Socialized Medicine: Be Careful What You Wish For

OK, I generally agree that we need some semblance of universal healthcare in this country. But be warned about what you are in for. You’ll remember that, a couple days ago, I told you my dad had a minor stroke because he has 69% blockage in his carotid artery.

Well, today he found out that they will not operate on him. He has to have 90% blockage in order to be considered.

If you want socialized medicine in this country, know what you are getting into. The decision about my dad was not made from a health perspective. If it was, he’d have been in the operating room already. It was made from a rationing perspective, and I am pissed off royally. It would not have happened here. You can talk all you want about the people who don’t have healthcare in this country, and I definitely sympathize with that because my ex-partner’s parents, who I love dearly, are ill and don’t have insurance. But if you do have health insurance, and if your carotid artery is 69% blocked and you had a stroke because of it, you’d get the operation here.






167 replies
  1. 1
    crack says:

    Stuff like that happens here too. Or they’ll let you get the operation and then deny the claim.

  2. 2
    Joshua says:

    In the USA:

    1. If you don’t have insurance, you’re screwed for obvious reasons.

    2. If you do have health insurance, you might get covered, you might not, it depends on your insurance. And if you do have insurance, the company might say its covered, then say its not, then you have to spend years fighting it or just accept the financial ruin that comes with having a gigantic medical-related dump plopped on your finances.

    It’s rationing all the same, let’s just be clear about that.

  3. 3
    donovong says:

    As much as I hate that your father is suffering as a result of beaureaucratic bullshit, I don’t believe that such an idiotic attitude and socialized medicine necessarily have to go hand-in-hand. Not that I have any faith in our ability to avoid it, but I can’t dream, can’t I?

  4. 4
    malraux says:

    The idea that insurance companies will cover pretty much anything seems not well grounded. I can’t say that my current insurance provider is all that generous with coverage.

    Also, the NIH recommends surgical intervention with >75% blockage. link That makes me think that US insurance wouldn’t cover it either.

  5. 5

    Actually, that’s exactly what happened with my husband’s late stepdad — and he lived in the US. They didn’t want to operate until the blockage got really bad as it’s a rather tricky surgery. In fact, complications from that surgery dogged his final months.

    (On edit: Malraux found the link for me that I was going to cite. So this wasn’t so much rationing as not wanting to do a risky surgery on an elderly patient unless there were no better options available.)

  6. 6
    Dave says:

    Do they still have the lotteries to fund the hospitals up there? I remember being stunned the first time I went to Toronto and read a paper where I saw an ad for a hospital lottery.
     
    And while that may happen here at times, more often it doesn’t. People in the US have operations like this all the time, and if they were being denied coverage in waves it’d make the news.
     
    I don’t deny either that we need some form of universal health care. But I am annoyed to no end by people that hold Canada and the UK up as shining beacons. They both have serious problems of their own that need to be acknowledged. The US has to find the middle ground between our system and their system.

  7. 7
    John S. says:

    The US has to find the middle ground between our system and their system.

    I like how they roll in Germany and the Netherlands. Switzerland has a pretty good system, too, but good luck gaining entry there.

  8. 8
    Nicole says:

    @donovong: This hits the nail on the head- just because other nations aren’t doing it right (yet) doesn’t mean we shouldn’t make any attempt to do it ourselves. We spend more per person on health care and have higher infant mortality and lower life expectancy than most industrial nations, so I do think they are doing things better than we are right now. Canada’s mistake, I think, is in not allowing any sort of private insurance that people can choose to purchase in addition to what the state provides (Canadians, feel free to tell me why that’s wrong- I don’t claim to know a whole lot about it, and am always happy to learn more). Ideally, you’d think, seeing as how the politicians keep telling us how innovative and productive we are, some of our innovative minds could be put to figuring out a better system.

    Oh wait, now I’m dreaming…

  9. 9
    Michael D. says:

    @malraux:

    Also, the NIH recommends surgical intervention with >75% blockage. link That makes me think that US insurance wouldn’t cover it either.

    My guess is that if the patient already had a stroke because of a LESS THAN 75% blockage, the NIH would cover it.

  10. 10
    Caidence (fmr. Chris) says:

    I’ve known the entire time what we’re getting into. Everyone wants to live forever, it costs on a function of exponential growth, and now government is considering that everyone should get immortality.

    Why don’t we teach in school that everyone has to die, and you should be thankful you get for every day after 35? That was old age a couple millennia ago.

    One of the upsides of this recession is that Congress won’t be able to get this off of the ground.

  11. 11
    leo says:

    Actually only the rightwingers say ‘universal health care’ means how they do it in the UK (endless lines, etc.) In reality, the example is irrelevant — except, again, to scare people.

  12. 12

    Unless you can pay out of pocket for a surgery like that, there’s no guarantee it’d happen here, either. We already have rationing here, Michael – go/no-go decisions are made by bureaucrats, actuaries, accountants, and boards beholden to investors all the time.

    @Dave:

    People in the US have operations like this all the time, and if they were being denied coverage in waves it’d make the news.

    Really? Somehow, I can’t see "Joe Blow Denied Coverage in Borderline Case" really making headlines.

  13. 13
    Michael D. says:

    @Caidence (fmr. Chris):

    One of the upsides of this recession is that Congress won’t be able to get this off of the ground.

    Yes. Thankfully, Congress never spends money it doesn’t have. :-)

  14. 14
    malraux says:

    A few other things: As mentioned, the surgery is risky. That cite said 1-3% chance of causing a stroke just from the surgery. Its not just rationing to deny the surgery.

    Second, I would assume they are going to give him medications to deal with the blockage in various ways. I would say that I bet those are cheaper in CA, but the specific drug they’ll likely use is already dirt cheap. Regardless, coverage of medication in CA is a lot better than the US.

    Lastly, now that the problem is known, they’ll likely monitor it. If it does get worse, they’ll probably reconsider surgery.

  15. 15
    Michael D. says:

    @protected static:

    Somehow, I can’t see “Joe Blow Denied Coverage in Borderline Case” really making headlines.

    BORDERLINE??

    I know it’s my dad, but I am not letting that cloud my judgment. The man had a fucking stroke. That’s NOT borderline.

  16. 16
    EarBucket says:

    I don’t understand why people keep talking about "socialized medicine" when nobody, literally nobody actually wants to do it here. What Obama and Clinton both ran on in the primaries was a system to make it cheaper and easier to buy health insurance.

    Socialized medicine is a system where the government owns and operates all the hospitals and employs all the doctors. It’d be like if we expanded the VA system to cover all Americans. That’s just not happening. Universal healthcare does not equal socialized medicine.

  17. 17
    Zifnab says:

    And while that may happen here at times, more often it doesn’t. People in the US have operations like this all the time, and if they were being denied coverage in waves it’d make the news.

    No it wouldn’t. And there are countless stories of folks getting denied or restricted coverage for asinine reasons. A recent classic case was Nataline Sarkisyan of Northridge, CA who died waiting for a liver transplant because the insurance companies had the claim wrapped up in court for months.

    Universal coverage isn’t a panacea, but it does create a baseline of coverage and raises the bar on private insurers. Certainly, Mike, your dad could have looked for a policy that would have covered more extensive care, but would he have been able to afford it? I’m sure if you’re willing to shell out $2k / month in premiums with a $10k deductible and a 50/50 copay, you can find coverage for just about anything.

    The root problem that your father has is that the medical treatment he needs to undergo is risky and expensive. All the insurance coverage in the world won’t change that. But public funding for hospital care and coverage will help defray the expenses involved. The goal is to make medical procedures cheaper and you can’t accomplish that by shrinking the pool of folks eligible for treatment.

  18. 18
    malraux says:

    @Michael D.: Read the source again. It specifically calls out TIAs as a reason to do the surgery, assuming the blockage is >75%.

  19. 19
    Zifnab says:

    @Michael D.:

    I know it’s my dad, but I am not letting that cloud my judgment. The man had a fucking stroke. That’s NOT borderline.

    It’s also not making headlines. That’s all he’s saying.

  20. 20

    Over at Respectful Insolence, there is a lot of discussion over the fact that waits as long as ten months are now common for women seeking mammograms in the US. Orac pegs legal ramifications as the main reason: Nobody wants to take up mammography when a big chunk of malpractice lawsuits involve breast cancer diagnosis and treatment.

  21. 21
    Doctor Gonzo says:

    No matter what, universal health care is better than the current alternative.

  22. 22
    Jeff says:

    But I bet he can get all the meds he needs to assist him and prevent further strokes or a heart attack. In the US only 55 percent of patients get treatments that scientific studies show to work, such as beta blockers for heart disease.

  23. 23
    Tim H. says:

    Can’t address your father’s case, but my neighbor had partial blockages of both carotid arteries a few years ago. It was bad enough that he lost his color vision. They actually didn’t operate on him for years because of the danger of the operation.

  24. 24
    Klaus says:

    Reputedly, the French health care system is the best among the OECD countries. French prisons, on the other hand, are some of the worst. Quid pro quo.

  25. 25
    Nicole says:

    @protected static:

    True about the bureaucracy- I have a friend who tore her ACL when she was 35 and the surgery to repair it was a failure. She ended up needing a knee replacement- she couldn’t walk without crutches. Insurance refused, saying she was too young to need a knee replacement. She spent two years of her life on crutches- two years of her mid-30’s, which, in my biased opinion, are some of the best years, unable to do anything active or even take the stairs, because insurance didn’t want to pay for a knee replacement. They finally replaced her knee, but she’ll never get those two years back, and she put on a huge amount of weight from being unable to exercise (and depression from the situation) that has resulted in her having to go on medication to deal with the weight, which insurance has to pay for.

  26. 26

    Yep. Because Health care in the U.S. is just dreamy. Look, I’m sorry about your dad but his story isn’t unique to socialized medicine and I’m not sure why you think it is.

    My guess is that if the patient already had a stroke because of a LESS THAN 75% blockage, the NIH would cover it.

    Nitpick: You mean NIH would recommend coverage, but since one risk associated with the surgery is strokes, maybe not.

    And of course, even if NIH recommends something, it still doesn’t mean a HIP will give a damn.

  27. 27
    Comrade MS-4 says:

    I’m a med student and I distinctly remember reading a reputable study which basically says that carotid endartarectomy in a patient with less than 75% blockage is of negligible benefit to the patient.

    As such, most insurance companies won’t cover the procedure even here in the U.S. where we don’t yet have the much hated "socialized medicine".

  28. 28
    Dave in California says:

    In an earlier post, you said your father was 71. So if he lived in the U.S., he’d almost certainly have Medicare, not private insurance. If you think that, as an American he would have gotten a needed surgery here that he wouldn’t get in Canada, then all you’re saying is that American socialized medicine is better than Canadian socialized medicine. You’re not really saying anything about socialized- vs. non-socialized medicine, or universal vs. non-universal care.

  29. 29
    cleek says:

    Do they still have the lotteries to fund the hospitals up there? I remember being stunned the first time I went to Toronto and read a paper where I saw an ad for a hospital lottery.

    in the US we have lotteries to fund education, instead.

  30. 30
    Caidence (fmr. Chris) says:

    @protected static final String COMMENT =

    Really? Somehow, I can’t see "Joe Blow Denied Coverage in Borderline Case" really making headlines.

    ;

    That’s because you’re not working it. If Joanna Blowjob, pretty Caucasian woman, was denied coverage, everyone would be covering it.

  31. 31
    Cabalamat says:

    Healthcare is rationed in all societies. As are all intrinsically scarce goods. Rationing by market forces (i.e. those with them ost monet get the operation) is still rationing.

    As to how health care should be run, I’m not sure there is a good solution.

  32. 32
    Michael D. says:

    @Phoenix Woman:

    waits as long as ten months are now common for women seeking mammograms in the US.

