"Sally Pipes summarizes a small part of the evidence."

Really? Sounds more like a whole lot of opinion to me, and a completely wrong opinion at that.

"The point is that for employers, health care is merely a part of total compensation: It reduces cash compensation for employees but it does not increase costs of employment. To argue otherwise is to argue for lower total U.S. compensation -- that is, lower wages for U.S. workers. "

Seriously? The amount of my health care that's paid by my employer is equal to about 90% of my salary. Are you trying to suggest that should my employer no longer need to pay that cost (an ideal situation, agreed) their costs won't go down? It sounds like someone's self-medicating. Take the cost of health care out of the pockets of the corporations, they can then give everyone a $10,000/year raise and STILL see huge profit increases. Anyone who tells you otherwise needs to go back to the first grade and relearn their math.

"I have become alarmed at the loss of freedom of choice that citizens in other countries have in the “programs” they are stuck in."

As someone who has been seriously considering a move to Canada for the last few years, I've done my investigations with friends and family who live there. Their assessment of the care they receive: "You'll probably have to wait to see someone for stupid shit, but you won't die of stupid shit like they do in the States, either." They have a love/hate relationship with it, but admit they would NEVER live under the one in the US.

"They have no alternatives and I am not speaking of alternative medicine"

If people want to go to a witchdoctor on their own dime, they're still allowed, no one can stop them. Fortunately, these systems reduce the amount of alternative "medicine" usage and thus reduced the number of ignorant morons who use it. People are getting actual, evidence-based, scientifically valid treatments.

"just the right to choose a different doctor, hospital, or get a second opinion."

Absolutely, unequivocally false. My Canadian friends laugh at US because WE don't have those choices. My own health care provider has refused my getting a second opinion a couple of times because THEY felt it wasn't warranted.

"Quality of doctors becomes a race to the bottom. The number of graduates is strictly limited and they are so over-booked because of the demand and limited supply that there is no loss of patients for an indifferent and even incompetent care."

This is partially true. The biggest problem with the Canadian health care system, however, is the American health care system. Because costs and payments are completely out of sync with reality, doctors get VERY rich in the States...something it's hard to do in the true North, free and proud. So, the doctors come to the States to get rich, leaving their own country to suffer. Fix the US system, the Canadian system gets fixed for free. But, aside from that...are you suggesting the poor folks go to clinics stuffed with doctors that are of the same caliber as those you and I go to see?

But, to address the specific point: the suggestion here is that it's better for the poor to see no one, then even a half-competent doctor. The suggestion is that because we can't provide everyone with perfect care at all times, we shouldn't even try to provide them with any. You typically get this concept from people who have health care and no clue.

"More than one citizen of a country that has “universal” (state-run) medical care has told me they must get the approval of their doctor to have a simple test done that they are willing to pay for themselves."

They either lied to you, or had asked for a test their doctor felt wasn't necessary. Can you verify the friends are not actually hypochondriacs? This is an additional issue with health care today: WebMD. Too many people thinking they can do the jobs of their doctors just because they can look up symptoms. My own doctor has done the same, BTW, and with good reason. Yet, I've lived to tell the tale.

"It seems that a person’s health and information regarding it is no longer a personal possession. The state is asserting an interest and control of one’s health; and denying information and freedom of choice and self-determination to do it."

Put down the bong, take off the tinfoil. Seriously, Michael, do you read this asinine tripe before posting it? Why is it ok for Gee, Dubya to remove the rights of US citizens, but if a doctor tells you you don't need a test it's the end of civilization as we know it?

"A “one-size fits all” system cannot recognize genetic differences among individuals and cannot use genetic research to individualize treatment even when the research clearly points to the differences among treatments."

Nice reversal of the current course of reality. The fact is, genetic individualization is most likely (in our current system) going to be used to exclude people from access to health care. People who have a genetic predisposition to fatal, congenital diseases are going to be refused health care under an extension of the idea of "pre-existing conditions".

"Most of the cost of the medical system goes to treating chronic and easily prevented diseases. Among these are diabetes, obesity, atherosclerosis, high blood pressure, and the whole panoply of the chronic “diseases of civilization”. These are diseases of choice because they result from one’s personal choices of diet and lifestyle. A system that denies choice to individuals, restricts their access to information, and homogenizes individuals is doomed to failure."

Who IS this moron that wrote this? Can we please take them out and shoot them before they breed and pass this idiocy on? The reason our population suffers from these preventable diseases is simple: they don't have regular, consistent access to a health care professional to keep them "in line". My doctor and I work regularly to keep my health in line, and to avoid easily-avoidable problems. My in-laws, on the other hand, who don't have health care and therefore only get to go to the doctor when a leg is hanging off are all suffering from at least one of the above diseases. Access to preventative care is the ONLY way to prevent preventable diseases. That's why they call it PREVENTATIVE!

