~ by Ragnar
The other day I had what passes for a profound thought in my neck of the woods. Not the more typical kind of thing that usually comes right before statements like, “Hey ya’ll watch this,” or “Here hold my beer a minute.” No, this was actually a little deeper. I was thinking about all the debate on nationalized health care, or socialized medicine. (Sorry but let’s call a duck a duck). Now, I have some doctors in my family, so I may have a slightly different view than most, and I am lucky enough to have employment with pretty good health care coverage. In fact, let’s broaden this even a little more to socialized anything, or just plain ole socialism.
The last Literature class I had, about 20 years ago, included a short story about a society that sought to equalize its population’s physical capability by penalizing those who were overachievers. I forget the name of the story, but the idea was that if you were too tall, or too strong, too fast, etc. they would hang weights all over you so that your physical capability fell in line with the norm. They strove for mediocrity. I think that is the concept of socialized anything all in a nutshell. You strive for mediocrity because you remove the incentive to excel.
One of my relatives, a rather brilliant surgeon I am led to believe, tells me that every bill he submits to insurance is returned as, “beyond reasonable and customary.” It doesn’t seem to matter that his fees are in line with all the other surgeons in this part of the state.
Imagine if you went to the dealership with your car for a new head gasket, and when presented the bill, you just refuse to pay 70% of it. “Nope, above what my market study shows as reasonable and customary. Sorry, my market study is confidential.”
If you did that, and the dealership let you get away with it, I would imagine the quality of the repair work you received would begin to erode. Maybe the more skilled mechanics would no longer get the pay they now get and would decide to move to more lucrative ventures. Now imagine if the government ran all of the medical industry this way. You just might not get as great a job on your quindoubletriple bypass anymore. The brilliant, genius-level IQ, over-achieving, never-got-anything-but-an-A-in-their-life, people who entered medicine because they wanted to help people AND because they thought it would be cool to get a big return on their 10 years of college studying their arses off, followed by two years working 24 hour shifts as an intern, so that maybe just maybe they could make a butt-ton of money and live the American dream, well these people may decide to go somewhere else, to seek a more lucrative venture. And you know what? Some of them are smart enough to do it. To steal an analogy from the title of one of the greatest books ever written; “What if Atlas Shrugged?”
I think that is the inevitable result of socialized medicine, or socialized anything. The best people will leave because the incentive to stay will disappear, bureaucrats will muddle everything up, and the quality the consumer receives will suffer. The data is so overwhelming that you have to try really hard to ignore it, (kind of like the failure of gun control – sorry, had to work that in somewhere) and yet, my less-favorite political party is making it the center plank of their platform. I don’t get it. I guess the idea just seems so attractive that they cannot stop dreaming of making it work. It seems so perfect, it just has to work. Doesn’t work in the UK, doesn’t work in Canada, Michael Moore thinks it works in Cuba, which is about as likely as planting a horse-apple and expecting to grow a horse apple tree. But it just has to work. The government will provide for everyone, and nobody will be sick, and everyone will be happy, and everyone will be able to run as fast as everyone else, and the world will be a better place…sigh, utopia.
So here is the profound thought: “Socialism is like a perpetual motion machine; It would be the greatest thing ever, except it just doesn’t work. People never stop trying to reinvent it because it would be so great, but it just never works.”
Wow, here gim’me back my beer.
The story's called Harrison Bergeron and it was written in 1961 by Kurt Vonnegut.
I don't normally care much for his stories--too dystopian for my optimistic nature. However, I have to agree with you that this one is, next to Animal Farm, the best satire on socialism ever written.
So, Ragnar, and I know I've been harping on this--you want a Ron Paul sign for your front yard?
Tom
Pretty much no one ever drives by his front yard.
Man, why can't I get a house like that?
Tom
The first step in impressing people with your profundity is to figure out how to spell it. The second step is to think through your argument before you write it. Read it again. We don't have socialized medicine now. We have private insurance companies competing for business. This system isn't working for your uncle surgeon because the companies don't pay him the fees he asks. Ergo, socialized medicine just doesn't work. Maybe you should look up "socialized" before your next profound post.
I notice your thoughts were so profound that you didn't feel the need to support them with any facts whatsoever. So let's try throwing a few into the mix:
(1) The US spends $5,267 per capita on health care, compared to Canada's $2,931; France's $2,736; and the UK's $2,160.
(2) The private share of those costs is 55% in the US, compared to 30% in Canada, 24% in France, and 17% in the UK.
(3) Life expectancy is 77.1 years in the US, compared to 79.7 in Canada, 79.2 in France, and 78.1 in the UK.
(4) Infant mortality is 6.8 per 1000 births in the US, compared to 5.2 in Canada, 4.5 in France, and 5.0 in the UK.
(5) The US system leaves 47 million people without health insurance.
