Still the Best

I adhere to a lot of outré notions about the desirability of introducing massive socialism into our health care system and not satisfying ourselves with a lot of tinkering around the edges with subsidies and regulations and just having the government provide health care to people as a public service, just as we have roads and police departments and all the rest (and just as you can hire a security guard or build a driveway, people could also do whatever). There is, after all, tons of evidence in favor of such a system -- from the awesome cost-efficiency of the UK's National Health Service, to the massive amounts of ineffective spending, to, of course, the excellent quality of the VA system.

I remember reading Philip Longman's Washington Monthly article that he later expanded into a book on the VA system and expecting the end to be something like "so, as you can see, even though it's not politically practical at the moment what we really need to do is adopt massive socialism." Instead, though he waxed all pragmatic. Which I guess is fine. But still, the ponit should be made that we really ought to adopt massive socialism.

Fortunately, someone or other got the widely respected Congressional Budget Office to do some research into the VA system, leading to this (PDF) interim report. CBO Director Peter Orszag summarizes:

In general, VA’s experience underscores the potential for improving performance in a large and relatively integrated system through a sustained and comprehensive effort that involves indicators of quality, financial incentives that are aligned with those objectives, and the use of health information technology. It is important to note, though, that the combination of these factors — a large, relatively integrated system; well-designed incentives; performance measurement; and health information technology — likely creates much more substantial opportunities for improvement than any of the pieces taken by themselves. The applicability of VA’s experience to other parts of the health system, which often have a much different structure than the VA system, is therefore unclear and will be explored in CBO’s final report (which will be published next year).

In short: massive socialism works, but the applicability of its success to other models is "unclear." Thus, the case for massive socialism. But, yes, nobody wants to hear it.

Comments

But... the DMV, the DMV!!!!!!

Posted by drjimcooper | December 23, 2007 2:32 PM

Actually, I think we should move in the exact opposite direction, and privatize every public road and highway in America.

Then, motorists could buy "road insurance" from one of a number of competing "road-companies," entitling the driver to use a particular subset of roads during particular times of the day or week, as specified in *extremely* lengthy and complex "road-contracts."

This would give a huge boost to our economy, since the different road-companies would spend hundreds of billions each year on marketing, advertising, and administration, and also improve unemployment, since they'd need to hire many, many millions of road-checkers to police the entrances of every road and ensure that only authorized drivers were allowed in.

There'd be a gigantic growth in the information-technology section, assisting all drivers in determining which particular roads they were allowed to use at a given time, and optimizing their travel paths based on these complex road-use constraints. The resulting software could then be sold to Russia if it ever chose to return to centralized Soviet state planning, which similarly requires massively-constrained linear programming calculations.

I suspect that the road-sector of the American economy would soon be accounting for something more than one third of our entire GDP.

Thus, the invisible hand of the free marketplace would solve many, many of our problems at a single stroke.

Posted by RKU | December 23, 2007 2:39 PM

Have you spoken to anybody who actually has to rely on the VA system? Almost everyone I know who has to rely on the system for day-to-day care would prefer to use the crummy old system that the civilians are stuck with. I don't doubt that the VA system meets some sort of "efficiency" criteria but if you are a soldier and you are having a baby (or your wife is having one) you want to go somewhere else.

Posted by Paul Mooney | December 23, 2007 2:45 PM

Democratic Socialists of America will happily take your membership dues. asfdasd

Posted by Adrian | December 23, 2007 2:47 PM

RKU, you are hilarious and need a blog of your own.

Posted by Adrian | December 23, 2007 2:50 PM

I know that the quality of VA hospitals varies a bit but when I interned at the VA hospital in Philadelphia it was by far the worst medical facility I have ever seen. My friends and I still talk about the place when we get together with a sense of "How could it have been that bad?" My wife and I still talk about it and she only worked there as a resident and not an intern.
The wife and I both pretty much agree that at this point there is a need for some sort of health care reform that will especially address the need for portability of health care insurance and getting everyone insured. Please dont model this on VA care.

Steve

Posted by steve | December 23, 2007 3:30 PM

I don't know why Repubicans are against socialized medicine. Their allies in Britain have socialized medicine and still manage to get health care results as bad as ours by budgeting practically no money for it. We could do that too.

