Towards a government-run health care system

It had occurred to me that if the government runs a cheaper insurance program than private companies, that most people will get the government plan. And that if the government will insure people who don’t have insurance, that private companies will stop providing that benefit to its employees. George Will has similar concerns:

The puzzle is: Why does the president, who says that were America “starting from scratch” he would favor a “single-payer” — government-run — system, insist that health-care reform include a government insurance plan that competes with private insurers? The simplest answer is that such a plan will lead to a single-payer system.

Conservatives say that a government program will have the intended consequence of crowding private insurers out of the market, encouraging employers to stop providing coverage and luring employees from private insurance to the cheaper government option.

Read the whole column. Will concludes by suggesting a way to get people medical insurance who are too poor to buy it themselves or do not have a job with medical benefits: Just give them the money to buy it. That would be far cheaper than overhauling the healthcare system for everyone.

About Gene Veith

Professor of Literature at Patrick Henry College, the Director of the Cranach Institute at Concordia Theological Seminary, a columnist for World Magazine and TableTalk, and the author of 18 books on different facets of Christianity & Culture.

  • http://www.newreformationpress.com Patrick Kyle

    Saw a youtube video of a congresswoman saying basically that the idea was to put private Health insurers out of business, to the cheers of a crowd.

  • http://www.newreformationpress.com Patrick Kyle

    Saw a youtube video of a congresswoman saying basically that the idea was to put private Health insurers out of business, to the cheers of a crowd.

  • Crypto-Lutheran

    You’re about five years away from full-blown, single-player, state-administered healthcare.
    See a report on state-run healthcare in Canada:

    “Most Canadians take government-funded health care for granted today, but when it was first introduced in Saskatchewan in 1962, most of the province’s doctors responded by going on strike to protest against “creeping socialism.”
    The strike lasted three weeks – public support for the doctors had collapsed, persuading the doctors to accept a deal with the government. Within five years, government-funded health care spread across the country.”

    The worst thing is that you will take what the state offers whether you like it or not. Still, reports also strongly suggest that Canadians are healthier and live longer than U.S. citizens, and their system costs less per capita than in the U.S. But the opportunity for abuse is rampant and the flood of well and expensively-trained doctors from Canada to the U.S. is truly mind-blowing.
    CL

  • Crypto-Lutheran

    You’re about five years away from full-blown, single-player, state-administered healthcare.
    See a report on state-run healthcare in Canada:

    “Most Canadians take government-funded health care for granted today, but when it was first introduced in Saskatchewan in 1962, most of the province’s doctors responded by going on strike to protest against “creeping socialism.”
    The strike lasted three weeks – public support for the doctors had collapsed, persuading the doctors to accept a deal with the government. Within five years, government-funded health care spread across the country.”

    The worst thing is that you will take what the state offers whether you like it or not. Still, reports also strongly suggest that Canadians are healthier and live longer than U.S. citizens, and their system costs less per capita than in the U.S. But the opportunity for abuse is rampant and the flood of well and expensively-trained doctors from Canada to the U.S. is truly mind-blowing.
    CL

  • Crypto-Lutheran

    You are about five years away from full-blown, single-player, state-administered healthcare.
    See a report on state-run healthcare in Canada:

    “Most Canadians take government-funded health care for granted today, but when it was first introduced in Saskatchewan in 1962, most of the province’s doctors responded by going on strike to protest against “creeping socialism.”
    The strike lasted three weeks – public support for the doctors had collapsed, persuading the doctors to accept a deal with the government. Within five years, government-funded health care spread across the country.”

    The worst thing is that you will take what the state offers whether you like it or not. Still, reports also strongly suggest that Canadians are healthier and live longer than U.S. citizens, and their system costs less per capita than in the U.S. But the opportunity for abuse is rampant and the flood of well and expensively-trained doctors from Canada to the U.S. is truly mind-blowing.
    CL

  • Crypto-Lutheran

    You are about five years away from full-blown, single-player, state-administered healthcare.
    See a report on state-run healthcare in Canada:

    “Most Canadians take government-funded health care for granted today, but when it was first introduced in Saskatchewan in 1962, most of the province’s doctors responded by going on strike to protest against “creeping socialism.”
    The strike lasted three weeks – public support for the doctors had collapsed, persuading the doctors to accept a deal with the government. Within five years, government-funded health care spread across the country.”

    The worst thing is that you will take what the state offers whether you like it or not. Still, reports also strongly suggest that Canadians are healthier and live longer than U.S. citizens, and their system costs less per capita than in the U.S. But the opportunity for abuse is rampant and the flood of well and expensively-trained doctors from Canada to the U.S. is truly mind-blowing.
    CL

  • http://www.pottersschool.org/MrSpotts Dave Spotts

    I wonder what kind of discussion might happen if we consider this from a “lesser of two evils” perspective. What about the many people who are uninsured and unable to afford health insurance? Is it better for them to remain uninsured because they do not consider it appropriate for their government to be the guarantor of health care? Is it better for them to accept government health care because of the possible positive effect if they should be come ill, a decidedly positive effect when compared to bankruptcy and long-term health and financial problems with which their family can (or cannot) deal?

  • http://www.pottersschool.org/MrSpotts Dave Spotts

    I wonder what kind of discussion might happen if we consider this from a “lesser of two evils” perspective. What about the many people who are uninsured and unable to afford health insurance? Is it better for them to remain uninsured because they do not consider it appropriate for their government to be the guarantor of health care? Is it better for them to accept government health care because of the possible positive effect if they should be come ill, a decidedly positive effect when compared to bankruptcy and long-term health and financial problems with which their family can (or cannot) deal?

  • Matt C.

    It seems to me that comprehensive insurance is the big problem in the health care system. It radically separates the cost of health care from its actual value.

    For example, I recently had a diagnostic procedure that cost $6000. The insurance paid for most of it. If i hadn’t had insurance, I would have asked for the price beforehand and ultimately declined the procedure–it just wasn’t that important. As it was, I never even asked. The procedure wasn’t worth that much money, and I am highly skeptical that it actually cost that much to perform (it took half an hour and did not involve sophisticated equipment).