    Seriously? That’s like sticking your tit in a macine for 5 minutes right? You should be able to line 50 women up and do that shit in a few hours.

    We either have some really inefficient doctors, a short supply of mammogram machines, or quadrillions of wonen lining up for this.

    Not making fun. It’s just that this really surprises me. A mammogram takes no time at all. And I know that because I watch Discovery Science!

  33. 33
    Gus says:

    I’ve read somewhere that France has a pretty good system. I think it’s a combination of socialized and private care. I have no details, but as Dave says above, it’s not like we have to choose Canada’s system or our own. There are lots of models that are better than either.

  34. 34
    malraux says:

    Another link which also lists other possible reasons not to do surgery. IANAD, so I really can’t say what applies to your dad. That said, TIAs are often treated with medication, and there are good reasons to avoid the surgery.

  35. 35

    It’s rationing all the same, let’s just be clear about that.

    Absolutely, no matter what scheme is in place.

    In the American scheme, you opt out of rationing with money. With money, you can get whatever you want. Without money, you wait in line.

    Most Americans wait in line just like everybody else in the world. I have some of the best health insurance in this country, I am lucky beyond words … and I wait in line as instructed by the HMO gods.

    And what’s really different about our scheme as opposed to the scheme in Canada is …. if I lose my job, my access goes in the toilet and I would never get it back without spending very large sums of money. In Canada, that access does not go away. That distinction is far more profound than the distinction between 60% and 90% blockages. I mean no dismissal of the anger at the system in this case, but it is easier to attack a care protocol and fix it, than to fix an entire healthcare system.

  36. 36
    bootlegger says:

    I like how they roll in Germany and the Netherlands.

    Ditto. Everyone is guaranteed coverage and if you want the gilded service you can purchase it yourself.

  37. 37
    jlo says:

    Knock off with the "Socialized Medicine" bogeyman. Don’t confuse your anger and frustration about your father with sound health policy. For the first time in my life I have a job with good benefits and health insurance. By your rules that means that the health care crisis in America is solved.

  38. 38
    Kirk says:

    @Michael D.:

    BORDERLINE??

    I know it’s my dad, but I am not letting that cloud my judgment. The man had a fucking stroke. That’s NOT borderline.

    Michael? Yes, borderline.

    The operation is not to cure him. The operation is to make it less likely he’ll have a re-occurrence. Yes, he has a higher risk of an occurrence since he’s already had a stroke. He’s also at a significantly higher risk of dying on the table.

    I’ve an uncle who faced a similar situation (heart, not carotid). Because of his condition his likelihood of dying on the table went from less than a percent to over 5%. The likelihood of the operation preventing another heart attack within a year went down about 1% if it was only the operation, about 15% if he made major lifestyle changes (including drugs) and about 10% if he did the lifestyle changes without the operation. As an added bonus the lifestyle changes would make it possible to operate (relatively) safely in about a year if it were determined to still be needed/wanted.

    (As an aside, he refused to make lifestyle changes. We buried him a bit less than a year later.)

    The point is there is more than one factor and so yes, it is still borderline. The operation might make a difference. Because he had a stroke he’s more likely to die on the table. There are options available that while not as immediately effective as surgery will increase the chances of not experiencing the problem again. Before you wail and rage, check ALL the facts to see. The devil writes in 0.5 point script, down in the footnotes.

  39. 39

    My guess is that if the patient already had a stroke because of a LESS THAN 75% blockage, the NIH would cover it.

    Stop guessing. If you want to make a point about the US healthcare system then do some homework. I am sorry about your Father but the last thing this debate needs is more anecdotal evidence. As noted above, this procedure wouldn’t be performed in the US either.

  40. 40
    sparky says:

    @Cabalamat: agreed. there may not be a good solution, but pretending that everyone can have everything is a bad one. our current system sucks; the question is will we have a real debate about replacing it, or will the various actors manage to game it as they usually do?

  41. 41
    Scott de B. says:

    Why don’t we teach in school that everyone has to die, and you should be thankful you get for every day after 35? That was old age a couple millennia ago.

    Pedant alert. As a student of the ancient world, this is a misconception. It is true that the average life expectancy in, say, the Roman Empire, was 32 years or so, but that doesn’t mean that everyone keeled over in their late 30s. The average was brought down by the fact that a very large percentage of the population died in infancy.

    Once you reached adulthood, your chances of living to a ripe old age weren’t bad (although less than they are now, admittedly). The ancient Greeks generally considered 70 years to be the full human life-span. In 7th century Arabia, a man wasn’t considered to be at the peak of his mental and physical powers until he turned 40.

  42. 42
    libarbarian says:

    just because other nations aren’t doing it right (yet) doesn’t mean we shouldn’t make any attempt to do it ourselves

    Nonsense, that is exactly what it means. We only need to be the best and as long as we are the best then it is unpatriotic to try and make us better.

    And it’s not just a "better medical system" but "better". France may have a better medical system but they are a nation of frog-eating smelly-pants whom we are still WAY better than on the whole, so anyone asking us to emulate the French is clearly an appeaser of Hitler.

    Understand?

  43. 43
    malraux says:

    Re: waiting times. I needed to see my PCP in July. The first available appointment was last week.

  44. 44
    Montysano (All Hail Marx & Lennon) says:

    As donovong and Nicole already pointed out, the problem with the debate is the total negativism, esp. from the Right. As soon as the phrase "universal health care" is uttered, the reaction is not "Boy, that would be great". It’s "Noooooooo, no, no, no, hell naw!" So much for American Exceptionalism, for the much vaunted American spirit, in which the answer would be "stand back and we’ll show you how to do it right". Even more puzzling given the fact that most of those on the Right can be found sitting in a church pew on Sunday. If memory serves, Jesus had some unequivocal things to say about caring for your brethren.

  45. 45
    Caidence (fmr. Chris) says:

    @Cabalamat:

    Rationing by market forces (i.e. those with them ost monet get the operation) is still rationing.

    Language abuse! "Ration" strongly implies that the portions are of equal size, and then "rationing" historically implies a process where rations are spread evenly among a demand, because rationing processes aren’t necessary where market forces are already available and functioning.

  46. 46
    dana says:

    An insurance company in the U.S. might not cover it either. The idea that in the U.S., people make all of their decisions about health care based on the Platonic idea of health is just laughable.

    There’s always some form of "rationing", whether it’s because the patient has no insurance and can’t afford the procedure, or because the insurance company won’t approve the procedure. All "socialized medicine" does is switch out a set of industry bureaucrats for government ones.

  47. 47
    Michael D. says:

    @TheHatOnMyCat:

    In the American scheme, you opt out of rationing with money. With money, you can get whatever you want. Without money, you wait in line.

    Actually, I would have no problem with the wealthy being able to pay for healthcare. I think the biggest problem with single payer, like in Canada, is that the wealthy are NOT allowed to pay for their own.

    What I would like to see is basic care for all. I don’t know what that would look like because, well, I’m not educated about healthcare and am obviously not an expert in the economics of it all. But I don’t have a problem with rich people getting better care, as long as everyone has basic coverage.

    My ex-partner’s parents both have medical issues. His dad is mentally disabled and his mom has a heart condition. His dad relies on the VA, while his mom relies on the charity of her doctor (who relies on the free samples from drug companies to supply her.)

    I don’t think his parents need cadillac coverage. I just want them to be able to live with their illnesses relatively comfortably. In other words, I don’t think they need to have everything they want, but I DO want them to have everything they need.

  48. 48
    Brian J says:

    Nobody is saying Canada has a perfect system. They’re saying that the U.S. sucks so badly (relatively speaking, of course; it’s not like that of some war-torn nation) that even a crappy system like that in Canada is better by comparison.

  49. 49
    passerby says:

    But if you do have health insurance, and if your carotid artery is 69% blocked and you had a stroke because of it, you’d get the operation here.

    Sorry to hear about your dad Michael. That’s a raw deal.
    Fucking 90% ?!? Arrrgh! [Breathe in and slowly let it out, repeat.]

    With regard to how medicine can be widely delivered in this country, when done properly, rational Standards of Care can be established. 69% does not seem like a decent standard and whoever was responsible for establishing that parameter, seems to have acted without knowledge, wisdom and/or heart. Heartlessness is definitely a drawback of a large institution that relies on public money.

    But, couldn’t the USA create a system that is more proactive, by including incentives for maintaining health and by catching other infirmities before there’s a bad outcome?
    69% carotid blockage could fall under an "early detection" category because it saves costs down the road.

    Further, your dad’s condition, like my grandmother, her sister, and my mother who also had/have this condition, could’ve been detected way before the need for surgery arose vis-a-vis "early-detection" clauses that can be built into a new system. Non invasive or at least less invasive action could have been implemented.

    Obama has mentioned several times that he is for a Disease Prevention element in a future healthcare system, because it saves money in the long run. (moneymoneymoney)

    I am hopeful that Obama’s youth and fitness will influence more people to become fit or at least less sedentary and more mindful of the impact of their food choices.

    (Good positive vibes to your dad.)

  50. 50
    Caidence (fmr. Chris) says:

    @Scott de B.:

    Pedant alert. As a student of the ancient world, this is a misconception. It is true that the average life expectancy in, say, the Roman Empire, was 32 years or so, but that doesn’t mean that everyone keeled over in their late 30s. The average was brought down by the fact that a very large percentage of the population died in infancy.

    Once you reached adulthood, your chances of living to a ripe old age weren’t bad (although less than they are now, admittedly). The ancient Greeks generally considered 70 years to be the full human life-span. In 7th century Arabia, a man wasn’t considered to be at the peak of his mental and physical powers until he turned 40.

    Ok, well, damn. In that case, I’m going to sidestep and say "you fuckers should still be thankful for the today you have, instead of wasting it and then demanding a guaranteed tomorrow from the government."

    I outright admit to being guilty of the preceding statement (about wasting days).

    In any case, how can you accuse me of being a pedant if I didn’t get my facts right in the first place?

  51. 51
    Duke of Earl says:

    I still remember what Hillary Clinton had to say about health insurance.

    Clinton "said she could envision a day when ‘you have to show proof to your employer that you’re insured as a part of the job interview — like when your kid goes to school and has to show proof of vaccination,

    My suspicion and fear is that we’re going to be forced to buy private insurance in order to legally get a job. The insurance industry has a great deal of power and well nigh infinite resources, overcoming them will be extremely difficult and I frankly doubt many politicians in the US have the gumption to do it.

  52. 52

    And what’s really different about our scheme as opposed to the scheme in Canada is …. if I lose my job, my access goes in the toilet and I would never get it back without spending very large sums of money. In Canada, that access does not go away.

    –from my earlier post

    Michael, don’t you agree that access is higher priority than perfect protocols of care?

    As pointed out here, there could be any number of reasons why the 90% protocol exists in this case. IANAD either. But even if it’s just an arguable medical point …. isn’t access better than no access?

  53. 53
    Michael D. says:

    @TheHatOnMyCat:

    Michael, don’t you agree that access is higher priority than perfect protocols of care

    Yes, I do. And that’s where, perhaps, I am blinded by my dad’s situation.

    When I was 14, I had a tumor on my spine. I spent about a month in the hospital. That probably wouldn’t have taken so long here. But I DID get great care.

    So yeah, I agree with you.

  54. 54
    malraux says:

    The basic care for all, with extras if you buy them is the French system, essentially. Roughly, imagine Medicare for all. You can still buy supplemental insurance or pay out of pocket for more, but the basics will get covered. Nobody here wants either the Canadian system or the English system, though of course, those are both cheaper and better than out current system.