"The idea that health is managed through care is wrong. Care treats symptoms, not causes."

Care works that way now because that's all the insurance companies will pay for. They're all starting to get a clue, though, that preventative care reduces THEIR costs.

"And, care has become so haphazard and blind to individual differences that it does as much harm as good."

Where is that? Canada, where their standard of health is higher than ours while managing to spend less per person? Sweden? Same kinds of numbers. Australia? France? Germany? Japan? UK? All of these countries are spending LESS per capita on health care than the US, not to mention a lower percentage of a much lower GDP, yet still manage to field approximately the same number of doctors/1000 persons. They provide a better quality of care to EVERYONE that only a fraction of our population gets access to.

You can argue until you're blue in the face against a national health care system, but ALL of the facts are against you. Are there going to be issues? Certainly. We'll overcome them. We don't have any choice.

As for the article on Latin Americans: He's right, we should totally let the Mexican drug lords sort out their own issues. If a few (more) Americans get killed in the process, we'll get over it. We've got lots to spare. We should just ignore the problem and it'll probably just go away.

Posted by: Upstate Guy on April 13, 2009 10:41 AM

ST – Once again you jump on a phrase like "small farm movement" and turn it into a caricature of the Evil Empire sneaking communism into the organic strawberries. Seemingly driven by a pathological need to find everything and anything I say to be exactly what you hate about Woodstock you ignore the substance of my comment and the referenced links.

Admittedly, I have a love/hate relationship with Whole Foods. Both my wife and daughter are employees, so I'm far from unbiased. Still, one of the Daughter Unit's initiatives has been developing a program to show menus ideas enabling a family of four to shop for a week on $150. We shop the local farmers' market and other local providers as much as practical and buy locally grown items whenever we can in Whole Foods or Hannaford when shopping the supermarket. I'm no evangelical, fundamentalist, vegan locavore insisting that every bit of food that passes my lips be organic and grown within 100 miles. But I do think that one of the most conservative things we can do as consumers is to pay more attention to the quality and origins of what we consume and to do as much business with locals as we can, even if that sometimes means paying more for a given item.

And as for that grass fed beef, yes, it costs more to have beef raised grazing in pastures rather than in feedlots serviced by underpaid illegal immigrants. As long as price is the primary or only metric you're willing to use, you'll keep getting all the ills (health, environmental damages, regulations written by Big Ag lobbyists) associated with the status quo because Big Ag will always beat local farmers on price.

And mega dittos to Upstate Guy for his comments on health care.

Posted by: Chris White on April 13, 2009 11:45 AM

Seemingly driven by a pathological need to find everything and anything I say to be exactly what you hate about Woodstock you ignore the substance of my comment and the referenced links.

The truth, Chris, is that you are a caricature of the dingbat Woodstock hippie.

I grew up in a small farming town in central Illinois and I earned my B.A from the University of Illinois, one of the most important agricultural schools in the country. Your insistence that the farmers around my hometown, the U of I and their associated corporate businesses form some sort of evil conspiracy... well, that's the very trademark of the dingbat Woodstock hippie.

My parents and I lived through the development of large scale farming, so I know how it happened. The intention was to feed the world cheaply and make a good living. Farmers wanted this because it seemed better than going hungry and being broke. For instance, I worked as a kid for a Catholic family (18 kids) that started out owning about 500 acres of cornfields and, through progressive and intelligent management increased the size of their holdings to well over 10,000 acres. They are exceptionally smart, moral and industrious people. They have absolutely no intention of ripping anybody off or poisoning the environment.

The work of the ag school at the U of I, with which that family is closely associated, is equally impressive. They've found a way to grow in excess of 200 bushels of corn per acre in Illinois and preserve the topsoil. It may surprise you to know that the ag school and that family are acutely aware of the issues of soil conservation, pesticide overuse, etc. They are, however, also interested in feeding the world. They take great pride in their accomplishments, and I think they should. I still visit that family and consider them good friends. They are the face of "Big Ag."

That corporate superstructure you like to picture as inherently evil is something that grew organically out of the partnerships of farmers like the family I worked for, grain coops, suppliers, etc. Nobody set out to create something evil. They just wanted to make a profit and feed people.

There is no evil intent within what you call "Big Ag." You are, as usual, deliriously ignorant while posing as somebody who has expertise. Something very different happened over time, which might be termed blindness to the negatives of giganticism. This was a result of rip-roaring success. This is often a problem in human endeavors.

The success of Big Ag (i.e., success in feeding the entire world) is what has led us to this point where we can consider things like pure organic farming and grass fed beef. Believe me, when it becomes economically feasible to make money delivering organic foods and grass fed beef on a mass level, I'll bet that family takes the lead. And, the U of I and what you call Big Ag will be more than happy to deliver organic food and grass fed beef to the supermarket once they discover that consumers will buy it. It's already happening. ShopRite has an organic produce section.