    Another case: some people I know had to get a hospital bed for their home (they need it indefinitely–probably for a decade or more). Nothing fancy, just something that raises & lowers with rails on the side. Some rule in the system requires them to rent it–for about $500 dollars a month. Nobody would put up with that if insurance weren’t paying for it. Nobody would put up with absurdities like a $100 dose of aspirin in hospitals, or the $250,000 bill for a bed there for a couple weeks if they actually had to pay it themselves–and I’m crazy enough to think such things actually could be provided for less.

    Adding government insurance (which people assume to have bottomless pockets) will only exacerbate the problem. Putting the best construction on everything, though… Perhaps the government insurance WILL put all the others out of business. Then, when the government system falls apart (as it inevitably will) we’ll be left with a blank slate (after an extremely painful transitional period).

    We got here because employers started providing health insurance as a way to provide compensation that wasn’t subject to income tax. Unfortunately, we can’t just trace the same path back. Maybe the unintentional slash and burn that Obama is implementing will actually work out in the long-run.

  • Matt C.

    It seems to me that comprehensive insurance is the big problem in the health care system. It radically separates the cost of health care from its actual value.

    For example, I recently had a diagnostic procedure that cost $6000. The insurance paid for most of it. If i hadn’t had insurance, I would have asked for the price beforehand and ultimately declined the procedure–it just wasn’t that important. As it was, I never even asked. The procedure wasn’t worth that much money, and I am highly skeptical that it actually cost that much to perform (it took half an hour and did not involve sophisticated equipment).

    Another case: some people I know had to get a hospital bed for their home (they need it indefinitely–probably for a decade or more). Nothing fancy, just something that raises & lowers with rails on the side. Some rule in the system requires them to rent it–for about $500 dollars a month. Nobody would put up with that if insurance weren’t paying for it. Nobody would put up with absurdities like a $100 dose of aspirin in hospitals, or the $250,000 bill for a bed there for a couple weeks if they actually had to pay it themselves–and I’m crazy enough to think such things actually could be provided for less.

    Adding government insurance (which people assume to have bottomless pockets) will only exacerbate the problem. Putting the best construction on everything, though… Perhaps the government insurance WILL put all the others out of business. Then, when the government system falls apart (as it inevitably will) we’ll be left with a blank slate (after an extremely painful transitional period).

    We got here because employers started providing health insurance as a way to provide compensation that wasn’t subject to income tax. Unfortunately, we can’t just trace the same path back. Maybe the unintentional slash and burn that Obama is implementing will actually work out in the long-run.

  • Steve

    @Dave Spotts

    I see your point, but I do think that George Will’s solution would ultimately work for those uninsured–poor or otherwise–far better than a gov’t sponsored solution. It would force these uninsured people to take responsibility for their health insurance choices (which sounds okay to me), and it would certainly be cheaper in the long run. Perfect? No, it wouldn’t be. But in this situation, this may end up being the “lesser of two evils.”

    Bottom line, I’d trust individuals and families to make health insurance choices far more than I’d trust the self-serving federal government.

    Just my two cents.

  • Steve

    @Dave Spotts

    I see your point, but I do think that George Will’s solution would ultimately work for those uninsured–poor or otherwise–far better than a gov’t sponsored solution. It would force these uninsured people to take responsibility for their health insurance choices (which sounds okay to me), and it would certainly be cheaper in the long run. Perfect? No, it wouldn’t be. But in this situation, this may end up being the “lesser of two evils.”

    Bottom line, I’d trust individuals and families to make health insurance choices far more than I’d trust the self-serving federal government.

    Just my two cents.

  • http://www.hempelstudios.blogspot.com Sarah in Exile

    What about the self-employed, who end up paying two or three times as much as a person who is employed by a company. The insurance situation is a total disaster. The government adding to it will only help a segment of the population in the short term. For the long term, we need some serious think tanks to come up with an alternative solution. Something new. Something that doesn’t involve communism or health insurance.

  • http://www.hempelstudios.blogspot.com Sarah in Exile

    What about the self-employed, who end up paying two or three times as much as a person who is employed by a company. The insurance situation is a total disaster. The government adding to it will only help a segment of the population in the short term. For the long term, we need some serious think tanks to come up with an alternative solution. Something new. Something that doesn’t involve communism or health insurance.

  • DonS

    What will actually happen if government insurance is introduced into the market alongside existing private insurance is that poor health risks (older and sicker people) will gravitate toward the government plan, while young and healthy people will stick with the private plans, which will become much cheaper as risks decrease because of their healthy beneficiaries. This will cause an outcry in the politician community about the evil private companies making money at the expense of the government, and the private plans will ultimately be abolished.

  • DonS

    What will actually happen if government insurance is introduced into the market alongside existing private insurance is that poor health risks (older and sicker people) will gravitate toward the government plan, while young and healthy people will stick with the private plans, which will become much cheaper as risks decrease because of their healthy beneficiaries. This will cause an outcry in the politician community about the evil private companies making money at the expense of the government, and the private plans will ultimately be abolished.

  • DonS

    Matt C. is correct above concerning what is wrong with the system today, and hits on the head why more government insurance is not the answer. We are running MediCare into the ground, so why is expanding that program to more people going to work?

    This is what needs to happen to begin fixing our health care problem:

    1. Health insurance needs to be mandatory, to get healthy people into the pool of insured.

    2. We need to return to the concept of insurance being for major catastrophes. First dollar cadillac plans are stupid. Insurance plans should be major medical plans only, or, alternatively, high deductible plans coupled with a Health Spending Account (HSA), which are currently available and permit people to put pre-tax dollars aside to cover health costs. We have such a high deductible HSA insurance plan and we love it! Its premium is about half that of a normal low deductible/small copayment plan. After the deductible is reached ($3,000 for the family), the plan covers 100% of everything. Even before the deductible is reached, it covers certain well care expenses, to encourage preventative health care measures.

    3. The government needs to get out of the business of mandating certain coverages, like abortions, dental care, mental health care, etc.

    4. Health insurance premiums and deductibles can be fully or partially covered for those with demonstrated financial need.

    The key, of course, is to put the consumer back into the market, as Matt suggests above. Make the consumer aware of costs, and consider those costs before elective procedures are chosen. Health care is not a right, it is a privilege, keeping in mind, however, that emergency treatment to prevent serious injury or death is, of course, a moral imperative of civil society and of health care providers.

