Rationing Health Care

By Charlie Sprague | July 20, 2009 at 8:59 am | News, Opinion | 78 comments | |

 

The distinguished utilitarian philosopher Peter Singer has written a bold and courageous piece in the New York Times entitled “Why We Must Ration Health Care.”  If you have not read the article yet, I strongly recommend that you spend the time do so.  Regardless of whether you agree with his ideas, it’s time we began a public discussion on how we will ration health care and Singer’s article offers an excellent starting point.The rationing of health care is currently a third rail in American politics: no politician will dare mention it.  Senator Max Baucus, the Democratic chair of the Senate Finance Committee and one of the most important Democratic leaders pushing health care reform, told CNSNews in April that “There is no rationing of health care at all” in his proposed reform.  For the American public at large, the rationing of health care conjures up images of soulless bureaucrats deciding who lives and who dies, which is why the practice has such a poor reputation in America.

Almost all other developed countries with universal health care, however, engage in some type of rationing of health care.  In Britain, for example, the National Institute for Health Service, a government-financed but independently run organization, provides guidelines for the National Health Service to follow.  By calculating the costs and benefits (in terms of improving the quality of life and extending life) of different types of medical care, other countries with universal health care ensure that scarce medical resources are not wasted on expensive treatments with little chance of success.  Furthermore, the citizens of these countries are happier with their 19health-600-2largely government-run and rationed medical systems than Americans are with our system.  Singer cites a Gallup poll in which 73 percent of Canadians and Britons expressed confidence in the “health care of medical systems” in their country, compared to 56 percent of Americans.  This difference is all the more revealing given that the United States spends much more, per person, on health care.

The only real alternative to rationing health care through a government-run public program that cost-effectively allocates medical resources based on need is to rely on how the private sector rations all other types of goods: rationing based on ability to pay.  As a staunch believer in the general efficiency and justice of markets, I’m happy to acknowledge that rationing based on ability to pay is the correct thing to do when it comes to goods such as televisions and concert tickets.  But when it comes to a good such as medical care, it seems proper that society should do more of its rationing based on need rather than ability to pay.  Keep in mind that countries that ration based on need through public-run health care systems, such as Britain and Canada, also allow private health insurance if individuals want more expensive care beyond what can be provided to all at the public’s expensive.

As Singer also mentions, a large reason government-sanctioned rationing seems so wrong is that we are fooled by the “identifiable victim” effect.  We hear stories about individuals in other countries harmed by a government’s decision to limit the cost of health care, but the people who die in emergency rooms because they lack health insurance are invisible to the public at large.  Rationing based on need would also help America make the sensible move to reallocate resources away from end-of-life care towards saving the lives of younger people.  It’s not that I don’t care about the lives of the elderly (my grandfather’s recent death has in fact put this consideration at the front of my mind), but, as Singer wisely argues, “If the U.S. system spent less on expensive treatments for those who, with or without the drugs, have at most a few months to live, it would be better able to save the lives of more people who, if they get the treatment they need, might live for several decades.”  I have plenty of fierce philosophical disagreements with utilitarianism, but Singer’s rule-based utilitarianism for rationing health care seems quite persuasive at the moment.

More posts by Charlie Sprague »
Charlie Sprague

I love to debate, but I hate it when people take arguments about their politics personally. I love to travel for free. It's one of the best things I've gotten from my CMC education. Sunday is often the most frustrating day of my week (I'm a 49ers fan).

 
 
 
 
  • A Parent

    I disagree and think it might be because I have more perspective on life, at least more than that of you, an 18-22 year old.

    I have two kids who mean the world to me. 14 years-old and 18 years-old. I would do anything to save them, including give my own life.

    So let’s say my 18 year-old developed a rare disease for which treatments exist that cost ~$20 million for the rest of his life. For our purposes, let’s say that Obamacare does not cover it because it’s over the rationed limit of $15 million.

    What if I can easily afford the other $5 million? Shouldn’t I be able to take the $15 million from Obamacare (which I paid into) and supplement that with another $5 million? What if I can afford the full $20 million– can I buy it outright?

    To put it another way: what is the point of working hard to earn my fortune in a society that doesn’t allow me to spend that on what’s most important to me– the health of my family? At what point, when Obama increasingly strives to raise taxes on the wealthy and ration health care, does capitalism give way to socialism?

    If you are advocating to become more like Canada or European countries, you are advocating for a more socialist state. Just come out and say it.

  • A Parent

    I disagree and think it might be because I have more perspective on life, at least more than that of you, an 18-22 year old.

    I have two kids who mean the world to me. 14 years-old and 18 years-old. I would do anything to save them, including give my own life.

    So let’s say my 18 year-old developed a rare disease for which treatments exist that cost ~$20 million for the rest of his life. For our purposes, let’s say that Obamacare does not cover it because it’s over the rationed limit of $15 million.

    What if I can easily afford the other $5 million? Shouldn’t I be able to take the $15 million from Obamacare (which I paid into) and supplement that with another $5 million? What if I can afford the full $20 million– can I buy it outright?

    To put it another way: what is the point of working hard to earn my fortune in a society that doesn’t allow me to spend that on what’s most important to me– the health of my family? At what point, when Obama increasingly strives to raise taxes on the wealthy and ration health care, does capitalism give way to socialism?

    If you are advocating to become more like Canada or European countries, you are advocating for a more socialist state. Just come out and say it.

  • http://claremontconservative.com Charles C. Johnson

    I am tempted to refute this point by point, but instead, I’ll just point to one thing:

    Charlie Sprague believes that doctors can make the determination about how we ration health care. Perhaps this is because he believes, as per usual, that benevolent, all knowing bureaucrats populate our government. He says that people die in emergency rooms because they lack health insurance. Bullshit. It’s federal law for doctors to provide care to anyone within 250 yards whether or not they can pay. And for everyone person that goes into an emergency room with a life threatening injury (they are mostly injuries anyways, Do your homework next time.

    Sprague foolishly cites level of satisfaction in Canada and the UK as somehow indicative of anything
    If that were true, why have thousands of Canadians flocked to the U.S. for care?

    Here’s a metric would do better to consider: survivor rates. Here’s what an actual medical journal published.

    “Survival was significantly higher in the United States for all solid tumors, except testicular, stomach, and soft-tissue cancer, the authors report. The greatest differences were seen in the major cancer sites: colon and rectum (56.2% in Europe vs 65.5% in the United States), breast (79.0% vs 90.1%), and prostate cancer (77.5% vs 99.3%), and this “probably represents differences in the timeliness of diagnosis,” they comment. That in turn stems from the more intensive screening for cancer carried out in the United States, where a reported 70% of women aged 50 to 70 years have undergone a mammogram in the past 2 years, one-third of people have had sigmoidoscopy or colonoscopy in the past 5 years, and more than 80% of men aged 65 years or more have had a prostate-specific antigen (PSA) test. In fact, it is this PSA testing that probably accounts for the very high survival from prostate cancer seen in the United States, the authors comment.” http://www.medscape.com/viewarticle/561737

    My mother was one of those people who the doctors counted out, initially. She fought back and beat her cancer. No one should have to wait in line to safeguard their own autonomy. Her cancer was extremely aggressive and had she waited until some bureaucrat told her it was okay to have a mammogram or a check up (which actually happens in Canada), I doubt she would have made it.

    The Forum should be embarrassed for publishing something so uncritically.

    • Let’s keep the hyperbole to a

      “The Forum should be embarrassed for publishing something so uncritically.”

      Just because you disagree with something on the merits doesn’t mean the other side didn’t think its arguments through.

    • Respectfully Disagree

      Without being incredibly offensive and throwing personal attacks and names at Charlie Sprague, calling him “foolish,” etc., I disagree with almost anything that moves this country away from capitalism and toward socialism, which is what this public health care program would do.

      I just hope the republicans in Congress can be respectful and constructive in opposing these plans, or they will look just as angry, hateful, and petty as Charles Johnson…

    • Grant

      Good grief, it’s hard to decide which falsehood to begin with.

      First of all, Canadians do not flock to the US for care. That is a lie. It is a lie spread by the insurance lobby, and they have been doing it since the 90s to scare people out of taking away their unlimited access pass to the wallets of the American people. The last time they tried to claim this someone went and studied it you see:

      http://content.healthaffairs.org/cgi/content/full/21/3/19

      The number of Canadians found to actually be crossing the border for health care was so small it was damn near immeasurable. The claim that there were hordes of Canucks scurrying across the border for medical care was pure bullcrap then, and nothing has changed since. Do a few Canadians cross the border for medical care? Sure. Do Americans travel to other nations for medical care they can’t get in the States? Damn right they do. The medical tourism industry ferrying US citizens to places like India to get surgeries performed is booming.

