Why I prefer French health care
reason.com
reason.com
I'd advocate for a freer health care market, but that's not on the table. In lieu of that, I'd advocate a more French-style system, but that's not on the table. So, I generally just sit health care debates out, aside from talking side issues with people.
For example. I have the best private health coverage I could find and I pay less than $130 a month AUD; but it doesn't stop there. We still have a free health care system if you're ok with waiting for major ops.
In terms of what it would cost me for a GP visit. My current GP costs about $20 a visit but often I can claim the majority back with our Medicare Bulk Billing system (not to be confused with the US Medicare.)
Our system seems to work extraordinarily well. Those who want to pay for health care can (like I do, it's not that expensive) ... those who can't afford too are still covered by our free system.
Ok, Medicare in Australia is a funded by an income tax levy that every Australian pays, set at 1.5%. It's an almost paltry sum of money when you consider it's free healthcare.
My private health insurance also receives a rebate from the Australian Government. From what little I understand about the system, the Australian Government funds this out of my Medicare levy I pay, so that I'm not paying twice.
We also have plenty of other medical programs running in Australia - like the Pharmaceutical Benefits Scheme which helps low income people afford the medications they require. I'm not up on the numbers, but I think it caps the costs of certain medications at about $5
It works well, I don't know too many people that complain about our system at all. The cost of health care certainly isn't an issue at all that weighs on too many peoples minds
"of which you have no first hand experience"
You know this, of course. And one more person's anecdata would be so revelatory on this issue, breaking through the logjam of regurgitated partisan talking points.
Personally, I'm waiting to hear the reason for your apparent ego investment in those two systems.
See, now, I thought that jmackinn's been so very understated and reasonable, thanks for clearing that up for me.
If you're looking for general pointers, you might try the "Criticism" sections of Wikipedia articles on the NHS of England, articles on the subject by organizations like Cato, and that sort of thing.
Walking 30 min/day adds 1.3 years to your life (source: http://walking.about.com/od/healthbenefits/a/livelonger1105....). Moderate obesity takes 3 years from your life (source: http://www.sciencedaily.com/releases/2009/03/090319224823.ht...).
But obviously, none of these factors affect average national life expectancy. Only health care does.
This is why I don't argue for or against health care reform.
Of course the systems aren't perfect, but they're the best of the alternatives.
Oh, Hell, I'll throw you a bone: what happens to comparative life expectancy numbers when you correct for differing definitions of live birth in the US and the UK?
Now, carry on.
So you can't see past the political concretes of today, and you are powerless to influence the future. Some agent for change you are!
That said I have enjoyed the medical care of The Netherlands and the USA at different times and I much prefer the Dutch system. It's just cheaper and less hassle. They're both public/private organized but for whatever reason the Dutch system is just easier for me to deal with. I don't know which one is socialist or which one is free market or whatever. The Dutch one is just cheaper and I get better service.
Maybe the USA can attain lower costs and better service through introducing more competition. Or by training more doctors or public support. I don't care what idealology my elected leaders pick. Just come up with a plan, show me what I have to pay to go to the doctor and I'll decide if I move back to the USA when my time in Holland is up. But that's not going to happen if we as Americans can't move away from infantile and outdated idealogical debates rooted in cold war fear mongering.
What is it about Medicare and other existing US govt healthcare that convinces folks that the US govt can do healthcare on a larger scale?
That's why I make my offer.
Let's give Obama free rein wrt healthcare for folks whose healthcare is already done via the US govts at any level. Not just Medicare/Medicaid (and the state programs), the IHS and other programs, but local, state, and federal employees as well. I'll even throw in companies that get more 70-80% of their revenue from govt. That's easily 40%+ of the population.
Note that those folks are already under "single payer".
In return for free rein, the cost per covered person is capped at today's rates for the first two years and then decreased 5%/year each year for the next four years. Since single payer advocates claim at least a 30% savings and that's just a touch over 20%, that per-person savings should be a slam dunk.
To sweeten the pot, he can use the money from the per-person cut to increase the number of people covered. I'm willing to consider letting other folks/companies buy into the program for the budgeted amount.
The only thing non-negotiable is the total amount spent per person. Yes, he's free to negotiate, remove import restrictions, and the like. However, he can't force people to accept the prices that he'd like to pay - he can only refuse to do biz with folks who don't charge what he'd like. And, if he removes import restrictions, that applies to everyone, not just folks under obamacare.
At the end of six years, we'll know for sure whether the US govt can do healthcare. Heck - I suspect that we'll know earlier.
