The moment of truth for health care is at hand, and the distortion that perhaps gets the most traction is this:
We have the greatest health care system in the world. Sure, it has flaws, but it saves lives in ways that other countries can only dream of. Abroad, people sit on waiting lists for months, so why should we squander billions of dollars to mess with a system that is the envy of the world? As Senator Richard Shelby of Alabama puts it, President Obama’s plans amount to “the first step in destroying the best health care system the world has ever known.”
That self-aggrandizing delusion may be the single greatest myth in the health care debate. In fact, America’s health care system is worse than Slov””er, oops, more on that later.
As I have observed before, most of the Americans who are so proud of our system simply ignore the health statistics that rank us—with by far the most expensive healthcare system in the world—far behind some third-world countries. For the last several years of his life, my father-in-law in England got three visits a day from home health care workers, at least one a week from a qualified nurse practitioner, and at least one house call a month from a physician, in addition to an extensive cocktail of medications. His copay for all that was on the order of $10/month. We could not afford to bring him to America because providing equivalent care here would have bankrupted the entire family.
Yes, there are waits for elective surgery and the National Health Service doesn’t provide the same level of luxury as American private-pay patients expect. However, I have heard of far fewer cases of people being denied necessary care by faceless British government bureaucrats than of Americans denied necessary care by faceless insurance-company bureaucrats.
As Kristof says, the biggest obstacle to fixing the broken American healthcare delivery system is the utterly baseless popular belief that it isn’t broken. When more infants are dying in New Orleans than in Hanoi or Tegucigalpa, there [b]is[/b] something broken.
While I don’t believe the megabucks plan winding through Congress is either a considered or viable option, I do agree that something needs to be done. I don’t see why more time and discussion couldn’t have gone into it instead of the rush job we’re getting now. But – I work in a small business and i have seen the insurance package our employer has been available to provide dwindle from reasonably adequate coverage to a perfectly useless policy that costs him money and pays for nothing. Why not take a look at how “large groups” are definited? Why not allow for the creation of guilds or something similar, based on trade, neighborhood, religion whatever – something that would broaden the concept of a “large group” so that more people could be taken in? Above all, why can’t we proceed with manageable steps instead of a mammoth bill that threatens to choke us?
Sherri,
Oddly enough that was what was being proposed in the early 1940s. Regional health cooperatives – along with locally owned power plants – were very popular in the rural West, including the Mormon culture zone (Utah/Idaho and Alberta), and seemed to be the wave of the future.
Then the AMA cried foul and in the postwar period, employment-based insurance (which presumed that the future would be a matter of big business working in harmony with big labor) took center stage. I’ve never understood why reformers today rarely address the craft/regional approach.
[url=http://catholicandreformed.blogspot.com]Catholic and Reformed[/url]
Kristof simply recycles the conventional wisdom of the Times’ editorial board. (I think [url=http://corner.nationalreview.com/post/?q=YmMzYjQxYWYyZjZmMDA2YmY2NTJhZTMzMzA0MmMzYmY=]this Churchill quote[/url] is relevant.) His reference to the life expectancy of African-Americans in New Orleans illustrates a problem sadly common to journalists. Failing to take into consideration the causes of variation between cultures (e.g., from p 35 of the report Kristof cites, the murder rate in New Orleans is [i]14 times as high[/i] as the national average), he simply recruits any favorable statistic to his side without evincing the slightest curiosity as to why it stands out and whether it’s relevant.
The problems with the [i]cost[/i] of both health care and health insurance are directly traceable to actions taken by government at various levels, going back more than half a century, beginning with its having become an employer-provided benefit. Anybody who imagines that we’d have fewer denials of treatment under a nationalized system should just take a look at how Medicare and Medicaid, or even the various state health care plans, are doing on that front. And it wouldn’t hurt to review their performance in terms of costs and services since their inception. They don’t compare well with even the mandate-laden private insurance system we have today.
