Sure, if you ignore the fact that we have one of the highest standards of health-care in the world, as measured by empirical research (not opinion surveys and isolated incidents reported in news stories) at a lower cost of care than our neighbours, who pay more and apparently get less. Sounds like a real bust to me too.

I can't figure out where this idea that Canada's health-care system has failed comes from? Yes it has problems, and yes there are horror stories. But this is true the world over; every advanced health-care system on the planet is dealing with the problems of aging populations, higher expenses, etc. The fact is that all the objective benchmarks used to measure healthcare, and the aggregate studies used to evaluate healthcare continually identify Canada's system as one of the best. Until someone can offer an iota of empirical evidence to refute these findings, you can rage in the wind all you want, but nobody's going to listen.

Moving on...

Leder, I feel it necessary to point out that Arnold Klinger is an economist. Not because economists are idiots (as a rule I'm sure they're not, although I know one personally that is.) I make this point because the economist in question is evaluating health-care not from a position of the quality of service, but from a macroeconomic standpoint; he completely disregards quality of care in his arguments. This seems like a risky way to evaluate health-care. I realize that we'll probably never see eye to eye philosophically, at least insofar as medicine is concerned, but let me lay my cards out on the table. You say that socialism (or any government program which redistributes wealth or fungible assets) inherently impinges freedom, and is therefore immoral.

I say that forcing someone to decide on medical care based on whether or not that person can afford it is substantially more immoral. And my position has the benefit of greater financial efficiency on its side.



That's all well and good, but we have all sorts of facts to refute your claim, and you have none to support it. What you do have is lots of opinion pieces and conjecture. I've challenged you on this before, and I'll do it again: [u]find ANY study that proves that government bureacracy is inherently less efficient than bureacracies created privately.[u] Go ahead... just one. All of your arguments in this thread are based on the assumption that this theory is true, but you've yet to provide any proof, you've just said "well Hayek tells us" and moved on.

Part of that is true. I found the article here:
(http://query.nytimes.com/gst/fullpage.html?sec=health&res=9400EFDE113AF935A25752C0A9669C8B63)
...Where it appeared to be an op-ed in the health section. It seems I was in error. My bad.

The rest of that however, is comically untrue. My 'oft-repeated' comments stand, just as ignored as ever: the comments in the article are both unsourced and unspecific, a collection of horror stories one could easily pull together in the US if one wanted to. This 'argument by horror story' (which I already dealt with, by showing WORSE horror stories in the US) is absurd: far better to go by facts, numbers and figures, all of which show demonstrably better health service overall in Canada than in the US. Now who is counting strikes?




I most certainly did not. Firstly, that was not a quote from the article, just a comment about what the questions were, and I was absolutely correct.

"Respondents were also asked to rate their satisfaction with their health care services during the past 12 months as well as their satisfaction with physician services during their most recent visit (response categories were “very satisfied”, “somewhat satisfied”, “neither satisfied nor dissatisfied”, “somewhat dissatisfied”, or “very dissatisfied”).
When asked about their satisfaction with health care services in general, more Americans than Canadians reported that they were “very satisfied” (53% vs. 44%). Canadians were more likely to indicate that they were “somewhat satisfied” (43% vs. 37%). These differences remained when Canadians were compared with insured Americans.
Canadians were in fact more similar to uninsured Americans regarding satisfaction with care. The only significant difference between Canadians and uninsured Americans was the proportion reporting that they were “very dissatisfied” with their health care services: 9% of uninsured Americans and 3% of Canadians said they were very dissatisfied."

I mean seriously, this is a joint survey of the health care systems of two nations, in which people were asked to rate the quality of health care service they received. Are you seriously suggesting that they did not consider cross-border shopping with health care? The questions are clearly about the health care Canadians received in Canada, and Americans receiving in the US.

No, it did not overtly state that if you were an American who received health care in China, you should not include that on this survey of your satisfaction with the US health system. To assume otherwise is absurd, and presumes a level of utter stupidity on the part of those who created the survey.

And by the way, even if your bizarre supposition WERE true (and based on anything at all) it STILL would not necessarily have the alteration of results you presume. I take your supposed 'flood' of Canadian people getting treatment in the US and raise you huge quantities of seniors and the poor (and even municipalities) getting inexpensive drugs in Canada that they are unable to afford in the US.

http://www.cnn.com/2003/HEALTH/10/16/canada.drugs/index.html

So I guess all those people who responded 'very satisfied' in the US, were really satisfied with the Canadian system, right?







That doesn't even make any sense. how it is one of your phantom 'strikes' if I ask you to provide a source for an assertion? Good lord, if asking for a sources is some kind of 'strike', you have earned about a dozen of them for yourself just in this thread. Were you trying just a bit too hard to seem the superior there?





What are you TALKING about? It is a 'completely failed system' because you found three or four unsourced unspecific horror stories about people in the Canadian health care system 6 years ago?

EVERY SINGLE INDICATOR, including this massive joint health care system survey I have cited plainly shows exactly the opposite, that the Canadian system (while not perfect to be sure) is substantively better overall than the American, and better for 75% of the cost.

How on EARTH can you call this a 'completely failed solution'?

And if the Canadian health care system IS a completely failed system (despite comparative numbers that place it among the top five health care systems on the planet) then what does that say about the US system, which is overall worse in nearly every substantive way?

In terms of overall performance for the entire population, the World Health Organisation health care is much better in Canada than the US; Canada ranks 7th in the world in overall performance, while the USA ranks 70th.

