In response to this post, in which I mentioned how touchy “single-payer advocates are about the “S” word, I received a comment from C.M. Hughes reciting the de rigueur “progressive” talking point about socialized medicine:
The reason we don’t like equating single payer with a socialized system is because they AREN’T EQUAL! Socialized systems, like England’s, are ones in which the government owns everything … Single Payer systems, like the most succesful systems around the world, are like our Medicare and medicaid programs.
This shopworn trope ignores the real issue, of course. Regardless of what entity nominally employs the health care workers or owns the facilities, government-run health care is predicated on the notion that central bureaucratic control is somehow superior to the operation of the market.
Today’s news contains a fresh refutation of the claim that outcomes are materially different in these two types of government-run systems. In
Sarah Plank, a spokeswoman for the British Columbia Ministry of Health, said a spike in high risk and premature births coupled with the lack of trained nurses prompted the surge in mothers heading across the border for better care.
And, in Great Britain’s system of socialized medicine, there is an identical shortage of adequate care:
Many neonatal units were forced to refuse new admissions for considerable periods of time … Mothers and babies may be forced to travel long distances in search of a unit with the appropriate facilities to care for them.
Hmm … These examples suggest to me that the difference between “single-payer” and “socialized” health care is mostly semantic.
Maybe Hughes and the other the advocates of government-run health care could explain how an expectant mother with no bed in
Comments 19
Glad to!
First off, if we took the 1/6th or more of the population with either inadequate or no health insurance and put them in line with the rest of us, I can guarantee you we’d have longer lines.
Second, the idea that we don’t have waiting times is wrong. See here: http://cmhmd.blogspot.com/search/label/Waiting%20Times
Third: Some people come here for specific treatments, our people go there for medications. Which is worse? And in Pennsylvania, half of our hospitals that used to do deliveries do so no longer. We have our own crisis in access to perinatal care, unfortunately, and it’s not due to “socialized medicine.” If you ant more information on rationing in the US, go here:
http://cmhmd.blogspot.com/search/label/Rationing%20Health%20Care
4th: The difference is not just semantics, but it may be beside the point. I would argue that we should not adopt Canada’s or Britain’s or Belgium’s or anybody else’s system. We should pick and choose what will work for us. Don’t like the way the NHS prioritizes? Change it. Don’t like that Canada emphasizes primary care over procedures? Adjust it!
Lastly, it seems to me that we are having the wrong fight here. The only “anti-free market” thing I really think is essential to getting to universal healthcare is to get rid of private insurers as profit making ventures. And here is the difference between ’socialized’ and ’single payer’: I don’t think the government should own all the hospitals, employ all the workers, and take the competition out of home health service providers, etc. Just like Medicare, we let the free market determine the best providers, though with a bit better oversight that we’re hearing about in the news today:
http://www.npr.org/templates/story/story.php?storyId=15178883
Cheers,
Posted 11 Oct 2007 at 1:26 pm ¶Three points:
Medicare doesn’t “get rid of private insurers as profit making ventures.” CMS outsources the management of its health care programs to fiscal intermediaries. And what sort of “intermediary” do you think CMS hires to administer Medicare and Medicaid? Well, it hires insurance companies that DO make a profit.
Medicare doesn’t “let the free market determine the best providers.” CMS price controls (DRGs, APCs, etc.) drive providers in all sorts of absurd directions. This has already caused serious primary care shortages in rural areas, and many hospitals have had close their doors in the same regions.
If the government controls the money, it controls the system. This means the same bureaucratic nonsense that goes on in any government-dominated enterprise. In reality, most of the problems that you want to fix are CAUSED by the government programs we already have.
Posted 11 Oct 2007 at 2:03 pm ¶If the government controls the money, WE control the system, if we’re smart.
I’m well aware how Medicare uses intermediaries, that’s who sends me my checks. But their overhead and profits and red tape pale in comparison to private insurers.