  • DonS

    Matt C. is correct above concerning what is wrong with the system today, and hits on the head why more government insurance is not the answer. We are running MediCare into the ground, so why is expanding that program to more people going to work?

    This is what needs to happen to begin fixing our health care problem:

    1. Health insurance needs to be mandatory, to get healthy people into the pool of insured.

    2. We need to return to the concept of insurance being for major catastrophes. First dollar cadillac plans are stupid. Insurance plans should be major medical plans only, or, alternatively, high deductible plans coupled with a Health Spending Account (HSA), which are currently available and permit people to put pre-tax dollars aside to cover health costs. We have such a high deductible HSA insurance plan and we love it! Its premium is about half that of a normal low deductible/small copayment plan. After the deductible is reached ($3,000 for the family), the plan covers 100% of everything. Even before the deductible is reached, it covers certain well care expenses, to encourage preventative health care measures.

    3. The government needs to get out of the business of mandating certain coverages, like abortions, dental care, mental health care, etc.

    4. Health insurance premiums and deductibles can be fully or partially covered for those with demonstrated financial need.

    The key, of course, is to put the consumer back into the market, as Matt suggests above. Make the consumer aware of costs, and consider those costs before elective procedures are chosen. Health care is not a right, it is a privilege, keeping in mind, however, that emergency treatment to prevent serious injury or death is, of course, a moral imperative of civil society and of health care providers.

  • Crypto-Lutheran

    Socialized healthcare began in Canada in 1962 in one province: Saskatchewan. Doctors went on strike there for three weeks to protest the “creeping socialism” but capitulated due to media and political pressure. Within five years, socialized healthcare spread throughout the country. Whatever your opinion may be, it seems a fine balanced line of “semi-socialized-for-some” will be very hard to maintain and you are probably headed for a Canadian styled system.
    That being said, reports also say that Canadians are typically healthier, live longer and the cost per capita of universal healthcare is actually lower in Canada than in the U.S. but the studies did not necessarily take demographics into account.
    I would be inclined to oppose universal, single-payer healthcare.
    CL

  • Crypto-Lutheran

    Socialized healthcare began in Canada in 1962 in one province: Saskatchewan. Doctors went on strike there for three weeks to protest the “creeping socialism” but capitulated due to media and political pressure. Within five years, socialized healthcare spread throughout the country. Whatever your opinion may be, it seems a fine balanced line of “semi-socialized-for-some” will be very hard to maintain and you are probably headed for a Canadian styled system.
    That being said, reports also say that Canadians are typically healthier, live longer and the cost per capita of universal healthcare is actually lower in Canada than in the U.S. but the studies did not necessarily take demographics into account.
    I would be inclined to oppose universal, single-payer healthcare.
    CL

  • womanofthehouse

    Here’s my family’s current situation. I offer it as a real world example.

    My husband and I are self-employed, so we do not have health insurance through work. When we first became self-employed in 2001, we bought private health insurance for us and our two children at $350/mo. It was a catastrophic plan with a $10,000 deductible and no coverage for anything unless it involved hospitalization~~no maternity (if I’m remembering correctly). So we paid ALL our own medical bills (thank the Lord we were never seriously ill or injured) and we paid monthly premiums. Over the course of the next couple years, our premium was raised periodically until it reached the $600/mo. mark. At that point we could no longer afford to pay the premium AND keep paying our own medical bills, so we dropped the insurance. We had no choice. We NEVER received any payment of any sort from our insurance. Now we set aside money each month for medical expenses, and so far, everything has been all right except that I had to have a $7000 medical procedure last winter that we are now making payments on. But even if we had kept our insurance, it wouldn’t have paid anything because we hadn’t met the deductible. And I shudder to think what the premiums would be now!

    So if this government plan goes through, would it be better for us to sign up for it or to continue as we are? If we have a major medical expense, we would be sunk financially. (My husband and I are middle-aged.) Would it be better for us to rely on the government or to rely on friends and family for whatever help they could give, which would probably not be enough? Is it irresponsible for us to presume upon their generosity? How would they feel helping us out when there is a government plan available that we didn’t take advantage of?

    Let me make it clear that we are not in favor of any form of government involvement in health care (or most other areas of life for that matter). So do we stick by our guns and refuse to enroll in the government health care and thereby keep the risk of bankruptcy (remember, we have two kids) and presume on our friends and family, or do we take the opportunity that may arise to sign up for the government plan?

    We’ve been living by faith regarding this issue, and we want to continue to do so, but now the situation may be changing, and we are thinking through how to respond. Any thoughts?

    Thanks for bearing with me.

    Womanofthehouse

  • womanofthehouse

    Here’s my family’s current situation. I offer it as a real world example.

    My husband and I are self-employed, so we do not have health insurance through work. When we first became self-employed in 2001, we bought private health insurance for us and our two children at $350/mo. It was a catastrophic plan with a $10,000 deductible and no coverage for anything unless it involved hospitalization~~no maternity (if I’m remembering correctly). So we paid ALL our own medical bills (thank the Lord we were never seriously ill or injured) and we paid monthly premiums. Over the course of the next couple years, our premium was raised periodically until it reached the $600/mo. mark. At that point we could no longer afford to pay the premium AND keep paying our own medical bills, so we dropped the insurance. We had no choice. We NEVER received any payment of any sort from our insurance. Now we set aside money each month for medical expenses, and so far, everything has been all right except that I had to have a $7000 medical procedure last winter that we are now making payments on. But even if we had kept our insurance, it wouldn’t have paid anything because we hadn’t met the deductible. And I shudder to think what the premiums would be now!

    So if this government plan goes through, would it be better for us to sign up for it or to continue as we are? If we have a major medical expense, we would be sunk financially. (My husband and I are middle-aged.) Would it be better for us to rely on the government or to rely on friends and family for whatever help they could give, which would probably not be enough? Is it irresponsible for us to presume upon their generosity? How would they feel helping us out when there is a government plan available that we didn’t take advantage of?

    Let me make it clear that we are not in favor of any form of government involvement in health care (or most other areas of life for that matter). So do we stick by our guns and refuse to enroll in the government health care and thereby keep the risk of bankruptcy (remember, we have two kids) and presume on our friends and family, or do we take the opportunity that may arise to sign up for the government plan?

    We’ve been living by faith regarding this issue, and we want to continue to do so, but now the situation may be changing, and we are thinking through how to respond. Any thoughts?