Posted by Gary Sugar | December 23, 2007 3:44 PM

Steve,

When was this? If you read the articles you'll see that they acknowledge the VA was horrible for decades and the great system they now have has only come aroudn through a massive reform effort.

Posted by eric k | December 23, 2007 3:57 PM

Yeah. Maybe people are fine with Bill Gates having a better home security system than theirs. Will they be equally fine with him getting better chemo for his daughter under a socialized system?

That is, you can SAY that your system will simply allow for rich people to buy better care because it won't forbid it. And I guess you can argue that the system we have now very often favors the rich over the not so rich. But politically, how are you going to keep the system from ratcheting up to all care for all people no matter how much it costs? You get one little kid with cancer in Topeka, that kids congressman is going to get heat to pay for the treatment.

He's going to pay for the treatment.

I just don;t see how you can keep this from spiralling out of control.

Posted by Sam M | December 23, 2007 4:32 PM

"But politically, how are you going to keep the system from ratcheting up to all care for all people no matter how much it costs? You get one little kid with cancer in Topeka, that kids congressman is going to get heat to pay for the treatment.

"He's going to pay for the treatment.

"I just don't see how you can keep this from spiralling out of control."

You can't, at least if "control" means we have to have an un-healthy chunk of the population without health care. Sorry, Sam, but most of us want to help that kid in Topeka, regardless of cost. And someday, we will. Maybe we'll just have to scrimp when it comes to invading other countries.

Posted by Henderstock | December 23, 2007 5:16 PM

Road insurance was a great parody. But seriously, folks, what ever happened to universal medicare as a health care option? Try to find anybody over 65 who doesn't like it. The insurance companies could be partially pieced off with the opportunity to sell supplementary coverage, as they currently offer to seniors, and if the risk were spread over the entire population, the cost of universal medicare would be tolerable. I believe that Paul Krugman has done the arithmetic.

Posted by Etaoin Shrdlu | December 23, 2007 5:35 PM

"I know that the quality of VA hospitals varies a bit but when I interned at the VA hospital in Philadelphia it was by far the worst medical facility I have ever seen. My friends and I still talk about the place when we get together with a sense of "How could it have been that bad?" My wife and I still talk about it and she only worked there as a resident and not an intern."

Yes, quality at different VA hospitals varies, but I've had a similar experience working at the Baltimore VA. We complain about how the nursing staff is so bad, how the radiology techs stink, and how the OR never wants to do cases...

However, we compare the VA to the shiny, billion dollar private health system that we work at a couple blocks away.

The fact is, in large cities with excellent hospital systems, the seeming quality of care at the VA sucks. But, go to a rural hospital in North Dakota, or a crappy, public hospital - say the old DC General - and you'll soon be singing the praises of the VA.

Furthermore, the overt crappiness of the VA - dirty rooms, lackadaisical nursing staff, no supplies, etc. - masks the things that the VA system does really well: they control hospital infections better than anyone, they track long term patients better than anyone, and they get presciption meds to their patients more efficiently than anyone.

Our shiny billion dollar hospital is clear and the nursing staff is polite, but behind it there is just poor patient care. We don't like to admit it, but it's true. It's the reason why the VA gets such good grades - because behind clean rooms and a smile, most of our hospitals aren't very good at taking care of patients.

Posted by GtheK | December 23, 2007 6:53 PM

In Canada, Britain, Germany and just about every other "civilized" country, the McDonald's burger flipper and the CEO of the biggest corporation have access to the same medical care and while everyone grumbles about taxes, everyone knows that no other system would work.

What is it about the American psyche that allows for "socialist" institutions like fire and police departments and Social Security, yet seems completely unwilling to consider universal health care when the proof of its efficacy in all the other "civilized" countries is there before its eyes.

Posted by chet | December 23, 2007 7:59 PM

Leave it to liberal elite Democrats who would never, ever use public healthcare to propose a healthcare system that does not have pediatrics, OB, neo-natal care, barely has GYN, does not have ER's, and gets to skip many other programs that the normal insurance programs pay for.

Also remember that every patients at a VA hospital was healthy enough to be in the military and was intelligent enough to have a job and speak english.

