Response to comments on socialized medicine

Country XXX has socialized medicine and it sucks.

U.S. healthcare spending has been increasing faster than our economic growth since 1970. In 2007, that number was $7600 per person.

In this comparison chart by country for the year 2000, we see that the United States spends more money per person than any other country in the world, and by a significant amount in most cases.

Whatever we can say about socialized medicine, we can say that it in all cases it’s less expensive than the mess that we have in the United States.

To the extent that our healthcare may be better than country XXX, we are paying through the nose for the improvement in quality.

The reason why it’s important for Republicans to create the new socialized healthcare system is because I have more faith in Republicans to create a system that has incentives to make sure that quality of service is maintained. Democrats are incapable of understanding that people respond to incentives, so if we cede the problem to Democrats, we will certainly get a lousy implementation of socialized medicine.

When has forming a monopoly ever reduced prices?

Compared to what? An unregulated free market with perfect competition? Or what we have in healthcare, a highly regulated oligopoly in which the government is already the biggest player? I’m pretty sure that a well thought out monopoly would result in lower costs compared to what we have now. That’s costs, not prices. If you go to a doctor or hospital and don’t have any insurance, you would see how ridiculously expensive the prices currently are. There is no doubt that a monopoly would reduce prices.

What a great idea! Then health care can be like Amtrak, FEMA, the Defense Department, the post office and all the other efficient, user-friendly, low cost government bureaucracies.

We have the best military in the world, the U.S. can take over any country in the Middle East. The post office will send a letter anywhere in the United States for a mere 42 cents; that’s a bargain. I ride Amtrak all the time and I am generally happy with the service. A train ticket from New York to DC is a lot less expensive than a visit to the doctor, and unlike the doctor, the train is 90% on schedule--I never have to wait as long for the train as I do for the doctor.

What part of the U.S. Constitution delegates the power to create a national health care system, and force citizens to participate in it, to the Federal government?

The Supreme Court would say the General Welfare clause of Article I, Section 8. And I never said it should be illegal for people to seek healthcare outside the system.

[The current system is not like socialized medicine because:] If someone in my family needs to go to the doctor or hospital, they pick the doctor or hospital of their choice…the whole process seems rather free market to me.

That’s like saying that cable TV is not a monopoly because I can choose what channel to watch. Or that the post office is free market because I can choose where the letter gets mailed to.

People with Medicare can choose doctors and hospitals. Is anyone going to try to argue that Medicare is an example of a free market system?

Comments

[Peter]

Yes, we spend far more on heath care than any other country, but we also have the longest life expectancy and the lowest infant mortality, and ... oh wait.

[Tonic]

Yes, we spend far more on heath care than any other country, but we also have the longest life expectancy and the lowest infant mortality, and ... oh wait

I wonder why that could be?

[Half Sigma]

Previous blog post on infant mortality.

[jaakkeli]

I don't understand why Americans assume that privatized and socialized health care are mutually exclusive. (Perhaps because in most English speaking countries there's only one kind?)

Finland, for example, has government-funded public health care but happily allows the private sector to run clinics as well. It works much like you'd expect - the (almost) free care has the ridiculously long lines, the nurses who hate you and so on while the private clinic gets you good service and instant treatment if you have the money. Actually, I guess it's much like the Canadian system, except that the private clinics aren't in a neighbouring country...

[Tonic]

Previous blog post on infant mortality...

Posted by: Half Sigma | July 02, 2008 at 12:02 PM

I'm still waiting for janie's paper on the single payer system, bitch!

[Ned]

"We have the best military in the world, the U.S. can take over any country in the Middle East"

True. Also the most expensive military - the US spends two-three times as much of its GDP on the military as most other developed countries. Is this how the government saves money?

"The post office will send a letter anywhere in the United States for a mere 42 cents; that’s a bargain."

