How Democrats can make themselves useful.

November 9, 2006 3:51 PM

The Health Care Crisis and What to Do About It. Is it time to socialize medicine in the US?
posted by homunculus (128 comments total)

No. Next question.
posted by ZenMasterThis at 4:05 PM on November 9, 2006 [1 favorite]

why not?
posted by slow, man at 4:10 PM on November 9, 2006

Are you serious? Do you see who's running the show on Capitol Hill? I don't care if it's the (R)'s or the (D)'s, until Congress is a majority of (L)'s (ie: people actually working for the VOTERS), there will never be socialized anything in this country.
posted by wfc123 at 4:11 PM on November 9, 2006

ZenMasterThis can't afford his meds.

Let the medicine mingle!
posted by srboisvert at 4:12 PM on November 9, 2006

I predict this will go well.



wfc123 writes "until Congress is a majority of (L)'s (ie: people actually working for the VOTERS),"

Oh look, a joke! (L) candidates only work for a vanishingly small fraction of the voters. Extrapolating that to the entire populace is just a tad naive.
posted by dirtynumbangelboy at 4:12 PM on November 9, 2006

Are you serious?

I know it will probably never happen, but these articles are pretty compelling.
posted by homunculus at 4:13 PM on November 9, 2006

I can see how simplifying the overly-complex health care/insurance industry would be beneficial to the Democrats and the country, but socialized medicine? No, no, uh-uh, danger danger. If we're going to put a shitload of money into something, I say let it be education.
posted by billysumday at 4:16 PM on November 9, 2006

Yeah, 'cause god forbid every American have access to basic healthcare.

LIFE, LIBERTY, AND THE PURSUIT OF HAPPINESS.

If you can afford the premiums.
posted by stenseng at 4:17 PM on November 9, 2006

billysumday writes "but socialized medicine? No, no, uh-uh, danger danger."

I'm still waiting for an actual logical explanation of why this 'cannot be done' in the USA. Seems to work just fine up here in canada, not to mention, as far as I know, the overwhelming majority of Europe.

Oh, right, profits.
posted by dirtynumbangelboy at 4:19 PM on November 9, 2006

Well, I don't mean that it couldn't happen, or that it won't happen. But I guarantee that if the Democrats push for socialized medicine - undisguised as an increase in Medicare or something - just flat out government-run and taxpayer-funded health care provided to all citizens (and non-citizens), there will be a cultural/philosophical war unlike anything we've seen besides maybe Roe/Wade. Does this make the issue unapproachable or unacheivable? Absolutely not. But the Democrats currently have a little bit of political capital and I'd be surprised if they spent it pushing this issue - it would be like Bush pushing his Social Security reform - a dead issue. You have to have a lot of muscle and a huge mandate to push something like that through, and right now the Democrats don't have it and I don't think that they are spoiling for a fight of the magnitude that the debate over socialized medicine would bring. Reform, yes. Complete overhaul to a socialized system, don't kid yourself. (IMHO).
posted by billysumday at 4:26 PM on November 9, 2006

God willing, with the Democrats in power, America will soon have a socialized healthcare system to rival its socialized education system.
posted by hoverboards don't work on water at 4:32 PM on November 9, 2006

Just to clarify - OpenSecrets.org lists the American Medical Association as the 13th highest political donor in the country, to the tune of $23,139,274 since 1990.
posted by Orb2069 at 4:32 PM on November 9, 2006

hoverboards don't work on water writes "God willing, with the Democrats in power, America will soon have a socialized healthcare system to rival its socialized education system."

Oh snap!
posted by dirtynumbangelboy at 4:34 PM on November 9, 2006

"God willing, with the Democrats in power, America will soon have a socialized healthcare system to rival its socialized education system."

(Michael Jackson voice): That's just ignorant.
posted by billysumday at 4:38 PM on November 9, 2006

There are only two industries that should be socialized in the US.

Healthcare and legal representation.
posted by SirOmega at 4:39 PM on November 9, 2006

I have a tough time seeing why this would be a bad thing for the US. But then again, I am Canadian.
posted by nightchrome at 4:42 PM on November 9, 2006

Seems to work just fine up here in canada

Sure does. When I'm bored, I cheer myself up with a cat-scan.
posted by CynicalKnight at 4:43 PM on November 9, 2006

Sounds like a reasonable prediction to me, billysunday. That said, as a European, I'm always amazed by the cries of horror that greet any suggestion of reforming the US health system - especially since, as the Slate piece points out, 'the United States spends about twice what Canada, France, and the United Kingdom do on health care [...] yet ranks lower than these countries on life expectancy and higher on infant mortality.'
posted by Mocata at 4:45 PM on November 9, 2006

CynicalKnight writes "Seems to work just fine up here in canada

"Sure does. When I'm bored, I cheer myself up with a cat-scan."

If you actually needed one as an emergent case, you'd be having it right now. If it's not urgent, you wait.

Sure, the system has its pitfalls... but everyone gets treated. And nobody has to choose between life-saving surgery or their mortgage, or whatnot.
posted by dirtynumbangelboy at 4:52 PM on November 9, 2006

last time the Democrats tried this, they immediately got a huge can of whupass poured all over them -- 12 years of merciless Republican control of Congress (and a Democratic President was impeached by said Republican Congress). and the difference is, in 1994 they didn't have the Iraqi occupation to syphon away hundreds of billions of dollars.

try again? they can't be that dumb, really. if you touch that issue, you die, simple and plain -- remember those Harriet and Harry ads, or whatever the fuck their names were? massive, massive PR campaign waged by the health care industrial complex. I'm sure Madame Hillary still remembers that stuff pretty well.

Bill Bradley said it so well in 2000 -- "if not now, when?". Iraq and the Bush tax cuts took care of that question I suppose
posted by matteo at 4:55 PM on November 9, 2006

until Congress is a majority of (L)'s (ie: people actually working for the VOTERS), there will never be socialized anything in this country.

If that (L) stands for Libertarian, I don't think that word means what you think it means. And what makes you think that Libertarians have some sort of monopoly on faithfully representing their constituents (and I ask that from the perspective of a pretty committed libertarian)?

There are only two industries that should be socialized in the US. Healthcare and legal representation.

Education? Defense?
posted by Doofus Magoo at 4:57 PM on November 9, 2006

hoverboards don't work on water writes "God willing, with the Democrats in power, America will soon have a socialized healthcare system to rival its socialized education system."

Public schools treated me just fine.
posted by stenseng at 4:58 PM on November 9, 2006

It seems that the scaremongering did is work , the mere IDEA of socialization is rejected entirely, or so it seems.

Fine, privatization ican be a mess as well. Just look at the money wasted in Iraq, were there was no incentive to increase efficiency and efficacy, nor punishment as you could just blame the terrorists for anything.

But one doesn't need to look at iraq, just look home. Why should a pharma company, whose profits are generated by SALE of drugs invest money into CURES that would quickly and cheaply resolve problems ?

Similarly, if we paid companies for each patient CURED, they would have an incentive to find more patients to cure, by making up diseases that don't even exist, by delaying recovery claiming additional costs.
posted by elpapacito at 5:13 PM on November 9, 2006

If we're going to put a shitload of money into something, I say let it be education.

Wow, that must be the stupidest thing I've heard all day. Sure, who needs health when one's got education!
posted by c13 at 5:13 PM on November 9, 2006

America had a great socialized education system until the "less government" crowd appeared on the scene in response to Barry Goldwater's defeat.
posted by Kid Charlemagne at 5:15 PM on November 9, 2006

I wonder if there's a 3rd path of somehow bypassing the insurance/managed care industry. I've read (wish I could find the article) that some doctors are actually attempting to extricate themselves. Not sure if this means that patients have to sign waivers stating that they won't ever sue, no matter what happens . . . but apparently some are finding ways to operate outside the system & still manage financial risk.
posted by treepour at 5:18 PM on November 9, 2006

Since metafilter is about the links, there’s no reason to read anything before you comment.
The Krugman and Wells piece was interesting. Didn’t go thru under Clinton, so I doubt the Dems would be able to pull it off now. And I don’t need it myself, so I can only be so interested.
I am not among the many mefite experts on health care, so that’s about all I can say.
I will say though, whether it should or shouldn’t be socialized, I’d rather look at the data and make that choice myself rather than have some special interest asshats in D.C. tell me I’m a communist for chewing it over.
posted by Smedleyman at 5:19 PM on November 9, 2006

"The percentage of the nation’s population without health insurance coverage remained stable, at 15.7 percent in 2004. The number of people with health insurance increased by 2.0 million to 245.3 million between 2003 and 2004, and the number without such coverage rose by 800,000 to 45.8 million."

