Posted on 03/12/2006 4:58:03 PM PST by Ultra Sonic 007
Greetings. I have a piece of text I'd like to copy and paste from a topic on another forum (known as Marble Garden, which is where political, philosophical, and sociological threads and debates are posted). I had started a topic (username: Ultra Sonic 007) about health care, asking which system would be better; socialized or private?
One of the forumers there is TheCycle, a Canadian. He just recently posted a long post on the universal health-care system and why it would be a good idea for the US to make the switch to such a system. It was in response to snippets from Michael Savage's book 'The Enemy Within' that regarded health-care. Snippets I posted.
This is where I ask for help.
Huh? What do you mean? Socialist? What are you talking about?
Rich people have this idea that they should be able to get what they want, when they want it, rather than getting in line like everyone else.
There are 2 ways for an average Canadian like me to get to the front of the line for a new knee, or even for life saving surgery.
1. The person in line ahead of me dies. (not good)
2. The person in line ahead of me pays to have their work done in Quebec, or the US, thereby moving me forward in the line.
We need the third way. People working hard to deliver excellent health care.
Competition.
Oh, OH.
I'm sorry, I accidentally put italics around TheCycle's quote. My apologies for the misunderstanding.
Just in case you're curious, I was the one who started the health-care topic on Marble Garden as a comparison topic; which systems work better? And what could be done for improvement? That's all. And in the face of Cycle's initial post, I wanted some assistance in debunking his points. After all, I use Free Republic as a research site much like other sites on the Internet (for instance, using abortionfacts.org for abortion info, and otherwise).
Sorry for somewhat inferring I was a socialist (God forbid. XP ).
The government also gets involved in micromanaging our charting procedures, so that we spend less time taking care of patients and more time complying with stupid additions to charting for certain medications called "chemical restraints"... it's a stupid nightmare.
Price fixing? I'm not sure what you mean.
His follow-on post explains in his own words; price fixing.
Wrong. In the case of doctors, each provincial government works out an annual agreement with the Canadian Medical Association, which is the professional association representing all the MDs in the country (it's basically a union, only it calls itself something else), and creates payment schedules for everything from a routine checkup to a triple-bypass. /---------------/Everyone else -- nurses, assistants, technicians, receptionists, even housekeepers -- is unionized and pretty much does the same thing.
Because a Canadian doctor or health-care specialists can't charge more in discretionary situations They're inclined or even forced "to provide poorer service by less qualified individuals using older equipment and technology."
I received my refund cheque within 14 days of filing my tax return.
LOL Canada is good at rebating withholding Tax over-payments.
If for any reason the CMA is not satisfied with the agreement, they withdraw services. In other words, the doctors go on strike./---------------/Recently the BC government tried to cut the nurses' pay and they nearly provoked a general strike. In fact, basically everyone who works in the public sector is unionized and fully protected from the kind of unilateral decision-making you just described.
A doctor on strike is worse than the Guillotine. Forbid it, Almighty God!
The basic problem is that once health care becomes a political matter, your voice in it is effectively subordinated to what bureaucrats determine is in your best interests.
I'll forgive you for saying this only because you don't live in Canada and are unfamilliar with the political climate here. But basically, with the sole exception of oil-rich Alberta, every government in the history of this country that has tried to screw with health-care, or toyed with privatization, has been kicked out by the electorate on this sole issue.
Give up! The Canadians aren't American because they didn't have the fortitude to fight their oppressive colonial government and it is obvious they still can't recognize oppressive government even when it's biting them in the hospital bed.
Private health care system in Canada is technically illegal under the law, and yet the "single-payer" system is so overburdened -- with demand for services that far exceeds the available capacity -- that provincial governments are now contracting with private clinics to reduce the burden on the public system. Just think about that for a moment . . . you've got governments entering formal contractual relationships with businesses that aren't even permitted to exist under the law!
