Nicholas, what’s so bad about health care costs growing? People are getting valuable services for those increased costs. Yes, eventually if health care spending grows to some huge percentage of total GDP it’d be hard to pay for that out of taxes without economics disincentives, but that scenario is such a long chain of compounded hypotheticals I can’t imagine how it’s an argument about today. Europe seems to have productivity growth just fine with their public spending share 20 points above ours, for example; we can clearly go to that level without problems.

“Yes, I certainly am claiming there’s a problem with democracy. The problem is that, when you have a good for which popular demand is extremely high and inelastic, and people who want it get to pay for it by raising other people’s taxes, the incentive for cost control is quite weak.”

1) The tax incidence in the United States is pretty flat in actual terms. The amount of income transfer from the rich to the middle class (who do all the consuming) is small. The political incentives for endless tax increases paid for by everyone else is small, apparently, unless you have an alternate explanation for the last few GOP presidents who got elected on tax cutting.
2) What’s an actual real-world example of a US program this is occuring for? Oil demand is high & inelastic, yet the government doesn’t pay for that with taxes on the rich.

It just don’t get the tenuous hypothetical bad outcomes multiple generations in the future relying on worst-case analysis of democracy public spending thing. Didn’t people notice that Friedman’s public choice theory turned out to pretty much be wrong?

For health care, the floor is quite close to the median. This is the lesson in the US from every effort to construct a minimum acceptable benefit package and the benefits provided in the state/federal Medicaid program for the poor. Arguments about “Cadillac” medicine are red herrings. People are uncomfortable when the avaiable care falls below the level of a Corolla, while we’re quite comfortable with people living in the equivalent of 30 year old Yugos.

The closest service that mimics the situation in health care, is education, where we tolerate large discrepancies between poorer urban schools and typical suburban schools but have a substantial discomfort about it.

Perhaps the reason for the priority status of health care and education in this list is that they are most important in creating “capability” in the sense that Sen used the term, and that fairness demands access at levels comparable to the average.

The crudest measure of health care performance suggests the United States is not getting its money’s worth. Average life expectancy in the United States is below that of many advanced countries, most notably Japan. However, life expectancy depends not only on the interventions of the health care system but also on the shape of the population it has to work on. Lifestyles in Japan are healthier than in the United States. The proper way to measure the performance of health care is to measure the difference it makes in the quality of life of people who come for help. We simply do not know how to do this. No government agency, university, or hospital systematically measures the results of health care. Thus, we have no nationwide accounting for the products and services delivered by health care. We can’t tell by how much those products and services grow each year nor can we tell how the total compares with other countries. All we know is how much we spend. What we need to know is whether the higher level of spending means the United States is much less productive in health care than other countries.

In an attempt to test the limits of knowledge here, we studied the treatment of four diseases—diabetes, cholelithiasis (gallstones), breast cancer, and lung cancer—in three countries: Germany, the United Kingdom, and the United States. These three countries were the only countries for which comparable data existed for these diseases, either nationwide or for large regions. Even then we could not get data for diabetes in Germany. For the cancer cases we used an output measure of life expectancy after treatment. For diabetes and cholelithiasis, which have low mortality rates, we used a complex index developed by others to measure the quality of life after treatment. None of these measures of the products and services of health care are very good. However, they are a lot better than nothing, and good enough to tell us whether the United States is much less productive in these diseases than other countries. For the resources used in health care, we counted the “real” operational resources devoted to disease treatment. We counted such things as doctor and nurse hours, pharmaceutical consumption, hospital capital costs, etc.

