Democrats are clear that they have no intention of proposing a British-style single-payer health care system this year.
That said, many liberals believe that government-run health care really works. And while strategically they are willing to acknowledge the shortcomings of the Canadian and British systems, in their hearts, they still believe.
President Obama basically endorsed this view in a March town hall.
So I think we can accomplish it. Now, whether we do it exactly the way European countries do or Canada does is a different question, because there are a variety of ways to get to universal health care coverage.
A lot of people think that in order to get universal health care, it means that you have to have what’s called a single-payer system of some sort. And so Canada is the classic example: Basically, everybody pays a lot of taxes into the health care system, but if you’re a Canadian, you’re automatically covered. And so you go in — England has a similar — a variation on this same type of system. You go in and you just say,
“I’m sick,” and somebody treats you, and that’s it.
The problem is, is that we have what’s called a legacy, a set of institutions that aren’t that easily transformed.
Is the problem with converting American health care to a single-payer system “legacy”? Or is it that these systems don’t actually work?
22 responses so far
1 ottovbvs // Apr 21, 2009 at 11:05 am
What do you mean they don’t work? They are working in some form or other in just about every country in the western world. And at half the price we pay while covering all citizens.
2 ottovbvs // Apr 21, 2009 at 11:10 am
What do you mean they don’t work? They are working in some form or other in just about every country in the western world. And at half the price we pay while covering all citizens. Please avoid the juvenile practice of condemnation by anecdote. Sure there are horror stories you can bring up about failures in Britain or Canada but one can produce as many or more about failures in our system. Do we say the FBI doesn’t work because it occasionally screws up. Or the NYFD. These anecdotes are worthless as commentaries on a system.
3 barker13 // Apr 21, 2009 at 11:49 am
David,
Apparently Ott doesn’t bother to actually click on the links you’re good enough to provide as back-up to your contentions.
Ott may feel ignorance is bliss, but that’s because he (she?) has access to a health system where except for those on transplant lists (where there’s no free market btw) few American die due to “queing” lengths between that first doctor’s appointment and actual treatment.
BILL
4 cmhmd // Apr 21, 2009 at 11:59 am
It is heartening to see that this tired old line of misinformation is all that conservatives have left to offer in their efforts to cling to the status quo.
I keep a health care reform debate blog, and I have a special section for people who like anecdotes.
http://cmhmd.blogspot.com/search/label/%22Anecdote-Off%22
Anecdotes are a very bad way to conduct this debate, but if that’s what you like, have at it, but when you compare American horror stories to other nations’, we lose, and we lose badly.
If you want to see exactly what Obama was talking about, i urge you to read Atul Gawande’s excellent New Yorker piece from a couple months ago:
http://www.newyorker.com/reporting/2009/01/26/090126fa_fact_gawande?currentPage=all
Cheers,
5 sinz54 // Apr 21, 2009 at 12:09 pm
Mr. Gratzer is employing the usual political ploy of cherry-picking one extreme case as a way to discredit an entire system.
No doubt a few folks fall through the cracks of the British NHS and suffer for it. But you can find plenty of horror stories about the American system as well. In fact, you can even find a few horror stories about prestigious hospitals too. Does the fact that Dana-Farber Cancer Institute, one of the most prestigious in the world, screwed up this one case mean that it should be shut down or something:
http://www.gapscenter.va.gov/stories/BetsyDesc.asp
Let’s not engage in that kind of cherry-picking here. Let’s examine health care systems with an eye toward their *structural* advantages and disadvantages, always keeping in mind that a few folks are going to be unhappy under any system.
6 // Apr 21, 2009 at 12:37 pm
Mr. Gratzer,
You really perform a disservice to conservatives when you provide such a juvenile critique of “what liberals really want.” It seems as if you’re suggesting that the mere fact that liberals want something is proof in and of itself that it is bad. In essence, that’s nothing more than glorified name-calling.
It would be much more helpful if you could state whether you believe there is a healthcare problem in the U.S. and, if so, offer a viable solution to the problem.
The fact of the matter is that there is no way to address this problem without providing universal coverage and controlling the costs of treatment. You have to do both, and neither the free market nor any other conservative idea will accomplish that.
A single-payer system will do both. It may not be the only way to do both and it may have some drawbacks, but it is a solution. if you don’t like this solution please provide a better one.