I have already cited rates for survival of cancer (better in Canada), rates of average lifespan (higher in Canada) rates of child mortality and infant mortality (lower in Canada).


What have YOU provided? An article in the NYT 6 years ago which gives an assortment of unspecific and unsourced horror stories, which even if they are accurate in NO way could form an accurate representation of the system as a whole. You openly stated that these kinds of horror stories 'simply could never happen in the US'.

Fine, since you were trying to 'count strikes, lets deal with this whole premise right away, hall we?

Blackstone cites:



... then openly states:



...than adds:



Really? Never happen in the US? Ever?
Really, if similar horror stories DID exist in the US, it would render your ONE piece of evidence irrelevant?

Hmmm...

-San Francisco ambulances being turned away and hallway medicine being practiced.
http://www.sfgate.com/cgi-bin/article.cgi?.../20/MN45734.DTL

-Los Angeles ambulances CONSISTENTLY being turned away, due to no beds available:
http://www.jems.com/products/articles/17753/

"In a small room, a computer screen flashed mostly red: 15 of the 18 area hospitals listed on the county's ReddiNet system were on diversion. The only black letters belonged to County-USC, still open. Nurse Jennifer Waldron said she sees a screen like that "more than half the time."

-Average wait time for Intensive care units in the US is four hours.
http://www.pubmedcentral.nih.gov/articlere...i?artid=1065047

-Consisten turning away of ambulances and lack of beds in US hospitals.
http://www.weinsurehealth.com/PatientsSurg...20ambulances%22

(note: this article also contains a surprising statistic about the US health system (the one you claim is NOT a total failure)):

"Since 1985, the number of hospitals (in the US) has declined about 14 percent, with the number of beds shrinking 18 percent, the American Hospital Association says."

-Denver hospitals turning away uninsured patients
http://www.wicuba.org/hospitals_turn_away_ill.htm

-Poor marks for US health system
http://www.webwire.com/ViewPressRel.asp?SE...=&aId=20726

-US ranking against socialised commonwealth countries in health care? Last.
http://www.washingtonpost.com/wp-dyn/conte...5110301143.html


Finally, how about a study which looks at waiting time sin Canada, and the supposed phenomenon of cross border shoppers for health care?

http://www.amsa.org/studytours/WaitingTime...iting%20time%22

"A "waiting list" is a list that patients are enrolled in once they opt to pursue an elective
procedure, assuming that they cannot get this procedure performed immediately. In Canada,
waiting lists do NOT exist for emergency procedures. It is a myth that Canadians with serious,
life-threatening illnesses are enrolled on a waiting list before they can receive life-saving
therapies."

"Indeed, while waiting lists certainly do exist for certain non-emergent procedures, it is not at all clear that the "waiting list crisis" that is so often talked about by the media and opponents of single payer actually exists."

-and these 'masses' of cross border shoppers?

"During this period, these hospitalizations (Of canadians in the northern states) represented only 0.23% of all the hospitalizations that occurred in the three provinces bordering these states.

The idea that Canadians flock to the U.S. specifically for healthcare loses even further
legitimacy when one considers that the number of Canadians treated in the U.S. does not just
include people who specifically go to the U.S. for healthcare; it also includes care given to
Canadians traveling in the U.S., Canadians working in the U.S. on business travel, and Canadians
who move to the U.S. during the winter to avoid the cold ("snowbirds")."


-Finally, debunking the 'no waiting lists in the US' argument.

http://www.ncbi.nlm.nih.gov/entrez/query.f...p;dopt=Abstract

In Canada, there were waiting lists of up to 8 weeks for (elective) knee surgury. That may seem like a long time, but even in the US, the average waiting time was still three weeks.

And of course, to cite from the amsa document above:

"Furthermore, the short waiting times apply mainly to those who have insurance;
for those who do not, the waiting line is arguably infinite. Finally, the short waiting lists in the
U.S. should be tempered with the realization that the lack of universal healthcare in the U.S.
means less demand for the system."



So, how many 'strikes' for you is that?

Is healthcare a right?

I believe it is a basic human right in a civilized society. To argue that it is not would be to turn away a person who cannot afford to treat his condition/disease and condemn them to suffering or even death. Of course, we certainly have the option not to be a civilized society, where only the wealthy receive health care, and the poor die on the streets (which could create jobs – body collectors!) and plagues decimate the population, but Europe did that in the Middle Ages and it didn’t work so well.

How do we fix the healthcare problem in this country?

First of all, a “D” is generous. I can’t imagine the US’ broken healthcare system getting anything higher than an “F”. Add to that the fact that many state-of-the-art surgeries and treatments used for years in other countries with much success are not even approved by the US FDA, and you have the birth of a new, bizarre term: “medical tourism”. I discovered this phenomenon when I was diagnosed with degenerative disc disease in my lower spine. The only option given me was a 2-level spinal fusion. I discovered an innovative alternative through a back pain support group – disc replacement…problem is, it was just then going through clinical trials in the US (I believe one of them has now been approved...at more than twice the cost). Many people opted to travel to Europe to have the surgery. Unfortunately, my budget didn’t allow it, nor does it allow for me to pay the 20% of what a spinal fusion would cost me or the time off work, so I live a less active life than I’d like, and medicate the pain when I must.

How pathetic is it that now US companies are realizing it’s cheaper to send their employees to other countries to get medical procedures that are cost-prohibitive in the US?



To me, the biggest problem is the stranglehold the corporate boards have on our health care system, and coming in a close second is governmental bureaucracy (Medicare, FDA, etc.). As long as profit is Number One, and patients are far down the list in importance, then our “health care” system will remain a misnomer. Sick people are not profitable.

