Guns, Butter and European Health Care

Europeans often moralize about the American reluctance to join the “civilized world? by implementing “universal? health care. A typical example of this condescending attitude can be found in the comment stream of this post at OVER!MY!MED!BODY!, where a Danish student offers the following: 

Today there’s not a single country in Europe that doesn’t have publicly sponsored and regulated health care; in fact, of all the countries in the Western world, the USA is the only one without universal health care.

She also boasts about the low cost of Danish health care:

I’d have you know our ‘free’ health care system only costs 8% of anyone’s income. As a student that means I pay $65 a month for as much health care as I like, with no fuss and no paperwork.

There is, however, one issue that she neglects to mention: The United States subsidizes the health care systems of Denmark and all of the other EU countries that provide “free universal care.?

Because Denmark and the other EU members emulate Canada in allowing the U.S. to pick up the tab for their national defense, these nations are able to spend their own money on various social welfare programs.

Indeed, this is why most EU members can get away with having Lilliputian military establishments. It isn’t because they are more civilized, but because they freeload off the American tax payer.

So, rather than moralizing about how uncivilized we Americans are, perhaps those oh-so-superior Europeans should be thanking us.

Comments 24

  1. Graham wrote:

    I’m sorry, what enemies does Denmark have that we’re protecting them from again?

    Posted 23 Oct 2007 at 10:39 am
  2. Marc Brown wrote:

    ‘Two NATO soldiers killed when Taliban extremists attacked their base in southern Afghanistan were Danes, the Danish army said on Thursday.’

    Posted 23 Oct 2007 at 10:46 am
  3. Catron wrote:

    What enemies does Denmark have that we’re protecting them from again?

    You may recall an obscure historical event sometimes referred to as “the cold war.” We covered their butts for several decades pursuant to that little dust-up.

    And, if you’ve been following Putin’s antics at all, you will (I guess) realize that it is not unlikely that Denmark will need our protection again in that quarter.

    Posted 23 Oct 2007 at 10:47 am
  4. Cecilie wrote:

    You’re evading the real question. The debate you refer to is not about European health care, it is about American health care. The USA spends 16% of its GDP on health care, more than twice as much as the European average, so obviously it’s not a financial issue despite military costs. So, regardless of how and why Europe finances its health care system, the question remains why the USA does not have equal access to good health care for all its citizens?

    As for my alleged moralising, I fail to see how stating facts and correcting misinformation can be condescending. My opponents in this debate have done little but scaremongering, using false information and outright lies to validate their opinions, evading direct questions and starting arguments on completely irrelevant subjects. I never did say the USA should implement universal health care at all costs; I’m merely saying it’s not impossible and shouldn’t be countered with lies.

    I do, however, find it slightly amusing that this should be so offensive to you as to warrant an entire blog entry. You do know what is said about arguing on the internet, right? ;) Relax and let’s have a friendly discussion about a complex and highly relevant subject, as I believe was Graham’s original intention; civilised adults shouldn’t have to resort to slandering and name-calling when polite conversation would prove much more enlightening for both parties.

    ~Cecilie, Danish student.

    Posted 23 Oct 2007 at 2:49 pm
  5. Catron wrote:

    Civilised adults shouldn’t have to resort to slandering and name-calling.

    Perhaps you could indicate the passage in which I have engaged in slander or name calling. I’m having trouble locating it.

    Posted 23 Oct 2007 at 3:20 pm
  6. Cecilie wrote:

    Calling me condescending and moralising (while in the very next sentence proclaiming America’s superiority and demanding that the entire world grovel in gratitude before this nation), quoting me out of context in a completely different blog, and accusing my country of freeloading off the American tax payers is only a start, though I wasn’t referring only to you but also to other participants in the debate in Graham’s journal.

    And you’re still evading the real issue. Is your position really that indefensible, or are you just incapable of constructing a convincing argument in your favour without resorting to misinformation and lies? I’m still waiting for your reply over at Graham’s, just take your time.

    ~Cecilie, not impressed.

    Posted 24 Oct 2007 at 12:50 pm
  7. Catron wrote:

    The original issue addressed by Graham’s post involved the alleged “right” to health care. My position is that no one can have a “right” to someone else’s labor or resources, and that (it seems to me) is always the end product of mandatory universal health care.