U.S. Census Bureau Report, August 30, 2005

In the U.S., roughly 1 person in 6 is not covered under the current system[s].
posted by gimonca at 5:21 PM on November 9, 2006

What I don't get is why big business (excepting the insurance companies) doesn't step in and support socialized medicine. Businesses have to spend tons of money on expensive health care programs for their employees, the costs of which would disappear if America switched to a socialized system.
posted by NickO at 5:27 PM on November 9, 2006

The New Yorker had a great article on this subject.
posted by mullingitover at 5:27 PM on November 9, 2006

National health care is even less likely now than in 1992, simply because the "health care" industry is one of the few sectors of the economy making big bucks.

And that includes "not for profit" hospitals, many of which have for-profit subsidiaries. Ever wonder why not for profit hospitals spend millions on advertising?
posted by words1 at 5:28 PM on November 9, 2006

Interesting paragraph from the Krugman review:

Employer-based insurance is a peculiarly American institution. As Julius Richmond and Rashi Fein tell us in The Health Care Mess, the dominant role of such insurance is the result of historical accident rather than deliberate policy. World War II caused a labor shortage, but employers were subject to controls that prevented them from attracting workers by offering higher wages. Health benefits, however, weren't controlled, and so became a way for employers to compete for workers. Once employers began offering medical benefits, they also realized that it was a form of compensation workers valued highly because it protected them from risk. Moreover, the tax law favored employer-based insurance, because employers' contributions weren't considered part of workers' taxable income. Today, the value of the tax subsidy for employer-based insurance is estimated at around $150 billion a year.

So our current health care system is an artifact of wartime controls? I hadn't heard that before.
posted by gimonca at 5:31 PM on November 9, 2006

Doctors aren't the opposition to health care reform.

Insurance companies and HMOs are.

Doctors spend more and more time being squeezed by the insurers, are making less and less, and are being insulted by being second-guessed by the insurer's cost-cutters every time they make a medical decision.

A doctor I know -- never sued for malpractice, in an expensive specialty -- complains she makes half what she made 10 years ago.

Doctors do want reform. It's the CEOs who don't.
posted by orthogonality at 5:33 PM on November 9, 2006

God willing, with the Democrats in power, America will soon have a socialized healthcare system to rival its socialized education system.

We have free education now? Damn, I want the $100,000 that I spent on college back!
posted by Pollomacho at 5:33 PM on November 9, 2006

just flat out government-run and taxpayer-funded health care provided to all citizens

Don't use the phrase "socialized medicine."

Don't even use the phrase "taxpayer-funded health care."

At least, not unless you really mean it. Because there's a world of difference between single-payer insurance or even state subsidized insurance or even state standards for billing/coding and.... KaiserExceptRunByTheGovernmentForEverybody(TM). And that last thing is something that stands barely a snowballs chance in hell of actually working, much less finding its way into policy.
posted by weston at 5:35 PM on November 9, 2006

Meh. This will get dealt with sometime in the next 25 years because large corporations will increasingly demand it as a way to reduce their personnel costs.

However much the AMA gives, Ford + GM + Daimler + Intel + AMD + Boeing + Microsoft + Citibank + Wachovia + Lockheed + Exxon + so on give more and can issue more meaningful threats (ie, deal with this or we move the plant to .mx or .ca).
posted by ROU_Xenophobe at 5:35 PM on November 9, 2006

US Defense is socialized, and it's a pork-barrel corporate-welfare system on an incomprehensible, unprecedented scale, orders of magnitude more so than anything else owned by any government anywhere. Fix that and there's enough money to buy every American health care, and probably a Porsche, a pony, and a new TV.

While I think that health care should be socialized, the fact that health is so badly screwed up is emergent from the underlying problems in the US's chosen economic approach. These include: (1) counting the gross positive effect of an economic activity, rather than the net effect (which is often negative); (2) frantic socialization of any and all risk and cost incurred as a result of an economic activity, and equally frantic privatization of benefit; (3) social morale problems caused by a disparity of wealth that is grotesque in its magnitude and which favors a large number of persons of very low moral values, (by "moral" I mean, "do unto others as you would have them do to you" and the consequences logically derived from that) thus deprecating the value of morality in the eyes of the people; (4) strong freedom of speech without responsibility for the accuracy and the effects of that speech. The Republicans (and Randist libertarians), are far worse in these regards than the Democrats.
posted by aeschenkarnos at 5:37 PM on November 9, 2006 [1 favorite]

It's not yet the time. Given your use of the term "socialized" you aren't serious either. At some time in the future we will have government sponsored health care, it will not be that far off, but it will come slowly, and then probably some big push in the end. Gay marriage will follow a similar track. Push too hard too fast and you set back your effort. This is a victory, but this is not a democratic victory. This is a loss for the GOP machine and a victory for common sense. The folks who made this victory were the moderates and independants. If the left wing tries to take advantage we are back to a GOP majority in two years - all gains lost. Have some patience.
posted by caddis at 5:43 PM on November 9, 2006

Ever wonder why not for profit hospitals spend millions on advertising?

Good point, let's extend to why should an hospital advertise to begin with ? Advertisment costs time, money, resources and can be highly inefficient.

For instance if we have two product who are roughly similar , but produced by two different companies, we will also have an investement in advertisement by both, each one trying to capture a segment of market (ideally the whole market) or to steal from the other.

But competitive advertising has diminishing returns, as increases in advertisement doesn't necessarily guarantees increases in revenues ; but it is certainly a good way to hide money under the voice of "costs" and to move this money into other companies (advert companies) who can turn it into something untraceable (or hardly so).

Yet Shak's endorsement of this or that cat-scan is completely useless, irrelevant to people with health problems.
posted by elpapacito at 5:44 PM on November 9, 2006

Sure, the system has its pitfalls... but everyone gets treated. And nobody has to choose between life-saving surgery or their mortgage, or whatnot.

It sure takes the worry out of life. For various reasons, mainly low cash flow while I was starting my business, I didn't pay my provincial medicare premiums for a long time. I figured I could pay at a clinic if I had something minor and, if I had a major problem they'd have to treat me anyway. (Nominate Turtles now for outstanding citizen award!) Anyway, at one point I did have to go to Emergency--I tentatively handed my card to the clerk at the front desk; she swiped it and got a concerned look on her face. She told me that it had been refused but gave me a number to call. Which I did; the nice lady on the other end of the phone said: "Oh, it looks like we thought you'd moved because we hadn't had our letters (read: bills) returned. Would it be okay if we reinstated your coverage as of last week?" I assured her it would (and now pay those bills religiously, BTW.)

So in light of this kind of experience, it baffles me that Americans put up with crap like "We can't insure you because you have cancer and that's a pre-existing condition. Good luck!"

It's inevitable that a socialized system will have its problems. Canada's certainly does now. But the great benefit of a single payer solution is that you can come up with a reasonable response to problems. If you have hundreds of parties in the negotiation, many of whom are motivated by profit, it makes it much more difficult. No, impossible.

