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Healthcare? You gotta be kidding!

me in hospital

From Steve Dunkley, first published on the BBC news website…with a few edits by me.

I should have credited him previously but failed to do so.  Sorry about that Steve!

If I do quote other writers I usually highlight in italics.

Duncan

Forgive the pun, but I’m sick of listening to the ideological bigotry being used by both sides in the current debate over healthcare reform. Even the fallacy that the debate could possibly be encapsulated by “two sides” makes me so angry. The very idea that being able to shout louder than someone else or that a few words written on a placard contributes anything to a debate on such an important issue is simply asinine. Such behavior, including mindless chanting of simplistic slogans, effectively halts all objective discussion and obscures the real issues.
So, stop mouthing off, stop quoting anecdotal examples and stop using prefabricated, emotive labels designed to perpetuate already polarized thinking.
This maybe a revolutionary idea, but why don’t we start looking at factual evidence backed up by legitimate research. Yes I know this a new concept, but just bear with me for a while, you never know, we might then draw some reasoned and sensible conclusions.
Here are some facts:
• The United States of America does not have the best health system in the world
• The United States of America does not have the worst health system in the world
• The United States of America has some of most advanced healthcare expertise in the world
• The United States of America’s delivery of overall healthcare and its health outcomes do not compare well to most other industrialized countries
• The United States of America has the capability to offer expert treatment to patients of all ages
• The United States of America has an illogically high incidence of infant mortality and avoidable death rates

Here are some factual statements and observations:
• The United States of America spends more (per capita) on administering the bureaucracy of its healthcare than any other country in the world. Sometimes by a factor of three or four over countries with effective universal systems.
• There is no particular reason why employers should continue to be responsible for providing healthcare. It is an invidious practice that can be extremely detrimental to both employee and employer interests. The practice has its origins in the pay freezes of World War II, yet now seems entrenched in the American working life. Why should your employer decide what health cover you get? Your family physician doesn’t tell you where you should work!
• There is no reason why a national, universal health plan should increase individual or government healthcare costs. Individual tax costs will increase but, if a scheme is implemented effectively, there will be no health insurance premiums to pay. Employers should no longer have to pay their portion to the insurers and there should be no co-pay. In case you missed that – NO CO-PAY! Your employer may even pass his or her savings on to you as a wage increase.
• Effective preventative healthcare makes an enormous contribution to the quality of life and the longevity of that life. In the current situation prevailing in the United States of America, there is little incentive for health insurers to finance preventative care. The premise is that, as people change jobs and healthcare insurers, the financial benefits of preventative medicine might be enjoyed by organizations other than those that originally funded it.
• Viewed from afar, the citizens of the United States of America are hypochondriacs obsessed by illness. This hypochondria is fueled by a constant barrage of television commercials for prescription drugs containing information that should only really be evaluated by competent medical professionals. Trendy acronyms only exacerbate the obsession – why not become obsessed by health and wellness instead?
• Market forces and human nature are generally inappropriate in healthcare. Physicians are encouraged to treat where treatment is perhaps unnecessary. Pharmaceutical companies need a steady stream of new illnesses, gullible or mercenary physicians and new drugs to keep them in business. Health insurers need to be able to promise nurturing care from cradle to grave and yet be able to deny treatment on all possible occasions.
Now that you’re thinking about shouting or painting a placard, here are some comparisons that will restore your faith in man’s inhumanity to man
Universal schemes can only provide the greatest good for the greatest number and will spend any and all amounts of money provided
Private schemes will drop you if it looks as though you might get a long-term illness
• Universal schemes will always treat acute cases first and will generally do these well. less urgent cases may well wait some time for treatment
• Private schemes will treat your acute or less urgent conditions entirely in respect of financial considerations, but will have you back in your car about the same time the anesthesia wears off, often causing you to come back again (with another co-pay) in a couple of days
• Universal schemes often provide unintentional long-term accommodation for the homeless
• Private schemes always use the latest and most expensive treatments irrespective of whether they are superior to proven treatments.
• Universal schemes are often unwilling to adopt new procedures until cost and/or patient benefits have been established

