Poll Shows Most Americans Want Public Health Care
The poll is the New York Times/CBS News latest:
Americans overwhelmingly support substantial changes to the health care system and are strongly behind one of the most contentious proposals Congress is considering, a government-run insurance plan to compete with private insurers, according to the latest New York Times/CBS News poll.
The poll found that most Americans would be willing to pay higher taxes so everyone could have health insurance and that they said the government could do a better job of holding down health-care costs than the private sector.
Yet the survey also revealed considerable unease about the impact of heightened government involvement, on both the economy and the quality of the respondents’ own medical care. While 85 percent of respondents said the health care system needed to be fundamentally changed or completely rebuilt, 77 percent said they were very or somewhat satisfied with the quality of their own care.
That paradox was skillfully exploited by opponents of the last failed attempt at overhauling the health system, during former President Bill Clinton’s first term. Sixteen years later, it underscores the tricky task facing lawmakers and President Obama as they try to address the health system’s substantial problems without igniting fears that people could lose what they like.
These poll results add to the evidence provided by the NBC/Wall Street Journal poll that came out a few days ago (emphasis mine):
Yesterday’s NBC/Wall Street Journal poll has both good news and bad news for health reform. Public opinion is mixed on “Barack Obama’s plan” (odd, as Barack Obama doesn’t currently have a plan). About a third think it’s a good idea. About a third think it’s a bad idea. About a third don’t know. That suggests that we’re still early enough in the process that the bulk of people with opinions are the partisans who didn’t need to actually form one. Indeed, a few questions later, the pollsters describe the plan in more detail, and support shoots to 55 percent, but opposition barely budges.
But make no mistake: There are elements of health reform that are important, but will be sharply unpopular. Almost 60 percent, for instance, oppose efforts to tax generous health care benefits. I’d guess that when people hear about penalties in the individual mandate, that policy will prove controversial too. Luckily, there are some elements of health reform that meet with overwhelming public approval. Among them is the public plan. According to the poll, 76 percent of Americans believe it’s either “extremely important” or “quite important” to “give people a choice of both a public plan administered by the federal government and a private plan for their health insurance.”
Much in health reform is unpopular. The choice of a public insurance option isn’t. And given the many hard and controversial choices that will need to be made to achieve health reform, it’s not clear to me that the Democrats can afford to lightly remove the genuinely popular aspects of the legislation.
Conservatives who are ideologically opposed to public health care are not about to come around just because it’s what most Americans want — although, to be fair to them, they don’t agree that most Americans DO want a public health care option. Those conservative bloggers who posted responses to the New York Times/CBS News poll are implying, or saying, that — to quote one — the poll was rigged. Donald Douglas implores us to think of the children. No, not this child, silly. Look at the picture again, you’ll figure it out.
Jason Arvak at Poligazette pays me the compliment of mentioning me several times in his fairly lengthy post on the Times/CBS poll and the health care debate in general. He makes a number of specific points with regard to my views:
This stridently dishonest approach has been eagerly embraced by the ideologues of the left, who prefer slogans to debate. A characteristic example is TMV’s Kathy Kattenburg, with her no-discussion-tolerated demand “We Need Single-Payer Public Health Care — NOW“. Kattenburg’s post does identify a legitimate problem that requires reform (the practice of “rescission” — the arbitrary denial of coverage using flimsy and even dishonest excuses), but its willingness to only consider one possible solution and its intolerance for any discussion of problems or alternatives makes it a dangerous diktat rather than a progressive proposal. …
If single-payer health care were the nirvana its advocates claim it to be, this wouldn’t be a serious problem. But continuing experience in Canada, for example, shows that serious problems with availability and rationing in critical care areas such as cancer treatments persist in single-payer systems. The hostility to debate and discussion among single-payer advocates like Kattenburg is thus revealed as more than simply self-righteous arrogance — it is a serious threat to the viability of a future post-reform system. Refusing to discuss potential problems may marginalize and disempower opposition, but it will not prevent those problems from occurring in reality. And the economic logic that causes rationing is impervious to proclamations from high atop a moral white horse: Providers in a single-payer system can only expect to receive whatever the government’s political process deems an “appropriate” payment. Since those payment levels will inevitably remain fixated solely on present costs, there is no room left to invest for the future. As a result, investment in new equipment and technology is slow and unreliable and, as a result, available capacity inevitably lags behind demand. The outcome in the end is that cancer patients and other patients who would benefit from immediate treatment have to wait in line and, inevitably, some of them die while waiting.
But, of course, such matters are of little interest to self-righteous purists like Kattenburg. All that matters to them is demonizing the other side enough to score an easy rhetorical “win” before blithely moving on to the next item on their infinite list of political vendettas. Actually making the system work is Somebody Else’s Problem. And, after all, any problems that do crop up can always be blamed on Republicans, conservatives, or “the rich”. A big advantage of refusing to even talk to your critics is that you can continue that same practice to evade accountability later on as well.