(As a side note, this is one thing that makes Canada such a great country, despite its clear leftist leanings. The place is so large and sparsely populated that it is basically ungovernable, which means that any law is effectively unenforceable as long as even a small portion of the population -- maybe no more than 10% -- make up their minds to ignore it. This is how gun owners can freely ignore the "mandatory" national gun registry law, why Canada is utterly incapable of projecting military force anywhere around the world, and why British Columbia is now one of the top producers of certain narcotics for drug users all over North America.)
In addition to this specific point, I would add some general arguments about the basic flaws in the delivery and payment processes for any service that involves payment through an insurance-based system. See all of my posts on this thread, particularly the detailed points in Post #34:
It is interesting that the comparisons are always made to the worst of the public health care systems, which are undoubtedly in Canada and England.
Canada has effectively communized its doctors, refusing to permit any of them to truly practice privately. Britain does allow private practice, but costs are prohibitive.
When Mrs. Clinton decided to try and nationalize American health care, her model was essentially the German model of insurance pools.
But I am going to talk about none of those models, nor Cuba nor Tadjikistan. I'm going to compare the US with the best system of public health care: France.
FReepers love to hate France, which is fine.
But let us be objective.
How can one objectively measure and compare health care systems? I would say that two numbers give a good, though not perfect, feel: life expectancy and infant mortality.
Neither of these things are perfect, of course. The Japanese diet is very heavy in fish, as is the Swedish, and they live longer. Is this because Japanese and Swedish health care are superior, or because they eat a lot of fish?
But Canada, America, France, Britain and Germany: these are comparable countries. The heaviest drinkers in that group are the French; the heaviest smokers, I believe, are the English, although the French are much heavier smokers than the Americans. The dietary practices of all of these countries are generally poor. Americans and Canadians eat fast food. The Germans eat tons of sausage. The French butter their cheese. And the English eat, well, garbage.
So, we are comparing relatively comparable groups, with no stellar dietary practices among any. And the French are heavier smokers and much heavier drinkers than the Americans. But they live longer than any of the countries mentioned. They also have the lowest infant mortality rates. Those things are attributable to health care.
The thread already discusses the bad things about the British, Canadian and German health care systems, the heavy hand of government, rationing, etc.
What is the French system?
It is not "government health care", really.
The French system is the American health care system: doctors are independent and free. There are public and private hospitals. Entry into the medical profession is unrestricted and available to any students who want to study it and get good grade. And anyone can go to any doctor or facility he chooses. There is all of the liberty of the American system in the French system, and none of the heavy-handed restrictions.
So, what is the DIFFERENCE then?
The difference is that primary health insurance - NOT provision of health care, but insurance to pay for health care - is provided by the national health insurance, called "Social Security" - the Secu.
You go to the doctor, you pay, yourself. And then you send the bill off to the Secu. The Secu reimburses you the portion of that which is covered according to the schedules. The schedules are relatively generous, but there is a co-pay element for most things of 10-20%. The fact that you have to pay for the care first, out of pocket, and then be reimbursed is itself a deterrent to abuse. The 10-20% co-pay is also a deterrent to abuse.
Everyone is covered. Everyone pays taxes, of course.
Now, if you think about it, America already has this system. It's called "Medicare" and it covers all retirees. In France, Medicare covers everyone from prenatal care through death. That's the difference. So, in France there is nobody who is not covered. That is one advantage of the system.
A second advantage of the system is that everyone is in the pool. Pooled insurance is always cheaper per capita than individual or small group insurance, and the bigger the pool, the more the cost is spread.
What are the disadvantages of the French system?
Three:
(1) People who do not have the means to initially pay for the care have to scramble a bit. Of course the truly indigent get state assistance, but it is true that you pay out of pocket first, and get reimbursed later. This is intentional. It's a deterrent to abuse and hypochondria. Not a huge deterrent but a deterrent. The advantage of doing it this way is that the doctor is paid at once. Medical practitioners do not have to battle with the insurance company the way American doctors do. The individual submits his or her claim to the Secu.
(2) The co-pay. 20% of health care expenses can be quite high for expensive conditions like cancer. Once again, the truly indigent are covered, but everyone else isn't. The solution, of course, is found in the free market. There is a robust private health insurance industry in France, which aims exclusively at the "Gap". Of course, the same is true in the United States with Medicare "Gap" coverage.