Here is a dirty word:
Single-Payer
Actually it’s two words, but you get the drift. Most universal or national health schemes operate this policy. Supporters of the status quo in United States health policies consider it blasphemy. It is a prime example of the emotive labeling so apparent in current healthcare discussions.
Single-payer simply means that payment for medicines and treatment comes from a single source. That single source is the organization that operates the health service – almost invariably the government. Pharmaceutical companies and medical practitioners abhor this policy because they are unable to play numerous payers (with differing priorities) off against each other. Instead they have to deal with a single body that has the single objective of balancing cost and patient benefit – more simply known as value for money. The VA health system bureaucracy “sorta-kinda” operates in a similar way to single-payer.
This does mean that many medical practitioners will get less for the work that they do. Pharmaceutical companies will undoubtedly claim that they will be unable to research new treatments. Personally, I can live with this because the physicians that earn substantially less will only be those who have been financially focused in their practices. Pharmaceutical companies will continue to research and develop because that is what they have to do to exist. Maybe these new pressures will force them to be more focused on effective remedies? Am I the only person who wonders whether drug companies develop new products and then look for an illness to treat with it? The objective of a healthcare system is to look after the receivers of that healthcare – not to make a few professionals obscenely wealthy.
The bottom line is that the current healthcare systems (in terms of delivery and outcomes) in the United States of America are ineffectual and probably irreparable in their current form. Federal and state politicians are scared to death of the pharmaceutical lobby and failure to be re-elected (but then I repeat myself). The AMA represents the interests solely of the medical profession and has stood four-square in the way of any proposed initiatives that benefit patients at the expense of their members. I don’t think insurance companies care one way or the other because they think they will still get a large slice of the cake whatever happens. When it dawns on them that single-payer may become a reality, they will get the rest of the politicians that the pharmaceutical companies missed.
It should not (and cannot) be beyond the wit of the US Government to take the time to investigate the healthcare schemes that are the most successfully operated in other industrialized countries. Surely, somewhere in this nation, we have officials with the ability to judge and evaluate the best of those and surely we have the expertise to implement such a scheme here.
According to the Organization for Economic Co-operation and Development (OEDC), in 2003/2004, per capita health expenditure in the United States of America was $6,120 (15.3% of GDP), life expectancy was 77.5 years and infant deaths, per thousand, were 6.9. During the same period in Japan, per capita health expenditure was $2,249 (8% of GDP), life expectancy was 81.8 years and infant deaths, per thousand, were 2.8.
Here are some final kickers. How can the country that considers itself the most advanced economy in the world, allow its citizens to be denied preventative healthcare because of corporate avarice? How can it allow around 700,000 families each year to bankrupt themselves seeking healthcare? How can it let people die for lack of healthcare?
For those that say government cannot afford universal healthcare, consider this: in 2003 (according to the World Health Organization) the United States government spent more, per capita, on healthcare than each of the governments of the United Kingdom and Sweden. Two countries that each have universal healthcare, the citizens of these countries did not have co-pays and both countries achieve generally better health results than the United States of America can boast.
Personal net expenditure on healthcare would drop significantly under a properly implemented universal scheme and a single payer scheme would have the potential to cut billions of wasted dollars out of administrative costs.
Finally, President Obama’s scheme will not work because it does not address the fundamental underlying problems. The supporters of the status quo will gladly watch the percentage of GDP spent on healthcare rise to 20% in the unreasoned belief that the marketplace will deliver effective healthcare and that we already have (of course) the best healthcare in the world. Basically we’re screwed!

18 replies on “Healthcare? You gotta be kidding!”

What has always amazed, amused, and disturbed me are the people screaming “socialist” like that was a bad thing. Do any of these people actually know what the idea is, what socialism is? I grew up and live in the Canadian province where universal healthcare was born. while our system is far from perfect,no one goes without what is considered a basic human right, access to adequate or better healthcare regardless of income level. It is also a place which has the highest rate of volunteerism in the country, and whose citizens donate the most money per capita to various causes. While we range in political view from far left to far right, our underlying ethic is “socialist”. That may seem contradictory but it works.