Your “price controls” are my abuse prevention. Remember Length of stay before DRGs? And you’ll notice, in the articles you posted on neonatal care in canada and britain, they have recourse: They petition the government to improve things. And Americans are very vocal about our needs, so I don’t see that happening here (much). And again, if you think America is inferior and can’t do as well as Belgium and the Netherlands…
And I really do not understand why you defend private insurers. They have the worst, worst, worst bureacracies you can find. Just becasue they aren’t government agencies doesn’t make them any less painful to deal with.
Maybe there is something we can agree on: Private health insurance companies are, by and large, leeches on society. Discuss.
Cheers,
Posted 11 Oct 2007 at 2:31 pm ¶‘Tis true that I’m no fan of the insurance companies. That’s why I include them among the “forces of darkness” on my “about” page. And they do indeed have bureaucracies.
Nonetheless, my 20+ years dealing with Medicare, Medicaid, and the insurance companies has convinced me that the latter will respond to the market in ways the government won’t.
In other words, it’s a classic “lesser of two evils” choice.
Posted 11 Oct 2007 at 3:00 pm ¶Is this a “Come to Jesus” moment?
Cheers
Posted 11 Oct 2007 at 3:19 pm ¶Geez, I hope not.
Posted 11 Oct 2007 at 3:39 pm ¶Maternity services/obstetrics is a bad example to pick, David - you have a grossly undervalued midwifery and dreadful problems running full obstetric services, not least because of litigation and doctor shortages. Once again, do look to home first before sounding off.
Posted 11 Oct 2007 at 5:16 pm ¶OK, then, for discussion:
We pass a single payer bill that:
1.) expands Medicare to all citizens who wish it
2.) Medicare is funded as a general program, without the MC withholding and is pay as you go.
3.) you can pay for your private health insurance if you like, but Medicare is now a benefit for all.
what happens?
Posted 11 Oct 2007 at 5:22 pm ¶Here’s what happens:
Expand Medicare to all citizens who wish it.
That sounds lovely, but here’s the rub: You can’t have universal access, high quality, AND low cost. You have to give up one of the three. So, the real question is: Which goes overboard?
Medicare is funded as a general program, without the MC withholding and is pay as you go.
The problem here is “pay as you go.” The electorate answers generic poll questions about “universal health care” in vaguely positive ways, but the voters will never stand for the kind of tax increase it would take to pay for this.
You can pay for your private health insurance if you like, but Medicare is now a benefit for all.
Well, that’s the beginning of a two-tiered system, isn’t it? Rather like our public school system, we would have mediocre performance for the general public, but good quality service for those who can cough up the bucks for the private alternative.
Posted 11 Oct 2007 at 7:25 pm ¶There you go again, America-hater!
Why do other counties manage all three but we couldn’t?
Voters won’t stand for not paying health insurance premiums or won’t want their healthcare benefits dollars converted to higher salaries and out-of-pocket expenses go down? silly me. You think many people would lose in this exchange?
I agree this will result in a two tiered system, but not in the way you think. I’m guessing one percent of the population opts to pay for their own healthcare or insurance out of pocket, everyone else going for the tax funded system. The private tier (3 million people)will get concierge type service, but the bulk of doctors and the ones you want, the academic and high performing ones, will largely be in the single payer system. So the private tier, i imagine, will be able to pay to go to the best hospitals, but won’t be getting anything the rest of us can get. There will be places, I’m sure, that will cater with private hospitals as in London. I’m OK with that.
And, BTW, as you would expect, I favor more equitable financing for public schools, too!
cheers,
Posted 11 Oct 2007 at 7:58 pm ¶Another thought, though, I shouldn’t put it past the 1 percent to screw it up for everyone by buying politicians to lower spending for healthcare. Then we’d end with the stories you love about Canada and britain’s shortages of neonatal beds, etc.
Cheers
Posted 11 Oct 2007 at 8:01 pm ¶Those “other countries” you admire also tend to have oppressively high income tax rates.
Posted 12 Oct 2007 at 9:03 am ¶‘Those “other countries” you admire also tend to have oppressively high income tax rates.’
