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Tuesday, August 04, 2009

20/20 segment on health care reform

This 20/20 segment on health care reform aired on Friday. John Stossel talks to experts about waiting in the Canadian system, town lotteries to get a family doctor, the price of innovation, and one way you CAN get fast access to health care in Canada. (Hint: you have to bark!)

Another post from MI Health Facts.

Posted by Janet Neilson on August 4, 2009 | Permalink

Comments

What’s weird is the US system is not a pure for profit system. A substantial portion of their health care is already provided by government programs like Medicaid, Medicare and MediCal. These are the areas that are underfunded to the point of bankruptcy. I read somewhere that they now account for almost 50% of the health care in the US. They provide zero innovation and the quality of care provided through these delivery systems is declining while cost is escalating, yet these are the models that Barrack and the Dems want to expand. It is the private 50% that accounts for all of the innovation, competition and economic advantage. Laffer (of the Laffer curve) said this morning on CNBC if you like how the Department of Motor Vehicles and the Postal Service work then you will love ObamaCare. Three words: expensive, inefficient and abusive. I will make a prediction, should the Obama health care initiatives fail, he will be a one term wonder, the dems will lose control of congress and sanity will return to the US economic, political and social world.

Posted by: B | 2009-08-04 10:10:20 AM


"What’s weird is the US system is not a pure for profit system."

Precisely. But you haven't even begun to scratch the surface. The supposedly private segment of the US healthcare system is controlled at every level by government. These controls limit competition and drive up prices. Some like to call it compassionate capitalism. Anyone with any understanding of history and economics know it for what it really is: fascism.

Posted by: Charles | 2009-08-04 10:24:04 AM


To me, the biggest dilemma with fully private care is the trap of getting chronically ill while uninsured. If this occurs, you're essentially screwed.

For example: if you're parents are deadbeats, and do not insure a child, and that child develops diabetes, insurance companies will never touch that child with a 1,000ft pole. Or they'll say: Sure we'll insure Betty... for $15,000/month.

On the Hot Room, I think it was Peter who said, that's not a problem because charity will simply step up to fill in that gap... but I'm not too sure about that.

Posted by: Mike Brock | 2009-08-04 10:45:49 AM


It's also worth mentioning, that studies have shown that about one-third of uninsured Americans are in this very boat. They are not lazy, poor, or the likes. They want to be insured, but pre-existing health conditions make them too much of a liability for health insurance companies, making them uninsurable.

There is no option for these people, other than to make trips to the emergency room (which they don't pay for), or rack up hundreds of thousands of dollars in debt and declare bankruptcy (which they do), or hope that something like ObamaCare comes along.

The anarcho-capitalist theory is that once government disengage from involvement in healthcare, private charities will spring up and save the day. Which sounds similar to socialists believing that once the profit motive is removed, everyone will switch to intrinsic motivations, such as love for their fellow man.

Actually, it's essentially the same theory, isn't it? :)

Posted by: Mike Brock | 2009-08-04 10:51:55 AM


I should mention, that Ron Paul in his latest book, The Revolution, makes the prediction that once Medicaid and Medicare are eliminated, that doctors will provide more pro bono work, and charities will fill the void, as well. However, he only cites anecdotal evidence that this will be the natural outcome of complete privatization.

Posted by: Mike Brock | 2009-08-04 10:55:28 AM


Charles

I understand your point but if the US system is "fascism", then by the same measure of exaggeration, the Canadian system is pure communism. I can still freely contract with health care delivery professionals in the US. Can you name me one country where a pure "for-profit" system exists or one which offers better care than the US? Better still, can you name me one "private sector" anywhere that does not have some level of state control? My point is the label fascism applied to mixed economies is rather useless as they are unfortunately, omnipresent. As a tool for putting perspective to the left right fallacy describing variants of statism I think it serves more purpose.

Posted by: John Chittick | 2009-08-04 11:01:11 AM


Mike -

While this might get me skewered by purists, I don't see a huge problem with the government stepping in to help with someone who becomes chronically ill without insurance or is born chronically ill if they can't afford their own treatment.

That is, I think the government should pay for *treatment* - not try to force insurers to cover them and subsequently raising premiums for everyone. It would probably be the cheapest solution - certainly cheaper than the House bill put forward by the Democrats.

