Jeff Hoard wonders why Americans are suspicious of Socialized Medicine. This article for the Heritage Foundation by Kevin Fleming may help him understand. (The Executive Summary of Fleming's heavily footnoted piece is here). Based in part on an analysis of the British and Canadian experiences, Fleming describes the ten things one can expect from a single-payer health system.
The first is reduced quality of care. For example, only three of 29 countries studied by the OECD had fewer practicing physicians than Britain. And in a study of cancer survival rates in 17 countries, Britain ranked near the bottom in lung cancer, colon cancer, and breast cancer survival. Britain has fewer medical oncologists than any country in Western Europe.
The second is periodic funding crises. Providing "free" medical care increases demand for it. When the government responds by restricting spending, as it has in Britain, patient demand far outstrips health care supply. As Fleming shows, this has been the pattern under Britain's single-payer system. Indeed, Britain has underinvested in health care during the past 30 years compared to the European average.
The third is politically driven inequalities. As Fleming documents, Canada has a three-tiered system. The wealthy jump queues by going to private clinics or to the U.S. for rapid treatment. The second tier consists of the well-informed and the aggressive, who push their way to the front of the line. This leaves behind the elderly, the poor, and the disenfranchised. Similarly, a 2002 investigation showed that in Britain more than 10,000 private-pay patients were given preference over National Health Service patients in Britain's best hospitals.
The fourth is labor strikes. Strikes are common in state-operated enterprises. The health care industry has proven to be no exception. CBC News reports that Canadians have "come to expect [strikes] as part of the negotiating process between doctors and the government." In the past three years, Canada has experienced major health care related work stoppages in New Brunswick, British Columbia, and Ontario.
The fifth is personnel shortages. According to Fleming, Canada has a serious shortage of physicians such that 18 percent of Canadians have trouble finding a doctor. Canada has 2.1 physicians per 1,000 people, compared to an OECD average of 2.8.
The sixth is outdated facilities and medical equipment. In government-run industries, equipment purchasing and technology investments are driven by politics. Fleming shows the adverse consequences that have resulted from this reality in Britain and Canada. For example, according to the president of the Canadian Association of Radiologists, much of the country's diagnostic equipment "is so outdated it would not be used by radiologists in the U.S."
The seventh is waiting times. This is topic Michael Moore didn't want to discuss. Waiting times in Canada and Britain are notoriously long. In Canada, for example, the average wait time between general practitioner referral and specialty consultation is 17.7 weeks.
The eighth is signifcant variations in patient care based on region and economic status. This, of course, is a major problem with health care in the U.S. But Fleming shows that it exists to a substantial degree under single-payer systems, as well.
The ninth is financial waste. In 2001, Britian reportedly lost 20 percent of its total spending on its national health care system due to "waste, fraud, and inefficiency." Britain now has more administrators than consultants in the system.
The tenth is loss of personal liberty. Personal freedom in the health care context means that patients can choose their treatments and which doctors will provide them. Under Socialized Medicine, a government official makes these choices. Pressure also arises for government officials to impose behavioral decisions on individuals in order to keep health care costs down. Americans tend to be quite suspicious of giving the state this kind of power, particularly in the life and death context of health care.
In sum, as the U.S. grapples with the issue of health care reform, there are very good reasons to eschew Socialized Medicine.
Reader Comments ( Page 2 of 15)
16. Jack--I understand that "medicare for all" is not socialized medicine. You should understand that "medicare for all" is socialized insurance. If there is one thing that the twentieth century should have taught us is the horrors of socialism. I don't recall comming across a right to "opt out" of paying for medicare or any other government health care. Could you tell me where to go so I can do that and get my money back? If you will recognize my right to opt out of all aspects of government health care, and do not require me to pay for your socialized medical insurance,I could care less what kind of socialism you care to join with other like minded individuals.
George Lundstrom at 1:04PM on Jun 24th 2007
17. George:
I don't understand the hostility towards socialism. I think you may have it mixed up with communism or facism. Are the scandinavian countries (Sweden, Denmark, Norway, Iceland and Finland) and Great Britain and France all subjects to the "horrors of socialism"? They all are socialist states. It's called social-democracy, and builds on the priciples of socialism and democracy.
Håvar at 1:23PM on Jun 24th 2007
18. Nate, I do understand Medicare. I'm on it now and have paid into it for 55 years. It doesn't matter how much tax I pay NOW. I've did my duty and when you are on Medicare someone else will pay for you. It isn't perfect but it's the most efficient system we have.