  55. 55
    DJShay says:

    Insurance companies in the US put the same kind of limitations on treatment no matter what happens. It’s got nothing to do with being "socialized". My employer based plan has limitations on coverage, and private insurance is even worse.

  56. 56
    dana says:

    @Michael D.:

    I’d have to look into this more, but private insurance does exist in Canada. It hasn’t been outlawed. But the real problem here (there’s an evidence-based medicine standard for when treatment is covered) doesn’t seem like it would be solved by private insurance, either.

    My in-laws (extended) have had various cancers. They live in Alberta (which has particularly good health care coverage), and none of them went into debt, lost the family farm, nothing. They got treatment, and got better. I am reasonably certain that given the coverage typical to an American family of similar means, that here, they would be bankrupt.

  57. 57
    bootlegger says:

    Obama has mentioned several times that he is for a Disease Prevention element in a future healthcare system, because it saves money in the long run. (moneymoneymoney)

    Actually, turns out it doesn’t. We save money if people die younger, old age health care is expensive. So the more you prevent diseases early, the more you spend on it later in life.

    Same is true with smoking. My brother was a statistical consultant on the Big Tobacco suits and his data clearly showed that the states spent less money on health care for smokers because they died earlier (he quit his job after that one).

  58. 58

    So yeah, I agree with you.

    I’m a little verklempt ……

  59. 59
    Michael D. says:

    @dana:

    I’d have to look into this more, but private insurance does exist in Canada. It hasn’t been outlawed.

    Only in Alberta, as far as I know. And it’s been challenged as unconstitutional. But perhaps someone who has lived in Canada in the past 10 years knows more aboutthis than me. I’m kinda out of touch.

  60. 60
    Mike from DC says:

    I think the problem is that health care will be rationed, regardless of whether we have a single payer health system, nationalized health care or a private system. Part of what determines the types of waits and the level of coverage is how much money and resources are applied (see Britain under the Tory government in the late 70s). I am very grateful that I have decent health insurance, but I haven’t always had it (and there’s no guarantee that I’ll continue to have it if the economy gets bad enough), and when it was lacking, my options for care would have been very limited (rationed, if you will) if I did get sick or injured. Furthermore, having insurance doesn’t mean that health care isn’t rationed (as others have said above). So, instead of asking whether or not we ration health care, the more pertinent question is HOW do we ration health care, and (should we change to a single payer or nationalized health care system) how much money should the government allocate to health care in this country.

  61. 61
    Michael D. says:

    @TheHatOnMyCat:

    I’m a little verklempt ……

    If this was a drinking game, you’d be in a relatively dry county.

  62. 62
    bootlegger says:

    As pointed out above, we’re not talking about "rationed" health care in the market model, but the "distribution" of health care. I realize this is a semantic point but talking about the distribution of health care, as a resource, highlights the fact that it is distributed unequally according to a system of stratification.

  63. 63
    chris says:

    More surgery isn’t always better surgery. With both of my parents, after they died, I learned they’d had dangerous, pointless, or unnecessary surgery (and chemo), because surgeons like money.

  64. 64

    waits as long as ten months are now common for women seeking mammograms in the US.

    At least they get to have one eventually, if they live that long.

    I had an ex with liver problems who couldn’t get on the transplant list, he died some three years later, which was about five years ago.

  65. 65
    dana says:

    @Michael D.:

    Yeah, that’s another thing to keep in mind about Canada; it varies greatly from province to province.

  66. 66
    passerby says:

    I think the biggest problem with single payer, like in Canada, is that the wealthy are NOT allowed to pay for their own.

    and

    What I would like to see is basic care for all. I don’t know what that would look like because, well, I’m not educated about healthcare and am obviously not an expert in the economics of it all. But I don’t have a problem with rich people getting better care, as long as everyone has basic coverage.

    I’m envisioning a medical care delivery system that employees competent, medical professionals where ANY citizen may obtain the same level of (again) competent service. Uniform across the board.

    As soon as "better service" or service-on-demand comes into the picture, there’s gonna be trouble. I think healthcare should be taken out of the free market and established as a basic human right.

    Once stockholders are involved, focus is shifted off patient care and onto profit care. That’s what we have now: hospitals bending over backwards to cut costs to keep the stockholders happy and remain viable as a financial entity. Patients are essentially cash cows in the current scheme. The evils of 3rd party pay is equivalent to inflated costs.

    If there is a system where moneyed people can pay for an advantage, then, MD’s and other resources can be lured toward the money. The whole system then becomes corruptible.

    Let’s create a system where everyone enjoys the same access to the same physicians, the same treatments, the same drugs.

    Good healthcare shouldn’t go to the highest bidder.

  67. 67
    Xenos says:

    @bootlegger: A distinction without a difference, no?

    Still, words are supposed to mean something.

  68. 68
    South of I-10 says:

    Insurance companies in the US put the same kind of limitations on treatment no matter what happens.

    I had this conversation last night. Daughter is on husband’s insurance. They will not pay for well child visits or vaccinations. If she gets whooping cough and has to be hospitalized, they will pay for that. I don’t know what the answer is, but the health care system has to change. My plan through my employer has a big deductible. Any visits or medications are out of pocket to $2800. Until this year my employer paid the premiums. Been here approximately 10 years, the premiums have increased a minimum of 20% each year, even with them changing the plan, raising deductibles, etc. Soon, no one will be able to afford insurance, and the coverage sucks.

  69. 69
    Kirk says:

    @bootlegger:

    Actually, turns out it doesn’t. We save money if people die younger, old age health care is expensive. So the more you prevent diseases early, the more you spend on it later in life.

    Actually, you’re right and wrong. It doesn’t save money (per se). What it does is increase production. Not just in avoidance of illness, but in day-to-day productivity as they aren’t as rundown or tired or borderline ill. The last is critical. Borderline ill today means (for most people) come in anyway. Since borderline ill is actually early stage/contagious it means what they’ve done is make most of their co-workers spend sick days as well once it passes into that stage.

    It does allow old people to live longer, and old people do use more healthcare. On the other hand it allows a LOT more people to both reach old age AND allows people not yet old to be ill less frequently. The two together increase total wealth, some of which gets spent on the "problem".

    I’ll live with the cost.

  70. 70
    Michael D. says:

    @passerby:

    think healthcare should be taken out of the free market and established as a basic human right.

    I think healthcare IS a basic human right. Quote:

    Amendment IX

    The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people.

    The right wing would have you believe that, if a right is not enumerated in the bill of rights, it is NOT a right.

    It shows their ignorance of the Bill of Rights.

  71. 71
    Caidence (fmr. Chris) says:

    @bootlegger:

    [health care] is distributed unequally according to a system of stratification.

    The big sticking point with many people though, is that MANY things are distributed unequally according to a system of stratification.

    For one thing, Americans aren’t a thankful and gracious and interconnected people, and they’ll sit on their fucking asses all day unless forced to get up (I plead Guilty, your Honor), and giving them things for free isn’t great policy. For this country specifically, I mean.

    So if we HAVE to look into distributionism, it starts with the simple, cheaper things that actually keep a person from getting sick. Like good food and safe neighborhoods. And before you start handing out good food, you fix the problems in the farming market so people have a better chance of eating healthy on their own dime.

    You can’t have safe neighborhoods without keeping people occupied. You can’t be handing people food without demanding that jobless people give up at least 4 hours of plainly hanging out on the street: that’s how crime is started.

    You see the pattern?

    If you follow the pattern to the end, you realize that this universal healthcare thing is for a very small country or for an America in the 26th century. We have SO MANY SIMPLE PROBLEMS right now, demanding the complicated one be fixed first is just more demagoguery.

    And I assure you as a systems engineer: you put this healthcare thing through without fixing the foundations like good nutrition and better drugs programs, it’ll fall apart FAST.

    You’re asking to build a skyscraper on swampland.

  72. 72
    Tim F. says:

    I don’t think his parents need cadillac coverage. I just want them to be able to live with their illnesses relatively comfortably. In other words, I don’t think they need to have everything they want, but I DO want them to have everything they need.

    That, Michael, is an argument for the universal system that America is most likely to get. It is emphatically not an argument for the system we have since neither the VA nor your mother-in-law’s doctor are available to the majority of people in their position. It is easier to see if you do not argue by anecdote.

  73. 73
    Original Lee says:

    Michael, I’m sorry to hear about your dad, but I agree with the others on the thread that the surgery would almost certainly not be occurring in the U.S., either, maybe not even if you paid for the surgery up front in full. The insurance companies will not pay for risky surgeries of marginal benefit, period. Aside from the risk of the actual surgery, the risk of cardiac dementia from *any* cardiac procedure in older men is quite high, so they *really* don’t want to do those procedures unless they absolutely have to.

    Anecdata: My dad (age 72) needed a pacemaker for about four years but the insurance wouldn’t pay for it until the cardiologist could document that his heart slowed to below 44 beats/minute more than once a week. (That was fun – his resting heartrate varied from 46-100, but he couldn’t get a pacemaker until his heart almost stopped on a regular basis.)

    Plus, after a certain point, a doctor’s malpractice insurance rates increase with every additional patient s/he treats, regardless of whether or not s/he is sued, because the risk of a lawsuit increases with the number of patients treated. (I found this out when my neighbor, an anesthesiologist, tried to retire to rural S.C. but keep practicing – she offered to work for free in the county hospital if they would pay her malpractice insurance premiums, and they couldn’t afford her because she’s been practicing so long.)

  74. 74
    Caidence (fmr. Chris) says:

    I think healthcare IS a basic human right

    Depends on what you mean by "healthcare." If you mean perform on-the-scene CPR, yes. If you mean "magically make your dad all better", your dead wrong.

    A right is something we all have a duty to provide one another. We can’t be saddled with the duty to prevent everyone from dying in the myriad different causes. It won’t happen. It will fail, and we’ll all be criminals.

  75. 75
    Tim Fuller says:

    Read about your dad the other day. Best wishes, but don’t think that the situation is better here. I can assure you, it is not.

    How can I prove it? Statistics. Which one you wanna pick? Longevity or infant mortality? I’ll bet the US will lose in a comparison with any of the countries with ‘socialized’ medicine?

    Enjoy.

  76. 76
    Michael D. says:

    @Original Lee:

    Michael, I’m sorry to hear about your dad, but I agree with the others on the thread that the surgery would almost certainly not be occurring in the U.S.,

    Not arguing against that, because I don’t know if it would be covered. But a few years back, I had a rhinoplasty to repair a deviated septum that, in essense, just helped me have more convenient breathing. The operation cost about $7000. Why would this be covered but not something life threatening like a blockage of the caroitid artery?

    I know. I know. I’m asking a question about a fucked up healthcare system! :-)

    Edit: When I said I am not arguing against that, I mean that, although I DID argue against it earlier, I seem to have been corrected in my assumptions by the commenters here. Just clarifying.

  77. 77
    Flugel_Horn says:

    Anecdotal evidence of the poor quality of socialized medicine…

    I was tasked to travel to the UK for 3 months to train a new manager and his staff in our products. Two weeks into my trip, the manager I was training had a heart attack. He worked through the UK Socialized Healthcare system and was placed in what amounts to a general pop, MASH unit style room with no curtains/dividers for privacy. Other patients of all ages with vast array of ailments were also in this room. He was subjected to the constant moaning, screaming and grieving of the others who were unfortunate enough to be there. He could get no peace.

    He remained in this cold, depressing room for TWO WEEKS waiting for a heart specialist to see him. Finally, he had to pay several thousand pounds out of pocket to receive treatment at a private facility so that he could return to work.

    Another gentleman I worked with, a Canadian who worked in Detroit but lived in the Great White North, contracted an infection in his right ear. He was placed on a 9 MONTH waiting list to see a specialist, knowing full well that by the time he saw the doctor, he would have suffered permanent hearing loss in his right ear. He refused to see a US doctor in Detroit. He told me, “No one should have to pay for basic healthcare.” Wow.