For anyone with time to read, look at [url=http://www.heritage.org/Research/HealthCare/wm250.cfm]this[/url] (from 2003, but the historical analysis stands) and [url=http://www.heritage.org/Research/HealthCare/wm2671.cfm]this[/url] for a free-market perspective, or look at [url=http://krugman.blogs.nytimes.com/2009/07/29/medicare-versus-insurers/]this[/url] (a brief blog post with some interesting comments) from nationalization proponent Paul Krugman. Krugman’s post is interesting for what he leaves out of the comparison, e.g., that Medicare & Medicaid keep cost low in part by (1) setting prices far below market (or even below [i]cost[/i]) and (2) offering a minimal range of services, not to mention the problem of unfunded mandates for states.
#4 Don – actually, the evidence is that, once the the adjustments have still been made, we have the worst health care system in the world.
In fairness, Medicare and Medicaid allow private insurers to reap more profits because they take people who are more sick out of the system. The problem is that patients are still seen as sources of money for doctors. The reason why costs are expensive is that there are few incentives that lead to health, and plenty for money.
I’m intrigued why you choose the Heritage foundation or Paul Krugman rather than Kenneth Arrow, who is the founder of Health Care economics. Until I can hang out a sign saying “surgery, $100” it’s not really a free market system. Until we treat our health like cars (I want only to have a small amount of health, like a kia, rather than be really healthy, like a Lexus), a “free market” system is intuitively utopian, unrealistic and cruel.
I do note, however, people have a propensity to be moved [url=http://www3.interscience.wiley.com/cgi-bin/fulltext/122260824/HTMLSTART?CRETRY=1&SRETRY=0]more by motivations and beliefs than by facts[/url].
# 1 Dale Rye. Have no idea where you came up with stats to back your statement about infant mortality in New Orleans versus Vietnam or Honduras. A simple Google search will provide comparisons with U.S., Louisanna, Vietnam, and Honduras that will show you are way out in left field. Translate: dead wrong.
Apparently the thing that you like or liked most about the English health care system was that the majority of the late-in-life care provided your father-in-law was paid for by someone else. That’s called redistribution of wealth. As someone who held a job, sometimes two, most every day of his life from age 14 until retirement at a little over 70, worked his way through college (3 degrees), sent two kids through college and one of those through law school (with loans, they also worked, and still paying back), was the primary support for his mother the last 30 years of her life including a private nursing home towards the end, I am getting tired of this redistribution of wealth thing. And make no mistake, that is what universal medical or socialized medicine or public option or Obamacare or whatever you want to name it is all about.
Are there things about our healthcare system we could do better or cheaper? Undoubtedly. Howver despite the premise of the Kristoff article that things are better elsewhere, the the legislation wending its way through the Congress is not about doing things better or cheaper. It is primarily about redistribution of wealth.
I happen to agree that medical services should be available to everyone who need them. And I agree that we should do something for those who legitimately cannot afford them. But that is a far cry from what is being proposed in the various programs floating around Congress.
[blockquote]…we have [b]the worst[/b] health care system in the world.[/blockquote]
John, even as one of those MDs who you characterize as seeing patients as a source of money (only?), I think your hyperbole is showing.
And I’m the first to concede that there is much in the present US system that needs improvement, I’d REALLY like to see the rank hyperbole, convenient ignorance of hard stats, etc. on BOTH sides of the debate to end. Liberals are just as guilty of creating straw men as conservatives in this debate. Next time, back your assertions with some empiric data.
#5 John Wilkins,
[blockquote][A]ctually, the evidence is that, once the the adjustments have still been made, we have the worst health care system in the world.[/blockquote]
Assuming even that you meant it somewhat hyperbolically, I have never found the evidence to support that claim. Like Kristof’s example, it always falls apart when we look into the details. We who benefit from good health insurance plans provided by our employers may well overestimate the wonders of American health care, but it seems to me that you’re conflating issues of quality, cost, and availability as if that’s what the term “health care system” is reducible to. While those are important factors, I’d argue that the US doesn’t really have the sort of monolithic thing that term implies. Furthermore, given that, the law of unintended consequences will wreak havoc if we try to impose the sort of centrally-planned, one-size-fits-all (or one-size-fits-all-with-special-exceptions-for-favored-constituencies) approach embodied in the legislation currently proposed in the House and Senate.