(6) To take one example of the effects of this lack of insurance, patients diagnosed with colorectal cancer are 70% more likely to die within 3 years if they do not have health insurance.
(7) While there are long waiting lists for elective surgery in some non-US systems, the procedures for which these waiting lists exist account for only 3% of US health care spending, which does not account for the almost 200% more we spend on health care than those non-US systems spend.
All of this ultimately shows that while we spend way, way more money on health care in this country than is spent in countries with universal health care, we end up with inferior health care in general, and we fail to cover about 16% of our population. It is a lose-lose situation any way you measure it, and this doesn't even get into the strain that this puts on employers (and consequently, jobs and prices and the American economy in general) due to the current employer-based system in this country.
It is so terribly, terribly easy to say, "socialism doesn't work" - which it doesn't - "so therefore socialized medicine won't work." But the economy is way, way more complicated than that. Certain goods are better provided in the private sphere, while certain goods are better provided in the public sphere. To reduce every debate over whether a public good should be provided to an argument over socialism is far, far, far from profound. It is lazy and wrongheaded and petty.
I don't want socialized medicine for ideological reasons; I just want a health care system that works. What we have now is broken and it is getting more broken every year. A few of us are lucky enough to have health plans that actually cover the services we need, but if you don't realize how many people can't just call the doctor when they're sick, see him that day if it's serious, get specialized treatment to fix it, and not have to worry that they're throwing away their financial future to do it, you need to spend less time blogging and more time being in touch with the real world. We lucky folks with genuinely good health plans need to realize that if the out of control costs don't get fixed, our health care will get crappy too or the jobs that provide it as a fringe benefit will go away as the entities -- governments or private companies -- on the hook for the bill go bankrupt.
I'm not sanguine that any of the large scale reforms the Democrats have suggested would really fix it, but I'm dead certain that the Republicans are just competing to arrange the deck chairs the most nicely, and we've already hit the iceberg.
I'm not crazy about either socialized or employer-based health insurance. So, I'd really like to hear some alternatives, but I didn't hear any from you, Ragnar. What do you propose instead?
"The data is so overwhelming that you have to try really hard to ignore it,"
Huh? What data are you talking about?
Karen, I suggest you and anyone else looking to learn more about American healthcare and the threat of socialized medicine read The Business of Health. I won't ruin all the fun, but within its pages these health experts show that when homicides and accidental deaths are discounted for all countries, the United States has a longer life expectancy than all other western nations. They also show that cancer survival rates for American patients are better (in some cases ridiculously so) than in any other country.
A few quick points:
Brian notes that:
(3) Life expectancy is 77.1 years in the US, compared to 79.7 in Canada, 79.2 in France, and 78.1 in the UK.
(4) Infant mortality is 6.8 per 1000 births in the US, compared to 5.2 in Canada, 4.5 in France, and 5.0 in the UK.
--
These indicators are quoted a lot, but they aren't terribly effective at measuring the quality of health care. I would defend this statement but I've loaned out all my health care information to my brother.
I don't think it's correct to say that the U.S. has "inferior health care" unless one is strictly looking at the uninsured. I would put it this way: "American has the best health care money can buy,if you can afford it."
Nevertheless, Brian is right that reducing the issue of health care down to platitudes such as "socialism" or "the free market" isn't helpful. This is one issue where it is better to get into the meat of the sub-issues, such as:
1.) Standardization v. Experimentation - Experimentation is extremely important because it moves the science of medicine forward. But it is inherently risky, and risk means expensive lawsuits. So there is a countervailing pressure to standardize and homogenize medicine through the adoption of best practices. So we might ask:
Should medicine be highly standardized? And if so, who makes the standards, the government, insurance companies, doctors associations?
2.)Access v. Cost control - Regardless of who provides health care, there is a serious tension between how much health should be given free or cheaply versus how much cost the consumer should bear. Of central importance to this question is studies like the RAND study that suggest that unlimited access to free health care has extremely modest benefits. This question plays heavily into the question of private v. government provided health care because they propose radically different approaches to the access v. cost control question.
3.)public interest v. personal autonomy- Taxpayers are paying about 40-50% of all health care costs, but the biggest determinants of those costs are private health decisions such smoking, alcohol use, and overeating. To what extent should public policy be used to curb poor health habits to control costs?
As always, there are many other considerations, but the point is clear: Health care is just not simply a "socialism" vs. "free market" question.
One important stat Brian left out is that the cost of health care adds about 1200-1500 to the price of every GM car. Our health care system is plaguing American competitiveness.
I solved the problem. See my post today.
Tom
OK as usual most of you “intellectuals” completely missed my point. To the moron who criticized my spelling, the title is what you call a “play on words.”