Though I like the idea of socialized medicine, I don’t trust our government enough to endorse it. Since our government has proven itself so incompetent it couldn’t pour pee out of a boot without instructions printed on the heel, I doubt socialized medicine would work well here. But, I’d be willing to bet a bunch of intelligent, business-savvy people - like those here at - could get together and hash out a better plan than anything the health care industry or any vote-sensitive politician ever could. But I also know that will never happen, and we’ll limp along putting band-aids on the system as it continues to deteriorate.

Questions for Debate:
Is healthcare a right?
No it is not right. Im sick of sitting in the ER for hours...

How do we fix the healthcare problem in this country? We first have to localize the problems and corruption in the hospitals, including overpaying doctors. If America can find the problems, then we can have better health care.

nighttimer, which of the above statistics indicates that we have a health-care "crisis?" This is what befuddles me. Insurance talk dominates the argument, but really what does it say about health care? No hospital is allowed to turn away patients in need of urgent treatment. I have relatives that go to charity hospitals, and they aren't much worse than the socialized ones I saw in the United Kingdom. Of the 45 million without insurance, how many are young, relatively healthy people?

I agree that the insurance model, tying health care to employment is an idea whose time has come and gone; what I don't see is a 'crisis' any more than the other manufactured "crises" I'm told to worry about from day to day.

UJ, you must know that I will respect whatever opinion you may have just as I would hope you would find respect for my views.

Now onto the issue. An understanding of the economic consequences of going to a universal coverage or any plan for that matter is essential to finding the best solution for the American people. Klinger is an economist and I would find that the healthcare problem is also an issue of economics. There are millions of people who are uninsured and who do not have access to the healthcare they need. We need to understand why that is. Its because prices are too high? Well why are prices too high and why hasn't the invisible hand of the market brought down the prices to where supply meets demand? These questions need to be answered. From my perspective, government regulation is to blame for its regulations and price controls. Trying to argue that the insurance companies are just being greedy doesn't really explain the economics of the situation. If one company has their prices too high for the consumer to purchase, then they are only hurting themselves because either the consumer won't purchase healthcare or they will go to a competitor. Obviously there is a huge demand for healthcare is not being met...why is that and how can we bring the market to equilibrium? I brought up Medicare and Medicaid in my previous post to point to a government program that has hurt instead of helped the American people from a macroeconomic standpoint. While i will concede that quality is not considered...but how can one objectively ascertain quality? Poll data? So because Americans are unsatisfied with their care and Canadians are satisfied that equals better quality care in Canada? No. Quality is a subjective term that really cannot be explained.

Furthermore, its wrong that so many people do not have access to real healthcare but i again reiterate that the solution should not be a government one because it is the government that is hindering the market from letting the private sector get out the best possible product.



Well lets see these facts UJ. Because I think the example of medicare and Medicaid are too easy examples of government mismanagement. And no i did not offer opinions and conjectures as much as I did backed sources with research information on the financial state of our healthcare system. Furthermore, I hardly think the burden of proof is on me to proove that the government is better or less efficient that the private sector. In my mind it is insignificant. There are certain responsibilities that should be reserved for the government and everything else should be reserved for the private sector. I mean if I except your premise, than why would i bother believing in the free market? Why not just nationalize all industries? Becuase that has worked out so well in the past. No, history is my example of how government bureaucracy is inferior to the free market. You will counter, well look at our healthcare system under the market now. But again i point to the hand of government abusing its power over the economics of the situation.

Your contributions to this thread have been light with no information for me to counter, just your own personal conjecture and opinion. If you want to propose a national healthcare system in the US then make your case and I will do my best to offer an alternative.

Please stop infecting our AD friends with rhetoric that isn't true. Wal Mart offers health care.
Read this.

Secondly, children of low-income families in the US CAN get preventative health care via medicaid and other government programs.
Read this.
Some families give Medicaid out at as high as 200% above the poverty level.

I know that a large part of the US doesn't have health care. However, for children this really isn't the case. Kids can go to the hospital. Illegal immigrants, a small percentage of the working poor, and many people who chose not to pay for health care all factor into our "uninsured" figures.

I'm not defending our healthcare system, but would state that the US and our vast expanse and large population is relatively healthy all things considered. You can't compare the problems of a state like Rhode Island to the issues that Texas might have, could you? That would seem absurd. That's what people do with countries like Canada (who's healthcare, consequently isn't any better) and the US.

I believe, and have stated before, that it's not healthcare reform that needs work but the health insurance companies that need work. Our nation's health care system doesn't work off true capitalist strategies like maybe restaurants do. Frankly, you go where the insurance let's you go, don't worry too much about costs and pricing, and generally use what's close or within "network". That basically means that some hospitals will charge x and some will charge y, but it's none of your worry so long as the insurance pays. You don't worry about whether they hit you with bandages, procedures that necessarily don't need to be done, etc. If this was your car, and you had to pay for repairs... how would you react? You'd never just agree to procedures 1-10 without asking what they're for... but healthcare isn't this way. All we worry about is the deductible and go about our way. Hospitals and health insurance companies are insanely profitable, but if were open to truly free choice, some may fail miserably. If I got the money from my employer that health insurance cost (if I opted out), and healthcare were affordable out of pocket, I think that everyone would be elated to "shop" providers. Hospitals and clinics would be more concerned with being speedy, friendly, and cost effective.