What Americans have to come to terms with, though, if they decide on a single payer system, is this: would you, as a wealthy individual, be willing to wait for your operation until the poor guy got his broken leg treated?
posted by Turtles all the way down at 5:45 PM on November 9, 2006

Out here in Oregon we have ex-Governer John Kitzhabers Oregon Health Plan. At first it was pretty easy to get on it and it really helped alot of people - including myself. I was able to get knee surgery I would not have been able to afford myself and subsequently got back to work sooner than without. Nowadays I hear that you really have to be very poor to get on it and in some cases you pay a premium. It was really hard to find a dentist when I was on it but really, the level of care was equal to any other time I have paid for it myself or was on my parents insurance. It seems ridiculous that we can spend 3 Billion dollars a week on a war that just about everyone knows is bullshit, but we can't get affordable healthcare. Unless you are uninsured you don't know what it is like. I just had routine bloodwork done and it cost me $390.00. Add the $95.00 for the doctor visit and $25.00 for a prescription and I have paid over $500 for a very routine diagnosis. Now I start saving to see the dentist.
posted by tatnasty at 5:47 PM on November 9, 2006

weston writes "KaiserExceptRunByTheGovernmentForEverybody(TM). And that last thing is something that stands barely a snowballs chance in hell of actually working, much less finding its way into policy."

You mean the way it doesn't work in Canada? Sweden? Norway?

aeschenkarnos writes "(4) strong freedom of speech without responsibility for the accuracy and the effects of that speech."

Oh my God. Finally saying what Americans need to hear vis-a-vis FREE SPEECH OMG. Freedom to, or freedom from, carries with it a responsibility.
posted by dirtynumbangelboy at 5:48 PM on November 9, 2006

(L) candidates only work for a vanishingly small fraction of the voters.

Who's naive? Do you understand what "liberal" means?

They would have to control congress. That means they would have to be a majority-- which I agree is a longshot unless a true revolution occurs in this country..

You are naive to think today's Democrats = Liberal. There are maybe one or two real liberals in Congress. The rest have become moderate to full-blown Republican.
posted by wfc123 at 5:53 PM on November 9, 2006

This will get dealt with sometime in the next 25 years because large corporations will increasingly demand it as a way to reduce their personnel costs.

Which is why every single new auto plant gets built in Canada. And why all those big US corps have relocated here. And why the UN moved their HQ here.

Oh, wait...
posted by GuyZero at 5:53 PM on November 9, 2006

..and they have not become that way because there are less liberal voters, they became that way because of the corruption in Washington and the conservative bias of the media and the demonzation of the liberal.


Congressmen are afraid to be true liberals nowadays, because they know they would be smeared and never get re-elected.
posted by wfc123 at 5:56 PM on November 9, 2006

But one doesn't need to look at iraq, just look home. Why should a pharma company, whose profits are generated by SALE of drugs invest money into CURES that would quickly and cheaply resolve problems ?

This meme floats around the web a lot, and it sounds good until you start to think about where diseases come from. While there are a few where the take-antibiotics-to-kill-the-thing-making-you-sick model holds, but, for the most part, it doesn't hold true to the diseases most people would put on their big list of things needing cures.

Type 1 diabetes is an easy example. Pancreas transplant is an option (if you don’t mind the lifetime of immunosuppresants and maybe a failed kidney or two). Not exatly easy or cheap. Islet transplants are not as invasive, but have the same immune issues.

Rheumatoid arthritis is an autoimmune disease. You can block TNF or one or more of the interleukins but that’s not without risk and again, violates your demand for a CURE. Hitting the patient with high dose radiation therapy to knock down their immune system would cure rheumatoid arthritis. I'm trying to imagine the marketing campaign for that and comming up blank.

I might actually have something for you for heart disease, but at some level it’s still a stop-gap measure because after treatment people are going to have the same physical mechanisms that put all the crap on their artery walls in the first place and they're going to keep on doing it.

I guess what I'm trying to point out is that the problem is usually not a situation where, if we just eliminate X the problem will be solved becauses X is part and parcel of you.
posted by Kid Charlemagne at 6:03 PM on November 9, 2006

You mean the way it doesn't work in Canada? Sweden? Norway?

I think it's not unreasonable to assume that what may work for Norway could be disastrous in the U.S. All of those countries have a population an order of magnitude smaller than the U.S., and Canada's the only one I'd believe has to struggle with the regional/cultural range of differences present in the U.S. Trying to push GovHMO down from the federal level here would be a political disaster here, and it would quite probably be a practical disaster congruent to FEMA handling of Katrina.

Standardizing some range of practices regarding how the business side of things is done and subsidizing care, on the other hand, is probably within the realm of manageability, and something we're doing by half-measures now anyway.
posted by weston at 6:10 PM on November 9, 2006

I wish that the voters would insist that their representatives in Congress have NO betterhealth insurance than that which the general public has...they have the best there is and for many of us, nothing, or not much of one.
posted by Postroad at 6:10 PM on November 9, 2006

If we're going to put a shitload of money into something, I say let it be education.

Uh... part of the merit of socialized healthcare is that is costs much LESS MONEY and delivers better healthcare at the same time. The current system is bloated with middlemen taking a profit cut at every step of the way, special interests, lobbyists and other parasite industries piled on the gravy train, that the simplist inexpensive thing costs a gobsmacking amount.

Heathcare here in the US is so third-world I just can't understand what the objection is (other than simple ignorance) - it's not like any alternative, let alone a system already proven to work in the rest of the developed world - could break it worse than it already is. Keeping the current disaster is not only pouring good money after bad, it is ruining lives, including the lives of many people I know.
posted by -harlequin- at 6:10 PM on November 9, 2006

weston writes "All of those countries have a population an order of magnitude smaller than the U.S."

I would draw the absolute opposite conclusion. Economies of scale.

-harlequin- writes "part of the merit of socialized healthcare is that is costs much LESS MONEY and delivers better healthcare at the same time. "

NO! Bad! You're going against the talking points! Don't confuse them with facts, man.
posted by dirtynumbangelboy at 6:19 PM on November 9, 2006

Are you serious? Do you see who's running the show on Capitol Hill? I don't care if it's the (R)'s or the (D)'s, until Congress is a majority of (L)'s (ie: people actually working for the VOTERS), there will never be socialized anything in this country.

Yes. Libertarian socialized health care. I see.
posted by Jairus at 6:20 PM on November 9, 2006

HELL YES IT IS TIME.
posted by mwhybark at 6:22 PM on November 9, 2006

WELL PAST FUCKING TIME IN FACT
posted by mwhybark at 6:24 PM on November 9, 2006

IT WAS TIME FIFTY FUCKING YEARS AGO FUCK YOU VERY MUCH AMA
posted by mwhybark at 6:25 PM on November 9, 2006

You know, I'm not really having a meltdown. But this is one of the things that makes me doubt the sanity of my fellow citizens voters.
posted by mwhybark at 6:28 PM on November 9, 2006

Yes.

This was another edition of Simple Answers To Simple Questions.

Seriously, you only ever see questions like this on AskMe from Americans. I only ever read "I can't afford treatment" on AskMe from Americans. Whenever I read of terror at losing/not getting jobs because of the medical insurance benefits, I know the writer is an American. You guys are just boiled frogs as far as this issue goes.
posted by i_am_joe's_spleen at 6:30 PM on November 9, 2006 [1 favorite]

For my fellow Americans, here's a bit of info about Canada's health system as seen by an American who moved to Canada. Pretty damn eye opening. No, it's not perfect, but it makes a lot of sense.

We should copy this. NOW.
posted by Brandon Blatcher at 6:32 PM on November 9, 2006

Socialised healthcare also creates more competitive efficient markets by creating real negotiating positions to, for example, play drug companies against each other, so that they really must compete hard with one another to secure business. Additionally, it allows win-win cross-demographic bargaining (eg in exchange for selling new HIV drug cheaper, representitive might agree to start buying older HepC drug from same company instead of competitor. and so on).

For some reason that blows my mind, the Bush changes to Medicaid prohibited these kind of competitive/free market benefits - just making a totally FUBARed system even more costly to the users, for no gain (unless you have a profit stake in pharma).
posted by -harlequin- at 6:33 PM on November 9, 2006

and doesn't the American military have socialized medicine?
posted by Brandon Blatcher at 6:33 PM on November 9, 2006

the problem is usually not a situation where, if we just eliminate X the problem will be solved becauses X is part and parcel of you.

I agree that we can't talk about "cure for" a problem when the cure's consequences are worse than the problem they solve (destroying immune system to prevent autoimmune response doesn't seem to make much sense) , but as long as the "treatement toward cure" or "treatement to reduce the negative effect "remain quite a profiteable revenue stream there is little incentive to even look for a "better treatement" or a "definitive cure" unless the customer can immediately notice that it is better.