While it’s plausible that Medicare and Medicaid somehow reduce costs for private insurance companies, I’ve never seen evidence to support the claim. The main benefits I see them providing to insurers is the opportunity to sell policies to fill gaps in coverage.
I picked Heritage and Krugman simply because they are, for better or for worse, well-known and credible representatives of opposing views. I really don’t know much about Kenneth Arrow.
Regarding being moved more by motivations and beliefs than by facts, that’s commonly called [url=http://en.wikipedia.org/wiki/Confirmation_bias][i]confirmation bias[/i][/url] these days, but it’s certainly been recognized for a lot longer than that term has been around. It’s an intrinsic failing of humans, affecting not only our interpretation of information, but also how or whether we look for it. Because it’s among the host of things that makes true improvement of the human condition more difficult, it’s an important reason we should be skeptical of investing too much power and wealth in a single entity. If one or a few companies fail because of bad analysis or general foolishness, that’s a manageable problem compared to when governments fail.
For an alternative to the expensive bohemeth (HR 3962) now moving through Congress, check out the substitute amendment sponsored by the GOP. This plan relies on interstate competition, HSAs, and tort reform, and according to the Congressional Budget Office, would only cost $61 billion in the first ten years of the plan — or slightly less than 6% of what Democrats plan to spend to overhaul the entire system. It also, according to the CBO, would reduce premiums.
Will this be debated on the floor of the House or Senate? Probably not – it doesn’t fit the agenda.
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And don’t forget that if the Pelosi bill passes in its current form, we’ll all be paying for abortions:
Lets see, the government has known about H1N1 for a while and can’t get enough vaccine. Cash for clunkers had more problems than can be imagined. Social Security broke, etc! I know lets let the clowns run our health care? Sounds good to me…
john m “I am getting tired of this redistribution of wealth thing”
But comments such as that surely leave one open to the charge of sounding selfish and callous towards the less fortunate in society, don’t they?
[i]We rank 37th in infant mortality (partly because of many premature births) and 34th in maternal mortality. [/i]
Why does he think that statistics are comparable between countries? Does he really think reportage in third world countries is adequate?
[i]Canadians live longer than Americans do after kidney transplants and after dialysis, and that may be typical of cross-border differences.[/i]
This could easily be because only the healthy patients live long enough to survive the waiting period in Canada, and the unhealthy ones cross the border to have a chance to save their lives.
I’ve held off from commenting to see where the comments on this thread would go, but I think the editors of this blog need to broaden their news information sources beyond the NY Times and National Public Radio to include more reliably objective sources. That is, unless they are not interested in presenting a balanced discussion of issues when such issues move beyond internecine Anglican ones.
I’ll close with Mark Twain’s famous references:
Okay, I just have to jump in here. I was trying not to. But comments like the one Fr Mark referenced in #12, and what is stated in #13 are just too much.
Yes, this comment “I am getting tired of this redistribution of wealth thing†definitely speaks of selfishness, and also of total arrogance. What that commenter failed to recognize is that in a system like Canada’s EVERYONE pays the SAME THING into the health care system. EVERYONE is offered the SAME care as they need it. At one point in time, my neighbor might need the services more than me, so I’m helping him by still making my contribution through my taxes. Then later on down the road I may fall very ill, have a really catastrophic accident, etc., and I will require more services than my neighbor will need. His contributions will help me then. The point is that it all balances out in the end. ALL citizens are offered care. NONE of them have to live with having to stress about becoming bankrupt if they need more services for a period of time. This whole process shows very clearly how “loving your neighbor” is defined in my opinion. I was born and raised in Canada. I have never begrudged any other citizen in Canada for needing to use more services than me when they needed to. Instead, I was glad they could get the care and knew I would get it when I needed to, and always did. Unfortunately, with living in the States now, I can’t say the same thing. This sick system has caused me more frustration than I care to describe here.