      And would people stop cherry picking a few medical conditions where the US does a decent job and pretending like that’s the be all end all of how well the system performs? Try this one on for size:

      http://www.openmedicine.ca/article/view/8/1

      They did a systematic review of studies of comparative outcomes in Canada and the United States for cancer, coronary artery disease, various chronic illnesses, surgical procedures… and guess what? The two nations generally produced fairly equivalent outcomes with a slight edge to *Canada*. And the Canadians do it for a little over half the cost of the US system.

      And no, some bureaucrat does NOT decide if you get a mammogram in Canada you clueless wonder. That’s what happens in the United States where your doctor has to check with some bean counter at your insurance agency to get approval for having the procedure covered. In Canada you go to your doctor, he gives you one, then he bills the provincial insurance plan for the cost of the service. Bureaucrats not involved.

      And yes, you’re quite right that emergency rooms in the US do have to treat. Then they bill… at exhorbitant cost. Which there is little chance the uninsured person will be able to pay so they end up financially wiped out for the cost of the emergency treatment.

      An ALL they get is the emergency treatment. If you’re uninsured in the States and walk into an emergency room and you’re dying of cancer they might do their best to stabilize you, and then they’re throwing you right back out. They will NOT put you on a long term course of treatment to cure you, because you see cancer isn’t considered an “emergency” situation, it’s a “chronic condition”. And treating it is really expensive, and they’re not taking the hit for it. They might give you pain killers, but you aren’t getting chemo. What you’re getting is left to die a slow death unless you raise some serious money.

      • http://claremontconservative.com Charles C. Johnson

        Grant,

        Sigh. I actually have to work so this is really going to be taxing. As for the pleasure of using another country’s health care, I waited 9 hours to be seen by a doctor when I had an acute strep in France. There’s my anecdotal contribution to the discussion.

        It’s not a lie and I — along with other people in my family — have helped bring women from Canada across the border to get mamograms. This is entirely false. If it were, why have huge companies sprung up in Canada to help these women and others afflicted get across the border?

        The U.S. already has an extremely non-market health care. One in two health care dollars are spent by the federal govt. through social security and medicare. I agree that it could PERHAPS be cheaper to have a fully socialized system than a hybrid as we do now, but that still doesn’t explain how health care costs keep balooning in socialized systems, leading to more and more pervasive rationing.

        Again, you’re ignoring the free rider effect that many of European and other socialized systems benefit from when they import our drugs. They don’t have to finance the development of the drugs and hence their systems can tend to be more efficient. As for the tax dollars, we have mandates in many states that regulators decide must be covered by insurance which leads to some of the problems of the health care costs.

        The OECD stats have lots of biases built into them. For one, the U.S. has a largely unequal population as a function of its immigration policies. Correct for that and a lot of the disparity in longevity disappears. Better to compare health outcomes across various quintiles. Consistently, for healthy adults our system performs better. We have 10 million illegal immigrants (and probably 15 to 20 million other Americans, including many younger Americans who refuse to get health care) here who use our ERs as primary care. Many of them don’t pay their bills and so the costs increases for the rest of us. i.e. health care inflation. A study in 2001 found that $35 billion a year is spent by the U.S. government to help people who choose to live without health insurance and who rarely pick up the tab.

        I think we should wait and see before we jump to any conclusions. Many keep parroting the line that there are 45 million Americans without insurance, but that’s patently untrue.

  • http://claremontconservative.com Charles C. Johnson

    I am tempted to refute this point by point, but instead, I’ll just point to one thing:

    Charlie Sprague believes that doctors can make the determination about how we ration health care. Perhaps this is because he believes, as per usual, that benevolent, all knowing bureaucrats populate our government. He says that people die in emergency rooms because they lack health insurance. Bullshit. It’s federal law for doctors to provide care to anyone within 250 yards whether or not they can pay. And for everyone person that goes into an emergency room with a life threatening injury (they are mostly injuries anyways, Do your homework next time.

    Sprague foolishly cites level of satisfaction in Canada and the UK as somehow indicative of anything
    If that were true, why have thousands of Canadians flocked to the U.S. for care?

    Here’s a metric would do better to consider: survivor rates. Here’s what an actual medical journal published.

    “Survival was significantly higher in the United States for all solid tumors, except testicular, stomach, and soft-tissue cancer, the authors report. The greatest differences were seen in the major cancer sites: colon and rectum (56.2% in Europe vs 65.5% in the United States), breast (79.0% vs 90.1%), and prostate cancer (77.5% vs 99.3%), and this “probably represents differences in the timeliness of diagnosis,” they comment. That in turn stems from the more intensive screening for cancer carried out in the United States, where a reported 70% of women aged 50 to 70 years have undergone a mammogram in the past 2 years, one-third of people have had sigmoidoscopy or colonoscopy in the past 5 years, and more than 80% of men aged 65 years or more have had a prostate-specific antigen (PSA) test. In fact, it is this PSA testing that probably accounts for the very high survival from prostate cancer seen in the United States, the authors comment.” http://www.medscape.com/viewarticle/561737

    My mother was one of those people who the doctors counted out, initially. She fought back and beat her cancer. No one should have to wait in line to safeguard their own autonomy. Her cancer was extremely aggressive and had she waited until some bureaucrat told her it was okay to have a mammogram or a check up (which actually happens in Canada), I doubt she would have made it.

    The Forum should be embarrassed for publishing something so uncritically.

    • Let’s keep the hyperbole to a minimum

      “The Forum should be embarrassed for publishing something so uncritically.”

      Just because you disagree with something on the merits doesn’t mean the other side didn’t think its arguments through.

    • Respectfully Disagree

      Without being incredibly offensive and throwing personal attacks and names at Charlie Sprague, calling him “foolish,” etc., I disagree with almost anything that moves this country away from capitalism and toward socialism, which is what this public health care program would do.

      I just hope the republicans in Congress can be respectful and constructive in opposing these plans, or they will look just as angry, hateful, and petty as Charles Johnson…

    • Grant

      Good grief, it’s hard to decide which falsehood to begin with.

      First of all, Canadians do not flock to the US for care. That is a lie. It is a lie spread by the insurance lobby, and they have been doing it since the 90s to scare people out of taking away their unlimited access pass to the wallets of the American people. The last time they tried to claim this someone went and studied it you see:

      http://content.healthaffairs.org/cgi/content/full/21/3/19

      The number of Canadians found to actually be crossing the border for health care was so small it was damn near immeasurable. The claim that there were hordes of Canucks scurrying across the border for medical care was pure bullcrap then, and nothing has changed since. Do a few Canadians cross the border for medical care? Sure. Do Americans travel to other nations for medical care they can’t get in the States? Damn right they do. The medical tourism industry ferrying US citizens to places like India to get surgeries performed is booming.

      And would people stop cherry picking a few medical conditions where the US does a decent job and pretending like that’s the be all end all of how well the system performs? Try this one on for size:

      http://www.openmedicine.ca/article/view/8/1

      They did a systematic review of studies of comparative outcomes in Canada and the United States for cancer, coronary artery disease, various chronic illnesses, surgical procedures… and guess what? The two nations generally produced fairly equivalent outcomes with a slight edge to *Canada*. And the Canadians do it for a little over half the cost of the US system.

      And no, some bureaucrat does NOT decide if you get a mammogram in Canada you clueless wonder. That’s what happens in the United States where your doctor has to check with some bean counter at your insurance agency to get approval for having the procedure covered. In Canada you go to your doctor, he gives you one, then he bills the provincial insurance plan for the cost of the service. Bureaucrats not involved.

      And yes, you’re quite right that emergency rooms in the US do have to treat. Then they bill… at exhorbitant cost. Which there is little chance the uninsured person will be able to pay so they end up financially wiped out for the cost of the emergency treatment.

      An ALL they get is the emergency treatment. If you’re uninsured in the States and walk into an emergency room and you’re dying of cancer they might do their best to stabilize you, and then they’re throwing you right back out. They will NOT put you on a long term course of treatment to cure you, because you see cancer isn’t considered an “emergency” situation, it’s a “chronic condition”. And treating it is really expensive, and they’re not taking the hit for it. They might give you pain killers, but you aren’t getting chemo. What you’re getting is left to die a slow death unless you raise some serious money.

      • http://claremontconservative.com Charles C. Johnson

        Grant,

        Sigh. I actually have to work so this is really going to be taxing. As for the pleasure of using another country’s health care, I waited 9 hours to be seen by a doctor when I had an acute strep in France. There’s my anecdotal contribution to the discussion.

        It’s not a lie and I — along with other people in my family — have helped bring women from Canada across the border to get mamograms. This is entirely false. If it were, why have huge companies sprung up in Canada to help these women and others afflicted get across the border?