    In the US, hospitals cannot refuse treatment based on insurance, income, etc… Generally, anyone can get at LEAST this level of healthcare in a county facility, regardless of insurance. Technically, no one can refuse treatment, but private facilities tend to transfer indigent/un-insured patients to county facilities.

    Prescriptions are a different matter.

    Bottom line… Socialized medicine sacrifices the over-all level of healthcare for EVERYONE so that each person can have less than mediocre healthcare and the rich/privately insured still get the best available. It is the classic example of flattening the curve to cater to the lowest common denominator. This does not work in education and it does not work in the Healthcare system.

    I think the trick to it in the US is something along the lines of requiring that everyone buy health insurance, much like car insurance. This will bring down everyone’s premiums and make sure everyone is covered.

  78. 78
    Lupin says:

    I’m an American expat living in the South of France.

    In 2005, an acquaintance of mine, a Brit, who also lives here, went for a check-up at the local hospital. It turned out they found he had some kind of heart condition that required surgery.

    So he asked when they could schedule the surgery. They replied, well, it’s not an emergency, but the surgeon will be here on Thursday, if if it’s okay with you? This was Tuesday. So they admitted him, the surgery went fine, he was discharged, he’s been doing great ever since.

    Anecdotal data proves nothing, but I do think the french system is excellent. It is a mix of public and private, with private insurance on top of national insurance with price controls.

    An emergency appendectomy was billed just under 5,000 euros (everything included) to an unfortunate American visiting our region. She got the bill about two months after she’d returned home to SC.

    A friend of mine in NJ without insurance (freelancer) had to pay $35,000 out of pocket to his hospital for same surgery, after begging for their lowest rate.

  79. 79
    dana says:

    Why would this be covered but not something life threatening like a blockage of the caroitid artery?

    Expected outcomes. It’s really easy to fix a deviated septum, and the procedure has a reliable effect on someone’s ability to breathe. The clinical data seems to show, in this case, that in a blockage of under X%, doing surgery doesn’t improve outcomes.

  80. 80
    Zifnab says:

    @bootlegger:

    Actually, turns out it doesn’t. We save money if people die younger, old age health care is expensive. So the more you prevent diseases early, the more you spend on it later in life.
    Same is true with smoking. My brother was a statistical consultant on the Big Tobacco suits and his data clearly showed that the states spent less money on health care for smokers because they died earlier (he quit his job after that one).

    Not to put a damper on your eugenically friendly outlook, but you also have to factor in productivity. If you look at it strictly from an expenditure standpoint then, yes, the longer you live the more you spend on health care.

    But children and the elderly consume far more health care than their middle-adult neighbors. So you want to keep people in that middle-aged bracket as long as possible because that is when you get the most return on your initial health care investments. Investments that translate into higher company incomes and higher tax revenues.

    In that case, having a 60-year-old healthy man who continues in full employment for another five to ten years, then retires and lives another decade or two is preferable to having a 50-year-old man stricken with emphysema who isn’t expected to see 55. Sure you save yourself decades of future medical coverage, but you also sacrifice decades of work productivity. And the experience of age is an invaluable work asset. At my small company, if one of my managers were to run off and croak on us, we would be so up shit creek without a paddle because they don’t have anyone capable of replacing them. Although, you know, in the long run the company insurance premiums might drop a few bucks.

  81. 81
    Xenos says:

    Don’t start on the malpractice issue. Doctors could have a perfectly workable system to track malpractice, and cover everybody under a no-fault system like we have for automobiles. Not acceptable to the AMA, however, just like universal coverage.

    Another case of elites run amok.

  82. 82

    If you want socialized medicine in this country, know what you are getting into.

    You’ve been out of the country too long, Michael. We don’t have socialized medicine, we have universal coverage.

    The situation with your dad sound bad, and you have my sympathy and hopes for the best. But both my parents ended their lives with chronic medical problems, and they never had to worry about coverage, never had to worry about affording premiums, never had to be concerned about with doctor of facility they could use, never had to pay a dime in deductibles, and were never denied treatment that others in the same condition were given. My father received a kidney transplant at sixty years old, for example.

    Medical care is always rationed on some basis. In some places, it’s rationed based on the patient’s condition or on availability of treatment. In others, it’s rationed based on their income.

    I’ll take our system, thank you very much.

  83. 83

    Sounds like Mike D. doesn’t have Kaiser…

  84. 84
    Jeff says:

    @Lupin: On average, hospitals in the US overcharge the uninsured somewhere between 3x and 5x what medicare pays and what the insurance companies negotiate. Also, they are notorious for billing errors in their favor.

  85. 85

    @Michael D.:

    I know it’s my dad, but I am not letting that cloud my judgment.

    No, not cloud your judgment, but you’re certainly far more invested in him getting the surgery than almost anyone else would be.

    I understand your frustration – but you can’t pretend that this is something that doesn’t happen under the current system in the US. My (well-insured) partner spent the last two years trying to get progressively more serious neurological symptoms diagnosed. Because she only meets 80-85% criteria for multiple sclerosis (probably 50% when the symptoms started – but they were classic early-onset MS symptoms), guess what? It took her two years of actively seeking out a specialist who was willing to fight for the more expensive testing that could make the MS diagnosis. She’s got top of the line insurance, but the insurance company certainly wasn’t going to help her navigate the system. And this is with a disease where early and aggressive intervention is the best path – but the medications are hellishly expensive, as is rehab and PT.

    Under the current US system, doctors are gatekeepers as much as the suits that underwrite them. It’s far worse under payment plans that mandate capitated service levels: if you exceed your however-many-thousand-dollars/year limit, too bad, so sad, sucks to be you. Your services can and will be cut off – and that’s often with ‘good’ insurance that you’ve paid premiums on for years.

  86. 86
    Fern says:

    Actually, in Canada rich people DO pay more for health care, because they pay proportionally higher levels of income tax, which is how the healthcare system is funded.

  87. 87
    Adrienne says:

    While I’m sorry to hear about your father, I must tell you that you’re off base here. We already HAVE rationing in this country. People who have insurance get care (at varying levels) and people who don’t have insurance don’t get care except for ER care. Either way, it’s rationing. I’d just rather have rationing where we ALL get a basic level of care and may have to fight over whether you need 90% or 80% blockage to get a specific surgery after a stroke than to have the rationing that leaves people out of care altogether.

    Even though your father may not be getting exactly the care that you or he would LIKE him to get, he’s still getting care which is a helluva lot more than I can say for my mother who died in 1996 of Lupus after only being diagnosed for less than 6 months but had the disease probably her entire adult life. She didn’t have insurance so when she was experiencing all these symptoms, she never went to the doctor – until it was too late.

    Be thankful that he’s being cared for, looked after, and that the hospital bills from the stroke won’t cause him to have a heart attack when he files for bankruptcy.

  88. 88
    bargal20 says:

    Australia has a two-tiered system. Everyone earning beyond a certain amount pays for the universal health care system (Medicare) whether they want to or not, while those who can afford and want it may take out private health insurance, for which the government offers a 30% rebate.

  89. 89
    mattH says:

    In any case, how can you accuse me of being a pedant if I didn’t get my facts right in the first place?

    I believe Scott de B. was referring to himself, and I thank him for being the pedant I didn’t have to be.

  90. 90
    Cheevans says:

    Long time reader, first time writer

    I’m a Quebecer, or Quebecois to be PC

    In regards to Private healthcare in Canada, it is a gray area. Montreal, specifically Westmount (wealthy area) there are a few private clinics popping up mostly for MRIs, and Gastroenterology stuff. If you have the cash, you will have first rate care without lines. Not to say that the care otherwise provided isn’t good. What we are seeing happening here are Doctors opting out of the Medicare system and offering procedures, tests and treatments that Medicare would not cover in their own private clinics. Also, just to add a little clarification, Medicare in Canada is not "universal" each province has a set amount that it charges for a procedure. If I broke my leg in Alberta, had it set and a cast put on. The Alberta hospital bills you. You then submit it to the Quebec Gov’t for reimbursement. If the Alberta amount is higher than what Quebec pays, you’re out some cash. But at least your not footing the entire bill.

  91. 91
    Caidence (fmr. Chris) says:

    @Adrienne:

    People who have insurance get care (at varying levels) and people who don’t have insurance don’t get care except for ER care. Either way, it’s rationing.

    More language abuse with the same word.

    Rationing means there’s an authority handing out a limited supply (yup) to a demanding populace (yeah) with the intention of being (or at least appearing) equitable (NOPE).

    Please be careful to not abuse language in the midst of hot-headed discussions about public policy. It only serves to confuse more people that already don’t know what they’re we’re talking about.

  92. 92
    bootlegger says:

    @Xenos: Perhaps. But "ration" really does refer to equal distribution, which is certainly a laudable goal, but it is not what the market system does. The market system "distributes" resources, which usually means it’s stratified with some getting more of the resource than others.

    Both are distribution systems, but rationing implies an equal sharing of a limited resource.

  93. 93

    If this was a drinking game, you’d be in a relatively dry county.

    I have never understood that dry county thing. Why would a state government be so afraid of the demon rum that they’d let the counties decide whether to be dry or not?

  94. 94
    Krista says:

    Canada’s mistake, I think, is in not allowing any sort of private insurance that people can choose to purchase in addition to what the state provides

    That’s a very common misconception, believe it or not. But no, private insurance is still very much legal. Most people who obtain it, get it to top up what the government provides. As an example, MSI (my province’s coverage), doesn’t pay for dental care, eye care, or prescription meds. So, we got a low-level package from Blue Cross that’ll cover that stuff. It’s more for when we have kids, in case they have any health problems (FSM forbid.)

    Our system definitely has problems…we can’t keep doctors in rural areas, there’s a nursing shortage, and yes…there do tend to be waiting lists for some diagnostics and for what I call "quality of life" surgeries (i.e. joint replacements, things like that.) However, the fact remains that even when I was unemployed and living off of EI for awhile, I still had my medical coverage.

    And yes, my taxes pay for it. Some people probably freak out at the idea of their taxes being raised to pay for universal healthcare. The way I see it is this: look at how many of your tax dollars are already completely wasted due to cronyism and pork. Wouldn’t it be nice for a change to have your tax money go towards something useful?

    And no, I don’t necessarily think that government is more competent than corporations. However, I do know that for corporations, their primary raison-d’etre is the profits. They will look for any excuse to deny a claim. And if you start actually costing them money, they’ll look for reasons to drop you. The government can’t do that. That alone is reason enough for me to be a fan of universal coverage.

  95. 95
    passerby says:

    @Caidence (fmr. Chris):

    And I assure you as a systems engineer: you put this healthcare thing through without fixing the foundations like good nutrition and better drugs programs, it’ll fall apart FAST.

    "You’re asking to build a skyscraper on swampland."

    I agree that creating a new system will be a MASSIVE undertaking requiring a great deal of political will and fortitude.

    Public education coupled with Obama’s use of the bully pulpit to advocate for healthy living would be a necessary component to create the necessary shift from our current culture of sedentary ways and ignorance of nutrition. [Look at the availability and affordabilty of junk food].

    If a cultural shift of this type succeeds, imagine that McDonald’s, BK, Wendy’s, Taco Bell, et al, will either have to change in response to public demand for healthy items or have to go out of business. The unconscious eating habits we have now, favor the proliferation of fast food joints at every corner in every town. Complete market saturation. Public demand can change that. That’s our responsibilty.

    Insurance companies will fight with all they have against a system that excludes them. This factor alone makes ANY change of our current sucky system seem like a pipe dream.