Posted by: Janet | 2009-08-04 11:16:48 AM


Janet,

That's exactly my position, actually. So we're in no disagreement.

Posted by: Mike Brock | 2009-08-04 11:23:25 AM


Mike

Every state has their own mandates and provisions. Many have Insurance pools explicitly for those who have been denied private insurance due to pre-existing conditions. The cost of those plans are higher than private insurance with similar annual deductibles but not beyond what an average income earning person should be able to afford. I know because I have used one while the time limits on pre-existing conditions ran out.

In the absence of these state and federal interventions, I see no reason why similar programmes could not exist in the NGO sector.

Posted by: John Chittick | 2009-08-04 11:29:17 AM


John,

"As a tool for putting perspective to the left right fallacy describing variants of statism I think it serves more purpose."

That was the point. Canadians constantly state that US has a completely deregulated system; which is absurd.

I'm simply trying to point out that we seem to be setting up a false choice here. Canada versus the US. There's a third option. I believe a free market system would would drive costs down to a sufficient point where most people would be able to afford healthcare.

Americans could do this by eliminiating the FDA, getting rid of regulations at every level, changing the ridiculous tax provisions which send ordinary consumers into the arms of corporations, etc.

We would need to completely overhaul our system as well.

As for Janet's and Mike Brock's concerns, I share them. But I think programs to help people out who've made bad choices should not be administered at the federal level. I believe municipalities and charities would be much better equiped to deal with the problem.

Posted by: Charles | 2009-08-04 1:24:11 PM


There is no perfect system anywhere, but there is no shortage of evidence to confirm that our system is among the worst along with Britain's NHS. Why people insist on limiting the choice to either what we have or what exists south of the border is amazing. There are several European countries with mixed systems offering better health care and even Mexico offers a wide range of different types of coverage with excellent health care in cities.

As long as politicians treat our existing system as a sacred cow it can only get worse. Why not consider some of the models that work better without falling into the trap of believing the American system is the only alternative?

Posted by: Alain | 2009-08-04 3:09:17 PM


I'm simply trying to point out that we seem to be setting up a false choice here. Canada versus the US. There's a third option. I believe a free market system would would drive costs down to a sufficient point where most people would be able to afford healthcare.
Posted by: Charles | 2009-08-04 1:24:11 PM

BINGO!

Posted by: The original JC | 2009-08-04 4:45:12 PM


Alain

Perhaps the debate in the US will focus enough attention on Canada's failings to shame the political class into allowing the debate (to allow a private insurance and delivery option) to finally be heard. Perhaps a free vote in the house? There would have to be dead and dying people all over the streets for the NDP and half the Liberals and even some Conservatives to consider it otherwise.

Posted by: John Chittick | 2009-08-04 4:50:13 PM


As long as politicians treat our existing system as a sacred cow it can only get worse. Why not consider some of the models that work better without falling into the trap of believing the American system is the only alternative?

Yep. But the mentality of Canadians has more to do with fairness than general quality of care. Hence, why Canadians are ideologically opposed to people using their own money for care.

It's complete insanity.

When you hear fearmongering about a two-tier system, the fear is that The Rich(tm) will get better care. Not so much that Working Families(tm) will get worse care. It's a position from spite at the end of the day. They just can't live knowing that someone got better care, because "it isn't fair!"

Posted by: Mike Brock | 2009-08-04 5:03:13 PM


Spot on, Mike. The irony is that the rich (the true ones) and politicians already get better care outside of Canada. But as long as people choose to be prisoners of envy, the facts do not matter.

Posted by: Alain | 2009-08-04 7:35:59 PM


The irony is that the rich (the true ones) and politicians already get better care outside of Canada.
Posted by: Alain | 2009-08-04 7:35:59 PM

And guess which system "they" use?

Posted by: The original JC | 2009-08-04 9:17:24 PM


It is not economically feasible what they are proposing to do. Its not "sustainable".

If they really think government can have a role here is an idea. Force people to buy catastrophic care insurance, only for the worse kinds of problems. Thats what is costing the government so much. Nah, they should encourage it with tax credits or something.

People should also be allowed to have Medical Savings Accounts, not that they can't do it on their own, but it shoulod be tax free. Then the government should end all of the ludicrous mandates on insurance policies.