Hospitals run by the government will be like everything else run by the government. Awful. How many times have you been to the DMV, to apply for a bldg permit, to register for whatever, etc.. and just thought that you wanted to smack someone? Welcome to standardized healthcare... so long as profit isn't a motive, effectiveness won't be either...

You're still getting into a chicken/egg thing. The human body hasn't gotten harder to take care of. So absent an increase in the actual amount of resources necessary to do the job, costs do not just "go up". Someone has to make a decision charge a higher price. And they do this because they know they can get paid for it.


It's always "in bulk" at the beginning of the process. But when it gets to the individual level, it's no longer in bulk, because each individual person gets only one policy. It's not like buying eggs by the dozen or by the gross. It's not like you, the customer, can get three policies for the price of two or something like that.

And when you go to the supermarket, the supermarket got everything in bulk, but you don't. No matter how you slice it, by the time the insurance policy gets to you, the consumer, it's no longer in bulk. It was always in bulk for those above you in the chain (including the insurance company itself), but that doesn't mean the savings get passed on to you. In fact, the more middlemen there are between you and the product, the more you may end up paying.

Incidentally, another way insurance companies could charge less is by increasing co-pays for doctor's visits, and deductibles for inpatient stays and non-emergent procedures. I personally would be perfectly happy with a policy that offers a low rate but high deductible. Why should I pay an insurance company middleman for costs that I'd be likely to incur? The reason for having insurance (in any field, not just health) is to cover really high costs that you don't plan on, that only a small fraction of people incur. If we got back to that for health insurance, I think rates would be a lot lower.



I didn't ignore your point. I addressed it by saying that the situation presented in that article could not very likely be applied to the U.S. Of course the U.S. has its own problems. If you're asking me if the stories you presented at the bottom of your post were indicative of the problems faced in the U.S. healthcare system, they do. But it's different from the problems of the Canadian system.


Now this is just sad. You got caught red-handed making an utterly false statement, and how do you respond? By moving the goal posts and pretending you were really talking about something else. Not gonna fly. The finding we were discussing was the one about unmet health care needs, not the one about patient satisfaction. It's the one that reads, "Overall, more Americans reported that they had experienced an unmet health care need in the previous year compared with Canadians (13% vs. 11%). There was no difference in the proportion who reported unmet health care needs between Canadians and insured Americans."

Unmet means unmet. If a person had a need that was met by going to whatever country, then he could not claim to have an unmet need. There's further evidence for this in your CDC link. On page 18 of the report, it states, "In both countries, those with lower incomes experienced higher levels of unmet needs compared with those with higher incomes." (it listed 17% unmet for lower-income people Canada, compared to the national average of 11%) Now why would that be the case in Canada, where rich and poor are treated exactly the same by the system? The only explanation I can think of is that wealthier people could afford to get care in the U.S.


And what does that have to do with the decision to prohibit private insurance in Canada, which is what we're discussing? If anything, it may show that Canadian price controls on drugs mean that people in the U.S. are subsidizing cheap drugs for Canada, by bearing more of the costs per capita of developing them.


It would really make the discussion go a lot smoother if you were to take my earlier advice, which is to slow down a little, so you can read what I'm actually saying, instead of what you're geared up for me to say. I did not say "failed system". My comment was not about the Canadian system overall. It was about one particular aspect of the system.


Thank you for finally acknowledging, after I had asked a couple of times, that your issue isn't with the accuracy of the reporting. As for its significance, what I stated was that the actual situation described in that article would not be found in the U.S. I already acknowledged that the U.S. has a different set of problems.


What you found is that there are hospitals in the U.S., as in Canada, that suffer or suffered overcrowding. You haven't found that the situation in the U.S. is as described in the NYT article. It pertains mostly to ERs, not to the other types of care mentioned in the article, and even in that area wasn't as acute: Nothing about permanent hallway locations, or parking lots full of ambulances, or up to 20% of heart attack patients waiting an hour or more to be seen.


I never said that waiting lists were for emergency procedures. But "elective" can still mean hobbling around in awful pain for 8 weeks, even though you can afford the procedure yourself, all because of some dip___ ideological policy that prohibits you from doing so. Even though that by paying for it yourself, you'd not only be helping yourself, you'd also be helping those less fortunate than you who are in line behind you. This is rational?


Whereas in Canada, the long lists are a result of the completely avoidable demand placed on the system by the laws that unnaturally keep people in it.

Any way you take it, to make available healthcare for those that currently do not have it will take government involvement, either by the government forcing private sector to do it, or taking on the burden itself, or course private sector could sacrifice itself for people, but that will dry up as soon as the company endangers itself in some form via such. Anyway, I don’t think either is safe from what someone could call corruption being both are run by people.

To not make healthcare available for those that do not have it, means fitting the bill at the emergency room, at which point it costs more in every regard you can think off, besides that its basically just saying no healthcare unless you can obtain it yourself, so then you are stuck with basically horror stories exiting in America.

Well why not apply that logic to every industry, why just healthcare? The private sector cannot be trusted to do whats in the best interest of the consumer but the government is.


We are already fitting the bill. We pay more for healthcare than any other nation...money is not the problem. Its the system and its the regulations placed upon it. I don't know how anyone can say we need more money into healthcare when we pay so much.

I hate to sound like a broken record., but Leder, can you please try proving that regulations are the problem? The closest thing you've done to this is citing ballooning medicare/medicaide programs; but you've established correlation not causation. Medicare could just as easily cost so much money because it is attempting to operate in an free-market environment.