Duncan, I have not seen a finer deconstruction of the health care debate in quite a long time. You should be teaching at UCLA School of Public Health. Seriously. You have nailed it. Best, Leslie R, MPH

I agree with you Duncan. There’s so much data to back up what you have said. It’s enough to drive anyone mad. Here’s the question: How do we, we the people, stand up to the government, big business, big Pharma, insurance companies, etc… How do we make effective change in a non-violent way? Any ideas?

Moveon.org is going after Blue Cross for increasing rates up to 39%. We’ll see if Moveon’s actions will effect change…

You won’t hear any argument from me. I help deliver care in this broken system, and we hate turning people away because we can’t always find a loophole to get them seen under. The injustice of it is evil and cruel, and too many are ignorant about it, as well as to how easily unexpected medical expenses could bankrupt them.

Obama should never have begun with “if you like your health care, you can keep it” because two-thirds of voters immediately tuned out. The debate should have started with all the horror stories and then proceeded to “this could be you”.

(I’m still posting about my weirdest past jobs.)

Hello Duncan. Love checking out this blog, and I remember reading in an entry you wrote this year that you had an actor friend that networked at film festivals. I’ve never thought or heard of this, but I’m an actor and definitely interested in how exactly I go about doing that. If you get some time, would you mind e-mailing me? Thanks, hope all is well.

Here in Norway, we get healthcare in return for paying tax. Everyone gets it whether they like it or not. Here in Norway we have to have car insurance to get license plates to drive.

How can USA afford to have budget deficits while fighting unneccessary wars? It makes no sense: why are Americans proud of such a system?

The problems in American health care have been caused by decades of government interference in the free markets for health care and health insurance. The problems of rising costs, long waits, unhappy patients and providers are more reminiscent of the long bread lines in the former USSR, not of capitalist systems.
In contrast, note that in the most free (i.e., least regulated) sectors of American medicine, such as LASIK eye surgery we see a pattern of falling costs and increasing quality that we take for granted with free market economics. And this is precisely because such procedures and services are not regarded as “rights” that must be somehow guaranteed by the government. Free market reforms such as eliminating onerous guaranteed-issue insurance laws, eliminating mandated benefits, allowing patients to purchase Health Savings Accounts for routine expenses and allowing patients to purchase catastrophic-only insurance policies across state lines could reduce costs over 50%, making health insurance available to millions who cannot currently afford it. Rather than imposing more government restrictions on the market (more of the same that caused the problem in the first place) we should loosen those restrictions and allow the free market to work in health care.
Whenever a government attempts to guarantee a good or service such as health care as a “right” it must also control it even if only to keep costs down. If the government lets people have as much health care as they want, then the system will quickly go bankrupt. In a free market individuals, providers, and insurers decide how health care is allocated based on mutual self-interest. In contrast, in a system of universal health care the government decides who gets medical care and what kind. Countries like Canada typically use waiting lists and rationing to keep costs down. A Canadian woman who feels a lump in her breast may wait months before she gets the surgery and chemotherapy she needs, with tumor cells multiplying with each passing week. An American woman can get the care she needs within days. In countries with “universal health care”, the allocation of resources and services is ultimately determined by politicians and bureaucrats, not by physicians and patients. Far from being a “right”, health care becomes a privilege dispensed by the government on the government’s terms.
Name one program the government runs without massive waste and corruption, and I will consider your argument for government run healthcare.

What sections of your population are accessing Lasik surgery?
When I had a lump in my breast I was processed immediately.
When has a “free market” ever provided adequately for everyone?
Possibly Cuba?
Just a few thoughts.

How do you explain Companies like Timely Medical? A Canadian company that helps Canadians on long medical waiting lists to leave those waiting lists and take personal charge of their own healthcare. Timely Medical has helped hundreds of Canadians to get timely care in the U.S. for which they cheerfully paid out of their own pockets.