    Thanks for bearing with me.

    Womanofthehouse

  • Just Me

    DonS (#7)

    You said, “1. Health insurance needs to be mandatory”

    Then you stated, “The government needs to get out of the business of mandating certain coverages”

    So if they don’t mandate any coverages how could they mandate any insurance?

    I am a free market guy, let’s get government get out of health care and watch prices drop and care improve.

  • Just Me

    DonS (#7)

    You said, “1. Health insurance needs to be mandatory”

    Then you stated, “The government needs to get out of the business of mandating certain coverages”

    So if they don’t mandate any coverages how could they mandate any insurance?

    I am a free market guy, let’s get government get out of health care and watch prices drop and care improve.

  • DonS

    WomanoftheHouse@8:

    I certainly sympathize with your plight.

    We live in a fallen world. There is the world as we would like it to be and the world that is. If, in the world that is, there is offered a government health plan which better provided for your family then available private plans, by all means sign up for it.

  • DonS

    WomanoftheHouse@8:

    I certainly sympathize with your plight.

    We live in a fallen world. There is the world as we would like it to be and the world that is. If, in the world that is, there is offered a government health plan which better provided for your family then available private plans, by all means sign up for it.

  • DonS

    JustMe @ 9:

    Good point. I am also a free market guy and completely agree with you, in general.

    When I say health insurance needs to be mandatory, I mean major medical coverage — a bare bones plan that covers you for large in-hospital/emergency room procedures that are urgent in nature. So it is a different question than the issue of mandating a lot of extra coverage, as government has become habituated to, like abortion, maternity, drug rehab, Viagra (I’m not kidding — mandatory in a number of states), dental care, and the like. The reason why health insurance needs to be mandatory is to address the vexing problem of “guaranteed issue”. The one major problem we have with health insurance today is that many people who need it, because of a pre-existing health condition, can’t get it. Insurance companies have committed to guaranteed issue policies if health insurance is mandatory, so that the healthy people are in the insured pool. Bottom line is that we are in a society which is not going to permit providers to deny urgent medical care to anyone, so we need these folks to be covered. The problems WomanoftheHouse discusses above are largely related to the issue of care for the uninsured. Many emergency rooms have closed over this problem, and the cost of health care is so high because providers are forced to average the costs the uninsured don’t pay over the charges to the rest of us.

  • DonS

    JustMe @ 9:

    Good point. I am also a free market guy and completely agree with you, in general.

    When I say health insurance needs to be mandatory, I mean major medical coverage — a bare bones plan that covers you for large in-hospital/emergency room procedures that are urgent in nature. So it is a different question than the issue of mandating a lot of extra coverage, as government has become habituated to, like abortion, maternity, drug rehab, Viagra (I’m not kidding — mandatory in a number of states), dental care, and the like. The reason why health insurance needs to be mandatory is to address the vexing problem of “guaranteed issue”. The one major problem we have with health insurance today is that many people who need it, because of a pre-existing health condition, can’t get it. Insurance companies have committed to guaranteed issue policies if health insurance is mandatory, so that the healthy people are in the insured pool. Bottom line is that we are in a society which is not going to permit providers to deny urgent medical care to anyone, so we need these folks to be covered. The problems WomanoftheHouse discusses above are largely related to the issue of care for the uninsured. Many emergency rooms have closed over this problem, and the cost of health care is so high because providers are forced to average the costs the uninsured don’t pay over the charges to the rest of us.

  • DonS

    JustMe @ 9:

    I posted a response to your comment about an hour ago, but it is apparently stuck in moderation. It will, presumably, eventually appear. :-)

  • DonS

    JustMe @ 9:

    I posted a response to your comment about an hour ago, but it is apparently stuck in moderation. It will, presumably, eventually appear. :-)

  • Peter Leavitt

    Obama and his socialist buddies were rocked last week when the Congressional Budget Office estimated that the proposed health-care plan would cost the federal fisc negative $1.6 trillion over the next ten years. This, along with the $60triilion unfunded liability of the other major entitlements, has begun to penetrate the foggy illusions of these Beltway utopians.

  • Peter Leavitt

    Obama and his socialist buddies were rocked last week when the Congressional Budget Office estimated that the proposed health-care plan would cost the federal fisc negative $1.6 trillion over the next ten years. This, along with the $60triilion unfunded liability of the other major entitlements, has begun to penetrate the foggy illusions of these Beltway utopians.

  • Rose

    Matt C,
    Your procedure cost $6000 because it is priced to shift costs from the uninsured to you, or in this case, your insurer.

  • Rose

    Matt C,
    Your procedure cost $6000 because it is priced to shift costs from the uninsured to you, or in this case, your insurer.

  • Peter Leavitt

    I, also, posted a comment that is apparently lost in moderation. Frustrating.

  • Peter Leavitt

    I, also, posted a comment that is apparently lost in moderation. Frustrating.

  • gluadys

    As a Canadian who remembers what it was like to be without a universal health-care funding system, I am always intrigued by American discussions on the issue.

    Gene says: “if the government will insure people who don’t have insurance, … private companies will stop providing that benefit to its employees.”

    I don’t know the specifics of Obama’s plan, but in Canada, private insurers are not allowed to offer insurance for what is included in the government plan. They can and do offer insurance for what the government plan does not cover–principally prescriptions and dental care, but also many other procedures and services. In my province, medicare was at first paid for through premiums. Private companies often paid all or part of their employees premiums and provided a private insurance plan as well. Under current law employers pay a tax contribution toward government insurance and premiums have been eliminated. My employer also provided additional coverage through a private insurance company.

    Matt C. says “Adding government insurance (which people assume to have bottomless pockets) will only exacerbate the problem [of separating cost of health care from its value].

    If it is run strictly as an insurance program, I think you are right. This may be a reason why our system was changed from one of premiums to a tax-funded one. The need to keep taxes reasonably low is one tool to discourage lax use of the system. Far from perfect though.

    DonS says “What will actually happen if government insurance is introduced into the market alongside existing private insurance is that poor health risks (older and sicker people) will gravitate toward the government plan, while young and healthy people will stick with the private plans, …”

    Bang on. That is the basic reason private companies in Canada are not permitted to insure what the government already insures. Without that precaution, private companies can skim off the cream of young healthy people who are the least expensive to insure while the government (and the taxpayers) get stuck with the more expensive demographic. Much as private schools can cater to the students of their choice while government schools must take everybody. Naturally the private system looks a lot more attractive to those who can afford it.

