Conservative Canadian Senator Defends Single-Payer Health Care
Hugh Segal (official photo)
Canadians who are interested in politics tend to be fairly well-informed about U.S. political debates, so I’ve sort of been waiting for the day when some right-wing Canadian politicians would step up and defend their fair land’s health care system from the smears of the American right. Now it seems that Conservative Party Senator Hugh Segal is doing just that.
Now as it happens the Canadian Senate is not a very important policymaking body. But irrespective of what lurks deep in the hearts of Canadian Tories, all leading right-of-center politicians in Canada understand that their health care system is far too popular and well-loved to seriously propose replacing it with an American-style system in which whether or not you receive treatment for an illness is determined by the whims of a for-profit insurance company. Indeed, the Conservative Party of Canada lists as one of its founding principles the idea “that all Canadians should have reasonable access to quality health care regardless of their ability to pay.”
All of which is to say that one fun way to shake up the somewhat stale health care debate would be to have a right-wing Canadian politician debate a right-wing American politician. On substance, what does this prove? Well, I think it’s noteworthy that where national health care systems exist, nobody ever seems to want to dismantle them. By contrast, you have lots of examples of countries lacking a national health care system and deciding to build one.
68 Responses to “Conservative Canadian Senator Defends Single-Payer Health Care”
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June 28th, 2009 at 4:18 pm
I’d love to have the right-wingers who have been slamming the Canadian health system debate Canadian conservatives on the virtues of Canadian healthcare.
June 28th, 2009 at 4:22 pm
Segal’s an old-school “Red Tory,” liberal on social issues and really conservative only on fiscal policy. If he were an American politician he’d be to the left of most of the Bayh block of “moderate” Democrats.
June 28th, 2009 at 4:41 pm
Bingo! It’s always illustrative to compare Canadian and American conservatives, if only to show how loopy many Republicans really are. A funny story to read recently was our Prime Minister, Stephen Harper, defending President Obama’s fiscal stimulus on Fox News; I’ll bet the Fox interviewer’s head was spinning on that one.
As Paul Krugman observes so often, your GOPers are outside the bounds of common sense in many policy debates. I was wondering lately if U.S. Republicans are among the furthest right, (supposedly) widely supported politicians in the world. To whom would you compare them?
Thanks, Mr. Yglesias, for the always thought-provoking blog.
June 28th, 2009 at 4:50 pm
I was in Britain for a few years in the ’80’s. In the elections Labor would accuse the Tories of wanting to switch to an American style health care system, and the Tories (under Thatcher) would loudly claim that was a filthy lie.
June 28th, 2009 at 5:11 pm
Canada’s number one all-time hero was a dirty stinking socialist. That’s right. The infamous progressive agitator from Saskatchewan, Tommy Douglas.
Tommy “enemy of the people” Douglas is credited with introducing universal health care to Canada. Ever since, Canadians no longer have the option to pay $14,000 for a twisted ankle.
Canadians believes Tommy “the commie” Douglas was the greatest human they have produced. That is all you need to know about Canada.
June 28th, 2009 at 5:14 pm
Is someone going to pick a part Mankiw’s moronic column he worte for the NYT. sheesh what a shame.
http://www.nytimes.com/2009/06/28/business/economy/28view.html?ref=business
June 28th, 2009 at 5:23 pm
That’s good, and we should be talking about single-payer healthcare too. Maybe it’s not the only thing to be talking about, but freezing it out, when it’s the most cost-effective way to cover all, is completely wrong.
June 28th, 2009 at 5:24 pm
@Zaid
It is horribly bad. I suspect Krugman and DeLong will have something to say about it momentarily.
June 28th, 2009 at 5:24 pm
Whatever is wrong with Canada’s single-payer health care, i.e. long waiting lists for elective surgeries ranging from cataract removal to liposuction, can easily be fixed in an American single-payer system by simply creating a few million more jobs in the medical, technological, and construction fields. In a few years, there won’t be any waiting lists here.
June 28th, 2009 at 5:25 pm
Mankiw seems have taken the facts that we spend more money than other nations, and have less government involvement, to mean we MUST have a much better system than eveyrone else.
He’s been grasping at any straw he can to support that notion for quite a while.
June 28th, 2009 at 5:35 pm
Whatever is wrong with Canada’s single-payer health care, i.e. long waiting lists for elective surgeries ranging from cataract removal to liposuction, can easily be fixed in an American single-payer system by simply creating a few million more jobs in the medical, technological, and construction fields.
It would easily be fixed in the Canadian system, too, if the majority of Canadians thought it were an important enough problem to need fixing. That’s one of the beauties of government-run single-payer systems — every few years, you get to give your opinion on the people responsible for them. Try that with a private company.
June 28th, 2009 at 5:37 pm
…all leading right-of-center politicians in Canada understand that their health care system is far too popular and well-loved to seriously propose replacing it with an American-style system…
Most right wing politicians in the US possess similar knowledge: they know extensions of the safety usually prove highly popular. Otherwise, it would be in their interest to let reform pass — just be on record as voting against it. That way when the horrible side effects of “disastrous” new program starts to manifest themselves, the GOP can sit back and reap the political harvest. But the reality is they’re terrified of letting reform — at least a robust reform with a public option — get to Obama’s desk
June 28th, 2009 at 5:56 pm
[Mankiw]’s been grasping at any straw he can to support that notion for quite a while.