Then hospitals should be allowed to offer their own health plasns at monthly membership fees and stuff in competition with the insurance companies. Let people actually have a choice in a competitive system where they have to pay the cost of the care.

Then for the low-middle class and such allow insurance companies to pay up front for minor medical care and then charge it to the patient with interest over year to a year and a half. Sort of Medi-Credit.

Just some ideas off the top of my head.

Posted by: Floyd Looney | 2009-08-04 10:57:54 PM


I have to disagree with all of you on health care. I've had four strokes, and each time I was treated I received the most excellent care, and I did not even have insurance. Now if I was living in the United States I would be totaly broke.

Believe me, you don't understand health care unless you totally need it. And for the government assistance, my medication costs over $400 a month. I can't work, and with that amount in medical expenses how am I suppose to live. Should I just crawl out and spend the rest of the days on the street. Remember, an emergency can happen to you anytime, and when it does, I bet you will change your tune.

So Shane, I bet you'd enjoy this bit of news, but I really don't give a fuck about you. As for people who are sick of living in this country, just leave, I bet that there are a lot people who would love to become Canadian citizens.

Posted by: Doug Gilchrist | 2009-08-05 8:27:25 AM


Doug,

I don't think it's a question of either or. Rather, how we can make the system more ethical from a liberty perspective, and still solve the problem you describe if, it is in fact, unsolveable by the market.

The argument about innovation is probably the most compelling argument, actually.

In my experience, the most serious cases in Canada get dealt with immediately, without wait. And emergency surgeries are performed with an excellent level of care.

In fact, overall health outcomes from the Canadian system exceed that of the United States.

The US only has a slight edge on cancer and heart attack survivability. And they are very small margins, when you point them out.

However, if you isolate out the highest quality care in the US, particularly for cancer and heart attacks, you find that care far exceeds anything you can get in Canada. And that's often where the criticism comes in. For example: if you're a millionaire, your chance of surviving cancer is much higher than that of the average person, in the US or Canada. Quite simply, because you can afford to pay for the best specialists, the best medicine (some cancer medications run tens of thousands of dollars), and all the other comprehensive supplementary care that goes with it.

The truth is, the average American does not have access to the highest quality care. In fact, HMOs and such can in some cases offer much shittier care than you'll find throughout Canada.

The argument being made here, is essentially that while the average person has no access to that level of care, the advances made in that top tier eventually filter down to the masses. What was only accessible to the rich 5-10 years ago, is now available to everyone.

The issue that I think most civil libertarians have a problem with, is not even that there is government health coverage, but rather there is a restriction on private care as an option.

Posted by: Mike Brock | 2009-08-05 12:25:39 PM


I like John Stossel on 20/20 I also enjoy when he speaks on freedom watch.

I don't know why any one would want to emulate our or British health care system. I hate it when people say its free. If health care is taking roughly half of the provincial budgets then is it not safe to say it close to half the tax we pay? If we pay roughly 38% on income tax alone (to many taxes to list), that's a lot of money. Health care is not a right, but the pursuit is.

Posted by: Calgary Libertarian | 2009-08-05 11:17:03 PM


My dog had back pain. I was able to call the vet to book him an appointment, the vet was busy so my dog had to wait 2 hours (perhaps you could say in dog years that's like waiting 2 weeks).

He then got his check up, his x-ray and his drugs all within one hour of his appointment. Total cost to me around 500$ (i don't have dog insurance so it was out of pocket). Why can I get better health care for my dog then I can for myself? I also had options for him when it came to treatment, I opted for the most expensive / effective treatment but of course there were cheaper alternatives.

Posted by: Calgary Libertarian | 2009-08-05 11:21:38 PM


Maybe Stossel should spend more time looking at why the United States is below Canada for quality of health care, expected life expectancy at birth and other indicators of quality of life. By no means is the Canadian system perfect but spending this much time attacking the Canadian health care system is a waste of time and simply a sideshow to the disaster that private care in America truly is.

Posted by: Roy | 2009-08-06 10:20:31 AM


Roy: We don't have a "free market" in healthcare in the US. If only we did.

Posted by: Floyd Looney | 2009-08-06 10:36:49 AM



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