        The U.S. already has an extremely non-market health care. One in two health care dollars are spent by the federal govt. through social security and medicare. I agree that it could PERHAPS be cheaper to have a fully socialized system than a hybrid as we do now, but that still doesn’t explain how health care costs keep balooning in socialized systems, leading to more and more pervasive rationing.

        Again, you’re ignoring the free rider effect that many of European and other socialized systems benefit from when they import our drugs. They don’t have to finance the development of the drugs and hence their systems can tend to be more efficient. As for the tax dollars, we have mandates in many states that regulators decide must be covered by insurance which leads to some of the problems of the health care costs.

        The OECD stats have lots of biases built into them. For one, the U.S. has a largely unequal population as a function of its immigration policies. Correct for that and a lot of the disparity in longevity disappears. Better to compare health outcomes across various quintiles. Consistently, for healthy adults our system performs better. We have 10 million illegal immigrants (and probably 15 to 20 million other Americans, including many younger Americans who refuse to get health care) here who use our ERs as primary care. Many of them don’t pay their bills and so the costs increases for the rest of us. i.e. health care inflation. A study in 2001 found that $35 billion a year is spent by the U.S. government to help people who choose to live without health insurance and who rarely pick up the tab.

        I think we should wait and see before we jump to any conclusions. Many keep parroting the line that there are 45 million Americans without insurance, but that’s patently untrue.

  • http://claremontconservative.com Charles C. Johnson

    Sorry, I didn’t transfer that right. I meant to say, “do your homework” next time when discussing the supposed high number of people who die in emergency rooms.

  • http://claremontconservative.com Charles C. Johnson

    Sorry, I didn’t transfer that right. I meant to say, “do your homework” next time when discussing the supposed high number of people who die in emergency rooms.

  • http://claremontconservative.com Charles C. Johnson

    For those who are interested in health care and want to see the consequences of a system that rations health care, here are a few links I have for you. They are all videos and you can watch them at your leisure.

    John Stossel on the Canadian system.
    http://abcnews.go.com/Video/playerIndex?id=7903062

    The net effects of Sprague-like rationing.
    http://www.youtube.com/watch?v=X_Rf42zNl9U

    • Grant

      ALL health care systems ration health care.

      What in the world do you think people without adequate insurance coverage are doing there in the States? Enjoying themselves immensely by choice? Every nation has a finite amount of health care resources and decides how they will be distributed throughout the population. Every. Single. Last. One. This insistence of people on the right to pretend like the US doesn;t ration care while millions go without it is comically absurd.

      The only difference between Canada and the US in this regard is the criteria used to perform the rationing. Canada rations based on urgency of medical need, like any competent medical professional performing triage would do.

      The United States rations based on size of the patient’s bank account balance.

      And not to put too fine a point on it, but Stossel rather clearly went out of his way to try to find the worst possible anecdotal view of Canadian health care in action then pretend as if that’s what the entire system looks like for everyone in the country… and he should be ashamed of himself for doing it.

  • http://claremontconservative.com Charles C. Johnson

    For those who are interested in health care and want to see the consequences of a system that rations health care, here are a few links I have for you. They are all videos and you can watch them at your leisure.

    John Stossel on the Canadian system.
    http://abcnews.go.com/Video/playerIndex?id=7903062

    The net effects of Sprague-like rationing.
    http://www.youtube.com/watch?v=X_Rf42zNl9U

    • Grant

      ALL health care systems ration health care.

      What in the world do you think people without adequate insurance coverage are doing there in the States? Enjoying themselves immensely by choice? Every nation has a finite amount of health care resources and decides how they will be distributed throughout the population. Every. Single. Last. One. This insistence of people on the right to pretend like the US doesn;t ration care while millions go without it is comically absurd.

      The only difference between Canada and the US in this regard is the criteria used to perform the rationing. Canada rations based on urgency of medical need, like any competent medical professional performing triage would do.

      The United States rations based on size of the patient’s bank account balance.

      And not to put too fine a point on it, but Stossel rather clearly went out of his way to try to find the worst possible anecdotal view of Canadian health care in action then pretend as if that’s what the entire system looks like for everyone in the country… and he should be ashamed of himself for doing it.

  • Patrick Atwater

    Singer’s ostensible point really isn’t that groundbreaking. Of course, we “ration” goods in the sense that he means: allocating scarce resources in a finite world. But what he’s really doing is trying to remove the pejorative connotation with the word “ration” and in doing so remove our moral compunctions against socialized medicine. Yet that really just begs the question of how to “ration” using this more accurate definition. People have sound moral reasons to oppose socialized medicine and making this nifty linguistic move is banal at best and disingenuous at worst.

    I’m not sure what the “right” answer is in this debate, but I think prudence dictates that we should begin unraveling the plethora of perverse incentives currently at play in the health care sector before we start talking about dramatic social changes like a move towards socialized medicine.

  • Patrick Atwater

    Singer’s ostensible point really isn’t that groundbreaking. Of course, we “ration” goods in the sense that he means: allocating scarce resources in a finite world. But what he’s really doing is trying to remove the pejorative connotation with the word “ration” and in doing so remove our moral compunctions against socialized medicine. Yet that really just begs the question of how to “ration” using this more accurate definition. People have sound moral reasons to oppose socialized medicine and making this nifty linguistic move is banal at best and disingenuous at worst.

    I’m not sure what the “right” answer is in this debate, but I think prudence dictates that we should begin unraveling the plethora of perverse incentives currently at play in the health care sector before we start talking about dramatic social changes like a move towards socialized medicine.

  • Josh Siegel

    I agree with Patrick– I’m not sure if I understand the importance of the rationing debate. Health care is already rationed by health insurance, and that’s in a free market. Each policy has limits on what it will or will not pay for. This has little to do with Obamacare or government.

    Of course, you will always be able to pay for any treatment you want. If you can afford it, you can pay millions for any treatment you want as long as the government does not set price ceilings, which I don’t believe will ever happen. But to expect unlimited care to come at a fixed price is unreasonable.

    The issue should be whether the US should have a public plan (and raise taxes on the wealthy to implement that plan). Rationing in health care is inevitable under any system. That’s the first principle of economics.

  • Josh Siegel

    I agree with Patrick– I’m not sure if I understand the importance of the rationing debate. Health care is already rationed by health insurance, and that’s in a free market. Each policy has limits on what it will or will not pay for. This has little to do with Obamacare or government.

    Of course, you will always be able to pay for any treatment you want. If you can afford it, you can pay millions for any treatment you want as long as the government does not set price ceilings, which I don’t believe will ever happen. But to expect unlimited care to come at a fixed price is unreasonable.

    The issue should be whether the US should have a public plan (and raise taxes on the wealthy to implement that plan). Rationing in health care is inevitable under any system. That’s the first principle of economics.

  • Sam C

    I am just baffled by the fact that this is even being argued in the United States.

    I have worked in South Korea and currently working in Japan. Both countries have national health insurance that’s supposed to be “rationing” and “socializing” health care. But the quality of service that you receive in these countries are far superior than what an average Joe in the United States get.

    When I had a broken arm in Seoul, my visit to hospital was flawless and they even directed me to the emergency room which treated me right away. And how much did it cost? Less than $50 with their “compulsory” national insurance. MRIs and CTs don’t cost a fortune, and if the doctors decides that it is needed, it is done immediately without a need to reschedule.

    If same thing had happened in the US( and it actually did ten years ago), I probably would have had to wait four or more hours because I walked into the hospital rather than ambulance and emergency personnel carrying me in, let alone thousands of dollars that I would be billed.

    And oh the great American system that made me make appointments 2 weeks advance for simple cleaning when I was going to college.

    I don’t think I would go back anytime soon to the US which has one of the lowest life expectancy out of OECD.

    • Sam C

      (by cleaning, I meant dental cleaning)

    • http://claremontconservative.com Charles C. Johnson

      1. Both of those systems require huge taxes to finance them, do not have a massive illegal immigrant population like the U.S. which uses its health care system, etc. Whereas in our system, you get covered if you show up.

      If you’re going to use anecdotal cases, we could just as easily point to examples in Canada, like this one. http://www.youtube.com/watch?v=q2jijuj1ysw

      Instead, compare average wait times in Canada versus the U.S. In the U.S., it is less than an hour. In Canada, a system that Obama likes, it is 20 hours. http://sigmundcarlandalfred.wordpress.com/2008/08/07/the-waiting-game-er-wait-times-in-canada-vs-us/

      2. The figure about the OECD is misleading. Could it be that Americans are less healthy than other countries (especially our poor), and not that our health care system is bad?

      3. Schedule your cleaning during off hours. I usually go in at like 6 AM. But I agree with you, it should be more efficient. You should be able to pay to get higher in line. People price their teeth differently.

      • Grant

        Wow, correcting all your misinformation is a full time job.