Deal?
What they share with France: a mandate, a national price list for services, no claim denials allowed for anything on the pricelist, no coverage denials, electronic medical records, subsidies for the poor.
They do better on stats than we do, at much lower cost.
Irrelevant because that doesn't imply that the US govt can do that. (Also irrelevant because the German and Japanese populations are very different.)
That's why I proposed the experiment - let's see what the US govt can do.
Many of us prefer Google to other search engines. Google's existence proves that better is possible, but it doesn't prove that Yahoo or Bing can do better than they do.
One of the things they do, though, is force a price list on providers, something you've taken off the table.
On the other hand, the VA actually has quite a good reputation these days. That's sort of your experiment right there. Costs are holding steady despite a pretty messed-up patient population, doctors and patients like the system, they have a very good electronic medical records system (which they've opensourced, btw) and they use those records to analyze the data and use the treatments that the evidence shows are most effective.
It's been widely reported that about 98,000 people a year die from avoidable medical errors, a lot of it from medication errors. Most hospitals won't talk about their error rates. The VA told everybody, then they fixed it. For example, in a VA hospital every patient has a barcoded wristband. So does every nurse, and every medicine bottle is barcoded too. Every time a nurse gives a patient a pill, she scans all three barcodes, and a computer checks to make sure the patient is getting the right medicine at the right time.
Most private hospitals have little incentive to fix errors, and certainly none to report them. Reporting just gets you sued, and in a fee-for-service system, fewer errors just means less money.
My point is that the US govt will be doing the regulating.
Note that the US govt doesn't actually provide medical services under medicare either - it just "regulates" them.
I didn't say anything about what Obama could do - free rein means he gets to decide. He can go with regulation, govt hospitals, whatever.
> in a fee-for-service system, fewer errors just means less money.
IIRC, Medicare mandates fee-for-service. Under the terms of my deal, Obama gets to change that.
My private health care doesn't work on a fee-for-service system (at least as far as doctors and medical staff are concerned). I doubt that it's the only one.
Yes - it's in the US. If its existence surprises you....
The argument you make is like someone claiming McDonalds is better than a Fine Restaurant for the diner. Because you can swipe your card at the counter in Mcdonalds where you have to get a pen and fill out the receipt at a Restaurant.
They might claim this, but they would not have the data to back the claim up.
* Canadian health care costs less than half the money, per capita, as American health care.
* Median wait times in Canada are the same as or better than in the US.
As someone who lives in Canada and has had many opportunities to experience Canadian health care - from head injuries to electrocution to infected burns to pneumonia - I can state anecdotally that the publicly funded, single payer medical care I and my family have received has been uniformly timely, professional, skillful and professional.
If you look at the breakdown of things you'll see that a lot of the cost difference is because people in the U.S. have a choice and they choose the more expensive option. There are also issues of tort reform which the U.S. desperately needs. Because the current system leads doctors to order thousands of dollars in additional treatments to rule out things that Canadian doctors don't have too (and while the actual suits themselves are a relatively small portion spent on health care it should be mentioned that the U.S. pays 4 times more per capita on malpractice suits)
As for wait times it's true but the base line number doesn't take into account the fact that many don't have health care. Again I reiterate the U.S. system is screwed up. But the fact is people with insurance in the U.S. tend to have shorter wait times and it's only when you factor in things like free clinics and government programs that the wait times rise above those in Canada.
Meanwhile, non-mandatory health insurance, in the absence of other factors, is a recipe for adverse selection.
As for your last point i can't really refute it because you didn't really back it up and if it were obviously true than the health debate would be settled already.
"It is not from the benevolence of the butcher, the brewer, or the baker that we expect our dinner, but from their regard to their own interest." Are doctors different?
Adverse selection is also a pretty basic economics concept. You can read more about its applicability to health insurance here - and cites more:
* They passed the toughest, strictest malpractice reforms in the country.
* Seven years later they're still seeing the same skyrocketing health care costs as before the reforms.
Also the banning of private care and noninclusion of drug benefits in most of canada is draconian and half assed at the same time.
Heck, last time I was in the ER the wait times are just as bad as they are in Canada (4 hours in my case), and one of the primary arguments for privatized care is that it reduces wait times for urgent care. Er, not so much.
The question is in the specialized medicine. When you have Canadian officials flying to the U.S. for heart surgery and cancer you start to wonder. The same can be said for the relatively large industry of U.S. insurers who sell policies to Canadians.
Again, that stuff might not mean anything but it points out the problem of anecdotal evidence.