7 Mike K // Apr 21, 2009 at 6:19 pm
“sinz54
12:09 PM
Mr. Gratzer is employing the usual political ploy of cherry-picking one extreme case as a way to discredit an entire system.
No doubt a few folks fall through the cracks of the British NHS and suffer for it. But you can find plenty of horror stories about the American system as well.”
In fact, the NHS is so bad that 56% of members believe it should be scrapped and the British should start over. The best health care system in Europe, and probably the world, is the French and I have done an analysis that starts here:
http://abriefhistory.org/?p=400
It goes on from there. I have been a physician 43 years and have a graduate degree in health economics from Dartmouth. The US system is good for those with good insurance but it is not stable. Most medical groups in California are insolvent. Older physicians are leaving practice and the more stressful specialties, like general surgery, are not filling. I have a very accomplished niece with two degrees who chose nursing school over medical school. I couldn’t fault her logic.
8 HHomer // Apr 22, 2009 at 1:38 am
Critcising other nations universal health care schemes does nothing to remedy the situation in the US. All systems are flawed, all impose costs on the taxpayer and there will always be mistakes. But the overall effect is more humane than what the US has at present.
What is David’s plan to ensure that all his fellow citizen’s can get health care? Or does he believe that allowing tens of millions to have inadequate coverage is a price worth paying to keep the status quo?
Remember, under the current set up, impoverished Cuba has better infant mortality rates than the US.
There are a lot of votes in improving affordable health coverage, so the GOP needs some better ideas than laissez faire.
9 cmhmd // Apr 22, 2009 at 7:59 am
HHomer:”What is David’s plan to ensure that all his fellow citizen’s can get health care? Or does he believe that allowing tens of millions to have inadequate coverage is a price worth paying to keep the status quo?”
I can tell you when I have discussions with my fellow physicians, this is exactly how the conservative ones think. They don’t care what happens to the poor and those who can’t afford insurance, when it is compared to their rigid ideology.
Consider this from former AMA president Don Pallisimo
“It is unlikely that Congress will deliver the ideal health system reform. But no matter what errors Congress makes, physicians can remain in practice and patients can have access to quality care if the fundamental right of Americans to privately contract remains intact.
“Currently in Medicare, Medicaid, and much of managed care from those healthcare companies that have monopsony power, that right is forbidden or penalized (In Medicare, if the physician privately contracts for fees different from Medicare, the physician has to get out of Medicare for two years and the patient can’t get reimbursement from the government for any services delivered under that agreement with the physician).
“The hallmark of the Free Enterprise System is the right to privately contract. Physicians and patients should not let politicians frame the debate. Don’t accept that physicians must be under government price controls. Change the debate to one where the government rightly
decides what allocation of money will be spent by government on health system financing. An example is the defined contribution approach.
“Then if the patient wants more tests or treatments and the doctor agrees the additional care is appropriate, then the doctor and the patient negotiate and agree on the difference in cost. Imagine the uproar in America if business stores were told the sale of a product
was price-fixed by the government and yet the cost of the product from the wholesaler was more than that. Price fixing throughout history has led to rationing and decreased availability of a product or service.”
Reminds me of “The Grapes of Wrath” – if profit cannot be made…
Cheers,
10 ModerateGal // Apr 22, 2009 at 10:40 am
The World Health Organization ranks France’s system at #1. The United States is at #37. It seems that we might be able to learn something from the 36 countries ahead of us on the ranking.
http://www.photius.com/rankings/healthranks.html
11 cmhmd // Apr 22, 2009 at 11:56 am
barker13: “Still… look at some of the inane emotionally driven responses folks like you get when you try to make an argument based on facts and rational analysis.”
I had never really tought about it in this way before, but this is a recurring conservative meme, and I think I understand it now. Whenever we bring up arguments based upon universal moral tenets, we are “emotional.”
Every major religion and philisophical school of thought has a version of the Golden Rule. All cultures honor taking care of the less fortunate. I’ll speak to my religion, Christianity and say that Jesus implored us to clothe the naked, feed the hungry, comfort the sick, visit prisoners, and so on. I think being “emotional” (read: moral) about universal access to health care, respecting the dignity of each person is virtuous, not some childish altruistic whim to be sneered at.