    This post was not meant to address that issue, however. It is a “spin-off” post that addresses another point that is pretty hard to refute: That the U.S. is subsidizing the care of the very people who criticize our system.

    No commenter has yet shown that assertion to be inaccurate.

    Posted 24 Oct 2007 at 3:48 pm
  8. drmatt wrote:

    Cant remember anything close in the us budget that supports the UK military, despite that it is not total amount spent, it is per person per year. The US spends far more (no matter where the money comes from) per person per year, this is what a “Free” market economy has done for health care, it is rather impressively stupid.

    Posted 25 Oct 2007 at 3:15 pm
  9. Catron wrote:

    Two points:

    The UK is actually one of the few European nations that carries its own weight on defense.

    The U.S. doesn’t have a free market for health care. It is our most heavily regulated industry.

    Posted 25 Oct 2007 at 6:20 pm
  10. drmatt wrote:

    Which part would you call regulated? As a doctor practicing solo I had licensure only, as far as govt regs (included DEA etc). Now that I have written a book on Health care in the US (with research of course) I was able to find very few laws limitting/regulating health insurance companies. So do you refer to hospitals? What do you mean by “heavily regulated” if it is the “most” heavily regulated surely you have a definition and some comparison industries? I suppose if you are a purist, then there is really no such thing as “free market” all industries are regulated to some degree. In any case, bottom line, we spen way more per person with worse results over all, the current system is a mess I think anyone who has looked at it at all agrees with that. No such thing as a perfect health care system (or any system for that matter). What we all need to do is sit down, define what we want our system to be before we talk about how to get there. Currently we are all arguing over how to navigate yet we haven’t come to consensus on where we are going!!

    Posted 26 Oct 2007 at 5:43 am
  11. Pierre wrote:

    Get off your high horse David. Name me one time the U.S. has “actually” and physically come to the aide of Canada. The freaking cold war is NOT an example. Your ignorance is astounding.

    Posted 27 Oct 2007 at 3:09 pm
  12. Flighterdoc wrote:

    Pierre: WWI, WWII, to name just a couple – yes, the US was allowing the British Commonwealth (which Canada was a dominion of) to survive, but at least we didn’t waste Canadian lives as the Brits did at Vimy Ridge, 2nd Somme, and Verdun – 10% fatalities and another 30% casualties at Vimy, of course…thanks to incoompetent leadership by Haig. The waste at Dieppe and Hong Kong, the sacrifice at Juno Beach.

    Happy Remembrance Day, and don’t forget to buy your poppy.

    DrMatt: How about health insurance regulations in each state that allows a company to only offer insurance in one state (avoiding economies of scale), requires them to cover things even if the insured customer doesn’t want them?

    How about the FDA itself, where a NDA requires an investment of 750-million? Where the plants that manufacture drugs and medical devices have to meet governmental regulations and the vagaries of governmental inspectors? Where everything you say about a medical device has to be approved by an FDA overlord, or it’s pulled from the market? Where even the most innocuous claims have to be supported by evidence (BTW, how long do you think ASA would be OTC, after the FDA discovered it’s anticlotting effects?)

    How about Medicaid and Medicare, which sets the rules that health care operates in? Medicare that won’t allow a hospital or provider to offer services for free (no matter how needy the individual) because they DEMAND the ‘lowest offered price’? Or even that they require ‘certification’ by an independent agency like the JCAHO that adds cost (and endangers patients) in their arbitrary and capricious demands on the fly, that aren’t supported by regulation, EBM, or anything but some evaluators wild-assed on the spur of the moment demand?

    How about the civil legal system that adds costs to physicians and health care manufacturers, without any measureable benefit for the patients (in fact, looking at John Edwards efforts wrt C-sections and CP, they add RISK to the patients)?

    You wrote a book, and didn’t find any of these? Must be nice to write a book and already have your point made: It saves so much on research.