For instance take alcohol dependence and the very significant health and social problems it causes.

It would certainly make sense to study and produce a molecule that has the same 'desidered' effects without negative ones or with reduced negative ones. It wouldn't be a "cure from abuse", but that would still beat curing the recurring effects of recurrent abuse, or at least would reduce them.

But where is the incentive to develop such a product ? Alcohol industry ? Maybe, but why invest for a replacement product that maybe doesn't give dependence ? They count on dependence. Pharma industry ? Medical treatement industry ? Nay , the effects are already profiteable enough and can't trust people to really stop drinking booze, if they don't want to , they would blame us for their lack of will.

Casual drinkers wouldn't benefit much from it, ordinary drinkers would enormously, but their demand just isn't that interesting and actually goes against interests.
posted by elpapacito at 6:37 PM on November 9, 2006

I would draw the absolute opposite conclusion. Economies of scale.

I'd need a really good argument to be convinced that the real gains economies of scale make possible in a context like industrialized manufacturing would apply to health care as an industry. To the equipment and processes involved? Maybe. To the challenge of managing the organization across the U.S. while still maintaining the quality when it comes to the art of individual care? Economy isn't the only thing that can scale with size. Challenges scale up too.
posted by weston at 6:38 PM on November 9, 2006

I think it's also worth pointing out that the linked article in Brandon Blatcher's post specifies something important:

In socialized medical systems, the doctors work directly for the state. In Canada (and many other countries with universal care), doctors run their own private practices, just like they do in the US. The only difference is that there's one insurer: the provincial government.

This is what I meant when I tried to distinguish between single payer insurance and "socialized medicine." I didn't mention this because I don't know whether or not Norway and Sweden are places where most if not all doctors work for the state (IIRC, Norway may be) and I think that the scale argument is fairly compelling when it comes to looking at differences between smaller European nations and the U.S. But I definitely think it's interesting to note that the Canadian model is single payer, and of the three nations dnab brought up, there are a number of reasons to believe it might be the most readily adaptable to the U.S. system, chief amongst them that Canada is the most culturally similar to the U.S. and that we wouldn't have to nationalize a significant portion of actual health care providers, which is where it seems likely to me any real attempt at fully socialized medicine would fail politically and practically.
posted by weston at 6:46 PM on November 9, 2006

Seems to work just fine up here in Canada

Ya know about six months ago I developed vertigo so I did what any canuck would do, I called my doc. Except its been a long time since I last saw him and in the interim he's moved elsewhere (and no one replaced him). So now doctor-less, I call the local hospital to enquire about any doctors in the area taking new patients and wouldn't you know? There aren't any*. I still have the vertigo but I'm sure if tomorrow I was to be hit by a car I'd get top 'o' the line care at the hospital (with antiquated equipment and staff stretched to the limit) and who knows maybe they'll look into why I've been having these dizzy spells. Great system innit?

*about 100,000 people in BC are without a family doctor btw

btw I fully support socialized medicine but as it stands right now our system is in a terrible state and not sure it should be held up as the shining example of all that is good with socialized health care.
posted by squeak at 6:52 PM on November 9, 2006

It's not yet the time. Given your use of the term "socialized" you aren't serious either.

Actually it's not my term, it's the title of the second article. But I take your point.
posted by homunculus at 6:52 PM on November 9, 2006

[Hmmm, where I said "socialised", replace that with "universal", it appears there is a lot of debatable baggage and confusion surrounding the term "socialised", while my points apply regardless]
posted by -harlequin- at 6:55 PM on November 9, 2006

not sure it should be held up as the shining example of all that is good with socialized health care

Canada is the only country whose systems many Americans are likely to have heard something about, so regardless of how good or poor an example Canada makes compared to other countries, Canada is the one that is going to get used in any layman discussion :-/
posted by -harlequin- at 6:58 PM on November 9, 2006

and doesn't the American military have socialized medicine?

Yes, and it works.
posted by homunculus at 6:58 PM on November 9, 2006

As a physician-by-training I can assure you that there's no difference between being a family doc in Canada and a family doc in the US other than the Canadian one doesn't spend any time wrangling with insurance companies.

It seems to me that Americans and Canadians are fundamentally different. Canadians are more likely to view their fellow citizens as equal to themselves; they have more of a "we're all in the same boat" philosophy. My experience is that Americans are much more likely to think "I'll protect me and my family, and if you end up losing out, sorry!" A generalization, obviously, but one I think is rooted in truth.

So American style socialized health care is going to be different than the Canadian model. For a start, it's definitely going to be two-tiered: rich people will continue to get the excellent, Star Wars quality of care they enjoy now. But if you guys can get it together the remaining 95% of the population will still receive the best of American medicine, you won't have to worry about losing your coverage when you lose your job, and a bunch of insurance companies will be out of business. Boo hoo.
posted by Turtles all the way down at 7:00 PM on November 9, 2006

would you, as a wealthy individual, be willing to wait for your operation until the poor guy got his broken leg treated?

Socialised medicine does not preclude private operators. While not hugely au fait with the American system, waiting lists are often a problem in countries with socialised care, and the wealthy can leap frog this by paying a premium.
posted by Sparx at 7:01 PM on November 9, 2006

squeak, things are almost that bad here in the US. Even if you have a regular doctor it can take weeks to get an appointment. I went into urgent care a while back with abdominal pain. I was told that abdominal pain means you go to the emergency room instead of urgent care which was fine, same waiting room. after waiting for six hours without being seen I went home. I have good insurance, I work for the University that the hospital belongs to. Fortunately the meds I started helped the problem. People claim the care is better here but I've heard about equal numbers of good and bad reports from people.
posted by sineater at 7:04 PM on November 9, 2006

*about 100,000 people in BC are without a family doctor btw

This is something I think people who are serious about moving towards universal health care have to take a hard look at.

In my own thought experiments, this shouldn't be any more true than it is in the United States. Because practices and hospitals are private, they should be driven by supply and demand in the same way practices and hospitals in the U.S. are. The only difference is that they receive their insurance dollars from a public entity instead of a private one.

But if what squeak's saying is broadly true, there's got to be another factor at work. My guess is that it might be that their single payer system somehow presents some kind of barrier for starting up a new practice, but I'm not sure of the precise mechanics, and I'm interested in other theories.
posted by weston at 7:05 PM on November 9, 2006

No, seriously, Ameripeeps, read the post. I don't care if it's Democrats, Republicians or goddamn yodas that do it, but someone will have to step up to the plate and be willing to risk their political future to make this happen.
posted by Brandon Blatcher at 7:10 PM on November 9, 2006

I wish that the voters would insist that their representatives in Congress have NO betterhealth insurance than that which the general public has...they have the best there is and for many of us, nothing, or not much of one.

This is a persistent myth, with the accent on myth.

Members of Congress receive the standard federal-employee health insurance. They get the same package as entry-level people who take your forms at the local Social Security office.

Likewise, they get basically standard retirement packages. They're grouped, IIRC, with FBI agents and other federal employees who for one reason or another run a serious chance of not serving for 30 years.
posted by ROU_Xenophobe at 7:13 PM on November 9, 2006

Has anyone observed that over the past fifteen or twenty years that the cost of health care has risen much faster than inflation, yet doctors' pay is not rising to match? What has made a bad system worse is the middlemen who got involved in the guise of "managing" care. Legal sequelae mean that "managed" care devolves into ass-covering at the patient's expense.

The system that needs to be allowed to work is one where doctors render treatment, rather than paperwork.

If you have ever been in a VA hospital you'll know why I think medical facilities shouldn't be run by the government.
posted by jet_silver at 7:15 PM on November 9, 2006

Holy crap. From the blog post linked by Brandon Blatcher: The province does charge a small monthly premium -- ours is $108/month for the whole family -- for the basic coverage.

I pay 33 dollars a month for the absolutely-EVERYTHING-included health care provided through my employer, in America. I guess I've got it pretty good?