Where I live, the postal service sucks. The mail arrives late and often mangled. There are always lines at the post office, and the clerks are rude and unhelpful. I have complained, but it doesn't change. Guess I'll just take my business elsewhere....

"I ride Amtrak all the time and I am generally happy with the service."

I rarely ride Amtrak. Here in the Midwest, the service is horrible. The trains are infrequent and almost always late. Earlier this year there was a crash.

"People with Medicare can choose doctors and hospitals."

Maybe not much longer. Medicare is facing a 10.6% fee cut for doctors, which should have gone into effect yesterday. The cuts are being delayed while Congress tries to figure out what to do. If these cuts do take place, see how much "choice" Medicare recipients will have, especially when looking for specialists outside big cities.

[blue]

In this comparison chart by country for the year 2000, we see that the United States spends more money per person than any other country in the world, and by a significant amount in most cases.

But the US has a much larger fraction of low IQ people than those other countries do. Low IQ people will be huge burdens on the taxpayer because they tend to be both sicker and poorer.

Possibly because of the larger fraction of low IQ people, Americans are sicker than Europeans. Therefore whatever health care system we have will cost most more than whatever Europeans have.

See this article here for instance:

"The study published on the Web today by the journal Health Affairs found that Americans were nearly twice as likely as Europeans to be obese (33.1% versus 17.1%), and they also were more likely to be current or former smokers (53% versus 43%)."

...

When it comes to cancer, the higher diagnosis rate appears to be due to more intensive screening in the U.S., they said. But higher rates of obesity-related diseases and conditions, such as high blood pressure, suggest Americans also are, indeed, sicker.

I am also thinking of articles like this from the NY Times series of diabetes.

Low IQ and ethnicity (Hispanics, South Asians) both contribute to the epidemic in NYC. Does Switzerland or Norway have problems like this?

[unemployed]

A Backlog Of Cases Alleging Fraud

By Carrie Johnson
Washington Post Staff Writer
Wednesday, July 2, 2008; Page A01

More than 900 cases alleging that government contractors and drugmakers have defrauded taxpayers out of billions of dollars are languishing in a backlog that has built up over the past decade because the Justice Department cannot keep pace with the surge in charges brought by whistle-blowers, according to lawyers involved in the disputes....

[afreakin]

Any health care system will soon collapse in the face of human waves of angry nihilistic [underclass] people.

[Al Fin]

HS, did you forget tort reform? Look at Mississippi's happy experience with tort reform and you will find a better part of the answer.

If you like long lines and less high-tech medicine then by all means go single-payer. Pioneering new treatments and technologies is expensive. If you want a better system, MAKE PEOPLE PAY FOR SERVICES and take the sharp knife to the tort system.

You never get something for nothing.

[unemployed]

The tort system is about the only reason left not to go to Mexico or Thailand (or Canada?) for health care. You can't sue your doctor in Mexico either.

[David Alexander]

I wonder why that could be?

Supposedly, our infant mortality rates are high because we're prone to saving and delivering babies that Europeans are less reluctant to deal with. As for our life expectancy, supposedly, even when comparing white Americans to your average Englishman, our life expectancy is somewhat lower.

I don't understand why Americans assume that privatized and socialized health care are mutually exclusive.

Primarily because they keep looking at the Canadian system which is effectively what you describe and suffers from having no private provision, IMHO.

IMHO, there's two ways to aim for healthcare coverage. Either turn insurance into a catastrophic & long-term car program where check ups and other tests are performed out of pocket, and hope that prices will come down, or follow the French model which comes across as "Medicaid for all", but with co-pays based on income, and employer-based (or individual based) private insurance and hospitals supplementing the private system.

I ride Amtrak all the time and I am generally happy with the service.

I suspect the main reason you ride Amtrak is because the high fares chase away the proles who end up riding Chinabus or any of the other alternative bus services.

FYI: I've racked up enough Amtrak Guest Rewards points for four Regional trips. Of course, thanks to the high price of gas, it's pretty easy to use the Amtrak Guest Rewards credit card to build up points...