You don't know what you're talking about, Chris. As usual. And, yes, you are the very caricature of the meathead Woodstock hippie.

Posted by: Shouting Thomas on April 13, 2009 12:25 PM

Great rant Upstate Guy. I can honestly say I haven't read anything this dumb on health care in a long long time. He seems completely uninformed on the subject--not just what's going on in other countries, but what's going on right here in the US. "No right to choose a doctor or get a second opinion"? "One-size fits all"? "Approval of a doctor needed for a simple test"? That's us, today, here and now--unless you're fabulously wealthy and can afford to buy your care directly, and don't need to rely on health insurance.

Michael, PLEASE go out and read some informed bloggers on the subject, like Ezra Klein.

Posted by: Steve W on April 13, 2009 1:26 PM

Christ, I think after 4 years of reading this blog and ST's rants, I'm fully qualified to write his biography. Never have I encountered anyone, online or in person, who injects details of his personal history into the discussion of ANY topic as well as you, ST.

Agree with CW (surprise!) and Steve W about the health care article. There are certainly caveats to going with a universal type of plan, but the most of the ones described in the article already exists under our (the US) current system.

Posted by: JV on April 13, 2009 2:22 PM

Yeah, that awesome Canadian healthcare sure helped Natasha Richardson out!

"The reason our population suffers from these preventable diseases is simple: they don't have regular, consistent access to a health care professional to keep them "in line". My doctor and I work regularly to keep my health in line, and to avoid easily-avoidable problems. My in-laws, on the other hand, who don't have health care and therefore only get to go to the doctor when a leg is hanging off are all suffering from at least one of the above diseases. Access to preventative care is the ONLY way to prevent preventable diseases. That's why they call it PREVENTATIVE!"

No wonder why I'm overweight, smoke, don't exercise...I don't have access to a doctor! Thanks again for the laugh.

Posted by: Sick on April 13, 2009 2:33 PM

Christ, I think after 4 years of reading this blog and ST's rants, I'm fully qualified to write his biography. Never have I encountered anyone, online or in person, who injects details of his personal history into the discussion of ANY topic as well as you, ST.

The depth of your jealousy and envy over my lifetime of experience in a variety of fields and locales is duly noted.

To paraphrase Ronald Reagan: "I promise not to use your lack of experience and maturity against you."

I haven't revealed even a tenth of my life experience here. If I did, you would explode with jealousy and envy. That's your problem, not mine.

Posted by: Shouting Thomas on April 13, 2009 2:52 PM

Please get a grip there Shoutin'. Weren't you the guy lecturing me a thread or two back about how misguided it is to try to change things for the better because you never know what the negative side effects are going to be? Now you're offering the utopian goal of feeding the world through better chemistry as a paragon of family farmers' pure motives when some of the negative side effects of the system that resulted from that benign impulse are being discussed.

If you can put a good spin on, for example, Monsanto suing farmers, who don't use their products but still end up with seed stock containing GMO gene structures due to cross pollination, for patent violations or suing local dairies that advertise "our farmers pledge not to use artificial growth hormones", give it a go. Monsanto is only trying to feed the world at an affordable price just doesn't cut it.

Like a lot of areas this is one where a true conservative, or believer in small "c" capitalism would see that exactly the same dynamic is at work in the agricultural sector as it is in the financial sector. There are the huge players, with well-paid lobbyists, supporting compliant elected officials, gaming the system and quelling competitors by any means at their disposal. How is the analysis of this in terms of Wall Street Gamers fodder for calls to gather the pitchforks and torches, but has no place being discussed as Big Ag impacts agriculture and our food choices?

FWIW - you're the one finding vast conspiracies and setting up absolutes here, not me. My position is simply to buy local whenever possible. My comment referenced the Matt Mullenix link about a House bill that came out of the recent spate of food contamination scares. It purports to be about protecting consumers, but a bit of digging shows it is more a threat to small operations without significantly protecting against the problems associated with Big Ag's model. The purveyors of raw milk, the farmers with a few hundred acres will find it far more difficult to operate, and the risk in Big Ag will fall disproportionately on folks like your farm owners to protect the corporations at the top of the system. This also works to keep the production (and thus retail) prices for the small guys as high as possible, thus insuring Big Ag's price point advantage is as large as it can be.

It is interesting and heartening to see some of the links, specifically the Mullenix and Dreher pieces, that point to a different take on certain labels like "conservative", and coming to some of the same conclusions as various folks from the "left" have. Maybe that whole right left thang needs to be sent in for an overhaul.

Posted by: Chris White on April 13, 2009 3:28 PM

Chris I was also interested in the Dreher post and added a comment here:

LINK

I'm sure you're familiar with Wendell Berry, who is nobody's liberal. But the agrarian, neighborly world he knows and writes about is one that could be co-opted by any political party. I keep waiting for it to be snapped up and carried, crowd-surfer style to the front of the political arena. So far, crickets.

