In other words, right now in america, employment basically decides the level of care. The better job you have, the better benefits you get, the better insurance plan you are enrolled in, the better care you will generally receive. (taking out of the equation the truly wealth who can pay cash for care and will always have the best care regardless of the system).

In gov't controlled "universal" health care, the gov't decides who gets what level of care. The idea that everyone will get the same level of care is absurd. Do people really believe that in the U.K. or Canada, high muckity-mucks in local and federal gov't are getting the same level of care as minimum wage earners?

The left seems to work under the idea that once gov't is in controll of health care, health care immediately becomes an infinite supply. they fail to realize that healtch care will still be a finite product that must be rationed in some way.

Instead of care being rationed according to the market, care will be rationed according to the whims of the government beauracracy. The question is, which is generally more efficient at rationing finite goods?

cathyf

The utterly obvious point is that babies have a habit of showing up on their own schedules. Because of how random processes work, any individual maternity ward should cycle through days when they are bursting at the seams, days when they are yawning empty, and lots of days when they are comfortably busy. The 3-standard-deviation oddity has a 1% chance of happening -- in other words, an average of 3.65 days per year. The simple (and obvious) way to deal with the periodic sudden cluster of babies who decide to come all at once is to take advantage of the independence of the random processes. While there is a 1% chance of a single hospital having a one-out-of-a-hundred day, the chance that two neighboring hospitals have their one-out-of-a-hundred day the same day is 0.01% (one out of ten thousand). Or, in simpler terms, when one hospital is having a run on laboring women they use the telephone (great technological marvel there!) to figure out how busy each of the neighboring hospitals are, and to divert women and their midwives to the place that makes sense from a capacity and location constraint.

Hospitals (and individual doctors) who do not have the occasional cluster of deliveries that strains their resources are automatically suspect. The only way to get babies to come at convenient times is to misuse labor induction and/or elective c-section -- i.e. to commit malpractice. Both of these practices entail real risks of injuring or killing both babies and mothers.

cathyf

I suppose that the takeaway point from me is simply more proof of TM's original contention, which is that journalism is a profession populated by the hopelessly innumerate.

PeterUK

CathyF,
There is also a shortage of midwives.Also the fecundity of the newly immigrant population was never factored in.Thirdly,although billions have been thrown at the NHS,most has disappeared without trace.Our Dear Leader omitted to get guarantees of reforms and improvements before hosing money on the institution.

boris

can pay cash for care and will always have the best care regardless of the system

In relative terms only. If US goes the way of UK & Canada where will the rich go for the "best care"? In absolute terms there will be no best care. It is one thing to disparage the mess coverage has become in the US but it still is producing the best care for the wealthy of the world to come here for.

The well employed are unlikely to toss that away, it can be demogogued to some extent but it is as much a third rail as social security. Not that complacency is warranted, but IMO eminently defendable.

Affordable coverage is possible for example simply using dated drugs and treatments. In the long run that is better because 2nd tier coverage with maximum advance of medical technology means that 20 yrs from now even the dated healthcare is better than what government issue would be.

So the problem really is with the idea that healthcare for profit is somehow immoral and that everybody should be getting the "best care" even if that is inferior to affordable rate healthcare in a market where better care is available to those who can afford it.

Bottom line, it's "health morality" pitted against third rail reality where politicians will seek to exploit the former, avoid the latter at all costs, and just make the situtaion less managable.

cathyf

Well, boris, this goes along with my assertion that every individual American can freely choose Hillarycare drug coverage for him/her self without impinging on the freedoms of anyone else.

Ok, start by imagining that Hillarycare had passed in, say, April, 1993. This would have caused all pharmaceutical research and development other than cures for baldness and impotence to halt immediately. It's now April, 2008. Patents last 17 years. In two years every single drug (except for baldness and impotence cures) would be out of patent and available as a cheap generic.

So it's clear that, at least for drugs, any individual American can have personal Hillarycare, without passage of any laws, or any interference in the freedom of other Americans not to have Hillarycare. All you need to do is to not use any drug patented after the date when Hillarycare would have passed during the first Clinton administration. Bill Clinton was first inagurated more than 15 years ago -- there aren't that many drugs left with pre-Clinton patent protections, and the number goes down each day.

PeterUK

Boris,
The result is exactly what we have in the UK,a two tier system,with one simple rule of thumb,if the ailment is long term go NHS,but if you need it quick pay.
Universal health care always means rationing and it always leads to state interference in personal health matters.Smokers and the obese,the latter determined by the statistical legerdemain of theBody Mass Index.

Great Banana

Well, I would argue that the market will correct for that - and top line care will pop up in other places for the rich to travel to (India, or South American countries - after all, U.S. doctors may want to move rather than take an enormous pay cut).

But, I think it is fair to say that there will still be pay service for the rich in the U.S. I'm not sure, but I believe the rich in Canada and the U.K. can still get care at private institutions outside of gov't care. I would assume the same would be true in the U.S.

As to the morality of "best care" available versus some other level of care, I entirely agree. It is similar to the "poverty" argument. by any historical standard, one is hard pressed to find true poverty in the U.S. today - our poor are fed (obesity being a problem among the poor in the U.S.), clothed, sheltered, have heat, cable t.v., cars, cell pones, computers, education, and even some level of health care. [leaving aside the issue of "homeless people - which is generally a mental health issue rather than a true economic issue] Compared historically, or even compared to poverty in other countries, the U.S. has no poverty. But, the left compares our poor to our rich. It is the difference between the two, not the improvements in the standard of living of the former that matters to the left.