    But, the with the economic wheels coming off so many institutions, now would be the time to negotiate something far different than what we currently have which is 3rd party pay, which equals "deep pockets" which causes inflated costs, which causes the patients to be used as cash cows.

    This is the rat that ate the malt that lay in the house that Jack built.

    Caidence is right. Interconnected elements make a shift to universal care a monster of a challenge and we can’t settle for piecemeal adjustments in the system. Expert minds need to come up with a phased plan or an all-at-once plan. Either way there will be unfortunate ones who will be caught in the bubble during any transition.

    Edit: I give up on blockquote mastery.

  96. 96
    bootlegger says:

    @Kirk: Oh, I agree completely. Preventive care is a quality of life, and thus productivity, issue. I’ll take a healthy life and when I get so old only cyborg implants keep me alive, pull the damned plug. Fine with me.

  97. 97

    Only in Alberta, as far as I know. And it’s been challenged as unconstitutional. But perhaps someone who has lived in Canada in the past 10 years knows more aboutthis than me.

    Private insurance certainly does exist. I have extended health coverage through my employer’s benefit package.

    What does not exist is private treatment. All medical treatment that can be covered by medical premiums must be part of the system. This means that should you have the disposable income, you can’t jump ahead of others in line.

  98. 98
    DanM says:

    I think I’m missing something here. Certainly, rationing is a clear sign of a failure in a governmental health care system, but how is this different than the legions of American’s who are denied care by their insurance companies?

    We’ve got a huge systemic problem where needed operations are routinely denied by insurance companies, and claims are frivolously denied, and chronically ill individuals have reached their lifetime maximum of care, while "pre-existing" conditions are never covered.

    The US has the most expensive health care system in the world. US businesses are expected to directly pay the brunt of those costs. It’s inefficient, unjust, and unaffordable. The net effect destroys our competitiveness. US business cannot afford the massive informal payroll tax that our current health care system represents.

    Socialized health care is no panacea, but its a damn sight better than a system that combines all of the drawbacks of such a system while reaping none of the benefits.

  99. 99
    Michael D. says:

    @TheHatOnMyCat: Heh. Last weekend, my partner and I decided at 11:30 pm that we’d like to have a beer (we made a pizza), so I went to the Kroger in Dekalb County in Atlanta. I picked up a half dozen Sam Adams. They wouldn’t let me buy them because it was 11:46. You cannot sell alcohol in stores after 11:45pm in Dekalb county.

    Across the street at the BP Station (in Fulton county) I bought the same thing at 11:55.

    Alcohol sales laws are generally stupid.

  100. 100
    bootlegger says:

    @Zifnab: Ok, before anyone thinks I’m arguing for a Logans Run solution to health care, I’m not. But it is important that we have the correct information and it does, in fact, cost more to live longer than to die young. This does not factor in, as many note, quality of life issues or productivity. It may be that these make up for the "costs" of old age, but that wasn’t my line of reasoning. I’m all for universal health coverage with a heavy focus on prevention and healthy living, but not because it saves us money.

  101. 101
    Adrienne says:

    Please be careful to not abuse language in the midst of hot-headed discussions about public policy. It only serves to confuse more people that already don’t know what they’re we’re talking about.

    While I understand what you are saying, I was going with the common usage and understanding that already exist on BJ with regard to the usage of the term "ration". In the context of this discussion, I don’t quite see the harm. However, if it will keep your panties from bunching in your crack, I’ll use the another term.

  102. 102
    r€nato says:

    well, if we’re going to make decisions by personal anecdote about something as monumental as switching from privatized health care to universal health care, I’ll throw into the mix that my elderly grandmother in Italy, during the final three or four years of her life, had to go to the hospital about three or four times a year.

    It was never anything gravely serious, but serious enough that it required a hospital visit each time.

    In the US, she would have not gone at all for fear that even a single visit would have bankrupted her or burdened her with bill collectors and debt for the remaining years of her life. She would have likely died several years earlier as a result.

  103. 103
    McDuff says:

    What’s the deal with people saying you can’t buy additional health insurance in the UK? You don’t opt out of the taxation like you do in Germany – which is ludicrous, by the way – but you can pay a premium to a private insurer as well as your taxes. Also, because of a sharing relationship between the two sectors our insurance is much better value than in the USA.

    We do have a few issues that could do with some policy examination. We insist that private patients stay private, rather than dipping into the NHS for things. As good an idea it is in concept, it hits a few snags because NHS patients can’t fund experimental treatments that NICE decide not to offer on the NHS.

    Whether your father would get treated here or in the US is a matter of pure speculation. I rather suspect that it would depend on how much money he put into it.

  104. 104
    Caidence (fmr. Chris) says:

    @Adrienne:

    I was going with the common usage

    That’s not common around here. You say "rationing" in NYC, people think of Great Depression breadlines and soup kitchens. Because that’s what New Yorkers obsess about.

    if it will keep your panties from bunching in your crack

    Those aren’t my panties. They’re my girlfriend’s.

  105. 105
    Blogging in the Wind says:

    When I was 14, I had a tumor on my spine. I spent about a month in the hospital. That probably wouldn’t have taken so long here. But I DID get great care.

    No, here you would be sent home after 5 days because the cost to house you in the hospital would be prohibitive to the insurance company. If you didn’t have insurance, then places like USC/County General Hospital would have a cab drive you to skid row and drop you off in front of the Salvation Army mission still in your hospital gown (true–it’s done in LA all the time to the homeless).

  106. 106
    ImJohnGalt says:

    I think the biggest problem with single payer, like in Canada, is that the wealthy are NOT allowed to pay for their own.

    The only problem I have with this is that it will suck doctors from the public system to the private one. Unless there are enforceable ways to keep doctors (especially the best ones, who are likely to bolt to the likely better-compensated private system) fully participating in the public system, I would have a problem with this.

    I don’t mind a two-tier system here, as long as the quality of care is comparable, and doctors are required to work in both, rather than just choose the more lucrative.

    As for your anecdotes, MIchael, they are just that – anecdotes, and not predictive of anything. Your emotions *are* colouring your opinions. For every stupid anecdote you can provide for why the US system would be so much better for your dad, we can easily find 50 that showcase how the Canadian system is better.

    Can we not just admit that both systems can be improved, and that, generally speaking, neither system would be *trying* to kill your father? That is, as neither of us are doctors, we can admit that there may be actual *medical* reasons for the course of treatment that is recommended?

    You keep asserting that if he was in the US certain things would happen, but I can tell you (I’ve lived in both systems) that your assumptions about both systems are horribly flawed.

  107. 107

    But if you do have health insurance, and if your carotid artery is 69% blocked and you had a stroke because of it, you’d get the operation here.

    That’s a BIG if and even if you have insurance there’s no guarantee that you’ll get the care you seek. The insurance companies are for profit, they make money by denying care – not providing it.

    We have two options, we can ration based on medical need or we can ration based on economic status. There’s no escaping the need to ration, the question is what is the most humane and efficient manner to ration that care.

  108. 108
    Xenos says:

    @r€nato:

    well, if we’re going to make decisions by personal anecdote about something as monumental as switching from privatized health care to universal health care, I’ll throw into the mix…

    As much as it is considered to be bad form, you can’t really discuss the moral dimension of health policy without using anecdotes as examples. The fear that your grandmother would have felt in the American system is important. It illustrates the dehumanizing aspects of relying on market forces to determine who we care for and how we do so.

    Even if a purely free market system had better efficiencies than a state-subsidized and regulated system, would those efficiencies be worth the fear and insecurity felt by so many people for so much of their lives? More to the point, is the contemporary American health system really how we ought to be caring for one another?

  109. 109
    scarshapedstar says:

    Huh? You’re saying that US healthcare providers never deny a procedure?

    You might want to rethink that.

  110. 110
    malraux says:

    Is it also worth pointing out that in the US, your dad would be insured through a socialist system, as I’m assuming he’s 65?

  111. 111

    Alcohol sales laws are generally stupid.

    Again we agree (scary, isn’t it?).

    Out here we have stupid law. On Sunday, you have to wait until 10 am to buy alcohol, because the prudes are afraid there might be a drunk driver on the road when they head to church.

    As if preventing Safeway from selling beer before 10 am would keep drunk drivers off the road.

  112. 112
    jcricket says:

    Geez, we get 87 posts in and no one points to one of the better references on the various sytems around the world, from Ezra Klein?

    The facts are that the US spends the most, and, compared to other well-off countries, gets middle-of-the-road (at best) health results. We also leave 50 million people (and counting) uninsured. Britain spends by far the least, and surprisingly, still gets far better results. Health care per capita spending and health outcomes are not as directly tied as one might think. There’s a lot of waste, big pharma selling "me too drugs" and interventions that produce no better results than placebos or old treatments. But no one thinks we should turn into Britain, or even Canada. Switzerland, France and Germany are far more likely models for us to adopt, and any would be a massive improvement.

    There’s no reason we can’t simply put together a system that’s a mixture the good stuff from other systems, and avoids some of the bigger mistakes (i.e. Britain’s conservatives love low taxes, so they regularly gut the NHS funding base, which leads to the harsher rationing and low doctor pay/satisfaction).

    If funded properly, overseen by the "right" people and allowed to implement the proper protocols (i.e. push doctors, drug companies, insurance companies, people to "do the right thing") we would see massive cost reductions, universal coverage, increased health outcomes across the board. Yes, it wouldn’t make us all live forever, and there would still be plenty of debate (which drugs, protocols, how much spending at beginning/end of life, what about abortion costs, etc.). But let’s not let the perfect (which doesn’t even exist) be the enemy of the good.

  113. 113
    bootlegger says:

    @Xenos: Exactly. The issue must be wether or not the modern social contract should include doing whatever we can to help each other maintain health. It is my opinion that we have the knowledge and resources to do this so the its just a matter of will. This is where the hypocrisy of the Xtian Free Marketeers is so blatant. Whatsoever you do unto the least of my brothers….

  114. 114
    Sonny says:

    Note that the surgery is dangerous and can by itself cause nasty complications like a major stroke. I suspect that’s the main reason behind waiting. The cure can be worse than the disease at 69% blockage.

  115. 115
    Earl Hathaway says:

    Look — I’m sure this is a hard time for you, Michael, but this post added me to the "why the hell does Michael D have posting privileges here" brigade.

    We ration care in this country too, just by whether you can pay for it instead of directly by government bureaucrats. My father was denied an "experimental" cancer treatment and he lived another 3 years because my parents could plunk down $580k out of pocket. So I’d damn well call that rationing unless you think most of the country has that type of semi-liquid assets.

    But if you do have health insurance, and if your carotid artery is 69% blocked and you had a stroke because of it, you’d get the operation here.

    Yeah, assuming that 1- you have insurance, 2- they don’t manage to screw you out of paying for it (oh, that’s a preexisting condition, blah blah blah), 3 – they don’t just not pay and f***k you (did you know the insurance company’s liability if you die because they refused to pay for treatment and so you weren’t given treatment is generally limited by a series of supreme court decisions to the value of the health insurance payments? It’s true! Read a book called High Wire by Peter Gosselin Further, you can’t sue while you’re alive, because the lawsuits won’t cover your legal costs — your maximum payout is the price of the treatment you needed. Hope you can cover $300/hour lawyers out of pocket. Sucker.).

    So yeah — I’m gonna go with maybe you should reconsider this post.

    And everybody should read High Wire.

    earl

  116. 116
    passerby says:

    @Flugel_Horn:

    Bottom line… Socialized medicine sacrifices the over-all level of healthcare for EVERYONE so that each person can have less than mediocre healthcare and the rich/privately insured still get the best available. It is the classic example of flattening the curve to cater to the lowest common denominator. This does not work in education and it does not work in the Healthcare system.