Why not look at VISTA for the family members to see how government insurance works. Or why not look at the DoD system that actually has to provide all of those services like peds, OB, and sports medicine that the VA gets to avoid.

Posted by superdestroyer | December 23, 2007 8:36 PM

Also remember that every patients at a VA hospital was healthy enough to be in the military and was intelligent enough to have a job and speak english.

"...intelligent enough to...speak English."

Unfortunately, one apparently doesn't have to be intelligent enough to lift oneself out of a infantile nativism in order to post comments on Yglesias' blog.

Posted by goethean | December 23, 2007 9:00 PM

"Leave it to liberal elite Democrats who would never, ever use public healthcare to propose a healthcare system that... does not have ER's..."

Some of what you say may be true, but the VA system most certainly does have Emergency Departments. I've worked in them.

Posted by GtheK | December 23, 2007 10:02 PM

"Sorry, Sam, but most of us want to help that kid in Topeka, regardless of cost."

Yep. And there's the rub, Matt. We DO want everyone to get the best care. But we don't want to pay for it. At least not what it costs. And to run this program in the way Matt suggests it should be run--that we provide a base of care and let Rich people add on to it when the care they want isn't covered--is never going to fly politically.

Even Matt admits that we can't pay for care "regardless of cost." That's why he continues saying that the super-rich can buy extras. But as the response to my initial posting suggests, for a lot of people, socialized medicine means Junior gets the cancer treatment even if it costs 80 billion dollars. Because... "most of us want to help that kid."

It's a recipe for disaster. And it's completely untenable. Politically. Because of statements like that. You can cry all you want about rights and justice and all the rest. But every single person cannot have the absolute best care in every case. They simply can't. And in the socialized system Matt suggests, someone has to pick winners and losers.

He says we all win. Only the rich win a little more by.. buying AFLAC or something. Count me among the child-hating, cancer-loving capitalist pigs, I guess.

Posted by Sam M | December 23, 2007 10:47 PM

Rudy Giuliani's mom received wonderful socialist Medicare for thirty years.

Maybe Rudy should refund the money - Though asking this is sort of a Hannity type stunt.

Medicare is actually more socialist than France's excellent health program.

Israel has fantastic national health care -
Why won't AIPAC make copying Israel's health care policy part of their program? Israel's medical care is far more popular, among Israelis, than Ehud Barak.

Posted by Comment | December 23, 2007 11:11 PM

Mean to say more popular than Olmert - Anyway - Larry Kudlow dismissed the VA as a "small drink of water." Also Rudy talked about the painful incentive for people (not his mom) to do the right thing - That national health care would take the scare out of them - You know, no pain, no gain.

Posted by Comment | December 23, 2007 11:14 PM

Two tracks

We could, and should, move universal health care forward down two tracks, Medicare for All (a national health insurance), and The VA for Everyone Who Wants It (voluntary participation in a national health service). There's nothing mutually exclusive about these two options, nor anything that would prevent the continued existence of out-of-pocket payment for services, though the national health insurance should be much cheaper than any financially viable private health insurance, and should leave out of coverage only services that aren't medically necessary (e.g., cosmetic surgery, contact lenses where eyeglasses will do), and therefore private health insurance would have no viable market left.

In time, the national health service, if it is able to deliver better quality at competitive rates, might put the natonal health insurance out of business. Let the "market", and I mean the market of patient preference, which is the only sort of market that should be allowed in medical services, decide.

Posted by Glen Tomkins | December 24, 2007 12:53 AM

A few years ago, British Medical Journal published a study comparing the British NHS with Kaiser Permanente in California. The study found "Kaiser achieved better performance at roughly the same cost as the NHS because of integration throughout the system, efficient management of hospital use, the benefits of competition, and greater investment in information technology.
http://tinyurl.com/33o7pv

My stab at socialized medicine would be, nationalize Kaiser Permanente and expand it so it covers every American who wants to join. You'd still be free to buy private health insurance, but just as everyone pays school taxes even if they don't have a kid in school, everyone would pay for the health system whether they use it or not.

Posted by beowulf | December 24, 2007 2:19 AM

Sam M, I have trouble imagining a system under which Bill Gates' daughter wouldn't get better care than I do. Unless it's a socialized system where people are forbidden to purchase additional services, which I don't think anyone is proposing. So, what the hell are you talking about? Every other country in the industrialized world seems to have solved the allocation problem, what makes it insoluble here?