The waiting is a myth, like all myths and old wives tales have no ot little facts.
How come all the other countries who have a health care system did not go bankrupt?
America needs a wake up call, I agree totally with Moira’s viewpoint, it’s not perfect but it is available for everyone.I personally have never had to wait for surgery when i lived in England.I never saw a doctors office any more crowded than here in the states either.Timely care is a private company , you can opt for private healthcare in the UK too,comparable to a a stay in a luxory hotel. Me, I would take the healthcare system in the uk rather than the lousy choices here. I love living here, but for that.
My husband recently had a visit which cost $987.00 to be told come back in a month, no diagnosis, no prescription , and our insurance did not cover him.oH AND WE PAY$856.00 A MONTH FOR LITTLE TO NOTHING!

The health care policy in this country, like all other laws, is written for the enrichment of billionaires by millionaires enriched by the billionaires. Any serious attempt to bring about health care reform in this country will ultimately bump up against the “sacred” profits of health insurance companies, pharmaceutical companies and medical equipment manufacturers.

I have several friends in the UK and not one has told me of having to wait in a crisis.BUT i have had to wait here with family members who had perfectly good insurance and my sister nearly died from the wait.[perforated intestine]
I am concerned also that government run healthcare would be another mismanaged mess, but oyy..it sure as hell cant be any worse than what it is now!
I am currently without insurance, which scares me to pieces, but thank goodness colorado has a healthcare plan in place that you can apply for or id be shit outa luck.

I can’t explain my concerns any clearer then Rick Baker the founder of Timely Medical Alternatives did in a speach he gave recently to a group an anti-reform group in South Dakota. These examples he sights frighten me to death! I don’t think UHC is right nor do I think the current system in the US is correct, but I certainly believe it does not have to be one way or another.***I APOLOGIZE IN ADVANCE FOR THE LENGTH OF THIS REPLY*** I JUST HAD TO SHARE BECAUSE FRIGHTENS ME

…”Now, don’t get me wrong. The Canadian healthcare system isn’t universally bad. We have an excellent primary care system – if you are lucky enough to have a family doctor. More than 15% of Canadians cannot find a family doctor. In some rural communities, when a new G.P. comes to town, the town holds a lottery. The lucky winners get to be on the new doctor’s patient list. The losers continue to have no family doctor.
Canada’s emergency healthcare is also very good. Sure, there are waits in E.R. departments – but there are also waits in American hospitals for emergency care.

It is the delivery of elective surgeries and medical care that the Canadian system fails its citizens. And fails them badly. In a country of 33 million people, there are more than 750,000 waiting for medical care. I’m going to give you some examples.
What’s that I hear you say? “Why would people leave a country where healthcare is free, and travel to the U.S. where they pay for their care?” My answer is simple – why did hungry Russians pay for loaves of bread in the morning, when by standing in line until the afternoon, they could have had it for free? The irony is, of course, that it isn’t really free. Nothing is free. Even the handouts being offered to Americans (and Canadians) in our respective stimulus packages, aren’t free – they come with a cost. The cost is higher future taxes. Canadians know all about income taxes. We pay crushing levels of tax in order to fund our promised “free healthcare” system. But when the need comes, for many Canadians, the promise is broken.

OK, enough of this philosophizing. What about concrete examples? Here are a few for you – and your congressmen & women – to think about.

In Edmonton, the capital city of the province of Alberta – a city of over 1,000,000 people, you cannot get elective spinal surgery. To understand why, you need to look socialism in North Korea. Tens of thousands of North Koreans starve to death every year, while their leader Kim Jong-Il dines on lobster, washed down with Hennessey Cognac every night. Everyone in North Korea is equal – but some are “more” equal.

In Edmonton, the federal police, people on workers compensation, and prison inmates, are “more equal”. These people get elective spinal surgeries. But the self employed farmers and their families do not get elective spinal surgery. There is not enough money to pay for sufficient nurses, so whole wards of hospitals are down. So if you aren’t among those fortunate people who are “more” equal, you wait on a long list – a list which never gets shorter. We send many of these people to excellent US hospitals where they pay for their care.

