8 Comments:

What exactly do you mean by rationing of services?

By  Hammer, at 12:58 PM  

If you had stuck around for Rockonomics you would have learned about public goods. (Actually that wasn't in Rocky's econ 201 class, it was later, but I just wanted an excuse to type"Rockonomics".)

I've never said I wanted the government to run the health care system, just pay for it.

"In 2002, the latest year for which comparable data are available, the United States spent $5,267 on health care for each man, woman and child. Of this, $2,364, or 45 percent, was government spending, mainly on Medicare and Medicaid. Canada spent $2,931 per person, of which $2,048 came from the government. France spent $2,736 per person, of which $2,080 was government spending." (figures via noted economist Paul Krugman in the NYT.)

America spends more on health care per person than any other Western nation and gets worse outcomes than most of them. There is plenty of money out there for universal heath care and I've predicted here a number of times that we will pretty soon see many major corporations pushing the government to move in that direction. ((Here's one of those posts.)

"The New England Journal of Medicine estimated that administrative costs took 31 cents out of every dollar the United States spent on health care, compared with only 17 cents in Canada." I'd have to do some research but I think Medicare admin costs are around 10%. Every dollar made by health insurance companies is a dollar spent on healthcare that does not go to making people healthy.

And even if you did have to find new revenue to pay for it (which you might not with lower admin costs, more preventative care for people who currently wait until they have to go to an ER, and if the government would actually negotiate with pharmaceutical companies for better prices like most other countries. W's Medicare drug bill of last year actually mandated that the government NOT negotiate for lower prices! ) I wonder how much business would kick in to be relieved of their current burden of insuring workers? If American corporations are currently paying X billion dollars for insurance would they willing trade that for say .25X billion dollars in new taxes? They just might.

This is too big an issue to be resolved in blog comments and far smarter people than me have their own solutions, but the "we can't afford it" argument is not really the problem.

By  Jambo, at 2:18 PM  

Oh, and as for rationing healthcare, we already do it. People with good jobs or lots of money get lots of it and people without money get very little. If the government paid to insure everyone in the country to a certain level of care rich folks who demanded to have that MRI right NOW would of course still be free to purchase what ever kind of add-on insurance they liked.

By  Jambo, at 2:21 PM  

I mean that when something people want is given away for free, demand will skyrocket. People will go to the doctor every time they get a runy nose 'cuz its FREE!

Sounds like you would like to eliminate insurance entirely. After all, after my co-pay for an office visit, my insurance pays for everything else. For people with insurance, the change is relatively minor. Besides, insurance companies already limit what doctors can charge -- check out your explanation of benefits.

By  Hammer, at 2:38 PM  

You don't have car insurance to replace your wiper blades because it's not economically feasible. Neither is it is long-term feasible to insure routine, minor medical care. That's why we have a problem now.

I think that's because if the wiper blades wear out, the engine doesn't seize up. Routine, minor medical care saves costs. The VA does a great job long-term care, because they emphasize prevention.

By  Hammer, at 2:55 PM  

There's no perfect way to measure quality of care between nations and life expectancy is perhaps a poor one. But the US also trails most other Western nations in infant mortality and of course if you measure quality of healthcare by the percentage of people who are insured we are right at the bottom. As for overhead costs just about everything I can find puts Medicare overhead at about 4% with private insurance ranging from 17% to 30% with bigger pools of insured resulting in the lowest overhead which is part of the point. Having everyone in the same system creates better returns to scale and avoids tons of administration time involved in clinics and hospitals dealing with dozens, or even hundreds, of insurance carriers. And of course a government program doesn't have to pay dividends to stockholders, giant salaries to executives, doesn't have to advertise, doesn't have to hire teams to figure out who are the good health risks...

As to free lunches and who's wacky on economics don't get me started on tax cuts, budgets, and the current White House!

In any case, Captain, thanks for checking out the blog and better still, posting thoughtful comments. It's always nice to have a nay sayer or two to keep the arguments honest. Joseph and Sean can't be everywhere after all.

By  Jambo, at 5:16 PM  

Thanks for the comments, Cpt. Liberty. A few quibbles:
The preventive care stuff is a nice theory, but it doesn't happen. Doctors in the socialize systems see more than 3x the # of patients per year than US docs...spending less time and doing less for them.

Yes, the American system does everything possible to keep people from seeing doctors, because doctors are too expensive. Thus the advent of nurse lines, PAs, and so on.

Govt. systems deny expensive, advanced care to very sick people because they can't afford it - they have millions of people lined up to see doctors for the sniffles, wsating doctors time by not showing up for appointments since they don't have to pay for them, and calling ambulances for rides to the clinic cuz its free!

Rather than dispute such apocryphal anecdotes, let me suggest this. I'm certain some in Canada abuse the health care system, just as some in the United States abuse our private insurance system. Every system is abused. Even -- gasp! -- the free market. The only way to eliminate abuse from the delivery of health care is to eliminate health care.

By  Hammer, at 9:54 AM  

In a way it is unfair that blog hosts generally get the last word (mainly because they are more invested in the forum than folks who post comments) but here is mine:

When I quote Krugman I should just post the whole darn thing: "Somebody is sure to bring up the supposed horrors of Britain's government-run system, which historically had long waiting lists for elective surgery.

In fact, Britain's system isn't as bad as its reputation - especially for lower-paid workers, whose counterparts in the United States often have no health insurance at all. And the waiting lists have gotten shorter.

But in any case, Britain is not the country we want to look at, because its health care system is run on the cheap, with total spending per person only 40 percent as high as ours.

The countries that have something to teach us are those that do not pinch pennies to the same extent - like France, Germany and Canada - but still spend far less than we do. (Yes, Canada also has waiting lists, but they are much shorter than Britain's, and Canadians overwhelmingly prefer their system to ours. France and Germany do not have a waiting list problem.)"

The closest I can come to an expert on this subject is my friend CotB who is an economist (PhD and everything) and is from the US but now teaches in Canada. In a nutshell I think he would say (and I take this straight from similar discussions in the past) that he likes the Canadian system but admits that it is fairly expensive in terms of taxes. In order for a similar system in the US to actually save us money compared to what we spend now would require that all the current programs like Medicare and Medicaid, V.A. et al be rolled into the new program which he thinks (perhaps correctly, but I'm not so sure) is politically impossible.

By  Jambo, at 12:16 PM  

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