(3) The French system is expensive. Let's not kid ourselves here. The French have the best health care system in Europe, and are about the only ones to have a thriving pharmaceutical and medical research industry (because the doctors are free and therefore, like Americans and unlike English and Canadians, have an incentive to research and advance new techniques), but it costs a lot more per capita than the English, Canadian or German system. The French pay a lot more in taxes for their Secu than the Germans or English do. But it's still cheaper than the American system, and it produces better results.
Now, when I saw that Mme Clinton was studying health systems and going to propose something for the United States, I was surprised that, having studied different systems, she opted for a quasi-German system instead of the French system. Clearly she was not aiming at the highest quality of care - or she would have chosen the French public insurance system. She was looking for something much cheaper. The trouble with that is that it just isn't as good, and Americans will never accept that.
Americans, like the French, want the highest quality medical care in existence. And they are willing to pay a premium for it. The French system delivers as high, or higher, standard of care as the US, at a very high price compared to the rest of Europe, but at a moderate (though not low) price compared to America.
Part of this is the effect of economies of scale. Having one pooled insurer cuts down on costs, as the article says.
There are other structural differences with the USA, though, which do come into account. In America, licensing is by state. This is nonsensical. The human body does not change jurisdiction by jurisdiction. But the American Medical Association has a monopoly on access to the profession, and uses licensing requirements and rigidities to maintain a sort of protected guild system. This, of course, inflates the cost of care for Americans and reduces the mobility of doctors. But this is only a small thing.
The key difference between the French and American system which accounts for a substantial portion of the difference in costs is not medical at all. It is the incomprehensibly bad - if not outright insane - American legal system, in which a spilt cup of hot coffee results in a $2 million fee, and normal bad luck in medicine is invariably sued for millions. American malpractice insurance is tens of thousands of dollars a year, and this of course drives the cost of medicine sky high. Also, American doctors practice extremely defensive medicine, undertaking unneccessary tests that have no medical value, but which protect against lawsuits. Doctors get sued in France too, but things are limited by a naturally conservative legal system that does not like to be used like a slot machine and which does not award significant punitive or speculative damages.
Strip those elements away, and French health care is only a bit less expensive than American, and a LOT more expensive than the other European alternatives. But everyone is covered, and it produces better average results than the American.
It's a good system.
Of course, therefore, Mme. Clinton did not even consider it.
I scratched my head and pondered WHY at the time, and why NOW, whenever national health systems or insurance is discussed in America, the bad models are always cited to, but never the good French model, which really allows the market to ration the care, and relies upon taxes and private insurance to pay for it...and still ends up cheaper per capita than the US system...
It took me some time to figure out WHY the French system is ignored in the US. On the right, of course, ANY sort of "public" system is met with hostility, and anything French MUST be bad. But that is only what we should expect to hear.
But why does the American LEFT ignore France's model and focus on the Canadian and British models? Many Americans of the Left know France. They are not wholly ignorant.
I pondered this long, and then it hit me.
The American Left ignores the French model because it is too free. The doctors are left free to do as they please. And the private insurance companies still have a substantial and lucrative 20% niche. Patients are not herded through gatekeepers and HMOs. French medicine is as free to its participants as American. The only difference is the public insurance pools and universal insurance coverage (and, of course, a sane legal system).
The American Left does not like this model, because there is no control. The doctors are not controlled. The patients are not controlled. The insurance companies are free to compete in their niche. American leftists do not JUST want universal coverage. They want universal coverage WITH PATRONAGE, POWER and POLITICAL CONTROL.
And that is emphatically NOT the French system.
The French system still has a large research sector, and is quite expensive by European standards precisely because it is NOT centrally controlled. The professional bodies of doctors oversee the medical profession itself. Not the funding bureaucrats.
This is too free.
Americans always talk about Canada and Britian and their not-very-good health systems because that's all the American LEFT ever proposes to them. The American left, like the left everywhere, above all desires not quality care but COMMAND.