One of the chief obstacles in this debate seems to be the application of extremely generalized rules/ideas (of economics, philosophy, etc.) to a very specific system. The human body hasn't gotten harder to take care of; it still functions for the most part the way that it did 100 years ago. However, the nature of that care has changed substantially. People's diets are vastly different, standards of care have improved dramatically, life expectancy has skyrocketed and in general medicine has grown infinitely more complex... I don't know... maybe that has some impact on the costs? And as long as insurance is the primary model for healthcare delivery (whether private or public) those costs are going to be saddled on all health-care users, not just the ones who use these services.



Just so Lederuvdapac doesn't think I'm picking on him, I'm going to hammer away at this again. Prove that government bureacracy is inherently less inefficient than corporate bureacracy. That doesn't mean a quote from Adam Smith, or some sardonic platitude, but any actual evidence. If government was as generally incompetent as you suggest, then surely the evidence would be overflowing, and as such there would be MOUNTAINS of studies verifying this. I've never found one. Are there inefficiencies in government bureacracies? Certainly, but everything I've read suggests that this is just a function of the complexities/size of said organizations; which are a result of demands on the system (universal access, business models which are inherently unprofitable, etc.) and not of corruption, incompetence or some other public-sector boogeyman.

And does that explain why the cost of health care has been rising faster in the U.S. than in most other lands? If not, then I think my above analysis holds.

edited to add:


You just confirmed what lederuvdapac said, Uj. He didn't say that it was a result of corruption, but of lack of incentive to perform because of lack of profit. I tend to agree. Maybe governments in other countries are better contsituted to handle the job, for whatever reason, but I'm not sure I trust the government in this one with such an important task, based on my observations of it.

You know, I figured "prove it" was a fairly self-explanatory statement. Perhaps I was wrong. Public sector organizations are sometimes unprofitable... true. They are inefficient... also true sometimes. They are inefficient because they are unprofitable... who the hell knows. Simply saying "that's what I think" is a pretty flimsy rationale; yet you are willing to do so without pause. On what level am I able to have a productive debate when you either disregard my point or oversimplify it, offer a "I just don't trust the government on this one" response, and move on?

I'll say it again, just for fun. Prove it. If the profit motive enhances efficiency in the health-care industry there has to be some proof out there somewhere... so lets see it.



It doesn't have to; the escalation in American costs can be attributed to any number of circumstances; malpractice costs, the inefficient distribution of health-care resources, and bad economics. Throughout this thread people have offered evidence for all of these explanations. Lets see yours...

Yet, in every thread dealing the GW goverment- you are perfectly willing to defend "goverment" say- in Iraq? If you are going to say the goverment is doing things badly- how about some consistancy?

Seriously Blackstone- the main problem with medicine is that it is absolutely NOT compatable with a profit motive- you just don't get better care through capitalism. Think of it like the police force- do you want your police force to be working on the profit motive? How about the army- how would they get thier profit? Well, poor criminals don't have any money for the most part- so how do they earn the profit? IT is the same way with medical system in America.

Now- I might except some of Leders and your arguments- IF we stopped some serious anti-capitalist anti-freedom groups like the FDA and the AMA.

Also, medical education, like becoming a nurse or Dr, is horrbly expensive. They have to recoup that money through thier salaries- and entry to Medical school is artifically hampered by the AMA- they purposely limit entry into medical school to keep Drs salaries up- no other country in the world- socialized or not, has that particular wierd caveat in thier system- in every other country in the world- you have the grades and will, you can go to medical school. That is why "Drs without borders" was formed out of France- part of that being because France had a Dr SURPLUS- the opposite of America.

First off- we need to reform our medical education system, then our drug approval system, then our health insurance system- do away with it entirely-

Aevens is essentially correct in that we have great equipment and personel, as good as any in the world- but we don't have access to that care for all- unlike those other countries-

and Blackstone- I can personally attest to 10 horror stories in the medical field that is more horrible than your Canadian examples, every day. It is so very, very asinine to think we have a less wait time than Canada for anything- - I had to wait two months for routine shoulder surgery- and I had no choices of Drs, there is only one or two Drs locally that did my surgery.

OK, but I was just going by your own statement. If you want to disown it, go ahead and do so, but until then, I don't think I'm unjustified in holding your own arguments to it.


I haven't ruled out government involvement, if that's truly what's necessary. I'm just expressing my own apprehension. If you really want to debate this angle, take it up with leder, since he's the one who's been after you on this. I'll just remain open-minded, but cautious.


I offered my evidence that health care costs have been rising in the U.S. for reasons other than the amount of resources actually necessary to take care of people's health. As I said, the evidence is in the fact that such rises are almost completely unique to the U.S.



If you can offer a private-sector alternative that would defeat al-Qa'eda over there, I'd be fascinated to see it.


Ah, that must explain why King Hussein of Jordan went to the Mayo Clinic for his lymphoma, instead of going to the clearly superior system in Canada . What do you think healthcare would be like worldwide if it wasn't for the profit motive? That's why I can't take these ideological statements seriously.

1 - Patients' satisfaction with their cataract surgery is affected by long wait times, and to some degree inversely correlated. link

To be fair, I left in the bit where Canadians (and Swedes!) would rather wait than pay. Considering that the Swedes in particular are taxed to death for their 'free' government health care, I think that this is a side-effect of the system, not consumer choice.

2 - In Alberta, outsourcing cataract surgery in Calgary has led to shorter wait times. link


Based on (1) and (2) above, it seems that introducing private health care (a profit motive) has improved cataract care in Calgary.

