America's Next Great Debate: Health Care

In Canada, a single pregnant woman unable to get into a hospital to deliver makes the news, and gets reported on blogs like this one. That's one woman. In the US, millions of women can't afford healthcare at all. The story described here is incredibly one-sided.

I think you lose the point here.

No one is arguing that the US healthcare system is NOT the best and most advanced in the world, but the lack of a "National Security System" (a la the old continent) is hitting especially hard the poor and unlucky in your country. I don't know if Schwarzenegger's plan will work, but I believe healthcare is one of the few services that needs to have a certain social basis.

Of course you can debate as long as you want on this 'certain' quantification...

anonymous:

I don't see American women delivering babies in roadside ditches.

anonymous,

The problem with Canada's system is not that the poor don't have access, but that even the rich don't have access. The fundamental point is that someone else, regardless of how much you value your health care and are willing to pay, will be deciding how much they want to spend on treating you. Here's an excellent little film with an example of the situation:
http://www.onthefencefilms.com/video/brainsurgery.html

Wow, what an incredibly condescending, arrogant one-sided right-wing piece of Twinkie. And quite disrespectful to our extremely competent european and canadian colleagues.

You even managed to sneak our excessive defense (offense) spending into the debate...

I apologize to the non-US readers of this blog.

I actually find it a bit unusual to find such an opiniative piece on a site like this that's primarily news about medical technologies. I agree that this story is one-sided, and not entirely correct in some aspects. For example, while it is true that America gave a lot of money to European nations post-war, it does not continue to do so. The reason European countries can afford universal healthcare is because:
A) They have a tax rate often around the 40-50 percent level and
B) Doctors don't earn as much as they do in the US (at least in Germany they don't). These countries also spend significant amounts on other areas such as defence, education systems and infrastructure and haven't been parasites on the US Department of Defense for a good while now.

As far as I'm concerned, the question of universal healthcare should come down to principle rather than economics. Does each human being deserve to receive the best possible medical treatment? And by "people", I do mean those who can't afford health insurance (along with millionaires, doctors, congressmen, etc. etc.). I'd hope that a country trying to live up to the admirable ideal that all men are created equal would attempt to assist those who fall through gaps in the social fabric.

Coming from Australia, where there is a rather odd combination of public and private health-care, it's common to see people fleeing the public (free) system because of long waiting times for elective surgeries, etc. These are the same people who complain that the system is broken, and yet whine about excessive taxation levels. I don't believe you can have it both ways.

DrO -- obviously, you won't see Canadian women delivering babies in roadside ditches either. The stories you give are anecdotes, and have nothing to do with anything. If you want to make an effective argument, then talk about proportions of women unable to afford hospitals, etc. You can "prove" anything you would like by anecdote.

As a Canadian, I know that our system has flaws. On the other hand, I am fully confident that it will be there for me when I need it, without my ever worrying about how I pay for it and whether I have insurance right now. Everybody I know who has dealt with serious illness has received top quality healthcare in this country.

Is it perfect? No! Of course not! There are a variety of things that we give up by providng equal quality healthcare to everyone, but to me, and to most Canadians, this tradeoff is fully worthwhile. It's a values question: I am more than willing to take a few risks and have longer waitlists for some conditions if that means that everybody in this country has access to quality healthcare.

And as a med student who plans to practice here -- you couldn't pay me enough to get me to move to the American system and have to deal with the HMO's and people who can't pay and the rest of the garbage that you guys have to put up with.

Thank you to everyone who has responded so far. I feel that health care will be the most important issue in the coming months and years. Some of have expressed your frustration or concern that the article was too "one-sided." Yes it was. It had to be. For better or for worse, when it comes to the topic of socialized medicine, there is no comfortable middle ground. There is no room for moderates in this discussion. Ultimately, you either believe that health care is a right and that all should be taxed for it, or you feel that HC should rely on personal responsibility like food, clothes, and shelter. Either you feel that the gov't should pay for everything and take complete control, or you lean towards supporting personal freedom and liberties.