Then again, I've never tried to use it, so maybe it actually sucks and just looks good on paper.
posted by synaesthetichaze at 7:17 PM on November 9, 2006

I pay 33 dollars a month for the absolutely-EVERYTHING-included health care provided through my employer

Your employer is also paying money. Under the Canadian, they would not be. and are you talking about just for yourself or for a family? If so, how many?

It costs us, a family of three, about $280 a month, not including co-pays ($20 a visits), which can ad up for our varioius health issues.
posted by Brandon Blatcher at 7:26 PM on November 9, 2006

Yeah, I realize of course that my employer pays in (a considerable amount, although I don't know precisely how much). And yes, it's just me.

I just found it odd that the system that costs so much less to society would end up costing me more, personally. I guess if all that capital isn't tied up in funding a corrupt medical system I could theoretically get paid more, though.
posted by synaesthetichaze at 7:36 PM on November 9, 2006

"...and if you end up losing out, sorry!"

I'm with you Dr Turtles all the way down. I used to tell people those "W" stickers people put on their cars stood for "What's in it for me?"
posted by jaronson at 7:47 PM on November 9, 2006

Seems to work just fine up here in canada,

...unless you require a prescription to live. Then, you have to have private insurance, or pay full price for your prescriptions.
posted by oaf at 7:55 PM on November 9, 2006

I just found it odd that the system that costs so much less to society would end up costing me more, personally.

synaesthetichaze, are you saying you pay $33 a month total for an entire family?

My employer pays 75% of my insurance costs, and I still pay twice what you pay every month. That's just for me, since I'm single. And there are still some semi-significant first-dollar costs. And I'm told that statistically I'm better off than most of Utah.
posted by weston at 7:57 PM on November 9, 2006

I have been in debates with right-wing people who hate abortion but equally hate socialized medicine. When I asked them why they are willing to let people die without medical help (anti-life), but were willing to force people to breed in poverty without health insurance (pro-life), they would always reply to the effect: "Fetuses are pure and innocent and shouldn't be killed, diseased people aren't (and should be killed)." America is slow to socialize medicine because it still serves a master-slave mentality which punishes those who get sick on the slave job.
posted by Brian B. at 8:05 PM on November 9, 2006 [1 favorite]

It's really simple, folks. As long as there are stupid people who vote, they'll continue to fuck themselves and their neighbors at the polls.

If it came down to a national referendum, it would lose. The people who would vote it down would be the same people who desperately need it.
posted by mullingitover at 8:26 PM on November 9, 2006

i just wanted to pipe in here to say, the health care industry is fine, its the health insurance industry thats broken.

think about this for just a moment. Back in the day, money used to pass between the patient and the doctor.

Now, money passes between the patient, the insurance company and the doctor.

Now think about how much juice the insurance company is pulling out of that transaction each year. What do you suppose is the annual profit of the health insurance industry each year? In the billions right? *thats* whats fucking health care. (mind you im not an economist or a doctor so ignore me as you see fit).
posted by Tryptophan-5ht at 9:14 PM on November 9, 2006

One of the biggest problems right now with the Canadian Health care system is indeed a shortage of doctors, nurses and other medical workers. These shortages are largely because the CMA was panicing in the late eighties and early nineties about there being too many doctors, thus forcing rates down. They pressured the provinces (who run the universities) to cut Med school admissions by 1/3 to 1/2. The nurses' unions likewise shtting down the nursing programs. I was in university at the time and many of my friends got hit by this. Two hundred spots one year, 120 the next. Really brought up the GPA needed to get in. I remember people with 90% averages coming out of high school getting rejected from nursing college.

So with the boomers now getting creaky knees and worse, and a demographic shortage of MDs, RNs and other two-letter acronyms, of course we're short of med staff. It's going to take about five years to correct; the provinces are only just now raising enrollments again.

Probably the bigest win of our "socialized" medicine is the drug costs. Drug prices, last year, grew at rates less than 5%, a miricale when a couple of years ago, they were increasing at more than 10% a year. The governments played hardball with the drug companies though, even threatening to make Cipro a generic during the SARS panic in Toronto (essentially revoking the patent on it---national security was the reason given). The drug companies hate, Hate, HATE Canada, but they give us their best prices. The US market is too fragmented for any HMO to pull that off, so you pay more, and get absolutely absurd bulshit from big Pharma justifying their extortionate pricing (which only the US insurers pay) shoved down your gullets to boot.
posted by bonehead at 9:15 PM on November 9, 2006 [1 favorite]

FWIW, my g/f and I had insurance through her former employer (we qualify as domestic partners) and paid about $240 a month for the coverage. It was excellent, though, since we could see any doctor at any time, but still had minimal ($10) copays for office visits and such. Even the ER was only $50, everything else was paid for in full if we used an in network doctor, otherwise there was 20% coinsurance. Best of all, there were no idiotic geographic restrictions on network doctors.

Many insurance companies that offer coverage across the country divide their territory into regions in which the insurance applies in non-emergency situations. Go out of town and get an infection or something? Pay full price out of pocket.

The COBRA stuff came the other day, and the cost to continue coverage for both of us is over $800 a month.

Now, thanks to the new employer's requirement that domestic partners be registered with the city/county/state government, and the state we live in has one of the "marriage" amendments, I can't get insurance through them. On the bright side, I can get health insurance (no dental or vision, though) with a $5000 deductible for about $100 a month. :p

Anyway, thanks to the way the new company's coverage works, she doesn't have any coverage until the beginning of next month since she started too late to be covered this month. And it covers less, and it's more expensive than the old employer.

Employer-based health insurance is absolutely ridiculous, IMO.

The other thing that's ridiculous is how much doctors and dentists discount their services for the health plan. At my dentist, a simple filling is over $100 if you're not insured, but the price for people with my (former) dental coverage was $60, of which I paid 20%. The endodontist charges almost $1000 for a root canal. Cost if you're on the dental plan? $600. It's a rip.
posted by wierdo at 9:40 PM on November 9, 2006

I'm in ur hospital socializin' ur medicine
posted by aerotive at 10:19 PM on November 9, 2006

This argument (not here, but in society at large) always seems to flow on rhetoric, not empiricism, but I'd like to quote some facts from one of the links:

"the United States spends about twice [per person - I've seen the figures] what Canada, France, and the United Kingdom do on health care (all three have socialized medicine) yet ranks lower than these countries on life expectancy and higher on infant mortality.

(note: I have actually a) read articles which detail the per capita spending on health care and b) checked CIA factbook on life expectency and infant mortality. The quote is just a nice summary)

It is undeniable that the US pays more money, and has worse health.

The private system is broken. I have no idea why anyone would defend it unless they were a) brainwashed by propaganda and lies about public healthcare (which are constantly being printed, both in the US and in countries with public healthcare) or b) really like an inefficient, expensive system which leads to poor public health.

Yes, I know that some might say that b) describes public healthcare, but I would direct them back to the facts which says that they would be wrong.

Why would anyone argue for keeping something so obviously broken? Higher GDP per capita, more densely populated, but a lower life expectency and higher infant mortality? Hearing people defend the American system is like visiting a mirror universe, where good is bad and death is life.
posted by jb at 2:41 AM on November 10, 2006

To respond to above:

All of those countries have a population an order of magnitude smaller than the U.S., and Canada's the only one I'd believe has to struggle with the regional/cultural range of differences present in the U.S....posted by weston at 2:10 AM GMT on November 10 [+] [!]

Everyone always makes the argument, oh, but we have too many people in the US!

It's a stupid argument - it's not the number of people, it's the number of people to the numbers of doctors/health care professionals/equiptment that matters. And the US has the same proportion or greater of all of those.

And the regional issue? Again, it's not the distance that costs money, the large costs are in providing care to low-density populations - a mile/doctor ratio, if you would like. The United States is much more densely population than Canada - about 10 times more densely populated - and the continental United States is probably more densely populated than Norway (which has large areas of Arctic).

It does cost a lot more money to provide health care to the northern territories of Canada - but we still do it.