Posted by: Matt Mullenix on April 13, 2009 5:05 PM

While not a fan of everything Wendell Berry has to say, he's long been a favorite of mine in many areas, especially where he champions the 'small is beautiful' ethic and aesthetic. And here in Maine it may be the green independents that get there first approaching the topic as a political platform.

Posted by: Chris White on April 13, 2009 7:00 PM

OK people, a few facts about the Australian health care system. Its basically a subsidised private health care system where people can get free access to health care in an public hospital and at subsidised/free care at privately practicing general practitioners.

The cost of our system is less than yours for many different reasons.

1)The British system of medical training; its better. We tend to be more broadly trained and access to specialists is limited by family physician(GP)referral, Family physicians in Australia do much more than family physicians in the U.S. I do most of my own psychiatry, cardiac and respiratory care, paediatrics etc, minor office surgery. Specialist care is expensive care, so the GP tries to fix the problems first and if unable, they then refer on to specialists. Furthermore the GP usually has a holistic view of the patient, you're more than just a cardiac or gastro patient. Integrated health care commences at the point of delivery not further up the therapeutic chain. This is a massive cost saver. However:

2)We have inherited your legal practices so therefore out of fear of being sued we don't do as many procedures as we used to, which of course means more expensive specialist treatment. It also means higher insurance fees and defensive medicine(i.e unnecessary medical tests/specialist referrals to cover your arse) along the entire therapeutic chain. Everyone from the manufacturer of Lignocaine and sutures, to the pathologist interpreting your test result has this constant real threat of being sued. This bumps up the cost significantly.

3)In Australia, 14% of the health insurance payments go to doctors(that's including the specialists) The rest goes to everyone else, Admin, nurses, podiatrists, physiotherapists,lab technicians etc. Doctors aren't gouging the system, neither are they generally in the U.S.

4)When the government pays the government decides what you get, but more importantly it decides what you don't get. Also the decisions tend to be political not medically based. Chris White, would you like Shouting Thomas to make decisions with regard to your health care? The government influences the practice of medicine by subsidising the practices it wants done. We get a guidebook each year telling us which drugs we are allowed to use for what condition. Right wing governments give us more free reign than left wing governments. There is no individualisation with government subsidised health care. Furthermore, political factors influence health care, chiropractic and osteopathy, two well established branches of witchcraft are partially subsidised by the state. When the medical profession advised the government not to subsidise these, they were percieved as acting out of malice.

5)Waiting lists. You can have a free hip replacement but you have to wait two years to get it done. I know people who have died waiting for heart surgery.

6)Free health means that the doctors time is frequently wasted with people who come to the doctor at the slightest symptom. There needs to be a bit of a dis-incentive with regard to attending a doctor. Coughs and colds do not need to be immediately seen, patients tend to abrogate all self responsibility. The medical system gets gummed up by these people taking up the doctors time which would be better spent looking after sick people.Once our practice started charging all patients, our numbers went down significantly but we tended to see more sick people per unit of time.

7)Free health care means more money for luxuries. Until some recent government changes millionaires were just as able to to access free care as the most destitute. Is that right?

8)Doctor numbers. When the government is paying the bills the government tries to restrict doctor numbers. Each doctor is a potential point of increased government expenditure. The Australian government did this and then suffered the political consequences, the next thing it did then was import massive numbers of Third world doctors in response to political pressure, net result, the locally trained doctors are busy always, since people don't like the third world doctors either due to cultural or competence issues. Medicine is not an amateur sport, it's fucking hard at times, and there will only ever bee a small pool of naturally talented people who are going to be good at it in any group.

9)"Most of the cost of the medical system goes to treating chronic and easily prevented diseases. Among these are diabetes, obesity, atherosclerosis, high blood pressure, and the whole panoply of the chronic “diseases of civilization” So, so true. Statistically thinner active people are healthier. No medical therapy is as good as preventing heart disease as stopping smoking. Most diabetics go into remission if they loose significant weight and hence don't suffer all the complications of diabetes. Obesity and smoking are issues of self control and lifestyle. Personally I'm all in favour of denying public money cardiac surgery to smokers. A year of smoking in Australia costs more than a year of health insurance.

10)American health is expensive because it's American; it's what happens when health care meets American culture. You guys like to sue, find technological fixes for moral problems, demand the best in everything and want it strait away by right of being American. The Leftie Americans are worse of course, because they want it all for free.

So much more to write about but the post is long enough.

Posted by: slumlord on April 13, 2009 7:36 PM

Having experienced health care in both the US and Canada, I may be more qualified than most people to comment on the quality of care one receives in either place.