And Brad DeLong was swatted down his argument simply enough: is the American non-system really worth the extra that Americans pay over their foreign peers? Mankiw’s just a fucking hack who never has to worry about being bankrupted by a medical bill.
Canadians believes Tommy “the commie” Douglas was the greatest human they have produced.
And if you fuck with the legacy of Tommy Douglas, his grandson will come round and nut you.
June 28th, 2009 at 6:22 pm
pseudonymous in nc
Yeah, Kiefer Sutherland just plays tough guys, his grandpappy Tommy Douglas actually was one.
Tommy was an accomplished amateur boxer. He won the Manitoba lightweight championship in ‘22 and defended it in ‘23.
In later years he stared down Saskatchewan doctors when they went on strike in ‘62. For 23 days they refused to see patients. But Tommy Douglas hung tough. He brought in doctors from around the world to feed into his newly created Provincially run health care system, and broke the back of the strike.
By ‘65, Saskatchewan doctors were happy as hell to be part of the new socialist system.
To bad Americans are not allowed, by law, to learn something from history, because it is all around us. Or at least to the North of us.
June 28th, 2009 at 6:32 pm
pseudonymous in nc
Yeah, Kiefer Sutherland just plays tough guys, his grandpappy Tommy Douglas actually was one.
Tommy was an accomplished amateur boxer. He won the Manitoba lightweight championship in ‘22 and defended it in ‘23.
In later years he stared down Saskatchewan doctors when they went on strike in ‘62. For 23 days they refused to see patients. But Tommy Douglas hung tough. He brought in doctors from around the world to feed into his newly created Provincially run health care system, and broke the back of the strike.
By ‘65, Saskatchewan doctors were happy as hell to be part of the new socialist system.
To bad Americans are not allowed, by law, to learn something from history, because it is all around us. Or at least to the North of us.
Sorry… forgot to say great post – can’t wait to read your next one!
June 28th, 2009 at 7:17 pm
Re: Segal’s an old-school “Red Tory,” liberal on social issues and really conservative only on fiscal policy.
Healthcare is far more a fiscal issue than a social issue
Re: I was wondering lately if U.S. Republicans are among the furthest right, (supposedly) widely supported politicians in the world.
The world? No. Certainly the Iranian mullahs and Putin’s folks in Russia and various other Third World authoritarians make the GOP look like Little Bo Peep. But in democratic countries, yes, the GOP is the furthest rightwing party.
Re: Canada’s number one all-time hero was a dirty stinking socialist.
Um, how about Laura Secord, who did a sort of Paul Revere act (but on foot) in the War of 1812 to apprise the British and their native allies of the American invasion plans, thereby saving Canada from ending up as American territory.
Re: But the reality is they’re terrified of letting reform — at least a robust reform with a public option — get to Obama’s desk
No, the politicians aren’t the ones who are terrified. It would actually be in the GOP’s best interest to get healthcare off the table once and for all. But the vested interests who hold their purse strings are the ones who are terrified.
June 28th, 2009 at 9:05 pm
@16 JonF “Um, how about Laura Secord”
Laura Secord, savior of Canada, came in 35th on the CBC’s list of the 100 Greatest Canadians.
Such notables as Gordon Lightfoot, Celion Dion, and Stompin’ Tom Conners, the Canadian country singer with the big hit “Bud the Spud,” were in front of her on the list, as was pretty much everybody who ever suited up for the Habs.
I hate to say it, but Canadians are apparently as dumb as their American cousins.
Here is the list. I must admit, half the people on the list I consider Americans. I mean, William Shatner? You gotta give him to us.
http://www.cbc.ca/greatest/greatcanadians/
June 28th, 2009 at 9:11 pm
Nah, I’d still give Tommy Douglas the edge. Affordable health care really, really matters. Especially since (1) we’re talking about control of the Niagara Peninsula, not all of Canada; (2) I’m not sure the US would have been able to hold on to Canadian territory, given that the British were able to burn the US capital with impunity; and (3) Aboriginal scouts had probably already delivered the news. Which is not to suggest that Laura Secord doesn’t get an “A” for effort. I’d suggest Summer Glau for the film version, where she could singlehandedly beat up the 14th US Infantry.
June 28th, 2009 at 9:23 pm
“Well, I think it’s noteworthy that where national health care systems exist, nobody ever seems to want to dismantle them.”
Post-communist Eastern Europe may be an exception. Hungary has a British-style fully government-run system (i.e. not just single-payer but doctors are mostly government employers) which is corrupt and well-hated, and performs pretty bad in UN surveys (compares badly with other nations at a comparable level of economic development). A couple of years ago there was a major and unsuccessful push to change it to something like what liberal Dems want here: universal coverage, community rating, subsidies, and a public plan, but the medical profession blocked it. A few years before that, Slovakia did the same but there the reform succeeded. My understanding is that the outcome there is not all that popular. So, there you have it.
June 28th, 2009 at 10:07 pm
Tell the Canadians that they can’t have the technologies developed with private capital in pursuit of profits to earned in the U.S., and their cheeriness about the equity in their regime would recede significantly. Of course, Matthew will never have to explain to someone why they are going to croak, or suffer, because it was just too damned expensive to develop the technology that would have saved them or their suffering, so what doe he care?
