Is it time to adopt the American Health Model?

We discussed the Singaporean Health System recently on Slugger. They’ve been discussing the US Health System on Reddit for a while now. For me, this settles the debate –

My wife recently had a baby, this is the bill…

  • Brian MacAodh

    Did you see Obama’s sppech?

    Everyone will be covered, it will be better coverage than what’s available now, those who are covered now will see what they are paying drop, people on medicare or medicaid won’t lose any benefits-in fact they will get expanded benefits,people will have no choices, doctors can make better decisions without worrying about fees, there will be less bureacracy involved in health care decisions (???), and the kicker-it will actually REDUCE our national deficit.

    Give me a fucking break.

  • Brian MacAodh

    *people will have MORE (not “no”) choices*

  • OC

    The whole US medical system reform debate is confusing to me.

    We do hear ALL of the time about countries with socialised medicine sending patients to the USA for treatments that are unavailable in their own country, or long waits for treatment, etc.

    On the other hand, the current USA medical care paradigm rests on the assumption that the vast majority of folks are covered by their employers. But with workers being laid off because their jobs are being given to illegal aliens, predatory work visa holders, or even sent overseas, and all this BEFORE the current economic crisis, I am losing confidence in the current model.

    As for a surtax upon wealthy income earners (including capital gains), the USA should give these folks a medal in recognition of their extraordinary support of fellow citisens’ medical coverage, and perhaps a banquet dinner with the President, which of course, the hoi polloi would be excluded from.

    Other than that, give us 98% employment with good paying jobs, and socialised medicine becomes irrelevant.

    Submit the word you see below: both

  • Brian MacAodh

    Reform is necessary, of course. Why in gods name does this need to get rushed through by the next few weeks. As evidenced by his answer to a question last night, he doesn’t even know what’s in the bill or not.

  • Dread Cthulhu

    OC: “On the other hand, the current USA medical care paradigm rests on the assumption that the vast majority of folks are covered by their employers. But with workers being laid off because their jobs are being given to illegal aliens, predatory work visa holders, or even sent overseas, and all this BEFORE the current economic crisis, I am losing confidence in the current model.”

    The catch is is that the current healthcare paradigm wasn’t designed. It grew out of anomalous circumstances and needs correcting. The mixture of private and public insurance systems conspire, whether by design or circumstance, against the self-insurer, gouging them with higher costs than either the public or private insurers.

    OC: “As for a surtax upon wealthy income earners (including capital gains), the USA should give these folks a medal in recognition of their extraordinary support of fellow citisens’ medical coverage, and perhaps a banquet dinner with the President, which of course, the hoi polloi would be excluded from.”

    You’ll find that the definition of “wealthy” will go through several revisions before this is done and the medal, at best, would be stamped tin on a bit of rag as a cost-savings measure.

  • abucs

    I think there does have to be a basic level of universal health care.

    The problem is that there are so many diseases, old, new and recently discovered that keep adding so much costs to the system that our expanding of the care, while in the short term no one would argue isn’t a really good thing, in the long term it is unsustainable.

    Patient X has this rare condition and all we need is 2 million pounds to save her life. Sure, why not ?

    There are 2 million persons with condition Y that will have their quality of life enhanced for the small cost of 200 million pounds/dollars a year. Sure, why not ?

    Etc, Etc. The thing is these ‘small amounts’ grow and are added to continually with new medical breakthroughs.

    Taken individually 2 million here or 200 million there we would all agree is a good spending of resources.

    Until it grows too much and the older population creates an even more heavier demand and we end up going backwards very quickly and risk losing the whole thing. (AIDS, obesity, cancer levels, age care, stress level, diabetes and whoever knows what next).

    i think we need to break down medical care into basic and extra categories. Everyone should be entitled to the basic. Certain designated hospitals within Europe should specialise in certain areas of health expertise to cut duplication. These should specialise in the extras as well as the basic – perhaps a 30 – 70 split.

    Charitable organisations should be co-opted (not pushed out) to provide care and bed space for people to take the pressure off hospital beds. Regulations on this charity should be eased and funding kept to an absolute minimum.

