I get several technical bulletins from ReedLink, and there has been an ongoing sidebar discussion on universal health care. I finally jumped in, as the editor was soliciting opinions. The situation is unusual, as the target audience is business and technical staff who tend to be well-paid and to have good insurance coverage. I excerpted the sidebar in italics with my responses below.
To peter.cleaveland {at} reedbusiness.com
From a reader named Paul: "How can the key to our productivity be based on turning the best health-care system in the world over to the same people who gave us the IRS and the Postal Service?"I'm fine with turning it over to the people who gave us the interstate highway system, the Apollo moon landing, the Internet, the aviation industry and the computer industry. On those last two, it was many years of generous federal funding that enabled private industry to eventually be in a position to make profits in those fields. Boeing's commercial aircraft division didn't turn a profit at all for its first twenty years of existence. And Paul should just thank whatever deity he prefers that Bill Gates bought MS-DOS instead of the TCP-IP protocol. Had a private entity decided to maximize profits at each step of information transfer back then, he would not be engaging in online conversation with you because the Internet would have been strangled at birth.
From Tim in Pennsylvania, who asked why we had not provided any details on how such a system would work or be paid for "and better yet, why people from countries with universal health care come to the U.S. for health care, instead of waiting 9-12 months to get their free universal healthcare."That's mostly mythology. Most foreigners who get medical care here are travelling or are semipermanent residents. We do get some medical tourism at major research hospitals, but China, India and Cuba are the leaders there (reasonable quality at low cost). Our waiting periods are in fact on a par with those in the rest of the world, and longer for under- and uninsured people. That a few people have enough money to jump the queue here does not impress me in the slightest.
From Jeremy in Utah: "Apparently John, who suggested that universal health care would ease the strain on American companies, has not studied basic economics. The money for universal health care has to come from somewhere, and would be funded by ever higher taxes on companies and individuals. Additionally, any product or service that is considered 'free' will be abused and over-used (hence the strain on our emergency rooms, which treat everyone, regardless of ability to pay, and get overloaded with cases that should be handled by normal office visits). There is no free lunch."Countries with universal health care don't have overused emergency rooms precisely
because they have universal care. Given that we spend twice as much per capita as these countries, it is just nonsense that we need more money. We just need to spend what we are already spending more productively. We are
already paying for universal health care; we just aren't
getting it.
From Sid in Utah: "Tell John to go live in those nations if he thinks universal health care is a good thing. England and Ireland both have income taxes that range just under 50%, and on top of that because so much of income tax is eaten up by health care they have a 20% value-added tax for purchased goods. Most doctors in Ireland are from India because the Irish doctors have moved to the U.S."People in England and Ireland show no great desire to have our health care delivery system, particularly since the poorest British enjoy better health than the wealthiest American demographic.
http://www.ncpa.org/newdpd/dpdarticle.php?article_id=3289From Gene: "I'm hard-pressed to find even one thing that government could do better or cheaper than private enterprise. Private enterprise must yield to the bottom line and spend accordingly, whereas governments merely increase taxes higher and higher to cover expenses regardless of how high they get. ...I can think of quite a few things that the government does better and cheaper. Fire and police protection, roads, water and energy, for starters. Three competing fire departments in a city would give you vastly worse service for far more money, just like our current health care non-system. Ever since Benjamin Franklin founded our first public fire department, nobody has been stupid enough to try that, but we do know what happens to health care costs in towns of similar size that have more than one hospital. Two hospitals means higher costs, and three means even higher costs. That's because health care economics is like fire department economics, not like iPod and and home entertainment center economics.
10% of the population accounts for 72% of all health care costs, and in any given year 50% of the population has NO health care expense at all. That means that you are somewhat more likely to get expensively sick or injured than you are to have your house catch fire, but not by much. Though neither is likely to happen to you, either could happen to you or to anybody. We don't push the entire burden of supporting the fire department onto only those people who have fires. It makes no more sense to stick mainly sick people with most of the burden of supporting the cost of health care. Unfortunately, private insurance exists only to do that to the greatest extent that they can get by with, which is why it is such a disaster. Let's have no more cherry picking--put everybody into the biggest and cheapest risk pool of all, which is all of us.
As Enron and Reliant have demonstrated, maximizing profit in the energy industry is at its root a criminal enterprise. They found that they could make more money by withholding power than by supplying it, so that's what they did, just as insurance companies make more money by denying care as often as possible. Note that publicly owned utilities in California didn't have any brownouts during the manufactured 'crisis'. Using private health insurance is like hiring someone to tap into your power line between the meter and your house and siphon off as much as they can get by with. Isn't it about time that we realized that all infrastructure (health care, energy, fire protection, etc.) is a public good that should be either owned by or closely regulated by the public? (This of course does not rule out subcontracting the provision of some public goods to private entities where appropriate. That seemed to have worked fine with the interstate highway system.) Investment in the public good is the foundation of private opportunity.
Compare the U.S. with Canada for a glimpse of universal health care. Here, you can get any procedure done virtually on-demand, yes, as long as your insurance covers it or you can pay out-of- pocket. But in Canada, you have to wait sometimes years for critical operations such as bypasses, etc. How many Canadians cross the border so they don't have to wait those years?"Not as many as you think. If the operation is in reality critical, you don't have to wait. I'm fine with waiting in line for expensive treatment if whatever condition I have isn't going to kill me any time soon. Most Canadians who have treatment here are either people who are travelling or wintering here or whom the government purposely sends here because it's cheaper for them than maintaining unused capacity. A few years ago, my lab's old thermal analysis equipment finally gave up the ghost. We looked at the demand for that service and decided not to keep it in house because we didn't have enough work to justify the capital investment. Odd that behavior which is considered good business practice in the private sector is considered evidence of abysmal incompetence when governments do it, no?
Also, Gene probably doesn't live in Washington or any other state bordering Canada. If he did, he'd know that there was quite a bit of traffic in the other direction. Canada had to institute a more stringent ID requirement in the mid 90s because hospitals in some cities in Ontario had a caseload that was 5-10% American freeloaders. Health Care for All-Washington has has compiled a list of Canadian doctors willing to see Americans on a cash-only basis. If you live close enough, you can get treatment at about half what you would have to pay here.
http://www.healthcareforallwa.org/Helpline/tabid/59/Default.aspxThis is not just poor people either. Lasix eye surgery was introduced in Canada earlier than in the US, but even though we have now caught up, it's still popular for middle-income Americans to go to Canada for this treatment. They often aren't doing it to save money because they make a vacation out of it. For the price of the surgery alone here (twice what it costs in Canada), in Victoria you can get a weekend with high tea at the Empress, a visit to Butchart Gardens and some nice wool sweaters and Tlingit carvings plus the surgery.
Sorry for ranting so long, but this subject really pushes my buttons. I often went hungry as a kid because my parents were partially disabled and couldn't get health insurance at any price. Everything was out of pocket, and we survived only by endlessly refinancing the house. In any other industrialized country, we would have been just ordinary middle class people. I'm royally sick of all the smug, healthy, affluent near-sociopaths who whine about the possibility of being forced into the same risk pool as actual sick people, and who whine still more when those same sick people wind up in the emergency room on the public dime as a result.
Everybody in! Nobody out!
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