Fortunately, not everyone embraces this vicious and irresponsible approach. Moderate Democrats in the Senate are eschewing the temptations of the extreme purists and are trying to craft a compromise that might address some of the legitimate concerns about single-payer health care. Whether such proposals can gain steam in spite of the dogmatism of the purists remains to be seen, but the willingness of pragmatist liberals like Justin Gardner at Donklephant to actually recognize and discuss legitimate concerns about purist approaches to health care reform is a very hopeful sign.
The bottom line is that the choice is entirely in the hands of liberals. Partisan Democrats dominate the entire political playing field, from the Congress to the elite media to the blogosphere. If they choose to embrace the intolerant purism of their Kathy Kattenburgs, then Americans may have little more to look forward to than a dreary march to technological stagation, rationing, and the decreased quality of care that results from decreased timeliness of care. The fact that enlightened liberals will have “won” over evil insurance companies will be of little comfort to the breast cancer patients who see their tumors metastitize while they linger on the waiting list for radiation and chemotherapy treatments. But if they instead adopt the willingness to compromise of Senator Kent Conrad and Donklephant’s Justin Gardner, a centrist consensus might just be possible.
As Jason knows, I cannot respond to his points in Poligazette’s Comments section. However, I can certainly do so here. Without going on at great length, here are a few of my thoughts in response to his (Jason’s comments are in italic):
If single-payer health care were the nirvana its advocates claim it to be, this wouldn’t be a serious problem.
Jason is using a very common rhetorical device here. (I have been known to use it, too, on occasion, so I cannot judge Jason too harshly on this one.)
Of course single-payer is not nirvana, and in truth, there are no advocates of single-payer who claim it to be nirvana. I think it goes without saying (but maybe not) that no system devised by human beings can ever be nirvana — by definition, since human beings are imperfect. In the countries where some form of universal public health care exists, however (which is, to my knowledge, all industrialized nations except the United States), that type of system does a better job of delivering basic health care to all citizens than does the privately administered, for-profit model that exists in this country.
Refusing to discuss potential problems may marginalize and disempower opposition, but it will not prevent those problems from occurring in reality.
I agree, but refusing to discuss potential problems is not, in my view, the sticking point — I think most people are willing to discuss potential problems with a public health care option (as well as potential problems with the for-profit model), and to figure out ways to address those problems. There is a difference, though, between discussing potential problems and possible solutions, and giving up. I cannot speak for anyone else, but for me, the inclusion of a public health care option as part of any reform package is non-negotiable. Note that a public option is already a step down from single-payer. A public option is already a compromise. I don’t know what line in the sand, if any, Democrats in Congress will decide to draw — but for me personally that line is labeled “public option.” No public option, no go.
Providers in a single-payer system can only expect to receive whatever the government’s political process deems an “appropriate” payment. Since those payment levels will inevitably remain fixated solely on present costs, there is no room left to invest for the future. As a result, investment in new equipment and technology is slow and unreliable and, as a result, available capacity inevitably lags behind demand. The outcome in the end is that cancer patients and other patients who would benefit from immediate treatment have to wait in line and, inevitably, some of them die while waiting.
Check out this recent 60 Minutes segment, Jason. Cancer patients without health insurance are dying right now in our country because the low-cost or no-cost hospital-based clinics they rely on for essential care are being closed due to recession-fueled budget cuts. The rationing and waiting lists that exist in some public health care systems are bad — but not getting the health care services at all because you are uninsured and don’t have the money to pay for them is worse.
98 Responses to “Poll Shows Most Americans Want Public Health Care”
Poll Shows Most Americans Want Public Health Care | The Moderate Voice…
The poll is the New York Times/CBS News latest: Americans overwhelmingly support substantial changes to the health care system and are strongly behind one….
Well, Kathy, I think I see his point.
Uhhh, surprise!
[...] substantial changes to the health care system and are strongly behind one. See more here: Poll Shows Most Americans Want Public Health Care | The Moderate Voice Share and [...]
Tell you what, how about the taxpayer pay my mortgage? That's the plan I expect to see, and I'm quite willing to discuss potential problems with it, but the bottom line is that's really what I insist on. And please don't suggest compromises to me, because I've *already* compromised. I should really have a much larger place than I do. The average home in Canada is, like, twice the size of mine, and it's even cheaper!
Don't I sound open-minded?
You sound like someone who does not believe that health care is a human right. I am someone who does believe that health care is a human right.
Is clean water and sewage a right? Is clean food? What about safe playgrounds? Good schools? Are those rights or accessories?
This is why I'm hesitant to label healthcare a “right” because “rights” are a loaded word. At the same time, I'm baffled by anyone who seems to think our healthcare system is “teh awesomest thing.”
And the “I don't want my tax money pay for blah the blah” isn't even a strawman, it's a Burning Man. There are literally thousands upon thousands of programs people don't want their tax dollars going to, yet off they go anyway. I don't understand why we can have Goldman Sachs rolling around in piles of government issued money but when it comes to healthcare, people just trot out the tired “let 'em die!” argument. Why this issue more than any other? What makes people yawn for paying tax money to corporations or unions or politicians or shitty schools and roads and stupid wars but when you're paying for someone else's X-ray, suddenly the world flips upside down?