So, at this point conservatives always tell me this has to be done by individuals in the form of charity and shouldn’t be forced upon people by “the state”. If there was a snowball’s chance in heck of this happening (hasn’t yet, any where in history in the world without societal intervention), I’d be all for some fantastical Randian solution, but there isn’t.
So, in this case, how about we let “the state,” or “we the people” come to an arrangement that provides health care for all and do the emotional/moral thing on this issue. Or allow the continued mess to continue, leaving the suffering of many to be offered up on the altar of the “free market.”
Cheers,
12 sinz54 // Apr 22, 2009 at 2:10 pm
cmhmd: Jesus did implore *us* (i.e., the common folk) to help out one another. He did *NOT* tell us to take over the government and use the power of government to help those we want to help. Render unto Caesar vs. render unto God, you know the routine. Jesus was careful to separate earthly kingdoms from the heavenly kingdom.
Liberals constantly confuse individual charity, through one’s church or synagogue or mosque, with government welfare programs financed through compulsory taxation.
So while there is a moral case to be made for government social programs funded through compulsory taxation, Jesus did not make that case.
So please don’t quote Jesus out of context anymore.
13 sinz54 // Apr 22, 2009 at 2:14 pm
I live in Massachusetts, and I’m very satisfied with the bipartisan health care reforms enacted here by then governor Mitt Romney working with the Dem legislature.
Our health care system covers 95% of Massachusetts residents, working mostly through the private sector.
14 barker13 // Apr 22, 2009 at 7:29 pm
Re: Cmhmd; 11:56 AM –
Ironic that the “free thinkers” running this site REMOVED my post that you referred to.
(*LAUGHING OUT LOUD*)
What do you think about that, Cmhmd?
So much for free exchange of views and perspective, huh?
What do you think they’re afraid of…???
Anyway… “cheers” right back at ya!
(*WINK*)
BILL
15 cmhmd // Apr 22, 2009 at 7:49 pm
“So please don’t quote Jesus out of context anymore.”
You make extrapolations about how jesus would view this argument and so do I. Why am I at fault? He lived in the Bronze Age for goodness sake!
And Barker, quit with the snort and chortles, you’re making an a** out of yourself. Just post your comments.
16 sinz54 // Apr 23, 2009 at 7:31 am
cmhmd: Your knowledge of history is as faulty as your knowledge of Christian theology. Jesus did not live in the Bronze Age. I guess you never saw any of those movies which (accurately) depicted the Romans with iron implements and weapons.
17 cmhmd // Apr 23, 2009 at 9:34 am
Sinz, you caught me in hyperbole, sorry!
You are correct on the theology thing though, I looked it up and, indeed, the central message of Christianity was indeed, “Every man for himself,” not “Whatsoever you do for the least of my brothers, that you do unto me.”
My bad.
18 barker13 // Apr 23, 2009 at 10:51 am
Re: Cmhmd; 7:49 PM –
Ducking the question, huh, Cmhmd?
(*SNORT*)
(*CHUCKLING KNOWING THAT THE SNORTS GET TO YOU*)
(*GUFFAW*)
Anyway… where was I? Oh… yes…
You won’t even defend free expression! And you expect to be looked upon as someone whose “approval” is worth seeking…??? You must be either delusional or joking.
Here… perhaps this will strike a chord:
“I may not approve of what you say but I will defend to the death your right to say it.”
Nope. Class “Big L” Liberal values give way to expediency and personal interest every time with folks like you and “the censors” at this site, Cmhmd.
I truly wish it weren’t so.
Beyond this thread… going to the heart of the divide between “Frum” Republicans and folks like Franco, Cherokee, Mike K and myself is that folks like us put basic “character” above and beyond mere policy disagreement.
All too often “your” side seems to have lost your way when it comes to basic concepts such as defending civil self-expression on a blog supposedly dedicated to building a MORE INCLUSIVE conservatism that can win elections.
(*SIGH*)
BILL
19 Mike K // Apr 23, 2009 at 12:19 pm
“Remember, under the current set up, impoverished Cuba has better infant mortality rates than the US.”
This old chestnut may get you some traction in those Trotskyist meetings but it hasn’t even a grain of truth in it. It’s more in keeping with the drunk under the lamp post reasoning.