There are some real advantages to US health care - assuming you have access to it at all, that is. 1) A greater variety of specialists are available in the US, and there are more of them in absolute numbers. 2) More new drugs available in the US, although these are not always as helpful as drug companies insist they will be. 3) American doctors tend to have more time to spend on their patients. Charging higher fees, they don't overbook to the same degree, so they don't rush you through an appt in 10 minutes. On the other hand, I've discovered that when I attend clinics whose doctors are on salary, the rushed feeling is no longer an issue. 4) American patients don't have to wait so long for important but voluntary surgery like knee or hip replacements and so forth.

But those are the only real advantages to the American system of which I'm aware - the ones which you feel on a personal level. On a system-wide level? The main advantage of American medicine is that it has more money available for research. It may be true, as some people say, that the rest of the world piggybacks on American medical research.

That doesn't mean, however, that I think the Canadian system would necessarily work in the US. For one thing, you-all keep thinking in terms of a "national" health care system, which we don't in fact have, or not really. Health care in Canada is a provincial matter, with the federal government providing some (not all) of the funding but not managing the system as a whole.
I've wondered why American states don't consider this possibility, but it seems they won't.
So if you ever do get a large-scale public health system, it's going to be run by your federal gov't, with all the opportunities that offers for loss of local power and autonomy.

Another problem: most provinces in Canada don't shell out for drugs, for dentistry, or for eye care. We pay out of pocket for our medicines, our teeth, and our specs, unless we have private insurance through our employers. (People on welfare have different arrangements.) How would Americans, who are accustomed to having these things paid for by insurance, cope? The SWPL crowd who favour a public health-care system would be the group most likely to suffer from such changes, and thus the system might lose the support of the very middle-class that it needs most. That's why socialized medicine tends to have rather draconian rules against "opting out" of the system for both patients and doctors. Would Americans be willing to tolerate such rules? As a people you are not known for meekly accepting authority.

Another issue: Americans are accustomed to being able to sue doctors for malpractice at the drop of a hat, and can receive huge settlements. Our system puts a firm cap on such payouts. Would you be willing to accept such caps? You would have to be, if Canadian-style health care were to be made to work in the US.

I think you'1l have to consider seriously whether your national culture could tolerate the restrictions that government-supported health care would impose on you.

Posted by: aliasclio on April 13, 2009 8:47 PM

Why are people talking so much recently about returning to a gold standard?

SImple. They're morons. We didn't go off the gold standard because it was working well, we went off it because it produces misery and degradation for the vast majority of the population in the name of defending the value of the wealth of the rich.

Item: in the years 1930-33 (the last gold-standard recession), personal income in the U.S. dropped by almost 50%. In the year 2008, the year we slipped into what will probably end up being the worst non-gold standard recession on record, do you want to know what happened to personal income, year over year? It was essentially flat. Yes, all the dislocations we are seeing around us are the effects of income simply not growing. You care to imagine what it would be like if it actually dropped? People who wax nostalgic about the gold standard always imagine that they would be the ones who had the gold.

Posted by: jimbo on April 13, 2009 10:55 PM

Slumlord & Alias Clio--

Thank you both for your penetrating reports from your respective more socialized than America's health care systems.

My own instincts are that the US should go for a bare bones socialized national medical system that approximates each of yours, or is maybe even a little less generous. To that people could either supplement with cash or with private employer or personal insurance if it's paid them or they wish to pay for it. More bare bones by far than our current medicare and medicaid.

Question for each of you. How do your systems handle the enormous last year of life medical expenses (Religious / moral questions expenses)?

In the US they apparently are 30% of our total health care expenditures. In some cases there's a real hope of reversing the degenerative condition. But in most not. Or not very long into that last year.

My answer is stop the money funneling in those cases. Move to a low cost facility or rather back home. And let the old person die. I'm not at all young myself, can see my end, and still I say this.

Posted by: dougjnn on April 13, 2009 11:22 PM

slumlord and clio, thank you very much for those comments. Reasonable and informed and not cleaving to one political side or the other.

Of course there are pros and cons to both types of systems. The current effort underway in the US isn't necessarily "universal health care," but an effort to insure as many people as possible, both by extending government subsidized coverage to those whose employers do not offer health coverage and therefor cannot afford it, and by making things like records and billing more efficient by brining much of those processes online and, yes, more centralized.

It's clear the current system in the US, while providing top-notch care to those who are lucky to have access to it, is growing increasingly expensive and excluding more and more people. A change that would bring as many of those people under some kind of planned and measurable coverage, while allowing those who are happy with their coverage to keep it seems to me the way to go.

Posted by: JV on April 13, 2009 11:24 PM

JV--

If we had a bare bones federal system as I suggest, then under what I have in mind, employers could still pay for premium upgrades to that system. As could anyone privately. Giving them what they have now. While everyone was covered in the basics.

Posted by: dougjnn on April 14, 2009 12:15 AM

doug, you described more clearly than I, exactly the kind of system I would like to see in the US.