    Posted 27 Oct 2007 at 9:06 pm
  13. drmatt wrote:

    FDA regulates medicine, regulations for insurance are on insurance (these are general insurance laws though only,the same laws that apply to the rest of the insurance industry barring 2), which one of these are you saying regulates “health care” ??? As far as the civil/legal system you can practice without Professional liability if you wish, there is no law or regulation that makes you buy it, but you wont get hosp priveleges, or be named a preffered provider. If you think the FDA is really over seeing things that heavily, what is your excuse for vioxx, and seroquel, and the unreported increased suicide rate with the antidepressants. The “health care” market is very free that is why you are begining to see concierge medicine practices and fee for service, the regulation is on the insurance companies. That does leave JAHCO (which I agree with you on, a true paper tiger) and Medicare (FYI medicaide does not regulate the industry, just poor persons state runned health insurance), So, leaving jahco and medicare hardly ranks health care as “The most regulated industry”. Sorry to see that you are so diluded doc, thanks for all the service though. Having said all that I would be willing to bet “health care” would be lucky to get into the top ten regulated industries, check into FCC laws, FAA laws, FDA laws etc.

    Posted 31 Oct 2007 at 4:58 pm
  14. Rich wrote:

    DrMatt –

    I don’t know what state you practice in, but there are states the DO require liability coverage and set minimum requirements by law.

    Medical practice not regulated?

    My practice is regulated by town, county and state authorities, not to mention distant oversight via medicare by the feds. My billing is monitored (by the feds or their agents) to look for “fraudulent” billing practices (which can mean you are committing fraud, or just billing reasonable rates). I have to meet CLIA/COLA requirements regularly in order to perform a urine disptick or stool guaiac. I have to be fingerprinted by state authorities to continue to pracitce (Yes! Fingerprinted, as mandated by NJ state law). I have to meet OSHA requirements and make certain that my staff are wearing the proper attire. Not to mention that my trash has to be properly disposed of, lest medical waste or, heavens, paper waste with a patient’s name is discarded inappropriately.

    The list goes on.

    Posted 01 Nov 2007 at 8:11 am
  15. drmatt wrote:

    Sorry to hear about the fingerprinting, what a pain. However, the arguement is whether “health care” is the most heavily regulated industry. Despite the regulations I dont think the argument is secure. In fact if you include OSHA, then you must also include building codes, fire codes, banking regulations, tax regulations, federal, state, county, town and so on. Then what we have here is a discussion about governments over regulation of industry in general, hardly supports an argument that “health care” in the most heavily regulated industry. I challange you to open a bank. Let us then define health care, is that not completely based on the interaction between you and patient? (I think you wrote a similar notion on your blog) which part of your actual interaction with the patient is actually regulated? Cant really include insurance requirments here, you dont have to take insurance. Bottom line is this, “health care is our most heavy regulated industry” is another example of a very general statement to support a personal opinion/arguement. If Catron is to base his argument on this notion it should be backed up, define health care, define regulation, give me comparisons! Actually, my home is the most heavily regulated industry, I have to live up to building codes, zoning law, there are massive codes that outline the sale and use of my heating oil, fire codes, neighborhood standards, the sale fell under the unbelievable list of codes and regulations required to buy a house (I didnt need a lawyer to open my practice but I did to buy my house). If Catron can show me that it is in actuality the most heavily regulated industry i will submit, otherwise he is spitting in the wind.

    Posted 01 Nov 2007 at 9:07 am
  16. drmatt wrote:

    A purist definition of “free market” would have no regulation at all, is that what we want? an everyman for himself medical system? the pharmacuetical industry can then go back to selling snake oil. I submit that most if not all regulations have one of two intention (the spirit of the regulation) to protect the public from undue harm, or to level the “business” playing field. I dont think any of the authors of any such regulation was ringing his proverbial hands saying “let’s screw the doctors and/or patients” when it was written. I further submit that it is the same generalized, unsubstantiated, opinionated statements ringing in the ears of the authors of such regulators delivered by lobbyists and special interests that got us into trouble in the first place. I doubt there is a single person who understands the whole system and all its complexities, thus any single person who is pushing for thier idea of a cure is suffering from paralex (physics term that based on your grand unification theory I know you understand).

    Posted 01 Nov 2007 at 10:12 am
  17. Rich wrote:

    “I dont think any of the authors of any such regulation was ringing his proverbial hands saying “let’s screw the doctors and/or patients? when it was written.”

    Unfortunately, the road to hell is paved with good intentions.

    Government intervention and regulation has been shown, time and again, to limit freedoms, increase costs, and degrade products and services. John Stossel has an excellent essay on this subject (even if you are not a fasn of Stossel, it is an excellent essay) in one of his books.