The results were counterintuitive. The United States is more productive in all these diseases except for diabetes in the United Kingdom. The reasons for this result can be traced directly to the huge differences in the way the health care sector is organized and governed across these three countries. The UK health care system is almost entirely government owned and run. The government has maintained very tight budget control of the system, and doctors are mostly government employees on the salaries. The result has been that the United Kingdom has not invested as quickly in technologies that have dramatically improved the diagnostic capabilities of medicine and significantly reduced recovery time. For instance, the United Kingdom was slower than the United States in adopting laparoscopic surgery. (Laparoscopic surgery is done with tiny surgical instruments and a tiny flexible scope with a light, all inserted through a small incision to minimize tissue damage.) As a result, the United Kingdom had to keep cholelithiasis patients in the hospital considerably longer than the United States. The United Kingdom did not invest as much in CT scanning of lung cancer patients. * * * The study goes on to show that administrative costs in the United States are about a third higher, but that the main difference is that the United States “pays its doctors twice as much as Germany and the United Kingdom.”

States’ rights; but the lack of reciprocity and the silly turf wars of state licensing boards is infuriating. Imagine being licensed as a psychologist in Rhode Island, for instance, where any client visit to MA or CT counts against your severely-limited ‘out of state’ allowance.

Everyone I know who has a health plan is on one that is a HMO. I am still currently covered under my former employer’s plan and it is a HMO plan. I cannot choose whatever doctor I wish. I cannot have physical therapy wherever I wish. When I need to see a specialist, I have to have a referral.

Yet I was and am thrilled to have a healthcare plan. If Sebastian wants to crawl back to the real world, he would find that many, many people have this sort of plan. It’s hardly “the king of health care,” yet most of us would hate to be without it.

1.) Why do we regulate state by state? Why do we have to get different licenses all the time. It really cuts into mobility.

2.) A friend married an older Japanese woman who is a doctor. She trained in Japan and then did a different specialty by doing a residency in Australia. (Her English is excellent, BTW) If she passes her boards, she will have to do a new residency. I know that medical standards vary from country to country, but a third residency seems excessive.

True, anybody can see what an awful failure Social Security is. That’s why President Bush’s campaign to privatize it out of existence has been so successful with the general public.

What are you gonna do? Impose a single-payer system on literally millions of people who don’t want one?

No, as the U.S.A. is a democracy, the idea isn’t to impose, Politburo-style, an efficient health care system upon Americans, it is to sell them on the idea.

Why don’t they want one? How many billions of dollars were spent in the last fifteen years by the health insurance lobby to convince ignorant voters that they don’t really want a health care system that costs four fifths of what they pay now and delivers superior results?

Selling the voters. In the early sixties, what were you going to do, impose integration upon literally millions of (white) people who don’t want it? No, you were going to sell those millions of white people on the virtues of it. Now that was inherently one Hell of a hard sell, because for most of those white people there was no immediate selfish reward to furthering desegregation. But the activists didn’t throw their hands in the air and say “What are you going to do?”, and eventually the vast majority of the public finally did come around.

Compare that with campaigning for single payer. The system we’ve got now is fairly good for doctors (not nurses or aides or orderlies, though) and of course it’s 365 days of Christmas for the executives and stockholders of the health care industry. For the other ninety-nine percent of the public our for-profit system is lousy, scary and grossly overpriced. And don’t forget that the executives of every other business are also getting thoroughly reamed by the private health-care system. If I ever want to set off the CEO of my company on a red-eyed rant, all I have to do is stroll up and ask “Yo, Bill, how are our health-insurance costs doing this year?”

Campaigning for single-payer doesn’t require appealing to anyone’s conscience, but only to their enlightened self-interest. Even voters who don’t give a damn about the forty million uninsured Americans do want secure and affordable health care for themselves and their families. By adopting one of the successful, time-tested systems used in Canada or Western Europe, Americans would get health care which won’t evaporate the instant their employers lay them off. And – this is the knockout selling point – they’d get that medical security at a twenty percent discount. I guarantee you, all working-class people would go for that.

The only disadvantage single-payer advocates suffer is the gross disparity on advertising budgets. If the majority of the general public were acquainted with the statistics all us CT readers have seen showing the proportion of GDP versus life expectancy for various nations, I’m confident we’d already have national health care in the U.S. But instead of hard numbers and honest argument, the public get grossly fraudulent Harry & Louise ads. The project, then, is not to impose on anyone’s consciences, but simply to get the word out there and refute the Harry & Louise lies. Once the public know the enormous advantages single-payer offers them it won’t be hard at all to convince them to support it.

