(cough)

by Ted on April 11, 2005

I wish I could have been a fly on the wall for this Reason party. Matt Welch:

What I still can’t understand, is how anyone—seriously, anyone—can think a system where it is extremely difficult for a perfectly healthy young person untethered to an insurance-providing job to obtain health insurance without lying, or without giving up the possibility of having childbirth covered, is a good system…

What I understand even less is how some of these same people will tell you with a straight face how terrible French health care is. Last Thursday-thru-Saturday, we spent a really wonderful time at “Reason Weekend,” which is what my employer does in lieu of a celebrity booze cruise. It’s a great event, filled with smart donors to the Reason Foundation, various trustees, and a few people from the magazine. Great speakers, panels, walks on the beach, etc. Anyway, we had some small discussion group about De Tocqueville, and someone (naturally) brought up France’s high taxes and thick welfare state. “Well, the thing is,” Emmanuelle said (quotes are inexact), “some of the things the French state provides are pretty good. For instance health care.”

“Wait a minute wait a minute,” one guy said. “If you were sick—I mean, really sick—where would you rather be? France or the U.S.?”

“Um, France,” we both said.

Various sputtering ensued. What about the terrible waiting lists? (There really aren’t any.) The shoddy quality? (It’s actually quite good.) Finally, to deflect the conversation away, I said “Look, if we made twice as much money, we’d probably prefer American health care for a severe crisis. But we don’t, so we don’t.”

{ 78 comments }

1

Uncle Kvetch 04.11.05 at 4:42 pm

Not terribly surprising, given the coverage of foreign health care in the US media (and not just in Reason Magazine, for that matter). I think it’s just a general article of faith among most Americans who haven’t lived abroad that even if our health care system is a godawful mess, the extant alternatives are far worse. Completely wrongheaded, but where are there any voices saying otherwise?

Anytime the New York Times (to take one example) publishes anything at all about health care in France, you can be sure that one of 2 templates will be followed: (1) horrible service, waiting lists, filthy hospitals, bureaucracy, waste waste waste; or (2) very good but unsustainably expensive service, they’ve pampered themselves for too long, now those spoiled brats are finally getting their comeuppance and learning that there ain’t no such thing as a free lunch, that’ll show ’em, ha ha.

2

chuck 04.11.05 at 5:01 pm

Bottom line when talking about this for me is – Is any politician in France running on the issue of health care privatization?

Does any politician in Canada say “I’m going to bring US style health care north!” ?

They can complain a little about it in those counties, sort of how we complain about potholes but go ahead and ask them if they want our system…NO!

3

catdancers3 04.11.05 at 5:11 pm

A couple of weeks ago there was a NPR article on the outsourcing of medical care to India. The care was as good or better. The particular gentlemen they highlighted was from Canada on a waiting list for a knee replacement, and his wait time was lengthy. I cannot remember the exact figures but the price differences of services in India compared to the US was impressive and travel expences were considered.

4

Daniel 04.11.05 at 5:13 pm

“Emmanuelle among the Libertarians” was clearly one of the series that I missed, but if it’s up to the standards of “in Space” and “in the Jungle” I’ll certainly look forward to getting it from Netflix.

5

praktike 04.11.05 at 5:19 pm

I’ve always suspected Welch was one of the good guys …

6

carla 04.11.05 at 5:24 pm

“Anyway, we had some small discussion group about De Tocqueville, and someone (naturally) brought up France’s high taxes and thick welfare state….”

This part kills me.

The perpetuated lie that somehow taxes kill economies and therefore leave the citizenry in a howling pile of quivering jello has been disproven:

http://www.preemptivekarma.com/archives/2005/04/yesterday_at_se.html

But I suppose that old adage of repeating a lie often enough….

7

Matt Weiner 04.11.05 at 5:24 pm

Yeah, praktike, this in particular is brilliant:

Not to be too much of a classist here, but it struck me then that part of the failure to communicate is a logical consequence of the expectation of wealth. Which is to say, of course the health care is better for people of means, so therefore of course it’s better. Expanding beyond health care, this is actually a theme you can see every day, if you look for it — rich or at least well-off people telling the po’ folk how they should behave, and/or how they should interpret the difficult choices they make

though I fear it’ll get him written out of the movement.

8

Jayanne 04.11.05 at 5:28 pm

Sorry to comment on a comment (Uncle Kvetch’s). Joel Krugmann just started an NYT series on health care systems, and he does know about France and does not attack the French system. Here in Europe we find it hard to understand the US system; I do know about it yet it still surprise, and sometimes shocks, me.
If I were very ill and very rich, I might choose a US hospital over a UK one. As it is I’d choose France or Germany over Wales — where waiting lists are amazingly long — and over the other parts of the UK that still have long waiting lists.
France spends about as much on health care as the US — we spend far too little but that’s changing, but not fast enough. It is going to spend less, it has to, but that will still leave it with a good system. Germany probably has the best system in the world but it’s a compulsory insurance one.

9

QrazyQat 04.11.05 at 5:29 pm

Girlfriend’s mom, having avoided doctors and gotten down to an extreme 70 lbs and severe osteoporosis, fell, broke her hip, and had to spend the last 4 years of her life in a hospital with round the clock care. Cost: $50 for the ambulance ride. That’s all.

Her son needed hernia surgery; went to a premier specialist clinic and had it done quite soon. Cost: $0.

10

John Gorenfeld 04.11.05 at 5:49 pm

Matt Welch is good, he gave me a ride home once.