    Posted 01 Nov 2007 at 2:08 pm
  18. drmatt wrote:

    I will have to read that, I have always been open to new ideas, opinions and viewpoints (not that I will disagree with him). In any case, now that we are driving on the road to hell, I can’t help but think regulations are a necessary evil to protect us from tyranny (which is one of the govt’s primary jobs) but it is how they come about. I personally would picture a room full of experts who understand all the different complexities of the sytem (including reps from docs and patients) with the latest facts and studies hashing it out. Never happens that way though, it is lobbyist and special interest groups who propogate rhetoric the way catron does here.

    Posted 01 Nov 2007 at 2:42 pm
  19. drmatt wrote:

    PS, do you know which book the essay is in, or where I could get a copy of the essay itself.

    Posted 01 Nov 2007 at 2:43 pm
  20. Rich wrote:

    I think I recall it in _Give_Me_a_Break_ – but there are several shorter articles on the topic. Here are some examples:

    Posted 01 Nov 2007 at 4:22 pm
  21. drmatt wrote:

    Interesting, I think consumer driven medicine works in elective health care, but how does anyone in the midst of an acute MI, apendicitis, auto accident, cancer, shop around? it doesnt work in those areas. Additionally the complexity of understanding the differences between good medical care, medical care, and bad medical care far exceed the abilities of the general population, this type of health economics will drive demand for “popular” medical care not “evidence based” medical care. Let people shop for elective crap, let’s find a way to provide “needed” care.

    As far as his implication about pharm, well, I agree “price controls” are the wrong answer but for different reasons. If you read how drug companies do research it is market based not health based. If a medication has proven to get market share, the other companies quickly shift a molecule around and sell a similar drug (no true benefit but increased cost), How many PPIs do we have? How many do we really need. Additionally a great deal of thier research is funded by universities and the NIH (that means you and I). In many cases you pay for these money makers three times, you pay for the research through the NIH (thanks to a bill by dole), you pay through medicare, and if you need that medication again you pay yourself. I propose we put evidence based barriers. A new drug that treats a problem previously untreated or poorly treated should have barriers removed, otherwise increase the barriers, then the drug companies will have to spend thier R and D dollars on new, helpful drugs. As far as the 1 billion in research, much of that money isn’t thiers and it pales in comparison to what they get back.

    Posted 02 Nov 2007 at 6:11 am
  22. Rich wrote:

    ” I propose we put evidence based barriers. A new drug that treats a problem previously untreated or poorly treated should have barriers removed, otherwise increase the barriers, then the drug companies will have to spend thier R and D dollars on new, helpful drugs.”

    This basically creates monopolies for the drugs that are fist to market, and will likely lead to higher prices for everything be removing competition.

    The hospitals at which I attend choose which PPI to stock. Basedd on what? Based on the lowest price, other things being equal. The health plan formularies and PBMs do the same thing. Do you think they could negotiate if there were only one PPI?

    Posted 02 Nov 2007 at 9:39 am
  23. drmatt wrote:

    I haven’t seen prices drop with copy cat or me too drugs. Besides doesn’t being an inventor with a patent give you a short lived monopoly (infact this is protected in the original body of the constitution)? If you remove one chapter from my book and change it should you then be allowed to publish and copy right it as your own? The hospital’s and insurance plans get thier medication prices down by bulk purchase. You do make a good point though, can’t think of another way to get big pharma to spend research dollars on actually improving health care rather than battling for market share. I am open to suggestions (not that it is up to me).

    Posted 02 Nov 2007 at 12:18 pm
  24. Lisa wrote:

    Didn’t read through all these posts but I’ll say this: Universal healthcare doesn’t work. A friend of mine lives in the UK. Her daughter was cutting herself. My friend was very concerned. My friend took her daughter to a therapist, only to be turned away with the explanation that her daughter “wasn’t sick enough.”


    Apparently private insurance is available in the UK but it is very expensive.

    As for heavily regulated here, yes, we are, at least, we are in the Garbage State of NJ. My husband is a doctor. We are barely making ends meet anymore in part because of regulation. I therefore disagree with the doctor who wrote earlier, saying we are not heavily regulated. It depends on the state you practice in.

    However, I am also feeling regulated by big business — the insurance companies — and I’ll be damned if I know how to stop it. No easy answers here.

    Posted 13 Jan 2008 at 8:38 pm

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