Second, as usual Brian misses the point more than I would have thought humanly possible, as usual falling back on quoting the standard bs liberal talking point statistics. Last time I checked, nobody can be turned away from an emergency room, even illegal aliens. I will take my chances with American health care any day. We were thinking of going to southern Namboobia to have our next baby, but not sure yet.
The POINT is that socialized anything, including healthcare is like a perpetual motion machine. It would be so great if it would work, it should work, it has to work if we keep fiddling with it, there are so many examples of how badly the world needs it to work, blah blah blah. But the truth is you can’t build a machine that creates more energy that it consumes. That is just the way the ball bounces, and having the government run the health care system just won’t work either. It is a perpetual motion machine.
Here is my idea. And by the way I like Tet’s idea.
I think there should be an option to sign a release to the doctor releasing him of all liability. Then he would not have the huge overhead of malpractice. You take your chances just like in the old days when the doctor drove his buggy out to your house and did his best. If you want the assurance that in the event of an error your heir can sue their ass off, you pay more. Simple.
"That is just the way the ball bounces, and having the government run the health care system just won’t work either."
Ah! I'm convinced! I presented a coherent argument that your position is totally wrong, but you have effectively countered that argument by...restating your position without responding to anything I said! Well-played, sir, well-played. My egg-headed wonkery is simply no match to your plainspoken, salt-of-the-earth, good ol' fashioned American ingenuity.
I apologize for the snarkiness, but it's abundantly clear that you are utterly incapable of even considering an argument that conflicts with your pre-established world view, so I figure why not just mock you and feel superior the same way you're doing to me?
"I think there should be an option to sign a release to the doctor releasing him of all liability. Then he would not have the huge overhead of malpractice. You take your chances just like in the old days when the doctor drove his buggy out to your house and did his best. If you want the assurance that in the event of an error your heir can sue their ass off, you pay more. Simple."
Actually a good number of doctors I had to visit for surgery a few years back had arbitration clauses which stated that they wouldn't treat you unless you agreed to binding arbitration (which they paid for and regularly used - totally fair system) if they screwed up.
One important stat Brian left out is that the cost of health care adds about 1200-1500 to the price of every GM car. Unions are plaguing American competitiveness.
Brian I just thought Mr. Niemerg did a quite effective job refuting your data and there was little to add. As to the cost of GM cars, well don't buy GM cars if you think they cost too much. If enough people do that they will be forced to change or go away. That is capitalism. We have that option with medical care. Go to Canada if you get sick and can get a better deal. Kind of like tax increases. Nothing is stopping us from paying higher taxes if we feel that Bush's tax cuts were egregious. Hey you first. I am intrigued by Hanno's experience with the liability waiver. Did it work? Did you save money? Did you think it was a good idea?
Anyway, one more shot at defending what I am saying. You take away the incentive to make money and the best and brightest will go somewhere else. Can our country afford that? When the Mercks of the world quite making billions selling pills, will they quit developing new medicines? My relative the surgeon is threatening to move to New Zealand because he believes he can practice medicine there without the snarls of red tape that are tangling him up here ( and he claims Illinois has a particularly bad business climate). My beef is more with the insurance companies and trial lawyers. I think they are the ones making the fouls, but I know making this a government run thing isn't going to improve it. At least if it did it would be defying all odds as the first government operated thing that functioned more efficiently that the private sector, wouldn't it? It is a remarkable electric motor that turns a generator that creates enough electricity for the motor driving it to run on, and it just goes and goes and goes.
Ragnar:
One good point you should be making is that Illinois lack of tort reform coupled with high insurance rates is forcing neurosurgeons to flee to surrounding states and we are getting a serious shortage of neurosurgeons.
Ragnar
On the arbitration clauses I have no idea how much they reduced costs. I imagine enough. The problem with an arbitration clause is that the system is skewed towards the frequent client (not necessarily corrupt, but more through familiarity) so the doctor will almost always get a better deal than he should in a perfectly fair and neutral system.
Ragnar, I'm the moron who criticized your spelling. Explain to me what is the play on words between "profoundity" and "profundity?" Do you actually know what a play on words is?
Also, before you start spouting simplistic slogans about reducing the cost of health care by restricting malpractice claims, you might want to take a look at the studies that have been done on that issue. I think you'll find that the cost of malpractice insurance adds very little to the cost of health care, something like 2 percent. So, my $250 co-payment for being treated at the Emergency Room at Carle would only be $245. What about my 30-year-old son who has worked hard all his life and has never had health insurance? The issue for him is not whether the cost is $245 or $250, the issue is he can't afford care.
And your comment about your uncle surgeon threatening to move to New Zealand is as uninformed as the rest of your comments. Guess what -- New Zealand health care and disability services is publicly funded, just like Canada, England, Australia and the rest of the Commonwealth countries. See this website for the New Zealand Public Health Ministry
http://www.moh.govt.nz/moh.nsf/indexmh/eligibility-healthservices