I await the the usual claptrap about how all important medical technology is developed solely via capital supplied by government.
June 28th, 2009 at 10:30 pm
Ah Will Allen, sociopath, here to provide more bad advice. One would think that the last month of car bombings in the Iraq created by listening to fuckwits like Will, that Will “Lets kill brown people for my comfort” Allen would shut the fuck up and stop giving bad advice.
Last time we spoke Will, you towering fucking moron, you suggested that the solution to our healthcare crisis was to force everyone at gunpoint to either sign a waiver saying they don’t want insurance at all or to give money to companies that will simply refuse to pay in any and all circumstances where they can get away with it, within and without the law. Good idea, sounds a lot like the system we have now, except the part where you get the government to effectively subsidize an inefficient layer of theft. I guess government is good thing when it steals money from the individual to give to corporations. Seems like there ought to be a name for that kind of governance.
Hey fuckwit, how much important medical technology is developed via capital supplied by insurance companies?
Look, any sane person, after having managed to help incite a war that has resulted in the deaths of hundreds of thousands, would simply crawl into a hole and pull the dirt in over his head. It takes a real fucking sociopath to continue to offer advice on how to make life a hell on earth.
June 28th, 2009 at 10:39 pm
Uh, no, stupid, I didn’t write that at all. You are hallucinating once again. I’m quite serious; you continuously read words which have not appeared, which is every bit as alarming as hearing nonexistent voices. You have a serious brain malfunction. Seek help.
June 28th, 2009 at 10:55 pm
Tell the Canadians that they can’t have the technologies developed with private capital in pursuit of profits to earned in the U.S.
You mean the algorithms to deny people reimbursement for care, libertarian Aspergian dipshit?
June 29th, 2009 at 12:35 am
Tell the Canadians that they can’t have the technologies developed with private capital in pursuit of profits to earned in the U.S.
Well, that’s fair. Are you willing to give up insulin? After all, Canadians discovered how to use it as a treatment for diabetes. You’d also have to give up a number of open-heart surgery techniques, quite a few elements of the standards HIV drug treatment cocktail, a lot of Parkinson’s and Alzheimer’s research, the polio vaccine, and a majority of surgical techniques designed for critically-ill children (Toronto’s Hospital for Sick Children is a groundbreaker in this area and always has been).
Wait, you don’t want to do that? Well gosh then.
June 29th, 2009 at 1:41 am
Having spent most of my life in the U.S. and the last couple of years as a permanent resident in Canada, I’m going to cast my lot with the Canadian system. Americans would be surprised to know that Canadians generally pity them for the sorry state of health care south of the border.
June 29th, 2009 at 1:48 am
‘I await the the usual claptrap about how all important medical technology is developed solely via capital supplied by government.’
No, I would suggest that if you wish to exclude that ever so vaunted American medical technology from the Canadian procurement list, the Canadians would just have to shop globally – the EU and Japan certainly manufacture equipment, technology, and materials as advanced as any in the U.S. For example, this link gives some nice background – http://en.wikipedia.org/wiki/Pharmaceutical_companies
I especially like the two following points seen together -
1. ‘The United States accounts for almost half of the global pharmaceutical market, with $289 billion in annual sales followed by the EU and Japan….US profit growth was maintained even whilst other top industries saw slowed or no growth.[17] Despite this, “..the pharmaceutical industry is — and has been for years — the most profitable of all businesses in the U.S. In the annual Fortune 500 survey, the pharmaceutical industry topped the list of the most profitable industries, with a return of 17% on revenue.’
2. ‘In many non-US western countries a ‘fourth hurdle’ of cost effectiveness analysis has developed before new technologies can be provided. This focuses on the efficiciency (in terms of the cost per QALY) of the technologies in question rather than their efficacy.’
But when you look at the rankings of pharmaceutical companies by revenue, something becomes apparent – in the top 10 list, the U.S. manages to place no. 2, 5, 9, and 10. Americans spend more, which is absolutely true, but they aren’t funding American companies which spread the wealth to the rest of the world, they are instead funding the profits of non-American companies who have no problem with fleecing American customers in a way that they would never consider doing in their home markets. In part, because the health insurance systems in such countries refuse to allow themselves to bled dry in the pursuit of profit for drugmakers.
The rest of the developed world loves the American health care system, as long as they don’t have anything to do with it on a personal level, apart from taking American money.
June 29th, 2009 at 2:37 am
Oh, good grief, mightygodking, and scottbott, I was not asserting that Canadians had never developed useful medical technology, or that only Americans or American firms did so. PBS ran a special several months ago , which was for the most part stridently in favor of any system other than the U.S. method. In the course of examining the Swiss method, a Swiss pharmaceutical company executive was interviewed, and the he and the interviewer talked in great detail about how wonderful it was that nobody feels pinched by purchasing their drugs each month in Switzerland. The interviewer then asked how the company made money. The executive replied that the U.S. maerket is what made making drugs a profitable enterprise. In other words, it was the U.S. market which made medical technology development attractive for private capital.
Now, if you are the sort of fantasist who thinks that private capital is trivial to developing new medical technology, there is no point in further discussion. If your point is that the industry is so profitable that margins could pinched, and private capital would still have no better destination, well, the most useful way to explore that hypothesis would be to simply shrink patent lengths, and then observe what happens.