        No, both of those countries do not, in fact, require huge taxes to finance their health care systems. How do people not get this through their heads? It is the *United States* that has the ridiculously expensive system. but putting aside the fact that the total private and public spending figures combined for these three countries as a percentage of GDP are (as of 2005, latest available OECD statistics):

        Korea: 5.9%
        Japan: 8.2%
        United States: 15.2%

        Let’s look at ONLY the public portion of that spending… as in tax dollars alone:

        Korea: 3.17%
        Japan: 6.78%
        United States: 6.855%

        Oops. The United States not only spends WAY more total on it’s system, it also spends a higher proportion of it’s GDP in tax dollars alone on it’s system than either of those nations do. Neither of those nations pay higher tax rates due to their health care systems. Nor do the vast majority of other OECD nations, who on average spend slightly lower percentage of their GDP in public funding of their system than the US spends on it’s own. The difference being those other countries actually give their citizens something substantial for their tax dollars. How much health care does the average American get for THEIR tax dollars?

      • http://claremontconservative.com Charles C. Johnson

        @Grant,

        There’s a huge fallacy in your assumption that health care as a percentage of GDP spending is worse for us as a whole.

        “There are several flaws in this reasoning, first and foremost its claim that a dollar spent is a dollar wasted. America’s health-care sector is larger partly because, unlike Canada’s, it includes for-profit corporations. Consider the benefit: companies invest billions each year developing innovative, life-saving drugs and devices. Are these expenses really something to lament? Similarly, is it a disadvantage that the U.S. has 11 percent more practicing doctors per capita than Canada? Or 15 percent more nurses? Is it a problem that the United States has almost four times as many MRI scanners per capita as Canada does, or that we preventively test more of our population for common cancers? Hardly. The fact that America’s health-care system is larger, more advanced, and better staffed than a system with rationed care is an advantage. To pretend otherwise is just a tactic to make the reform pill easier to swallow.

        So the American health sector doesn’t have to shrink. But it should certainly deliver care at a lower unit price. To see how, let’s stop comparing our health care with what’s available in Canada or Sweden or Mars and instead make some comparisons among various American health-care systems. Take two very different states: Wisconsin and New York. In Wisconsin, a family can buy a health-insurance plan for as little as $3,000 a year. The price for a basic family plan in the Empire State: $12,000. The stark difference has nothing to do with each state’s health sector as a share of its economy (14.8 percent in Wisconsin as of 2004, the most recent year for which data are available, and 13.9 percent in New York). Rather, the difference has to do with how each state’s insurance pools are regulated. In New York State, politicians have tried to run the health-insurance system from Albany, forcing insurers to deliver complex Cadillac plans to every subscriber for political reasons, driving up costs. Wisconsin’s insurers are far freer to sell plans at prices consumers want.

        The gulf in insurance-premium prices among American states is a sign that too much government intervention—not too little—is what’s distorting prices from one market to the next. The key to reducing health-care costs for patients, then, is to promote competition, not to dictate insurance requirements from on high.”

        Source: http://www.city-journal.org/2009/eon0722dg.html

    • Agree

      I agree with Sam C.
      Going to see a doctor in Korea literally means that you can decide to see one that same day, and it can be arranged, whether it is an emergency or a simple visit to get a check-up…without costing a fortune. It’s funny that U.S., which supposedly should be one of the more advanced nations, still hasn’t figured out a way to find affordable, nationalized healthcare for everyone. Financing the system and rationing are, of course, very important issues; however, in the debate with numbers, we should not neglect the fact that this has to do with the lives and the well-being of our families, which should theoretically be priceless.

      May I also mention that the doctors in the States seem to work less? I don’t have the quantitative evidence to prove this, but it has always seemed so– for me, at least. Most of them seldom are in office for more than 6-7 hours a day(maybe even less; I don’t know), whereas doctors in Korea treat scheduled and walk-in patients from 8am to 7pm on average. My dad works at a national university hospital in Korea, and he mostly does research and administrative work nowadays because of his new position. Regardless, he is still booked for an entire day out of the week, where he sees at least 100 to 120+ patients in clinic.

      I’ve definitely taken advantage of the system in Korea and seen doctors/dentists there when I go to visit family, instead of going through the process here. Last time I broke my arm in the States, it took me about a week before I finally saw the orthopedist through referral… whereas in Korea I could’ve just gone to the hospital/ER that day and gotten the cast..and probably paid nothing, because I have the national health insurance.

      • Money

        Most US docs are just in it for the money. Hence there is a chronic shortage of regular doctors. The money is in specialized professions or in research. The majority of US general practicioners don’t even have an MD but a DO (I’m not trying to discount DOs, they are just as well trained as MDs if not better trained, but historically, the better qualified get an MD and not a DO).

  • Sam C

    I am just baffled by the fact that this is even being argued in the United States.

    I have worked in South Korea and currently working in Japan. Both countries have national health insurance that’s supposed to be “rationing” and “socializing” health care. But the quality of service that you receive in these countries are far superior than what an average Joe in the United States get.

    When I had a broken arm in Seoul, my visit to hospital was flawless and they even directed me to the emergency room which treated me right away. And how much did it cost? Less than $50 with their “compulsory” national insurance. MRIs and CTs don’t cost a fortune, and if the doctors decides that it is needed, it is done immediately without a need to reschedule.

    If same thing had happened in the US( and it actually did ten years ago), I probably would have had to wait four or more hours because I walked into the hospital rather than ambulance and emergency personnel carrying me in, let alone thousands of dollars that I would be billed.

    And oh the great American system that made me make appointments 2 weeks advance for simple cleaning when I was going to college.

    I don’t think I would go back anytime soon to the US which has one of the lowest life expectancy out of OECD.

    • Sam C

      (by cleaning, I meant dental cleaning)

    • http://claremontconservative.com Charles C. Johnson

      1. Both of those systems require huge taxes to finance them, do not have a massive illegal immigrant population like the U.S. which uses its health care system, etc. Whereas in our system, you get covered if you show up.

      If you’re going to use anecdotal cases, we could just as easily point to examples in Canada, like this one. http://www.youtube.com/watch?v=q2jijuj1ysw

      Instead, compare average wait times in Canada versus the U.S. In the U.S., it is less than an hour. In Canada, a system that Obama likes, it is 20 hours. http://sigmundcarlandalfred.wordpress.com/2008/08/07/the-waiting-game-er-wait-times-in-canada-vs-us/

      2. The figure about the OECD is misleading. Could it be that Americans are less healthy than other countries (especially our poor), and not that our health care system is bad?

      3. Schedule your cleaning during off hours. I usually go in at like 6 AM. But I agree with you, it should be more efficient. You should be able to pay to get higher in line. People price their teeth differently.

      • Grant

        Wow, correcting all your misinformation is a full time job.

        No, both of those countries do not, in fact, require huge taxes to finance their health care systems. How do people not get this through their heads? It is the *United States* that has the ridiculously expensive system. but putting aside the fact that the total private and public spending figures combined for these three countries as a percentage of GDP are (as of 2005, latest available OECD statistics):

        Korea: 5.9%
        Japan: 8.2%
        United States: 15.2%

        Let’s look at ONLY the public portion of that spending… as in tax dollars alone:

        Korea: 3.17%
        Japan: 6.78%
        United States: 6.855%

        Oops. The United States not only spends WAY more total on it’s system, it also spends a higher proportion of it’s GDP in tax dollars alone on it’s system than either of those nations do. Neither of those nations pay higher tax rates due to their health care systems. Nor do the vast majority of other OECD nations, who on average spend slightly lower percentage of their GDP in public funding of their system than the US spends on it’s own. The difference being those other countries actually give their citizens something substantial for their tax dollars. How much health care does the average American get for THEIR tax dollars?

      • http://claremontconservative.com Charles C. Johnson

        @Grant,

        There’s a huge fallacy in your assumption that health care as a percentage of GDP spending is worse for us as a whole.

        “There are several flaws in this reasoning, first and foremost its claim that a dollar spent is a dollar wasted. America’s health-care sector is larger partly because, unlike Canada’s, it includes for-profit corporations. Consider the benefit: companies invest billions each year developing innovative, life-saving drugs and devices. Are these expenses really something to lament? Similarly, is it a disadvantage that the U.S. has 11 percent more practicing doctors per capita than Canada? Or 15 percent more nurses? Is it a problem that the United States has almost four times as many MRI scanners per capita as Canada does, or that we preventively test more of our population for common cancers? Hardly. The fact that America’s health-care system is larger, more advanced, and better staffed than a system with rationed care is an advantage. To pretend otherwise is just a tactic to make the reform pill easier to swallow.