    Too many charities have to conform to regulations that cost so much money that the government (us) end up paying anyway. And the charitable organisations are in danger of becoming little entrepreneul feifedoms instead of helping people.

    We need community involvement but we need it to be on a volunteer basis. If the charity is not up to scratch then it goes. Of course the big churches are the best situated at the moment to provide this. This is how most of our hospitals started anyway. But we can’t over-regulate them to the stage where they become commercial and not charitable or else no money is saved at all.

    We need volunteers who are motivated to donate their time and skills or else we are just moving around money from here to there and needing more of it each year.

  • Nomad

    Give me a fucking break.”

    Yea Brian. Just leave it the way it is now, see if we can take health care costs from 16% of GDP(!) to 26% in the next 10 years. Smart!!

  • Brian MacAodh

    Yes, nomad

    Because ANY bill would be better than nothing, right? No matter how terrible it is, right? What is another few trillion in the hold, you know?

    If other countries were as goddamn obese and fat as my adopted country is, then their costs would rise just like ours is. If you are sick in america, you will get care. Don’t listen to the partisans.

  • Nomad

    No Brian, maybe it’s because:

    a) the doctors are currently given incentives to perform as many checkups, operations as possible
    b) Negotiating control with drug companies has been made harder in the past few years for Medicare and Medicaid
    c) Insurance companies spend tonnes of money researching who is unhealthy so they know who not to insure.
    d) People without insurance flood emergency rooms who shouldn’t be there for various reasons (like they should have been helped way before that point).

    Oh, and for you and Bill O’Reilly- to the best of my knowledge there is no definite plan yet- so while I’m certainly not for whatever is proposed your angst against it is a little irrational.

  • Dread Cthulhu

    Nomad: “a) the doctors are currently given incentives to perform as many checkups, operations as possible
    b) Negotiating control with drug companies has been made harder in the past few years for Medicare and Medicaid
    c) Insurance companies spend tonnes of money researching who is unhealthy so they know who not to insure.
    d) People without insurance flood emergency rooms who shouldn’t be there for various reasons (like they should have been helped way before that point).”

    As opposed to the socialized system where:

    1) Patients have to wait weeks at a time for routine care, young patients frequently being told “you’re young, what’s the rush”. Downloading the UK waiting list stats, the wait goes out to 68 weeks and there are providers who use that column.

    2) The current intrusion of social medicine in the American system is part of the price problem — Medicare regulations prevent any sort of discounting, but permit insurers (including the gov’t) to negotiate “contractual allowances,” meaning that the private payor, in reality, pays a far higher rate than Medicare.

    3) I’d love to see any sort of proof of your point “c” above… and what makes you think the state / socialized model doesn’t do the same? Sure, they can’t not insure them, but the certainly can delay/deny their care, based on behavioral factors — smoker, over-eater, etc.

    4) Don’t kid yourself — a good number of those people flooding the emergency rooms don’t belong there and didn’t need help in the first place. Folks bring their kids in there when they have a sniffle or a low-grade fever — things to be watched, but not emergencies. Likewise, when folks don’t pay the bills, they are more inclined to overuse them.

  • Nomad

    Dread: “As opposed to the socialized system where:

    1) Patients have to wait weeks at a time for routine care, young patients frequently being told “you’re young, what’s the rush”. Downloading the UK waiting list stats, the wait goes out to 68 weeks and there are providers who use that column.

    2) The current intrusion of social medicine in the American system is part of the price problem—Medicare regulations prevent any sort of discounting, but permit insurers (including the gov’t) to negotiate “contractual allowances,” meaning that the private payor, in reality, pays a far higher rate than Medicare.

    3) I’d love to see any sort of proof of your point “c” above… and what makes you think the state / socialized model doesn’t do the same? Sure, they can’t not insure them, but the certainly can delay/deny their care, based on behavioral factors—smoker, over-eater, etc.