Yes we used 'anecdotal stories' to help illustrate our point, which was that all universal / gov't controlled / socialized health systems share several common problems. We hope by illuminating these inherent flaws, we will convince people that the Canadian System is NOT the holy grail of health care. That they suffer in many ways due to gov't restrictions on physicians and hospitals, they are hindered by the bureaucratic red tape, and constantly struggle against more taxes or less care.

Tommy: "I'd hope that a country trying to live up to the admirable ideal that all men are created equal would attempt to assist those who fall through gaps in the social fabric."
Tommy, thanks for the comment and i'd like to make 2 distinctions:
1) By supporting freedom, personal responsibility, and the free market, we DO believe we are living up to the ideal that all men are created equal. Remember, its the "pursuit of happiness" that the constitution grants us, not the guarantee.
2) Those who fall through the gaps DO deserve help. We're not against charity. Unfortunately in this debate, some are all too willing to say that those of us on this side of the issue don't care about the poor. Not true. We do. But we realize that the truth is, there just aren't as many poor as people think there are. We have the #1 economy in the world and even our poor have it pretty good. (before people slam me for saying that, yes i've been DIRT poor before). But just because there are a few % at the bottom, doesn't mean we should turn an industry on its head and tax the masses to provide a lower quality care for everyone [in 12-20 wks].

This piece made me cancel my rss subscription.

I'm sorry, but I can't see how this relates to the simple wonders of medgadgets. This piece is an insult to me working as a health professional in Europe.

Mr. Digre,
I ask how did we insult you? Did we lie? Did we misrepresent the facts? Did we challenge the intellect or skill of health professionals in other countries? NO.

If you are unwilling or unable to participate in this debate, than that sir, is infinitely sadder than the loss of your rss subscription.

What's amusing is how people are quick to criticize a blog for writing on a topic of freedom of choice. So, lets not have a choice in healthcare (single payer, who is not me), and lets not even discuss whether its right or wrong to do so. Now that's a way to show moral authority.

What's amusing is how people are quick to criticize a blog for writing on a topic of freedom of choice. So, lets not have a choice in healthcare (single payer, who is not me), and lets not even discuss whether its right or wrong to do so. Now that's a way to show moral authority.

Profoundly silly piece. I worry about the patients of doctors with such a limited understanding of how to use evidence in argument. Do they cherry-pick two or three stories of adverse reactions to beta-blockers and forswear providing them forevermore? I hope their clinical thinking is less muddled and emotional than their socioeconomic-political thinking.

There is a middle ground in this debate. It is to recognise that we are already taxed heavily for healthcare, via Medicare, Medicaid, the VA, etc. It is to realize that systems providing universal access (i.e., most of them) consistantly have healthier populations at a far lower cost. Hence, covering everyone can be done by spending the same tax dollars in a more intelligent way.

The moderate position also recognizes that while the state can't do everything, neither should it be forced to do as little as possible. The same polemics directed at universal health care could be directed at public education, public roads, or the CDC itself. The state provides all those things to people who couldn't pay for them. Providing health care, as well, may add an entitlement, which may or may not cost more than it saves, but which in any case will not transform our society from a free-market paradise to a socialist dystopia. We are not the former to begin with, and add one critically important piece of social insurance will not turn us into the latter.

Robert Farrell:

There is nothing silly in the piece. Unlike what you say, my taxes are actually to go up. Also, unlike what you say health care here is superbly better, more timely and less agonising for patients than the one in Euro-Canada. Yes, there are problems. But most of problems are from gov't intervention. Example? Placing pacemaker in a 91 year old on Medicare, with renal failure. Why do we do it? His family will not have to pay. So no one cares: it's all "gov't' money. If he were a private patient, we would not have to do this. Because it would cost him or his family. His family would even provide confort care at home for free.

Examples in the piece are not without merit. Have you forgotten thousands of dead French couple of years ago, from heat wave? There you have liberals' favorite gov't at work.

How about innovation in health care, health tech? We look everyday for it. And about 1% of what we report comes from Euro-Canada. It's all Siemens and Philips. Nothing new.