Someone earlier mentioned government health care as equivalent to the service levels at the DMV. Having lived in Glasgow, I'll second that. Staying with the UK example, here is another privatization example improving the level of care. link


Going back to Canada for a second, that article on Alberta also mentioned the law which bans private hospitals? Is this true? This was the "failed aspect" of the Canadian health care system that Blackstone mentioned. Can they do that? It would seem to be the equivalent of the US government banning private pensions because the government provides Social Security...


I see that it still says "Libertarian" next to your name, so I have to ask why the hate for private health care?

As for the police force, it's a good thing that the Chicago PD don't work on the "profit motive." Otherwise, those parking meters, tow zones, radar guns, traffic cameras, road blocks and speed traps would really be about revenue, not public safety. I'll keep that in mind.

edit - maybe I'm the only one who noticed, but I appear to have conflated Calgary and Edmunton in my post. Please continue to ignore this portion....I don't have time now to confirm this...

Since I work in the health care field- I am just being practical vs ideological-

fact #1- of all developed nations- US is about the worst- if not the worst- seriously- is there any other western society that is ranked below the US?

fact #2- Americans generally experiance worse health than all the other developed nations

Fact #3- We are the only nation, as far as I know- that allows the drug companies and doctors organizations to write thier own regs and govern themselves?

You guys want to say that Canada or Swiss or any other country has some sort of problems with thier healtch care systems- which, of course, is true, no system is perfect- they all just happen to have far better overall health care than we do-

So you have to ask yourselves- why do they do so much better than us, with less money spent, and more goverment oversite and involvement?

I am libertarian- and believe the main function of goverment is to make sure that the strong don't take away the rights of the weak, national security and equal application of the law for all, regardless of socio-economic status- and Health care flows along all those- so I think that health care is a legitimate extension of goverment service- much more than any other social service you may come up with- equal to education. Right up there with road building.

There are some domains of strict goverment oversite and service providing- police, justice etc- whose mission is 180* out from the profit motive- it is as inappropriate of a judges decision being handed down based on who pays the most for the decision. Health should not be a matter of who the highest bidder will be.

Introduction to Macroeconomics


Price Ceiling



Now how do price ceilings and regulations affect healthcare? Well first look to how the AMA established a medical monopoly. This form of corporatism that is becoming all too familiar here in the United States is a direct result of government regulation. If the government was not involved, what reason would interest groups have to lobby and spend money on candidates?

Furthermore, the regulation standards the FDA imposes on drug companies increases the cost of drugs:

Breaking Up the FDA's Medical Information Monopoly



Furthermore, I used Medicare and Medicaid as examples of government run programs that have had the opposite effect of what was intentioned. Medicare is failing in a free market environment because it is the complete opposite of what a free market environment is supposed to support.


I again reiterate that whether or not government is more/less efficient is inherently insignificant. In the case of a national healthcare system, the government would be making an arbitrary, moral decision about where the resources are best allocated, which is unjust. And if you do want proof I once again just point to history. Economist Jeffery Sachs' program of shock therapy that was applied in Former Soviet Republics and Latin America where nations were stuck with hyperinflation and massive economic problems produced results that we can all see today. Poland is now a developing country with a strong economy.

I am just a bit confused UJ on the argument you are trying to make. Are you saying that the government bureaucracy is just as efficient as the private sector? Does that mean that it would be beneficial (or make no difference) if all industries were nationalized or are you focusing your point specifically to healthcare?



Is there not proof in all other industries where regulation is light and where the market is allowed to reach equilibrium? Again the logic that you apply for the nationalization of healthcare can easily be applied to every other industry then what need is there for the free market?

Leder- you are hitting the nail on the head on some of this- ESPECIALLY the AMA- technically, our medical system can not be called free enterprise at all- it is corporatist- like you mentioned- with an oligarchy of "guilds" if you will, of corporate heads that manipulate the system.

You even miss the boat with regulatiobn though there Leder- you think goverment makes the wierd and onerous regulations? Not so! JACHO- one of the accreditation orgs, is not run by the goverment at all, nor does it have any oversite whatsoever- it is basically commisioned by insurance companies to acredit hospitals- and they will drop acredidation on the hospital if they don't comply- and there is no appeal, no oversite, no elected positions- NOTHING as far as a check and balance on thier power- and it is 100% insurance company mandated!

IF we got rid of health insurance, we would get rid of Jacho- and believe me, they cost some serious dough!

You see, they make a whole 'nother industry- the Jacho consultant- always a dr, always writing regs for the hospital to follow because of POSSIBLE "joint commision regs" that might be implemented in the future. Some pretty wierd stuff they require, that doesn't help anyone but does keep the consultant busy- and this is NOT a goverment agency!

And whaddaya know, the vast majority of those societies accomodate some form of private insurance or coverage. Canada, insanely, does not, and it has suffered the consequences.

Remember, you didn't say that the profit motive was insufficient for delivering health care in the best way. You said it was absolutely incompatible with delivering health care. That's the ideological part.

I appreciate the response Leder, I really do. It was thoughtful and persuasive... if we weren't talking about healthcare.

The theory you provide is nice, but again, it is general information. Yes, government intervention does create price pressures on a free-market system; but in a state run system there is no market. You can't say that intervention in the free market creates inefficiency, therefore a national program (eliminating said market) would create even more inefficiency. The dynamics are different.



This is actually what I was suggesting; Medicare/Medicaid aren't failing because government programs are inherently inefficient, they are failing because they are operating in a mixed-market system which creates additional layers of bureacracy and regulation; however, again, without the free market "competition" to these programs, the regulations and bureacracy would not need to be as complex and those inefficiencies could be alleviated.