    4) Don’t kid yourself—a good number of those people flooding the emergency rooms don’t belong there and didn’t need help in the first place. Folks bring their kids in there when they have a sniffle or a low-grade fever—things to be watched, but not emergencies. Likewise, when folks don’t pay the bills, they are more inclined to overuse them. “

    1) I’d rather be told to wait 2 months for an operation than get it and be billed for $30,000 if I was uninsured. Insurance is pretty expensive here and a shocking amount of young and low income people have none. Even many of those with insurance, who believe themselves to be covered don’t realize there are so many loopholes that when they do fall ill are only covered to a point. I have extensive bankruptcy experience in America, and about 1/3 to half of the people forced into bankruptcy do so because of medical bills. Many of them were insured.

    2) The intrusion of social medicine? If the government can negotiate as an entity for lower prices for a more efficient service then why not? We’re not here to please drug companies.

    3) While neither of us has direct access to the records of the private health insurers, (would probably make for interesting reading!) perhaps you’ve heard the term “preexisting condition”. Refer also to point 1.

    4) Point taken- I’m not going to argue this point too much except to say that I still believe it to be true in the US. I am from NI and know what you’re saying, but I’m currently only advocating for the fixing of the US system. I’d take the NHS over medical care in the US any day of the week. In the UK there is much to be done to fix this, if there was political will.

    At the end of the day, if you are going to compare everything to the NHS, perhaps you should bare in mind how much more money is spent on medicine in America. I have no doubt if taxes in the UK were to rise to the same level of funding as the US then it wouldn’t be hard to make the NHS even better.

    Oh- and I’m not claiming that America should even take the same route as the UK. The French and German models may be superior with a healthy public-private mix.

  • Dread Cthulhu

    Nomad: “1) I’d rather be told to wait 2 months for an operation than get it and be billed for $30,000 if I was uninsured. Insurance is pretty expensive here and a shocking amount of young and low income people have none”

    About 15% of the population, if you believe the “47 million” number they casually toss about. That said, in that number are illegal aliens, who don’t pay into the system, and the voluntarily uninsured — folks who do make enough money to have insurance of their own by choose not to.

    But, frankly, even if the honest number was 15%, why screw with *everyone’s* health insurance (except, of course, the politicians and their favored special interests — funny thing that) when the problem is the 15%?

    Nomad: “2) The intrusion of social medicine? If the government can negotiate as an entity for lower prices for a more efficient service then why not? We’re not here to please drug companies.”

    That just it — they aren’t negotiating, their dictating. Medicare reimbursement, for a fair number of treatments, doesn’t cover the hospitals and doesn’t even try. And I’m not talking about the drug companies, so pay attention. I’m talking hospital treatments, from the room and board charge to the aspirin.

    The government dictates that there will be one and only one schedule of prices for *all* payors. The government, via Medicare regulation, dictates that there will be no discounts, so private payors are hosed, right off the bat. The government then “negotiates” a “contractual allowance” (constructively a discount, but permissible under the regulations).

    The problems with government run health-care are myriad — they’ve tried to use it as a level of engineering — paying hospitals to train doctors, modifying the prices to get them to enlarge certain programs and de-emphasize other — hell, they use Medicare to make up for the short-changing they do to providers under Medicaid and thought that a “Medicare HMO” was a bright idea.

    Nomad: “3) While neither of us has direct access to the records of the private health insurers, (would probably make for interesting reading!) perhaps you’ve heard the term “preexisting condition”. Refer also to point 1.”

    Assumes facts not in evidence, Nomad… One of us happens to work for a Medicare intermediary… and then there’s you.

    Likewise, why should the tax-payor be soaked for the smoker’s lung transplant, the hard-drinkers new liver — even under the NHS, that one’s not uniformly covered. And why do you think that the government, where the only thing the gov’t employee is incapable of losing is their job, is going to make things any better??

    Nomad: “I still believe it to be true in the US. I am from NI and know what you’re saying, but I’m currently only advocating for the fixing of the US system.”

    What you’re advocating isn’t a fix. It is an experiment in governmental control, where the patient will be greeted with the same efficiency as they get at the DMV and the same charm as an IRS audit.

    Besides, the real problem that the “American system” isn’t a system and wasn’t designed. It arose from an anomalous set of circumstances — wage controls in the forties and its been a set of unintended consequences, with each “fix” leading to new problems. The further the government has pushed into the medical field, the higher the prices have gotten. Hell, medical insurance has taken physicians from a good living to a country-club and Jaguar living.

