I would say there would be certain exceptions built into the law that would give the .gov run system a distinctly unfair advantage.

See postal service v. UPS/FedEx, for example.

Well, an advantage with respect to what? The question is, what’s the main objective? Is it to provide the service as effectively and inexpensively as possible? Or is it to turn a profit. If the primary objective is the latter, then you may be right. But generally speaking, free-market types argue that the free market can achieve both objectives for less money than it would cost the government to achieve just the former objective. At which point, they should welcome the opportunity to prove the point.

Channelling my inner conservative, I’d say the “unfair” aspect of the government run system is that it could be subsidized out of the general fund, so you wouldn’t know what it really cost. But that doesn’t explain why the VA and Medicare put a higher percentage of their intake into direct health care than any private system.

‘what’s the main objective?’

For the company, profit. For the .gov, beats me.

For now, one of the hindrances for companies is specifically government involvement. It’s excessive, some say, and all say it is slow to pay. If a doctor has to leverage money for a year, that hits his bottom line.

I actually like one of the talking points from a lot of Republicans these days: fix medicare first. Then, perhaps, someone will take it seriously.

‘that doesn’t explain why the VA and Medicare put a higher percentage of their intake into direct health care than any private system.’

Do they do R&D? Do they have the same compliance costs? Lawyers fees? Do they deal with the legal hurdles of insurance companies? etc. These are real costs.

Uncle:
For the company, profit.

Again, though, the free-market argument is that the profit motivation and the desire to get quality health care to everyone who needs it ought to be compatible, and that just hasn’t played out in practice. Anyway, my concern is getting everybody access to health care. If that can be effectively accomplished by private businesses making a profit, I’m totally cool with that. If it’s being funded by my tax dollars, then I want the best bang-for-the-buck option: if that’s a for-profit corporation, great. If it’s a purely government-run solution, that’s fine, too.

From where I sit, the private sector had its turn, and blew it. All the dire predictions they made back in 1993 (skyrocketing costs, lack of choice, long waits, increased red tape) have happened anyway, all courtesy of the private sector.

I actually like one of the talking points from a lot of Republicans these days: fix medicare first.

Except that the biggest obstacle toward fixing Medicare (unless by “fix” you mean “reduce coverage” and/or “eliminate”) has historically been the GOP (which should be no means construed as saying that the Democrats are blameless on this — they’re far from blameless, just not quite as bad). I’ve repeatedly argued that if you more aggressively investigated and prosecuted fraud and eliminated the corporate protectionism provisions, we could provide universal coverage for what we currently pay for Medicare.

Do they do R&D?

Well, no, but then neither do the private companies, at least not on their own dime. Most of the medical R&D done in this country (and especially the really important stuff) is done with government grants.

Do they deal with the legal hurdles of insurance companies?

Here, I think, we’ve hit on something we can agree on: the insurance companies are the single biggest problem — they artificially drive up costs (more even than any government involvement does), make excuses to deny coverage, etc. The best solutions involve either removing them from the mix or dramatically overhauling the way they work (e.g., if two doctors recommend a procedure, they’re required to cover it).

It should be noted that the VA in particular also has much higher customer satisfaction than private insurers. Another feather in the cap of those who argue that the government would provide better health care to more people than the private sector would.

Take a close look at countries with systems that seem to work with a mix of public and private.

In Canada it is almost impossible to get services quick and several people either suffer unnecessarily or die before getting treatment.

‘Most of the medical R&D done in this country (and especially the really important stuff) is done with government grants.’

I doubt that, immensely. Or, rather, most successful drug developments come from the private sector.

If the public option has to come out in the black every month like everyone else, if it can’t tell everyone else what services they can sell and what prices they can sell the services at, or hell even bothers following the existing rules on what services and prices can be sent, if they can be sued when they’re hilariously negligent, then it’s competition.

You know and I know that’s not the case. Have you seen the legal requirements to hold the VA responsible in a court of law? They get to tell you how responsible for negligence and what damages their actions amount to, and you have to prove otherwise in a federal court. Have you noticed Medicare’s compliance with any state regulation? Cause they’re not legally held to a single one — unlike private plans that have to obey every. Single. State. that they offer services in. Can you imagine a “public option” actually required to follow the legal capitalization rules every private option must. When the public option runs into red ink — and you know it will — will it be looking for investors or loans or even risk declaring bankrupcy? Or will you and I and Joe Taxpayer be paying off the difference, year after year?