If your point is that it sucks to have free riding populations benefiting from medical technology breakthorughs because the U.S. consumer makes funding such breakthroughs profitable, well, you may be right. It may suck more, however, to forgo such breakthroughs after the U.S. market is far less profitable.
My overall point is not to give a ringing defense of the U.S. system, which has penty to complain about. My point is that the tiresomeness of the defenders of the U.S. system is matched by the tiresomeness of the advocates of reform, who pretend we live in a world where trade-offs don’t exist, like when they pretend that reducing costs in the U.S. will not very likely entail making medical technology development much less attractive for private capital, and that will mean forgoing new technologies which would greatly extend lives and alleviate suffering.
June 29th, 2009 at 2:38 am
It’s a bullshit argument, anyway. The flipside is to ask whether Americans need to be bled dry by their medical bills in order to speed up advances in treatment. How about that? Quadruple the cost, and perhaps there’ll be a cure for all cancers next week. Let’s create an economy where every spare dollar goes to Big Med, and cripples will walk and the blind will see — just in time to sign the checks. Better still, invade Canada, dismantle Medicare, and the revenue stream will mean they’ll be bringing Michael Jackson back from the dead.
It’s a weird libertarian who worships profiteers. But Will Allen is a weird fucker.
June 29th, 2009 at 2:51 am
psyd in NC, ask a parent who haa a child recently diagnosed with a now highly curable form of leukemia, a leukemia which 20 years ago would have been much more likely fatal, if having highly profitable drug companies has been, on the whole, a good thing. In other word, have the honesty to plainly describe who you would be willing to see die in order to have your preferred form of health care delivery.
June 29th, 2009 at 3:19 am
popurls.com // popular today…
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June 29th, 2009 at 4:33 am
‘The executive replied that the U.S. maerket is what made making drugs a profitable enterprise. In other words, it was the U.S. market which made medical technology development attractive for private capital.’
Nice confirmation that Americans are paying not only for their own fairly mediocre health care, but that the world makes money from it. But why don’t you question why Americans are such suckers?
‘Now, if you are the sort of fantasist who thinks that private capital is trivial to developing new medical technology, there is no point in further discussion. If your point is that the industry is so profitable that margins could pinched, and private capital would still have no better destination, well, the most useful way to explore that hypothesis would be to simply shrink patent lengths, and then observe what happens.’
Strange – we extended patent lengths. Might have something to do with that 17% returns for pharma companies. I think the point has already been proven – and how many of the blockbuster revenue producers are actually medications which significantly increase health?
‘If your point is that it sucks to have free riding populations benefiting from medical technology breakthorughs because the U.S. consumer makes funding such breakthroughs profitable, well, you may be right. It may suck more, however, to forgo such breakthroughs after the U.S. market is far less profitable.’
Why? Do you really think the world needs another ADHD medication, or the latest successor to whatever the current blockbuster drug for anxiety is? The U.S. is profitable for multiple reasons, including the large amounts of medications which people use – a need not found in most other countries with cheaper health care.
Could be a connection.
June 29th, 2009 at 6:30 am
Re: Tell the Canadians that they can’t have the technologies developed with private capital in pursuit of profits to earned in the U.S
In which case the Canadians would be welcome to tell the Americans they can’t have any of Canada’s natural resources. And you do realize that to the extent new technologies are patented the Canadians are paying the price for them too.
Re: In other word, have the honesty to plainly describe who you would be willing to see die in order to have your preferred form of health care delivery.
Will Allen has been reduced to outright asinity. maybe someone should ask him if he likes the idea that people are dying in the US so that insurance companies can make fat profits. And no, children do not die of treatable diseases in Canada or Japan or Australiua, New Zealand, or Europe. Even if it is the case that some triage must be performed to keep medical expenses low, children are not on the triage list. People with incurable diseases who are near the end of their life are in that position. And yes, that happens in the US too. Look up the age limits on bone marrow transpalants. But worse in the US: people are triaged based on income, which is a moral outrage of first rank.
June 29th, 2009 at 8:15 am
Regarding Hugh Segal:
While senators are generally considered relatively unimportant in Canadian politics, Segal is one of the exceptions (and I don’t say that because he represents my region). He was a candidate for the leadership of the Progressive Conservatives back in the day, and was instrumental to bringing together the PCs and the Reform / Canadian Alliance to form the current Conservative Party of Canada.
So while he is a “red tory” who would be on the left end of the Canadian right (to say nothing of the American right), he is still an influential voice in the party.
Oh, and regarding Tommy Douglas vs. Laura Secord: insofar as popular opinion matters, in 2004 Douglas was voted the greatest Canadian of all time when that contest was held by the CBC (Canada’s BBC), beating out Pierre Trudeau, Lester B. Pearson, and even Sir John A. MacDonald (our first prime minister). I’m pretty sure Secord never made the top ten. Terry Fox, who ran cross-country with one artificial leg to raise awareness for cancer, is considered Canada’s most heroic runner, and he came in second.
June 29th, 2009 at 8:42 am
‘In other word, have the honesty to plainly describe who you would be willing to see die in order to have your preferred form of health care delivery.’