If America is driven by politics and needs to adopt a national health system, the Americans will be fools to not consider and adopt the French system. It is the only one that has the requisite degree of freedom, which Americans hold almost as dear as the French. The Americans have flirted with the German-style HMO system. It is better than the British system, to be sure, but it is still heavy handed, and the doctors command the patients and the patients cannot choose their care or go to specialists without permission.
This is absurd.
If America is going to have national health care, it should be INSURANCE that is national, and not health SERVICES. There should be co-pays, and private insurance for the gaps. And the doctors must be left free. And there must be tort reform. The French system is the only ones the American people would ever be able to stomach. Which is why the Americans have adopted it...for everyone over 63, in Medicare.
Perhaps it will make it more palatable if Americans pretend that it is not French?
Ultra Sonic has been debating a Canuck on another board and was giving us a chance to suggest possible rebuttals. The Canuck is a full blown commie socialist and does not seem to even understand arguments that don't fit with his world-view. If you scan above all the previous you may think of some responses.
I think he should tell the guy that Americans value individualism and don't want to visit a Doctor that treats his job like a union dock worker does and if he can't understand why, he is an idiot.
What I thought I noticed was our Utopian health care system being defended.
I couldn't let that stand!
:-D
FYI, Cycle lives in Vancouver.
LOL
Wouldn't it be nice if we could put all the (censored) in one place, away from us?
1. The U.S. has a much higher portion of its population living in exurban and rural areas where top-quality health care services may not be readily available. Countries with large portions of their citizens living in urban areas tend to rank very high on any list of health statistics based on life expectancy -- mainly because someone who suffers a serious illness or injury is far more likely to receive immediate care in an urban area than in a rural area.
2. The U.S. ranks relatively poorly in life expectancy and infant mortality compared to other industrial nations simply because we have much more of a libertarian outlook than other countries (and are far less homogenized), which means we have a much higher incidence of almost any physical/psychological pathology that could potentially reduce a person's life expectancy. For example, as recently as a few years ago a term like "crack baby" couldn't even be translated into Japanese -- because there was never any need to come up with a term to describe something that doesn't exist in that culture.
Ping.
I'm not as egalitarian as the French. I would rather leave the government out of health-care and just get the cost down with Tort reform. Medicare was a socialist mistake. Let Bill Gates and Hollywood create a foundation for underprivileged assistance.
France has a higher percentage of its population living in rural areas and engaged in agriculture than the United States does. This does not drag down the life expectancy figures.
But it is fine if you don't want to use infant mortality and life expectancy as measures to compare quality of care.
I am sure that anecdote will not suffice either.
So, what objective standard can we use to compare across systems?
"I'm not as egalitarian as the French. I would rather leave the government out of health-care and just get the cost down with Tort reform."
Yes, I think that this is a core difference.
At heart, France is a very Catholic country, and by way of that more communitarian than Protestant America is. I think that there is a key psychological component that cannot be gotten past easily, but I don't think that the difference is really political but moralistic.
Two other examples that come to mind is the heavier French protection of family, and the intense focus on privacy as a fundamental human right. These are persistent cultural traits which translate into law, but are not really political "choices" as such. They're just "there".
The French could not have a health care system that did not treat everyone, or in which people could not get more or less the same access to care. It would be one of the things too fundamental to the core of what French people think is right and wrong. They can't do the economic analysis on it because the emotion of good and bad overcomes it.
Another example would be the Kelo decision in America. Taking houses to give land to private developers would risk provoking a revolt in France. The French is much more bound to his piece of earth and less transient than the American is. Kelo was offensive enough in America. It's just unthinkable in France.
I don't think Americans are so much torn as to what to do as divided ethnically into different strains that carry with them these conflicting impulses. I would suspect that if on teased out the Catholic strain in America it would be much keener on universal health care than the Protestant, regardless of how the income distribution curve worked out.