“There are a lot of votes in improving affordable health coverage, so the GOP needs some better ideas than laissez faire.”
I agree although we are a long way from Laissez Faire. The reason I studied the French system is because it is so much like ours. It uses private insurance, fee-for-service and free choice all the way down. The big differences are two: free medical school and a fee schedule plus evidence based guidelines on what the system will pay for. The money comes from payroll deductions or other contributions and only a fraction from tax revenues alone.
We could do that from the place we are right now but it will not happen. It will not happen for the same reason that nuclear power is off the table and France gets 85% of its electric power from nuclear. They are hard realists and we have moonshine politics currently in power. If we had kept going with nuclear power at the time we shut it down, we wouldn’t need Cap and Trade.
Right now most people get health care but it isn’t a stable system. When I began in practice, I agreed to accept Medicaid. My office filled up with women who wanted varicose vein injections, for which the state paid $6. That included equipment. I quit the Medicaid list and, like everyone else, saw Medicaid patients on referral only. Many primary care docs didn’t even submit the bill as the paperwork was more costly than the payment a year later.
We need a better system but it won’t come from Obama or Pelosi.
20 sinz54 // Apr 23, 2009 at 5:38 pm
Mike K: In his column today, the liberal columnist E. J. Dionne said what liberals really want: To put America on an inexorable path to a single-payer health care system, with the Obama plan as the jump-start to move us in that direction:
“Many liberals believe our entire health-care system should be scrapped in favor a government-run single-payer plan along Canadian or British lines. The problem is that single-payer is not only politically impossible; it would also cause significant disruptions in the existing system. The public-option idea is a clever halfway house. It would allow the United States to move gradually toward a government-run system if — and only if — a substantial number of consumers freely chose to join such a plan. The market would test the idea’s strength.”
Mr. Dionne is being deliberately obtuse.
The public plan, able to draw on unbounded resources to drive down its fees and premiums, could always undercut the private plans, driven them out of business, after which it could jack up its prices and again and be free to stagnate without competition. This is exactly how an aggressive monopoly can develop in the private sector. That’s how Microsoft drove many of its competitors out of business. Such monopolistic practices are hated by liberals when they are practiced by private companies–but not, evidently, when they are practiced by government programs.
21 sinz54 // Apr 23, 2009 at 5:46 pm
And if Obama has his heart set on a public option, then the Republicans should insist on constraints to ensure that the public plan can never compete unfairly against the private sector, merely by drawing on Uncle Sam’s near-infinite bankroll (as Medicare competed unfairly against private old-age insurance).
The best way to do that is to means-test the public plan. That was Governor Romney’s approach in Massachusetts, with his public plan, MassHealth. It’s available only as a last-ditch plan to those who are too poor to afford any private plan. Hence it can never compete with private plans for the health care of the affluent.
If Democrats squawk at that, the next best option is to set scales for fees and premiums for the public plan, which are comparable to the average prevailing fees and premiums for private insurers. This would ensure that the public plan can compete with private insurers only on quality and availability of service, NOT on price. As long as the prices remain comparable, all could remain in business, just like UPS and FedEx continue to compete effectively with the U.S. Postal Service for package delivery business. (That would not be possible if Congress had decided to subsidize the Postal Service to such an extent that it could deliver packages for only one-fifth or one-tenth the cost of UPS and FedEx. That would soon force UPS and FedEx out of business.)
22 Mike K // Apr 23, 2009 at 7:17 pm
“”Many liberals believe our entire health-care system should be scrapped in favor a government-run single-payer plan along Canadian or British lines.”
This, I fear, is Obama’s mistake. Canada and England share our language, and for a president who speaks only English (in spite of his preening about monolingual Americans), this is attractive. He understands it. He thinks it will be easier to explain to an English speaking public. That’s why this will be a disaster for the future of good healthcare. This is buying an Edsel 25 years after it has been shown to be a poor model.
The French have one great virtue that Democrats (and Republicans) lack; they may say anything but they don’t believe their own bullshit. France gets 85% of electric power from nuclear. They have made no effort to meet Kyoto guidelines. Hypocrisy is the homage that vice pays to virtue. There actually is a good model for what we could do. Will we learn ? Of course not. It is about politics, not healthcare.
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