And you are wrong about motivation; it is not free. Medicare patients currently pay a 20% co-pay, which on a fixed income is significant and it does deter frivolous (AND needed) doctor visits. As well, most patients do not look forward to spending time in a waiting room for perhaps seven minutes in front of the doctor. They usually go when needed.
But even if they didn't the overutilization will come nowhere close to the 31% waste that currently exists because of the insurance bureaucracy.
Having spent 25 years as a health care provider prior to selling my company 3 years ago, let me assure you that free-market medicine started with the 1994 Republican takeover of the system, and it has gone further downhill every year.
And you are wrong about Medicare restrictions. For proof look at the number of Medicare patients that were talked into (or scammed into) signing up for a private Medicare HMO. The private restrictions exceed those of Medicare and (at least those who have needed more than the average amount of care) are now trying to dump the private system and get back into Medicare. My mother was one of them, and she could not get needed care. Private Medicare stinks and costs the taxpayers 20% more than regular Medicare. So much for privatization being cheaper than the government.
See http://www.madison.com/wsj/home/column/index.php?ntid=135129&ntpid=2
What is not covered by Medicare (which includes vision, dental, cosmetic surgery, breast implants and experimental treatments) can be purchased on the "free market." Remember that? It won't be eliminated. And if you want to compete by charging the patient lower than Medicare pays, you are free to do so. That's more free market! But there are upper limits, and having billed Medicare for over 20 years I can say they were always reasonable. Did they satisfy those who wanted to bill four times the norm, no, but nothing would satisfy them.
Yes, HMOs failed and the politicians erred by mandating those. But the politicians were on the take, and the industry took advantage of our corrupt political system to get HMOs passed.
Capitation (x dollars per patient per year) is bad for patients no matter how you cut it, and that's one of the biggest failings of the PRIVATE Medicare system today. The incentive is to provide less care than paid for so the difference adds to the profits and CEO salaries.
Jack Lohman at 1:53PM on Jun 24th 2007
19. I find it ironic that those who support government single payor healthcare are the very ones that have gone into epileptic fits over the Patriot Act and yet they are willing to allow the government access to and administration of their most private personal information.
hoads at 6:20PM on Jun 24th 2007
20. George, there is no way to opt out of taxes or Medicare payments. It's the price you pay to live in the US. Perhaps if I knew where you were coming from I'd be more sensitive to your motives. Are you young and healthy and don't need healthcare (today)? Are you going to opt in when you do need healthcare? Or do you just want to pay the 50-100% more for a private healthcare system? Or, finally, are you a member of the insurance or healthcare industry that benefits from the current rip-off system?
And Havar, your case is a classic. I could point you to many horror stories that occur here in the US. George is lucky.
Here is a very frightening tale of a friend of mine in the health care movement. He's in it because one of his kids has severe hemophilia and they have spent $1 million on him already. But what is frightening is what happened to his employer. His employer could not find another company that would insure them, and their current company just kept raising their rates. I'm sure they'd like to fire him but don't dare.
http://www.businesscoalition.net/Nathans_NYU_Summit_20070326_jel.pdf
Jack Lohman at 2:01PM on Jun 24th 2007
21. Havar--What do I have against socialism. Well, let's see. USSR--Union of SOCIALIST Republic. 25-60 million dead. Nazi--short for national SOCIALISM--do we really know how many dead? Every communist dictator calls their country socialist. How could I possibly be against socialism? Back to my original point--there is no right to health care; imposing it is morally wrong. There is no right way to do the wrong thing. End of story!
George Lundstrom at 2:02PM on Jun 24th 2007
22. Heathcare is 'not a constitutional Right, nor should be a governmental Entitlement' - However in stating this, I defer to the Millions in the so called GREATEST NATION ON EARTH that will die prematurely due to lack of care, fear of medical bills that will ruin their families financial future, or just 'quite simply' can not acquire medical coverage at any price or effort, let alone keep paying on a cash basis, from pride until they can not pay the high cost any longer for a diagnosis to be treated, or the Criminal Cost of medicine.
I state not a Right nor Entitlement - However between 18 and 65 there is no reason that a single pay system can not be implemented by being included in Medicare, as no personnel, facilities would need added (unless Government steps in) - it already exist! The Offset All are missing is that in a single payor system, why can't it be mandatory that all Insurance Companies take their porportionate share of Risk/Claims, as Mandatory Re-insurance of Risk to and of Medicare for ALL. They would re-insure and pay their portion or all licences would be revolked, They would still have the Right to issue all other Products to Gouge the wealthy among American's that pay exuberant FEE Premiems for so-called Class coverage and add-onn's like Long Term Care, and the many supplemental policies.