    DonS again: “The government needs to get out of the business of mandating certain coverages, like abortions, dental care, mental health care, etc.”

    The Canadian plan mandates all necessary health care provided by a doctor. (Not, unfortunately, by dentists or pharmacists). Since mental health care and abortions are provided by doctors and are deemed medically necessary, they are covered. Some people might question whether abortions are medically necessary, but I don’t see that applying to mental health care. Surely it is anachronistic to see mental health care as some sort of frill. Depression is just as much a health problem as cancer.

    DonS: “Health care is not a right, it is a privilege,”

    Access to health care is a defined human right and recognized as such in most jurisdictions. It is included in the UN Covenant on Social and Economic Rights and in many national human rights legislative instruments. In these jurisdictions, it is considered to be just as much a human right as education or the right to vote.

    I am not surprised that many people are unaware of their rights, as few school curricula teach much about them.

  • gluadys

    As a Canadian who remembers what it was like to be without a universal health-care funding system, I am always intrigued by American discussions on the issue.

    Gene says: “if the government will insure people who don’t have insurance, … private companies will stop providing that benefit to its employees.”

    I don’t know the specifics of Obama’s plan, but in Canada, private insurers are not allowed to offer insurance for what is included in the government plan. They can and do offer insurance for what the government plan does not cover–principally prescriptions and dental care, but also many other procedures and services. In my province, medicare was at first paid for through premiums. Private companies often paid all or part of their employees premiums and provided a private insurance plan as well. Under current law employers pay a tax contribution toward government insurance and premiums have been eliminated. My employer also provided additional coverage through a private insurance company.

    Matt C. says “Adding government insurance (which people assume to have bottomless pockets) will only exacerbate the problem [of separating cost of health care from its value].

    If it is run strictly as an insurance program, I think you are right. This may be a reason why our system was changed from one of premiums to a tax-funded one. The need to keep taxes reasonably low is one tool to discourage lax use of the system. Far from perfect though.

    DonS says “What will actually happen if government insurance is introduced into the market alongside existing private insurance is that poor health risks (older and sicker people) will gravitate toward the government plan, while young and healthy people will stick with the private plans, …”

    Bang on. That is the basic reason private companies in Canada are not permitted to insure what the government already insures. Without that precaution, private companies can skim off the cream of young healthy people who are the least expensive to insure while the government (and the taxpayers) get stuck with the more expensive demographic. Much as private schools can cater to the students of their choice while government schools must take everybody. Naturally the private system looks a lot more attractive to those who can afford it.

    DonS again: “The government needs to get out of the business of mandating certain coverages, like abortions, dental care, mental health care, etc.”

    The Canadian plan mandates all necessary health care provided by a doctor. (Not, unfortunately, by dentists or pharmacists). Since mental health care and abortions are provided by doctors and are deemed medically necessary, they are covered. Some people might question whether abortions are medically necessary, but I don’t see that applying to mental health care. Surely it is anachronistic to see mental health care as some sort of frill. Depression is just as much a health problem as cancer.

    DonS: “Health care is not a right, it is a privilege,”

    Access to health care is a defined human right and recognized as such in most jurisdictions. It is included in the UN Covenant on Social and Economic Rights and in many national human rights legislative instruments. In these jurisdictions, it is considered to be just as much a human right as education or the right to vote.

    I am not surprised that many people are unaware of their rights, as few school curricula teach much about them.

  • wayne pelling

    We Australians have had the current American health system held up as a complete disaster.
    We have Medicare-where the basic medical and hospital fees are covered out of taxation and people then pay for private health insurance from a company of their choice,to cover private hospital ,dental and optical expenses. Those who have no health insurance are covered by the medicare fund,but if their salary is over a certain amount they have to pay a bit extra in tax. those of us who have private insurance get 30% rebate but thanks to our Labor Government that is soon to go. It was the conservative Howard Government which brought in the private health rebate as incentive for people to get off public hospital waiting lists,which are a disaster as public hospitals are run by the States. There would be better co-ordination perhaps if the Feds managed the hospitals,after all they fund them but an even better component would be if private hospitals were funded to accomodate public hospital waiting lists.
    As for HMO’s they are an anathema as far as Australians are concerned. We have a different outlook to Americans ,as we see Health care as essential ,but our indigenous people and people with intellectual disabilities are still living less than the rest of the population
    I am speaking as a nurse who currently works for an aged care and disability service provider

  • wayne pelling

    We Australians have had the current American health system held up as a complete disaster.
    We have Medicare-where the basic medical and hospital fees are covered out of taxation and people then pay for private health insurance from a company of their choice,to cover private hospital ,dental and optical expenses. Those who have no health insurance are covered by the medicare fund,but if their salary is over a certain amount they have to pay a bit extra in tax. those of us who have private insurance get 30% rebate but thanks to our Labor Government that is soon to go. It was the conservative Howard Government which brought in the private health rebate as incentive for people to get off public hospital waiting lists,which are a disaster as public hospitals are run by the States. There would be better co-ordination perhaps if the Feds managed the hospitals,after all they fund them but an even better component would be if private hospitals were funded to accomodate public hospital waiting lists.
    As for HMO’s they are an anathema as far as Australians are concerned. We have a different outlook to Americans ,as we see Health care as essential ,but our indigenous people and people with intellectual disabilities are still living less than the rest of the population
    I am speaking as a nurse who currently works for an aged care and disability service provider

  • Don S

    gluadys @ 19: Thank you for your comment.

    Health care is not yet a defined right in the U.S., nor should it be. Of course, there is a moral imperative on society to provide emergency medical care in the event of serious illness or injury, but you don’t have the right to routine health care or elective procedures. The last thing we need to impose on the taxpayer is another entitlement. And where does it stop in the field of health care?

    Regarding Canadian care, what do you think about the inevitable rationing, and the long waits for service? The last thing I want to see is government bureaucrats determining when, whether, and where I can have a procedure, with no private alternative.

  • Don S

    gluadys @ 19: Thank you for your comment.