        So the American health sector doesn’t have to shrink. But it should certainly deliver care at a lower unit price. To see how, let’s stop comparing our health care with what’s available in Canada or Sweden or Mars and instead make some comparisons among various American health-care systems. Take two very different states: Wisconsin and New York. In Wisconsin, a family can buy a health-insurance plan for as little as $3,000 a year. The price for a basic family plan in the Empire State: $12,000. The stark difference has nothing to do with each state’s health sector as a share of its economy (14.8 percent in Wisconsin as of 2004, the most recent year for which data are available, and 13.9 percent in New York). Rather, the difference has to do with how each state’s insurance pools are regulated. In New York State, politicians have tried to run the health-insurance system from Albany, forcing insurers to deliver complex Cadillac plans to every subscriber for political reasons, driving up costs. Wisconsin’s insurers are far freer to sell plans at prices consumers want.

        The gulf in insurance-premium prices among American states is a sign that too much government intervention—not too little—is what’s distorting prices from one market to the next. The key to reducing health-care costs for patients, then, is to promote competition, not to dictate insurance requirements from on high.”

        Source: http://www.city-journal.org/2009/eon0722dg.html

    • Agree

      I agree with Sam C.
      Going to see a doctor in Korea literally means that you can decide to see one that same day, and it can be arranged, whether it is an emergency or a simple visit to get a check-up…without costing a fortune. It’s funny that U.S., which supposedly should be one of the more advanced nations, still hasn’t figured out a way to find affordable, nationalized healthcare for everyone. Financing the system and rationing are, of course, very important issues; however, in the debate with numbers, we should not neglect the fact that this has to do with the lives and the well-being of our families, which should theoretically be priceless.

      May I also mention that the doctors in the States seem to work less? I don’t have the quantitative evidence to prove this, but it has always seemed so– for me, at least. Most of them seldom are in office for more than 6-7 hours a day(maybe even less; I don’t know), whereas doctors in Korea treat scheduled and walk-in patients from 8am to 7pm on average. My dad works at a national university hospital in Korea, and he mostly does research and administrative work nowadays because of his new position. Regardless, he is still booked for an entire day out of the week, where he sees at least 100 to 120+ patients in clinic.

      I’ve definitely taken advantage of the system in Korea and seen doctors/dentists there when I go to visit family, instead of going through the process here. Last time I broke my arm in the States, it took me about a week before I finally saw the orthopedist through referral… whereas in Korea I could’ve just gone to the hospital/ER that day and gotten the cast..and probably paid nothing, because I have the national health insurance.

      • Money

        Most US docs are just in it for the money. Hence there is a chronic shortage of regular doctors. The money is in specialized professions or in research. The majority of US general practicioners don’t even have an MD but a DO (I’m not trying to discount DOs, they are just as well trained as MDs if not better trained, but historically, the better qualified get an MD and not a DO).

  • Anecdotal Evidence

    I think we should all agree that only anecdotal evidence will be considered valid in this debate. This is my first and only principle.

  • Anecdotal Evidence

    I think we should all agree that only anecdotal evidence will be considered valid in this debate. This is my first and only principle.

  • A few points

    1. Doctors, just like all humans, are corruptible and do things for the money. The cancer treatment industry alone is a $20 bln industry. Instead of focusing on creating cheap cures, many docs simply patent genes or techniques and sell it to big pharma. The only reason I am saying this is that trusting private capital via insurance companies, or public capital via doctor run committees still runs into the corruption problem.

    2. The US is truly not comparable to other nations with socialized healthcare. By almost all measures, we pay 2x on average for the same treatment. However, 1/4 of big pharma’s revenue goes into research and advertising, often for non life prolonging drugs (viagra anyone). About the same goes into research. The US also had the inane idea of mandating ERs to care for the uninsured but this led to unintended consequences. Now people wait for their illnesses to get so bad they have to go to the ER, and docs just patch people up with short term solutions which lead to long term inefficiencies. Also, the standard of living discrepancy is so much larger in the US than in Canada or the UK and simply put, poor lifestyle choices beget higher healthcare costs. Europe and Canada don’t have the ghettos and projects the US has and we pay dearly for them in healthcare costs and in other social costs.

    The real question for healthcare is how can we efficiently extend benefits to everyone and to what degree should we do it. Canada and the UK and South Korea have done it by nationalizing healthcare, limiting some higher treatments, and focusing more on common treatments. This leads to long lines for some advanced procedures and even death for some because they can’t get treatment.

    I believe that the gov’t should extend minimum coverage to most adults. This mimimum coverage would start at maybe $2 mln or so as a child, turn to $1 mln as an adult and quickly decrease with age. This coverage would not go towards supplementing more advanced or prohibitively expensive treatment which cost more than the coverage as simply put, the average American life is only worth about $7 mln (http://www.physorg.com/news134969804.html) and decreases over time.

    The reason I believe there should be some minimum coverage is that I believe preventative care is a huge investment we as Americans are missing out on. I don’t see why every spare penny we have doesn’t go into education (over a 6% annual ROE plus we get an educated citizenry) but preventative care should be our next fund to max.

  • A few points

    1. Doctors, just like all humans, are corruptible and do things for the money. The cancer treatment industry alone is a $20 bln industry. Instead of focusing on creating cheap cures, many docs simply patent genes or techniques and sell it to big pharma. The only reason I am saying this is that trusting private capital via insurance companies, or public capital via doctor run committees still runs into the corruption problem.

    2. The US is truly not comparable to other nations with socialized healthcare. By almost all measures, we pay 2x on average for the same treatment. However, 1/4 of big pharma’s revenue goes into research and advertising, often for non life prolonging drugs (viagra anyone). About the same goes into research. The US also had the inane idea of mandating ERs to care for the uninsured but this led to unintended consequences. Now people wait for their illnesses to get so bad they have to go to the ER, and docs just patch people up with short term solutions which lead to long term inefficiencies. Also, the standard of living discrepancy is so much larger in the US than in Canada or the UK and simply put, poor lifestyle choices beget higher healthcare costs. Europe and Canada don’t have the ghettos and projects the US has and we pay dearly for them in healthcare costs and in other social costs.

    The real question for healthcare is how can we efficiently extend benefits to everyone and to what degree should we do it. Canada and the UK and South Korea have done it by nationalizing healthcare, limiting some higher treatments, and focusing more on common treatments. This leads to long lines for some advanced procedures and even death for some because they can’t get treatment.

    I believe that the gov’t should extend minimum coverage to most adults. This mimimum coverage would start at maybe $2 mln or so as a child, turn to $1 mln as an adult and quickly decrease with age. This coverage would not go towards supplementing more advanced or prohibitively expensive treatment which cost more than the coverage as simply put, the average American life is only worth about $7 mln (http://www.physorg.com/news134969804.html) and decreases over time.

    The reason I believe there should be some minimum coverage is that I believe preventative care is a huge investment we as Americans are missing out on. I don’t see why every spare penny we have doesn’t go into education (over a 6% annual ROE plus we get an educated citizenry) but preventative care should be our next fund to max.

  • Jezz

    All those praising the American system I have one question for you. Have you ever lived in Canada or the UK and actually had the pleasure of using their health care? No I didn’t think so because most who criticize probably don’t even own a passport and have this America is number one complex.

    I worked for many years in both the UK and Canada and I can honestly say from my experiences that the U.S. health care system is lacking in comparison and extremely expensive.. I am currently living in NY, paying more tax than I did in either of those countries and I have to pay very high premiums for an insurance policy that limits me to 3 days in hospital with $500 excess before I have to pay the bill in total. My sister in the U.K. had a baby that was 10 weeks premature, both had to be hospitalized for several weeks. Both are now happy and healthy and the total bill was $0 under the nationalized health care. Try to match that without owning a ludicrously expensive health care plan.

  • Jezz

    All those praising the American system I have one question for you. Have you ever lived in Canada or the UK and actually had the pleasure of using their health care? No I didn’t think so because most who criticize probably don’t even own a passport and have this America is number one complex.

    I worked for many years in both the UK and Canada and I can honestly say from my experiences that the U.S. health care system is lacking in comparison and extremely expensive.. I am currently living in NY, paying more tax than I did in either of those countries and I have to pay very high premiums for an insurance policy that limits me to 3 days in hospital with $500 excess before I have to pay the bill in total. My sister in the U.K. had a baby that was 10 weeks premature, both had to be hospitalized for several weeks. Both are now happy and healthy and the total bill was $0 under the nationalized health care. Try to match that without owning a ludicrously expensive health care plan.

  • http://claremontconservative.com Charles C. Johnson
    • Forgetting the Facts

      The first rebuttal: “Doctors and patients won’t be the only ones calling the shots. A committee of Washington politicians will set a standard of care” He says that as though health insurance “bureaucrats” don’t already come between doctors and patients. They already determine in many cases what a patient can or can’t do for health care. Oops. So instead of being declined by the insurance company you are denied by the government. Sounds like it sucks either way.