If it’s being funded by my tax dollars, then I want the best bang-for-the-buck option: if that’s a for-profit corporation, great. If it’s a purely government-run solution, that’s fine, too.

Would you know?

Seriously, tell us off the top of your head. What’s the bang-for-buck of these wonderful options? Even many people with Medicaid infamously don’t notice the price, but surely you can do better. Let’s ignore, for now, a price-fixing scheme that’d have the Sherman AntiTrust act frothing at the mouth if anyone else tried it, and a government group that only pays a third of the bills on top of that, and a system that shifts almost all administrative costs.

How about the I.H.S., that paragon of efficiency and cautious design? Surely you know how many people it covers, and what percent of medical spending it makes up.

Well, no, but then neither do the private companies, at least not on their own dime. Most of the medical R&D done in this country (and especially the really important stuff) is done with government grants.

Except on the question of medical research, government grants and government-funded expenditures sum up to around 38% of the total. Government expenditures on development — that nasty part where you have to deal with human trials and liability and making efficient ways to produce something — is far lower.

But I’m sure you can redefine “important stuff” to where it’ll only count the DoHHS.

“Given all of this, I would expect free-market ideologues to welcome the “public option” with open arms. After all, it gives them an opportunity to directly demonstrate the efficiencies they’ve been telling us about all along.”

I don’t think the claim about efficiency means what you think it means. From what I’ve read, all the boohooing about the inefficiency has to do with the fact that, historically, states which have put into place government run healthcare plans, or government mandated health care coverage, have always projected a significantly lower budget than what these plans actually end up costing. I think a lot of people are irrate because it’s basically intuitive that a federally run healthcare plan is going to end up costing way more than what the lawmakers and the president said. I think they feel that there was a degree of ignorance and smugness in all the YES WE CAN-ing on this program, and, well, to be crude, everyone has sand in their vaginas over it now. But they’re also not wrong in their anticipation that keeping this program afloat will be a major budget issue in a few years. The inefficiency of the public plan will become evident, I wager ( I bet you a dollar and beer). Just like it has in MA, and like the children’s plan in Hawaii. I have an article about it somewhere…ah, got it:
http://www.foxnews.com/story/0,2933,440561,00.html

I would like to think that I’ll be able to keep my current insurance plan, but, like a lot of people, I can’t predict the future and shit happens and I might need to switch to gov’t insurance at some point. I doubt the government is adequately predicting just how many people will end up leaving their insurers for the gov’t plan. It will almost certainly be more than they expect, and it will end up costing more money than they are alotting the program.

My take on “the competition…” issue is that the problem isn’t that it’s unfair to the private insurers, but it’s unfair to the people who will end up remaining with their private insurers; the cost to subsidize healthcare will continue to go up and up due to more people switching over to the public option. Meanwhile, we all will have to pay more in federal tax money to keep it going, along with paying for our own health care if we wish to keep it.

Personally, I’m trying to respectfully reserve my “I told you so’s” until I start seeing the fallout.

Big U:

It’s getting worse here. At least where I am, a three-plus hour wait for a routine appointment (yes, three hours from the scheduled appointment time) is not unusual. Of course, that’s certainly something to be mindful of, but it strikes me as an eminently solvable problem.

In Canada, you may have to wait, but you can get coverage no matter who you are. In the US, if you don’t have a health care plan (which some 50 million-plus people don’t), you can only get what you can afford to pay for out of pocket, or go to an emergency room on everyone else’s dime, which is more expensive for everyone.

Putting the aforementioned number into a bit of perspective, the number of Americans who lack health care coverage is about one and a half times the total population of Canada, or about 16% of the US population — and that number is growing rapidly.

Uncle and Gatt:

Allow me to correct myself. The majority is funded by government grants and by grants from private non-profit organizations. The idea that medical conglomerates and pharmaceutical companies reinvest large portions of their profits into life-saving research is grossly overblown.