    The surest answer would be to unwind all the government intrusions, dump the mandated coverage and let people by health insurance the way they buy auto insurance or pizzas — the buy the coverage they want and go from there.

  • Cian O’Connor

    I remember several years idly looking at some statistics and noticing that the NHS consumed less of the UK’s GDP than the amount spent by the US government on healthcare (so excluding private healthcare, but including insurance for government employees and the like) consumed theirs. Spending has increased since then, so this may no longer be true, but I’d guess that the sums

    Comparing the two is fatuous. The US spends more on healthcare than anyone else by an enormous amount (even than the French, who really do have a gold plated system. Nobody who has experienced the French system prefers the American). The UK, spends a surpisingly small amount on healthcare. We could easily afford to spend more, we just don’t. Most of the problems in it are historical and are peculiar to the UK (such as the waiting lists, which are nowhere near as bad as they used to be, or as bad as claimed in the US).

  • Brian MacAodh

    As for the increased costs in US health care in recent years, don’t forget the high rate of obesity in the States. That does account for some of the higher costs. I remember the last time I went to the states, it had been a lil while since I had been there and the first thing I noticed at the airport were the fat people walking around. I knew I was back in the good ole US of A

  • Cian O’Connor

    Yeah, but admin is 30% of the medical cost. Which is insane.

  • Dread Cthulhu

    Cian O’Connor: “I remember several years idly looking at some statistics and noticing that the NHS consumed less of the UK’s GDP than the amount spent by the US government on healthcare”

    Sure — but, then, the UK has de facto rationing — what else would you call the long waiting periods? If people could get service on demand, instead of suffering until the get into see the doc, then wait to see the specialist, then wait to get the operation, etc. Hearing anecdotes from Canada, it can take *years* just to get a primary care physician? Additionally, America ends up subsidizing the medical costs in other countries — billing conventions being what they are, the US pays retail for drugs, whilst the socialized systems buy wholesale… except for Brazil and a few others, who simply ignore the patents and steal the product.

    One wonders how large that number would be adding back in the the folks who fly to the US and India for treatment…

  • Cian OConnor

    Sure—but, then, the UK has de facto rationing—what else would you call the long waiting periods? If people could get service on demand, instead of suffering until the get into see the doc, then wait to see the specialist, then wait to get the operation, etc.

    The US has de facto rationing, just by price. When large chunks of the population (including many with insurnace) don’t have easy access to good healthcare, that’s rationing.

    I’m not particularly defending the UK system, but one of my major reasons for staying here in the UK is the NHS (and yes I have an automatic right to a green card if I want one). The NHS is what you get if you don’t spend enough on a health care system, and let doctors structure the system (as well as the educational system) to suit their needs rather than patients. On the continent they structured the system to suit patients and spend more (though still rather less than the US) and have an amazing healthcare system. Still for all that, we have a very efficient system that provides good healthcare. If you want immediate access to a doctor then you can pay for it, either through insurance that is (compared to the US) very inexpensive, or directly (which is still very cheap compared to the US). Most people prefer to wait. We also get things that the US doesn’t provide even with insurance, such as midwives who visit the home after birth.

    I’m not sure what you consider a long waiting period incidentally. Currently my son is waiting to see a specialist about his foot, and the wait is about three weeks. You read in our newspapers who make up about half their stories (probably more in some instances) about six month waiting lists, but I don’t actually know of anyone who has experienced that. Three months is about the maximum I’ve heard of, though this was for non-urgent stuff.

    Hearing anecdotes from Canada, it can take *years* just to get a primary care physician?

    Given that I know many Canadians and have never once heard this (though I have heard several who lived in the US complain about the American system), I suspect these anecdotes originated in the US. Whenever I ask Canadians about these “anecdotes” that one reads in the US press they simply roll their eyes.

    One wonders how large that number would be adding back in the the folks who fly to the US and India for treatment…

    Excluding cosmetic surgery, I don’t know of anyone who has flown to the US or Indian for treatment. Not even anecdotally. I do know of people who have gone to France, Germany and Sweden for treatment. Though that is pretty rare.