Everyone, including me, is going to die. That is a certainty regardless of one’s preferred form of health care delivery.
And that fact is the one that distorts the American health care debate so fiercely, since a number of people absolutely refuse to accept that no health care system or technology will prevent us from dying.
All of us.
June 29th, 2009 at 8:58 am
In other word, have the honesty to plainly describe who you would be willing to see die in order to have your preferred form of health care delivery.
Shorter Will Allen: I would like to let the poor and the unlucky die. But I’m not actually going to come right out and say that, instead I’m going to accuse others of not being willing to face up to the consequences of their preferred solutions.
June 29th, 2009 at 9:43 am
Except Will Allen. He is American Right-wing Ignorant Stupidity personified, and thus immortal.
June 29th, 2009 at 9:48 am
I imagine the Canadians would be happy to make the following deal:
They can’t have our endless proliferation of patent-evading me-too drugs, and our high-pressure-sold and oftentimes lethal new medical devices.
We can’t have penicillin.
June 29th, 2009 at 10:24 am
Is someone going to pick a part Mankiw’s moronic column he worte for the NYT. sheesh what a shame.
I’ll step up and pick apart this bit:
Even if one accepts the president’s broader goals of wider access to health care and cost containment, his economic logic regarding the public option is hard to follow. Consumer choice and honest competition are indeed the foundation of a successful market system, but they are usually achieved without a public provider. We don’t need government-run grocery stores or government-run gas stations to ensure that Americans can buy food and fuel at reasonable prices.
We have, however, decided we need government-run fire departments, government-run police forces, government-run public sanitation, and government-run schools to ensure that Americans can be protected from natural disaster, crime and disease and that they can be provided with a basic education at reasonable prices, all of which Mankiw ignores. The demand for health care is far more analogous to the demand for those services than to the demand for consumer goods that Mankiw compares them to.
June 29th, 2009 at 10:25 am
And Mankiw knows that perfectly well. He’s just paid to lie about it.
June 29th, 2009 at 11:26 am
Look, any sane person, after having managed to help incite a war that has resulted in the deaths of hundreds of thousands, would simply crawl into a hole and pull the dirt in over his head. It takes a real fucking sociopath to continue to offer advice on how to make life a hell on earth.
Of course, Will will never have to explain to someone why their family was blown apart by an American missile because it was just so damned important to him to invade their country, so what does he care?
June 29th, 2009 at 12:07 pm
scottbot, if it is your assertion that the evidence suggests that centrally planned economies produce the more optimal mix of innovation vs. price, well, we’ll just have to disagree. If your point is that we protect intellectual property too much, and this results in a suboptimaL tradeoff between innovation and price competition, well, you may be right. It is an exceedingly difficult thing to measure. The way to approach that problem, however, is to gradually reduce intellectual property protection while observing capital flows carefully. I wish our Presdient had put forth such a proposal.
Finally, yes, if your brain chemistry is such that the new ADHD drug works substantially better for you than other, older, drugs, then you need that drug, even if few other people would so benefit. The problem I have with people like Matthew is that they are too dishonest to frankly admit that they want to tell such people that they are just going to have to suck it up and continue to suffer, in order to have Matthew’s preferred form of health care delivery.
June 29th, 2009 at 12:09 pm
Actually Stefan, I know people who have had family members killed in Iraq.
June 29th, 2009 at 12:09 pm
“Squeezing providers would save the rest of us money, but so would a special tax levied only on health care workers, and that is manifestly inequitable.”
WTF?
“He was an adviser to President George W. Bush. ”
oh-that explains it.
June 29th, 2009 at 12:13 pm
No, Jon F., I wasn’t actually proposing that Canadians be prevented from using health care technology developed as a result of private capital devoted to pursuing profits only available in the U.S. health care system. Sheesh.
June 29th, 2009 at 12:20 pm
Yes, Steven, all of the technology developed with private capital in pursuit of profits only available in the U.S. market is redundant or sold via high pressure tactics and often lethal, negating it’s value. You just keep telling yourself that.
This is the sort of fantasist I was referring to. One may as well have a discussion with the poor soul stading next to a shopping cart at the end of the freeway ramp. That’s not really fair, though, because that poor soul probably has a better appreciation of the ugly and inevitable reality of trade-offs than Steven.
June 29th, 2009 at 12:28 pm
Will, you are a fucking liar. Anyone who bothers to use a search on your dumb ass will see that you have, indeed, proposed to force everyone to buy health insurance – or sign a waiver. And I left out the best part of your totally fucking insane plan to funnel money to the insurance companies – the lifetime cap on payments! Hey good idea fuckwit. Now, if you could just stop lying about what you’ve said we might be able to get somewhere.
But then you wouldn’t be Will “I want to see dead people goddamn it, I don’t care what it takes” Allen if you debated in anything resembling an honest manner.
June 29th, 2009 at 12:30 pm
I believe we need to look at what works and does not work in other countries that have instituted such a system. This can only be done by careful and deliberate investigation. The problem I am concerned about is we may be pushing this one to fast and not evaluating all the pros and cons.
June 29th, 2009 at 12:32 pm
Will, how many of those people you know with family that died in Iraq are mourning innocents minding their own fucking business in their own homes when they were killed by the direct and indirect consequences of your lust for blood?