Posted by mtraven | December 24, 2007 2:42 AM

GtheK,

The DC VA Hospital on North Capital Street does not have an Emergency Room. Gang bangers who have been shot, stabbed, or beaten are taken across the street to the Washington Hospital Center. Thus, the VA never has to provide care to a hyper violent gang bangers who will never pay but whose injuries can really stress an emergency room.

goethean

It is easier for the VA to get marginally better outcomes when the patients can actually understand what they are being told. Also, the VA does not have to spend money with translators that inner city hospitals have to do. Also, when all of the employees and patients can understand English, it is much easier to lower infections than an inner city hospitals where housing keeping, patient transport, and many of the patients do not speak English.

Posted by superdestroyer | December 24, 2007 5:43 AM

Re: Will they be equally fine with him getting better chemo for his daughter under a socialized system?

Is there such a thing as better chemo? I don't think so. One of the unique aspects of healthcare is the lack of what economists call "inferior goods". There are no cheap substitutes (generic Rx is one of the very few exceptions). Sure, there are some frills and extras at the margin, but the basic treatments are necessarily the same for everyone.

Re: I just don;t see how you can keep this from spiralling out of control.

Because healthcare is limited ultimately by the amount of disease and injury that exists. Healthcare is a not a "good" it's "bad". You don't consume it for fun. You consume it when only when need forces you to.

Posted by JonF | December 24, 2007 6:29 AM

"So, what the hell are you talking about?"

You act like I am making this up. Great. Except a few comments ago someone made my exact point for me: "We want to help that kid no matter how much it costs."

And we had that tragic situation in California where the girl was turned down for the liver transplant.

Well, under a socialized system, we are STILL going to have to turn down some people for some treatments and watch them die. Or we are going to have to provide all treatments for all people regardless of cost.

All I'm saying is that I don't see politicians allowing kids to die if the politicians contriol the purse strings. So they will keep adding procedures to the "covered" list.

Someone else brought up education. Which is an excellent example. "No child left behind." See? We are saving them all. And paying something absurd like $15,000 a student in some places for terrible education. And guess what? Nobody is just sitting around talking about how great it is that rich people in DC opt out of the system and send their kids to St. Alban's. What they ACTUALLY do is continue ratcheting up what we spend on crappy public education.

Which is, er, what I am predicting will happen with health care.

Maybe I am wrong. And maybe that won't happen. But it's hardly so far off base that it counts as insanite.

We AREN'T happy allowing rich people to get better health care that poor people get. Isn't that sort of standard for goods that we socialize? So to glibly say that the cost concerns will all go away because we will tier the system, allowing rich people to get better care than poor people seems to kind of skip over the main issue.

I didn't say it. Someone else did: "We want to help that kid no matter how much it costs."

Go ahead an ignore that sentiment. It will make your position a lot easier to support. But it won't make it any more honest.

Posted by Sam M | December 24, 2007 7:14 AM

Sam M makes a good point. Under the current system, we don't all get the same care, but a middle class American with a decent job (or a part-time barista at Starbucks, for that matter) can get excellent, employer-provided health insurance that will pay for care at America's best hospitals. Those without health insurance (too much income for Medicaid, to young for Medicare) probably don't get the same level of care when they show up at emergency rooms. Advocates of nationalized/socialized health care are motivated by their sympathy for those without health insurance. But from a utilitarian perspective, the chances are that more of us would be worse off under a socialized system.

Under a socialized system, only the rich would get to trade up to America's best hospitals. Health care for the rest of us would be more like what the uninsured receive today. Count me out.

Posted by Fred | December 24, 2007 9:26 AM

Re: Well, under a socialized system, we are STILL going to have to turn down some people for some treatments and watch them die.

True, but those decisions shoudl be made for medical reasons, not economic ones. Triage is a valid medical tool, and we use it right now. People over 65 (I could be wrong about the exact age) are not approved for bone marrow transplants no matter how much money they have because they are unlikely to survive the procedure. That's the sort of decision we should be making, not saying "Well, gee, Patient X is a poor Black child so since she doesn't have any money her life is worthless and we can't be bothered to save it." I really wonder how some people managed to grow up without at least a basic sense of ethics that would recoil at that sort of logic. Too bad the Religious Right is a wholly owned subsidiary of the GOP. There really is a moral crisis in this country, and it has little to do with who is sleeping with whom.