"Ultimately, you either believe that health care is a right and that all should be taxed for it, or you feel that HC should rely on personal responsibility like food, clothes, and shelter."

Yes, I totally agree. But why not just state that at the outset of your artilce instead of trying to denigrate the other systems? It's not that one is better or worse in an absolute sense, it's that it's a choice. In most countries, as opposed to the US, most people feel that health care should be a right for all people. People who believe that often believe, also, that having occasional waitlists and imperfect health care performance is a fair tradeoff for living in a society where healthcare is a universal right.

And come on, healthcare is not anywhere in the same ballpark as food, clothes or shelter. Those are fixed expenses: you are not going to enter a catastrophic situation where you suddenly need to spend 25,000 on extra food, extra clothing, or a nicer apartment.

"Freedom of choice"? OK, how's this for freedom of choice: In a system with no safety net, if I can only barely afford necessities (food, rent, etc) and require treatment for a life-threatening condition that costs tens of thousands of dollars, where is my freedom of choice? I have but one choice: imminent death.

"we DO believe we are living up to the ideal that all men are created equal. Remember, its the 'pursuit of happiness' that the constitution grants us, not the guarantee."

Remember that the entire excerpt says that each citizen has "certain unalienable Rights, that among these are Life, Liberty, and the pursuit of Happiness"
Healthcare shouldn't be lumped into the 'pursuit of happiness', rather the right to life. It isn't an "optional extra" (cosmetic procedures notwithstanding). Rather, its absence prevents any pursuit of happiness and will ultimately lead to the loss of life.

Behind this debate, there seems to be a streak of Puritanism that says the poor somehow deserve to be poor, and that they're just getting what they deserve (and conversely that the rich are rich because they're good people). This in a nation that is largely populated by Christians.

Tommy,

To say that you have a right to life means that no one is allowed to kill you, a "negative" right. To say that you have a right to healthcare is a positive right because as opposed to just prohibiting someone from doing something, it requires someone to work on your behalf. In this case it requires a doctor to treat you. It therefore seems more like shifting the burden to having the doctor (or whoever else pays for his services) treat you rather than you doing it yourself or paying him to do it.
So its not a right, it cannot be a right to have someone slave for you. Health or whatever it is, you have no right to someone else's time or labor.

I agree it's not a right to have someone "slave for you". However, as a society it should certainly behoove a certain level of care for all its citizens, regardless of race, wealth or creed.

The main argument contained within the drivel written above is confounded by so many botched and muddled comparisons. Are we comparing access to basic health care needs by the traditionally medically underserved? Are we comparing the state of academic research in medicine between continents? Or maybe the availability of elite medical care to those who can pay for it out of pocket (when the Italian politicians come to have surgery at esteemed clinics in Ohio, who do you think pays for it)?

Let's also NOT confuse the governator's proposed patch-work privatization health care plan with a single-payer, government ("socialized") insurance. I strongly recommend you read some of the recent newspaper editorials on the state of health insurance in this country before comparing apples and oranges. The New York Times is a good starting point, and there are many others as well.

concerned in USA:

Below is from the editorial in the Wall Street Journal:

....
California should not, contra Gov. Schwarzenegger, do new regulatory harm; rather it should repeal existing regulations that cause harm--so as to make health insurance even more affordable.

There is one other way to deregulate: The California government could allow any Californian to buy health insurance from any willing insurer in any state and be subject to the regulations of that state. That way, people could shop for the degree of paternalism they want. If they want insurance from a state that requires many coverages, they could do so and pay the high premiums that result. If they want bare-bones coverage, they could do so also. The result would surely be that some of the current uninsured would buy insurance. Were I in the market for individual insurance and given the choice, I would not bother paying for coverage for alcohol or drug abuse.

If a version of Gov. Schwarzenegger's plan passes, the only thing certain is that there will be more regulation, more government spending and more taxes. A better path would be to deregulate, and thus achieve some increase in the number of insured--without new spending or taxes or regulation.
....

Well, if the Wall Street Journal thinks so, end of story. Would the people who creamed their pants in eagerness for the Iraq war steer us wrong? Case closed.