June 29th, 2009 at 12:34 pm
Actually, DMonteith, I have stated some of my preferences. I think it would be better to ration via a lifetime, inflation adjusted, benefit cap, with premiums starting at age 18, and the insurance being guaranteed issue, similar to Medicare supplements. I am agnostic as to whether the insurance wouold be provided by a government enterprise, or whether private insurers would be involved. I am willing to admit, however, that those who lacked the wealth to pay for their own care would be out of luck once they exceeded their benefit cap.
The key to such a regime would be to increase price competition, which may involve weakening intellectual property protection, and certainly would involve increasing the supply of health care workers while lowering the debt they incur in obtaining their education. When we saw doctors competing with discount coupons like oil change stores or pizza delivery outfits, we would then know we were going in the right direction.
June 29th, 2009 at 12:39 pm
’scottbot, if it is your assertion that the evidence suggests that centrally planned economies produce the more optimal mix of innovation vs. price, well, we’ll just have to disagree.’
Nope – just that the world’s leading exporter, home of a fairly notable industry devoted to producing some of the world’s finest medical technology, and a proud possessor of a completely private health care industry (unless you discount the church run charities and to some extent, hospitals) in terms of the drug companies, the doctors, and the various health insurers (apart from the AOK), is able to keep pace with American health care standards without really batting an eye, and for a third less of the American cost.
Of course, Germany isn’t paradise, and here, it is still basically considered appalling, bordering on illegal, to prescribe amphetamines to children. But then, Germany hasn’t experienced the incredible epidemic of ADHD that seems to have afflicted the U.S. – ‘Nearly 9 percent of American children have attention-deficit/hyperactivity disorder (ADHD), but only 32 percent of them are getting the medication they need.’ http://www.washingtonpost.com/wp-dyn/content/article/2007/09/03/AR2007090300729.html
9% – an amazing number, considering that the number of such case when I was in schools was something on the order of nil. That’s right – I have watched the growth of a disease right before my eyes, and yet oddly, the American children I’ve known over those couple of decades seem pretty much the same as always.
Obviously, I’m not a trained professional, but from 0.1% to 9% in a generation? Sounds like a successful marketing campaign. And it is lucky that various companies have been able to meet the needs of this ever growing population of children, without anyone actually ever questioning what is going on. Including such things as perhaps far too much time spent in front of screens, or changing mores that allow children previously seen as normal to be considered a prime market for the latest for profit product to control their condition.
So yes, count me in the suck it up camp – I don’t think the problem in this debate is that Americans don’t have enough health care, it is that they don’t have enough effective health care, as measured using an objective basis, including something as simple as international comparisons. For example, why is (North) America seemingly uniquely afflicted with a plague of ADHD, where other countries don’t even see a need for any child to receive such medications, except in the most extraordinary cases.
June 29th, 2009 at 12:40 pm
Yes, stupid, I would either tell people that they need to have an insurance policy, or forswear access to other people’s money with which to obtain health care. You are hallucinating about anything I allegedly said about insurance companies. You have a severe brain malfunction, which causes you to continually imagine that you are reading words which have never been written.
June 29th, 2009 at 12:47 pm
Yes, Germany exports a lot of useful technology, which doesn’t contradict anything I’ve written. If it your belief that that the profits available in the U.S. market attracts capital to technology development which only produces useless medicines, well, you just go right ahead and believe that.
June 29th, 2009 at 1:12 pm
Aspergian dicksplash Will Allen is extremely good at pretending that every discussion of this topic starts afresh, and that his one-liners — “you won’t tell us who you want to DIE, neener neener!” — are actually relevant. Alas, not.
Suppose there was a pharmaceutical corporation that discovered a cure for AIDS that required a daily supply of 100 fresh glibertarian fools at the start of the production process. At some point, the benefits that might be accrued do not justify the costs, and they certainly don’t justify profiteering.
June 29th, 2009 at 1:18 pm
If one is ever in need of a dose of irony, this is the forum to go to.
June 29th, 2009 at 1:20 pm
the ONLY reason WE do not have a “WAITING LIST” now is because one does not exist for people to sign up for
healthcare IS rationed to those with coverage (sometimes covered, sometimes denied) ALWAYS to those with the money to pay for it directly as will always be the case
–for those with insurance, there IS a beaureaucrat between YOU and YOUR dr. telling YOU what you can and can’t have, what MUST be done or can’t be done (covered and not or will not be covered), drugs that will be covered/not covered
June 29th, 2009 at 2:55 pm
I am willing to admit, however, that those who lacked the wealth to pay for their own care would be out of luck once they exceeded their benefit cap.
Shorter Will Allen: Whatever you do kids, don’t survive childhood leukemia because if you do and you’re poor, you’re SOL if you break your leg in your 30’s!
Yes, I have already noted that you want the poor and unlucky to die. Your willingness to put a brave face on other people’s misfortune is touching, though.
June 29th, 2009 at 3:28 pm
Yes, DMonteith, and you wish to have a large number of people die as a result of not having technology which was never developed because of your preferred regime. You just are too dishonest to say so.
Actually, however, since, as I stated, my preferred benefit cap would start at age 18, most childhood leukemia survivors would have a lot of benefits available. You really can’t understand anything, can you?