    I appreciate this perspective and I don’t know how long the socialized systems have been in effect in the UK and Canada, but consider the changes that have happened in the world since they were established. Changes, such as those seen in population density and age, environmental pollution, the corruption of the food chain, new medical technologies, and drug development, exist now that weren’t present when those systems were launched.

    Creating the modern paradigm of socialized medicine has the advantage of considering these changes as well as a view of how they impact current socialized systems. In this way pitfalls can be anticipated and planned around.

    The insurance companies are yet another shareholder venture and so their focus is not on the physical wellness of the patients. They only care about the patients’ willingness and ability to pay monthly premiums. Cash cows. So having a system based on mandatory insurance would keep this non-medical industry in charge of medical care.

    We would continue to see hospitals inflating costs (because of deep pocket payer) and, the quality of care fall by the way side because of money.

    Our system today is a scheme where hospitals and insurance companies shuttle our premium money around (with a whole lotta paperwork in between–a cottage industry) then deny payment for treatments when we make a claim. We’re SOL.

  117. 117
    BombIranForChrist says:

    If forced to make the choice, I would rather have my health care mandated by someone who is accountable to me (the government) than someone who is not (the insurance companies).

    If insurance companies worked in a truly competitive marketplace, it might be different, but the fact of the matter is that they have us all over a barrel and there is nothing we can do about it unless we get rid of them altogether.

  118. 118

    There’s no escaping the need to ration, the question is what is the most humane and efficient manner to ration that care.

    There’s also the pragmatic rationale. Universal coverage provides equivalent care at a cheaper price. This is because the single insurance provider has incentive and means to encourage preventative treatment, and early and better treatment of conditions that become more expensive later. For example, if a heart patient does not seek treatment early because of a lack of coverage, they will likely seek much more expensive care later. The cost of that treatment is shared by all of those paying premiums.

    Also, a universal provider has far less overhead and administration costs. That alone could make it worth implementing.

  119. 119

    Just a couple of points about health insurance in the US:

    If auto insurers tried to pull the stuff that health insurers do with regularity: vague and misleading info about what is covered, approving treatments and the deciding not to pay, etc., those insurers would be called on the carpet by insurance commissions, or facing criminal fraud charges.
    This is particulary a problem with employer-based insurance, I suspect.

    For "prevention", it’s time to align economic incentives. Require that health insurance coverage be bundled with a term life policy of appropriately large amount.

  120. 120
    cervantes says:

    Michael, I’m sorry, but you are missing the obvious here. Resources are not unlimited, and there are many people on this earth who have a much stronger claim than your father does on the resources that would be required for the surgery.

    Gardiner Harris in today’s Gray Lady has a long piece on Britain’s NICE. It’s got a lot of good information, but is a bit short on the deep thinking. Unfortunately, here in the U.S. we’re going to have to do some of that deep thinking if we’re ever going to get our knickers untwisted. Harris begins with a little case vignette:

    "When Bruce Hardy’s kidney cancer spread to his lung, his doctor recommended an expensive new pill from Pfizer. But Mr. Hardy is British, and the British health authorities refused to buy the medicine. His wife has been distraught.
    “Everybody should be allowed to have as much life as they can,” Joy Hardy said in the couple’s modest home outside London."

    And he ends with the Hardys as well (just like they taught him to do in J school):

    "Meanwhile, Mr. Hardy waits. In recent weeks his growing tumor has pressed on a nerve that governs his voice. He can barely speak and is increasingly out of breath. The Hardys are hoping that in January NICE will approve the use of Sutent, allowing Mr. Hardy further treatment.

    "It’s hard to know that there is something out there that could help but they’re saying you can’t have it because of cost,” said Ms. Hardy, who now speaks for her husband of 45 years. “What price is life?”"

    In between is a lot of facts and history (including that Sutent can be expected to buy Mr. Hardy 6 months of life, at a cost of $54,000) but little reflection on Ms. Hardy’s moral position. Should "everybody be allowed to have as much life as they can?" Does life have a price? What if we were to answer, as Ms. Hardy would like us to, "yes" and "no" respectively? What would be the logical consequences?

    If the British National Health Services — rather, the British taxpayers — are obliged to spend the $54,000 to buy Mr. Hardy those six months, what else are they obliged to do? Dare we even ask that question? Think it through, which you obviously have not done.

  121. 121
    Michael D. says:

    @TheHatOnMyCat:

    But here we have stupid law. On Sunday, you have to wait until 10 am to buy alcohol

    On the upside, if this is the case, you will never have to worry about me moving to wherever you are!! ;-)

  122. 122
    Shygetz says:

    Although I’m not an MD, and I’m certainly not familiar enough with your dad’s case to comment specifically, I can say that in many similar cases it would be best practices to not do the surgery, and instead attempt to treat your father with drugs and lifestyle changes due to the dangers and limited (if any) benefit of the surgery with such a relatively low amount of blockage. So I would hesitate to blame the lack of surgery on Canadian medical rationing; it may very well be that not having surgery is to your father’s benefit, and his doctor failed to make that clear.

    And to those who feel that supply and demand are sufficient to regulate health care, allow me to ask you a few questions. If, say, you (or your wife, or your child) are having a heart attack, how expensive would the treatment have to be before you would turn it down? How long would you spend pricing competitors, and how far would you be willing to drive your dying relative to get cheaper care? If the market isn’t free and demand is essentially unlimited (as in, those who require the service will literally pay any price they can get their hands on for it), the free market cannot regulate price/quality. There must be a public system to handle this market segment.

  123. 123
    Common Sense says:

    My stepaunt died at 27 with a tumor in her breast. Since she was so young her insurance refused to pay for initial diagnostics when she discovered the lump. They fought other treatments tooth and nail as well. Long story short — post lawsuit my stepuncle was able to pay for her medical expenses and there is now a nurse’s scholarship in her name at UT San Antonio. But she is dead because the insurance company not only wouldn’t pay for her procedure, they wouldn’t pay for an MRI or CT Scan.

  124. 124
    Shygetz says:

    @bootlegger: Saying that better health care doesn’t save money if you don’t count productivity is like saying that it’s cheaper to walk than own a car if you don’t count the fact that you can no longer get to your job. You can’t leave out an ESSENTIAL factor and expect your conclusions to be meaningful. There are lots of very serious economists who look deeply into this question, and I am not qualified to comment on the state-of-the-art, but to reduce it as you have makes your conclusions meaningless. It may very well be cheaper to have better health care for the population.

  125. 125
    Cyrus says:

    @Flugel_Horn:

    In the US, hospitals cannot refuse treatment based on insurance, income, etc…

    I don’t think this is true, not in any meaningful way. The only sense in which hospitals cannot refuse treatment is at the emergency room. That’s better than nothing, sure, but it does little for non-acute problems and it does fuck-all for preventive care. In the hypothetical example of your trainee who had a heart attack, an emergency room would deal with the heart attack even if they came in without an insurance card or credit card. If he had come in a month before complaining about early warning signs of a heart attack and asked for high blood pressure medication or help quitting smoking or something, though, they’d tell him to take aspirin or give him some brochures and send him on his way.

  126. 126
    Mnemosyne says:

    People in the US have operations like this all the time, and if they were being denied coverage in waves it’d make the news.

    It did. In fact, you can look at the LA Times archives and see their entire series about Blue Cross.

  127. 127
    passerby says:

    And one more thing about costs and then I’ll shut up.

    We have a system that charges for each and every article used in our treatment during a hospital stay or clinic visit. Ridiculous, incidental charges like $5 per aspirin, $50 for an admit kit or whatever.

    Larger procedures, say, open heart surgery, can run into thousands and thousand of dollars and will vary from place to place.

    Under a universal system, (without insurance company involvement) these costs could easily be standardized to effect a much lower cost (the economy of scale) and a streamlining of billing practices as well as delivery of services.

    [I’ve been a self-pay patient for the past 8 years and I receive a 30% discount for any office visit because of the lack of insurance paperwork.]

    So, yes, those who don’t carry their own weight healthwise and sit around waiting for someone to wave a magic wand to make them well or blame someone else for their lot in life, will be a burden on the system and that’s a problem. But the monetary burden will be MUCH less than what we currently pay. Wisdom is required in establishing the standards of care.

    With rights come responsibilities. We live in a culture that’s been creating outrage and victimhood thru the MSM for too long. A cultural shift toward self-reliance is called for. Demand leadership from Washington, but, claim responsibility for personal well-being.

  128. 128
    Shinobi says:

    Every time I hear someone proclaim that healthcare is a "right" I have to avoid rolling my eyes.

    The fact is that healthcare is limited in supply. At some point someone is going to need more of it than is available. We can either determine who gets it by who pays for it, or by some arbitrary impersonal government system.

    But no matter what happens, some people are still not going to have access to the health care they need because the simple truth is, there isn’t enough of it.

  129. 129
    Mari says:

    Hey, Cigna insurance was just awesome until I actually got sick and needed them.

    Then, not so much.

  130. 130
    Don says:

    The only sense in which hospitals cannot refuse treatment is at the emergency room

    The emergency room does not have to treat every issue you come in with. They have to provide life-saving care, but if you have a cold they don’t have to help you. They might be required to based on their local funding or guidelines, but nation-wide they don’t have to put a band-aid on your scraped knee.

  131. 131

    Every time I hear someone proclaim that healthcare is a "right" I have to avoid rolling my eyes.

    I think the "right" in question is equal right to access.

  132. 132
    Charity says:

    @malraux: Holy shit, that’s crazy. I called my GP for a checkup yesterday. I’m seeing her Monday morning. As in 4 days from now. O_o

  133. 133
    Blue Raven says:

    @Common Sense:

    My stepaunt died at 27 with a tumor in her breast. Since she was so young her insurance refused to pay for initial diagnostics when she discovered the lump.

    I suspect a lot of us have similar stories. My friend’s mother died of colon cancer. It took months to convince Kaiser to do a basic colonoscopy despite her clear symptom set because she was too young to qualify for the initial exam based on their care standards. By the time they relented, the cancer had metastasized. HMOs are the major evil of private-carrier medical insurance. Sure, your PPOs and standard insurance providers are capable of being total dicks (see CS’s remarks). It’s the HMOs who have turned it into an art form and it’s likely the selfsame HMO structure that scares anyone who imagines the US government managing health care.

  134. 134
    Randall says:

    Is Michael D really Andrew Sullivan? Because this post looks like
    something Sully posts once a week.

  135. 135
    passerby says:

    But no matter what happens, some people are still not going to have access to the health care they need because the simple truth is, there isn’t enough of it.

    During the great Depression there was not enough food to go around. Not because there was not enough farmland to grow food . Not because there were not enough bakeries to bake bread.

    There was not enough food because the distribution system was broken.

    Its the same with health care.

  136. 136

    When you say ‘operation’, what do you refer too?

    I checked what the normal procedures in the Netherlands would be (as in ‘most commonly advised’ so not specific for your father). We have universal healthcare and partly socialized medicine. Health insurance is obligatory, all kids under 18 can have health insurance for free (incl. basic dentist), there is a basic package that includes most essentials and health insurers compete with additional packages and more service. For me, spouse and three young kids we pay 250 euro per month.

    With a blockage of 50-70% the first choice often is to "dotter" (bring in a little balloon to make the bloodvessel wider, called after the inventor – I don’t know the English term) or, if during the operation is shown that the vessel doesn’t respond well they put in a little tube to keep the vessel open. According to the first Dutch hospital that showed up in google this operation this is a minor operation. You usually stay in hospital 2 days (the day of the operation and one day for checkups and scans) and without complications it costs about 9000 euro. There is debate about this though, because studies showed that for stable patients just medication might work just as well.

    Bypass would happen mainly when there are more blockages, when medication doesn’t work or when there is a lot of pain. Waitinglists are a few weeks and costs are minimal 15000 euro (incl. ICU and 9 days in hospital).