Iraq war has nothing to do with our discussion. In terms of WSJ, private enterprise produces more for humanity in one month than charities will ever produce. Not that I deny the need for private charities.

I still did not see anyone challenging us, and showing how privatization will improve care of patients. That's where the issue is.

A few points:

RF: Cost--You mentioned the cost of HC and that gov't might [debatable] be able to provide same or better care for less. Thats not the point. We're not arguing this from a purely fiscal point of view. I don't care if the gov't can provide more care for less money, but rather that they are intruding upon my rights and obligations as a citizen. I don't want uncle Sam believing that they can pay for everything I need and I sure as hell don't want them interviewing in my dr/pt relationships. Additionally, if the gov't really wants to fix the problem, they should deregulate the industry and get out of the way.

Anon 4:26: HC is not a right. I understand that people don't plan on 'spending 25k' on clothes etc, but THATS why you get ins. Ironically, the will spend that and more for cars, and homes but not their health? For 90% of the population, its not a lack of finances but a lack of priorities on what matters (hc).

Tommy: Bruder said it best. If you're going to be involved in this argument, you should already understand positive and negative rights. You don't have a 'positive right' to make me study for 12-18 years, work 80+ hours etc etc for free. I'd be happy to work for free if you/society/gov't would pay for my house/food/clothes/etc. But then who'd pay the carpenters/farmers/etc? Do you see how this quickly evolves into a completely socialized system where the gov't continually snowballs into a bigger beast?

Anon 8:16 -- "a society should provide some basic level of care". We can't. We hear this argument a lot that the gov't should AT LEAST provide a BASIC level of care for everyone. This is a moderates way of trying to avoid socialized medicine outright, but at the same time 'trying to help people.' The fact of the matter is that "basic care" and "standard of care" are equivalent. The basic/standard of care for a broken hip is surgical repair. The basic/standard of care for brain cancer is chemo/surgery. No middle ground. You either treat it (like in america) or you don't (like in england, ie "the jack brown story").

concerned in the usa: "recommend you read some of the recent newspaper editorials " Ummm. . . I know America hating is the 'in-thing' but have you tried reading the editorials from other countries about their HC? You are aware that citizens are [successfully] suing the Canadian gov't for failures in their system or that parents of Jack Brown had to move to the USA from England to get his neuroblastoma treated (NHS docs told them it was incurable). Again, this reinforces that our healthcare, although flawed, still infinitely superior.

Bruder: Thanks, its good to know people like you are out there.

I'd like to close this comment w/ a quote from the Judge in historic case against the constitutionality on the Canadian ban on private medicine and a quote from Any Rand.

1)"Some patients die as a result of long waits for treatment in the public system when they could have gained prompt access to care in the private sector." (See Chaoulli v. Quebec (Attorney General), [2005] 1 S.C.R. 791 at paragraph 37)

2)Doctors are not servants of their patients, they are traders like everyone else in a free society and they should bear that title proudly considering the crucial importance of the services they offer.

Ok. Seriously. Americans are slightly nuts.

Maybe it's time you actually took a *good* look at health systems outside your borders instead of relying on people like Mark Steyn for so-called research. For God's sake the man didn't even graduate high-school, and your quoting him on Healthcare Policy for hundreds of millions of people???! Come on - Weeks after the invasion of Iraq he assured his readers that there would be "no widespread resentment at or resistance of the western military presence". In December 2003 he wrote that "another six weeks of insurgency sounds about right, after which it will peter out"; and the following March he insisted that: "I don't think it's possible for anyone who looks at Iraq honestly to see it as anything other than a success story." The man's a fat-head.

If you do look outside the US, you'd find that many socialised systems are very efficient, very advanced and still manage to pay their doctors a big pay cheque. (When have you ever heard of a poor doctor in modern democratic societies??)

Additionally, the main reason you don't generally hear about the people the US system fails is because they're poor and your society would prefer to turn a blind eye rather than confront the huge poverty problems that exist.

Conversely, the reason you DO hear about the failures of the socialised systems is because they occur *very* rarely, and they mostly happen to vocal, litigious middle class citizens.