      • http://claremontconservative.com Charles C. Johnson

        Um… let’s think. Which would I rather? A government monopoly or an insurance market where if I don’t like how I’m treated, I can leave? Yeah, those two options are a tough call…

        In all seriousness, just because you dislike your insurance provider doesn’t mean that a government provider is the right way. Many of us are perfectly content with our insurance providers just the way they are, thank you very much.

      • Forgetting the Facts

        You’re ignoring a couple pieces of the puzzle, Charles.

        I’m currently covered by my parents’ insurance, whose premiums are shared between my dad and his employer. He has no choice over the insurance company because his employer chooses the service, and he cannot afford to opt out of company’s benefits and front 100% of the premiums for our family.

        Secondly, I will soon be starting work and will find myself in the same position with another kink thrown in. My new employer provides health insurance and pays a large part of the premium. The problem is, I may not be eligible to receive any care because I can be denied for a preexisting condition. You might say, well go out and choose a company that will insure you. Not an easy task. Individual plans are pricier than group rates, and if I have a preexisting condition, that rate will only grow. I can tell you that I cannot afford to pay for health care if I am denied by my employer’s plan.

        I’m not saying that Obama’s plan will work. I am actually rather skeptical both in terms of cost and efficacy. The current system works fine as long as you stay healthy or have deep pockets. So why is it that those who become ill or injured, the very people medical insurance was created to help, find it the hardest to continue on this path?

      • http://claremontconservative.com Charles C. Johnson

        @Forgetting the Facts, Post 2.

        I’m totally with you about it being rather foolish for you to get insurance through employment. (One wonders why you don’t get food, shelter, or entertainment out of employment…)

        And as someone with parents with pre-existing conditions (read: cancer), I’m very sympathetic. But you’re suggestion is that we make the perfect, the enemy of the good. And it by no means becomes cost prohibitive if you have a pre-existing condition. I think a serious debate could be had between your insurance company and you about what constitutes a pre-existing condition and whether you might be able to lower your costs.

        You’re right that people with pre-existing conditions are harder to insure, but that doesn’t mean that a market won’t exist to cater to their needs, especially as more and more genetic testing — and hence information — goes online. If you know the likelihood that I will get sick of x diseases, it will soon be possible to create a plan with other people likely to suffer from x diseases that is a heck of a lot cheaper than company provided insurance. Pools are already starting to form of people who have been genetically tested and want to lower their rates.

        Assuming you work in California, have no preexisting condition, and are single and employed, you can purchase a plan that covers you for about $100 a month. It’s exceptionally cheap.

    • spam policy

      Does the forum have a spam policy? Copying and pasting a link about if Obama’s healthcare plan was a restaurant isn’t debate and it smells spammy to me.

    • Forgetting the Facts

      “And it by no means becomes cost prohibitive if you have a pre-existing condition.”

      I can tell you that total out-of-pocket treatment for me run about $9000/year including premiums (assuming I foot 100% of the premium), copays, and other costs (supplies, travel, etc.). My premium is more than 4x your $100/month figure, and that’s after discounts for being on a family plan and being part of a corporate plan. The rate was also set prior to my current condition. I would guess premiums for me could double given the lack of the family and corporate volume discounts and the addition of a preexisting condition. That could raise my total costs to about $16,000 per year, if not more.

      Now, the typical CMC graduate going into employment this year (according to Career Services) will make about $52,000, or about $38,000 after federal, state, and payroll taxes. That means 23%-42% of my take home pay could go to pay my health care costs. I know anecdotal evidence can only go so far, but for a non life-threatening condition, that sure seems cost-prohibitive; where does that leave those with more serious, and likely expensive, treatments? And that’s with insurance. Without it, my costs would be approaching $30,000. Doctor visits alone can be in excess of $250/visit, and I’m approaching the triple digit mark for visits over the past year.

  • http://claremontconservative.com Charles C. Johnson
    • Forgetting the Facts

      The first rebuttal: “Doctors and patients won’t be the only ones calling the shots. A committee of Washington politicians will set a standard of care” He says that as though health insurance “bureaucrats” don’t already come between doctors and patients. They already determine in many cases what a patient can or can’t do for health care. Oops. So instead of being declined by the insurance company you are denied by the government. Sounds like it sucks either way.

      • http://claremontconservative.com Charles C. Johnson

        Um… let’s think. Which would I rather? A government monopoly or an insurance market where if I don’t like how I’m treated, I can leave? Yeah, those two options are a tough call…

        In all seriousness, just because you dislike your insurance provider doesn’t mean that a government provider is the right way. Many of us are perfectly content with our insurance providers just the way they are, thank you very much.

      • Forgetting the Facts

        You’re ignoring a couple pieces of the puzzle, Charles.

        I’m currently covered by my parents’ insurance, whose premiums are shared between my dad and his employer. He has no choice over the insurance company because his employer chooses the service, and he cannot afford to opt out of company’s benefits and front 100% of the premiums for our family.

        Secondly, I will soon be starting work and will find myself in the same position with another kink thrown in. My new employer provides health insurance and pays a large part of the premium. The problem is, I may not be eligible to receive any care because I can be denied for a preexisting condition. You might say, well go out and choose a company that will insure you. Not an easy task. Individual plans are pricier than group rates, and if I have a preexisting condition, that rate will only grow. I can tell you that I cannot afford to pay for health care if I am denied by my employer’s plan.

        I’m not saying that Obama’s plan will work. I am actually rather skeptical both in terms of cost and efficacy. The current system works fine as long as you stay healthy or have deep pockets. So why is it that those who become ill or injured, the very people medical insurance was created to help, find it the hardest to continue on this path?

      • http://claremontconservative.com Charles C. Johnson

        @Forgetting the Facts, Post 2.

        I’m totally with you about it being rather foolish for you to get insurance through employment. (One wonders why you don’t get food, shelter, or entertainment out of employment…)

        And as someone with parents with pre-existing conditions (read: cancer), I’m very sympathetic. But you’re suggestion is that we make the perfect, the enemy of the good. And it by no means becomes cost prohibitive if you have a pre-existing condition. I think a serious debate could be had between your insurance company and you about what constitutes a pre-existing condition and whether you might be able to lower your costs.

        You’re right that people with pre-existing conditions are harder to insure, but that doesn’t mean that a market won’t exist to cater to their needs, especially as more and more genetic testing — and hence information — goes online. If you know the likelihood that I will get sick of x diseases, it will soon be possible to create a plan with other people likely to suffer from x diseases that is a heck of a lot cheaper than company provided insurance. Pools are already starting to form of people who have been genetically tested and want to lower their rates.

        Assuming you work in California, have no preexisting condition, and are single and employed, you can purchase a plan that covers you for about $100 a month. It’s exceptionally cheap.

    • spam policy

      Does the forum have a spam policy? Copying and pasting a link about if Obama’s healthcare plan was a restaurant isn’t debate and it smells spammy to me.

    • Forgetting the Facts

      “And it by no means becomes cost prohibitive if you have a pre-existing condition.”

      I can tell you that total out-of-pocket treatment for me run about $9000/year including premiums (assuming I foot 100% of the premium), copays, and other costs (supplies, travel, etc.). My premium is more than 4x your $100/month figure, and that’s after discounts for being on a family plan and being part of a corporate plan. The rate was also set prior to my current condition. I would guess premiums for me could double given the lack of the family and corporate volume discounts and the addition of a preexisting condition. That could raise my total costs to about $16,000 per year, if not more.

      Now, the typical CMC graduate going into employment this year (according to Career Services) will make about $52,000, or about $38,000 after federal, state, and payroll taxes. That means 23%-42% of my take home pay could go to pay my health care costs. I know anecdotal evidence can only go so far, but for a non life-threatening condition, that sure seems cost-prohibitive; where does that leave those with more serious, and likely expensive, treatments? And that’s with insurance. Without it, my costs would be approaching $30,000. Doctor visits alone can be in excess of $250/visit, and I’m approaching the triple digit mark for visits over the past year.

  • ProfElwood

    The biggest problems that our health care “system” faces, stem mostly from problems in our political system, and therefore probably can’t be fixed.

    1. The free market has been all but destroyed. Because employer funded health insurance, which isn’t really insurance as we commonly know it, has become the norm since WW2, very few people purchase their own insurance. States have also added unneeded mandates and limited competition within the state. Because only 5% of the population purchases their own insurance, and group plans favor insurance that starts paying after a relatively low deductible, people aren’t encouraged to control their own costs. Almost every other business publishes their prices, but very few medical establishments do, because few people ask. The current house and senate bills would discourage individual plans.