11

praktike 04.11.05 at 6:03 pm

“though I fear it’ll get him written out of the movement.”

That sounds Marxist! To the barricades! Anyone with a driver’s license or who has paid taxes in recent years will be shot on sight!

12

Glen Hiemstra 04.11.05 at 6:10 pm

I spoke to a hospital board and staff retreat. The three docs on the exec team objected when I asked, “how is it that the other seven in the economic ‘group of 8’ spend about half as much on health care but in every case have longer life spans?” They responded, “The fact that their HC system gets better results, is way cheaper, and they live longer does not mean they have a better health care system.” Huh?

13

R.Porrofatto 04.11.05 at 6:33 pm

French System
Cost: 9% of GDP
Coverage. EVERYBODY
Rating: #1 in the world by the WHO

U.S. System
Cost: 15% of GDP
Coverage: 43 million people NOT covered
Rating: #37 in the world by the WHO

You’d think that simply enlightened self-interest would be enough. The sad fact is that while we’ve been at loggerheads over “socialized” medicine for 75 years or more, entire generations of other industrialized countries have enjoyed sensible, full-coverage health systems.

However, they are missing out on one thing that our system has in abundance: personal bankruptcies due to medical costs.

14

Kieran Healy 04.11.05 at 6:35 pm

“The fact that their HC system gets better results, is way cheaper, and they live longer does not mean they have a better health care system.” Huh?

Well obviously the insurance companies don’t make nearly as much money in those circumstances, so these systems must be failures.

15

Xavier 04.11.05 at 6:36 pm

Matt redeems himself somewhat in comments by proposing a relatively libertarian solution to health care, but this is still shocking and disappointing. Taking money from the rich to pay for health care for the poor is fundamentally unjust. I don’t care if it works; it’s just wrong.

16

mq 04.11.05 at 6:46 pm

One problem with the French health care system is that patients don’t have the protection of malpractice suits, so some doctors can be rather high-handed and ignore patients concerns and comforts. I have heard some bad stories about this.

As defenders of our American health care system are the first to point out, we Americans are firmly guaranteed legal protection against medical errors…ummm…wait a minute…

17

Steve LaBonne 04.11.05 at 6:52 pm

“French System
Cost: 9% of GDP
Coverage. EVERYBODY
Rating: #1 in the world by the WHO

U.S. System
Cost: 15% of GDP
Coverage: 43 million people NOT covered
Rating: #37 in the world by the WHO”

Could someone please persuade Soros or Gates or some other liberal-ish squillionaire to finance an ad campaign that blankets all media with this stark comparison? The gross ignorance of most Americans about health care in other industrialized countries is what enables the insurance companies to have their mendacious Harry and Louise propaganda taken seriously.

18

Walt Pohl 04.11.05 at 6:52 pm

Xavier, this is the most morally bankrupt thing I have ever heard anyone say: “Taking money from the rich to pay for health care for the poor is fundamentally unjust. I don’t care if it works; it’s just wrong.” Members of NAMBLA have a clearer notion of right and wrong than you do.

19

Uncle Kvetch 04.11.05 at 7:03 pm

Sorry to comment on a comment (Uncle Kvetch’s). Joel Krugmann just started an NYT series on health care systems, and he does know about France and does not attack the French system.

Jayanne, thanks for pointing this out. I’m going to take a look at Krugmann’s series. If it is, as you say, even-handed, then it marks a real departure from the norm, and a positive one at that.

20

P O'Neill 04.11.05 at 7:27 pm

Some of the conservative sputtering about French healthcare springs from their assumption that it must be same as Britain, only worse. But that’s wrong. The French system relies much more on private provision and something approaching actual insurance than the British one does. Of course the state is still the bulwark of the system, but there is service pricing and insurance at least at the margin, which offsets some of the cruder rationining in the NHS style approach (which would still do way better than the US fiasco of a system).

21

Jayanne 04.11.05 at 7:45 pm

You’re welcome, Uncle K. I’m going to follow the series and e-mail him (and do a bit of research first!)

Here’s a quote from today’s piece:

>>>
The United States has the most privatized, competitive health system in the advanced world; it also has by far the highest costs, and close to the worst results.
>>>

Link: http://www.nytimes.com/2005/04/11/opinion/11krugman4.html?hp

p.o’neill,

>>>>
Some of the conservative sputtering about French healthcare springs from their assumption that it must be same as Britain, only worse. But that’s wrong. The French system relies much more on private provision and something approaching actual insurance than the British one does.
>>>>

Yes — it’s also 2/3-tiered, i.e., you get more if you pay more, even within the overall system; that would help win over some of your more obdurate opponents of a decent health system… (I do know what they can be like).

But your system is so expensive partly because your doctors are relatively highly paid (we have a similar problem, ours are a lot better paid than doctors in Spain, significantly better than doctors in France) and partly because of your admin. costs. So you need to do more than win non-doctors over…

22

Andrew 04.11.05 at 7:49 pm

I don’t know about france… but there are waiting lists in US. I have to wait six months to see my opthamologist, and I have a serious degenerative eye disorder (glaucoma). My company pays $200 a month for this insurance that covers about 75% the cost of treatment as an otherwise healthy 24 year old with no “pre-existing conditions” from before I signed up for the company insurance

I still think that Japan has the best system. The insurance is nationalised so the pool is as large as is possible, but the treatment is mostly privatised, so treatment is generally better than that scary hospital in Newcastle near my grandmum’s house. The amount of money spent per person in Japan is quite low, particularly as a percentage of GDP, something like 6%. This is a nation whose population has aged so much that they are experiencing negative growth. And they live long lives, especially the women who don’t smoke two packs a day or drink every day like the men do.