    Health care is not yet a defined right in the U.S., nor should it be. Of course, there is a moral imperative on society to provide emergency medical care in the event of serious illness or injury, but you don’t have the right to routine health care or elective procedures. The last thing we need to impose on the taxpayer is another entitlement. And where does it stop in the field of health care?

    Regarding Canadian care, what do you think about the inevitable rationing, and the long waits for service? The last thing I want to see is government bureaucrats determining when, whether, and where I can have a procedure, with no private alternative.

  • david in norcal

    how do they provide health care that people rate highly for less money in other countries? i would like you to compare your suggestion to what they do successfully in some countries and see which is cheaper.

  • david in norcal

    how do they provide health care that people rate highly for less money in other countries? i would like you to compare your suggestion to what they do successfully in some countries and see which is cheaper.

  • Crypto-Lutheran

    Don S. at #21: thank-you. Cue-jumping is rampant up here. Canadian Silver-spoon socialists, who define their national identity by their nationalized healthcare beliefs, will routinely jump the cue to save their own lives. Case in point: family doctors routinely get family members up to the front of the line. And the richest Canadians go to the U.S. and pay directly for services.
    The notion that Canadians will want “to keep taxes reasonably low is one tool to discourage lax use of the system” is ludicrous. In my city there 50,000 people without a family doctor (remember the goal of the statist healthcare system is to keep people away to reduce costs – Hmmmmm). So folks bring in their “sick” kids (“I swear she’s dyin’”) to emerg where they wait 8 hours for triage, have the kid treated for minor sniffles and off go the bleary eyed parents at 3am, having cost the system about $1800. It’s beyond stupidity. I’m very thankful that I and my children are healthy because there are some problems I definitely don’t want to have.
    CL

  • Crypto-Lutheran

    Don S. at #21: thank-you. Cue-jumping is rampant up here. Canadian Silver-spoon socialists, who define their national identity by their nationalized healthcare beliefs, will routinely jump the cue to save their own lives. Case in point: family doctors routinely get family members up to the front of the line. And the richest Canadians go to the U.S. and pay directly for services.
    The notion that Canadians will want “to keep taxes reasonably low is one tool to discourage lax use of the system” is ludicrous. In my city there 50,000 people without a family doctor (remember the goal of the statist healthcare system is to keep people away to reduce costs – Hmmmmm). So folks bring in their “sick” kids (“I swear she’s dyin’”) to emerg where they wait 8 hours for triage, have the kid treated for minor sniffles and off go the bleary eyed parents at 3am, having cost the system about $1800. It’s beyond stupidity. I’m very thankful that I and my children are healthy because there are some problems I definitely don’t want to have.
    CL

  • Crypto-Lutheran

    Veith: What’s going on with the moderation?

  • Crypto-Lutheran

    Veith: What’s going on with the moderation?

  • http://www.geneveith.com Veith

    I don’t know! I had blamed the earlier problems on that turbo discussion overlay, whatever it was called, but I don’t have anything like that. Some comments, even those without links or bad words, are going right to SPAM. I’m checking and approving the ones I find, but I can’t always do that promptly. That’s because I can’t monitor this blog continually, seeing as how I have a day job. I’m doing the best I can. Has anyone had similar problems with WordPress or know of a fix?

  • http://www.geneveith.com Veith

    I don’t know! I had blamed the earlier problems on that turbo discussion overlay, whatever it was called, but I don’t have anything like that. Some comments, even those without links or bad words, are going right to SPAM. I’m checking and approving the ones I find, but I can’t always do that promptly. That’s because I can’t monitor this blog continually, seeing as how I have a day job. I’m doing the best I can. Has anyone had similar problems with WordPress or know of a fix?

  • DonS

    Dr. Veith, I think that day job is going to have to go! :-)

  • DonS

    Dr. Veith, I think that day job is going to have to go! :-)

  • gluadys

    DonS@21 “Regarding Canadian care, what do you think about the inevitable rationing, and the long waits for service? The last thing I want to see is government bureaucrats determining when, whether, and where I can have a procedure, with no private alternative.”

    There was enough public discontent over wait times that governments were forced to take action and they have been significantly reduced in all provinces. It’s a matter of demanding efficiency and sharing best practices.

    Also, contrary to what most people see as intuitive, adding private institutions to the range of options increases rather than lowers the wait times in public institutions. The key factor is not so much the number of clinics available as the number of doctors available. What happens is that doctors will divide their time between one institution and another. Since there are only so many hours in a day, the time a doctor spends in a private clinic are hours not available to those waiting for service in a public hospital or clinic. Those who can afford the private clinic get to jump the queue and get quick service. But those who cannot are left waiting longer and longer as doctors devote less time to them. It stands to reason that a doctor can see more people in eight hours than in four. So people in the public waiting room who might have been seen on Tuesday don’t get in until Wednesday or later, because the doctor has gone over to the private clinic on Tuesday afternoon.

    Of course, there are many other options for reducing wait times. A key problem with the Canadian system is that it is geared to in hospital care and care by doctors. Significant savings in time and money would flow from covering more preventive care, more at-home care, and providing for minor health ailments to be treated by nurse-practitioners instead of doctors. Only the province of Quebec has a significant network of one-stop community care clinics which are efficient and inexpensive.

    Rationing is inevitable, but is also a function of how much is invested into needed equipment & training. The more CT scanners there are in the province (and the more people trained to use them), the less rationing is necessary for that service. It is really no different than a private system in that respect. You get what you (can) pay for.

    I have no problem with private services as long as they are truly private. All bills go to the patient, neither the doctor nor the hospital is allowed to use the government as a collection agent and the patient gets no reimbursement from the government.

    What I don’t like are hybrid institutions (such as P3s) that divert public funds to private use. It’s more expensive all round as tax funds are paying for profit as well as treatment and the assets do not accrue to the government in spite of its investment in the project.

    Many studies have shown that parallel systems can be much more expensive, especially when doctors work both sides of the field. A study on eye surgery in Alberta not long ago found that the quickest and least expensive service was provided in a community which had no private alternatives. The most expensive was in a community well-supplied with private alternatives. This community also chalked up the longest wait times. A significant factor was that doctors attempting to maintain the profitability of a private clinic steered patients preferentially to them, and also to medical options which were more expensive and in some cases unnecessary.

  • gluadys

    DonS@21 “Regarding Canadian care, what do you think about the inevitable rationing, and the long waits for service? The last thing I want to see is government bureaucrats determining when, whether, and where I can have a procedure, with no private alternative.”