    Additionally, America ends up subsidizing the medical costs in other countries—billing conventions being what they are, the US pays retail for drugs, whilst the socialized systems buy wholesale… except for Brazil and a few others, who simply ignore the patents and steal the product.

    No, the US ends up subsidising the profits of drug companies (which are huge, while their R&D costs are pretty small, particularly if you strip out medical marketing disguised as “research”. Nearly all primary research into drugs happens in universities, not drug companies, incidentally). If the US as a country is too stupid to bargain and wants to overpay for non-generics, or me-too drugs, I really don’t see that as the world’s problem.

  • Greenflag

    Cian O’Connor ,

    Excellent post and to the point. One further consideration . Back in the 1960’s when Kennedy was US President health care costs amounted to 5% of US Gross Domestic Product . Today it’s over 16% and continues to gobble up an ever greater portion of the US economy . Even Americans who have health insurance are a job loss away from losing it .

    The American ‘model ‘ is broken . Whether Obama has the political clout to change it is problematical . Left to ‘reform’ itself I entertain not the slightest doubt that just as the ‘shadow banking ‘ financial services preferred to destroy the world economy for the sake of the mega profits of the Madoffia then so too would the American Health Care System (including Drug Companies , Private Insurance companies , medical and legal professions and the medical health lobby complex prefer to make money from 100 million Americans who can afford to pay excessive premiums and leave 200 million Americans to scrap for any remaining crumbs left on the table .

    Health is a matter of life and death . It should not be left to ‘profit’ making businesses as to who lives and who dies -nowhere – least of all in the USA

  • Dread Cthulhu

    Cian O’Conor: “The US has de facto rationing, just by price. When large chunks of the population (including many with insurnace) don’t have easy access to good healthcare, that’s rationing.”

    Sorry, but no. Any hospital that receives any Federal monies – which is all but the most private of private facilities – cannot deny treatment on the basis of ability to pay. But, hey, nice try.

    Cian O’Conor: “Given that I know many Canadians and have never once heard this (though I have heard several who lived in the US complain about the American system), I suspect these anecdotes originated in the US. Whenever I ask Canadians about these “anecdotes” that one reads in the US press they simply roll their eyes.”

    We obviously don’t know the same Canadians — mine were shocked you could get an MRI the same day the doctor told you you needed one, not after a six to eight week wait.

    Cian O’Conor: “No, the US ends up subsidising the profits of drug companies (which are huge, while their R&D costs are pretty small, particularly if you strip out medical marketing disguised as “research”. Nearly all primary research into drugs happens in universities, not drug companies, incidentally). If the US as a country is too stupid to bargain and wants to overpay for non-generics, or me-too drugs, I really don’t see that as the world’s problem.”

    And should the notion hit them to do so and the burden of prices shift, you’ll hear the same howl that arises whenever it looks like the “Yankee go home” crowd will get their wish and have US army forces move out of their country — suddenly “Yankee go home!” becomes “why are you punishing us??”

    Greenflag: “Back in the 1960’s when Kennedy was US President health care costs amounted to 5% of US Gross Domestic Product . Today it’s over 16% and continues to gobble up an ever greater portion of the US economy . Even Americans who have health insurance are a job loss away from losing it .”

    That’s partly a difference in medicine between then and now (longer lives, more options, more drug-oriented vs. procedure oriented treatment, etc.) and partly bad health-care regulation at the state and Federal level — the law of unintended consequences is fully in play and some of the incentives created by Federal and State regulation have had some interesting effects.

    Greenflag: “The American ‘model ’ is broken . ”

    It’s not really a model, since the “system” isn’t a system, but the accumulated detritus of sixty years of regulation and tinkering, starting with the wage controls in the forties.

    Greenflag: “Left to ‘reform’ itself I entertain not the slightest doubt that just as the ‘shadow banking ’ financial services preferred to destroy the world economy for the sake of the mega profits of the Madoffia then so too would the American Health Care System (including Drug Companies , Private Insurance companies , medical and legal professions and the medical health lobby complex prefer to make money from 100 million Americans who can afford to pay excessive premiums and leave 200 million Americans to scrap for any remaining crumbs left on the table .”