I rarely ride Amtrak. Here in the Midwest, the service is horrible.

Amtrak would suck less if it could replicate what it has along the NEC: fast and frequent service with different price points and comfort levels with dedicated (and owned) trackage so it doesn't have to rely on the "kindness of strangers" (aka freight rail firms). Due to political pandering in Congress, historical quirks, an awful regulatory structure, and the questionable choices of some railfans, Amtrak is considerably less useful than what it could be.

Where I live, the postal service sucks.

Dude, I lived in a black neighbourhood, and the mail was rather reliable, and I could count on stuff to come without being damaged. Maybe you should complain to a regional director in the USPS about the poor service.

[afreakin]

Censorship isn't just for pc liberals anymore.

[GreySwan]

I believe the primary reason healthcare costs are as high as they are is because of malpractice. Doctors will perform every test possible to avoid being sued, even if the cost/benefit of these tests is very largely negative.

[unemployed]

You can't sue your doctor in Mexico either.

[Tired of Smoke Rings]

Socialised health care by whatever name is going to be the typical BigGov, shuck and jive.

JA, Vim or one of their intellectual equals will ask in a disingenuious fashion:

What do I mean?

TOSR:

Nice question, well for the terminally obtuse let me expand. They will offer you more service at lower cost. They will deliver less service at higher cost. In other words they will sell the sizzle and eat the steak themselves.

Look at any government program and it supports my argument. No, Head Start is not a counter example. Neither is the military. Government programs however well intentioned and necessary are an invitation to fraud, abuse and rent seeking behavior. Expecting any other outcome is blindingly naive, bordering hard on the precincts of stupidity. Not trying to be mean spirited here, I like to leave that kind of work to experts like John "leagalize 'em all and let welfare sort 'em out" McCain.

[SteveBrooklineMA]

Obviously, other countries have lower medical costs because their governments strictly control prices. The only major relatively free market left, the USA, ends up footing the bill for medical research by way of high prices. In effect, countries with socialized care are not paying their fair share, they are passing the costs on to us.

What if the USA adopts socialized medicine like other countries? Then all would be on equal footing. But, as I pointed out in my previous comment, it would be a disaster for the advancement of medicine.

We can debate the plusses and minuses of health care policies, but to ignore the effect of said policies on the advancement of medical science is foolish and likely dangerous.

[M]

"Democrats are incapable of understanding that people respond to incentives, so if we cede the problem to Democrats, we will certainly get a lousy implementation of socialized medicine."

This is the single most incoherent sentence I've read in a long time. I like reading your blog, HS, but I think you have some deeply held twisted, far-left political views that don't mesh at all with the rest of your philosophy. Might I suggest a shrink?

[M]

"Obviously, other countries have lower medical costs because their governments strictly control prices. The only major relatively free market left, the USA, ends up footing the bill for medical research by way of high prices. In effect, countries with socialized care are not paying their fair share, they are passing the costs on to us.

What if the USA adopts socialized medicine like other countries? Then all would be on equal footing. But, as I pointed out in my previous comment, it would be a disaster for the advancement of medicine."

Absolutely, postiveily, 100% equiviocly seconded. The reason why socialized medicine in Europe and Canada isn't collapsing in on itself - although it's doing pretty terribly - is that all the research on future medicine is done here. With Osama in office, expect that to slow to a trickle or end completely.

[mnjohn]

"Obviously, other countries have lower medical costs because their governments strictly control prices. The only major relatively free market left, the USA, ends up footing the bill for medical research by way of high prices. In effect, countries with socialized care are not paying their fair share, they are passing the costs on to us."

Does anyone have any evidence on this? I'm not being a smartass, I honestly don't know whether its true or not. If there is anything to back it up I would be curious to read about it.

[mnjohn]

Also GlaxoSmithKline and some very large other drug companies are located in Europe.