This comment from #13 “This could easily be because only the healthy patients live long enough to survive the waiting period in Canada, and the unhealthy ones cross the border to have a chance to save their lives.” was more than a little rude. Who are you to make such a statement? Are you living in Canada? Do you know just how old people in Canada actually get? Do you know just how healthy people in Canada are compared to the States? In my opinion, the waiting periods here in the States are just as long or even longer that anything I experienced in Canada. Whenever I was really ill and needed quick health care services in Canada, I always got what I needed. All my family members still live in Canada. They always get what they need when they need it. The difference is they don’t think the system revolves around them. They don’t demand that elective procedures, unnecessary services, etc., be given to them NOW! They only use the services they need, when they need them. It is NOT about selfishness. It’s about EVERYONE! And in my own personal observation, most Canadians are a lot healthier than what I’ve witnessed, at least here in southern California. The level of obesity, laziness, prescription drug and over-the-counter drug usage I witness here is totally appalling. The constant ads on television regarding new products for prescription drugs is only feeding into that frenzy. Prescription drugs are not advertised on TV in Canada. I don’t think the general public needs to know about them. Doctors can be made aware of new products and can discern what their patients may need, but it’s not in the best interest of the general public to advertise these products to them. Most are not in a position to discern if these products are best for them or not.
No, the Canadian system is not perfect, but in my personal experience, it’s done me more justice than what I’ve experienced here. As for that older gentlemen in England who received services at home and only paid $10 a month. Someone after that comment went on a tirade about how they worked all their lives, went to university, etc. Well, you can just bet that gentleman did too. I’m certain he paid into his taxes all his life, just like every citizen in England does and when he needed that care, he was thankful it was there for him. I’m happy for him. Just think of the stress that knowledge relieved for him and his family. Does that happen here in the states? Heck no!!!! Most elderly, if they don’t have the large amounts of money left to pay, are just left to the dogs. Did a lot of them hold jobs most of their lives? Did a lot of them pay their taxes all their lives? You betcha! Do they deserve to be treated so poorly by the citizens of their OWN country? Heck, NOOOO!!!!!!
Wake up, you people! Stop thinking only about yourselves! It’s not only about you!
interesting commentary 14. i often think when some of us disparage other healthcare systems, why would those citizens allow it if it were indeed that bad? from what i have read most of them are quite happy with their healthcare. some will never admit that other countries might do anything better than we do.
the republican plan will never work because it doesn’t allow for covering every person, and it doesn’t get rid of pre existing conditions, which is really paramount to any effective reform.
As I am sure that Joshua 24:15 (#7) above can attest better than I, the [i]current[/i] burden imposed by the various Federal and state regulatory bodies on medical pratitioners is oppressive enough; I shudder to think what it will be like if any of the current bills passes. What I find absolutely astonishing is that, with all the cries about the “waste” and unneccesary treatments/tests in our current system, I have not heard a single question raised re: the role regulatory bodies, such as CMS – by virtue of their own regulations and micro-management of patient care – plays in perpetuating the waste.
Google “Core Measures” and you will see the criteria by which hospitals (and by extension physicians, since they are the ones who, by law, must order tests and treatments) are being scored. Because of “Core Measures” entire hospital [i]departments[/i] have been created for the sole purpose of abstracting data to be submitted to CMS. Want to see your government assume even greater influence in your medical care? Consider this: One of the “Core Measures” addressed the administration (within [i]their[/i]established parameters) of a particular class of blood pressure medication (like all other medications, this drug must be ordered by a physician). Hospitals were scored as to the percentage of their compliance with this standard…and like all other Core Measures, the results were plublished (updated quarterly) so the general public could see how hospitals compare with each other. The higher the compliance, the greater implied “quality” of care provided. As it turns out, treatment with this particular class of drug – deemed the “best practice” by CMS, for the specified health condition – actually [i]increased[/i] patient mortality. Hospitals were informed last December that we would no longer be measuring compliance with this standard due to the increased mortality. Here’s the kicker: it didn’t go into effect until 1-April. Thus, per the government, hospitals had to continue reporting their compliance with this standard for nearly [b]four months[/b] after the [i]very same[/i] government determined that survival rates were inversely proportional to compliance with its own mandate.