I do not believe in Socialized 'anything' - However, Drug manufacturer's should make their profit with a CAP price, the middle men regulated as to price / profits and American's will see Pharma Cost drop by 70%. If Pharma cost do not drop- then medicines should be purchased and distributed via the WOMB to TOMB Medicare system as set forth above, not free but at a realistic price. It is time the huge Pharma and Insurance Lobbies are Put in their Place or made illegal - 'We the People' in this Great Nation should not DIE due to lack of medical care or the medicines to make or keep well or lack of preventive early diagnosis! This Like our Education System, IS A NATIONAL DISGRACE! Which can be fixed with a simple Pen, Guts and a VOTE!
Travis M at 2:29PM on Jun 24th 2007
23. George,
Every political system have had their dictators. That doesn't necissarily make all of them wrong. There have been many examples of capitallistic dictators, for example Augusto Pinochet. Many dictators call their countries democratic, but that doesn't make them so.
And you still ignore all the sucessfull socialistic states, the ones based on democracy.
Back to your original point. By your reasoning, everything short of an anrachy would be morally wrong. BTW, the right to medical care is described in article 25 in UN's Universal Declaration of Human Rights.
Håvar at 2:24PM on Jun 24th 2007
24. Not ironic here, hoads... I support single-payer and I also support the Patriot Act. I also support concealed carry, national ID cards and zero taxes for corporations. I voted for Bush twice, though I now would like to change my vote. But this is not and should not be a political issue.
Medicare-for-all is the right thing to do, though whether it passes will depend much on political corruption.
Jack Lohman at 4:18PM on Jun 24th 2007
25. Paul - Why do you guys even bother to write this blog anymore. I see you're out whoring on the keyboard for your firm's extensive list of insurance clients. In the meantime, 17,000 working Americans or their children are DYING every year so you can afford a fabulous house and that top of the line whatever car. I personally do not know how you can sleep at night. You've sold your soul
Phil at 2:53PM on Jun 24th 2007
26. I have read Jack Lohman's points. Unfortunately, it seems he is making some invalid comparisons.
But first, I am sure Jack is aware that Medicare is seriously underfunded. My concern is that the proposal to apply Medicare to everyone is simply a back door approach to provide the cover to increase the funding.
Secondly, the heart of his comparison is what he calls "administrative waste". In that vein he is claiming that there is virtually no cost for administering Medicare. Yet, we know intuitively that this is not true. There are unreported costs of gathering the revenue from the IRS as well as the numerous frauds perpetrated on Medicare. We constantly hear about those. So, it could well be, if we consider these fraudulent claims, the cost of cost of administration of Medicare is substantially higher than the 2% or so that is often quoted. It would seem that Medicare could benefit from substantially higher administrative expenses targeted at weeding out the fraud. It is an unfortunate occurrence that to a government bureaucracy money is free and unlimited.
But, along similar lines, we can be pretty sure that the older population consumes more health care services than the rest of the population. In particular, the health care requirements of the aged tend to be larger per occurrence than that of the general population. Therefore, from an administrative standpoint, it is less expensive to administer one major illness than multiple childhood diseases. So, it seems unfair to make the comparisons Jack is making to bolster his claims.
Jack also claims he "paid his dues". But, those dues continue to go up for those paying them. The projections are that by 2015 there will be a ratio of those paying into Medicare vs those benefiting of 2:1. Hence, we will continue to need more money going into Medicare. So, it seems somewhat unfair to ask a worker to pay, not only for him and his family, but also for Jack. We can be pretty sure that it will take only one serious illness for Jack to recoup all that he has put into Medicare. After that, he is effectively on the dole. It seems that case happens pretty frequently.
Jack also seems pretty fond of claiming that we would still have private insurance. But, government tends to be an all or nothing kind of deal. We can be pretty sure that even if Medicare for all starts off optional, it will likely end up being mandatory because the government will decide it wants the premium income. Having multiple options is not the single payer philosophy that Jack seems to favor. But, it will probably end up that way. At that point, government will be in the drivers seat and can specify exactly what it will pay the medical people, when it will pay for it, how much it will tax, and who is eligible for what.
This is not just a slippery slope, but a guaranteed fall into a national health program. I am agin' it.