Goldman Sachs already payed back every dime of cash it took.
For the record I was against the bailout
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Excellent post Kathy.
It's refreshing to see someone able to counter the childish rants of the intellectual midget / hack Jason Steck. His claim of your having a “no-discussion-tolerated” attitude is a joke… particularly since his primary tool in any debate he's losing is to ban the individual that disagrees with him. The man is a coward and a fool.
Kathy,
Thank you for responding with a respectful tone. Let's see if we can maintain it in spite of the efforts of SteveK to coopt it into his apparent personal vendetta against me. BTW, it is not true that you are not able to comment at PoliGazette and that has not been the case for a long time.
As for the content of your response, I would note that I agree that some reform is necessary, but I object to the purist, no-compromise approach implied by your original headline and reinforced by many others on your side of the issue, most notably Paul Krugman in today's NYT. He specifically and in detail rejects all debate and compromise, insisting on a purely public option.
Also, you and other advocates of public health care do not address key issues of rationing problems found in other health care systems. The fact that our current system falls short in providing care does not mean that those flaws in other systems are meaningless. In building a reform package, shouldn't we try to correct BOTH the defects in our current system AND the defects in other models? Why does it have to be reduced to ideological “win” and “lose”? Yet that is exactly what you and Krugman and so many others on the liberal side seem to do with it — reduce it to an ideological zero-sum game. (The fact that such a Manichean worldview is shared by some on the other side of the aisle shouldn't constitute an excuse for the behavior.)
It is also disappointing that most on the liberal side refuse to address questions about how public/private “competition” could work given that the government can use its power to tip the tables and drive the private options out of business. The public plan would be subsidized by the taxpayers (thus concealing costs while not removing them) while the private plans have to answer to shareholders. The government can also operate with a deficit while the private programs cannot, again presenting the appearance of lower costs while in reality merely competing unfairly.
It is also distressing to see that compromise ideas like Conrad's idea for health care co-ops are simply ignored or dismissed out of hand. People like Krugman see compromise as an evil in and of itself. Such attitudes are not conducive to a thorough debate about various alternatives.
My bottom line is that I am NOT a purist on this. I concede at the outset that rescission is a travesty and that lack of available coverage for tens of millions is not a viable situation. If I could be persuaded that a public option would be efficient and comprehensive, I would be willing to support it. All I'm asking for is that liberals set aside their desire to “score a win” long enough to actually debate the complexities of the issue thoroughly and perhaps even question some of their own assumptions. Is that really too much to ask from the dominant political force in the country right now?
Is clean water and sewage a right? Is clean food? What about safe playgrounds? Good schools? Are those rights or accessories
Most of those items are human rights, if you tweak the language a little bit. Potable water is a human right, yes. I don't know what you mean by “clean sewage,” exactly, but certainly destroying sewage processing plants in war is a human rights violation, because it's destroying a people's means of survival. “Unsafe playgrounds” is a sort of reductio ad absurdum way of referring to people's right to be free of random violence and crime. So I guess if you have hypothetical playgrounds where all the play equipment is booby-trapped, or constructed to explode, it could get to be a violation of the human rights of children who used the playground. (You see, I can play the “let's be absurd” game, too.)
Lit3: “Why this issue more than any other?”
Because the economics of health care are different. Taxing to fund a welfare program helps the few at the bottom by taxing those at the top, and everyone comes a bit closer to average.
Health care is different because the *average* is too high, so bringing everyone closer to it doesn't help. *Everyone* is paying too much. It doesn't matter how aggressively you tax your neighbor to pay your doctor bills, they'll be taxing you back just as hard to pay theirs. Redistributing costs until everyone's bills are below average works only in Lake Woebegone.
The only way to make progress against that average is by improving cost efficiency. We need to shrink the role of these so-called insurance companies (private or public) that act as big gatekeepers to our medical care and are not accountable for value for money. Consumers need to take control back.
Actually, the UN Convention on Economic and Social Rights (to which the United States is a signatory) includes the right to be free from random violence and crime as a “human right”.
The key problem, of course, is as it is with most “human rights” — the practical problems of how best to implement them in practice. No one believes that government action can be perfect in all areas (i.e. there will always be crime) nor does any serious analyst contend that government action is always the best mechanism (for example, freedom of the press doesn't require government to provide all the media outlets nor would that be a functional way to honor the right).
Thus, the question of whether it is a “human right” is really semantic. The issue is how best to implement a functional and efficient system.
Since the poll was taken while intentionally hiding its price tag, I'm neither surprised by its results nor convinced of its accuracy. Let's run a NYT poll on this statement and see what the results are……..
According to our preliminary assessment, enacting the proposal would result in a net increase in federal budget deficits of about $1.0 trillion over the 2010-2019 period. When fully implemented, about 39 million individuals would obtain coverage through the new insurance exchanges. At the same time, the number of people who had coverage through an employer would decline by about 15 million (or roughly 10 percent), and coverage from other sources would fall by about 8 million, so the net decrease in the number of people uninsured would be about 16 million or 17 million.