And by “important,” I mean stuff like looking for a cure for cancer, AIDS, diabetes, and other chronic and acute diseases; development of new/improved flu vaccines; that sort of thing.

Not “important”: boner pills, toenail fungus treatments, eyelash lengtheners, incremental improvements to over-the-counter pain and cold medications, etc.

What the private sector spends on R&D on its own is largely in the latter category, not the former.

When the public option runs into red ink — and you know it will — will it be looking for investors or loans or even risk declaring bankrupcy? Or will you and I and Joe Taxpayer be paying off the difference, year after year?

Uh, who do you expect is going to pay for health care for people who can’t currently afford it? The money fairy? I thought it was pretty clear that Joe Taxpayer would be picking up a significant portion of the tab, with the only question being how. Do you expect that Joe Taxpayer will have to pay more if that money goes to buy a private health plan for Jane Q. Poorperson? Or a public plan for Jane? My guess is that the former will cost more.

Except on the question of medical research,

The hell, you say? “Except for the elephant in the room?” Apart from that, Mrs. Lincoln, how was the play?

government grants and government-funded expenditures sum up to around 38% of the total

If you’ve got a cite, I’d like to see it. And yes, I realize that I need to dig up some cites for some of my assertions, too.

SB:
From what I’ve read, all the boohooing about the inefficiency has to do with the fact that, historically, states which have put into place government run healthcare plans, or government mandated health care coverage, have always projected a significantly lower budget than what these plans actually end up costing.

Very likely true, but not terribly informative. For starters, it tells us nothing about how they do as compared to their private counterparts. Such plans are also generally rife with corporate protectionism, as I’ve already mentioned. (Example: Medicare Part D explicitly prohibits the government from negotiating for volume discounts, the way any other large buyer would.)

I think a lot of people are irrate because it’s basically intuitive that a federally run healthcare plan is going to end up costing way more than what the lawmakers and the president said.

Maybe, maybe not. But again, the relevant issue is not whether or not this is true, but whether it’s more true or less true of a public plan than it is of private ones. Recall that the main ways in which private insurers keep costs down and profits up are to deny coverage to members for expensive procedures, and to simply refuse to cover people with conditions that are expensive to treat. (Do the words “pre-existing condition” mean anything to you?)

So, yeah, a move toward universal coverage is going to be quite expensive, especially if we want to protect for-profit interests while we’re at it. Stop the presses, I tell you!

Regarding the Fox News story, a lesson to be learned from, certainly, but not a reason to start shouting “No We Can’t.” A better funding mechanism resolves that problem.

I doubt the government is adequately predicting just how many people will end up leaving their insurers for the gov’t plan. It will almost certainly be more than they expect, and it will end up costing more money than they are alotting the program.

Two things: First off, one study that was cited on The News Hour showed that if a public option were available, some 130 million Americans would opt for it. That’s about 80 million Americans who are currently on private plans switching to the public plan (and why the private plans are scared to death of the idea). So if they’re underestimating, it’d be an impressive number of people moving over.

But second, and more important, this is one of those situations where more people making the switch actually helps more than it hurts. The larger the pool of covered members is, the more widely the risk is shared, and the more that risk is diluted. Lots of low-cost healthy people paying in and helping to defray the costs of the relatively few high-cost people. Economies of scale work in your favor here.

And that’s an important point, by the way, worth reiterating: opting for the “public option” will not be “free” for most people. The only people for whom that would be the case are the people who wouldn’t be paying for a private plan, either. You seem to be of the impression that if John Q. Public opts for the public option, there will be no direct cost to him. That’s not my understanding of how the public option would work.

Now, my dirty little secret: I think the health care reform plans that are being discussed by the administration and in Congress are fatally flawed, precisely because they don’t do anything to destroy the perverse incentives that currently exist in the system, thanks in large part to the private insurers. In my perfect world, I’d like to see a single-payer system that still guarantees choice: the government becomes the insurer, but the doctors and hospitals remain largely private. But I believe we’ve discussed this before.

All this discussion seems to come down to a basic division:

On the one side are people who want their own health care costs to be as low as possible.

On the other are people who want the cost of making sure that adequate health care is available to all is as low as possible, using whatever mechanism will achieve that end.