As for cultural differences - well, unless you start arguing that people's bodies are entirely difference based on race, this is a bit of a silly argument. Cultural differences mean you need cultural sensitivity, maybe an afternoon of training, not more medicine. But to counter this (not very convincing) argument, I would like to point out that while the US has more non-white people, Canada is more culturally diverse. The United States has several very large non-white minority populations, most of whom are American in their culture, while Canada has a higher percentage of people born outside the country than the US. (Actually, in Toronto, where we have to deal with the most diversity and languages, we have far better healthcare than up north, where there are fewer languages. That would, of course, be because we have a dense population and a lot of doctors - many of whom are immigrants, and advertise the languages they speak.)

---------------

Frankly, I think that the the campaign for public health care in the US has entirely dropped the ball. They have empirical fact on their side, but they have let the other side dominate the debate.

If I were to do anything, I think I would start running television ads showing beautiful babies, and also babies' graves - and talk about infant mortality. Talk about how the private system "kills babies". It would be real "think of the children", but frankly, you all need to start thinking of the children.

Start running ads on people who have been bankrupted, on people who have died because they didn't have insurance.

Start telling the people - in simple words and emotionally rending pictures - exactly what terrible things socialised medicine could bring. Healthier people. More efficient medicine. Lower infant mortality. Higher life expectency.
posted by jb at 2:50 AM on November 10, 2006 [2 favorites]

$108/month for the whole family -- for the basic coverage.

In 1999-2000, my university's non-profit health plan charged $3000/year for a two person family was and $4344 for family of 3 or more. That's a NON-PROFIT plan. And it's gone up since then - but could I find the price on their website? No. Lots of crap about what good care they provide (which isn't true), but no price list.
posted by jb at 3:05 AM on November 10, 2006

I realised that I'm arguing for the pro-universal health care side to get good rhetoric, even as I denounce the anti-health care propaganda. That's because most people are narrow minded and not that bright and frankly won't be swayed by accurate yet boring facts when a flashy ad is telling them otherwise.

So the people on the side of truth need to get flashier ads.
posted by jb at 3:10 AM on November 10, 2006

Yeah, from the same people who did such a bang up job with public education and the war in Iraq, we bring you SOMETHING ELSE YOU HAVE TO PAY FOR.

Forget it.

FREEDOM DOESN'T MEAN THE CRAP YOU WANT IS FREE.

Why don't those of us that want to live as socialists band together in a PRIVATE SOCIALIST NETWORK.

Then, the rest of us who want smaller government and think that they can fend for themselves thank you very much can still have a decent free country.

Or, you can move to freakin' China. They got some socialization there I think.
posted by ewkpates at 3:26 AM on November 10, 2006

Ironically enough, China doesn't have, and never has had, either socialized or universal health care. There were "barefoot doctors" (paramedic types) providing really basic levels of health care to peasants in the Mao era (are they still functioning?), but higher levels of health care were dependent on your employment. So there would be a hospital run by the railway, but only for railway workers, etc. China also never had basic old age security. Basically, it was never socialist in the sense of having a social security net, it just had nationalised industry.

Oh, I'm sorry. These are facts, and that would interrupt your baseless screed.
posted by jb at 3:52 AM on November 10, 2006

ROU_Xenophobe writes "Members of Congress receive the standard federal-employee health insurance. They get the same package as entry-level people who take your forms at the local Social Security office."

If you honestly think that's the only coverage they have, I've got a bridge for sale.
posted by dirtynumbangelboy at 4:15 AM on November 10, 2006

Lower infant mortality. Higher life expectency.

Eheh and the conservatass, republicass, neoconass or generally people who oppose that for their benefit will claim this will ruin social security ! For some reason they are stuck in the past, possibly because their income depends from many not having an income or having a miserable one.
posted by elpapacito at 4:18 AM on November 10, 2006

Canada is the only country whose systems many Americans are likely to have heard something about

Indeed, Canada is the only country that many Americans are likely to have heard anything at all about.
posted by gimonca at 4:45 AM on November 10, 2006

The private system is broken. I have no idea why anyone would defend it unless they were a) brainwashed by propaganda and lies about public healthcare (which are constantly being printed, both in the US and in countries with public healthcare) or b) really like an inefficient, expensive system which leads to poor public health.

With all due respect, if you don't understand why people oppose socialism, then you owe it to yourself at least to find out. It's not the simple issue you guys seem to think it is.
posted by hoverboards don't work on water at 5:11 AM on November 10, 2006

My guess is that it might be that their single payer system somehow presents some kind of barrier for starting up a new practice, but I'm not sure of the precise mechanics, and I'm interested in other theories.

Serious population control by medical schools. Canada could open half a dozen medical schools tomorrow and the doctors would probably all find employment. We also make it very hard for immigrants who have trained outside Canada to work as doctors here. Plus pretty much any Canadian specialist can move to the US and make more money.
posted by GuyZero at 6:13 AM on November 10, 2006

I agree with socialized medicine, but one thorn for me is the amount of obesity in this country.

It would be difficult for me to pay more taxes when fat asses line up like cattle at the local Fried Pickle. There was a story on NPR yesterday that diabetes is the #1 illness that hospitals treat in the United States. Smoking is similar, but there has been a steady campaign to inform the public of the danger. And, while you can tell someone to stop smoking on the street, if you walk up to the parent of an obese 8 year old in Starbucks and say something like "please don't let your child order whip cream on top of that mocha chip Sundae split" you'll be a pariah. But in reality a fat kid is a overly visible sign of child abuse.

When the most underprivileged in your country are the most overweight, it is time to educate. In a way they are being exploited by ConAgra and Nabisco. Step away from the Kool-Aid and Doritos, and get thee a banana.
posted by four panels at 6:22 AM on November 10, 2006

Indeed, Canada is the only country that many Americans are likely to have heard anything at all about.

The funny part is being a Canadian and listening to US political ads about the horror of our collapsing health care system with incredibly long waits for emergency treatment. I even saw one on TV the day after I had a potentially life saving zero-wait emergency appendectomy that didn't bankrupt my family. That was 20 years ago. I'm still waiting for the collapse.

I've discussed this with a few anti-universal health care Americans(including a future wife of a surgeon) who are otherwise liberal and the answer I got roughly paraphrased was " I got mine". It seemed to be both about their needs already being met and a fear that resources would be taken away from them.

I wonder how the American health hare system would have handled the SARS outbreak?

one thorn for me is the amount of obesity in this country

Don't forget drinkers, smokers, athletes, risk junkies, drug addicts, the promiscuous, reckless drivers, people without seatbelts, criminals, meat eaters and mefi RSI warriors.
posted by srboisvert at 6:33 AM on November 10, 2006 [1 favorite]

Serious population control by medical schools. Canada could open half a dozen medical schools tomorrow and the doctors would probably all find employment.

The stupid, frustrating, crazy-making thing is that this is pretty much all at the feet of the CMA and their political dupes (you want a reason why Bob Ray is an idiot? Our current doctor shortage started on his watch). In the early nineties, the period when all of these problems started, the issues were all about doctors' pay and oversupply. Now hospitals can't find enough specialists and GPs have waiting lists for patients. The CMA and provinicial colleges of physicians and surgeons (the doctor's unions) should be decertified.

Restricting med school positions only one of the issues the colleges been lasting and horrible detriments to the Canadaian national interest: pain management? foreign doctors?---the list goes on.
posted by bonehead at 6:41 AM on November 10, 2006

Socialized medicine would be a disaster in the U.S. Just look a Britian.

Some countries, like France, can handle socialized medicine quite well.

You don't live in one of those countries.
posted by jeffburdges at 7:07 AM on November 10, 2006

Socialized medicine would be a disaster in the U.S.

Uh yeah also fridge turning off and all the food will spoil ! Oh NOES ! OMFG !
posted by elpapacito at 8:35 AM on November 10, 2006

Huh? What about Britain? The NHS works fantasticly well for me. The state of US health coverage is one reason why I would never want to live there.
posted by salmacis at 9:00 AM on November 10, 2006

I recall seeing a panel discussion on this some time ago. The gist of the discussion was that single-payer coverage is going to happen. Eventually. The major players already agree on it. The form it will most likely take is a through a steady, incremental rollback of Medicare age requirements, over a period of several years.
The problem, of course, is funding. The whole "government is the problem" crowd, coupled with American's predilection for wanting all the benefits without having to pay for them is a big stumbling block.
posted by Thorzdad at 9:22 AM on November 10, 2006

(you want a reason why Bob Ray is an idiot? Our current doctor shortage started on his watch)

Yes, because Bob Rae is primarily responsible for the recession that occurred when he came into office, putting a dent into the money available to the Ontario government.