Posted by: JV on April 14, 2009 12:29 AM

I should add, most of the people I know who support some kind of govt sponsored health care are more than willing to pay around what they currently do under employer-based health care to ensure the quality of care they are used to. It's not about the SWPL folks wanting something for nothing. It's about extending health insurance to those who can't afford it. And yeah, it would be the bare-bones kind that doug describes.

Posted by: JV on April 14, 2009 12:32 AM

Perhaps had the wealthy Natasha Richardson fallen on the ground at a ski resort for the wealthy in the US, the kind of protections and medical services available to the wealthy might have saved her life. Might have.

Of course, there are all sorts of people in the US not wealthy enough to be anywhere near a ski resort in the first place. Some of these people may even fall and hurt themselves. I wonder if the US system also does a superior job of giving them care?

Posted by: PatrickH on April 14, 2009 12:50 AM

Question for each of you. How do your systems handle the enormous last year of life medical expenses (Religious / moral questions expenses)?

Very, very good question. There is no standardised answer but generally speaking treatment is left in the doctors hands and most doctors are fairly sensible. When treatment is futile most doctors will stop it, especially family physicians. The worst offenders in this case are oncologists who feel that they have to try every (hideously expensive) treatment--of in many times marginal benefit--that's available.

Health cost skyrocket when the family becomes involved in treatment decisions for loved ones. No one wants to be held responsible for holding off treatment, emotions override objectivity. Some people are uncomfortable making decisions, some are influenced by miracle stories in the media, others have personal agendas that they wish to push. Its actually quite suprising how often the family will push the decision back onto the physician. This is where experts are better making decisions than the lay public. I've switched off ventilators, stopped treatment, ceased resuscitation many times, but it's always been with regard to the best interests of the patient. A good doctor knows when to stop. Emotive relatives frequently do not have the best interests at heart of the patient. Lots of relatives don't want to stop treatment because they will feel bad about themselves.

Another point here is that lots of doctors continue treatment out of fear of litigation. I've seen some pretty disgusting cases, bordering on outright torture, when doctors have carried on continuing treatment in obvious hopeless cases out of fear of the ambulance chasers. In my intern years I was looking after a patient with terminal multiple myeloma who had been resuscitated by the previous intern who was scared of being sued. The patient told me in no uncertain terms that he wanted to die as the boney metastasis were causing him a great deal of pain. When the Code Blue was called I respected his wishes.

The other big problem is specialisation, which tends to produce myopic physicians who only look at the patient through the lens of their speciality. Seriously I've argued with cardiologists about refusing to put 100 year old's in coronary care. I mean are we aiming to prolong life in this instance? The other day an audiologist recommended a cochlear implant in an 86 year old! No common sense, the patient was just as surprised as I was.

Australia is effectively an agnostic country and the medical profession is generally held in high regard (though socialised medicine has chipped at the reputation and prestige of the game) the courts generally support the medical professionals decisions. In the few "right to life "(i.e obligation to live) case that have been fought here, consensus medical opinion is still given precedence over the wishes of the patient, especially where the taxpayer is footing the bill. I'm not sure that such an outcome would occur in the U.S. as the lawyers seem to have far more power.

The other thing that many people have to realise is that death is a natural event. Trying to heroically forestall the inevitable is frequently frustrating, painful for the patient, hideously expensive and I imagine probably unethical.

Posted by: slumlord on April 14, 2009 1:45 AM

Here are a few of the things I especially appreciate and love about the American system.

1] The donation cans you find in small businesses in small towns raising money for some local family so they can get that life saving care for their Mom or little brother before the disease kills them.

2] The way roughly half of bankruptcies are due to overwhelming medical bills.

3] The way so many businesses get to choose between offering health care coverage and making a profit.

4] How economic forces rather than medical needs drives physicians into high paying specialties rather than general practice.

5] How those with employer provided coverage make career decisions based on keeping their insurance.

6] The vast number of hours patients get to spend attempting to get reimbursement for procedures their doctors called for but their insurer refused to cover.

7] Especially the way those who can afford coverage act morally superior to those who can't.

Posted by: Chris White on April 14, 2009 7:25 AM

If Natasha Richardson had gone to the local hospital when they initially asked her to, instead of three hours later, she might still be alive. My father died in similar circumstances last year (though he was a very old man). It's just very easy to underestimate the severity of a knock on the head.

Posted by: intellectual pariah on April 14, 2009 7:41 AM

Always interesting when posting these linkathons to see which of the proposed topics takes off in the Comments. No one has a strong opinion about who should be cast as Monica Lewinsky?

OK, then. A few points on health care for the rest of you to tear apart ...

1) Art De Vany is a very impressive guy. He may or may not be wrong or ill-informed in this particular case, and you may well disagree with him, but he has brain wattage to spare.