In fact I'd put the people in the U.S. against single payer a step above advocates only because at least they realize their system isn't working while many single-payer advocates refuse to look at the flaws in their own system.
All those countries with exception of greece and the uk are less "bankrupt" then america. None of them spend even 10 percent of their economy on healthcare.
If it is bankrupting them, for arguments sake, what is the alternative? Let individuals bankrupt themselves over healtcare bills or die from nontreatment. There really is no "civilized" choice except universal care.
As for a solution my personal preference is for a baseline supported free market. I face the reality that no society will ever let people die on the street (most single payer advocates ignore the fact that it's illegal for a U.S. hospital to turn away a sick person regardless of whether they can pay). So I have no problem with the Government providing health care for debilitated people.
I also have no problem with free preventative care because it's in society's best interest (being we'll have to provide for the person if they become debilitated).
But I'm for the free market providing those services to the Government. Beyond that I endorse a free market system for individuals in regards to the in-between stuff (broken legs, cosmetic surgery, etc...)
Isn't that the standard argument for capitalism trotted by free marketsrs. If it's OK for them, why isn't OK for socialized services.
The key point the author suggests, and which I agree, is the breaking down of market barriers such as:
- Why do I need a $200+ doctors visit to a "specialist" to get a prescription anti-fungal creme? (Answer: FDA)
- Why does a visit to a "doc-in-a-box" cost me $25 (copay) and my insurance company $75+ when I was only there for 15 minutes (after a 30min wait)?
(Answer: AMA regulates supply of doctors. We may have needed that before technology basically automated routine doctors visits, but we don't need such stringent accreditation for a bad cold diagnosis (flu scare).)
France doesn't solve the cost problem, they just spend their tax dollars on healthcare instead of Defense, Social Security, and Medicare.
Oh, and they have the MHRA - Which is equiv to FDA
Hmmm...something is odd here.
In a variety of countries (Egypt, India, Iran, Turkey, France, to name a few), you can buy many non-narcotic drugs in the pharmacy. So if you have amoebiosis, want birth control, or have the same fungus as the author, you just ask a pharmacist for help.
In the US, all require a doctor's permission.
Every other country in the world treats theur doctor's as humanitarians who deserve an above average but honest wage.
Here is an antibiotic.
btw, I'm not saying that years of school aren't worth it for docs that are more specialized (aka surgery)
Here is an antibiotic."
No, and this is what pisses me off about things like the FDA. They set the standard for risk, instead of letting the market find the appropriate level. And they've set it pretty high, and now basic shit is needlessly expensive and complicated. Cutting corners (ie, letting nurses handle it) is just fine. It might lead to more accidents, but it'll free up doctors to help a lot more people and more than make up for it.
Every other country in the world treats theur doctor's as humanitarians who deserve an above average but honest wage."
After at least 10 years of schooling (plus the debt), grueling work, and 12+ hour work days for many years, doctor's deserve the high wage. When you first start out as a doctor, you don't get that much. It only happens after specialization.
Other countries also pay developers $5/hour and you forget to mention that the cost of living in many "other countries" is significantly lower.
Cost of living is higher in most western european countries and japan than in the US, but their doctors are paid less than US doctors.
That's because most western European countries have socialized health care. The fact that doctors aren't paid well is a product of the system.
Anecdotal evidence seems irrelevant to me. My experience with the U.S. system is completely different from his. I've never wanted to go to a Doctor that was "out of network", I can always get an appointment next day, my co-pay is $10, meds are never more than $20 or so and my insurance company has never come back wanting money from me. Does that make me right? Of course not.
On the macro he's still against France's system for it's "punitively high tax rates that will have to increase unless benefits are cut" and he still endorses a free market system so I don't see this piece proving anything in that regard.
If you look at the breakdown of things you'll see that a lot of the cost difference is because people in the U.S. have a choice and they choose the more expensive option. There are also issues of tort reform which the U.S. desperately needs. Because the current system leads doctors to order thousands of dollars in additional treatments to rule out things that Canadian doctors don't have too (and while the actual suits themselves are a relatively small portion spent on health care it should be mentioned that the U.S. pays 4 times more per capita on malpractice suits) As for wait times it's true but the base line number doesn't take into account the fact that many don't have health care. Again I reiterate the U.S. system is screwed up. But the fact is people with insurance in the U.S. tend to have shorter wait times and it's only when you factor in things like free clinics and government programs that the wait times rise above those in Canada.
And the macro level influences your anecdotal experience too. Will you still have that same care you're happy with if you lose your job?