June 29th, 2009 at 4:18 pm
Again, Will Allen is not prepared to have his organs harvested for profit by medical kidnap squads so that others may live, but is too dishonest to admit it.
June 29th, 2009 at 4:38 pm
Yes, DMonteith, and you wish to have a large number of people die as a result of not having technology which was never developed because of your preferred regime.
Fuel efficiency will increase 1000 fold in the future, so if you drive your car at all you are a hypocrite because you are depriving people in the future 1000 times the benefit that you get from using that fuel now. Want to rethink this one, maybe?
Also, thanks for pointing out that there will be no incentives for doing things like curing cancer if the poor and unlucky don’t continue to suffer disproportionately. That’s compelling stuff.
June 29th, 2009 at 5:04 pm
One cannot repeat it often enough:
(—- One economic fact on private health insurance—)
Some 27% or such of your health insurance premium goes into overhead, administration, denial of claims, CEO salaries, and only about 70% go as payments for doctors, pharmacies, hospitals. (see also [1] for detail and comparison to Canada).
(I didn’t believe the 27% number until I had a quarrel over some bill; insurance claimed one payment amount (on the EOB [Explanation of Benefits], as payment, after rebate), but the check to the hospital -which hospital admins kindly faxed me – was some ~7 or 8% less (than the already rebated amount). I called the phone number on the check, and learned that this company – which processes payments for out-of-state insurers – takes out this amount for processing these insurance payments, and that the health care providers must give this fee as a rebate.) So if there’s such a big loss in one step, the ~27% overhead figure sounds believable. Some HMOs might be more efficient though.– As the 27% overhead taken by private insurance companies is such a big amount of money, any proposal to change this is doomed; the insurance industry has a 100-million dollar ad campaign against it as soon as it is recognized as a threat to their 27% take. (Remember the Harry and Louise ads when the Clinton plan was announced (ca 1993)?).–
By comparison, for Medical/Medicare, about 97% of the budgeted amount goes as payment for health care providers, and only ~3% to administrative overhead, fraud etc.
Anybody discussing health care and insurance not mentioning this fact does not have your best interests at heart (but probably gets a share of the ~27%).
And if you are afraid of government bureaucracies, you didn’t have to call your private insurer yet, to get them to pay a bill which they randomly rejected.
After my wife switched over from her employer’s BCBS plan to mine, the following years any health reimbursement request sent to BCBS (with the correct new number and copy of new insurance card) was routinely rejected, for not being insured any more, and required numerous phone calls and letters (with copies of the insurance card) to point out that indeed she was now insured by a different BCBS affiliate (like the one mentioned on the bill sent by the health-care provider).–
A colleague of mine has diabetes, so always requires the same meds and checkups; once a year his bills are rejected with the terse explanation, that his plan doesn’t cover this or that; and he spends then an hour on the phone pointing out that his plan covered this item, like in the preceding quarter. So much productivity lost!–
And unless you are actively bleeding, your HMO will also schedule any appointment later, rather than earlier, the later the less life-threatening the disease seems to be.
—————————
[1]S. Woolhandler et al.,
Costs of Health Care Administration in the United States and Canada NEJM (03) 349:768-775
http://content.nejm.org/cgi/content/short/349/8/768
“Results: In 1999, health administration costs totaled at least $294.3 billion in the United States, or $1,059 per capita, as compared with $307 per capita in Canada. After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada. Canada’s national health insurance program had overhead of 1.3 percent; the overhead among Canada’s private insurers was higher than that in the United States (13.2 percent vs. 11.7 percent). Providers’ administrative costs were far lower in Canada.”
H/T to http://scienceblogs.com/transcript/2008/08/lets_talk_about_facts_this_ele_2.php
June 29th, 2009 at 5:12 pm
Actually, however, since, as I stated, my preferred benefit cap would start at age 18, most childhood leukemia survivors would have a lot of benefits available.
Yeah, those fuckers who get cancer at age 18 are much bigger losers than those who get it at 17. They should obviously have their age at the time of diagnosis held against them for the rest of their lives. Especially the poor ones.
No matter how you slice it, arbitrary and inequitable is still arbitrary and inequitable. But, you’re right, I can’t understanding anything about how an age limit changes that. I’m dumb that way.
June 30th, 2009 at 2:55 am
‘If it your belief that that the profits available in the U.S. market attracts capital to technology development which only produces useless medicines, well, you just go right ahead and believe that.’
Would you like a list of the ‘blockbuster’ drugs which determine the share prices of major pharma companies on the NYSE? Because such a list will contain an amazing number of products which provide no measurable advantage in terms of efficacy to cheaper treatments (except for the corporate bottom line), were so poorly tested they needed to be recalled, or simply treat conditions that are newly discovered in the pages of major publications and over the airwaves – is it restless leg this quarter, or was it some sort of shyness syndrome?
The pursuit of profit for pharmaceutical companies has little to do with the pursuit of effective treatments for disease – just ask anyone with ALS (you can’t ask my mother – she is dead), because with just a few hundred thousand patients, the profits just don’t justify the necessary work to continue to actually search for an effective treatment. However, the number of restless leg suffers is about as large as a modern marketing campaign can create (and which not one, but two companies rushed to meet the demand for) – which is not to deny that a number of people suffer from anxietas tibiarum, though at least according to the link http://www.theness.com/neurologicablog/?p=183 the earliest reference to the ‘problem’ dates from the dark ages of 1960.