2) Saying you think nationalizing health care isn't the way to go doesn't automatically mean you want uninsured people to go screw themselves. And being for nationalized health care doesn't automatically make you a good person.

3) No one has mentioned immigration so I will. We already have as many as 20 million illegals in the country. You're already paying for school and other public services for them. How do you feel about paying for "free" health care for them? Because you know darned well that "advocates" and lawyers and do-gooding judges are going to be doing what they can to prevent us from "denying" "free" health care to them.

4) Incentives. If we're to set up a nationalized health care system, then something really needs to be done to seal up the border. Mexicans already have loads of reasons to come to the U.S. Imagine if we hand out free health care too.

5) I suppose we've already thrown out the Constitution, but just for the heck of it: Where in there is it written that the Federal government shall take care of health care?

6) Cultural diffs. Here I tend to agree with Clio. I don't have any on-larger-principle disagreement with nationalized health care. If a country wants it and can do it, go for it. But I think the U.S. isn't well-suited for it. For one thing there are tons of Americans who don't want nationalized health care, and/or who don't think the Federal govt should be expanding its powers, etc. What are you going to do, force it on them? For another, Sweden, England and France are smallish and (by our standards) highly-centralized countries with long traditions of looking to their rulers to take care of a lot of life for them. You can't say any of that about the U.S. Canada is big and spread-out like we are, but it also has a tradition of submitting to the center. And it has better control of immigration, and it doesn't have a wide-open border with Mexico.

7) I don't know if anybody else has noticed, but our Federal govt is already over-extended, and is doing a perfectly lousy job with many of its major obligations. I can't see how adding something as huuuuuuuge as health care on top of the Federal government's already-huge obligations is going to make basic matters any easier to attend to.

8) We're already broke.

Looking forward to being taken apart on all these points ... But do remember: 1) Just like you, I wish people well. 2) Being for nationalized health care doesn't automatically make you a good person. 3) Pointing out that we have problems now doesn't automatically mean that nationalization is automatically the right solution to any of them, let alone all of them. You still have to make the case that nationalizing is the best thing (or at least a good and sensible) to do. 4) It's wise to be wary of the "something's gotta be done!" reflex. Maybe something does gotta be done. But the urge to DO something, anything, just because "something's gotta be done!" often gets a society in loads and loads of long-term trouble.

Anyway, I'd love to hear the pro-nationalization camp explain where we're going to get the money, why they think the U.S. is well-suited to such a program, what they plan to do about the tens of millions of Mexicans who will try to piggyback on our system (I would too), and why they think our government (which regularly shows itself to be overextended and inept) will do a good job of managing something as ambitious as a nationalized health care system.

Posted by: Michael Blowhard on April 14, 2009 9:45 AM

"How do you feel about paying for "free" health care for them?"

I'm perfectly fine with paying for it. I"m not a selfish prick. They're human beings, too. Just because we have some artificial border between us doesn't change that. They come here, work and contribute to our economy (despite being little more than slave labor), so why shouldn't they have access to health care? And, what makes you think they don't already? Emergency rooms can't deny service to someone because they don't have an insurance card, so they already get care...they just don't pay for it. Cover them, the hospitals will at least get paid and not have to raise costs to cover uncovered patients.

"Because you know darned well that "advocates" and lawyers and do-gooding judges are going to be doing what they can to prevent us "denying" "free" health care to them."

It's sad that people have to be forced to do the right thing, yes, but that fortunately appears to be changing in this country.

"I suppose we've already thrown out the Constitution, but just for the heck of it: Where in there is it written that the Federal government shall take care of health care?"

Where does it say the government will protect us from murders and thieves? Just because something isn't in the Constitution doesn't mean it's not the right thing to do. In case you weren't aware: the health care industry didn't exist in 1776, so it's not likely it would've been covered by the founding fathers.

"why they think our government (which regularly shows itself to be overextended and inept) will do a good job of managing something as ambitious as a nationalized health care system."

As opposed to...?? The insurance industry which has made it all but impossible for a third of our population to be covered? The health care industry which has to continually raise costs to pay for the uncovered patients? You make it sound like we have even a partially working system now...we don't. It's not broken, it's not flawed, it's only slightly better than nothing. If there's a single human being inside our borders that can't get the care they need to stay alive, then the system is a complete failure. There isn't anything the government can do to make it worse.

Posted by: Upstate Guy on April 14, 2009 10:41 AM

"How do you feel about paying for "free" health care for them?"

I'm perfectly fine with paying for it. I"m not a selfish prick.

Translation: Anyone who does not agree with this is a selfish prick.

And I thought someone actually attempted to keep things adult and civil:
Saying you think nationalizing health care isn't the way to go doesn't automatically mean you want uninsured people to go screw themselves. And being for nationalized health care doesn't automatically make you a good person.