23

Randolph Fritz 04.11.05 at 7:56 pm

“Taking money from the rich to pay for health care for the poor is fundamentally unjust.”

Where did I leave my pistols?

24

sebastianT 04.11.05 at 8:02 pm

“Taking money from the rich to pay for health care for the poor is fundamentally unjust. I don’t care if it works; it’s just wrong.”
-Xavier

It’s not only wrong, but it is also stupid. Think of the spread of thinks like anti-biotic resistant turbuculosis and other disease among the poor and uninsured. Disease doesn’t care if you are rich or poor and when you create an ‘incubator’ for new and more virulent pathogens, all it takes is something new and nasty that, because a large segment doesn’t have any access to health care, is able to spread to epidemic proportions. Then you and everyone else will regret your selfish short-sightedness.

25

sebastianT 04.11.05 at 8:05 pm

Hmm. I should have previewed. I meant that Xavier’s comments are not only morally bankrupt, but stupid, not that the concept of universal health care was wrong or stupid.

26

Jonathan Dursi 04.11.05 at 8:11 pm

One often reads in the main Canadian conservative newspaper op-eds that go something like `Canadian health care per person is third most expensive in the world, so we should consider learning some lessons from the US system’.

I guess if they wrote it as `The cost of Canada’s system is pretty near average for G7 nations, so let’s learn some lessons from by far the most expensive system’, they figure it would be less convincing.

27

Uncle Kvetch 04.11.05 at 8:16 pm

Ouch, Jayanne! I have to tell you that I was disappointed when I looked at the Times. You identified the author as “Joel Krugmann,” and I thought this must be the name of a reporter who was doing a series of news items on health care, but it’s actually Paul Krugman, who’s a progressive columnist (and thus is paid to be strongly opinionated). Oh well…it was nice while it lasted. 8^)

My rap on the NYT is that the actual news coverage of this issue (as opposed to the op-ed pages) is consistently, impossibly skewed. It’s not like it’s a frequent topic, but when it comes up, it’s always in service of some master narrative: “It looks tempting until you see how it actually works” or “It worked great for 50 years, but now the wheels are coming off,” or something along those lines.

28

Dominion 04.11.05 at 8:22 pm

“Matt redeems himself somewhat in comments by proposing a relatively libertarian solution to health care, but this is still shocking and disappointing. Taking money from the rich to pay for health care for the poor is fundamentally unjust. I don’t care if it works; it’s just wrong.”

This is so typically libertarian that it makes my gorge rise. I mean, really, “fundamentally” unjust?

Libertarians just love to pretend they don’t live in a society, that me, me, me, is a perfectly OK personal philosophy, and the good life only to those that can afford it. I tremble to think that there are real people that think this is a workable solution to the problems of this country.

29

Jerry 04.11.05 at 9:03 pm

Without reading through all these entries — too tedious by far — did anyone touch on the 15,000 or so French oldsters who died in last year’s heat wave in part because so many doctors and nurses left Paris in August?

30

Matt Weiner 04.11.05 at 9:07 pm

Matt Welch, if you’re still around–I’m glad to hear that Reason is OK on health care–actually I find Reason quite congenial a lot of the time, especially considering how un-libertarian I am. But that bit I quoted sounded downright liberal. Like the sort of libertarianism I might sign off on (the kind that thinks positive liberty is important).

31

Sebastian Holsclaw 04.11.05 at 9:12 pm

“Does any politician in Canada say “I’m going to bring US style health care north!” ?”

Of course not. The world can get the research benefits of the American system without actually having the US style so long as there is at least one major country to free ride off of. That doesn’t it mean it would be great for medical advancements if the US emulated the other health care systems.

“I don’t know about france… but there are waiting lists in US. I have to wait six months to see my opthamologist”? Where do you live? I can get an appointment with a high level opthamologist despite a complete lack of emergency on one day’s notice. I in fact did so just last week. Is this a particular person you are talking about? Because if so, French-style health care doesn’t give an individual doctor unlimited time.

“U.S. System
Cost: 15% of GDP
Coverage: 43 million people NOT covered
Rating: #37 in the world by the WHO””

I don’t mean to be rude, but formulating it as covered/not covered is an odd way of doing so. People without insurance and without money get treated in the US all the time. It isn’t as if they are just dying like French people in a heat wave. (Yes I’m aware of Chicago. This illustrates the difference between silly rhetoric like ‘uncovered’ and useful discussion).

I don’t have enormous objections to the French system, other than that I worry that the US really can’t emulate it without hurting the world in research–something I’m not at all sure I’m willing to give up. Same problem with defense spending–the world would not be better off with the US emulating European defense spending. This is especially true if it came with a European negotiation ethic. You only have the luxury of waiting as long as Europe wants to in responding to threats if you have someone with huge amounts of military spending to back you up. Its great for Europe, but it is nothing that the US could wisely emulate.

32

floopmeister 04.11.05 at 9:28 pm

Taking money from the rich to pay for health care for the poor is fundamentally unjust.

Dreaming the American Dream…

33

Ancarett 04.11.05 at 9:32 pm

“Does any politician in Canada say “I’m going to bring US style health care north!” ?”