And how does the market allocate resources? Not in the most "moral" way; rather in the most economical way: those who can afford health-care can achieve it. You are free to invite morality into the equation, but you'll find that the "invisible hand" pays no heed to it.



In theory, bureacracy is bureacracy; there are variations from one to the next but the basic economics of private and public are the same; at least that's what the science bears out. This is a far cry from saying that government should run all businesses however. A government service is by it's very nature large and unwieldy, not because it is run by the government, but because it is large. Because it has to service everyone, it must develop a larger bureacracy; which leads to less efficient practices.

What I'm saying (in a rush here, sorry), is that a government run health-plan would be more efficient at serving the entire population, than a private system that would accomplish the same. Not because government is inherently more efficient, but because private industry is not structured to serve in an artificial market...

Of course, if you don't care if people can't afford basic health care, this is all irrelevant.

Any monopoly can only exist through the sanction of government. In this situation it is through the necessity for a license to practice medicine. The AMA thus has the power to restrict the number of doctors who are able to practice and then the amount of competition that is allowed to occur. Every state (or almost every) requires that a person be licensed to practice medicine, and to get the license, he/she must be a graduate of an approved school by the Council on Medical Education and Hospitals. This control over admissions is the most significant factor to hindering the free market to work in the area of healthcare.



Irregardless, I am not willing to trade a private monopoly for a public one. We should try to work to have the market sort things out and not a power as arbitrary as the AMA (even more so actually).


Ok heres the problem. I am trying to point to a free market solution to the healthcare problem while you are pointing in the complete opposite direction. You use our current system as an example of a market failure and an area the government should intervene. But as has been displayed by CruisingRam and I, the system is not actually free and that is a direct result of government regulation. I would agree the current system isn't working but its not because of the free market but because the lack of it.



The regulations and bureacracy would not need to be as complex if we did away with the regulations and the bureacracy. But here is another consequence that you must consider. In order to make healthcare more efficient you either have to tax the populace even more or take funds from other areas. So then you create a situation where everyone has access to healthcare but more people are going to need it due to their decrease in socio-economic status. "Tax only the rich" you say and leave the middle and poor classes alone? Well its just a slipper slope to the welfare state isn't it?



Exactly! The market is amoral. Nobody is making arbitrary decisions for other people. It is only the producer and the consumer making consenual contractual agreements about what is best for each of their persons. Its not fair that one kid is born into a rich family and another kid is born into a poor one. But nobody made that decision for them. It was completely random...luck if you will. Theres no morality with that, its just the reality of the situation. But when you say that one group should receive such and such from this group, that is a moral decision. And with the coercive power of government behind it, that decision could lead down the road to serfdom.



Being that we have never really had a free system, it would be difficult to support that claim. And the economics of the public and private are NOT the same. There is no competition in the public sphere and it does not adhere to the laws of supply and demand with the use of price controls and such. The adaptive nature of the market is one of its greatest strengths and why if the healthcare market was truly free that it would work.


Wow UJ, if this was a boxing match that kidney shot would pay dividends in the later rounds. I suppose I am just the cold and immoral classical liberal who cares not for the people and just cares about all the money i can get my greedy hands on? UJ, this card has been played throughout history to gain support for socialist policies and the emergence of the welfare state. Its not going to work on me because I know better. There is a serious economic question involved here that needs to be answered (and i think we have made some progress uncovering what the true answer is) but you would rather revert to the emotional, moral, and subjective argument that people need basic health care. I made no argument to counter this point, I just have a different perspective on how to achieve it.

That last sentence actually came out a bit different than I had intended.

You say that there has never been a free market for healthcare, but that's not true. During the 18th and 19th century the U.S. health-care industry was nascent, but almost entirely private. During the first half of the 20th century governments still had very low levels of intervention.



Of course. Who cares if the ocassional flipper-baby emerges, or doctors prescribe drugs which cause serious harm years down the road... the market will correct "the problem" in due time.

The problem with the free-market mantra that you are espousing is that it depends almost entirely on philosophical theory; communism has seen more practice, and there's never been a true communist government. A lack of regulation is not a panacea.... if you don't believe me, ask the people in Bhopal.

In response to lederuvdapac

I think he(uj) is making a point that one of the reasons the current medical plan for all Americans fails is simply because the free market pushes such out of reach for many, or the reality of economics as it would relate to the current medical situation in America, or why some people cant afford it in the first place. The idea is that fully state owned healthcare plans would avoid this, because it would not exist in the chaos of the free market. I do believe that the government steps in actually to break up monopolies really, though I guess without such we could all be employed by Microsoft in the future, and vote for them too.

I think a nice idea would be to take every state and allow them to work out some form of a plan, basically a think-tank if you will, but that a state must have a plan or something. I imagine after sometime if anything we could come to understand our economy better via that lense. I still do though overall stick to the idea of at least making healthcare available via being employed, but I do realize that would mean jobs for everyone that needs one, and by extension that plan would have to be able to take care of any dependents those people were caring for. I do find it funny in the realm of family first type of thinking in politics that healthcare seems less important, it must be difficult to balance the illusion and the reality of political goals.

Of course you are right but you can't really compare the market centuries ago and the market today as health care and what constitutes medicine is completely different. This doesn't really prove anything about whether or not the market worked or did not work.



Because these problems are not possible under nationalized industry?