Actually I thought about this a little today:
The US system is biased towards the extremely ill - it is essentially a bet against you getting an uncommon illness.
The UK system is biased towards the mildly ill - if you have an uncommon illness it doesn't work as well. So it is a bet against not getting an uncommon illness.
I would guess the UK system would bias against rarity since if you make spending decisions centrally you can get more bang for buck, the more people get the disease.
My point is that in the UK you can go see a doctor and get drugs with little effort/cost etc. Whereas if you have something rare or costly the chances of effective care diminish.
It's the reverse in the US because basic care is fairly expensive (if you need it) but if you have a rare or chronic condition the care is available.
Objectivism provides the essential philosophical basis for individualism and long-term rational selfishness required to properly support political conclusions in favor of freedom. Libertarians, on the other hand, don't know or understand the philosophy from which many of their political conclusions were copied, and are thus susceptible to reverting to political conclusions that appear momentarily practical, or consistent with altruism (which many libertarians implicitly embrace).
On top of that, "libertarian" has come to means so many things that it means nothing - there are libertarians in favor of and against abortion, in favor of and against anarchy, in favor of and against anti-trust regulation, to name a few random examples.
Objectivism isn't pervasive enough yet for political change based on it to occur, and libertarianism is a political dead end (because it's not consistent with the terrible mixed bag of present-day American values, or with itself.) So if you consider yourself a libertarian, and you don't like where Welch and his ilk are heading, I invite you to read Ayn Rand and new scholarly works that examine her philosophy deeply (Tara Smith's "Ayn Rand's Normative Ethics: The Virtuous Egoist".)
I've also found that treating social and political issues as axiomatic mathematical systems is the wrong way to go about things in the first place.
Finally, you may have misread the central point of the article. It wasn't an unreserved support of socialized medicine, but rather an acknowledgement that, whatever the problems socialized medicine has, the fucked-up, cronyist mixed system we have in this country is even worse.
The political stuff is just a downstream consequence of a much deeper set of ideas. It's important, but politics is at the periphery of Objectivism (in that Objectivism has political implications, just like any other philosophy), far from the core.
Not to mention, the logical path between Rand's axioms and the rest of Rand's philosophy goes through a thick layer of vague handwaving and unjustified assumptions.
Regardless of the window dressing. Every villain in history has had moral window dressing that claimed they were really good guys.
In popular usage, the word “selfishness” is a synonym of evil; the image it conjures is of a murderous brute who tramples over piles of corpses to achieve his own ends, who cares for no living being and pursues nothing but the gratification of the mindless whims of any immediate moment.
Yet the exact meaning and dictionary definition of the word “selfishness” is: concern with one’s own interests.
This concept does not include a moral evaluation; it does not tell us whether concern with one’s own interests is good or evil; nor does it tell us what constitutes man’s actual interests. It is the task of ethics to answer such questions."
"There is a fundamental moral difference between a man who sees his self-interest in production and a man who sees it in robbery. The evil of a robber does not lie in the fact that he pursues his own interests, but in what he regards as to his own interest; not in the fact that he pursues his values, but in what he chose to value; not in the fact that he wants to live, but in the fact that he wants to live on a subhuman level (see “The Objectivist Ethics”).
If it is true that what I mean by “selfishness” is not what is meant conventionally, then this is one of the worst indictments of altruism: it means that altruism permits no concept of a self-respecting, self-supporting man—a man who supports his life by his own effort and neither sacrifices himself nor others. It means that altruism permits no view of men except as sacrificial animals and profiteers-on-sacrifice, as victims and parasites—that it permits no concept of a benevolent co-existence among men—that it permits no concept of justice."
You drove to work today on a public road or public transit, were kept safe by publicly funded police departments and most likely hold a knowledge-worker job that you're capable of doing in large part because of public education (probably).
But, yeah, you're a self-reliant rugged individualist. I get it.
Rand shows that the world doesn't have to be the way it is right now; she presents a logically consistent philosophy, which we can use to guide ourselves to much greater heights of achievement.
Can you see some parallels between that and the point you're trying to make?
In what world would it make sense to privatize, say, road building and make every road a toll road? It'd be even more of a mess than private health insurance. (EDIT: equivalent mess to the government producing toilet paper, if you'd rather)
Anytime you manage to neatly distill reality to the point where a simple sound byte is the solution to all of our extremely different problems, you've probably entered fantasy land.