Actually, that person tried a couple of times:
2) Being for nationalized health care doesn't automatically make you a good person.

Posted by: Usually Lurking on April 14, 2009 12:19 PM

Upstate Guy,
How many illegals have you paid for down at your local ER? Let us know...

Posted by: Sicko on April 14, 2009 12:42 PM

One of the unsung reasons why gov't-supported health care was able to overcome the opposition of doctors and the well-to-do in countries like Canada and Australia is that those were countries with a large but nevertheless not especially rich middle class population. People there had little experience with the luxury of private care and so didn't resent the decline in quality its disappearance, or restriction, might impose on them.

The struggle was harder, I believe, in Britain, where the richest end of the middle-class was richer than elsewhere in the Anglosphere (except the US itself), and more resistant to change. Thus Britain ended up with a "two-tier" system in which standards in public health care were considerably lower, for a long time, than those in private care. I don't know whether this is still true or whether that kind of private care has now disappeared.

I suspect the US will face the same kind of problems as Britain in its attempt to impose national health care, especially since it's doing so very late, at a time when many American middle class people are rather rich - more of them than in Britain in the 1950s - and accustomed to a very high standard of care already.

I don't know how the nations of continental Europe managed these issues. I suspect that because of their various churches, esp. the Catholic Church, they were rather more accustomed to the idea of publicly-supported health care in the first place. Their doctors were probably also more willing to accept centralized control; and in any case they perhaps did not see themselves as businessmen out to make a profit. But again, I don't really know.

Posted by: aliasclio on April 14, 2009 2:49 PM

The core problems with nationalised health care is how do you limit abuse of it and how to constrain costs.

When things are free people don't value them and abuse them. People go to the doctors at the drop of a hat, frequently for trivial reasons. I remember once having a patient come in at night asking for a consultation. When I sat him down he asked if he could have a "band aid" for a cut on his finger as getting it from the clinic was for free as opposed to buying one from the supermarket. This was a simple straightforward clean cut. Now as he had stepped into my consulting room, I was obliged to make consultation notes (in case I got sued) and charge the government for the consultation (about $40 dollars at the time). The bottom line was that that band aid cost $40 to the community but was "free" to the patient. I have hundreds of literally similar stories to tell about abuse of the system by the patients and of abuse by the doctors. The patients abuse it far far more often. Hypochondriacs(and God knows there are a heap of them) gum up the system since there is no disincentive to go to the doctors. Now the important thing to realise here is while I'm seeing the "time wasters" I'm not seeing the genuinely sick, and since there are only a finite amount of doctors, this means the sick have to wait longer for treatment. People will game the system.

But just to show you how perverse human nature is, I think its worth sharing this little insight with you. Our clinic has a "drop in" facility for the genuinely sick, in other words we try to fit a consultation in between appointments for those who are urgently unwell. Now, old age pensioners who make an appointment are not normally charged for a consultation if they have made an appointment but they are charged if they "drop in" The purpose of this policy is to have time available to see the genuinely unwell while fobbing off the time wasters.Frequently Old age pensioners will come in if they are ill(quite prepared to pay the fee) for a consultation. Many "old school rightie doctors" like my self will see the patient and waive the fee if the patient has presented with a genuine medical emergency; we know these people are poor. The next thing you know once they are better they drop in at anytime expecting free treatment all the time, they don't bother making an appointment. When we charge them they abuse us, even though they are aware of the clinic's policy. Really there are days where I feel like giving it all up, human beings are revolting, especially those who feel welfare is a right.

Secondly medical costs can get out of hand real fast, especially if you have anxious relatives, litigious lawyers,ignorant public, expensive medial advances and jelly spined politicians. Now since the treatments that our system pays for are determined by politicians, which politician do you know would refuse to authorise a treatment of no proven benefit but of huge political approval? Here in Australia there is a tremendous amount of oversight with regard to drug company influence on doctors prescribing behaviour. So what the drug companies do now is get a popular current affairs show to promote their drug as a "major medical advancement", next thing you know the public pressures the politicians who authorise the use of the drug. Costs blow out. Democratic(i.e democracy) politics will eventually destroy universal health care.

It's clear the current system in the US, while providing top-notch care to those who are lucky to have access to it, is growing increasingly expensive and excluding more and more people. A change that would bring as many of those people under some kind of planned and measurable coverage, while allowing those who are happy with their coverage to keep it seems to me the way to go.

I'm not actually sure that the U.S has a top notch medical system even for those who can afford it. It seems hideously expensive per unit cost of health care compared to other countries. I think you Americans like to pride yourself on being the best, but even for your affluent middle class person who can aford top notch insurance, the system over treats and over medicates and does not know when to stop. I'm not sure if that is such a good system.

Oh, an who would I cast as Monica Lewinsky? A younger version of this girl.

Posted by: slumlord on April 14, 2009 7:27 PM






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