    There was enough public discontent over wait times that governments were forced to take action and they have been significantly reduced in all provinces. It’s a matter of demanding efficiency and sharing best practices.

    Also, contrary to what most people see as intuitive, adding private institutions to the range of options increases rather than lowers the wait times in public institutions. The key factor is not so much the number of clinics available as the number of doctors available. What happens is that doctors will divide their time between one institution and another. Since there are only so many hours in a day, the time a doctor spends in a private clinic are hours not available to those waiting for service in a public hospital or clinic. Those who can afford the private clinic get to jump the queue and get quick service. But those who cannot are left waiting longer and longer as doctors devote less time to them. It stands to reason that a doctor can see more people in eight hours than in four. So people in the public waiting room who might have been seen on Tuesday don’t get in until Wednesday or later, because the doctor has gone over to the private clinic on Tuesday afternoon.

    Of course, there are many other options for reducing wait times. A key problem with the Canadian system is that it is geared to in hospital care and care by doctors. Significant savings in time and money would flow from covering more preventive care, more at-home care, and providing for minor health ailments to be treated by nurse-practitioners instead of doctors. Only the province of Quebec has a significant network of one-stop community care clinics which are efficient and inexpensive.

    Rationing is inevitable, but is also a function of how much is invested into needed equipment & training. The more CT scanners there are in the province (and the more people trained to use them), the less rationing is necessary for that service. It is really no different than a private system in that respect. You get what you (can) pay for.

    I have no problem with private services as long as they are truly private. All bills go to the patient, neither the doctor nor the hospital is allowed to use the government as a collection agent and the patient gets no reimbursement from the government.

    What I don’t like are hybrid institutions (such as P3s) that divert public funds to private use. It’s more expensive all round as tax funds are paying for profit as well as treatment and the assets do not accrue to the government in spite of its investment in the project.

    Many studies have shown that parallel systems can be much more expensive, especially when doctors work both sides of the field. A study on eye surgery in Alberta not long ago found that the quickest and least expensive service was provided in a community which had no private alternatives. The most expensive was in a community well-supplied with private alternatives. This community also chalked up the longest wait times. A significant factor was that doctors attempting to maintain the profitability of a private clinic steered patients preferentially to them, and also to medical options which were more expensive and in some cases unnecessary.

  • gluadys

    david in norcal@22 said:

    “how do they provide health care that people rate highly for less money in other countries? i would like you to compare your suggestion to what they do successfully in some countries and see which is cheaper.”

    There are big savings to be had in administration. There are so many different private plans each with their own peculiarities that doctors and hospitals need a fairly large administrative staff to handle them.

    With a one-payer system the administration is streamlined. Most of the difference in health care costs between Canada and the US comes down to savings in administration. Here 2 secretaries can handle what may take the time of a dozen or more staff in a US hospital.

    Another saving is made in bulk buying. A government can purchase in sufficient volume to command significant discounts. The government of Ontario is able to realize savings of this sort on the drugs purchased for in hospital use.

    A third saving is widespread use of generic drugs where available.

  • gluadys

    david in norcal@22 said:

    “how do they provide health care that people rate highly for less money in other countries? i would like you to compare your suggestion to what they do successfully in some countries and see which is cheaper.”

    There are big savings to be had in administration. There are so many different private plans each with their own peculiarities that doctors and hospitals need a fairly large administrative staff to handle them.

    With a one-payer system the administration is streamlined. Most of the difference in health care costs between Canada and the US comes down to savings in administration. Here 2 secretaries can handle what may take the time of a dozen or more staff in a US hospital.

    Another saving is made in bulk buying. A government can purchase in sufficient volume to command significant discounts. The government of Ontario is able to realize savings of this sort on the drugs purchased for in hospital use.

    A third saving is widespread use of generic drugs where available.

  • DonS

    Yes, gluadys, I know that when we demand better service at the DMV and the Post Office, it works wonders!

    I’m sorry, but I’m just too individualistic and liberty loving to want to cede my health care to the bureaucracy. I will never view the sclerotic public bureaucracy, with its militant unionism, lavish pensions, and early retirement age, as “efficient”. I worked in the U.S. federal bureaucracy for eight years — most federal employees have long since ceased to care. The system dehumanizes them, and the citizens they are supposed to serve. They feel an entitlement to their jobs, and come to view the citizens as servants, losing all sense of the notion of “public servant”. Moreover, anything a government does is necessarily coercive. In other words, freedom-sapping. We have a situation here in California right now where people are turning in their leased cars and getting dinged for failure to pay parking tickets and tolls a year or more later. Turns out it is a “glitch” in the DMV software. But, thank goodness, the good people at the DMV think they can get it worked out by no later than 2011!!!! In the meantime, the suckers pretty much have to pay the fines or spend days in court resolving these problems themselves.

    I agree with you about parallel systems. I think MediCare and MediCaid should be dismantled as failed programs which have ruined our world class health care system. Their functions should be privatized. I have posted on previous threads about ways of simplifying and privatizing our system to maximize freedom and competition, ensure care for those in need, and ensure accoutability for costs to those using the system, so they don’t abuse it.

    You Canadians should be careful what you wish for. If we in the U.S. follow your lead into government health care, you will have no place to go when you really need timely care.

  • DonS

    Yes, gluadys, I know that when we demand better service at the DMV and the Post Office, it works wonders!

    I’m sorry, but I’m just too individualistic and liberty loving to want to cede my health care to the bureaucracy. I will never view the sclerotic public bureaucracy, with its militant unionism, lavish pensions, and early retirement age, as “efficient”. I worked in the U.S. federal bureaucracy for eight years — most federal employees have long since ceased to care. The system dehumanizes them, and the citizens they are supposed to serve. They feel an entitlement to their jobs, and come to view the citizens as servants, losing all sense of the notion of “public servant”. Moreover, anything a government does is necessarily coercive. In other words, freedom-sapping. We have a situation here in California right now where people are turning in their leased cars and getting dinged for failure to pay parking tickets and tolls a year or more later. Turns out it is a “glitch” in the DMV software. But, thank goodness, the good people at the DMV think they can get it worked out by no later than 2011!!!! In the meantime, the suckers pretty much have to pay the fines or spend days in court resolving these problems themselves.