What’s that I hear? “What if there are people who simply cannot pay?” Unlike in the U.S., where hospitals are mandated not to turn away people who come to the hospital with urgent medical issues, in Canada, these people are routinely medicated with strong narcotic pain killers, and sent home.

So what do we at Timely Medical advise these people? The advice we give them isn’t pretty. We tell them that there is a loophole in the dysfunctional system. If a patient arrives at the Emergency Department with feces in their underwear, their situation changes from “elective” to “emergent”, and they get their surgery.

Can you imagine how demeaning it must be, to have to intentionally soil your underwear in order to get surgery in a healthcare system which our Canadian government assures us is amongst the “best in the world”?

Other examples? We are currently working with a 68 year old client in Kingston, ON. She has a prolapsed pelvic floor. Her bowel is impinging into her vagina. You don’t need me to draw a picture in order to understand how awful her situation is. In her city, there is a 2 year wait to have a consultation with a gynaecologist. 2 years! So, will she get her surgery in 2 years? No, she won’t. The 2 year wait is just to have a surgeon examine her and confirm what she herself knows – SHE NEEDS SURGERY! That surgery could be anywhere from 6 months to 2 years after the consultation.
I cannot imagine the American public accepting such a system. Why would you? We will be sending her to Oklahoma.
So, who does get elective surgeries in Canada? Healthy people do. Sick people don’t. Let me explain. In Canada, the government, not physicians and not the patient, decides who gets care and when they get it.
Hip and knee replacements have huge waiting lists. The government is under pressure to increase the number of these procedures every year. And they are – but at what cost? People needing shoulder & elbow replacements are now waiting longer than ever because the orthopedic surgeons are being ordered to concentrate on hips and knees.
So, in addition to cutting back on other orthopedic procedures, how else does the government increase the numbers?
Easy, they just operate on healthy people. People with complications such as diabetes or high blood pressure or people who are overweight (or even underweight), go to the bottom of the waitlist because their surgeries tend to be more problematic and therefore cut into the time allotted for all hip and knee patients. These unfortunate people are “less equal” than their healthy neighbours. We send these unfortunate people to Kansas or to Maine.
And what about older people? The government has decided that people over 80 years old are ineligible for the hip and knee surgery priority program – again because their surgeries take longer. This is particularly ironic because older Canadians are arguably more entitled to these surgeries, having paid more taxes into the system over their lifetime, than their younger neighbours.
We had one 79 year old client who was in line for a new hip under the priority hip/knee program in British Columbia. When his name finally came up and he was telephoned with a surgical date, the official who called him noticed that he was now one week older than the 80 year cut-off.
We sent him to Phoenix for his new hip.
More examples. We had an 8 year old girl whose surgery (to have a drain put into her infected ear) had been “bumped” due to more urgent priorities at Vancouver’s Children’s Hospital. Her father contacted us in month 9 of a projected 15 month wait for her surgery. The surgeon, to whom we sent her, in Seattle, told her father that she would have died had she waited the full 15 months. She had a raging cranial infection. As it was, she lost all of the hearing in her left ear and ½ of the hearing in her other ear.
I had occasion to relate this story to an assistant Minster in the BC Ministry of Health. His response was a shrug.
Here’s another. Shirley Healey, a client of ours in Vernon, BC, had a 99% blockage in an artery that fed blood to her bowel. She couldn’t keep her food down and had lost 40lbs. She was starving to death. Her surgery was cancelled at the hospital in Kelowna, BC. Elective surgeries are routinely cancelled at this very busy hospital. A decision will come down in the early morning from hospital management, cancelling the entire slate of surgeries scheduled for the day. Why? No beds available for Shirley in which to recover had her surgery gone ahead as scheduled.
Shirley’s surgeon told her she had no more than 2 or 3 weeks to live, without the necessary life saving surgery. He also said he could not guarantee that she would get her surgery “in time”. He advised her to contact us.
Shirley got her surgery 2 days later in Washington State. Her surgeon told Shirley that by the time he saw her, she was “hanging by a thread”.
When Shirley returned home, she applied to the BC Ministry of Health for a refund of her out-of-country medical expenses. Her claim was based on an implied contract between her and the government; she paid taxes over her lifetime, on her income as a school bus driver. And the government, she argued, had promised to deliver medically necessary healthcare as its part of the contract. The government’s response was “Shirley’s decision to get her surgery in the U.S. was elective and arbitrary”, and therefore, since it wasn’t medically necessary, they wouldn’t repay her out-of-pocket costs. In case you missed the irony here – surgery for a patient with 2-3 weeks to live is characterized by the government, as “elective”.
Shirley’s response? “The only thing elective about my decision to go to the U.S. was that I elected to keep on living”.
By the way, Shirley’s specialist, a vascular surgeon, told me that he has lost all of his enthusiasm about his profession. He now spends more time (literally) telling his patients why he cannot offer them their badly needed surgeries, than he spends in the actual operating room.
Surgeons in Canada have their OR time rationed, depending on their specialty. Orthopedic surgeons in BC, for example, are only paid for 6 hours per week. If they operate for 8 hours, the last 2 hours are unpaid.
In frustration with this inefficient system, Shirley’s surgeon volunteered to go to Afghanistan for a month, where he operated on wounded Canadian soldiers. Presumably, his operating room time wasn’t rationed by the Canadian army.
I could continue – but you get the idea. Canada and North Korea are the only 2 countries in the civilized world, where it is illegal for doctors to take payment from patients for treating medically necessary procedures.
If a patient wants a medically “un-necessary” procedure, such as a breast augmentation or a face lift, then their plastic surgeon is allowed to charge the patient. In the “Alice in Wonderland” world of Canadian healthcare, if you need elective surgery, you have to wait for it and are forbidden by law, to pay for it. If the surgery is not necessary, you can have it immediately and paying for it is not an issue.
Adopting the Canadian, socialized, single payer healthcare system, would be the worst possible solution to America’s healthcare problems.
If a single payer system isn’t the answer, then what is the solution? It is very simple. We send our Canadian clients to sources of quality healthcare in the U.S. – hospitals which discount their services at up to 85% off the usual and customary charges. The difference between a $60,000 charge for a hip replacement, and the $18,000 which our clients pay, is fat. Eliminating this fat is the solution to the “crisis”, in my opinion.
By the way, if anyone in Congress or any self insuring employers wish to know why and how our Canadian clients get lower prices for their surgery than Americans do, I would be pleased to explain. But that is a story for another time.”