The same is true with respect to health care. The left would not be happy with decent health care given to the poor if it is not the same health care given to the rich. In other words, they would let the perfect be the enemy of the good, b/c their ultimate goal is not lifting the lowest up, it is bringing the highest down that is most important.

boris

but if you need it quick pay

One suspects that NHS dominates to a degree where advances in medical technology occur more in places like the US where it's better funded by the well employed and wealthy. It is the well employed who would be tasked with supporting univeral coverage rather than providing a market for better medicine.

Without that market, even the ability to get outside care will not be "the best" because the best will not get developed.

chris

I don't think that the UK and Canada are particularly good examples of how to run government healthcare. I think looking at places where things have worked out is probably a better idea.

Spain, for example, has 3 levels of care and it seems to work pretty well.

There's the public system, which is free, but there are significant waits for non-essential procedures.

There's private insurance companies, which generally provide for employees of big companies, and the coverage tends to be very good.

There's private private, where you just pay cash. This tends to be the best service for elective stuff as they treat you like royalty and see you right away. The prices are actually quite reasonable, since people always have the option to go wait in line in the public system.

Great Banana

Chris,

What is the level of taxation in Spain and what is the annual cost for the "free" public health care?

cathyf

Actually, chris, Spain sounds pretty much like the US. There is charity care, which has significant waits for non-essential procedures, insurance, which provides excellent coverage to employees of large employers, and pay-for care, for things like cosmetic procedures, where they treat the patients very well.

boris

don't think that the UK and Canada are particularly good examples ...

Perhaps not but they may share the US dislike of class distinctions. As with public schools there would be a strong tendency for the government system to overwhelm the private system by removing differences one way or the other and making the high taxed well employed pay for the "free system" in addition to their private coverage. Politically, the "free" one will simply tax enough that it can match (in theory) the private one.

Rick Ballard

Chavez has it all figured out. Perhaps RW could study the Venezuelan example for implemntation purposes?

clarice

cathy and boris (and of course TM) are such a treat for the brain.
The WaPo has an intreesting longish piece today on how all this emphasis on preventative care needs to be reconsidered..In many cases the cost of preventative care for all vs, the additional years of life saved by such care is ridiculously high.

Anytime a policy os of dubious worth we get legislation by anecdote. Personally, I think this was far less common in the bad old days on the Hill when seniority meant something ..I hate those hearings. I hate even more the sausage that comes out the other end when the kleig lights are turned off.

PeterUK

Boris,
The NHS is run by bean counters rather than medical professionals so we have wonderful bureacratic botch ups of epic proportions.In business,one tries for the best deal,you would think that the NHS as a vast organisation would have suppliers over a barrel.Think defense spending and you have the situation which obtains in the NHS.The unions have the socialist government by the throat,any reforms are painted as vandalism.
On the other hand the National Institute for Clinical Excellence (NICE,nobody laugh) keeps a tight grip on what drugs are allowed to be prescribed.Local Health Authorities are allow prescription according to budget.Two instances,a drug which could save the sight in the elderly was only prescribed after the loss of sight in one eye.Took quite a battle on that one.A cancer drug IIRC was refused a woman patient on the grounds of cost,when she said she was prepared to buy her own,she was told that in that case she would not receive any NHS treatment.
Hillary would be at home here,we probably wouldn't notice.

clarice

I just had a perfectly painless though complicated root canal by the best endodontist in D.C. (He won't bother with insurance companies. If yours reimburses you anything, good for you. My physician is the same.) I cannot imagine getting this level of dental care --or even seeing his high tech equipment--anywhere else but in the US.
In fact if I were advising US dentists, I'd tell them to get a luxury liner, dock it outside European continental waters and let the clients pour in,

Tully

I don't think that the UK and Canada are particularly good examples of how to run government healthcare.

They're not. Most other nations have universal coverage systems, not "government-run health care." That usually consists of a defined minimum-coverage basic policy that all citizens are required to purchase, with purchase subsidies for the poor and extra coverages available for those who want them. It's typically straight 70/30 or 80/20 coverage.

The UK and Canada are among the worst examples of how other developed nations handle health care, the UK especially. Italy has government-funded compulsory insurance and somehow produces nearly the best health-care outcomes in the world. Italians hate it, but it works.

boris

Italy has government-funded compulsory insurance and somehow produces nearly the best health-care outcomes in the world. Italians hate it ...

So free Americans should adopt compulsory government care they'll hate because why ???

Because it works well with Mediterranean diet and climate? Swell.

amr

Hillary appears to have missed (didn’t she or her staff know) a big point that should have told her something was wrong with the story, in the US by law hospitals can't turn away patients which is why ERs are closing all over. But if one has central control of budgets as in national health care, hospitals don't expand, have enough doctors, insufficient medial equipment etc as in Canada, GB and other parts of Europe. At least Germany and BG still have private care, if you can afford it. Will Hillarycare?

Ohio Health Insurance

Universal Health Care will not answer our problems. However...a series of tax incentives and increased use of Health avings Accounts will help.

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