Tuesday, March 03, 2009

Effortless snark (sorry)

There is probably a good argument for the government not meddling in health care. But, I'm not sure that this Charles Krauthammer column makes it:

"Obama wants to be to universal health care what Lyndon Johnson was to Medicare. Obama has publicly abandoned his once-stated preference for a single-payer system as in Canada and Britain. But that is for practical reasons. In America, you can't get there from here directly.

Instead, Obama will create the middle step that will lead ultimately and inevitably to single-payer. The way to do it is to establish a reformed system that retains a private health-insurance sector but offers a new government-run plan (based on benefits open to members of Congress) so relatively attractive that people voluntarily move out of the private sector, thereby starving it. The ultimate result is a system of fully socialized medicine."

Krauthammer believes that socialized medicine is a bad thing that will weaken our dynamic society, and so forth. But his argument here seems to be that we can't let people choose between our system and the single-payer system because nobody in their right mind would choose our shitty system, and we'd be screwed! I think he has to do better than that.

I've actually had both American health insurance and a Canadian health card (at different times!), so I have some knowledge about this. The bottom line: both systems suck in different ways, and honestly a sort of dual system would be the best possible option. However, let me say that I greatly prefer the Canadian system, and have actually never met anyone else who has used both systems who doesn't prefer the Canadian system.


Holly said...

OK, so... I live somewhere that socialized medicine is mandatory, *but* there are several different providers, AND auxilliary (sorry, can't spell that to save my life) private insurance is both popular and a thriving industry.

What I see happening here is that because so many people can and do subscribe to private insurance, vocal support for the socialized coverage is flagging, which means the funding is not getting the support *it* needs, and those programs are starving, and making hard choices that are inevitably unpopular.

And, because the socialized programs are breaking down, more and more people are motivated to put more money into the private coverage, which naturally pushes this whole thing in the direction of a vicious circle.

Tell me that's not happening in Canada?

I'm starting to think that outlawing private sector insurance might be the only way a socialized system could really survive in the long term, but of course that's difficult if not impossible to do in a democracy.

Rufus said...

Well, it's not happening in Canada. But that's because there's no real choice here. Basically, Canada and the US have two different systems and no choice to go to the other. The argument in the US is that, if you allow for state/public insurance, nobody will want private insurance; the argument in Canada is that allowing for more private insurance would kill off public insurance.

The problems in the US are well-known and amount to a lot of people not being insured or spending a fortune to be insured- my father is a perfect example because he is self-employed and spends over half of what he makes on his insurance. He is a Republican, Rush Limbaugh fan, etc. He also wants the US to go to socialized medicine because he's sick of his bills.

In Canada, the main problem is that doctors don't get paid as much, so many of them leave, often for the US. Choice isn't a problem and actually the quality of care isn't really a problem. But, medical providers get the short end of the stick.

So, I actually like the system you describe in some ways. But I would prefer to have nothing be mandatory. I would rather have the choice between paying what I do now for insurance, or just taking the public health card. It's funny because the article I posted says that, if given the choice, nobody would pick the private insurance, and you're saying that a whole lot of people do even with mandatory socialized medicine. I think of it as being offered the choice between going to the DMV or an equivalent in which there were no lines and you could get lots of bells and whistles that the DMV doesn't offer, but it cost three times as much. I don't think either the public or private options would thrive like they do in countries where they have an enforced monopoly, but I'm okay with that.

And, to be honest, even if it means that socialized medicine loses money and struggles, offering both options and letting public opinion decide sounds a lot more democratic and 'free trade' to me than saying 'You'll take what we give you and like it', which is what both Canada and the US are doing, in my opinion.

Rufus said...

You know, we might be able to make an interesting comparison to public education here. Even though the system has serious flaws, it would most likely be worse if A. nobody was allowed to send their kids to private schools, or conversely if B. there were only private schools and the child could only be educated if their parents could afford private school. So, even though all three scenarios have their problems, I still think that having the choice makes for the least-bad scenario.

clairev said...

Let me clarify a few things about the Canadian system that everyone is talking about.

Talk of a two-tier system as Holly outlines has been going on for nearly a decade in some parts of Canada. This would involve the regular system, then a high-tech system that you pay for, for them what can pay. The supposed advantage of this is that the rich can pay and get through faster, thus taking weight off of the regular system, which would mean that the regular system would be more efficient at serving us poor folk.

Obviously the downside is that this is designed so that if you need more urgent, exceptional care, you have to have money. Thusly it's fairly discriminatory towards the vast majority of Canadians, or that's the argument being put forth. So far I don't believe this is happening in Canada. yet. I would be lying if I said our system isn't in crisis in many areas.

From my own experience, it has been hard to get a decent psychiatrist. You get a diagnosis and then you have to wait 3 months (minimum) to see one. There they give you pills and you're on your way for another 3 months and in between, because there are few resources and no support, any number of shitty things including another hospitalization can occur. After working with 9 psychiatrists over a period of several years, I was finally accepted into a really good program and was able to get well. However, this means that in the 4-5 years in between, I was pretty much unstable, which led to my illness and my quality of life worsening. I believe I had to hit almost rock bottom to get picked up properly. That is a failure in care, simply put.