    The doctor is supposed to tell you the advantages and disadvantages of the various treatments. Even if you don’t have to pay for the meds, do you want to take them for 5 years if after 5 years the change of you being allright has gone up from 85% if you hadn’t taken them to 87% if you take them? Ditto for operations. You have to weigh the advantages, disadvantages and change it will make, including the possible effects of medication and change in lifestyle.

  137. 137
    Jon H says:

    cervantes wrote: "If the British National Health Services—rather, the British taxpayers—are obliged to spend the $54,000 to buy Mr. Hardy those six months, what else are they obliged to do?"

    Note that the British NHS is not the pinnacle of national healthcare. In fact, it’s somewhat infamous for doing stupid things, like denying Alzheimers’ meds to early-stage patients, and only paying after lots of damage has been done.

    NHS and Canada’s system get the most attention because they’re geographically convenient and the reporters don’t need a translator.

    But there are lots of countries with national healthcare. The French system is well-regarded. Germany’s had universal coverage since Bismarck.

  138. 138
    Morat20 says:

    Anecdote:

    My father, here in the good old US of A, with gold-standard health insurance from a very reputable company, spent eighteen months trying to get an MRI.

    He had a bone spur in a neck vertebra that was impeding nerve function. He initially went in with arm pain, the doctor ran a series of tests and told him that he needed an MRI — with his medical history and the in-office tests, a bone spur was by far the most likely culprit.

    The insurance company denied it, insisting he try a year of physical therapy first. After that, they hemmed and hawed for six months. All the while, the pain was getting worse and the nerve damage becoming permanent.

    Why the wait? They knew — probably even better than his doctor did — that the MRI would almost certainly reveal the bone spur, which they’d be required to pay to have fixed. (The surgery’s costs weren’t that bad — but it was still a major surgery with several days of hospital time and such) — and were hoping he’d switch insurance companies when his annual insurance enrollment occured at work.

    That way, some OTHER company would pay for the expensive MRI and surgery, and they’d get all the premiums for the years when Dad’s worst problem was a bout of the flu.

    He finally got the MRI, revealing the bone spur that the doctor had predicted from day one, and had the surgery. Unfortunately, due to the year+ wait, he has permanent nerve damage.

    Whenever someone screams about how universal coverage means a year long wait for an MRI "like in Canada", I have to laugh.

    We wait that long here. We just do it because we can’t afford it, or because the insurance company doesn’t want to pay for it.

    I’d prefer to ration it according to NEED — triage for medical resources strikes me as much more useful than the whim of the insurance company, and for "government beauracrats deciding your health care" doesn’t strike NEARLY the fear into me as "For profit company’s beauracrats deciding your health care".

  139. 139
    Adrienne says:

    We have a system that charges for each and every article used in our treatment during a hospital stay or clinic visit. Ridiculous, incidental charges like $5 per aspirin, $50 for an admit kit or whatever.

    Yeah, I find that ridiculous. My cousin fell off some 30 feet high scaffolding like two weeks ago, fractured two vertebra in his back, and fractured his leg and was put into a neck brace. He asked for some vaseline for his dry lips and the nurse told us how she has to charge him for it so she couldn’t just bring him a packet. I was floored.

  140. 140
    Church Lady says:

    Regarding liquor laws, some of the most insane have to be in Oxford, Mississippi, which is located in Lafayette County. Lafayette, outside of Oxford, is partially dry – you can purchase liquor, but not beer or wine. Within the city limits of Oxford, you can purchase liquor and wine, but beer cannot be sold cold, only warm. In order to get beer that is already cold, you must travel to either Tate or Panola County, or do some advance plannning. I have yet to figure out why warm beer is ok, but cold beer is not.

    The University of Mississipi is only partially located within the city limits of Oxford. The Grove, where everyone tailgates prior to home football games, is not within the city limits. While it is legal to have liquor in the Grove, both beer and wine are illegal. If the University Police or private Cobra security see beer or wine in your tent, they will confiscate it and pour it out.

    Also, both the city and county are completely dry on Sundays and the bars in restaurants have to cover their liquor supply with plastic from 12 am Sunday morning until they open on Monday morning. The whole thing is absolutely crazy.

  141. 141
    Jody says:

    A friend of mine died last spring because he couldn’t afford to go to the doctor to get his stomach pains looked at. Turned out he had stomach cancer. And by the time the pain got to be so great he DID get it looked at, they still wouldn’t treat it, because by that time it was terminal. Not that he could have afforded the treatment anyway. But hey, his widow has his medical bills to remember him by.

    Now, certainly any system that has human beings running it is going to have some fuckups, and universal health care is no exception. But there are no words for a system that would do what ours did to my friend and his wife.

    I don’t have anything to add to the conversation at large. I just wanted to say that.

  142. 142
    Sid says:

    Dear Michael,

    Please stay the fuck away from any healthcare debate, your lack of knowledge is astounding and you have nothing useful to contribute.

    As for your Dad, I would hope you would be a good child and use your hard earned money to pay for the treatment, the rich in Canada have access to pay as you go healthcare, its called the US.

  143. 143
    slightly_peeved says:

    Best of luck to your Dad, Michael.

    Whenever someone screams about how universal coverage means a year long wait for an MRI "like in Canada", I have to laugh

    I’m an Australian, paying for private insurance (AU$120 a month, which was US$120 a few months ago but is probably about US$3 at the moment). However, to get the real cost of the private health insurance, deduct the $300 they pay me for buying eyeglasses and contact lenses each year.

    Busted my ACL a few years ago. Got an MRI in less than a month, got a reconstruction a month or so after that.

    There are a few hospitals close to where I live, and I could have gone to any of the private hospitals that do knee reconstructions. As it turns out, the local one is a specialist sports clinic that treats olympians, so I got it there.

    My private health insurance covered the private room, and medicare covered the operation.

    I’ve never heard of anyone going through an approval process for private insurance coverage here; you know straight away if something is covered or not. There was no hemming and hawing about my MRI. My doctor said I needed an MRI; an MRI was booked. These days, the entire system is electronic, so I don’t even fill out forms; I just swipe my card and sign the docket showing how much the insurance company has paid for. The only time I’ve talked to my private health insurance company recently is to make sure the monthly payments are still going.

    Oh, and for normal doctor’s visits: the last couple of visits I’ve walked into the clinic without making an appointment and been seen within the hour. And that was the public system.

    If you want to discuss a system that combines private and public healthcare, and want to be able to discuss it in English, then take a look at the Australian system.

  144. 144
    That One - Cain says:

    If I get into this situation, I’m hopping a flight to Asia – Thailand, India, whatever.. Excellent doctors and it’ll be cheap compared to here. The difficulty might be getting the latest medication for some problems.

    I have the benefit of a multi-cultural family though so it might not be an option for some people, but it’s definitely something to think about.

    cain

  145. 145
    Ecks says:

    In the last prez debate McCain said health care was a responsibility, not a right. My acid test on this had been:

    "Can you imagine a situation in which a person has been so careless in socking away money that doctors should put their implements aside and just let them die?"

    If your answer is ‘no’ then you see health care as a right, and if your answer is ‘yes’ then you are a psychopath.

    This thought followed further at my blog

  146. 146
    Jeff says:

    @That One – Cain: Actually, companies are starting to do this. There was an article in Time a few years ago that discussed a company in NC that did this.

  147. 147
    MNPundit says:

    The French system is the best….

  148. 148
    janefinch says:

    I sympathize with your family, but you can hardly politicize it and blame "socialized medicine" for this. I could tell you about a friend of mine who was diagnosed with early-stage lung cancer on a Wednesday afternoon and was in chemo on Saturday…also in that same Canadian system…and my anecdote wouldn’t prove anything either.

    Health care is more complicated than that in both countries.

  149. 149
    Steve The Other Plumber says:

    Apparently Michael has never dealt with the far superior American system where your health care is determined by bean counters at insurance companies.

    Bleh

  150. 150
    AnneLaurie says:

    Seriously? [Mammography’s] like sticking your tit in a macine for 5 minutes right? You should be able to line 50 women up and do that shit in a few hours.

    Since nobody else seems to have picked up on this part of Michael D’s usual festival of cluelessness — No. Mammography’s like having a trained assistant take 2-dimensional pictures of your 3-dimensional tits (both of them, individually) on a very expensive piece of machinery, and then having the resulting pictures read by someone who can spot a pencil-point-sized tumor amid the tangle of veins, glands, scar tissue, calcifications and other "normal" breast changes. The better the assistant, the reader, and the machine, the sooner you’ll find out about the smallest, newest, not-yet-metastasizing cancer, while it can still be treated "conservatively". Therefore, under a rational medical-treatment system, you’d have dedicated treatment centers where the expensive machines were used all day long every day, and where the photographers & the readers got paid to keep their skills fine-tuned and up-to-date.

    HOWEVER, under America’s insane pay-for-play system, insurance systems will pay a GP more to perform a mammogram on his own machine than they’ll pay him to refer his patients to a dedicated provider. And while the for-profit companies theoretically want to catch small tumors sooner, in cold hard actuarial terms, paying for several hundred women to get top-quality mams in order to pick up a dozen microscopic tumorettes, and then paying for their biopsies, lumpectomies, possibly radiation or chemo treatment… after which those women will undoubtably demand long-term ‘prophylaxis’ aftercare with whatever taxol derivitive is making the front section of JAMA this month… is a lot more expensive than hoping some significant portion of those women will just ignore the ‘safety nazis’ and wait until they actually find a lump on their own, by which point statistically they’ll be some other insurance provider’s problem. So non-specialist doctors with less-than-optimum skills are doing too many mammograms even for the ‘fortunate’ subset of women who can afford them, and too many women don’t get diagnosed until their cancers are large & metastasizing, and that leads to a boom for American lawyers looking to find "someone with deep pockets" to sue just so that sick women can afford treatment.

    Breast cancer is kind of the Perfect Storm example where all the myriad small problems of America’s demented "for profit" healthcare system chain together (or cascade) to kill a lot of mothers, daughters, wives, sisters, etc. Every daily mundane penny-pinching decision — including "our" educational choices, where we’ve decided it’s not cost effective to train pink-collar mammography specialists for early intervention when we could spend 10 times as much training surgeons for after it’s too late — conspires to kill or cripple a lot of women while simultaneously costing every dam’ taxpayer and insurance buyer money.

  151. 151

    I live in Gatineau, Québec, which is in a province not known for stellar care. In fact, many western Québeckers go to Ontario for healthcare, even though they have to pay for part of it out of pocket.

    Keep in mind that every province in Canada administers their own healthcare system. The feds merely just provide block grant money and set guidelines as found in the Canada Health Act. So specific problems found in Ontario may not be occuring in Nova Scotia or PEI.

    It’s also important to remember that Canada went through a fairly severe recession in the 1990s for reasons that are similar to what the U.S. is facing today. In order to balance the federal budget and stop the red ink, there were deep cuts to the block grants provided to the provinces and healthcare suffered. Canada’s last recession ended and economically it has outperformed the U.S. economy for several years, but those block grants have not been fully restored nor have they kept up with rising healthcare costs.

    I still think our system is the best in the world, but if the funding isn’t there, it is going to suffer. If the U.S. institutes a Canadian style system some kind of safeguard needs to be in place to keep healthcare from coming under the knife in hard times.

  152. 152
    Mako says:

    Canadians just aren’t doing it right.
    Never would have happened in the Japanese single payer system.
    Of course no one ever looks to Japan for solutions, jeebus has anyone ridden the Metro in DC lately? Dark dank stations and dismal dirty trains (Who the fucks idea was it to put carpet on the floor of a subway car). And broke, cuz there is no advertizing…

  153. 153
    Darkrose says:

    @TheHatOnMyCat:

    And what’s really different about our scheme as opposed to the scheme in Canada is …. if I lose my job, my access goes in the toilet and I would never get it back without spending very large sums of money.