    2. Many insurance plans enjoy federal protection from lawsuits for denial of coverage. Look up ERISA 514a and 502i: they can prevent lawsuits in employer provided health insurance. This in turn encourages insurance companies to deny claims even when they know they are wrong. The current house and senate bills would push even more people to unknowingly give up their right to sue in case of denial.

    3. Medicaid and Medicare are not sustainable in their current form. Sprauge showed how willing polititians are to address, or even admit, this.

    http://www.ssa.gov/OACT/TRSUM/index.html

    4. The RBRVS (a Medicare/Medicaid reimbursement schedule) has favored pay to specialists over family doctors, which over the years has led to a glut of specialist while a shortage of family doctors are overworked for much lower pay. But specialists, with more time and money, can lobby congress more effectively. Neither the house nor the senate bills address this critical shortage, or the coming nursing shortage.

    5. The insurance model (third party pays after the service), is both hard to control and encourages paperwork, waste, overuse, and fraud. The house and senate bills force everyone, except federal employees, to use this model.

    There are alternate plans from radically different perspectives (truly free market, nationalized, dual layer, and many more) that do address these issues, but they are politically impossible to bring before congress because they would threaten the armies of lobbyists that currently control congress.

  • ProfElwood

    The biggest problems that our health care “system” faces, stem mostly from problems in our political system, and therefore probably can’t be fixed.

    1. The free market has been all but destroyed. Because employer funded health insurance, which isn’t really insurance as we commonly know it, has become the norm since WW2, very few people purchase their own insurance. States have also added unneeded mandates and limited competition within the state. Because only 5% of the population purchases their own insurance, and group plans favor insurance that starts paying after a relatively low deductible, people aren’t encouraged to control their own costs. Almost every other business publishes their prices, but very few medical establishments do, because few people ask. The current house and senate bills would discourage individual plans.

    2. Many insurance plans enjoy federal protection from lawsuits for denial of coverage. Look up ERISA 514a and 502i: they can prevent lawsuits in employer provided health insurance. This in turn encourages insurance companies to deny claims even when they know they are wrong. The current house and senate bills would push even more people to unknowingly give up their right to sue in case of denial.

    3. Medicaid and Medicare are not sustainable in their current form. Sprauge showed how willing polititians are to address, or even admit, this.

    http://www.ssa.gov/OACT/TRSUM/index.html

    4. The RBRVS (a Medicare/Medicaid reimbursement schedule) has favored pay to specialists over family doctors, which over the years has led to a glut of specialist while a shortage of family doctors are overworked for much lower pay. But specialists, with more time and money, can lobby congress more effectively. Neither the house nor the senate bills address this critical shortage, or the coming nursing shortage.

    5. The insurance model (third party pays after the service), is both hard to control and encourages paperwork, waste, overuse, and fraud. The house and senate bills force everyone, except federal employees, to use this model.

    There are alternate plans from radically different perspectives (truly free market, nationalized, dual layer, and many more) that do address these issues, but they are politically impossible to bring before congress because they would threaten the armies of lobbyists that currently control congress.

  • http://www.exotiqadventures.com/ Mike Holt

    I find this debate disturbing and sad. ALL citizens should be entitled to affordable or even free medical care. Yes, I said FREE. Here in Queensland, Australia, we had free medical care until about 30 years ago. How was it funded? Simple. The state government ran a lottery called The Golden Casket. The lottery made more than enough to subsidize all our medical care. And it gave the lucky winners a windfall. Then some political idiot in Canberra decided to nationalize the health care system. Now everyone in Australia is stuck with a semi-subsidized system that is open to corruption, and leaves no one happy.

    But looking at the mess in the USA, our system is fantastic compared to yours. Why can’t you make your politicians understand that health care should be available to ALL citizens? It should be the second most important priority just after top quality education for our kids.

    • Politicians

      Because politicians prioritize shorter-term incentives than any other profession in the world– yes, even Wall Street bankers. When all you’re worried about is winning reelection every two years, the long term horizon is unimportant. Think about that the next time you see some angry congressman grilling a Wall Street CEO on TV.

  • http://www.exotiqadventures.com/ Mike Holt

    I find this debate disturbing and sad. ALL citizens should be entitled to affordable or even free medical care. Yes, I said FREE. Here in Queensland, Australia, we had free medical care until about 30 years ago. How was it funded? Simple. The state government ran a lottery called The Golden Casket. The lottery made more than enough to subsidize all our medical care. And it gave the lucky winners a windfall. Then some political idiot in Canberra decided to nationalize the health care system. Now everyone in Australia is stuck with a semi-subsidized system that is open to corruption, and leaves no one happy.

    But looking at the mess in the USA, our system is fantastic compared to yours. Why can’t you make your politicians understand that health care should be available to ALL citizens? It should be the second most important priority just after top quality education for our kids.

    • Politicians

      Because politicians prioritize shorter-term incentives than any other profession in the world– yes, even Wall Street bankers. When all you’re worried about is winning reelection every two years, the long term horizon is unimportant. Think about that the next time you see some angry congressman grilling a Wall Street CEO on TV.

  • Moderate

    I heard this was a moderate proposal. So naturally I was intrigued. What do people think of Wyden’s health plan?

    http://www.thehealthcareblog.com/the_health_care_blog/2006/12/policy_wydens_h.html

  • Moderate

    I heard this was a moderate proposal. So naturally I was intrigued. What do people think of Wyden’s health plan?

    http://www.thehealthcareblog.com/the_health_care_blog/2006/12/policy_wydens_h.html

  • http://claremontconservative.com Charles C. Johnson
  • http://claremontconservative.com Charles C. Johnson
  • Karthik Reddy

    i apologize for any redundancies that I will most likely write, but I don’t want to waste a day reading through every single one of the above posts. Charlie did a good job of mentioning that we already ration health care, only using a price mechanism instead of a more bureaucratic rationing regime. Still, some serious problems:

    Has anyone noticed that our country is broke? Bush was irresponsible and left us with a mess. Obama exacerbated the disaster. $789 million in stimulus (only 25% of which will be spent in 2009), TARP, and a “rescue” of the automotive industry and BAM!, public debt now stands at 58% of GDP, over 41% in 2008. Someone is going to have to pay for all of this and, unfairly, its going to be our generation. When we have high taxes and subpar services during the high-income periods of our lives, we may not be so happy about the deficit we (and most reprehensible, our parents) are irresponsibly increasing.

    Perhaps you can come up with some list of long-term cost saving measures. Despite the likelihood that these statistics will be at best disputed and at worst nebulous, what about the short-term? Let me interject here by quickly noting that Douglas Elmendorf stated on July 17 that the bill would not reduce health care costs and would actually add $239 billion to the deficit over the next decade and even more after that. But anyway, how are we going to pay for this plan in the short run? The administration has supported a “millionaire’s tax” which, interestingly, would apply to people making significantly less than a million dollars per year. If I remember correctly, aren’t we in one of the worst economic crises in the history of this country? Should our goal not be returning America to prosperity so that more workers gain employment and wage increases? We may be on the left side of the Laffer Curve, but our goal right now is getting out country back on its feet, not tying it down with increased taxation.

    One last question for all those in favor of government-rationed health care: why do our obligations to others in the realm of health care stop at our borders? Why shouldn’t we create one supranational care-rationing body that would treat all individuals like equals, not just all Americans. If this is a moral question, why do our obligations to fellow human beings stop at the San Ysidro border crossing? The last time I checked, human beings lived on the other side of the border as well. Maybe we could fund that plan with a world-wide “millionaire’s tax” that would tax all affluent humans (making more than $15,000 a year) at an increased rate to fund health care for those less off. Just curious as to how this moral argument works if we only want it to apply within artificial and historically-imposed boundaries.

  • Karthik Reddy

    i apologize for any redundancies that I will most likely write, but I don’t want to waste a day reading through every single one of the above posts. Charlie did a good job of mentioning that we already ration health care, only using a price mechanism instead of a more bureaucratic rationing regime. Still, some serious problems:

    Has anyone noticed that our country is broke? Bush was irresponsible and left us with a mess. Obama exacerbated the disaster. $789 million in stimulus (only 25% of which will be spent in 2009), TARP, and a “rescue” of the automotive industry and BAM!, public debt now stands at 58% of GDP, over 41% in 2008. Someone is going to have to pay for all of this and, unfairly, its going to be our generation. When we have high taxes and subpar services during the high-income periods of our lives, we may not be so happy about the deficit we (and most reprehensible, our parents) are irresponsibly increasing.