Yes. He’s called Ralph Klein, premier of Alberta. He doesn’t completely call for a US style health care system, but he wants to adopt elements of it. His rhetoric has a following in the country, but hardly a majority.

It always amuses me when people in the US rail against other countries for “freeloading” on American R&D. Excuse me, but other countries fund this process both directly and via the extended patents enjoyed by the pharmaceutical and healthcare industries.

34

Bill Gardner 04.11.05 at 9:46 pm

Hi Sebastian,
“Where do you live? I can get an appointment with a high level opthamologist despite a complete lack of emergency on one day’s notice…”
Many people have insurance that is accepted by only a few local providers. Those providers are completely booked. Why get such terrible insurance? Maybe it was the only plan the employer offered.
“People without insurance and without money get treated in the US all the time.” It’s true that people without insurance who arrive ill at an emergency room are cared for. Thank God. However, there is also good evidence that people without health insurance receive less care and are less healthy than those with insurance, controlling for the relevant demographic factors.
“I don’t have enormous objections to the French system, other than that I worry that the US really can’t emulate it without hurting the world in research—something I’m not at all sure I’m willing to give up.” I completely agree that medical research is extremely important. However, it’s less clear to me what point you are trying to make about it’s connection to the US health care system (I won’t put words in your mouth, so I will hold back my arguments here).
By the way, the US government does a terrific job of allocating money for health research via the NIH. And the results are all in the public domain, unlike what gets done in the labs of, say, Glaxo.

35

Nicholas Weininger 04.11.05 at 10:02 pm

Um, guys, hate to rain on your smug little let’s-bash-the-libertarians party, but there is no sort of libertarian–orthodox, heterodox, radical, moderate, whatever–whose ideology demands a defense of the current US health care system. There are, unfortunately, some libertarians who do engage in such a defense. This is dumb, but says little if anything about the philosophy as a whole.

Also, there is, as Matt W. notes, considerable difference of opinion among libertarians about what to do with health care. But plenty of 100% hard-core libertarians who would *never* accept compromise solutions like Bailey’s still fully acknowledge the immense problems of the current system. We do, of course, tend to differ from most here about the reasons for those problems; most of us think the root cause is not that the system is too private but that it’s not nearly private enough.

36

dr2chase 04.11.05 at 10:07 pm

Anyone who cares to see the numbers for themselves can find them at http://www.nationmaster.com/; basic data is free, more interesting stuff costs money (I’m a satisfied customer, and otherwise have no affiliation).

It’s much more depressing than Krugman lets on; we’re not just worse than a few countries (by almost any metric you can name), we’re worse than 20 similar countries, by a good hunk. And on the bad measures, we’re (often) number 1. Motor vehicle death rate? #1 Child maltreatment deaths? #1 Teen age pregnancy (births) per capita? #1. Golly willikers, do you suppose there is anything we could possibly learn from some of these other countries?

37

fasteddie 04.11.05 at 10:18 pm

>>Taking money from the rich to pay for health care for the poor is fundamentally unjust. I don’t care if it works; it’s just wrong.

38

dr2chase 04.11.05 at 10:23 pm

The world can get the research benefits of the American system without actually having the US style so long as there is at least one major country to free ride off of.

If it were only about the money, then we’d only be suckers (kind of hard imagining a Libertarian defense of being a sucker; Ayn Rand would turn over in her grave), but somehow we manage to also get worse results. Not just chumps, but incompetent chumps.

39

Jayanne 04.11.05 at 10:26 pm

>>>>>>>>>
Ouch, Jayanne! I have to tell you that I was disappointed when I looked at the Times. You identified the author as “Joel Krugmann,” and I thought this must be the name of a reporter who was doing a series of news items on health care, but it’s actually Paul Krugman, who’s a progressive columnist (and thus is paid to be strongly opinionated). Oh well…it was nice while it lasted. 8^)
>>>>>

Aaaarrrggghhh I am *so* sorry about that — I thought there was something odd going on, I should have checked. (Yes, I read Paul Krugman regularly.)

I know the series will be an op-ed one still it’s better than nothing.

>>>>
My rap on the NYT is that the actual news coverage of this issue (as opposed to the op-ed pages) is consistently, impossibly skewed.
>>>

I am sorry to hear that, the NYT is usually reasonable — if not particularly progressive by my standards.

>>>>
it’s always in service of some master narrative: “It looks tempting until you see how it actually works” or “It worked great for 50 years, but now the wheels are coming off,” or something along those lines.
>>>>>

points that could well be made of the US health system (if my informants are correct) except, I suppose, that it never worked that well for the uninsured. Not that someone from the UK is best placed to criticise: our system isn’t anywhere near as bad as it’s said to be, but it isn’t as good as the French and German ones, also, Blair’s busily privatising it.

40

Matt Weiner 04.11.05 at 10:30 pm

Nicholas, I think the libertarian-bashing that’s going on is mostly directed at Xavier, who (if he wasn’t joking) made an over-the-top moral assertion, for which he is rightly drawing flack. Then there was my comment, which pertained to Matt Welch’s general observations about the cluelessness of the well-off about the choices the poor make; which is something that I think is something that is more in tune with liberal than with libertarian concerns. So there’s no smug libertarian-bashing party going on here; at least none that rests on the premises that libertarians have to defend the current health system.

As for the notion that our system isn’t private enough–the point is that it could become much better by becoming much less private, as in the French or Canadian system. That casts some doubt on your root cause.