Another factor is that, as far as I can tell, much of America simply doesn’t want nationalized single-payer health care.

And you base this on what?

http://cthealth.server101.com/the_case_for_universal_health_care_in_the_united_states.htm

“Repeated national and state polls have shown that between 60 and 75% of Americans would like a publicly financed, universal health care system.”

Another factor is that, as far as I can tell, much of America simply doesn’t want nationalized single-payer health care. As far as I know, nationalized health-care is part of Canada’s identity. (Canada also isn’t remarkable for the amount of money they shell out for defence purposes.) As far as I can tell, Sweden, France, England, etc are all smallish countries with long traditions of social welfare that emanates from the center. America is huge, rangy, has many different regions and centers, is made up of many different populations, and has a lousy record of running nationwide social-welfare programs. National consensuses (consensi?) are hard to come by here. What are you gonna do? Impose a single-payer system on literally millions of people who don’t want one?

We in the U.S.A. differ from, let’s say, Canada in such a way as to make our health care necessairly thirty percent more expensive?

Sure Americans eat a lot of McDonalds, take plenty of illegal and legal recreational drugs, and have the highest rate of gun violence in the so-called civilized world, but all that together couldn’t add up to thirty percent. They’ve got plenty of dope and fast-food, if not quite so much loose ordinance, up there in Canada too.

The biggest inherent difference between the U.S.A. and Canada I see is that here we let tens of millions of citizens go without preventative health care altogether until they’re so sick the emergency rooms can’t legally turn them away. This would tend to raise the per-capita cost of U.S. health care relative to other countries, but of course single-payer would eradicate that difference.

I reject that as a rational measure of whether there are “enough” seats, because as I said, to establish that we’d have to see what the demand would be if students had to pay the full freight (which they don’t come close to doign even in “private” schools.)

Well, but that is NO DIFFERENT than the state of things in ALL FORMS OF HIGHER EDUCATION IN THE U.S.—students in EVERY field are subsidized by some combination of state taxpayers, private donations, income from endowments, private or federal grants, etc. This issue is not at all specific to medical education and, therefore, has nothing to do with this debate.

Second, I absolutely agree that, any time there are more applicants than seats, there should be more seats. Like, why won’t the Pittsburgh Pirates let me play for them? Clearly, there are more applicants for Starting Second Baseman than here are positions. The Free Market demands more Major League Baseball! (And don’t talk to me about the minor leagues – that’s like becoming a nurse; not good enough for my undeniable skills!)

Third, as long as nicholas insists on referring to Ted’s specifically non-socialist idea as socialist, it seems only fair to refer to our current system as anarcho-capitalist.

Fourth, did the people up above supporting catastrophic care vote for Kerry? If not, then you’re fools. That was his plan – gov’t-run catastrophic insurance for all, thus eliminating the most expensive care from private insurance, reducing cherry-picking, and radically reducing the personal bankruptcy rate. But people were too worried about his windsurfing to pay attention to a truly effective, small-effort/big-impact proposal.

Fifth, since when is raising Social Security “raising someone else’s taxes”?! We ALL pay them, and we ALL benefit. That’s the point. Cripes, is this why libertarians knee-jerk object to gov’t programs? Because they’re physically incapable of recognizing when they receive benefits from them? I mean, a check comes in the mail, signed by the gov’t – surely even a libertarian can look at that check and think, “huh, I seem to have received a benefit from a gov’t program.” But no, someone else is benefitting, and they’re just paying taxes. Amazing.

Oh, and last – thank you, nicholas, for your brilliant suggestion about health care menus in hospitals. There’s nothing someone coping with cancer needs more than sole responsibility for negotiating with his insurer. After all, if he doesn’t get the service he wants, he can just take his business elsewhere.

Seriously, where do these libertarians live? Cos it ain’t this planet….

I reject that as a rational measure of whether there are “enough” seats, because as I said, to establish that we’d have to see what the demand would be if students had to pay the full freight (which they don’t come close to doign even in “private” schools.)