If the free market works so well, why can a serious pro-free market publication like the economist publish the following in their 20th February issue?

“Governments want to spur private insurance in the hope of solving three big problems bedevilling their national systems of health care: inadequate access to care; soaring costs; and a paucity of innovation. Tehy hope thus to impruve their citizens’ health without tearing more holes in tattered public finances. The evidence so far suggests that relying on private insurance may help in some respects. But it will not solve all these problems, and may even be making some of them worse.”

“To ensure equitable access countries forbid private insurers from discriminating against applicants because they are in poor health or at high risk of falling ill. This practice, known as “lemon dropping”, continues in the American market for individual health coverage.”

“to this has to be added the cost of treating health insurance like a utility: regulating prices and stopping insurers cherry.picking and lemon dropping. This cuts across government’s other objective, encouraging innovation: Mark Pauly of the Wharton Business School argues that “the goal of limiting risk selection clashes with the goal of innovation.” Even clark Havighurst, an academic affiliated with the American Enterprise Institute, a conservative think-tank, says: “As ong as health insurers’ only significatn fuction is the simple one of financing health care, government itself is probably capable of performing that role nearly as well as they do – without incurring competition’s added costs”, such as marketing, duplicative regional offices and so forth.”

Jenny, your ideas are so radical, it does not work statistically or in real life. researchers have given up this type of theoretical health care policy, because it simply doesn’t work. So should you.

Jakob, What ‘The Economist’ publishes has nothing to do with how a free market can help change our current healthcare problems.
You’re completely missing my point. A free market is not the sole solution neither is UHC. In my opinion the article you sight is simply “rearranging deckchairs on the Titanic.”