    You sound one loop of tin-foil short of John O’Connell territory, GF…

    Greenflag: “Health is a matter of life and death . It should not be left to ‘profit’ making businesses as to who lives and who dies -nowhere – least of all in the USA ”

    Neither should it be put in the hands of faceless bureaucrats.

    Like I said before, you should be able to buy your insurance in the same fashion as you buy your auto insurance — yes, mandatory minimums, but you choose what you want beyond that.

    Riddle me this, if no-profit systems are so wonderful, why do so many foreigners, patients, doctors and healthcare workers, come to the US? For example, if the Canadian system is such a model of efficiency and wonder, why do problem pregnancies (premature triplets in the case I recall off the cuff), MRI patients and the like routinely shipped across the border to get the services the Canadian system can’t provide?

  • Greenflag

    Dread Cthulhu,

    ‘Neither should it be put in the hands of faceless bureaucrats.’

    Here’s some news in which shows your ‘faceless bureaucrats’ at work trying to prevent the non faceless ‘ ethical’ private health sector from ripping off the US taxpayer .

    july 29th npr.org

    ‘Federal authorities arrested 32 people, including doctors, in a major Medicare fraud bust Wednesday in New York, Louisiana, Boston and Houston, targeting scams such as “arthritis kits” — expensive braces that many patients never used.

    It’s the third major sweep since Attorney General Eric Holder, Health and Human Services Secretary Kathleen Sebelius announced in May they were adding millions of dollars and dozens of agents to combat a problem that costs the U.S. billions each year.

    Using about a dozen agents in targeted cities, including Miami, the Medicare Fraud Strike Force, has recovered $371 million in false Medicare claims and charged 145 people across the country in just two months.

    More than 200 agents worked on Wednesday’s $16 million bust, which included 12 search warrants at health care businesses and homes across the Houston area.

    Federal authorities say those businesses were giving patients “arthritis kits,” which were nothing more than expensive orthotics that included knee and shoulder braces. Patients told authorities they were unnecessary and many never used them. But health care clinic owners billed between $3,000 to $4,000 for each kit.

    Houston’s other scam involved billing Medicare for thousands of dollars worth of liquid food like Ensure for patients who can’t eat solid food. Authorities said clinic owners never distributed the food to patients. In some cases, clinic owners billed patients who were dead when they allegedly received the items.

    The suspects arrested Wednesday in Houston will make court appearances Thursday morning. Suspects in Boston, New York and Louisiana will have first appearances later today.

    The first task force started in 2007 in Miami, a city authorities say alone is responsible for more than $3 billion a year in Medicare fraud. Clinic owners there would bill Medicare dozens of times for the same wheelchair, while never giving the medical equipment to patients.

    The problems have become more complex since then.

    Suspects have moved into more sophisticated scams including home health care, physical therapy and infusion drugs. They’ve even started tapping into Medicaid Advantage, which allows the elderly and disabled to get benefits through private health insurers. The plans receive a government subsidy and generally offer more benefits than traditional Medicare.

    Federal authorities say Miami residents are also moving on to other cities, bringing their scams with them.”

    And the above DC is just the tip of even worse that happens behind the doors of Private Health Insurance companies ‘claims ‘ departments where 400,000 people work on an incentive scheme which rewards them with bonuses for every claim they turn down.

    ‘(if no-profit systems are so wonderful, why do so many foreigners, patients, doctors and healthcare workers, come to the US? ‘

    Criminal scams have a propensity to attract the good the bad and the ugly from everywhere . The USA does not produce enough of it’s own medical doctors the cost of a medical degree being prohibitive for most Americans except those who wish to lock themselves into horrendous debt and twenty years of slave labour and long unsocial hours paying it off .

    But the sick truth is shown by the ‘free ‘ medical care day provided in Bristol , Virginia the other day when up to three thousand poor whites from that part of Virginia queued up for 24 hours to get a ticket so they could stand in line to see a doctor and receive medical treatment for many for the first time in years or since they lost their jobs .

    I personally have had only one experience dealing with American Health care and it resulted from being in an accident while visiting New York about a decade ago . The hospital I went to was the Columbia Presbyterian which is reputedly or was one of the best hospitals in the USA . I was kept waiting for several hours while various medical staff laughed and hooted their way along corridors . An elderly woman on a gurney beside me and obviously in pain had not been seen for three hours .