Add that to the budget deficit already incurred for the non-stimulus package and let's see how the voters vote in 2010.
Our high cost private insurance, disapproving treatment and claims for financial gain, and excessive co-payments are the leading cause of citizen bankruptcies, loss of homes and retirements, and lack of treatment. This is the greatest threat to our economy and quality of life, greater than the change required in going to a one payer system.
I have travelled to several countries with one payer/government medicine and have been surprised at the positive attitude towards the system. The waiting times described in emergency rooms etc were actually less than what I have experienced in the US. They found it horrifying that in the US that the uninsured or unable to pay could be pushed back on the streets once stabilized without follow-up treatment. Waiting for treatment seems better than no treatment for lingering diseases such as cancer, heart disease, high blood pressure, diabetes, TB, when you can’t afford to pay.
Waiting occurs in both private and one pay systems but treatment rates appear to be higher when profit is taken out as the primary motivator. Who has the ability to shop or discuss prices when you are in the middle of a medical emergency? Medical treatment is not a free market when your life or a loved one’s is in the balance. Why must so many choose between life and poverty? Do I die because my company no longer needs my services and I no longer have or can afford medical coverage? And once I am ill and lose coverage, who will cover me?
In our private system, fewer and fewer businesses and individuals can afford the premiums for even more limited coverage and still maintain resources necessary for their daily survival. Do I pay rent, put gas in my car, pay my electric or buy insurance? Do I purchase raw materials for manufacturing, pay for transport, or offer health insurance? It can be as bad as a choice between food and medication. These are real choices made by individuals and industry every day. It is a choice between survival today vs survival tomorrow. And realistically, we must survive today in order to meet tomorrow.
The lower per capita cost, greater longevity and higher birth survival rates indicate in objective statistics based on the purpose of healthcare insurance that public/one payer is performing better than private insurance. Having seen the success of the basically one pay public system in place for the US military, veterans, congress, government employees, the poor (Medicaid), and senior citizens (Medicare), I am highly in favor of extending this same coverage, a universal Medicare, to all our middle class citizens, middle aged individuals, the unemployed and other ineligible groups. A universal one payer system would give a better spread of the risk that will increase for all individuals as they grow older. It would significantly increase availability, reduce costs and level out premiums. Surprisingly it could be done at less than we are currently spending. It would simply be more efficient.
Finally, surveys of other countries one payer systems show better results on a per capita basis for half the money currently being spent in the USA. The lack of availability through high cost as risk increases results in indirect euthanasia of those who can’t afford coverage through failure to provide treatment. I really would enjoy having the coverage congress enjoys but would deny the rest of us.
What about that money funneled through AIG? What about the fact Goldman Sachs pretty much caused the damn recession by itself.
ChrisWWW, from first-hand experience, I know better about the limits of health care coverage than you can possibly know. I also know the virtues of a system that allows rapid access to treatment for conditions where time is an important factor. I would hate to see the virtues sacrificed just because concerns about reform are dismissed out of hand with breezily hateful stereotypes like “a freemarketeers wet dream”. It should be possible to set aside ideological combat in the interests of pragmatism, shouldn't it?
My latest efforts to do that are here: http://www.poligazette.com/2009/06/22/lessons-f…
Please note that I am not in favor of the status quo and I take seriously the need for reform and in particular expansion of coverage. I am dubious about purist proposals because I think they are willfully ignorant of potential problem areas and I think compromising approaches offer the potential to acknowledge and deal with the inevitable trade-offs rather than simply demonizing the issue into “good guys” and “bad guys” like you seem prone to do.
JasonArvak. I researched and found that timely and effective treatment predominates in the one payer systems. Priority is given to most serious cases. Unfortunately, in the US no treatment may be recieved if you can't meet co-pay or don't have insurance to cover the cost of prescriptions required.
As I have repeatedly said, I am aware of the access problems in the U.S. system. I agree that something should be done to fix the system. I am just saying we should take care to acknowledge the trade-offs and other issues that will affect any reformed system.
For example, you say “priority is given to most serious cases”, but it is important to note that “priority” is a small comfort if the total number of just the “most serious cases” exceeds the available supply of equipment. For example, one defect with single-payer health systems is that they have fewer MRI machines available because there is simply no incentive to invest in equipment for FUTURE demand and government budgets are designed only to address CURRENT demand. The result is that even that subset of “serious cases” who need MRI scans (to locate their tumors or check for metastasis) often have to wait months or even years.
Now this is an issue that would be possible to address, perhaps by including provisions in the system to allow for providers to invest in equipment based on future demand instead of just present-day compensation rates. But in order to address such issues, we have to first admit they exist, something which single-payer purists have thus far been loathe to do.
So do you think you can diverge from the pre-written scripts long enough to consider this adjustment?