41

Nicholas Weininger 04.11.05 at 11:17 pm

Matt, I had in mind your comment about him “getting written out of the movement” and especially praktike’s response. The idea that most or even many libertarians act like orthodoxy-enforcing Objectivists is silly, and is a convenient way for people to avoid grappling with the real diversity of libertarian ideas and philosophies.

As to the root cause argument: yes, in theory we could improve by adopting a French-style system, though that’s not saying much. The current half-socialist half-corporate massively-regulated hash is probably nearly the worst of all worlds. I think, however, that it could become better still by becoming much more free-market, and I have doubts about the institutional feasibility of implementing a French-style system here (I don’t actually think a Canadian-style system would be better; there are huge differences between the two nearly all of which are to Canada’s disadvantage).

Of course, part of the reason I think the optimum is to go much more free-market is that my definition of “better” is different from yours. In particular, universal coverage is not a goal for me, since I don’t believe in the positive right to rob others under color of law to pay for your sustenance; though I’d not have stated it as categorically and unqualifiedly as xavier, I basically agree with his moral intuition. Just so you know I’m in no danger of losing my Party card. :-)

42

nick 04.11.05 at 11:27 pm

Without reading through all these entries—too tedious by far—

In which case, you don’t know that your question has been covered at length here, and at the same time, have displayed both rudeness and ignorance. Well done, you.

The world can get the research benefits of the American system

Ah, yes, because no American doctor ever uses techniques and knowledge derived, whether directly or indirectly, from nations with public health systems. Not to mention the amount of primary, non-commercial research that comes from the NIH.

What a perfectly stupid argument. Are you suggesting that American hospitals and insurers should be patenting treatment methods and charging licensing fees to foreigners? Because that’s the only consistent basis from which to make the ‘freerider’ claim, other than as a cheap, empty jab; and it’s one that would rightly be considered abhorrent in the medical community.

43

Jonathan Dursi 04.11.05 at 11:29 pm

Sebastian and Bill:

“People without insurance and without money get treated in the US all the time.” “It’s true that people without insurance who arrive ill at an emergency room are cared for…”

It’s worth pointing out that the emergency room is about the most expensive place in the entire health care system to treat someone, and waiting until a condition gets serious enough to warrant an emergency room visit is about the most expensive way you could imagine to deal with it.

44

P.T. 04.11.05 at 11:33 pm

Yes. He’s called Ralph Klein, premier of Alberta. He doesn’t completely call for a US style health care system, but he wants to adopt elements of it. His rhetoric has a following in the country, but hardly a majority.

A very small following. When, before the last federal election, Klein (one of the country’s most prominent Conservatives) publicly hinted at a sharp veering towards private health care, the Liberals jumped on this “hidden agenda” and many observers credit Klein’s gaffe with reversing the Liberals’ slide in the polls and their eventual near-majority return to power.

45

drkoop 04.11.05 at 11:59 pm

Most providers are roughly 50% there to single party payer via their numbers of medicare patients. You don’t hear medicare recipients generally complaining about queuing up or healthcare rationing. The difference between US and elsewhere not discussed on this thread is obesity and income disparity. As recently as the early 1980’s US women over 65 had the longest life expectancies anywhere. The decline subsequently mirrors the take-off in obesity. Let’s see: type 2 diabetes, hyperlipidemia, coronary artery disease, hypertension, stroke, degenerative joint disease, increased rates of colorectal and breast CA, gastroesophageal reflux to name a few results of that upwardly trending phenomenon, and we just so happen to market a few expensive pills for most of these. Single payer can provide relief for the income disparity portion of the problem, but as far as the major trend-setter in this country’s health decline is concerned, it’s probably time to ration the Ben & Jerry’s.

46

Juke Moran 04.12.05 at 12:09 am

Let the uncovered poor die of whatever diseases they contract. Isolating them from the master classes shouldn’t be too hard now that surveillance is everywhere and there are gates on most of the important communities.
Not all of them will die, and the ones who live will have stronger immune systems.
Then we can let them breed (selectively) with the young of the lesser-but-still-privileged, and, after further selection and breeding, the benefits of their strengthened immune systems will accrue to our own superior, albeit somewhat weak in this regard, gene pool.

47

M.A. 04.12.05 at 12:13 am

[i]Yes. He’s called Ralph Klein, premier of Alberta. He doesn’t completely call for a US style health care system, but he wants to adopt elements of it. His rhetoric has a following in the country, but hardly a majority.[/i]

Technically adopting elements of the US health care system would make Canada more European than American — most European countries have more room for private health care than Canada’s system (where, unlike in France, the waiting lists and inefficiency are real enough problems).

48

rc 04.12.05 at 12:14 am

Here are a few cross-national comparisons that may help to make the point:

Percent of GDP spent on healthcare

Per capita expenditures on healthcare

Life expectancy and child mortality

49

praktike 04.12.05 at 12:17 am

Matt, I had in mind your comment about him “getting written out of the movement” and especially praktike’s response.
——-
You protested, and then proceeded to go off into a rather Objectivist moral stance against the very idea of progressive taxation. Odd.

50

Andrew Boucher 04.12.05 at 12:37 am

“Without reading through all these entries—too tedious by far—did anyone touch on the 15,000 or so French oldsters who died in last year’s heat wave in part because so many doctors and nurses left Paris in August?”