Posted by JonF | December 24, 2007 12:44 PM

SamM & Fred's comments rest on the assumption that the United States has a superior quality of health care compared to countries with more socialized health care systems, when studies suggest the opposite:

"Health outcomes for patients in Canada are as good as or better than in the United States, even though per capita spending is higher south of the border, suggest Canadian and U.S. researchers who crunched data from 38 studies.

The findings were published in the inaugural edition of Open Medicine, a new online medical journal launching Wednesday in the aftermath of a rift last year between some editors and the publisher of the Canadian Medical Association Journal.

"In looking at patients in Canada with a specific diagnosis compared to Americans with the same diagnosis, in Canada patients had at least as good an outcome as their American counterparts – and in many situations, a better health outcome," said one of the 17 authors, Dr. P.J. Devereaux, a cardiologist and clinical epidemiologist at McMaster University in Hamilton.

See also the report on comparative health care performance by the Commonwealth Fund, which finds that:

Compared with five other nations—Australia, Canada, Germany, New Zealand, the United Kingdom—the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives.

Posted by Peter H | December 24, 2007 2:14 PM

Also, it's a little bid odd for Sam M to warn about the dangers of cost explosion under socialized health care, when it's well known that the United States spends vastly more on health care expenditures per capita than any counries with socialized systems.

Iagree that universal healthcare, in itself, or even switching to a single-payer system, is not going to lead to cost containment. We need to address the incentives in American health care that encourage wasteful & excessive care, fragmentation among health care providers, lack of application of cost-effectiveness criteria,etc. Otherwise, not only will healthcare continue to be expensive, but we won't be able to afford universal healthcare.

Posted by Peter H | December 24, 2007 2:42 PM

"SamM & Fred's comments rest on the assumption that the United States has a superior quality of health care compared to countries with more socialized health care systems"

Absurd. I never mentioned anything of the sort. What I mentioned was Matt's idea that under his preferred system, we are just going to have rich people buy more health insurance and get better care. And that nothing is preventing that from happening.

But of course something is preventing that from happening. Such as... children with cancer. And people who insist that the system must "help that kid no matter how much it costs."

Anyone can be for socialized medicine. It's easy. Free aspirin for everybody. Nothing more. People can insure themselves beyond that.

Where this gets hard is deciding what gets covered. More specifically, it gets hard when you start deciding--politically--which procedures get covered and which don't. Because, again, "we want to help that kid no matter how much it costs."

Because of course people want more than free aspirin. They want top-flight experimental care for themselves and their children. Things only Bill Gates--and the federal government--can afford. And to say that we will allow Mr. Gates to buy it on his own and let everyone else die... I just don't see that as politically viable. Rather, what I see happening is what I said before: an incremental ratcheting up of covered services.

Take a look at that poor girl in California. Her insurance company wouldn't cover the procedure. And everybody raised holy hell. So the insurance company caved. Are you suggesting that the local congressman will be more fiscally responsible? On what do you base that opinion?

And then there is this: "It's a little bit odd for Sam M to warn about the dangers of cost explosion under socialized health care, when it's well known that the United States spends vastly more on health care expenditures per capita than any counries with socialized systems..."

I don't think it is odd at all. I never argued that the system has effective cost controls right now. What I am arguing is that, politically, there will be immense pressure to undo what Matt seems to see as a real positive of his plan. Namely, he says that his plan will allow really rich people to buy better care than the average Joe gets. I am saying, "Bullshit." Socialism can maybe do lots of things. But you have to take the good with the bad. And a system run by bureaucrats who get paid by politicians is going to be really bad at resisting calls to increase the list of covered procedures. Particularly when NOT covering them leads to a big pile of dead children.

Seriously, I don't see what's all that contrversial about what I am saying. I am not even saying Matt's system isn't the best system. Or the least bad. Or whatever. Maybe it's the best we can do.