The conflict arises because members of the first group are afraid that meeting the goal of the second group will cause their own costs (specifically, their net cost including any taxes potentially used to subsidize the “public plan”) to go up.

And for some, it’s true, they might. Mine might. But this by-no-means-wealthy household (with an income of roughly 2/3 of the median for a household of this size) remains firmly in the second group.

As a PS, my own “dirty little secret” is that I agree with T. that the “public option” is clearly inadequate – but I would go beyond single-payer to a National Health Care system.

LarryE:

Well stated.

Tgirsch > When I say wait, I don’t mean three hours. I have a family doctor. To get in for a physical, I need to make an appointment up to 6 months in advance and then I take what they offer. If I have anything else happen in an emergency type way, if lucky I can see him for a couple of minutes on a week’s notice.

If I go to a walk in clinic, my wait may be up to 12 hours. We have actually had two patients die in hospital waiting rooms because they died before they could get checked in (one sat waiting for over 7 hours).

So, yes, we do have coverage for many things, however, accessing that coverage can be incredibly difficult. (lots of stuff is not covered which is why many employees have private health plans as well).

That being said, I’ve seen the US problem first hand with some relatives and I do not envy you. As I said, countries need to look at what works and usually that is a system in some of the European nations.

Big U:

As I already acknowledged, I’m fully aware that the Canadian system leaves a lot to be desired, especially if you live in a more rural area. As previously stated, it’s a solvable problem. In Tgirschtopia, I wouldn’t model the health care system after Canada’s any more than I would after the US’s. Probably something more like Sweden.

I’ve heard the UK system is wonderful for general medicine, however, as many brits will say, they pay for it in taxes, and the waits to see specialists or get in for surgeries are horrendous.

I’m all for universal care, but I really dislike the proposed plan. Not because it doesn’t address the problem of doctors leaving general medicine for more lucrative ventures – I think this will be a problem regardless of who is providing coverage – but because it’s an untested idea (HITECH ACT) that looks to be full of fail in terms of things that could go awry, and the fact that I believe it will be a huge black hole for funding and very inefficient. I’m not expert in these things, but if our president said “ALL states must come up with a universal healthcare option by the end of 2010, which meets the following objectives….,” I would feel a whole lot better. Granted, states that have attempted this have all come accross similar budgetary issues. However, and this comes down to the “big government gripe – just a forewarning, I think state governments *should* be expected to have slightly better efficiencies in such ventures, as opposed to federal government. I don’t hate all government, and I don’t begrudgingly categorize all increases in government spending as “pitfalls of ‘big government’”, but I think it makes more sense to govern from the state level as opposed to the national level. No doubt that costs for programs vary from state to state. Or cost for anything. For example, the cost of water should be more expensive if you live in the desert. Not because of sociological-anything, but practically, it costs more to allocate certain resources to certain places. Likewise, costs for healthcare should vary accross the board – and I don’t believe this is an original idea on my part. If the healthcare budget in state A is much greater than in state B, it doesn’t make sense that residents of states B, C, D and so on should shoulder the costs of subsidizing healthcare to such a state.

Also, regarding Sweden…firstly, it’s a much smaller country, and is also very culturally homogenous, which is nothing like the U.S. Secondly, Sweden is, for better or worse, nothing like the states. They place quality of life above almost all else, but the key is that, culturally, they all get behind the idea that it needs to be paid for out of taxes. Swedes pay a shit-ton of taxes. I’m not saying this is a bad thing, because it’s really the only way to sustain these programs. We don’t have a tax system like theirs. We’re floundering to support programs because of the fact that so many people arent paying enough taxes to cover it. We disagree on where this tax money should come from. I still think it’s absurd that tens of percents of our population don’t help foot the bill for the programs that support them. We always talk about the miniscule percentage increases that the wealthy piss and moan about. Well, there’s alot less wealthy people than there are poor people, right? If everyone on the poorer end of the spectrum paid a few – like 10 extra dollars (pulling randon number) – wouldn’t it have a similar effect as increasing taxes on 1% of the population?

Barbie,

I really have trouble thinking that it increases fairness to tax the poor before it’s free for those same poor people to go to college. The real problem with poverty is that under our current economic and cultural systems, in the majority of cases, it spans generations. I can’t imagine any appeal to fairness in taxation that can trump that.