(If you actually believe that, I'm sorry for you.)
posted by oaf at 9:47 AM on November 10, 2006 [1 favorite]

With all due respect, if you don't understand why people oppose socialism, then you owe it to yourself at least to find out. It's not the simple issue you guys seem to think it is.

Disregarding the miserly who might have their taxes raised, I found out for myself why most people are hypocrites, and why their ignorance of the national benefits of some socialized programs. Socialized education is perhaps easier to understand first. Someone who is insecure about their chances of educational success will happily pull the ladder away from anyone else in order to not embarrass themselves. Yet they hide from this reason by feigning wealth or self-importance or appealing to a false common sense such as a slippery government slope (exposing their paranoia too).

Opposing socialized medicine is even more pathological. Average opposition struggles to deny their own lower status in the world in a class system, faithfully waiting for the day they break into the big money leagues as promised. To compound this, they secretly want the uninsured to just die or go away because they are locked in direct economic competition with them. To admit equal needs or status would threaten their fantasy and their secret hope to out survive the competition.

To really understand these emotional "reasons" one only needs to examine other irrational positions such as abortion. Nobody wants to admit that old fashioned breeding and multiplying is outmoded and needs management. It's quite a human shock really. So the bottom dwellers naturally preach otherwise. Their opposition is not because they preach against, but because they are secretly powerless and must enforce a very simple dogmatic fantasy about life which features themselves as fertile, happy and powerful.
posted by Brian B. at 9:53 AM on November 10, 2006

*turns fridge off*
posted by Smedleyman at 9:57 AM on November 10, 2006

The US system is designed to benefit the rich. I've lived in both the US and the UK and have concluded that health care is one of the few things the UK is undoubtedly better at. I'm fortunate to be a middle-class suburbanite in full-time work. On the few occassions I've needed medical attention, I've been very happy with what I've experienced. When I lived in the UK I recieved equally good care from the NHS.

The significant difference is waiting time. In an emergency, far as I can tell, each works equally well, on the whole. For non-urgent treatment in the UK, you might have to wiat a bit but you'll eventually get what you need. If you're better off, you can always pay for private care sooner (private vs. state-sponsored medical care isn't an either-or thing), but the NHS is a safety net for those who can't or won't or aren't in a hurry. It's by no means perfect and will always be a political football in the UK, but it's infinitely better than no tax-funded system at all.

For non-urgent treatment, the availability, quality and immediacy of care in the US is utterly proportional to wealth. I'm fortunate and can see a competent doctor almost immediately, should I need to, because my wife and I pay hundreds of dollars a month for insurance. The thought of needing extensive treatment when unemployed or with no significant personal resources is a nightmare. It cost me a $600 out of pocket to be treated for a straightforward minor scratch to an eye when I was injured when unemployed. This system penalizes the less well who try to be careful about their finances. You can be financially destroyed, however careful you try to be, if you're unlucky enough to get sick.
posted by normy at 9:58 AM on November 10, 2006

To really understand these emotional "reasons" one only needs to examine other irrational positions such as abortion.

The fact that you can dismiss the pro-life position so simplistically shows that you have made no attempt whatsoever to engage in the arguments of your opponents. I wish I had your certainty about everything.
posted by hoverboards don't work on water at 10:19 AM on November 10, 2006

The fact that you can dismiss the pro-life position so simplistically shows that you have made no attempt whatsoever to engage in the arguments of your opponents. I wish I had your certainty about everything.

By refusing to fund of the offspring they force into the world, and exempting themselves from this personal responsibility, they reveal their irrational and incompetent moralizing.
posted by Brian B. at 10:33 AM on November 10, 2006

As for cultural differences - well, unless you start arguing that people's bodies are entirely difference based on race, this is a bit of a silly argument. Cultural differences mean you need cultural sensitivity, maybe an afternoon of training, not more medicine. But to counter this (not very convincing) argument, I would like to point out that while the US has more non-white people,

Perhaps the term culture is a poor fit for what I'm trying to get across, since it's tied up with ethnicity, which I suppose does indeed have something to do with the issue, but what I'm talking about has more to do with what you're talking about when you adress the "culture" of a company or a "culture" of corruption in congress. In terms of who we tend to lead and follow, in terms of our ideas about rewards and karma, in terms of what we respect, FedGovHMO isn't a good fit for our culture.

Frankly, I think that the the campaign for public health care in the US has entirely dropped the ball. They have empirical fact on their side, but they have let the other side dominate the debate.

And to come back to my first post in the thread, part of the problem may be that its advocates don't adequately communicate. I think I'm being misunderstood by some in this thread as an opponent of any kind of universal health coverage. I'm not that person. I believe a single payer model could be succesful, but my experience has been that many people -- on *both* sides of the issue -- don't make any distinction between it and nationalizing the entire health care industry.

And you will never get most conservatives to accept the later option. Even if they were wrong about some of the practical difficulties of doing so (and I don't think they are), the vision of an entire nation whose health care system looks like a cross between the DMV and the overwhelmed underfunded county clinic is simply going to be impossible to banish.

I *have* had some success talking to very conservative individuals about the concept of single payer insurance. Once you get the point through that the government isn't administering care at all, once you get through the point that private providers still compete in a free market for health care dollars, once you get through the point that the only thing you're replacing are the insurance companies -- who almost everyone hates -- you really increase the number of people who are willing to listen to you on the subject.

I also have noticed that there are people who'd never listen to proposals that start on the federal level who will talk with more interest about proposals that work at the state level. In some places, a state run HMO might almost be manageable, though I still think from a practical (and, again, cultural) standpoint, only touching insurance is more likely to be effective even at a local level. Still, if you're going to point to Norway as a success, it's worth pointing out they're roughly the size of a U.S. state and a little reading I did last night seems to indicate the system is municipally focused.

Ultimately what I'm trying to say here is that I don't think the problem of universal health care is out of reach for a nation with our resources. But as a hazy concept "universal health care" is going nowhere in dialogue, partly because it's too easily equated with a system that would indeed be very difficult for us to pull off well. If it's ever going to go anywhere, advocates are going to have to be able to talk specific mechanics and address practical problems sensibly.

Maybe caddis said it in fewer words.
posted by weston at 10:49 AM on November 10, 2006

All the US government needs today to do is to promise to pay 50% of every health bill presented, but leaving other paying agents in place to monitor for fraud. This is a slight increase from the 41% they currently pay (though unevenly). The instant economic benefits are threefold. Costs are controlled up front, not under the table, essentially paying for the slight increase in government spending through price caps. Secondly, almost everyone who can work becomes privately insurable and can get a job or change jobs easier, increasing productivity. Third, states can then finally afford to get into the coverage game (without attracting the uninsurable from other states), and increase local oversight and batch buying of meds (currently outlawed through lobbying).
posted by Brian B. at 11:19 AM on November 10, 2006

I have this debate with my doctor sometimes. (Yes, I actually sit and talk with my doc, even joke, rather than be shoved out the door after a five minute check-up.)

He argues that if we were socialized, I'd have to wait months for an appointment. Secondly, some of the newest drugs available in the U.S. aren't on all the provinces formularies. For my disease, Rheumatoid Arthritis, any delay in getting a treatment that works could lead to permanent disability.

Meanwhile, I go through an insurance merry-go-round here, since my husbands job doesn't provide insurance and I'm a SAHM. I'm on NYS insurance, but it caps prescription coverage at $3000 (less then three months of my current medication). This means that I'm going to have to switch to an in-patient procedure that will end up costing more money than the prescription would have. Excellent planning on the part of the insurance company.

Can the eventual move to socialized medicine be done on a state by state basis instead. I know that New York, Vermont and Massachusets are moving in that direction, are any other states doing the same?
posted by saffry at 1:57 PM on November 10, 2006

With all due respect, if you don't understand why people oppose socialism, then you owe it to yourself at least to find out. It's not the simple issue you guys seem to think it is.
posted by hoverboards don't work on water at 5:11 AM PST on November 10

With all due respect, but if you don't understand the topic of the conversation, then you owe it to yourself to at least find out.