What I am saying is that one single claim he is making--that rich people who don't like the plan can simply go ahead and buy a better one--seems kind of poorly thought-out. Namely because people won't stand for Joe Six-Pack dying a painful death when Thurston Wingate III pays $80 million to cure Thurston Wingate IV. Joe Six-Pack is going to go to the polls and elect someone to get his dying kid in on the action.

Are you saying this is not the case? If so, please explain to me the maximum amount the government should pay doctors to cure a kid of cancer? Obviously, if it's $10, go ahead. Everybody will be for that. But what if it's a cool billion per case? A trillion? Obviously this is absurd, but equally obvious is the fact that there has to be an upper limit. What should it be? Let's say it's a million. What do you do when someone comes in with a case that will cost that plus $1,000? That plus $20,000?

I'll tell you what you do. You pay. No matter how much it costs. Because people people reallym honetly feel that, and i quote again: "most of us want to help that kid in Topeka, regardless of cost. And someday, we will."

Posted by Sam M | December 24, 2007 3:10 PM

Sam M,

Sorry for misinterpreting your argument. The claim that socialized/universal healthcare leading to diminished quality was actually made by Fred.

Whether or not the United States allows wealthy individuals to purchase supplemental health care outside that which universally provided, I don't see that making a big difference with regard to health care costs. In my opinion, the major reason for our explosive costs in health care are that (1) providers have a financial interest in providing more and more costly care, (2) price and utilization controls by government or private payers are ineffective (3) the overall fragmentation of the health care system. I don't think a small percentage of wealthy individuals purchasing their own health care is going to affect those factors, one way or the other.

Posted by Peter H | December 24, 2007 3:48 PM

Maggie Mahar, a fellow at the Century Foundation, has some good observations about public insurance and cost control:

The backlash against the for-profit’s industry’s attempt at “managing care” was inevitable. For-profit insurance companies simply do not have the standing—politically or morally-- to make decisions about which drugs and treatments our health care system should cover.

By contrast, Medicare isn’t trying to turn a profit, meet Wall Street’s inflated earnings expectations, or pump up the value of its executives’ options packages.

This may be one reason why both patients and doctors are less suspicious of Medicare’s coverage decisions. Over the years doctors and patients have accepted the vast majority of decisions that Medicare has made about what products and treatments it will and won’t pay for. (italics added) (Though virtually everyone agrees that Medicare needs to be expanded to cover prescription drugs).

But Medicare does not try to micro-manage care; doctors do not spend hours on the phone arguing with Medicare clerks.

Moreover, as I mentioned in my first post, MedPac, the independent panel that advises Congress on Medicare spending, is urging Congress to improve the way Medicare makes coverage decisions by funding independent “comparative effectiveness” research that will make head-to-head comparisons between competing products and
treatments. (This is research that both the drug industry and the device industry have long resisted.)

In this way Medicare can fine-tune its coverage decisions, weeding out new drugs, devices and procedures that are more expensive than the rivals that they are trying to replace-- but no more effective for most patients. In some cases, Medicare might well agree to pay for the new product only for small group of patients who would benefit.

So that's one reason why Medicare could be more effective in controlling health care costs- it has much more credibility than a private insurer.

Posted by Peter H | December 24, 2007 4:16 PM

"In short: massive socialism works"

No, it doesn't.

Posted by ostap | December 24, 2007 10:50 PM

A better thing would be to reduce the influence of the insurance companies and let people pay for services directly. Paying for more stuff out of pocket would save a lot of money. Since people would pay out of pocket, prices would be more likely to decrease. This is the same principle as in any other aspect of the free market. A 42 inch flatscreen television used to be 20,000 to buy, but now you can get one for under 1,000. Now people will argue that healthcare is different. How can you shop around if you have a gunshot wound or have gotten your arm sawed off? Well that is a catastrophic illness. People would still have insurance, but it would only be coverage for catastrophic illness. Most healthcare is not catastrophic and insurance is just a waste of money to a third party. This is where paying directly for services would eventually lead to more price reductions. Just like a person can shop around for a hamburger, you can shop around for a routine doctor's visit a dental cleaning, or whatever else.