[Andysan]

As the parent of an adult, developmentally disabled man, I can speak with some authority about how socialized medicine has worked for him. This site is something I put together to assist other parents.

http://bestplacefordave.org/

In a nutshell, socialized care for the handicapped has been an unmitigated disaster. I am not optimistic that socialized medicine would be any different. Long wait lists, poor care, inappropriate care, frustration and wasted taxpayer's dollars are the norm.

[Lawful Neutral]

HS, I'd like to see your answer to my comment. This is a trade, right: socialized medicine for immigration restriction? Well, what could possibly enforce that deal? The most likely outcome is socialized medicine AND massive immigration; it doesn't sound too appetizing to me.

Another commenter has pointed out that Britain has socialized healthcare, but that doesn't stop them from allowing massive unskilled immigration.

[ckdh]

Here's my problem:

- I am employed and I pay a lot of taxes. (with state and city it's like 40% or so) It's outrageous.
- One of the benefits of being employed is that you get free medical insurance. (and it's a pretty good one too)

I already am highly taxed. Socializing health care would mean increasing my taxes and taking away my free medical insurance and giving everybody medical insurance, payed by me.

In other words, it doesn't seem to be fair that the working salaried people pay for welfare state and the rich and poor people who decide not to work. Socializing health care would help small businesses, but would hurt the working people. It also encourages people not to work

[Gil]

Is not the problem one of problem of medicine is that it is expected to available to all regardless of injury or ability to pay? If someone can't afford a TV, no one is expected to pitch in and buy that person a TV. Or a house, car, DVD player, etc. Hence the true free market is simply one of ability to pay or go without. Would this then smarten the act of down-and-out poor people? Break an arm and you're in big problem because it going to get untreated? Go to backyard surgeon when the arm gets too bad and have it amputated?

[Vim]

Gil: "Go to backyard surgeon when the arm gets too bad and have it amputated?"

They'd probably just die, Gil. There are a lot of countries where this is how it works. Nobody seems to be any smarter.

[Turambar]

Whats the score card?

Military: Not cheap but the best
NASA: expensive and kind of dumb
Education: bad and expensive. Saved from disaster by some very good schools
USPS: not cheap but getting better thanks to competition
IRS: bad
New Deal: disaster and expensive
Great Society: fair and expensive

Other government:
DMV: Usually disaster
Big Dig: poor and expensive

I think the odds are against giving the government more to do is going to work out well.

I think you are right in your sentiment that this would be better attempted by sober Republicans than gleeful socialists.

What is the language that you propose for the authorizing constitutional amendment? I'd be interested to see if you can produce something that is useful but will curb congress legislating a compulsory, confiscatory system.

[Peter]

One of the benefits of being employed is that you get free medical insurance. (and it's a pretty good one too)
I already am highly taxed. Socializing health care would mean increasing my taxes and taking away my free medical insurance and giving everybody medical insurance, payed by me.

Your employer-provided health insurance is unlikely to be free. You're probably paying a substantial share via payroll deduction. And the share that your employer pays is money not available to pay your salary.

[Al Fin]

Only idiots believe their medical insurance is free. Nothing is free.

If you love the option of being able to sue your doctor so much, then don't go with single payer socialized medicine.

Better yet, let your lawyer provide your healthcare.

[Dan Morgan]

The cost of US health care alone is not a good enough reason to socialize it. Table 1 at the first link below shows that US private investments into biomedical research is 5x higher that the EU - even though the EU has a larger population.

Also, the US government outspends the EU by more than 5x on medical research. I guess under a socialized medical system all of the pressure is to spend the medical dollars on patients rather than research for future patients.

So just like the rest of the world has leeched off of US military spending, the same appears true of medical research.