Rick
Rick Caird at 2:59PM on Jun 24th 2007
27. Poster Steve J has disdain for the Heritage Institute, but at least the author cites his source and is careful to explain what the facts in evidence are: how many physicians per thousand population and the occurence of labor strikes are verifiable claims. Mr. "J", doesn't engage the facts either disputing them (like for example , citing some other credible report giving different numbers) nor their relevance (the effective definition of "physician" may vary from place to place). Instead, in the manner of a leftist internet hack, he cites vague conclusions from some "report". Maybe that organization is credible, (though many gilded-era perpetual trusts of their sort have been infested with leftist hacks) and maybe the reports conclusions are being fairly represented (not always the rule among the left-blogosphere). But life is too short to follow op on every one of these leftist myths.
mrad at 3:01PM on Jun 24th 2007
28. Jack Lohman writes: And you are wrong about Medicare restrictions. For proof look at the number of Medicare patients that were talked into (or scammed into) signing up for a private Medicare HMO. The private restrictions exceed those of Medicare and (at least those who have needed more than the average amount of care) are now trying to dump the private system and get back into Medicare. My mother was one of them, and she could not get needed care."
Jack, that certainly has not been the case with MY Medicare advantage plan. They have never denied me anything, and since I have been a paraplegic for 25 years this are starting to REALLY break down. Their costs have been enormous, their approvals are instantaneous if needed and within a day otherwise, and there has NEVER been a denial of needed care or even a fight about it.
However, each state is different, and depending on the insurance environment in the state - some states offer vastly more choices than others. I know I would be DEVASTATED if I lost my Medicare Advantage Plan - and am sorry your mother was not as lucky and happy with hers as I have been.
Phil at 3:03PM on Jun 24th 2007
29. Rick, Medicare is seriously underfunded because the conservatives that want to dry it up from the inside in favor of the privatized system (they receive campaign funds from) have loaded it up with taxpayer giveaways (Medicare Part D will send $780 billion to the pharmaceutical industry in the next decade).
I'm a lifelong Republican (though not a very good one lately), but I can only hope the Dems save Medicare from the special interests for my kids and grandkids. At 70 I don't have to worry, but the youngsters do.
If you really want to see how to cut health care costs see http://www.fightingbob.com/article.cfm?articleID=515.
No, we don't have to increase funding, we need to get the politicians out of it and turn it over to a nonpartisan non-conflicted commission. We know that the insurance bureaucracy consumes 31% of health care dollars without ever providing direct patient care, and we know that without this 31% of waste the system will work better than with it. Administrative costs will level out to about 9%, not the 2-3% claimed for Medicare and not the 31% of administrative waste.
We know that heavy insurance expenses go toward broker and salesman commissions, actuarial costs (determining who you are going to cover and who you are not), marketing costs, gatekeepers, high executive salaries, and tremendous shareholder profits. All costs of which Medicare does not have. See http://www.throwtherascalsout.org/Three%20Kings.jpg for shareholder increases that Medicare is not burdened with.
Let's talk about Medicare fraud: It exists and should be eliminated. But fraud on the PRIVATE side is twice as high because federal laws involve jail time and the state laws are much weaker. I know of one (now defunct company) that was billing private insurers (fraudulently) 30 times for the same 30-day test that they (appropriately) billed Medicare ONCE for. The FBI is now investigating, but even the FBI is underfunded.
On handling the administrative claims, yes, the "per claim" cost is the same with high and low claims, so the percentage is higher for small claims. So what? There are more administrative personnel in the City of Boston than in all of Canada! What matters is that, on average, we could provide health care to 100% of our people for the same 16% of GDP we are spending today. Of course you could make the system more complicated, but you increase administration costs with every change.
So Rick, all of your convoluted attempts to argue against a simplified system are for naught. Simple works and simple doesn't break. Medicare is not now and never has been "all or nothing." Quit trying to scare people. Or are you next going to throw in the words "rationing" and "wait times," neither of which will not be a part of the system if we continue funding at 16% of GDP.
And you worry about a "government" slippery slope when in fact we are fighting a "privatized" slippery slope that will ruin our economy if it remains.
Take a look at these slides, all with their sources: http://www.businesscoalition.net/slides.htm
That said, Rick, I have no skin in this game. Are you involved with either the health care, insurance or pharmaceutical industries? If not, I would hope that you take an honest look at the benefits of a single-payer plan.
Jack Lohman at 4:34PM on Jun 24th 2007
30. Jack
My motives are to retain the United States as a free society. My personal situation is irrelevant to the points that I make The points I make are independant of me. Please make your comments relevant to my points. By the way, the price we pay to live in a free society is to respect the rights of others and mind your own business.
George Lundstrom at 4:38PM on Jun 24th 2007