P.S. and don’t get me started about capital gains and estate taxes.

The hell, you say? “Except for the elephant in the room?” Apart from that, Mrs. Lincoln, how was the play?

My apologies for being unclear. My skill with English is… lackluster. The statement was meant to indicate skepticism of your statement regarding medical research in specific, then provide numbers which make your statement false. The values were for research only, not for development; the federal government does and can do very little in terms of development, to the point where I’m unable to find any values attempting to compare the two.

The numbers on how much medical research spending comes from government or government grants can get a pretty varied number of responses, but the New York Times said 57% of biomedical research money from 2003 came from private industry, and a University of Toledo report extolling the benefits of the NIH uses the more conservative value of 36%. There’s a Chicagobooth.edu study saying 38% for federal and state, and another one that puts it at somewhere around half. You’ll excuse me if I avoid getting caught in a filter by adding too many links.

The government get its name on the funding for something like three out of four drugs only by having a lot of work in the early and relatively inexpensive steps. Derek Lowe has a very good breakdown here and on the following four or five pages. These are valuable services — things like finding new chemical pathways or providing manpower and building space for a phase I or II trial — but the short version is that they’re valuable services provided by grad students, post-docs, and professors on very small scales. Coincidentally, as the increasing levels of oversight and regulation have become present since the days of going straight to testing on human children like many early vaccines, the amount of work necessary for the steps that the government funding doesn’t (and practically can not) cover has increased.

The majority is funded by government grants and by grants from private non-profit organizations. The idea that medical conglomerates and pharmaceutical companies reinvest large portions of their profits into life-saving research is grossly overblown.

I know this is going to sound like a ridiculous, far-out, inconcievable concept, but do you think that possibly a system that will inevitably result in greater governmental spending and tax assessments could possibly reduce grants? I mean, does the money stop coming from a private industries profits just cause some rich bastard decided to make a funny named foundation?

Uh, who do you expect is going to pay for health care for people who can’t currently afford it? The money fairy? I thought it was pretty clear that Joe Taxpayer would be picking up a significant portion of the tab, with the only question being how. Do you expect that Joe Taxpayer will have to pay more if that money goes to buy a private health plan for Jane Q. Poorperson? Or a public plan for Jane? My guess is that the former will cost more.

I don’t seem to be phrasing the complaint properly. Even ignoring the matter of taxes, if the “public option” is in no way required to actually make ends meet, it has what we call a “major advantage” over competitors that have to actually pay for the services they provide. It’s a strong disincentive toward efficiency, since using all allocated money is alone considered justification in a wide sector of the political sphere to justify additional funding, and the same lower-than-other-wise-possible prices are presented to those “purchasing” the services even if the true (and hidden) cost of the services are higher than that of other groups.

Also, to borrow from “Father Ted“, there’s a fun ethical question in there that I’m not quite equipped to debate effectively, but on other matters, last I checked no one said that the “Public Option” would be limited to people who can’t currently afford it. Given the wide variety of other unfair advantages that the “public option” would have, it seems rather unlikely that the “public option” would be limited to those who can’t afford health care otherwise, unless you want to remove the question of competition completely from the equation.

Dan, believe me, I’m not making a statement about the fairness of our tax system. I just don’t think a largescale federally subsidized healthplan is going to be sucessfull without increasing taxes on *everyone*, if other countries’ somewhat more successful models are any indication.

Once all taxes are considered, it is close to 1/2 a working person’s wages that go to taxes in Canada. And we are nowhere close to being able to fully fund universal health care. Don’t kid yourself, universal care is expensive.

[...] free-marketers should support the public option? Only if you don’t know what a free-marketer [...]

Thanks, Barbie, that makes a lot more sense.

Part of the problem here is that people in the “the government is my nanny and needs to take care of me” camp insist upon putting it in terms of a “public health care option” when what they really mean is a “public health insurance option”

Health insurance providers are not health care providers. In order for health insurance to mean anything, there has to be enough providers of the service to cover everyone who needs covered.