Thus, the question of whether it is a “human right” is really semantic. The issue is how best to implement a functional and efficient system that fixes the problems in the status quo while avoiding the flaws in other systems.
Okay, but the point is that whether one views access to health care as a human right or a commodity to be bought and sold for profit affects how one views the solutions as well. If the goal is to make a profit, that precludes a public option. If the goal is to deliver quality, affordable health care to every American citizen, a public option is essential, and a fully nationalized, universal, publicly funded system is optimal.
My brother has lived in Canada for over 30 years, and although he acknowledges the problems with the Canadian health care system, he still prefers it to the American profit-motivated model. If he has an emergency in the middle of the night, for example, he knows he can go to his local hospital in Winnipeg, be treated, and not have to worry about being billed. Yes, he may have to wait, but he will get the health care services he needs without mortgaging his entire financial future.
By contrast, when I slipped on ice this past winter while walking my dog and injured one of my knees so badly that the next day I could not walk or stand up, I went to a local ER and was given excellent care…. and then, about a week later, I received about half a dozen separate invoices for the services I had used, adding up in total to over $3,000. I can't pay that. And by the way, I had to wait for quite a long time in the ER waiting room, too, before I was seen. And I was billed for thousands of dollars that I have no way of paying.
Moreover, Canada's health care system is not the only nationalized, universal health care system in the world, as you obviously know. Opponents of universal health care in the U.S. always point to Canada because it has problems, but they never point to France, or Germany, or the Scandinavian countries, where single-payer works very well. Even in England, which is also sneered at by opponents of single-payer, if you or I, as Americans, go to England on vacation or business and fall sick or have a medical emergency, we can walk into any hospital, wherever in England we are, and be treated at no cost. A British citizen visiting the U.S. cannot do that.
One more anecdote from my brother: A few years ago, he and his partner were in Europe, and Meaghan developed a serious urinary tract infection while in The Netherlands. That may not sound very dire, but UTIs and go from zero to 360 in a very short period of time, and when they do, they are excruciatingly painful and can have major health consequences if not treated promptly. That's what happened to Meaghan. It was at night, and within a matter of minutes it was a full-blown emergency. Dave told me that from the time they knew they had to get to a doctor, fast, and the time they were walking out of the doctor's office with Meaghan having been treated, feeling much better, and with the medication she needed in hand, about two and a half hours passed. The medication cost the equivalent of about $10, but that was because as non-citizens they were not actually enrolled in the health care system. That was the only expense associated with the medical care Meaghan received.
Try making that happen in the United States if you are not wealthy or upper-middle-class. I dare you.
Starley, our system definitely needs reform, but I simply don't believe the numbers you laid out. I don't believe the “better results for half the costs” statistics, which are disputed in a number of different directions. Our cancer survival rates are better than Europe's. We don't have the queues-as-a-way-of-life that are routine other places. Many statistics around death rates tend to be collected differently in different countries, and it's difficult to compare apples to apples.
Most importantly, I haven't seen any data to suggest that more socialized countries have licked the problem of costs going up 5% every year. What I've read suggests the opposite, that they can contain them for a few years only at the expense of giving people less care than they want, and the cost creep continues. There are a bunch of ways we can help the uninsured, and we must. But this problem looks harder to solve and more deadly over the long run. It's what keeps me up at night.
A few other areas of factual dispute:
1. What we have is a private system. It's not, it's part private, part public, and heavily shaped by rules the government has set up. If you want to compare a socialized system against a free market one, ours cannot serve as an example of the latter.
2. A single-payer system would take the profit out of the equation. Not at all, it would just take it out of insurance companies, and they're only 20% of the industry. Doctors and hospitals would still be making profits on the quantity rather than the quality of treatments they provide.
3. Medicare for all would be cheaper than what we're currently spending. Medicare is the Bernard Madoff of health care funding, producing very pleasing results provided you don't look at the liabilities it's accruing. It's cheaper only because the government is deferring the bills for our children and grandchildren to pay. This is not a recipe for a responsible, sustainable system.
For example, one defect with single-payer health systems is that they have fewer MRI machines available because there is simply no incentive to invest in equipment for FUTURE demand. …
That emphasis on “investing in” equipment for future demand translates also into doctors and hospitals buying the newest, latest, most cutting edge equipment. That is one reason health care costs are through the roof and continuing to climb.In a capitalistic marketplace health care system, health care providers have a powerful incentive to do this: It allows them to charge more money.
Of course, there are always trade-offs anytime a system is changed, but with the condition health care is in in the U.S., both in terms of costs and in terms of access, I really think there's no direction to go in but up.
Fraudulent poll. The CBS/NYT poll was exposed over the weekend for having a dramatically left-leaning sampling, and there fore cannot be trusted… much like one cannot trust the NYT or CBS.
172 million Americans have health insurance, and 70% of those rate it as good to excellent. It's very hard to swallow that all those people are going to “vote” to destroy what they have.
As for reform: getting the government out of medical care is a good start.