They also have healthier and happier people with much less crime and inequality.
Posted 12 Oct 2007 at 11:22 am ¶Those “other countries” you admire also tend to have oppressively high income tax rates.
Well, since the portion of their GDP and their expenditure per capita is significantly lower than ours, that should mean, unless I have a faulty circuit, that the portion of their oppressively high taxes that goes to health care would be less per capita and per total GDP expenditure than our current payments/expenditures.
The rest of their taxing and spending policy is immaterial to our discussion.
Cheers,
Posted 12 Oct 2007 at 12:05 pm ¶Maybe if we had oppressively high tax rates and a socialized medicine system, then we might someday have healthier happier people with less crime and inequality too!
Posted 12 Oct 2007 at 2:51 pm ¶Not socialized, single-payer. Say it, “Like Medicare for everyone!” It’s not that hard.
But these are trade-offs a society makes. If you saw Sicko, the French have decided their tax rates are not sufficiently oppressive in view of the vast benefits they get. That is a societal, political decision.
Have you seen how Europeans live, by the way? You may not like it, but they sure seem to have nicer life styles than most of us. They don’t have as much “stuff”, but they do OK.
But I digress, don’t you think that the end result of a single payer system will be less total expenditures by America for healthcare even while we cover everyone?
I do have a compromise: we could separate out the portion of our taxes alloted to healthcare separated out so we can see exactly what they are. If you want, we could call them “Single Payer Premiums” or something. Then we can argue more accurately about what we should or should not spend/cover and how much it is actually costing us.
Chris
Posted 12 Oct 2007 at 3:38 pm ¶I don’t think Americans would tolerate the typical European lifestyle, although it is fun to visit there to see how other cultures live. For the same reason, we would not tolerate their healthcare systems either. We are more impatient and demanding, in general.
I think those in the top 10% of incomes (those who earn over 100K and who currently pay 68% of all taxes) would be taxed significantly more to pay for any socialist plan. Yes, it is socialism when you take money from the wealthy and redistribute it to the poor.
There is no way we could cover an extra 49 million people with less total expenditures unless widespread rationing on the NHS scale were instituted. While the poor might benefit, the rich would pay not only with higher taxes but with inferior service and longer waiting times.
Those paying the bills won’t accept paying more for less.
Posted 12 Oct 2007 at 9:10 pm ¶… would not tolerate their healthcare systems either.
Yeah, who would tolerate a better system.
We are more impatient and demanding, in general.
And this should ensure adequate funding and a beter system. Unless we do it stupidly, which is possible if we’re not careful.
I think those in the top 10% of incomes (those who earn over 100K and who currently pay 68% of all taxes) would be taxed significantly more to pay for any socialist plan. Yes, it is socialism when you take money from the wealthy and redistribute it to the poor.
Fine, you like to call it socialism, but that ship has sailed. Progressive taxation is accepted, accomplished, game over.
There is no way we could cover an extra 49 million people with less total expenditures unless widespread rationing on the NHS scale were instituted.
In spite of all examples and evidence to the contrary; you can ignore the successful systems, focus on the problems with the less successful ones if you like, but none of them would trade their system for ours.
While the poor might benefit, the rich would pay not only with higher taxes but with inferior service and longer waiting times.
The poor and vast sections of the middle would abolutely, definitely benefit. The very rich will aways jump line. I’m really not worried about them.
Those paying the bills won’t accept paying more for less.
They won’t. They will pay less for more. Do some research beyond ths silly pissing match with anecdotes. If you want to do an anecdote contest, we generally lose.
Cheers
Posted 12 Oct 2007 at 10:28 pm ¶As if your mind would be changed by even the most convincingly researched response that was contrary to your preconceived notions. You would be as likely to post some completely unrelated NEJM “response” and smugly claim righteousness and victory.
No thanks…I’m content with just posting my opinions.
Posted 15 Oct 2007 at 8:31 am ¶Post a Comment