Tyler Cowen has written (see 2nd link below):

"The American government could use its size, or use the law, to bargain down health care prices, as many European governments have done. In the short run, this would save money but in the longer run it would cost lives."

http://ostina.org/downloads/pdfs/bridgesvol7_BoehmArticle.pdf

http://www.nytimes.com/2006/10/05/business/05scene.html?bl&ex=1160452800&en=6737dbf98961a2a6&ei=5087%0A

[ckdh]

Your employer-provided health insurance is unlikely to be free. You're probably paying a substantial share via payroll deduction. And the share that your employer pays is money not available to pay your salary.
No, it's actually free (but it is one of the benefits) However, it's a good benefit, because it's not paid by me. If I were to be paid more and then pay for medical insurance, I would have to pay it after tax, which would suck. (after 75k, basically you get almost no deductions) This would give me an incentive to work less, maybe only 20 hours and get 20% of the pay.

[ckdh]

I meant 50%.

[anon]

The Supreme Court would say the General Welfare clause of Article I, Section 8.

And the Supreme Court would be dead wrong.

The Constitution is a document of enumerated powers. This clause appears in a section on taxes and debts for crying out loud. It was NEVER intended to be a loop hole through which the government could assume any and every power with the excuse of "general welfare", confiscate our property, and force us into programs which micro manage all aspects of our lives.

The Supreme Court has failed to uphold the Constitution in this respect since FDR tried packing the court. You want a true rendering of the Constitution on this clause? Review decisions before the 1930's.

And I never said it should be illegal for people to seek healthcare outside the system.

Just impossible for anyone who doesn't make enough money to both pay their nationalized health care taxes AND afford a private doctor. We've seen how well that works out for the lower income, inner city families that actually care about their children's education.

[seeitnow]

You are overlooking the possibility that the reason so much is spent on health care in the US is a combination of other factors: maybe the typical American diet contributes to the general unhealthy weight problems with the average American, perhaps Americans see doctors and emergency rooms way to often for rather minor reasons, maybe American doctors prescribe way to much protect themselves - not to mention the additional fees to support their expensive lifestyle (which I believe is the highest in the world), and then there is the American lawyers constantly advertising on TV and other venues to attract lawsuits against doctors and hospitals, I could go on. By the way I'm not a doctor or in the health care system.

[Fed Up]

Sigma is correct to address the healthcare-funding issue. Yes, government control will involve stupid minority doctors, etc; on the other hand, early intervention and other prevetatives might end up saving money. Whoever brought up the collectible analogy vis a vis pricing is brilliant: I can't add to that.

[anon]

I wonder why people continually fall for socialist economic theory when it has been so completely and thoroughly disproven, time and time again.

Half Sigma would most likely not even engage a creationist in a debate, preferring to mock their beliefs. I would give more respect to a creationist's theories than to any socialist theory. That's how completely the presumptions and predictions of socialism have been shattered.

Socialism doesn't even deserve a debate. People who suggest it should be mocked because they have fallen for something so stupid. We should shame people away from socialism. That's how stupid it is.

[Hawke]

I would agree the system currently is broken, I don't agree with the logic: The system isn't free market, therefore we should socialize. Why not "The system isn't free market, let's make it free market."

Why stop with health care? Fuel costs are rising for us. Let's socialize all the fuel production and distribution. And why not housing. And car insurance?

If your assertion is true - that socializing medicine will result in lower costs and better quality for the common welfare, why not extend that to any essentials like transportation, fuel costs, housing, clothing? Sure... leave the luxury goods alone, but I just don't see how you can say socialized medicine works but nothing else socialized does.

If you're really asserting that we should socialize EVERYTHING, than I can see the consistent logic of that position much more easily and it becomes a debate on whether or not it actually would work.

[Social Services Drone]

Wrong about people with Medicaid or Medicare choosing their own doctor.

Most Dr's offices avoid the coupons like the plague. In my neck of the woods, people who use Medicaid typically have one Dr and no dentists to choose from within a three hour drive. Most of those on Medicaid cannot reach it by bus either.