Objectivism holds that it is not enough to think about something in isolation to determine its validity. It is equally important to compare ideas with observable facts, and throw out those that are not factually supported as false. ("The true in theory is the successful in practice.")
A fully legitimate government protects individual rights (as defined by Rand); foreign governments or local "revolutionaries" are the initiators of force if they attack such a government. Remember that they would be attacking an entity that does not take anything forcibly from anyone (as it would be funded by voluntary contract insurance sold for individual transactions), and exists only to arbitrate between disputes and protect individuals from being deprived of their property.
Governments come at the end of a very long process - people constantly evaluate, adopt and reject philosophical ideas. These ideas, whatever they may be, are the ultimate determinants of history, and they matter. It's not a given that governments will always grow more corrupt, or that they always need to expand unnecessarily. That those things have always happened to every government in the past is really a stain on the political repercussions of altruistic philosophy rather than men (as they could and should be) or the concept of a legitimate government.
Ideas matter. Anyone who wants to live happy, fulfilling life needs to take philosophy seriously. When a majority of the populace doesn't do this for a long stretch of time, tyranny results, no matter what the government or its laws may have been.
1. The government would initiate force against me to protect their own monopoly on the business of rounding up burglars, giving them a fair trial, and locking them up. 2. The government would let me continue unimpeded, at which point they relinquish their monopoly on the legitimate use of force and cease to be a government. They are simply one of many competing retributive justice agencies, and we have anarchy.
As you can see, Rand's philosophy is not "logically consistent"--it comes to vastly contradictory conclusions.
Though Rand's interest in the-thing-that-she-should-have-just-made-up-a-word-for actually makes aspects of her philosophy appealing to me. I just tend to think more in the terms of the everyman who shouldn't be crushed in the name of The People, rather than the Great Man. Great Men tend to fend for themselves very well...
Sadly, libertarians like me will be tarred with the Randroid label until the end of time, even the anarchists I've known who trace their ideas back to Lysander Spooner. Over the same timeframe, Objectivists will alternately denounce libertarianism and claim they invented it.
Just one of those eternal tempests in a very small teacup.
Unless you have something more substantive to ask than "Oh, yeah?", we're done here.
Here is a source where she does advocate minimal govt:
http://aynrandlexicon.com/lexicon/government.html
> The only proper purpose of a government is to protect man’s rights, which means: to protect him from physical violence. A proper government is only a policeman
What is the basis for this assertion?
> and are thus susceptible to reverting to political conclusions that appear momentarily practical, or consistent with altruism
I don't understand why you are using the word reverting. Are you implying there is something wrong with political conclusions that appear practical or altruistic?
> On top of that, "libertarian" has come to means so many things that it means nothing
That people exist who pervert a term does not render the term meaningless.
> there are libertarians in favor of and against abortion, in favor of and against anarchy, in favor of and against anti-trust regulation
I agree there is no clear-cut libertarian stance on abortion, because there are several confounding factors upon which libertarianism does not opine -- e.g. when does life begin? The libertarian umbrella does indeed ostensibly cover anarchy, and it should not be a surprise that there is a spectrum of belief. If you desire a concrete libertarian platform, you can look to the Libertarian Party.
> libertarianism is a political dead end (because it's not consistent with the terrible mixed bag of present-day American values
Can you elaborate on this? By calling it a dead end, you are saying it has no future, but you are basing this on present-day values, as though these values can never change in the future. I am still unsure as to which values you refer.
> or with itself.)
Libertarianism does indeed cover a spectrum of beliefs. I don't see how that implies that it is a political dead end. Other viable political philosophies cover spectrums of belief (e.g. republicanism, conservatism, populism, liberalism, etc.)
The alternative in the US of course is bipartisanism, which has given us wonders not limited to every iteration of the PATRIOT act, including the recent renewal.
So he opposes "ObamaCare" but loves the French system (no surprise, the French system is clearly one of the best in the world) which he has access to by virtue of marrying a Frenchwoman.
New Reason health care plan: marry a European!
The author of the article was frivolously using medical resources, which is why he couldn't get insurance. If he has been so healthy that he hasn't missed more than three days of work due to illness since 1986, why does he need "routine checkups" every four months. If I was looking at that from the perspective of an insurer, the conclusion that I would draw is that, should this guy ever actually come down with something, he'd be in the hospital for months.
As for IP, what we should really do is get rid of pharmaceutical patents entirely. There are plenty of other ways to fund the research. Half is funded by the government anyway, and a lot of what the big pharms fund is "me-too" drugs and ways to extend existing patents, which makes the spending numbers kind of misleading.