The major problem was that the situation was entirely new for the French. In very cold weather in winter the French open metro stations in Paris to let the homeless sleep; they didn’t do the equivalent (opening air conditioned gymnasisums) during the heatwave because they never had had the problem before. Many of the old people who died were living by themselves. But many were also living in nursing-home equivalents, which had no air conditioning.

Anyway, the French health service is very good. Somebody above mentioned that NYT’s articles on French health service always mention waiting lists. I can’t believe the NYT is so misinformed; I presume the commenter was thinking of NYT’s articles on the British health service and was just making the mistake that all socialist health services are the same (they aren’t, of course).

Would the US get British-style national health care or French?

There is an important economic difference between France and the US. Big American companies (GM, Ford) are dying under their health care bills. Under WTO rules countries with national health services have an enormous advantage, which counterbalance advantages such as lower taxes and less regulation.

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Matt Weiner 04.12.05 at 12:41 am

Well, Praktike, Nicholas’s moral pronouncements aren’t necessarily Objectivist. Robert Nozick would’ve agreed with those pronouncments, and he was no Objectivist, nor (I’m pretty sure) an orthodoxy-enforcer.

But my point wasn’t about orthodoxy-enforcing–it was that Matt Welch’s comments seemed to strike at the very heart of libertarianism. I guess they’re not strictly incompatible with the tenets of libertarianism–you can think that all taxation is morally wrong (except as required to support the minimal state) and also think that the rich ought to better understand the choices the poor have to make, I guess–but they’re in pretty serious tension. Matt Welch seems to be saying that social systems should be judged by how well they do by the poor, whereas libertarianism of most any stripe seems to be committed the idea that social systems should be judged by how much freedom they give to people’s purchasing power.

So I don’t think it would be rigidly orthodoxy-enforcing to say that Matt Welch’s comments–the parts that don’t have to do with health care–aren’t something that a real libertarian would say. If some liberal said to me, “You know, taxes are in themselves a very great evil,” I’d say, “You sound like you’re more of a libertarian in disguise.” If some libertarian were to say to Matt Welch, “You sound like a liberal in disguise,” I don’t think that’d be unreasonable or rigid. I say that to him.

(But–Brewers to win the NL Central? One of us is going to be looking silly in October.)

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Shai 04.12.05 at 2:51 am

Anytime the New York Times (to take one example) publishes anything at all about health care in France, you can be sure that one of 2 templates will be followed: (1) horrible service, waiting lists, filthy hospitals, bureaucracy, waste waste waste; or (2) very good but unsustainably expensive service, they’ve pampered themselves for too long, now those spoiled brats are finally getting their comeuppance and learning that there ain’t no such thing as a free lunch, that’ll show ‘em, ha ha.

This is the template too for every article they publish about Canadian health care. They are all written by Clifford Krauss their Canadian correspondent, who is totally incompetent. My sense is that the NYtimes is only looking for novelty stories here. Their stories about asia are even worse, however.

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Bill Gardner 04.12.05 at 5:13 am

Hi Jonathan,
Your point about the cost of ER care is well-taken. Careful, though. I have seen some hospital accounting from the inside & what is charged in ERs isn’t necessarily well-correlated with what it costs. What is even more troubling is that when you get your care through the ER, you have no ongoing relationship with a physician. Continuity of care matters.

It is also important to note that although you can get treated without insurance at an ER, it won’t be free to you unless you are truly indigent.

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R.Porrofatto 04.12.05 at 7:33 am

I don’t mean to be rude, but formulating it as covered/not covered is an odd way of doing so. People without insurance and without money get treated in the US all the time. It isn’t as if they are just dying like French people in a heat wave. (Yes I’m aware of Chicago. This illustrates the difference between silly rhetoric like ‘uncovered’ and useful discussion).

I knew I shouldn’t have gone to sleep. “Uncovered” obviously means “without health insurance,” because, as you probably know, that is what the 43 million figure refers to. As such, when talking about the benefits or lack thereof of any healthcare system, it is neither “silly” nor “odd” to speak of citizens who are simply not a part of the healthcare system. If some of these citizens still manage to get treatment for serious illness or accident through charity or hospital emergency rooms, this has very little to do with an efficient and universal system of health, in fact it underscores the very deficiencies of the system in question. I would imagine that any discussion of health care in the U.S. that did not address those without health insurance would be more than odd, it would be pointless. You do understand the difference, don’t you, despite thinking it silly?

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praktike 04.12.05 at 8:10 am

“Brewers to win the NL Central?”

Troubling indeed.

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Nicholas Weininger 04.12.05 at 8:34 am

Matt, I think you’re applying a somewhat wishful construction to the other Matt’s comments. “Social systems should be judged by how well they do by the poor” is not there, I think. Rather, what he seems to me to be saying is that in judging the overall efficacy of a system, you can’t judge it *only* by how it does for the well-off, and that if a large percentage of the population– including plenty who are not actually that poor– are excluded from the system, that’s a big problem. In particular, he’s complaining that his purchasing power, as a not-rich-but-not-particularly-poor-either person, is severely affected by the ghettoization of individual health-insurance buyers in the current system. (Apologies to the other Matt if I’ve misconstrued).