    Perhaps you can come up with some list of long-term cost saving measures. Despite the likelihood that these statistics will be at best disputed and at worst nebulous, what about the short-term? Let me interject here by quickly noting that Douglas Elmendorf stated on July 17 that the bill would not reduce health care costs and would actually add $239 billion to the deficit over the next decade and even more after that. But anyway, how are we going to pay for this plan in the short run? The administration has supported a “millionaire’s tax” which, interestingly, would apply to people making significantly less than a million dollars per year. If I remember correctly, aren’t we in one of the worst economic crises in the history of this country? Should our goal not be returning America to prosperity so that more workers gain employment and wage increases? We may be on the left side of the Laffer Curve, but our goal right now is getting out country back on its feet, not tying it down with increased taxation.

    One last question for all those in favor of government-rationed health care: why do our obligations to others in the realm of health care stop at our borders? Why shouldn’t we create one supranational care-rationing body that would treat all individuals like equals, not just all Americans. If this is a moral question, why do our obligations to fellow human beings stop at the San Ysidro border crossing? The last time I checked, human beings lived on the other side of the border as well. Maybe we could fund that plan with a world-wide “millionaire’s tax” that would tax all affluent humans (making more than $15,000 a year) at an increased rate to fund health care for those less off. Just curious as to how this moral argument works if we only want it to apply within artificial and historically-imposed boundaries.

  • Karthik Reddy

    The last point obviously pertains to government-rationed health care, not Obama’s plan. Maybe Obama’s plan will get us there, but only the first three paragraphs pertain to Obama’s plan.

  • Karthik Reddy

    The last point obviously pertains to government-rationed health care, not Obama’s plan. Maybe Obama’s plan will get us there, but only the first three paragraphs pertain to Obama’s plan.

  • Lee Smith

    Is this the same Peter Singer of infanticide and animal liberation infamy. Here is one of his quotes:
    “Racists violate the principle of equality by giving greater weight to the interests of members of their own race, when there is a clash between their interests and the interests of those of another race. Similarly speciesists allow the interests of their own species to override the greater interests of members of other species. ” so I guess it follows that non human animals should also be included in the rationing of health care. But don’t worry about the finances because if Singers philosophy of infanticide and euthanasia is followed, much money will be saved.

  • Lee Smith

    Is this the same Peter Singer of infanticide and animal liberation infamy. Here is one of his quotes:
    “Racists violate the principle of equality by giving greater weight to the interests of members of their own race, when there is a clash between their interests and the interests of those of another race. Similarly speciesists allow the interests of their own species to override the greater interests of members of other species. ” so I guess it follows that non human animals should also be included in the rationing of health care. But don’t worry about the finances because if Singers philosophy of infanticide and euthanasia is followed, much money will be saved.

  • Thumbs up for Grant

    I did not follow the entire reply discussion here, but from what I read, I approve of the way Grant considers, refutes, and cites arguments. His text is very informative, although of course, Charles brings up some good counterpoints to consider. To be perfectly honest, I found Grant’s arguments more uniformally solid. My knowledge on the health care system in and outside of the US is limited, so thanks for putting all that evidence out there.

    • http://claremontconservative.com Charles C. Johnson

      @Thumbs up for Grant,

      I agree. I find that evidence unpersuasive for reasons I’ll get to in a moment, but at least it is based upon evidence, which is to Grant’s credit.

      Here’s why I find it deceptive to say that it is bad that health care GDP spending in the U.S. is higher. I am citing, verbatim, this piece in City Journal. http://city-journal.org/2009/eon0722dg.html

      “Officially, the logic is this: the larger health care’s share of the economy, the higher the per-unit cost of care to the government, to employers, and to you. In Canada, for instance, health care is just 10 percent of GDP. Further, our northern neighbor covers almost every citizen and we don’t. The U.S., then, seems to be paying far more to insure a smaller share of its population—to be paying more for less.

      There are several flaws in this reasoning, first and foremost its claim that a dollar spent is a dollar wasted. America’s health-care sector is larger partly because, unlike Canada’s, it includes for-profit corporations. Consider the benefit: companies invest billions each year developing innovative, life-saving drugs and devices. Are these expenses really something to lament? Similarly, is it a disadvantage that the U.S. has 11 percent more practicing doctors per capita than Canada? Or 15 percent more nurses? Is it a problem that the United States has almost four times as many MRI scanners per capita as Canada does, or that we preventively test more of our population for common cancers? Hardly. The fact that America’s health-care system is larger, more advanced, and better staffed than a system with rationed care is an advantage. To pretend otherwise is just a tactic to make the reform pill easier to swallow.

      So the American health sector doesn’t have to shrink. But it should certainly deliver care at a lower unit price. To see how, let’s stop comparing our health care with what’s available in Canada or Sweden or Mars and instead make some comparisons among various Americanhealth-care systems. Take two very different states: Wisconsin and New York. In Wisconsin, a family can buy a health-insurance plan for as little as $3,000 a year. The price for a basic family plan in the Empire State: $12,000. The stark difference has nothing to do with each state’s health sector as a share of its economy (14.8 percent in Wisconsin as of 2004, the most recent year for which data are available, and 13.9 percent in New York). Rather, the difference has to do with how each state’s insurance pools are regulated. In New York State, politicians have tried to run the health-insurance system from Albany, forcing insurers to deliver complex Cadillac plans to every subscriber for political reasons, driving up costs. Wisconsin’s insurers are far freer to sell plans at prices consumers want.

      The gulf in insurance-premium prices among American states is a sign that too much government intervention—not too little—is what’s distorting prices from one market to the next. The key to reducing health-care costs for patients, then, is to promote competition, not to dictate insurance requirements from on high. Unfortunately, a government-run insurance plan is the core of ObamaCare.”

      That pretty much sums up my views on why the government takeover of 15% of our economy will be misguided.

  • Thumbs up for Grant

    I did not follow the entire reply discussion here, but from what I read, I approve of the way Grant considers, refutes, and cites arguments. His text is very informative, although of course, Charles brings up some good counterpoints to consider. To be perfectly honest, I found Grant’s arguments more uniformally solid. My knowledge on the health care system in and outside of the US is limited, so thanks for putting all that evidence out there.

    • http://claremontconservative.com Charles C. Johnson

      @Thumbs up for Grant,

      I agree. I find that evidence unpersuasive for reasons I’ll get to in a moment, but at least it is based upon evidence, which is to Grant’s credit.

      Here’s why I find it deceptive to say that it is bad that health care GDP spending in the U.S. is higher. I am citing, verbatim, this piece in City Journal. http://city-journal.org/2009/eon0722dg.html

      “Officially, the logic is this: the larger health care’s share of the economy, the higher the per-unit cost of care to the government, to employers, and to you. In Canada, for instance, health care is just 10 percent of GDP. Further, our northern neighbor covers almost every citizen and we don’t. The U.S., then, seems to be paying far more to insure a smaller share of its population—to be paying more for less.

      There are several flaws in this reasoning, first and foremost its claim that a dollar spent is a dollar wasted. America’s health-care sector is larger partly because, unlike Canada’s, it includes for-profit corporations. Consider the benefit: companies invest billions each year developing innovative, life-saving drugs and devices. Are these expenses really something to lament? Similarly, is it a disadvantage that the U.S. has 11 percent more practicing doctors per capita than Canada? Or 15 percent more nurses? Is it a problem that the United States has almost four times as many MRI scanners per capita as Canada does, or that we preventively test more of our population for common cancers? Hardly. The fact that America’s health-care system is larger, more advanced, and better staffed than a system with rationed care is an advantage. To pretend otherwise is just a tactic to make the reform pill easier to swallow.

      So the American health sector doesn’t have to shrink. But it should certainly deliver care at a lower unit price. To see how, let’s stop comparing our health care with what’s available in Canada or Sweden or Mars and instead make some comparisons among various Americanhealth-care systems. Take two very different states: Wisconsin and New York. In Wisconsin, a family can buy a health-insurance plan for as little as $3,000 a year. The price for a basic family plan in the Empire State: $12,000. The stark difference has nothing to do with each state’s health sector as a share of its economy (14.8 percent in Wisconsin as of 2004, the most recent year for which data are available, and 13.9 percent in New York). Rather, the difference has to do with how each state’s insurance pools are regulated. In New York State, politicians have tried to run the health-insurance system from Albany, forcing insurers to deliver complex Cadillac plans to every subscriber for political reasons, driving up costs. Wisconsin’s insurers are far freer to sell plans at prices consumers want.

      The gulf in insurance-premium prices among American states is a sign that too much government intervention—not too little—is what’s distorting prices from one market to the next. The key to reducing health-care costs for patients, then, is to promote competition, not to dictate insurance requirements from on high. Unfortunately, a government-run insurance plan is the core of ObamaCare.”

      That pretty much sums up my views on why the government takeover of 15% of our economy will be misguided.

  • http://www.google2.com glasnost

    Well Done! I Like it!

  • http://www.google2.com glasnost

    Well Done! I Like it!