There aren’t enough health care providers in this country now…what makes you think there will somehow magically be enough to provide care with another 50 million or so customers…who’s “insurance” will only pay out a fraction of what the care actually costs? (in addition to the millions already on Medicare and Medicaid which are notorious for late payment, refusing to pay and paying too little when they do finally pony up).

One of my best friends is married to a doctor who is considering pursing a different career because of these factors. My personal doctor is in the process of building and opening a shooting range and gun shop in the local area as a “fall back position” in the event that he feels compelled to leave medical practice.

These are not uncommon considerations in the medical community.

Now combine that with the rapidly rising cost of higher education. How many new doctors will we be making when it reaches the point that they will not be able to, in their entire career as a doctor, pay back the massive debt they incur during 8 years of higher education and four years of internship and residency?

How many RNs and LPNs will have to be laid off because private insurance companies, in “competition” with government subsidized plans, have to reduce the amounts they’ll pay out?

Medical care is commodity that is just as subject to the rules of scarcity as any other commodity. Pretending that there is a neverending source of “health care” to tap in order to provide this commodity to anyone and everyone who wants or needs it, and at a uniformly low cost, is a utopian pipe dream.

There Aint No Such Thing As A Free Lunch.

Sailorcurt:

That’s actually not a bad job of summarizing some of the problems we face. Now, if you could take it a step further and offer up some solutions, apart from “leave bad enough alone,” we’d really be getting somewhere. I won’t hold my breath.

For the record, as I mentioned above, I’d prefer a system in which any government-subsidized health coverage paid the providers directly, rather than wasting money on the middlemen in the insurance industry. Want to reduce costs? Eliminate health insurance entirely.

gatt:
Even ignoring the matter of taxes, if the “public option” is in no way required to actually make ends meet, it has what we call a “major advantage” over competitors that have to actually pay for the services they provide.

I still fail to see how the presence or lack of a public option significantly changes this equation. Are the private insurers going to be able to dictate what the government pays them? Or are they going to have to make do with what the government gives them? If the former, then you’ve done nothing to keep costs under control. If the latter, it’s no different than with a public option.

It’s a strong disincentive toward efficiency

Yes, because more than anything, the private insurance industry we have today is famous for its efficiency…

it seems rather unlikely that the “public option” would be limited to those who can’t afford health care otherwise

I don’t believe anyone has ever argued that the public option would be so limited, but so what? Government bureaucracies are inefficient (we’re told), and the red tape is far too much (we’re told), and the services they provide are subpar (we’re told). If those things are actually true, then a large number of people would actually willingly pay a little more for the superior service provided by the private entity. So even with those caveats, it doesn’t address my initial argument: if the private sector is inherently better, and provides better service, it shouldn’t fear competition from the government, even when the government is substantially cheaper.

The introduction of low-cost overnight shipping by the USPS hasn’t exactly killed FedEx, as Uncle was quick to point out, despite all of the postal service’s “unfair advantages.” Private schools thrive, despite the existence of free (to the parents, anyway) public schools! Why should health care be any different?

Barbie:

Taxing the lower end of the income spectrum may make you feel better, but it doesn’t really accomplish very much. According to the Heritage Foundation, the bottom 40% of Americans earn barely over 11% of the total income. For the bottom 20%, it’s just 3.5% of total income. The latest stats I can find (2004) show that the total (individual) income was about $6.85 trillion, so the bottom 40% had $753 billion in income, and the bottom $240 billion in income. You could take every penny the bottom quintile makes and still not even cover 50% of the DOD budget (for example). Take every penny the bottom 40%, and you’ve just barely covered the DOD and interest on the national debt.

Now, I’m all in favor of some VERY small tax on EVERYONE, just so that everybody has skin in the game, but the real money’s going to have to come from the people who have it. Which, generally speaking, ain’t the poor.

regarding Sweden…firstly, it’s a much smaller country, and is also very culturally homogenous, which is nothing like the U.S.

i hear Americans saying this kind of thing a lot, and every time i hear it again, it sounds more like a weak excuse to me.

yes, the Scandinavian countries — indeed, most European countries — are smaller than the USA. so what? that’s in our favor; as has been pointed out, economies of scale are our friends when setting up diluted-risk systems.

yes, the USA is far more multicultural than most European nations. again, so what? how does that make providing mass healthcare and health insurance significantly more expensive? monocultural countries are indeed far different from the USA, but what part of those differences are relevant to this topic?

bear in mind, i was born and raised in Finland, just a short hop-and-skip eastwards from Sweden, and with a quite similar national healthcare system. that’s how i know socialized healthcare works and works just fine. it’s very true my native country was and remains ethnically homogenous, but if that fact made its healthcare in any significant way cheaper, i’d like that way explained to me.