    Now I relate the above personal experience vis a vis your ‘Canadian ‘ story . I’m positive that the vast majority of Canadians would no more want to import the American Health Care model than they would to import the ‘black death ‘ And the same would go for most European countries in the EU .

    The American Health Care system is a cancer eating away at the heart of the American economy . Unfortunately there are too many vested financial interests from the corporate drug companies to the private health insurance companies who are milking a corrupt system for all they can at the expense of the American people .

  • Greenflag

    DC,

    ‘It’s not really a model, since the “system” isn’t a system, but the accumulated detritus of sixty years of regulation and tinkering, starting with the wage controls in the forties.’

    I understand that but the detritus has now reached a point where it has infected the body politic and more importantly the economy to an extent which makes reform of the mess almost impossible .

    PS – I’m not maintaining that ‘no profit’ or single payer systems are perfect . A Health Care system needs to be paid for by everybody as a percentage of income and by employers with percentage contribution decided by sales volume and from general taxation and/or a sales tax . A single payer would be administratively more efficient and less costly. A ‘health’ care tax can be imposed generally on known addictives such as tobacco and on alcohol to reduce excessive consumption. And a determined effort has to be made to get health care costs as a percentage of GDP below 10% within 5 years and down to 7% within a decade !

    Those goals will never be achievable under the present chaotic mess !

  • Cian

    “Sorry, but no. Any hospital that receives any Federal monies – which is all but the most private of private facilities – cannot deny treatment on the basis of ability to pay. But, hey, nice try.”

    And is this treatment free? Why no it is not, the hospital can bill me and send debt collectors round if I don’t pay up. So its still limited by the ability to pay, unless I’m so poor that I have no assets to seize. I mean its good that in emergencies hopsitals won’t let me die, even if I’ll spend the next several years of my life paying it off, but it doesn’t make non-emergency treatment any more accessible.

    “We obviously don’t know the same Canadians—mine were shocked you could get an MRI the same day the doctor told you you needed one, not after a six to eight week wait.”

    Only if you have good insurance. People on HMOs typically have to wait until their insurer approves it (if they do, they may not), which can easily take weeks. Obviously if you’re well off and have very good health insurance then you get very good treatment in the US. Most people don’t. Of course you’d get better treatment in France which offers the entire population better healthcare than almost anyone gets in the US, while spending less on healthcare than the US.

    Though whether immediate access to an MRI for any but the most urgent cases makes much difference (or whether MRIs should be as routinely used as they are in the US, given they are not without risk), is a moot point.

    “And should the notion hit them to do so and the burden of prices shift, you’ll hear the same howl that arises whenever it looks like the “Yankee go home” crowd will get their wish and have US army forces move out of their country—suddenly “Yankee go home!” becomes “why are you punishing us??”

    Which roughly translates as “I don’t have an argument, so I’m going to throw a bogus analogy into the game and hope nobody notices.” Weak, dude, very weak.

    “Riddle me this, if no-profit systems are so wonderful, why do so many foreigners, patients, doctors and healthcare workers, come to the US?”

    Doctors and healthcare workers in part come to the US because they will earn a lot more.

    “For example, if the Canadian system is such a model of efficiency and wonder, why do problem pregnancies (premature triplets in the case I recall off the cuff), MRI patients and the like routinely shipped across the border to get the services the Canadian system can’t provide?”

    Without knowing the specifics of each case it is impossible to answer. But in the case of the births the most likely answer is the same as it would be in any hospital. They probably had had too many premature births, and so didn’t have the facilities to deal with three more. All hospital premature units have to close from time to time for this reason.

    As for MRIs. One reason might simply be efficiency. Small towns and cities tend not to have the same equipment as more expensive hospitals because they don’t have the demand to justify the cost/resources (this is less true in the US, which is why so much expensive equipment lies around unused). It may be that in some cases small Canadian towns/cities on the border are closer to large American cities, than Canadian ones – or simply that it was contractually cheaper to use an American hospital. Sensible use of resources is what the free market is supposed to be about, though in practice it seems the state run systems are much better at it.