I work with children/adolescents in my job. In my catchment area there is one child and adolescent psychiatrist, who has an 18-month wait list just to get an assessment so basically I have to send clients to emerg for things that should be handled in a private office.

I don't have a solid number or any stats so what I am saying next is purely my experience. Most people I know have supplementary insurance through their jobs. This includes, generally, money for prescriptions, vision and dental and in some cases there is extra room to include other service providers such as therapists, chiropractors, massage therapists etc. If you are relatively healthy, you get by. If not there is a small element of playing russian roulette with our system. An example would be not getting that x-ray in time, or that CAT-scan. It's free, but at what cost? Canadians often travel to clinics in the states for urgent medical care and just pay for it. We often talk about how we'd rather pay to get instant care, but would not like to lose the free system.

I personally like the idea of a two-tier, or a variation of it. I have seen firsthand how detrimental complete socialized medicine can be. Mental health is probably the bottom of the barrel in terms of how a medical silo is functioning here; cancer care seems to be exceptional in Canada. I'd like to even things out but continue to have the same services available for everyone. I have no ideas on how to administer this, what it would look like or the logistics. But as a person who fell through the cracks of socialized medicine, I cannot sing its praises just because it is supposedly equitable and free.


The Pagan Temple said...

The big objection to a socialized system here is the idea of government bureaucrats deciding on what kind of and how much coverage and treatment you qualify for, and having the final say over you and your doctor.

But hell, we have that here already, only its the private sector that's yanking the chains instead of a government bureaucrat.

Both systems are crap, not just for that reason, but for a variety of them. Here if some poor bastard gets the wrong leg amputated you have a bunch of baboons sitting in a jury deciding, "hey it would really send a message if we find in favor of the plaintiff and award him twenty gazillion dollars", which of course means the guy lost his leg and isn't going to get squat for it. If he does get anything his lawyer will get half of it.

The way I see it if a doctor screws up that bad he doesn't need to be anywhere near another patient. Getting rid of guys like that would eliminate the excuse to jack up the insurance rates of other doctors and hospitals.

Bring all that under control and stop taxing the pharmaceutical and insurance companies (or at least lower their taxes substantially) and the expense of medical care will fall in short order.

It would help if newly graduated doctors got some relief from their student loans. Most of them spend twenty years running patients through an assembly line as quick as they can in a vain attempt to get out of debt.

Obama and the dems are right about streamlining paperwork, and that's about it. It would help their case if they came up with a comprehensible method of doing that.

clairev said...

"The big objection to a socialized system here is the idea of government bureaucrats deciding on what kind of and how much coverage and treatment you qualify for, and having the final say over you and your doctor"

hm. we don't have that here. you can choose your provider and everyone gets the same coverage; which is by most standards generous.

Those issues don't even come into play with our insurance companies, who just pay the bill when it comes through (obviously, you need proof that you need a chiropractor so you have to submit notes etc.) but they ask surprisingly few questions. The exception is therapy where no one asks and it's confidential.

I guess that's a benefit of our system. I've always been frustrated that rufus gets to pick between 2 sleep clinics in the US whereas I can go to any one in Canada should I choose and my care will be the same.


Rufus said...

Yeah, I am too. Actually, it always strikes me as weird that Americans will bring up the issue of 'choice' as a problem with socialized medicine because I have a lot less choice with my American insurance company than with the health card. The insurance will only pay for one or two doctors in the county on a list that they give me. In Canada, I pretty much can go to all of them. There's no comparison.

Holly said...

Maybe it's just my cynicism showing, but the US seems to be a victim of a vigorous and enduring propaganda campaign. Inspiring fear is easy, inspiring confidence is hard.

The Pagan Temple said...

I've known of people who were run through hospital in less than a day for situations where they should have at least been able to wake up in the morning to a shitty hospital breakfast. It's not all anecdotal either. I have an uncle who had a stint run up somewhere close to his heart who was in and out of the hospital in something like seven hours. Two of those hours was just waiting for the procedure.

It's not doctors or hospital administrations who make these rules, it's private sector bureaucrats, who have done as much to increase the cost of health care as government bureaucrats ever would by way of increased taxes, and limited the quality and quantity of health care at least as much as would be the result of a socialized system. You are at the mercy of your insurance company now, if it is ever turned the other way you'll just be at the mercy of public bureaucrats, who would at least though be SOMEWHAT accountable (I hope), which could be the reason it's not so bad in Canada.

Still, I think a middle ground is the best way to go, private sector driven with reasonable oversight. The doctor and patient should have the last word on patient care, generally speaking. Give too much authority to anybody else-including hospital administration, by the way, who mainly care also about the bottom line-and you do considerable damage to the health care system in general.