Take 1,000 random patients who were rushed to hospitals in the suffering from heart attacks. Calculate which portion of them survived the emergency room visit, then figure out how long they lived (on average) after they were released from the hospital.
Do the same thing for car accident victims, cancer patients, pneumonia patients, premature babies, victims of mining accidents, etc. It isn't perfect, but I think it's a far better method of assessing quality of care than using simple measures of life expectancy and infant mortality.
Excellent observations, especially this one. American politicians are sometimes EXTREMELY nasty. Both Nixon and Clinton used the IRS against their political enemies. Hillary, who had more than 900 FBI files on political enemies stolen, would not hesitate to deny medical treatment to any of them had she the power, and THAT type of danger is the BIGGEST reason to keep medicine out of the hands of those who monopolize power (governments, duh).
"There is danger from all men. The only maxim of a free government ought to be to trust no man living with power to endanger the public liberty." -- John Adams, 1772"There is one safeguard known generally to the wise, which is an advantage and security to all, but especially to democracies as against despots. What is it? Distrust." -- Demosthenes: Philippic 2, sect. 24
"All of history attests that the centralization and concentration of power breed despotism." -- H.A.Scott Trask
"Government is not compassion ... Government is nothing more than structured, widespread coercion ..." -- Glen Allport
"What the government is good at is collecting taxes, taking away your freedoms and killing people. It's not good at much else." -- Tom Clancy on Kudlow and Cramer 9/2/03
"The two enemies of the people are criminals and government, so let us tie the second down with the chains of the Constitution so the second will not become the legalized version of the first."-- Thomas Jefferson
"The United States was supposed to have a limited government because the founders knew governmental power attracts swarms of crooks, demagogues and despots as surely as horse manure attracts swarms of horseflies." -- Rick Gaber
"As government grows, its increased power to grant favors or inflict pain attracts more people who would abuse the system." -- John Fund
"The coercive power of government is always a beacon to those who want to dominate others -- summoning the worst dregs of society to Washington to use that power to impose their will upon others." -- Harry Browne
"Force always attracts men of low morality." -- Albert Einstein
"Give government the weapons to fight your enemy and it will use them against you." -- Harry Browne
"Give a good man great powers and crooks grab his job." -- Rick Gaber
"Any time you give power to government, it will be abused, it will be enlarged, it will be used in ways you never intended." – Harry Browne on The Drudge Report 7-31-99
"Political power is everywhere the most serious threat to liberty. The more power politicians have, and the more able they are to disregard constitutional rules, the more serious the threat. Precedents for expanding government power are sure to be exploited by politicians more dangerous than those who set the precedents." -- Jim Powell
"Power tends to corrupt, and absolute power corrupts absolutely." -- Prof. John E. E. D. Acton
"Power draws the corrupted; absolute power would draw the absolutely corrupted." -- Colin Barth
"Power kills; absolute power kills absolutely." -- Prof. R. J. Rummel
"The greater the power, the more dangerous the abuse." -- Edmund Burke
"Grant no power to government you would not want your worst enemies to wield against you." -- "Smokin'" Joe Freeper
-- all culled from THIS PAGE
Your suggestion is good.
It's tough to find this instantly compiled.
I did see a five post-treatment cancer survival rate study comparison of Europe. The highest was France, with about 58% (the lowest was Poland, without about 25%). The American figures in that particular article were a bit higher than France, in the 62-63% range. I didn't delve into the study, since I was just trying to get an impressionistic look.
I didn't see anything readily compiled on heart attacks, etc.
I would like to see that.
I think you are right: that would be a good, although not perfect, indicator of quality of care in certain specialties.
I don't know that I would make much of a few percentage differences in a report like that, but I definitely would not want to get cancer in Poland.
"American politicians are sometimes EXTREMELY nasty."
I think one of the reasons French politics are simply not as nasty as American is that the politicians hold a multiplicity of offices and posts, and all have some sort of permanent posting in the cadres of the national civil service. So, regardless of who is in power, the others are all also in some sort of power.
The bickering is, therefore, petty, but it does not reach the sort of murderous proportions that it seems to in the United States.
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