I am sure that the sufferers of restless leg sleep better at night, not only comforted by the finest free market therapies available, but also because most people with ALS die an estimated 1.5 to 3 years after diagnosis, unlike sufferers of restless leg, who may be using the product for decades.
I am sure you can see the logic which has provided the sufferers of restless leg several products to choose from, enhancing the bottom line of several companies so they can continue to discover other, equally profitable, drugs. Whereas the minor market of people with a fatal disease is neglected merely because the profit motive is not present.
This is merely an illustration, by the way – my mother hated the focus on AIDS when she was first diagnosed, feeling that the intense government and commercial interest in finding medications to help a large number of people with a fatal and communicable disease was simply unfair, as most people with AIDS were not in the same category of innocent victim as her.
Welcome to the real world, not the script writer’s version. Resources are finite, and everyone will die.
Nothing will prevent that, neither the free market nor government planning. Recognizing that truth might help in recognizing how completely skewed the current American system is, even using its own logic.
June 30th, 2009 at 1:11 pm
One problem with the American debate about health care, imho, is that the problems are wrongly stated. There is not one problem, there are two: how to run a health care system, and how to pay for it. Of course they overlap, duh, but it’s important to see that the big weight has two heavy separate ends.
Canada has the world’s best system of payment for health care, hands down. Costs of payment are about 0.4% of throughput — which compares with roughly 30% rake-off that the insurance industry takes in the US for administration, advertising, lobbying, and profits.
Single payer wins. There’s nothing to debate. Just look at the facts.
The other problem is how to run a health care system. This is a difficult question in the ecology of politics, culture, administration, construction, labor relations, research, training, education, and on and on and on.
Here to Canada does pretty well, but people ought to pay a little bit of attention to how it’s done. It takes a huge and complicated mulch of universities, Provincial governments, national medical associations (the old Royal Colleges), and county and city medical associations, all toiling away, associating, and getting stuff done.
For comparison, America’s delivery system seems to be dominated not by busy people struggling to get things to work, but rather by creatures like the American Medical Association, groups which distinguish themselves mainly as right-wing propaganda machines.
Nothing Obama does about the financing of health care will do any good until there is a root and branch attack on the actual delivery system –which is a.) utterly corrupt, and b.) off the radar because all the talk is about “insurance.”
July 1st, 2009 at 2:33 pm
That’s because there is a tendency to always tend towards big government rather than small government- even Thomas Jefferson said that way back in the day, and he was a small government guy.
It’s virtually impossible to dismantle the large national health programs since doctors and nurses are public employees, etc. That’s like saying the United States would get rid of a federal agency. When’s the last time that ever happened? Pretty close to never.
July 2nd, 2009 at 12:14 pm
64, Why is it so necessary to dismantle government run programs; by the people and for the people mean anything to you?? Do you honestly believe that the “Madoffians” who can cook up Enron can be trusted to run a healthcare system? We should surrender the health of our children to profiteers; that they will somehow put our health before their profit margin? What fantasy land do you live in? A properly managed single payer national health system is enjoyed by almost every citizen of every advanced economy on the planet except for …. You fill in the blank. Time for the US government to come in from right field and get to bat for it’s people.
July 4th, 2009 at 8:42 pm
It’s funny. You’re often hearing the American political right alluding to “Canada horror stories” in our health care system. We Canadians hear that and look at each other quizzically. It does something like: “What? *shrug* Oh well. I guess it will keep them south of the border. See ya, eh?”
July 4th, 2009 at 11:40 pm
Here’s what the Canadians and the Americans think of their respective healthcare systems. It’s a Harris poll so read into it what you will
http://www.google.com/url?sa=t&source=web&ct=res&cd=2&url=http%3A%2F%2Fharrisinteractive.com%2Fnews%2Fnewsletters%2Fhealthnews%2FHI_HealthCareNews2008Vol8_Iss6.pdf&ei=B45MSqa7LIyysgP6vsHpBQ&usg=AFQjCNGM1zYK2DPagCQo8YL3pcxQ1BqVxA&sig2=LI7fTuwMzp51R-jbby39SQ
July 5th, 2009 at 7:44 am
As an older woman (77), living on a fixed but not generous income, I am reaping the benefits of my Canadian medicare system which I have supported with my tax dollars since it came into force decades ago. Because of the fairness built into this system, I have always had excellent medical access, with maintenance of my health as the chief goal. I have had my own family physician for over a quarter of a century. I also have the benefit now of a recently developed pharmacare system which uses my province’s purchasing power to control the price of drugs and limit Big Pharma’s ability to reap excess profits. As for the wait times scare tactics, when my husband, a diabetic age 83, appeared to have a stage 1 cancer in his lung, he was operated on within two months and has since recovered and enjoys a better sense of well-being than before the cancer scare. I pay for this care through my income taxes, at a rate that is determined by my income level. Were I poorer, I would pay less but enjoy exactly the same benefits. And when I was younger, I paid the same way so that the system could function, and would be there for me in my older and more needy years. Health care is a human issue first; it is not and should not be a goldmine for the pharmaceutical companies and health care for maximum profit industry.
Our hero, Tommy Douglas had it right.