I would happily sign the Economist‘s editorial today on US healthcare myself (but for that paper’s irritating misuse of the word “America”). Many ‘Bloggers with an unthinking fetish for “market solutions” would do well to give it and the associated special report a scan:
[N]owhere has a bigger health problem than America. Soaring medical bills are squeezing wages, swelling the ranks of the uninsured and pushing huge firms and perhaps even the government towards bankruptcy.
…
America’s health system is unlike any other. The United States spends 16% of its GDP on health, around twice the rich-country average, equivalent to $6,280 for every American each year. Yet it is the only rich country that does not guarantee universal health coverage.
…
In the longer term, America, like this adamantly pro-market newspaper, may have no choice other than to accept a more overtly European-style system.
To quote this week’s Normblog profile:
What philosophical thesis do you think it most important to combat? > That instincts or feelings trump facts. They don’t—get over it.
“[N]owhere has a bigger health problem than America. Soaring medical bills are squeezing wages, swelling the ranks of the uninsured…”
And might it be because of the luducrous legal lawsuits that get filed over there, leading to the inflation in medical insurance.
“America’s health system is unlike any other. The United States spends 16% of its GDP on health, …. Yet it is the only rich country that does not guarantee universal health coverage.”
So that would be similar to the UK where there is universal health care coverage but you get to play the waiting list hokey cokey too.
Rationing is rationing. In the UK healthcare is rationed, in the US healthcare is rationed. Different methods of rationing, the US is a little more honest.
Censorship is censorship. In the UK the media are censored, in Cuba the media are censored. Different methods of censorship, Cuba is a little more honest.
“Different methods of censorship, Cuba is a little more honest.”
Two different courses, two different horses.
Censorship is a means to hide the truth, that is why the Cuban administration have made a point of using it, come to that so did the stalinists, very effectively too.
The Labour administration would have us believe that since they have come to power the british health service has gone from “being the envy of the world” – remember that tired old saw? – to being the best in the world.
Funny how you don’t see too many countries rushing to adopt the british health care system!
To do so they have to reconcile the propaganda – that there is no rationing in the NHS – with the experience of a large proportion of people who use the NHS that there are waiting lists. Fer chris’ sake, there are waiting lists for waiting lists.
Waiting lists == rationing
Censorship == a means to deny the fact
Propaganda== a tool to disguse the fact.
Censorship and propoganda, two tools loved by totalitarians around the world.
APL, I rephrased your formulation about “rationing” to highlight the logical emptiness of your original argument and because it, and the rest of your “yeah-but” response, resembled a Right-wing version of the sorts of lists of excuses Lefties use for various failed Communist projects:
sounds to me rather like: “Yeah, but it’s because of the US sanctions; Cuban Communism would work if it was allowed to develop without outside interference.” (And, at that point, Dave Spart would start drivelling on about the wonderful Cuban system of free healthcare.)
No, it wouldn’t.
There is an absolute qualitative difference between the form of coverage offered by the US healthcare “system” and that provided by the NHS (to cite just one of many European alternatives). This is a distinction that even the not-notoriously-socialist Economist acknowledges and you choose to dismiss as merely quantitative one, a matter of degree.
You made no factual or logical case for the US model. (Though, apparently, it’s more “honest”, which I am sure is a great source of comfort to a family being made bankrupt by the cost of treating one of its members for chronic kidney disease—“Never mind, Joanie, at least our plight displays the inevitable difficulties of running a healthcare system transparently; just think of those poor English people who have to search through the statistics to see how their quality-of-life is eroded on the margins by necessary compromises.”)
One more rambling comment later and you still haven’t made a factual or logical case for the US model.
Instead you’ve now started pointing at random objects on the horizon in a vain attempt at misdirection.
Who said anything about the British Labour Party? Who said anything about the NHS “being the best in the world”?
My original post directs readers to a damning survey of a US healthcare system in crisis and an editorial, by a Right-of-centre newspaper, suggesting that it could learn something from Europe. You’ve yet to dent even superficially the case made by either of these articles. Please stop cluttering up my comments until you have.
Yup, healthcare in America is so bad, Americans cross the border to partake of Euro-style healthcare in Canada, and many others are queueing up to emigrate to Europe. The border guards no longer keep people out – as if anyone would want to go to America and suffer such a healthcare system! If it wasn’t for the endless stream of innovations that European healthcare comes up with, American healthcare probably wouldn’t function at all.
Until Americans realise that health is far too important to be left to private enterprise, and until they agree that everyone is entitled to unlimited free healthcare, regardless of the cost, they will be condemnned to struggle along with the pathetic joke of a healthcare system that they now endure.