This is just one example…did you know that the government influences the type of antibiotic you receive prior to surgery and how long it is continued post-op? How about the timing of your urinary catheter removal? Oh sure, your physician is the one who must write the order – but the government is telling him/her what to write. Can you imagine what it will be like if the tentacles go deeper?
I’m just asking.
Shalom <(((><
On infant mortality rates, methods of reporting live births and birth weights very from country to country making meaningful comparisons problematic. Here is a source from 1994: International Infant Mortality Rates:
Bias from Reporting Differences
EmbryM Howell, PhD, and Beatrice Blonde4 PhD, here is another source: The Doctor Is In: Infant Mortality Comparisons a Statistical Miscarriage: Babies don’t do better in countries with socialized medicine. August 3, 2008 – by Dr. Linda Halderman. The other point is that people have better cnacer survival rates in the U S (Cancer Survival Rates Improving Across Europe, But Still Lagging Behind United States
Zosia Chustecka. I have known for a long time about infant mortality variations and only recently found out about the differances in cancer survival rates.
#15, I don’t know what the answer is for the States either. I think it’s been allowed to run amuck for far too long, so it’s going to take much more work to attempt to fix it. What really got to me was the inappropriate comments that I referenced in my comment at #14. They were rude and very self serving comments. We are supposed to be Christians. We should be quite concerned about those around us. The fact that so many in this country are lacking in health insurance should concern all of us. It shouldn’t be about who makes the most money, or whether that wealth is being shared. The concern above all concerns should be the welfare of our neighbors.
Yes, in my experience, most Canadians truly love their health care system. I certainly had no problems with it. From what I’ve read here, the folks in England also like their health care system in general. I have no experience there, but I’ve read many positive comments from many who live there and use that system. I doubt any system in the world is perfect, but I just don’t see the universal care systems being the nasty systems that many Americans are making it out to be. I have a gut feeling that many are butting any other ideas for many reasons. Some don’t want the change. Some don’t want to pay more taxes, even though they, themselves, will benefit from it. Some want to just line their own pockets from the profits the current health care system racks in. And many more reasons.
No, I don’t think the republican, or democratic systems being promoted in congress right now are the right answer either. I definitely don’t think anyone with pre-existing conditions should be denied health care on any level. I also don’t think a private insurance system (like HMO’s) and a public system will work side by side either. Not only will it cause mass confusion with the health care providers for their paperwork, but they will be at totally opposite ends of the spectrum. The public system will be trying to serve the public at large, and the private system will be trying to serve themselves, as usual. That is just like trying to mix oil and water. It just won’t work. That’s my take on it anyway.
All I would like to see is for every legal resident of this country to have access to the same level of care as everyone else. Every human being should be treated the same when it comes to health care. It’s just wrong to segregate care for the wealthy, over the poor. I truly HATE being restricted to a specific medical group for any care I may need. PPO plans are only in it for the money. I don’t see why anyone can’t choose who they want to see for their doctor. Why not have a family physician you like in one location, and have a specialist who serves you best at another location? That’s the way it was for me in Canada. I had a fantastic family physician. My whole family went to her for our general medical care. Whenever a specialist was required we were able to choose where we wanted to go; often another community. There was no authorization process to hold things up. When we left our doctor’s office, we already had our appointments made for any specialists our doctor wanted us to see. Whenever our doctor ordered any diagnostic tests, the nurse in our doctor’s office gave us the requisitions before we left, and the appointments for those tests were also made before we left. It was a much more efficient system. I also found that I didn’t have to constantly repeat my history of the illness to every doctor I saw. My doctor had already sent the appropriate information to the doctor I was going to see, so that doctor already know why I was there, and we just discussed options regarding care from that point on. It was just a lot more efficient in my opinion. These are some examples of how I felt the Canadian system worked better. I’m always fighting with health care officials here in the States to get things done. It’s always a hair pulling experience.