Imagine if you had car insurance that covered gas fillups. You might pay the insurance company 1000 dollars a year, but only get 500 dollars worth of gas in return. That is what is basically happening for a lot of healthcare. Most healthcare is NOT catastrophic so involving a third party just leads to more waste. The government has all these mandates that make insurance companies cover everything. If insurance companies didn't have to cover every single thing, then it would be a lot cheaper to buy an insurance plan that would cover major catastrophes. Poor people would be able to buy these stripped down plans. If the poor were still unable to get enough healthcare, then the government could tax the wealthy and redistribute some of the money into healthcare savings accounts that the poor could use. I think this method would be better than having more government control of healthcare.

With more government control, there are price controls. Price controls mean fewer life saving medical technologies. Europe used to be a world leader in getting medical technologies to market, but now it significantly trails the US. This is in large part due to price controls which have stifled innovation. There is a huge barrier to get things to market and unfortunately the government is less likely to poney up the dough to bring something to market than a "for profit company".

The main problem is that insurance companies are for profit. But replacing them with the government will lead to healthcare shortages, reduced innovation and increasing taxes. The third way is reducing government influence AND insurance company influence. Having as little money going to a third party is the best option in my opinion.

Posted by mike | December 24, 2007 11:59 PM

This quote below from this thread is one of the most profoundly ignorant things I have ever read on the internet:

"Is there such a thing as better chemo? I don't think so. One of the unique aspects of healthcare is the lack of what economists call "inferior goods". There are no cheap substitutes (generic Rx is one of the very few exceptions). Sure, there are some frills and extras at the margin, but the basic treatments are necessarily the same for everyone"

Its just completely, 100% wrong. THere are hundreds of examples where a better health care choice is available, but not used. Just one example: the utilization rates of TNF Inhibitors for RA in the EU vs the US. TNF inhibitors work better and are safer than the older agents. TNF Inhibitors also cost 5-10X as much. So they dont use them much in the EU. That how they are so "efficient" Here is another, take a look at survival curves for cancer in the UK vs the US. The English approach is give em some morphine get your affairs in order. These are just 2 of many examples.

"THe basic treatments are necessarily the same for everyone" - SUre, thats why MDs spend 10+ years in training

Here is a clue, dont believe everything you saw on "Sicko". Its propaganda.

Massive Socialism does not work. WHat makes you think the government will be skillful at managing healhcare - its stellar record in education? The DMV? The welfare system? Govt attracts dullards and pateralistic bureaucrats. Please leave them out of the system.

Posted by Lots of ignorance on this thread | December 25, 2007 4:06 AM

Re: They want top-flight experimental care for themselves and their children.

They don't get that right now. Even the rich don't, unless they are deemed suitable for experimental trials. Let's look at this realistically: the majority of people not covered under our current system are young and healthy people. The few who are otherwise end up socializing their care through the bankruptcy courts and the "miracle" of cost shifting (our premiums reflect the cost of uncompensated care and unpaid bills). Achieving universal coverage will not result in higher healthcare bills overall as we would simply be paying the current bill in a different way. Hopefully, a more efficient way, so costs may even come down, at least at the margin. I am skeptical that there are vast savings to be wrung out of the system, but I am even more skeptical that there are even higher costs waiting in the wings (beyond what will occur due to population growth, etc. no matter what we do). This isn't Haiti or Bangladesh, we don't have sick people dying in the streets.

Re: Imagine if you had car insurance that covered gas fillups.

Apples to oranges. Gas fillups are the equivalent of a trip to the grocery store (and oil changes are the equivalent of a trip to the gym). Health insurance never pays for the former and only very rarely pays for the latter.

Re: Its just completely, 100% wrong.

You are talking marginal stuff-- and I already admitted that generic Rx is one area where are there are cheaper substitutes.

Re: Here is another, take a look at survival curves for cancer in the UK vs the US. The English approach is give em some morphine get your affairs in order.

The myth of lower cancer survival rates in Europe was debunked on this site long ago. To repeat though: it is mainly due to the fact that these cancers are detected later in life in the EU. An American who finds out he has prostate cancer at 55 and lives ten more years and a Englishman who learns this at 60 and lives five more years both die at 65. The proof is in the life expectancy figures. If Europeans were dying left and right of treatable illnesses it would not be mathematically possible for their life expectancy figures to equal or exceed ours. And yes, elderly people in this country do not necessarily receive aggressive treatments either. My aunt was diagnozed with multiple myeloma at age 80. She was given supportive care and, yes, morphine at the end. How is that different from your claim of how cancer is dealt with in Britain?