    I agree with you about parallel systems. I think MediCare and MediCaid should be dismantled as failed programs which have ruined our world class health care system. Their functions should be privatized. I have posted on previous threads about ways of simplifying and privatizing our system to maximize freedom and competition, ensure care for those in need, and ensure accoutability for costs to those using the system, so they don’t abuse it.

    You Canadians should be careful what you wish for. If we in the U.S. follow your lead into government health care, you will have no place to go when you really need timely care.

  • gluadys

    Crypto-Lutheran @23 said:
    ” So folks bring in their “sick” kids (”I swear she’s dyin’”) to emerg where they wait 8 hours for triage, have the kid treated for minor sniffles and off go the bleary eyed parents at 3am, having cost the system about $1800. It’s beyond stupidity.”

    Yes, it is beyond stupidity–and it happens in the US too, where the only option for getting care is often the emergency room.

    The stupidity is in not providing a better alternative. We have only about 30 community care centres in the whole province of Ontario. Why is there not one in every community?

    At least the government has started a good 24-hour phone-service for medical advice. That can take care of a lot of the minor sniffles problems without a trip to the emergency room. A step in the right direction.

  • gluadys

    Crypto-Lutheran @23 said:
    ” So folks bring in their “sick” kids (”I swear she’s dyin’”) to emerg where they wait 8 hours for triage, have the kid treated for minor sniffles and off go the bleary eyed parents at 3am, having cost the system about $1800. It’s beyond stupidity.”

    Yes, it is beyond stupidity–and it happens in the US too, where the only option for getting care is often the emergency room.

    The stupidity is in not providing a better alternative. We have only about 30 community care centres in the whole province of Ontario. Why is there not one in every community?

    At least the government has started a good 24-hour phone-service for medical advice. That can take care of a lot of the minor sniffles problems without a trip to the emergency room. A step in the right direction.

  • Crypto-Lutheran

    Yes, Canadian healthcare over the phone. First class all the way. Every statement by the “Phone Nurse” is followed by the caveat “but if you’re still nervous, please go to your fam. doctor or emerg.”
    The biggest problem with our system is that use=cost. The goal then of the gov’t is to reduce use. A great example is the NDP (socialist) Ontario gov’t of the 90s. Our fearless premier Bob Ray did something totally brilliant to reduce healthcare costs: he reduced enrollment at medical schools. We’re still paying for that decision in very real ways. I mentioned the 50,000 people in a southern Ontario city without a family doctor. Diagnosis of serious diseases just can’t happen effectively. Numerous drugs (Cancer drugs are in the news a lot lately) must go through years of testing when they are widely available in the U.S. and elsewhere.

    “Nuf said. Gluadys, you sound like a civil servant! You talk like all my RPN sisters (whom I love): arbitrary and self-perpetuating.
    CL

  • Crypto-Lutheran

    Yes, Canadian healthcare over the phone. First class all the way. Every statement by the “Phone Nurse” is followed by the caveat “but if you’re still nervous, please go to your fam. doctor or emerg.”
    The biggest problem with our system is that use=cost. The goal then of the gov’t is to reduce use. A great example is the NDP (socialist) Ontario gov’t of the 90s. Our fearless premier Bob Ray did something totally brilliant to reduce healthcare costs: he reduced enrollment at medical schools. We’re still paying for that decision in very real ways. I mentioned the 50,000 people in a southern Ontario city without a family doctor. Diagnosis of serious diseases just can’t happen effectively. Numerous drugs (Cancer drugs are in the news a lot lately) must go through years of testing when they are widely available in the U.S. and elsewhere.

    “Nuf said. Gluadys, you sound like a civil servant! You talk like all my RPN sisters (whom I love): arbitrary and self-perpetuating.
    CL

  • Crypto-Lutheran

    OK. My last post missed again.

    Another senseless thing: Our Premier (that’s a Canadian “State Governor”) in Ontario levied a $900 “premium” onto the average (i.e. middle-class) Ontarian’s income tax 2 years ago. You get that? The Premier, wielding a state monopoly, when there is no choice for payer or provider, has the audacity to force me, against my will, to pay a $900/per annum premium for a provincial service in which there is no private choice. I don’t care what the service is, quite frankly, that’s statism at its worst. Ontario healthcare is beholden to unions, and believe me, there are people cheating the system, cheating within the system, and dying because of it. Studies of Quebec hospitals have shown that the cleaning staff moves in and out of rooms and between floors with the same mops and mop water which was and is a major contributing factor to the rampant spread of the “C Difficile” bacterium in that province’s hospitals. Can you spell “superbug”? And, contrary to hyped up liberalspeak, Cdn. healthcare is not equally accessible to all: Native Canadians live in communities where there is filthy squalor in the hospitals. It is a well-known fact that the Natives receive subpar healthcare, despite its “universality” in northern communities. Like in all banana republics, the most important thing in the end is not what you know (skill and intelligence) but whom you know (cronyism and thuggery) that will get you ahead – in this case – get you some healthcare.
    CL

  • Crypto-Lutheran

    OK. My last post missed again.

    Another senseless thing: Our Premier (that’s a Canadian “State Governor”) in Ontario levied a $900 “premium” onto the average (i.e. middle-class) Ontarian’s income tax 2 years ago. You get that? The Premier, wielding a state monopoly, when there is no choice for payer or provider, has the audacity to force me, against my will, to pay a $900/per annum premium for a provincial service in which there is no private choice. I don’t care what the service is, quite frankly, that’s statism at its worst. Ontario healthcare is beholden to unions, and believe me, there are people cheating the system, cheating within the system, and dying because of it. Studies of Quebec hospitals have shown that the cleaning staff moves in and out of rooms and between floors with the same mops and mop water which was and is a major contributing factor to the rampant spread of the “C Difficile” bacterium in that province’s hospitals. Can you spell “superbug”? And, contrary to hyped up liberalspeak, Cdn. healthcare is not equally accessible to all: Native Canadians live in communities where there is filthy squalor in the hospitals. It is a well-known fact that the Natives receive subpar healthcare, despite its “universality” in northern communities. Like in all banana republics, the most important thing in the end is not what you know (skill and intelligence) but whom you know (cronyism and thuggery) that will get you ahead – in this case – get you some healthcare.
    CL

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