    …if you get it back at all. I’m not sure I could find an insurance company who would cover me. I’m a 38-year-old overweight asthmatic black woman with high blood pressure and a family history of stroke and diabetes on both sides. Between the family history and the pre-existing conditions, I’m not sure I could get private insurance at all.

  154. 154
    Darkrose says:

    @Blue Raven:

    I suspect a lot of us have similar stories. My friend’s mother died of colon cancer. It took months to convince Kaiser to do a basic colonoscopy despite her clear symptom set because she was too young to qualify for the initial exam based on their care standards. By the time they relented, the cancer had metastasized. HMOs are the major evil of private-carrier medical insurance.

    On the other hand, when I found a lump on my right breast last year, I walked into Kaiser Davis and had a mammogram within 15 minutes. Two days later, they called and said they wanted me to come in for an ultrasound. Two days after the ultrasound they did a biopsy.

    I have no family history of breast cancer, or cancer at all, actually. And as it turned out, the lump was dead tissue from where I’d walked into a car mirror (What? I’m short!). But Kaiser treated it like it could have been serious until proven otherwise, and I was very happy.

    [My wife just pointed out that there’s a big difference between Kaiser NoCal and So Cal, though.]

  155. 155
    Jim Heim says:

    This decision had nothing to do with rationing. It is considered too risky an operation until the blockage exceeds 75%. Sometimes medical decsisons are just that. You dad’s doctor should have explained the risks and the reasoning. Even if he wanted to pay for the surgery out of his own pocket, the surgeon would be foolish to do it.

  156. 156
    RS says:

    toujoursdan, it’s been my understanding that in addition to the recession generated cuts, there are also free market/ small government advocates in Canada who are vested in the failure of Medicare and who bear some responsibility for it’s underfunding. How true is that?
    "Universal" and "socialized" are not synonymous. I expect that kind of conflation by the right-wing opponents of single-payer, but I expect deeper thinking from the posts at Balloon Juice. I don’t think Michael D. is Andrew Sullivan, as someone noted- more like Andrew Rooney.
    There’s nothing wrong, real or imagined, with any of the single-payer systems in each and every other developed country around the world that provides it for their citizens that you couldn’t go a long way toward correcting by simply raising their per capita spending to even 3/4 of of what we are spending in the US (where we still manage to leave almost 1/3 of the population, virtually all from the 18-65 year old demographic, uninsured).
    I may have missed it upthread, but there is a lot of administrative waste (approximately 30%) in the private sector, relative to about 5% overhead for Medicare. In case any one reading is unaware, in February 2008 Rep. John Conyers introduced H.R. 676 (the United States National Health Insurance Act, aka "Medicare for All"). The bill now has over 91 co-sponsors. Call your rep and find out where they stand.

  157. 157
    Fr33d0m says:

    It was made from a rationing perspective, and I am pissed off royally.

    When you calm down a little you may look at this differently. We all go a little over the top when we’re pissed off.

    In the US if you can afford to have health care insurance, those same kinds of decisions are made by a different group of people. That group has profit as their motive. Most folks don’t have a choice but to get whatever treatment, surgery etc. they need to live a good life. Considering the result of not getting that surgery, is that decision made out of profit motive necessarily better than one made out of some bureaucratic rule a better decision?

    As others have said, our elected politicians have not been engaged in a real debate over socialized medicine. Our future is still set to be ruled by profit motive albeit with some government intervention. The difference may well be how much control the public can collectively exert over the system and how they can exercise that control–not to mention cost control issues.

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    onceler says:

    Hmm, I dunno. Sounds like a pre-existing condition to me, I’m afraid we can’t cover something like surgery for a blocked artery. After all, it certainly didn’t become clogged overnight!

    Of course, a situation like this is not at all a necessary side-effect of ‘socialized medicine’, it would be very easy to write a statute or policy which states that by definition any arterial condition which has caused a stroke requires the surgery, no matter the percentage of the clog or what have you. You just can’t have accountants writing the health care policy in the first place, that’s how you end up with silly rules like this.

  159. 159
    Madison says:

    Your premise is absolutely wrong. In America, you will get the surgery only if you have a really top-notch insurance policy. Most ‘affordable’ policies will find any excuse to deny a claim. I know, I lost a grandparent because the insurance company denied a claim for a heart valve operation that every doctor I talked to said would have saved her life. We already have rationing… its just that the biggest ration goes to the people who can afford it.

    Yes, a single payer ‘socialized’ system will not be perfect, but that is what supplemental policies are for. The rich still get the best coverage, but at least everyone else gets something adequate… which is a lot more than what we have now. My inlaws are British. I’ve some experience with NHS. I’ll take it over our current system any day.

  160. 160
    elliottg says:

    Doesn’t this post need an update for multiple problems:

    1. Michael – you got the standard of care just plain F***ing wrong.

    2. Your dad would be covered in the US under socialized medicine (being over 65) and MediGap coverage (private insurance) would not make up for the difference since they defer to Medicare vis-a-vis the standard of care.

    3. Even if your dad was under 65, you would have a hard time convincing any insurance company to pay since they also follow the standard of care.

    4. You know NOTHING it seems about managing your dad’s medical condition and are unaware of the drugs and lifestyle modifications that are going to be tried to address the problem. These are more likely to be covered (or be lower cost) in Canada than here.

    5. Even if you were willing to pay for the whole damn thing out-of-pocket, you would have a great lawsuit if something terrible happened to your dad during the operation. The first question at the post-mortem deposition by your lawyer, would be, "given the standard of care, Dr. Greedy Surgeon, why did you operate on this man instead of trying medical management first?"

    PLEASE update the damn post with an apology to the Canadian health system for making rational, evidence-based decisions instead fo giving in to your irrational, emotion-driven preference.

  161. 161
    r€nato says:

    I’m not interested in humiliating Michael D for being so obviously wrong, but I’d sure like to see him man up and admit that he might, at the very least, reconsider what he wrote.

    The evidence is abundant, overwhelmingly so, that Americans are ill-served by the current health care paradigm.

  162. 162
    jcricket says:

    as seen by the most recent post on this site, Andrew Sullivan’s moving the goal posts all around the field like one of those little electric football players trying to avoid admitting he’s ridiculously wrong about Britain’s medical care.

    If we simply spent the same amount per person we did now but implemented a private/public system like Switzerland, France or Australia has (assuming the extra money went to paying for doctors and public health initiatives, not just into big pharma’s latest "me too" drug’s profits) – we would have the best system in the world.

    We could not design a worse system if we tried. I take that back. McCain’s proposal would result in all the crappy stuff we have now, only more chaos, more expense and fewer regulations.

  163. 163
    Leisureguy says:

    What?!!! You mean to tell me that if we go to national single-payer healthcare for everyone, we might still have occasional problems in the delivery of health services?!! Man, with our current system, there are never any problems. Why we want to go to a system that provides medical coverage for everyone if there will be some problem somewhere? I support only those changes that solve all existing problems in the system without introducing new problems. Hang in there, Michael D.
    /irony

  164. 164
    Raconteur says:

    Let them die and process the meat. It could be just what our export sector needs.

  165. 165
    pm says:

    sad to hear about your father, michael. hope he’s improving day by day.

    this discussion is a bit short on facts regarding carotid endarterectomy (CEA) for secondary stroke prevention. i’m a neurology resident (in canada) and i’m happy to fill you in a bit.

    it makes intuitive sense that your father’s stroke "came from" the 69% atherosclerotic lesion in his carotid. there may be other, competing possibilities for a culprit lesion (source of the clot that went downstream and caused the stroke), but in the absence of detailed information, let’s blame the carotid for the time being.

    the next question is whether CEA would be of benefit in your father’s case in preventing a second stroke. as you know, CEA doesn’t do anything to fix the damage already done.

    the evidence regarding benefit from CEA is usually stratified for mild (the first question then about your father is how the degree of stenosis was defined. if he’s only had ultrasound ("dopplers") the diagnosis will be "50-69%" stenosis, not 69% as such. did he have CTA or MRA? if not, "69%" is probably not the real number. i’ve seen patients who had "50-69%" stenosis by doppler flow studies whose CTA showed much less disease (like, 18%, or 45%). in a few cases, ultrasound underestimates the degree of stenosis and a "50-69%" turns out to be 82% on CTA. but i think i’ve only seen that once — for various reasons ultrasound tends to overestimate, not underestimate, the problem. which makes it a very good screening test: it’s sensitive, even if not all that specific.

    but let’s stipulate that your father had CTA and the stenosis is accurately pegged at 69%. will CEA help him?

    the definitive study on CEA for moderate (50-69%) stenosis was the NASCET trial published in the new england journal in 1998. here is a link to the abstract for the NASCET trial: http://www.ncbi.nlm.nih.gov/pubmed/9811916 . you can see that the benefit of surgery versus medical therapy in this group was not impressive. at 5 years post-surgery, 15.7% of surgical patients had a second stroke on the same side of the brain as the artery that was operated on, compared to 22.2% who didn’t have surgery. the number needed to treat was 15 — for every 15 operations, one future stroke was prevented.

    those aren’t great odds. CEA is a somewhat risky surgery (not superscary but worth taking seriously). some patients are poor candidates for surgery because of heart disease or other medical problems. some carotid lesions are hard to reach with conventional surgical methods. and 15 people have to go through the whole operation and perioperative course with only one of them statistically likely to benefit. once you factor in the risks (not just the costs) of surgery, it’s a net no-win situation.

    so the standard of care is not to operate in cases of moderate (50-69%) symptomatic stenosis. that’s true wherever academic evidence-based medicine is practiced, and has nothing to do with canada or rationing or socialism and everything to do with good medical care.

    you might also want to know that NASCET and studies like it are aimed in part at reigning in surgeons who, once CEA techniques were popularized in the 80s and 90s, started operating on all sorts of carotid lesions, including mild stenoses, including in patients who hadn’t even had a stroke. as with you, it makes intuitive sense to patients and their families that this kind of surgery is going to "help", somehow. people are often willing to undergo surgery, and with all its pain and risk and inconvenience, for what we now know to be no real benefit. as you might guess, CEA is most over-performed in the US, the land of consumer-driven health care. surgeons get paid, patients and families feel well looked after (because surgery is a big deal, so it must "really help"), so everyone’s happy.

    it just doesn’t work, that’s the problem.

  166. 166
    pm says:

    (sorry, paragraph in the middle got eaten.)

    …the next question is whether CEA would be of benefit in your father’s case in preventing a second stroke. as you know, CEA doesn’t do anything to fix the damage already done.

    the evidence regarding benefit from CEA is usually stratified for mild (

  167. 167
    pm says:

    (seriously, can’t use a "less than" sign without breaking the comment? good thing i wrote this in notepad…)

    the evidence regarding benefit from CEA is usually stratified for mild (less than 50%), moderate (50-69%) or severe (70% or more but NOT completely occluded) stenosis. screening for carotid stenosis is done with doppler ultrasound, which shows faster velocities of bloodflow through the narrowed area of the artery (bernouilli’s principle in action). the range of flow velocities gives an estimate of the range of stenosis, according to those 3 broad categories, mild, moderate and severe. CT and MRI angiography give a more detailed look at the blood vessels and are used to give a specific degree of stenosis (65%, or 69%, or 72%, not "50-69%"). they are are gold standard tests, considered equivalent to each other and far superior to ultrasound. conventional angiography is the other gold standard but is rarely used because it’s invasive and carries its own risk of stroke.

    the first question then about your father is how the degree of stenosis was defined…

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