Yes, reform suggestions have to be realistic. As you may have noticed, the polarized American political system renders meaningful change impossible when dealing with health-care, budget deficits and environmental policy amongst a host of issues.

Individual scare-mongering through the use of extreme examples can be found everywhere, with every system. We are all human, thus our rules and regulations are imperfect at best. An analysis of what the free market can do to change current health care problems has everything to do with what the free market can do to change current health care problems.

quoting you, Jenny:

“Rather than imposing more government restrictions on the market (more of the same that caused the problem in the first place) we should loosen those restrictions and allow the free market to work in health care.”

Government restrictions are not the fundamental cause of the problems in the American health system, billions spent on unneccessary wars is the direct reason why money cannot be invested in more useful areas. Free market models only work efficiently for the healthy or wealthy, if everyone were to pay a flat income-based tax for health care, more than 95% of americans would get more health care than they paid for in the long run. The richest 5% of americans can afford paying for the rest, and should be obligated to do so morraly. Paying tax gives you something in return, it’s not the government stealing your money.

“Whenever a government attempts to guarantee a good or service such as health care as a “right” it must also control it even if only to keep costs down.”

Good health is a human right, as the United Nations has asserted. It is easier to keep costs down with a governmental plan. No free-market, deregulated approach has been as cheap for the entire population of a country, as a governmental plan. Everyone needs to be taken care of, and has a right to be taken care of. That can only be done with a government option in place ensuring the economically weak at least one viable option.

“If the government lets people have as much health care as they want, then the system will quickly go bankrupt. “

Any system needs regulation, ensuring that those needing health care get health care, not those who want it or think they need it. The market can not make that distinction, only a public option has the legal rights and economic foundation of non-profit that renders this approach viable.

“In a free market individuals, providers, and insurers decide how health care is allocated based on mutual self-interest.”

This does not consider the ethical aspect, or long-term aspects, only short-term profit. Evidence: carbon emissions not being self-controlled by the market, fat cats exploiting the free-market system causing financial melt-down, cherry-picking and lemon dropping in the health care system.

These are the ideas I quoted a professional overview on, as well as the inherent and internal conflict of limiting risk (to ensure profit) and innovation within the medical field that exists if left in the hands of pharmaceutical companies, insurers and private clinics. Not all research is best done for commercial exploitation if it is to be utilitarian for society, and in extension the individuals therein.

Americans fight for their right to die if they cannot help themselves, just as they fight for the right to leave others dying. This is an extremist view. It is strange how many Americans deem themselves religious, morally speaking, as all major religions value empathy and the priceless value of human life.

Great post. I am easily distracted, but I read the entire post!
I think that the longevity of the two-party political system has social roots and consequences. In the multi-party system more common in European politics coalitions are formed around compromise. A trait that is mirrored in their respective cultures. The two-party system mirrors the American system of winners and losers. It’s a zero sum game – whatever one gains is at the other’s loss. That’s what makes this health-care debate so vociferous. In the American model, whatever gains the un/under-insured will be at the cost of others. It doesn’t occur to us that it could possibly be good for all of us.
You pointed out how the connection between employers and health insurance is a by-product of World War II. It has remained so because our puritanical background remains alive and well. God (and America) rewards the hard working and damns the unemployed, elderly, and disabled.
It is interesting that one side claims that the ability to choose your insurance coverage will be taken away if any of the current legislation is passed. As you pointed out – the vast majority of Americans have their insurance selected by their employers; whose criteria of selection probably differs greatly from their own.
Despite our image of being innovative, Americans are terrified of change. You invoked the boogie-man, “single-payer”. We bitch about the insurance company and how they reject our benefits, make us wait for hours on hold to speak to someone, and arbitrarily override our doctor’s orders. But, we are familiar with this. We can complain to our co-workers and they all understand. Single-payer is new, different, and scary to us. A nation which is too frightened to change when change is needed (and it is) is a nation of cowards. Hmm…didn’t we all hear in elementary school that cowards are the first to pick fights? Iraq….Afghanistan. Thanks again Duncan.

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