Why are we too stupid to do public health care? I've lived in a couple of different European countries that do it very well. I have received great health care in those countries. Why are they so much better at it than us?
If we can provide health care in the same way we provide for national defense, I believe we can have one of the best public health care systems in the world.
I disagree, not because I want to see “profit” being made, but because a “fully nationalized, universal, publicly funded system” has not always shown itself able to actually provide what it promises. Instead, rationing combined with under-investment in equipment has often served to make the system into an underperforming bureaucratic nightmare that denies effective treatments to many people who need it.
I'm prepared to consider a public option in a competitive system provided that competition is actually maintained. Competition could serve to prevent the growth of bureaucratic dysfunction that happens in a single-payer system as well as maintaining incentives for investment in research and equipment. If, however, the public “option” really becomes a “mandate” through the manipulation of government coercion that drives real competition out, those advantages would be lost and we would wind up with another false-promise of universal coverage.
That sounds fine when the “wait” is a few hours in a well-triaged emergency room, but when the “wait” is months for an MRI scan or a radiation treatment program that prevents metastasis for cancer (which is the area of my recent experience with the health care system), it is much more serious and consequential and potentially life-threatening. The satisfaction of those using a routine-care system is of little comfort to those with life-threatening conditions for whom “a little wait” is potentially the entire ball game.
I am thankful that the “profit-based” system that we have ensured rapid access for my wife that saved her life. I am resistant, I think understandably, to proposals that might sacrifice that in order to chase the vision of universal primary care. I'd prefer to slow down a bit and see if we can't find a way to get both. I do, however, understand the nightmare of billing and fighting with insurance companies. But I don't want to throw the baby out with the bathwater by being hasty and inattentive to the problems and trade-offs that we know exist in public health care options. (My most recent post on PG deals with the public health care system that has existed in the U.S. for decades: military health care.)
I concede the virtues of those systems, but I ask you to concede the concerns as well. Access is a virtue, particularly with regards to emergency care. But all the systems you mention struggle with the same problems of lack of availability for time-sensitive tests and treatment programs like MRI, radiation, and chemotherapy. I'm not suggesting that we adopt the infantile “anything Europe does sucks” attitude of the far right, but I also think we shouldn't romanticize those systems by pretending they are problem-free. Paying close attention to their problems might help us design a system that mitigates some of them.
P.S. I also know about treatment for UTIs and can testify from first-hand experience that rapid and effective treatment was also available for that condition in the United States — Minnesota specifically. Once again, I remind you that I am not ignorant of the virtues of other health care systems and I am not opposed to trying to model what does work in those cases. But I am opposed to blindly embracing them without first trying to acknowledge their flaws and find ways to mitigate them wherever possible. Perhaps if you could take a minute to acknowledge that I am not, in fact, an apologist for the status quo, we could find more productive common ground in discussing BOTH pluses and minuses.
Jason and Dr J
Enjoyed your replies. Appreciate well thought out responses. Dr J. Your point on cancer survival rates was very accurate and led to further research. When accidents/fatal injuries are deleted from survival rates the US actually has a HIGHER longivity rate than other countries. 76.9 years.
http://politicalcalculations.blogspot.com/2007/…
My concern however is we cannot sustain this level. Recent increases in unemployment have moved more and more people away from available coverage. The latest figure is 56 million without insurance.I am in that situation. And I don't believe employers are going to be willing to continue to foot the bill.
I do agree with the single payer system however. It allows for universal coverage and contract providers who would compete to provide care and allow for better oversight by a unified authority. It is not necessarily socialism. And Jason, don't forget that there will always be inovation looking to make a buck on that large money available in the industry. Dr J. You are right, someone will always be there to make a profit. And having better equipment will make contract providers more competitive.
an underperforming bureaucratic nightmare that denies effective treatments to many people who need it.
Jason,
That describes our health care system very well.
Our health care outcomes, on the whole, are not any better, and often times worse than in countries with universal coverage. What we pay, however, is nearly double what some of these other countries pay.
So again… we pay more and don't get better outcomes. There are fringe cases for rare and difficult to treat diseases where our system performs admirably. But I'm not sure how that can possibly outweigh the concerns of the millions who are uninsured and the millions more who are under insured.
Single-payer systems perform well at much lower cost. it's not hard to find cases of the system breaking down with either for profit or nonprofit care, so the point is which works the best most of the time. It has been estimated owes to the problems with single-payer systems, including waiting times would vanish if these countries paid a little more, but still far less than we pay. Jason disparages Paul Krugman, a Nobel prize-winning economist who favors a single-payer system and has the economic background to know what he's talking about. Doctors also favor it, by a margin of 59% to 32%. Commenting on the statistics by the World Health Organization, the Director of what is arguably our leading medical institution made this statement.
“The US should be particularly concerned about these findings,” says Gerard Anderson, director of the Bloomberg School of Public Health at Johns Hopkins University in Baltimore. “If I'm spending twice as much, I'd expect to have the better outcomes.”
A practicing physician describes why he favors public health care, and he probably sums it up better than I can:
A doctor explains.