This weaker statement is perhaps a rebuke to some naive forms of libertarianism– forms which unfortunately one does encounter from time to time– but is certainly not at its core anti-libertarian. If you search around a bit for libertarian discussion of the affordability and portability problems of US health care coverage you’ll find plenty of people on the subject who’d be rather surprised if you said they weren’t real libertarians. Not only Ron Bailey at Reason, but also Arnold Kling and Glen Whitman come immediately to mind. In a more general vein, the Georgists and mutualists out there– see e.g. mutualist.blogspot.com or http://www.progress.org– are also libertarians, quite radical ones too, who’d be extremely surprised if you suggested they were unconcerned with the less well-off.

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Javier 04.12.05 at 9:56 am

I have to second the claim that much of the libertarian bashing that is going on here overlooks the diversity of opinion among libertarians with regards to health care. Here’s one good article by Ronald Bailey that I suggest people read:

http://www.reason.com/0411/fe.rb.mandatory.shtml

I don’t agree with all of Bailey’s arguments, but I think the overall thrust of the article is correct.

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Javier 04.12.05 at 10:03 am

Here’s another libertarian perspective on health care from CATO, which is a summary of a much longer book on the subject:

http://www.cato.org/pub_display.php?pub_id=3627

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Nicholas Weininger 04.12.05 at 10:12 am

Thanks for the links, javier.

I’d also recommend, though it’s a bit dated, Richard Epstein’s book Mortal Peril. Any definition of libertarianism that would read out Epstein is very narrow indeed.

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Steve LaBonne 04.12.05 at 11:37 am

Bailey’s article is full of myths and inconsistencies. Sample myth: a single-payer system would put a stop to progress in medical science. (Last time I checked NIH wasn’t being supported by the insurance companies.) Sample inconsistency: the standard right-wing rants against free-lunchism don’t go well with the standard blinkered-American plaint that other advanced countries have waiting lists for non-urgent procedures. How could any system control costs if it paid for so many MRI machines that everyone had walk-in access??

Sorry, the idea that there is a resposnible libertarian position on health care is a crock.

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digamma 04.12.05 at 2:11 pm

it was that Matt Welch’s comments seemed to strike at the very heart of libertarianism.

You can regard two policies as undesirable but still regard one as more desirable than the other. Certainly most libertarians would say that a true free market in healthcare would be ideal. But given the choice between the un-libertarian system in the US and the un-libertarian system in France, the ideology doesn’t pick a clear winner.

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Javier 04.12.05 at 2:56 pm

Steve, nationalized health care would not stop advances in pharmaceuticals and medical technology. Would it significantly slow the pace of advance? It would and I think this fact is undeniable. As Kenneth Rogoff, a professor of economics at Harvard, writes

if all countries squeezed profits in the health sector the way Europe and Canada do, there would be much less global innovation in medical technology. Today, the whole world benefits freely from advances in health technology that are driven largely by the allure of the profitable US market.

And as Doug Bandow, a CATO fellow, notes:

U.S. citizens are bearing a steadily increasing medical burden: Since 1999 America has accounted for 71% of the sales of new chemical entities, up from 62%. Japan and Germany, the next two largest pharmaceutical markets, account for just 4% each.

Are you claiming that advances in drugs and medical technology would continue at their current pace if private healthcare companies had less of a market and fewer potential profits?

A different, more interesting question would be how much the pace would slow if the United States nationalized health care.

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Dylan 04.12.05 at 2:58 pm

Childbirth should never be insurable in a society with birth control and legal abortion because it’s not a risk. If you require it to be insured you’re simply transferring wealth from those who don’t want kids to those who do. If that’s what you want to do, mandatory health insurance for hospital costs incidental to childbirth is a pretty inefficient way to do it.

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Javier 04.12.05 at 3:12 pm

Sample inconsistency: the standard right-wing rants against free-lunchism don’t go well with the standard blinkered-American plaint that other advanced countries have waiting lists for non-urgent procedures.

I don’t know what you’re trying to say here.

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Steve LaBonne 04.12.05 at 3:12 pm

There’d be just as much basic research (and shouldn’t a real libertarian oppose that, by the way, since it’s almost all government funded?) There’d certainly be a lot fewer me-too drugs developed and marketed at great expense to no public health benefit. Whether there would really be a deficit in genuinely useful new drugs (which, to big pharma’s chagrin, actually don’t come along all that often) is at best unproven. I note that it’s almost always economists- who generally understand very little about science- who make these alarmist claims.

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Steve LaBonne 04.12.05 at 3:19 pm

Javier, I thought I was very clear. It’s hypocritical to complain out of one side of one’s mouth that people expect lavish care when somebody else is paying, yet out of the other side try to claim that having to wait for an MRI is a supposedly dreadful defect of other countries’s systems. In any system, controlling total expenditure = rationing non-emergency care, and people claiming to make hyper-rational analyses of the health care system are the last ones who ought to be caught obfuscating that fact.

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Javier 04.12.05 at 3:26 pm

There’d be just as much basic research (and shouldn’t a real libertarian oppose that, by the way, since it’s almost all government funded?) There’d certainly be a lot fewer me-too drugs developed and marketed at great expense to no public health benefit.

Steve, do you have any evidence for this claim? I’m not trying to pin you down, I’m just genuinely curious about this topic. Do European countries with nationalized health care produce as much basic research as the United States?

And what some examples of some “me-too drugs”? Some potential examples are antidepressants, cholesterol drugs, diabetes treatments, and anti-psychotics. These have mostly been privately produced and marketed, and have generated massive profits. But anecdotally at least, I’ve observed first hand that these drugs have greatly improved the quality of some people’s lives, including the lives of several family members and friends. Wouldn’t shrinking the market in pharmaceuticals reduce the kind of innovation that produced these drugs?