It doesn't depend on philosophical theory. The laws of supply and demand are economic laws...not theory. The poor experiences with the free market in countries like India and other Asian countries is not due to capitalism but usually due to institutions independent of capitalism such as the legal structure. If the laws of a nation do not have respect for private property and individual rights, then obviously people will be taken advantage of just as they would under any command economy. Thats why NGOs like the Grameen Bank work with microcredit with the poorest people of countries so they can build up their credit and get loans to enhance their entrepreneurial capabilities.

Things that motivate themselves in our eyes or some peoples eyes into what is called a law is simply because it just occurs. Gravity is a fine example of this, we don’t yet fully understand gravity and there is much theory behind the efforts to do such, but this does not do away with existence of gravity. Theory as its correct definition would hold it only exists as long as scientific hypothesis will support such through time, or of course hypothesis over hypothesis.

I cant really stand all the aspect of liberal thought that has to do with control on every aspect of your of the human experience or life and the far right everybody needs to be a Christian mentality, plus I really despise communism, so please don’t perceive me in that light, just wanted to add that in.

On that note though I am in the boat that thinks Americans regardless of economic status should be able to obtain healthcare, I think morally Americans would not let millions of our own citizens go without, and we all know the current system has many problems that basically deal with trying to keep it as capitalist as it can be in many ways, but in that light the simple logic is it goes back to why those people could not obtain it in the first place. If we accept emergency room medicine, it will only cost us more in the long run. The healthcare system in communist era Russia is a fine example of this, they never ever cared for preventive medicine approach, this basically bloated the cost of healthcare for them to the point of collapse. Its a common idea in the healthcare field that early detection or care for health issues is better also, and its that same opinion that coincides with the idea that preventative medicine can save a lot of resources involved.

Its also that the field of medicine on a whole is not very efficient. There is gross waste more often then not in hospitals in America. To me the issue of course is about the money like usual, but a real understanding of all matters that would pertain to the issue could probably help resolve a lot of misunderstanding about real cost. Another avenue that we are talking about is simply what percentage of Americans would actually need such a program, it would not be all on a whole of course, just basically those that live in the poverty line or above it for the most part I think would be a major proportion of such. I doubt how many people would take themselves to that area in life simply to get free medical insurance to cover the "make a government system and it will be abused" avenue.

The private sector as it stands I think could only carry so much on a level of charity as long as they were being successful, so if overall it comes down to the idea that private sector cannot realistically in America take care of what is millions of people that go without, something other then private sector needs to step in a help if you agree with such, the only other real body for that is the government, unless Americans should pander to the U.N or something, I mean Citgo tries to play that angle.

The argument you are basing your free market theory on is flawed. Healthcare competition does not work like many other aspects of a free market. Your comparing apples to oranges. Prices are competitive in a free market due to competition, supply and demand. Hospitals virtually dont have competition in the United States. The only real competition that exist are contracts with insurance companies (those dreaded HMO's that you might have to drive out of your way for and to a doctor you dont know) and government funds for research. There isn't a Best Buy lowering their price because a Wal-Mart was built across the street.

Its not because of the governments limited regulations that health care and health insurance costs are so high. If it were then beef prices would be up the roof, or batteries or almost every other item we buy. The US does not have a free market. We have a very regulated market with many government regulations pertaining to thousands of different consumer goods. It costs companies millions every year to adhere to government regulations. Everything from beef to the car you drive.

Competition is not exlusive to a free market. Companies compete for government contracts all the time. The supply in the area I live in for a good doctor is very limited. If I looked around I could find maybe three good doctors to choose from -- and I would chose the one recommended by a friend/family member without even looking at prices. When I drive down the road I can find about 10 places within 10 miles to buy food. I can find one hospital. Are they really that concered that if they charge you $10 for an aspirin (as many places do) that you won't come back? It's just a matter of demographics.

When it comes to health care consumers don't really shop around much and there usually isn't a whole lot of competition in the area. Alot of doctor's are recommended by a friend/family member or chosen because it's the closest hospital or health care center. Also when someone finds a doctor they normally stick with them other than looking around for someone better with cheaper prices -- which drives down prices for so many other products and services. So the driving force behind a capitalist system that keeps prices in check simply does not exist for health care.

You just can't compare market reactions to buying a nintendo as opposed to getting knee surgery. It's not the same type of market... no matter how you slice it there will always be heavy government regulation on health care because of the nature of the product.

Edited to add (I also added some points above) :

Look at it this way, if your car insurance payed for you everytime you went to buy a car... would you really care how much it cost? You would purchase the Lamborghini not a Kia. You just goto the closest one or the one recommended by a friend/family member. This is why I thought the HSA would be the best opportunity for a capitalist system because you pay out of pocket for a large percentage of minor doctor visits, and the insurance only kicks in paying larger percentage's of the bill when it goes above a certian amount (say $1,000) so that would help to drive consumers to look around for competitive prices, even if it means driving another 30 minutes.... this didn't work out as I explained in my previous post.



Since the underlying competitive force is not nearly as strong for health care as it is with say a nintendo price in the "free market" (as explained removing govt. restrictions is not the problem) -- as demonstrated by many other countries across the globe -- I have come to the conclusion that the best solution should be taking examples of government ran programs around the world, attempt to pick the best parts from each one and come up with our own government ran solution.

And again, you just about make my point for me. I wrote to you earlier:


What you said is quite consistent with that. The only difference is that HSAs merely represent an addition onto the current system that many people would regard as experimental - better to stick with what they're familiar with. In other words, the overwhelming inertia of what you correctly note is "our already well established system" runs roughshod over these rather timid innovations. But if we fundamentally strike at that system by eliminating the tax breaks that support it, and we'd have a much better chance of replacing it with something designed around the goals that both you and I describe.