Sales of drugs from Canada to customers in the US, often elderly patients who have insufficient Medicare cover, are worth about a billion US dollars per annum.
Toyota and GM have both cited health insurance costs as reasons for choosing to open plants in Canada rather than in the US (despite offers of large subsidies from the states they were considering).
I’m not going to bother with the collection of straw men in your second paragraph accompanying the ill-advised sarcasm of the first, but I’m looking forward to some facts for the defence appearing in this thread. It’s got to happen some time soon.
Everyone knows Europe sux! But you still want us to follow Stalin and build hospitals like tractor factories.
You’ll have to pull the telephone I’m using to call my maddeningly inefficient and obstructive healthcare provider out of my cold dead hands before you impose your Godless socialistic perverted medical practices on the freedom-loving U S of A.
If your health service is so perfect how come we had to save you in two world wars, huh?
Who invented vaccination and antibiotics then, Euroboy?
It’s interesting that supporters of free markets use vocabulary like this when talking about corporations migrating around broken healthcare systems, but rather different vocabulary when talking about corporations migrating around unfavourable tax regimes. Inefficient healthcare systems are like unfair taxes: they stifle industry and discourage investment.
For the same reason they buy brand-new Audis and drive them off the forecourts of overpriced dealerships in clouds of depreciation. That rich people are prepared to pay large sums of money for luxury goods says nothing about the value-for-money they represent. The real test is to ask the highest-paid NHS employees what they think of paying for a private bed—it can be illuminating.
If you were to argue this, you would be wrong (again). This level of innovation comes from the US having a government research and development budget of 2.6 percent of GDP, compared to, for example, the UK’s 1.9 percent (of a smaller GDP). This, incidentally, doesn’t stop the UK from outperforming the US its research publication tally: over 90 citations per million pounds sterling spent compared to the US’s 60 (in 97). British scientific researchers are, incidentally, paid significantly less. (These figures are for all of science, engineering, and medicine, but since biomedicine is widely considered to be one of the UK’s strengths they’d be even more embarrassing for the US if you stripped out stuff like space science and computing.)
No one is advocating this, but even if they were, your argument is broken. One of the main reasons freemarketeers’ approaches to health provision always fail is because like you, they assume that talented people practise medicine for the money. Just as with the open source movement, the truth is that the best are happy to contribute to the common good if they know their generosity isn’t going to be profited from unfairly. (The counter-example I always give is that of the horrible consequences in HIV and hepatitis infections of US bloodbanks paying for donations compared to the British voluntary blood donor system.) Once they are securely employed, people do more and better work in biomedicine in return for freedom from exploitation and a guarantee of public goodwill than they do for extra hard cash.
At last we get to the crux of the matter. What you really mean when you object to European healthcare models is that you believe some people don’t “deserve” treatment. Why didn’t you just come out and say it in the first place? Then we could have had a real argument.
[Note that, scaled for population size, scientists in the UK had the best performance throughout the 20th century in winning Nobel prizes in general and, I think, over the 21st century so far, have performed particularly well in medicine: I can think of four winners since 2000 without even looking them up. How do they do it on such low pay?]
…corporations migrating around broken healthcare systems…
I doubt Toyota and GM give a toss about the broken-ness or otherwise of the healthcare system of the country they are in, but whether that healthcare system represents a drain on their bottom line or not is of far greater concern. And it still doesn’t address my point that the behaviour of users is important: companies don’t use healthcare systems, they only fund them, or not, depending on the environment.
Describing private healthcare as a “luxury good” is an interesting argument. It certainly doesn’t provide the ego massage that driving around in an expensive car does; not many people I know wear badges saying “I spend a fortune each month on BUPA! So there!”
I’m not sure I completely follow your innovation argument. On the one hand, you seem to be saying that the US benefits from a higher Government R&D spend, both as a percentage of GDP and in absolute terms. But you then say that the UK outperforms the US in terms of one productivity standard, research papers published. So shouldn’t The Economist be writing articles lauding the UK for its “impressive innovation” in healthcare? Must have missed that one.
In any event, the issue is a red herring: research papers and government R&D spending are all well and good, but are only indirectly related to innovation in the sense that The Economist meant, and not at all related to consumer choice. For example, it doesn’t take a research scientist to figure out that running a CAT scanner 8 hours a day, 5 days a week is a waste of a good resource. But if you work for the State, you don’t really care. If, on the other hand, you are an entreprenuer who has borrowed a few million to set up a CAT scanner in a clinic, you will want to pay off your loan as soon as possible. Running the scanner 24/7 will do that, and will also provide a better service to patients through greater throughput and shorter waiting times.