Re: Here is a clue, dont believe everything you saw on "Sicko". Its propaganda.

I have never seen "Sicko" and I find Michael Moore and his propaganda quite disateful. However I used to work in the health insurance industry. Occasionally I even defend it here from unjust demonization. But I do know enough about it to understand the basics of what we are talking about. I disagree with Matt that the VA is the best way to go. However anyone who thinks that our health insurance system is somehow saving us money really needs to put down the crack pipe and look at the numbers: we are paying more, way, way more, and getting less. That's the reality. Deal with it.

Posted by JonF | December 25, 2007 8:51 AM

Re:The myth of lower cancer survival rates in Europe was debunked on this site long ago.

It's not a myth. Rudy Guiliani may have gotten the figures wrong, but the US does have better cancer survival rates than canada and europe.

http://www.ncpa.org/pub/ba/ba596/

"Survival Rates for Specific Cancers. U.S. survival rates are higher than the average in Europe for 13 of 16 types of cancer reported in Lancet Oncology, confirming the results of previous studies. As Figure II shows:"

Re: If Europeans were dying left and right of treatable illnesses it would not be mathematically possible for their life expectancy figures to equal or exceed ours.

http://www.nationalcenter.org/NPA547ComparativeHealth.html

Life expectancy has more to do with ethnicity (i.e. lifestyle choices, genetics, diet, income) than the healthcare system of a nation. Hispanic whites have a higher life expectancy than non-hipsanic whites even though their rates of uninsurance are 3 times as high. Japanese-Americans have an average life expectancy similar to that of Japanese.

Posted by Mike | December 25, 2007 12:04 PM

Socialized medicine will reduce innovation, which the US does best.

http://www.nytimes.com/2006/10/05/business/05scene.html?ex=1317700800&en=5889b4819eaf787a&ei=5090&partner=rssuserland&emc=rss

" Even when the initial research is done overseas, the American system leads in converting new ideas into workable commercial technologies."

"About 400,000 European researchers are living in the United States, usually for superior financial compensation and research facilities. Medical innovations improve health and life expectancy in all wealthy countries, not just in the United States."

http://www.silverbook.org/browse.php?id=58

"Each new drug approved between 1970 and 1991 saves an average of 11,200 life-years in 1991.
The United States would have spent $634 billion less on health care in 2000 without many of the improvements in health and the associated investments that were seen between 1980 and 2000. However, there would have been 470,000 more deaths, 2.3 million more disabled, and 206 million more days in the hospital."

http://www.cnsnews.com/ViewNation.asp?Page=/Nation/archive/200708/NAT20070816b.html

"Democratic contenders for the 2008 presidential election want to use the federal government to lower the cost of prescription drugs, but while the move may be well-intentioned it could end up costing lives, an economist argued during an event in Washington, D.C."

The US has the most innovative market in the world because companies are allowed to make enough profit.

Posted by Mike | December 25, 2007 12:37 PM

JonF

You are confusing generic substitution with therapeutic substitution. Read up on both and get back to us. I am not talking about generic substitution. The point is there are better drugs and lesser drugs, and the lesser are used more in EU. For me, I'll take the better ones. You can go ahead and use the lesser ones.

There is a spectrum of quality of care, in drugs surgical approaches, and diagnostics. To argue that there are no inferior goods is just ignorant and betrays a basic lack of understanding of medicine.

I also said that the EU system gets its ledgendary "efficiency" by delivering lesser quality care at the top end and I will add by rationing (Why do you think they are diagnosed later?) In the case of many cancers, early diagnosis is key, while others you are better off not knowing, but that isnt the point here.

Also using your aunt as an example is very convincing. One case

Pointing to overall life expectancy outcomes is not proof that their system is better. The US is quite different demographically from the EU. women of Japanese ancestry in Bergen County, NJ have a life expectancy of 91 - does this mean the health care system there is the best in the world?

What did you do in the insurance industry?

Posted by Lots of ignorance on this thread | December 25, 2007 12:58 PM