[url=]Here’s another brief response[/url] to the Kristof article. There are a couple of salient points from publications linked to in the response. First from a review of a report [url=http://politicalcalculations.blogspot.com/2007/09/natural-life-expectancy-in-united.html]here[/url]:
[blockquote][O]nce fatal injuries are taken into account, U.S. “natural” life expectancy from birth ranks first among the richest nations of the world.[/blockquote]
And then from [url=http://www.nber.org/papers/w13429]here[/url]:
[blockquote]We show that the efficacy of health care systems cannot be usefully evaluated by comparisons of infant mortality and life expectancy.[/blockquote]
Kristof’s essential premise, that American health care is [i]so[/i] bad that the government has to act to correct it, simply doesn’t withstand scrutiny. That is emphatically not to argue that nothing should change, but rather only that his assessment of the current situation is wrong. I really doubt there are many people who are what Kristof labels “opponents of reform”; the disagreement is over what needs reform and what such reform should look like.
#16, I don’t know a lot about how mortality rates or cancer survival rates are reported by different countries. But I do know that doctors (in Canada anyway) make their own decisions about what prescriptions to write, what procedures to do, and how long certain procedures need to be done, etc. I’ve had several discussions about those very things with my own doctor. I’ve also served as a registered nurse in the Canadian health care system for almost 20 years. We always made decisions based solely on the needs of each individual patient. There were no governmental requirements placed on us regarding those things. We didn’t have “codes” to enter for each and every thing we did like is done here. Believe me, it’s a very different approach entirely and the patient is at the center of all of it. What you wrote above is very disturbing indeed.
#19, this comment “the disagreement is over what needs reform and what such reform should look like. ” is where I stand. I truly don’t know what needs to be reformed in the health care approach in this country. I just know that it needs it badly.
I have worked in the US health care system for 30 years. My step daughter worked at a neonatal cardiac unit in a large hospital in Atlanta. Many of the children born with non viable cardia conditons would have been reported as a dead birth in other countries. We report them as live births pushing up our infant mortality rates. She works with nurses from other parts of the world that have reported this to her. America has had tremendous inovation in medications, surgical proceedures, transplant proceedures etc that have helped mankind. I do not want to throw out the baby with the bath water.. I also know how inept government can be having lived through Champas, Tri care etc while on active duty and in the reserves. Just look at the problems with cash for clunkers, cost three times as much as projected, peopple simply traded in old trucks for much more than they were worth getting new trucks with the same MPG and in some cases worse MPG. The health care bill is 1017 pages and impossible to understand (cross referencing other laws and bills and amending them etc)..do you really think it will be better than what we have now?
Peace upon your houses and greetings from autumnal London. A wish: that you would all stop yanking each other’s hair out as to whether the US system is better than, or worse than, that of other countries. So unhelpful. In today’s global culture, many countries have cheerfully learned from and borrowed from the US and grafted the new on to their own culture. From Irving Kristol’s obituaries I learned that Margaret Thatcher’s references to supply-side economics used a phrase he invented and a concept he helped to shape. On a less serious note, who taught our kids to wear jeans? You did! We live in a cross-fertilizing world.
Now take a deep breath: while being true to yourselves, surely you can learn from other countries and take the best from their own experience? How to discern and how to meld … those would seem to be the questions. Is it possible to keep a market economy in health care with patient choice and universal coverage? Yes, provided that the principle of subsidiarity prevails, ie each level, each unit, decides with maximum responsibility, only referring upwards the minimum necessary for good governance.
And oh yes, it will require extra taxes. Ouch, please stop throwing things at me …
One other item of note. With in the health care bill is a provision that reduces the amount of maney a state will recieve if that state has a cap on awards to lawyers in law suits. What does that have to do with health care reform?
The study cited by Kristof has this in the opening paragraph of the conclusions :Summary and
conclusions
Taken collectively, the findings
from international studies of health
care quality do not in and of
themselves provide a definitive
answer to the question of how the
United States compares in terms of
the quality of its health care! How then can this be referanced to condemn American health care! I think Kristof is reaching beyond the results of the study!