He also points out how the uninsured pay others' bills without getting any care for themselves.
The current system disadvantages small businesses and their employees.
Finally, those who oppose changes in our insurance mediated health care system he will soon be arguing for or against taxpayer bailouts of health insurance companies. I suppose one way we could back into a single-payer system is to buy their stock when they crash. 14,000 Americans are losing their coverage every day, and of course, insurance companies are losing 14,000 customers every day.
Dr J. This link gives per capita costs for healthcare. Even though the longevity issue is relatively equal, the costs are almost double. http://www.infoplease.com/ipa/A0934556.html
Only if we keep those elements in our system in some form. If we follow the prescriptions of purists, we will strip out all possibility of making a buck in favor of comprehensive cost controls and bureaucratic mandates that prohibit moving outside the system. Single-payer systems intrinsically involve this since no one exists except the single payer — the government — which sets the rates of compensation as low as possible, too low to leave any room for risk-taking through innovation.
As I have said (and the more script-driven commenters above insist on ignoring no matter how many times I say it), I am open to some major reforms including a public option that functions in a genuinely competitive system. But I think ignoring the problems of other systems and the virtues of our own in favor of an ideology-driven approach is a serious mistake in spite of its obvious emotional satisfactions for a few.
How much of the truly breakthrough innovation (the non-pen1s pill kind) has come from the “market” versus research funded by government grants? I'd like to see statistics on that.
Those statistics are really hard to come by because ideology twists all the available study. I believe it likely that in pharmaceuticals, the government funds a huge part of the truly innovative research (variations on Viagra don't count) especially after 9/11. But in the area of medical technology and particularly in the investment in equipment, the government does not play a large role and that is a facet that we really need to examine carefully before throwing away too much of our current system.
Jason, I've responded to your points, except the MRI issue. This is a bit of a red herring. The TOTAL MRI equipment industry in the US is $700 million. We probably have enough of them, but even if we were talking about the taxpayer buying them for hospitals, which we're not, it's not as big a budget item as you seem to believe. As I pointed out above, by cutting our cost by LESS than half, we could avoid virtually all the issues you raise with current single payer systems.
Like you, I would support a public OPTION with competition from the private sector. Those of you who believe the current system will serve you better can have it. The market will decide if its market can be sustained. And by the way, you didn't respond to MY point. The for-profit model is in trouble, as unemployment rises, fewer employers can afford to cover their employees, and the economic downturn drives insurance customers to cheaper plans. I read that UnitedHealth has lost 9 million customers since September. The numbers of customers downgrading their coverage was not reported. Will we bail them out when they suggest to legislators that they are “too big to fail?”
The MRI is an example of a type of issue (medical equipment availability), it is not in and of itself the entire issue.
And as I have REPEATEDLY said, I do not support the current system. Geez. How many times do I have to repeat it before you will stop reading off your script?
“script-driven, gross logical fallacy, you should not be so shallow in your thinking”
You know, you're the one who said “Thank you for responding with a respectful tone. Let's see if we can maintain it.” How about a bit of civility in our discussion. I'm not an idiot and am not treating you as one.
I'm not following a script. I'm responding directly to your points about “trade-offs,” which I think are exaggerated, and can be minimized. I quoted the doctor to show how some within the profession see the need for change. By quoting physicians, polls, public health professionals and even defending a respected economist you were deriding, I remind readers that it is not some fringe cadre of bloggers driving the call for change. (oh, and BTW, your attack on the Nobel Prize process is an insult to the many brilliant people who have earned them.)
I am currently out of the office and will not be checking e-mail.
I will reply to your message as soon as I return.
I am currently out of the office and will not be checking e-mail.
I will reply to your message as soon as I return.
See, and here I thought that awarding Nobel Prizes to Al Gore and Paul Krugman as a way of lashing out at Bush was the REAL insult to the many brilliant people who have ACTUALLY earned them.
Jason, there is no reason private industry could or would not compete in a one payer system. Some of the largest pharmacutical companies are in Europe. New and innovative products are constantly coming into the market and they would not develop if there were not a market with most modern countries having a one payer system.
Jason,
Your description of Krugman was the most accurate I’ve ever seen on this website.
As someone who is just a smiggen right of center, I favor a hybrid healthcare system using both free market and socialized elements, with the complete elimination of health insurance.
On the free market side, I believe in individual health savings accounts (subsidized for the needy) that would provide a dignified means for everyone to purchase whatever healthcare they choose to buy. The individual would have the power to pick their doctor, procedures and tests.
This type of capitalistic system has been proven to be the best method of delivery on every imaginable service and healthcare would be no different. I envision a time when advanced degree nurses (ADN) would come to your home to listen to your symptoms, take tests, observe your surroundings and spend the amount of time necessary to get a good idea of what the problem is. Then, using their medical knowledge, these ADNs would transmit their findings and speak with the appropriate medical specialty necessary for the situation. Cost savings plus better service – how good does this get?