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Steve LaBonne 04.12.05 at 3:31 pm

A steady flow of new statins that often perform worse than the old ones is “innovation”? We can all live without that.

Your proposed comparison is irrelevant unless you can explain why government investment in basic research is somehow connected to the health care system. Before WWII, for example, the US had if anything a more genuinely capitalist health care system than it does now, but negligible governmetn investment in medical or any other kind of basic science research.

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Steve LaBonne 04.12.05 at 4:01 pm

P.S. Most of the profits of the pharma industry come from rent seeking in the form of government patents- another thing that’s hard to square with libertarian ideology, n’est-ce pas? So we have a situation where almost all the intellectual basis for new drugs comes from reasearch funded by tax dollars, and almost all the big profits the pharma companies allegedly need to finance the final steps of drug development come from exploiting the patent laws. Do you see why I’m having trouble understanding how libertarians, of all people, supposedly know how to maintain the flow of medical innovations?

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Nicholas Weininger 04.12.05 at 5:33 pm

Steve, you’re certainly right that before WWII we had a much more capitalist health care system; indeed we had a much more capitalist system before 1965. And before 1965 the relative performance of the system was better and the relative cost as a % of GDP lower. There’s a moral to that.

Moreover, your dichotomy (good basic research vs. bad me-too drugs) is incredibly simplistic; most of what goes on in the medical innovation business doesn’t fall into either category, so it’s ludicrous to claim that all we’d lose in a socialist system is the me-too drugs.

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Steve LaBonne 04.12.05 at 5:58 pm

Steve, you’re certainly right that before WWII we had a much more capitalist health care system; indeed we had a much more capitalist system before 1965.

And that goes right along with my point that the medical advances we now enjoy- I’ll specify, if our like, those since 1965- came out of a system that at at no stage and in no respect had much resemblance to a free market. The vast majority of the actual science underlying new drugs comes from research directly funded by the taxpayers. Until you and Javier deal with these facts, your arguments appear faith-based rather than empirical.

Of course you can have a bad, inefficient government-based system- that is indeed what we’ve had since around 1965. You’re arguing against a straw man- nobody is claiming that government intervention always and necessarily produces good results. On the other hand, there are in observable fact a number of single-payer systems that produce markedly better results for markedly less expenditure. (Where are the pure free-market systems, or anything even close, so that we can judge their actual performance? More faith-based argument.) If your biggest worry about these is loss of future medical progress, you’ll have to expand your argument quite a lot before I start to share that worry.

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Nicholas Weininger 04.12.05 at 9:18 pm

Steve, it is not in fact the case that most of the work required to develop new drugs is done by taxpayer-funded agencies. Basic science is necessary to drug development, but is not remotely sufficient.

Claiming that free markets would work better is not “faith-based argument”; it’s based on the overwhelming record of the success of free markets in every industry in which they have actually been allowed to work. My point in bringing up the pre-1965 system is that, relative to the level of medical knowledge at the time, it worked better than what we’ve had since, and would have continued to improve if the damned social engineers hadn’t interfered with it.

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Jason McCullough 04.13.05 at 12:11 am

“The world can get the research benefits of the American system without actually having the US style so long as there is at least one major country to free ride off of.”

For such a long-lived and frequently conservative talking point, there’s little actual evidence to support this. Where’s the regressions, Sebastian?

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cm 04.13.05 at 1:16 am

matt weiner (comment 7): Good quote; the shorter version is “let them eat cake”.

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cm 04.13.05 at 1:41 am

jayanne (comment 8): As far as I know, having (and paying for) “public” health insurance is only mandated for members of the “worker’s club” in Germany, i.e. employees. And then only with incomes above a minimum and below a cap. Others are free to choose between the public system or private insurers, or go without. (Civil “servants” kind of have their own system.)

Not quite sure what others could have mandatory insurance. I think it’s only workers of various descriptions.

Insurance premiums are around a nominal 14% of gross income. For employees, the employer has to pay 50% as a “hidden” wage component.

Healthcare is provided to unemployment and welfare recipients through one insurer (AOK) to which the others have to make transfer payments.

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Jerry 04.13.05 at 6:42 am

If you’re really sick in Canada and you’ve got money, you join the good doctors migration and come south for treatment. It’s like voting with your feet.

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Steve LaBonne 04.13.05 at 7:14 am

Nicholas, that’s the standard drug-company propaganda line, and it’s partially true but misleading. (Especially since an honest accounting, which we’re unlikely ever to see, would probably show that their real R & D expenditures are embarassingly modest when compared to their marketing expenditures.) Other arrangements most certainly could be made to do the parts of the process they do. The most useful drug of all time, penicillin, was brought to market, after a long delay, through the action of the US government which wanted it availalbe for servicemen after we entered WWII- not by any initiative from the pharma industry.

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RS 04.13.05 at 8:02 am

If the US market is subsidising the rest of the world, surely it is in the US’s interest to switch to the same model and share the costs with those freeloading Europeans?

Or perhaps, given that the pharmaceuticals market is immensely profitable, with only a small proportion of profits reinvested in R&D, and carrying immense marketing costs in the US system, with profit seeking deforming research priorities, safety and efficacy testing, and approval, the freerider idea is simply another American myth?

Note, that I don’t subscribe to the infantile idea that pharmacueticals R&D is easy or cheap, just that this claim that the Europeans are piggy-backing research funded by US market profits is just storytelling.

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