(i hate WordPress’ godsdamn spam filters. i wouldn’t, if they hadn’t started this pointless vendetta against me, but they did and so i do.)

regarding Sweden…firstly, it’s a much smaller country, and is also very culturally homogenous, which is nothing like the U.S.

i hear Americans saying this kind of thing a lot, and every time i hear it again, it sounds more like a weak excuse to me.

yes, the Scandinavian countries — indeed, most European countries — are smaller than the USA. so what? that’s in our favor; as has been pointed out, economies of scale are our friends when setting up diluted-risk systems.

yes, the USA is far more multicultural than most European nations. again, so what? how does that make providing mass healthcare and health insurance significantly more expensive? monocultural countries are indeed far different from the USA, but what part of those differences are relevant to this topic?

bear in mind, i was born and raised in Finland, just a short hop-and-skip eastwards from Sweden, and with a quite similar national healthcare system. that’s how i know socialized healthcare works and works just fine. it’s very true my native country was and remains ethnically homogenous, but if that fact made its healthcare in any significant way cheaper, i’d like that way explained to me.

Sailorcurt at #23 basically points out that health care will always have to be rationed, since it is by its nature a scarce good.

well, yeah, nobody sensible thinks any different. nobody has any horn of medical plenty, so even a fully socialized single-payer system will have to ration care.

so what? we ration access to healthcare right now, the free market doesn’t have that horn of plenty either. point of import: our current rationing scheme is badly dysfunctional, unreasonably expensive, and blows goats. there are better ones.

Medicare and Medicaid which are notorious for late payment, refusing to pay and paying too little when they do finally pony up

Y’know, I’m really tired of that nonsense. I’ve dealt with insurance companies (and the Ms), and not only as a consumer but also as an employee of a Medicare-supplemental insurance outfit and the spouse of an RN working in a doctor’s office.

The notion that Medicare/Medicaid are significantly slower in making payment than private insurance doesn’t hold water. In fact, just today I got a statement from my family physician and I noticed that there was a gap of seven months between the time a service was performed and the time BC/BS finally paid. My wife had a rather large hospital bill not long ago; it took us over a year to get payment out of insurance.

It’s not that the Ms are significantly slower, it’s that whenever they are slow, you get “well, of course, it’s the government, what do you expect.” (The “red light” hypothesis in action.)

And don’t get me started on the “refusing to pay” crap as applied to private industry – or did you miss the story from last week of insurance companies using any excuse they can to cancel coverage for people who file large claims?

Finally there is the “pays too little” gripe. That one really galls me. Medicare is required by law to pay the local “prevailing rate” for procedures. But that prevailing rate is based on yearly surveys of doctors and hospitals, asking what they charge. They grumble and grouse about having to fill out “more forms” so they don’t do it – so the information Medicare has is outdated, resulting in low payments, about which the providers loudly whine. But it’s their own damn fault.

A couple of other observations:

only pay out a fraction of what the care actually costs

Umm, no. Not what it “actually costs,” but what is actually charged. The two can be quite different.

Part of the problem here is that people in the “the government is my nanny and needs to take care of me” camp insist upon putting it in terms of a “public health care option” when what they really mean is a “public health insurance option”

Sneering is only useful when done from a position of knowledge. Since no one here has talked about needing a government “nanny” and the concern that has been expressed is for others, your sneer is from ignorance and stains anything else you have to say.

As for care vs. insurance, people talk about health care because that is the goal. Insurance is merely a means.

Finally, as for me, I most definitely talk about health care because, as I said earlier, a National Health Care System is what I advocate. I think national health insurance plans are clearly inadequate to the task to which we set them and even if we get one, I’ll continue to advocate for a NHCS.