The medical savings accounts would be linked to a debit card that pays instantly after each procedure. Cost information is automatically entered into a database for cost comparison in your area over the internet. At the point of sale (the doctor’s office for example), when you swipe your debit card for payment, the average cost in your area would be shown along with the last 10 similar procedures with the physician’s name and price. Medical savings accounts would be funded up to $8000 per individual. There would be a $7000 “donut hole” between the point that the base savings account is depleted and the socialized catastrophic plan kicks in.
As to the socialized plan, the only reason I propose this method for the upper catastrophic end is so that government can impose some end-of-life limits on heroic efforts when the quality or quantity of life is not significantly extended by these hyper-expensive procedures.
Only government, in its dehumanizing, bureaucratic form can set the limits that need to be set.
Of course there is much more, but this is enough for one comment.
Again, I would remind you that the economics of innovation work differently with regards to pharmaceuticals versus medical technology like scanners and other advanced testing equipment. But I agree that it would be possible to design the system in such a way as to maintain incentives. Doing so will require that purists stop their headlong rush long enough to actually pay attention to the issue, however.
jwest, please feel free to also join the discussion on Poligazette.
http://www.poligazette.com/2009/06/22/lets-have…
Ok, Jason, I'll start by extending a bit of the respect you are unable to show me. I respect your willingness to come over here to TMV to add to our discussion, which has been going on for months now. Perhaps you believe all my points are directed at you, but that's not the case. This post begins with quotes from you blasting single-payer proponents like Kathy. You point out shortcomings of the proposed alternative; I point out shortcomings of the current system. Both are important in balancing “trade offs.”
We have commenters here who take the position that no one should pay for anyone else's health care. I for one do not mind that I have supported your health care for the 15 years you were in the service, nor do I object to contributing to a system that deals with our health care crisis in what I consider to be a pragmatic, cost-effective way. I do not consider a single-payer system to be a panacea, but we need to achieve savings, and the most wasteful costs, in my opinion, are the excessive costs of private insurance, its damage to small businesses including my own, and its propensity to deny payment and exclude those who need it the most.
Jason – curious. Why do you feel equipment would be different from Pharm?
jwest. Explain more on your savings plan. I'm not clear.
GreenDreams,
I do not agree with your assumption that criticism of another person's argument constitutes disrespect. If you want to see real personal disrespect, scroll up to read what SteveK wrote about me and about which you had no complaint. I haven't written anything even remotely similar to that, even when I was lambasting Kathy's original post on health care.
I also do not agree that single-payer systems can be assumed to be cost-savers. As I have pointed out before, the cost savings enjoyed by many single-payer systems now come about at least in part because the for-profit system in the U.S. is provided an unintended subsidy and because the governments implementing those systems impose rationing and other controls that may not be acceptable to American consumers. So we can't just jump to the conclusion that single-payer implementation in the U.S. would lead to the same cost savings. We have to look more closely and evaluate other alternatives, like Kent Conrad's proposal for health insurance co-ops modeled on co-ops for other critical commodities and services.
starleys,
Equipment is different from pharmaceuticals because providers purchase them at different points. Pharmaceuticals are purchased pretty much as-needed in both for-profit and non-profit systems. Thus, matching demand is relatively easy. Equipment, however, is purchased in for-profit systems in expectation of future demand and in non-profit systems only to meet current demand.
In a single-payer system, this plays out in ways that causes the incentives for innovation to differ as well. Pharmaceuticals can still be developed in expectation of future demand because that demand will develop automatically and the purchase cost will be recovered in short order. But a new piece of equipment won't appear on the government's reimbursement schedules for months or years and even then will be at a rate that will be unlikely to reimburse the much larger purchase cost until that piece of equipment has been used hundreds or thousands of times.
What that has resulted in in systems like Canada is a general reluctance of providers to invest in enw equipment at all. Knowledge of this reluctance serves to discourage innovators from developing new equipment because they doubt whether a market for that equipment will emerge in sufficient timeframe to recoup their investment.
Now, I think there are ways to adjust to this phenomenon, but doing so requires admitting that the problem exists, something which purists seem loathe to do.
We can see that single payer systems currently implemented are cheaper. The insurance industry's own study shows their cost plus profit to be 17% and Medicare 5% and headed down. The items private insurance spends on that Medicare doesn't are detailed by the physician I quoted. They don't include the subsidies granted to the employer-insured at the expense of the privately insured, which as I noted, is an increased burden on employees of small businesses who are the major source of new jobs. Could government inefficiencies gobble up the12% upcharge for Medicare-style coverage? Perhaps, but to date, the government programs, including yours, pay less per patient despite higher risk populations (elderly, for example)..
I'm not talking about government inefficiencies gobbling up cost savings (was that an item you were expecting from a script? because I never mentioned it). I'm saying that at least some of the reasons that other single-payer systems are cheaper might not apply to the U.S. case, specifically that some of their cost savings have resulted BECAUSE we are a for-profit system.
Jason,
Now be fair, you did say that it would be a “underperforming bureaucratic nightmare.”