You say that no-one is advocating that the State control costs by paying people less, yet that’s exactly what happens, and while I don’t pretend that everyone is only motivated by money, for a large percentage of people it is at least a factor. You also seem to be particularly arguing about scientists. Obviously money is less important to your average scientist than to your average non-scientist, but as I said above, I don’t think we are talking even mainly about scientific innovation, but about general business innovation.
You say that the free-market approach to medicine always fails (a bit presumptuous, no?) because we assume that people practise medicine for money. Firstly, I don’t think that vague comparisons with the open-source movement (which is largely borne on the shoulders of students and people working on their own time) are a sufficiently compelling argument as to why practising medicine, as opposed to any other useful endeavour, should not be assumed to be undertaken for the financial reward. Secondly, it’s not just about the doctors, it’s also about the efficient allocation of capital and the effect of the profit motive on management.
What you really mean when you object to European healthcare models is that you believe some people don’t “deserve” treatment.
No, I do not; if I meant that I would have said so. I object to the European healthcare model because the level of care is set, not by disinterested market forces, but by the very bureaucrats whose jobs depend on there being a certain level of care, and then everyone is forced to pay for that level, and also to pay for the incredible inefficiencies wrought by that system’s insulation from market forces and the effective voice of patient choice. Spending on the NHS has skyrocketed under Labour, yet no-one thinks it has improved the level of care. I believe that if we really cared to give people the healthcare system they wanted, we would let them buy it in an open market. It works for everything else. Why is healthcare different?
> Sales of drugs from Canada to customers in the US
Subsidised by Canadian taxpayers. If they weren’t, there’d be less demand for them.
> This, incidentally, doesn’t stop the UK from outperforming the US its research publication tally: over 90 citations per million pounds sterling spent compared to the US’s 60 (in 97).
1997? That would be after the international campaign got under way to force US pharmaceuticals companies to give away their drugs to the Third World and those companies’ R&D budgets plummetted accordingly. Not saying your point is wrong, necessarily; just that I’d be more interested in seeing figures from, say, 1987, before the very real threat of patent destruction distorted the economics.
> > “I’m not convinced that everyone who “should” have coverage, is actually interested in getting it.”
> At last we get to the crux of the matter. What you really mean when you object to European healthcare models is that you believe some people don’t “deserve” treatment.
That’s a gross misinterpretation of what Stephen said, as I’m sure you’re intelligent enough to know full well. The point is that not everyone wants to spend their money on healthcare. Fair enough, I say. Same as some people want to kill themselves through smoking: I think they’re wrong, but it’s not the government’s place to force them to stop.
What if someone does the maths and decided that it’s probably cheaper, long-term, for them to put money aside to pay for their health than it is to take out insurance? What if they’re just plain rich? Well, they’ll find themselves included in the uninsured statistics and used as proof that US healthcare is inhumane and awful. I’m not saying that all or even most of the uninsured are like that; I’m saying that the use of uninsured figures as a blunt instrument obscures the fact that a lot of people simply make perfectly rational decisions about their own lives. And why shouldn’t they? Sure, it’s a decision that might backfire and be regretted. But all sorts of decisions can be regretted. Are we to put all of them in the hands of the state? Mandatory swimming lessons? Mandatory first-aid courses? Mandatory driving lessons? Mandatory low-fat, low-sugar diets?
I do realise what some commentors didn’t — that your post was supposed to be a criticism of the US, not pro-NHS — but I’ll answer this next one anyway, since it’s come up.
> “Never mind, Joanie, at least our plight displays the inevitable difficulties of running a healthcare system transparently; just think of those poor English people who have to search through the statistics to see how their quality-of-life is eroded on the margins by necessary compromises.”
That’s pretty much exactly the conversation my wife and I have had a hundred times over the last few years — except that you’re hopelessly naive if you think that the NHS is only sub-par on the margins. Get yourself a serious life-threatening condition and you’ll begin to see just how sensible the statement is. Because the problem with the NHS is not only its appallingness, but also the state propaganda that tells you from an early age that your health is covered. The way that most British people find out what the NHS is really like is that they get something nasty. If they’re lucky, it’s curable. If it’s not — diabetes, for instance — then they’re fucked: the NHS’s “care” is so bad as to be almost useless, and no private insurer will cover you for something you’ve already got. At the same moment that you discover how bad the NHS is, you discover that you no longer have any choice but to use it.