We are not talking about socialism, aka Stalinist-Leninism.

We are talking about single payer public healthcare. It's like public education, only it saves your life!

I have asked people why they are against it. Their answers (as in this thread) consist of:

a) "but public health care isn't as good", which has been demonstrated to be WRONG. People believe it because the private health care industry has spent many years and a great deal of money lying to them about it.

b) "but it wouldn't work in the US" - why, because you are all somehow inferior to Canadians or Brits or the French? Come on, believe in yourselves!

c) "I got mine". Which is, at least, an honest answer.

But it's one to which I would answer, screw you. You want to live like an anarchist warrior, no trappings of government? Then you aren't allowed to drive on the roads, to send your kids to the public schools, etc -- and you have to foot the bill of all of these things for anyone you might employ too. You are already benefitting from all sorts of invisible subsidies from the government, subsidies which disproportionately help rich people. Including the internet, founded with public money. So if you feel that way, turn off your computer, get off the electricity grid and go fight the grizzlies for some salmon.

Because the rest of us have a society to participate in, and the healthier our society is, the more productive and wealthy it is, and the better it is for all of us.
posted by jb at 2:44 PM on November 10, 2006 [1 favorite]

Perhaps the term culture is a poor fit for what I'm trying to get across, since it's tied up with ethnicity, which I suppose does indeed have something to do with the issue, but what I'm talking about has more to do with what you're talking about when you adress the "culture" of a company or a "culture" of corruption in congress. In terms of who we tend to lead and follow, in terms of our ideas about rewards and karma, in terms of what we respect, FedGovHMO isn't a good fit for our culture.

Okay, I understand what you mean now, and that is a good point. I don't really think I agree though, because I think you are overestimating the differences between the United States and Canada and Britain. Having lived in all three places, there are some strong differences, but not as many as people might think (especially between Canada and the US).

the vision of an entire nation whose health care system looks like a cross between the DMV and the overwhelmed underfunded county clinic is simply going to be impossible to banish.

But this comment reminded me of something my husband has suggested.

Basically, public health care in the US is like public transit in Canada. It exists, but it's only used by a minority of people, and that minority is the least likely to complain. So public transit isn't that good - because the powerful articulate people don't ride the bus, any more than they go to an underfunded county clinic.

But in Canada, every single person in an area uses the same public hospital. No one can upgrade to the nicer one down the road. And that means that those hospitals (and the government that funds them) have to answer not only to the poor and inarticulate, but to middle and upper class people who have far more sway and know how to use that sway. So the hospitals and doctors' offices in Canada are just as nice as private ones in the States.

(Incidentally, this is where I feel the British combination of private-public can be quite cancerous, in addition to actually increasing wait-times for NHS care (by bleeding doctor hours and resources out of the public system). Because the richer can opt out of the system, increasingly the rest lose their advocates. The middle class are still firmly invested in the NHS for a while yet, but if they stop being so, the system will get worse.)
posted by jb at 2:53 PM on November 10, 2006 [1 favorite]

Actually, Canadian healthcare is provincially managed.

But in Canada, the provincial divisions have lead to uneven care across the country, slowed down the sharing of new technologies and new treatments (like children with spina bifida dying in Nova Scotia in the 80s, while they were treated successfully in Ontario at the same time), and gaps in health care coverage every time you change province (up to 6 months before you can get OHIP after moving to Ontario).

So I would say that it's not a good thing to have our healthcare managed by province - though it might be necessary in the States to do it by state, because of the constitutional relationship between the states and the federal government.

He argues that if we were socialized, I'd have to wait months for an appointment.

So, your doctor would plan to become a plumber if there were universal health care? Because I don't see how appointment waits would suddenly increase unless there were actually less doctors. I've waited far longer for treatment in the US than I ever did in Canada.

He is right that some drugs aren't on the formularies - just like some aren't approved by the FDA. It is a different country. That said, I used to work at an arthritis research unit (dealing with the treatment of arthritis), and drug availability did not seem to be a major issue in rheumatoid arthritis; drug costs were a problem, according to the person at the unit who happened to have RA (drugs are not covered at all in Ontario, you have to have private insurance - RA is the perfect example of why they need to be covered). Diagnosis seemed to be the biggest problem, especially considering how many people and GPs might assume it's just osteoarthritis. (I sometimes suspect my aunt has rheumatoid, but she needs to go and get a referral to a rheumatologist).
posted by jb at 3:05 PM on November 10, 2006

No one can upgrade to the nicer one down the road.

If they have enough cash, they absolutely can. It's just that they have to leave Canada to do it.
posted by oaf at 3:10 PM on November 10, 2006

saffry: Many, if not most, states are doing so, but only (or mainly) for children. AFAIK, there aren't a whole lot of states left where children of low income families don't get free care and middle class children don't get something generally equivalent to decent commercially available health insurance.
posted by wierdo at 3:39 PM on November 10, 2006

Brian B. writes "The fact that you can dismiss the pro-life position so simplistically shows that you have made no attempt whatsoever to engage in the arguments of your opponents. I wish I had your certainty about everything.

"By refusing to fund of the offspring they force into the world, and exempting themselves from this personal responsibility, they reveal their irrational and incompetent moralizing."

Precisely. Without Godwinizing the thread by way of abortion, the whole concept of the 'pro-life' stance would be less of a horrible joke if they: looked after the children in question, ensured mothers & children would have decent access to health care and education, voted against the death penalty (oh but them criminals is bad! yeah? and the religious justification you use says that you don't get to judge, motherfucker), demonstrated against war... shall I go on? Their arguments deserve to be engaged in when, and only when, they are not disgustingly hypocritical and laughable on their face.



jb writes "(up to 6 months before you can get OHIP after moving to Ontario). "

Having moved from Ontario to BC and back again, this is BS. 3 months' gap--and you're covered by your previous province's plan for that time period.
posted by dirtynumbangelboy at 7:06 PM on November 10, 2006

But if what squeak's saying is broadly true, there's got to be another factor at work.

Some factors: More female doctors, ageing population of current doctors, more physicians are specializing, cuts to educational spending, not enough residencies for foreign doctors who wish to practise here and not as many are coming to Canada, doctors are working less &c.
posted by squeak at 1:52 AM on November 11, 2006

Having moved from Ontario to BC and back again, this is BS. 3 months' gap--and you're covered by your previous province's plan for that time period.
posted by dirtynumbangelboy at 3:06 AM GMT on November 11 [+] [!]

That's good to know. I don't know if that's a change or my brother just got it wrong. (He didn't switch provinces, just addresses, but they were threatening him with cutting him off since he couldn't prove he'd lived in the province. Obviously, he wouldn't have been covered by any other province.)

But what about when you move back from other countries? My husband is Canadian, but has been living in the UK - and he'd been told he'd have several months when he would have to buy private insurance or something after he returned.

I was just saying that Canadian health care could be better, and the divisions between provinces is not a good thing. The NHS works the minute you step in the country - I've known a woman who married a Canadian and who has gone months waiting for OHIP (and insane paper work). Whereas I'm married to a dual British/Canadian citizen, and had NHS coverage the minute I arrived in Britain. I also don't have to worry about where I travel within Britain - anywhere I go, I have the same coverage. There is no reason Canada couldn't offer that.
posted by jb at 2:20 AM on November 11, 2006

dirtynumbangelboy: hoverboards wrote the comment on pro-life you're responding to; Brian B. just had a similar response.

But I also wanted to thank weston for offering some thoughtful and intelligent opposition.
posted by jb at 2:26 AM on November 11, 2006

jb writes "That's good to know. I don't know if that's a change or my brother just got it wrong. (He didn't switch provinces, just addresses, but they were threatening him with cutting him off since he couldn't prove he'd lived in the province. Obviously, he wouldn't have been covered by any other province.)"

Yeah, moving from one country to here can cause issues, as you have to prove residency in Canada before any provincial plan will cover you.

jb writes "dirtynumbangelboy: hoverboards wrote the comment on pro-life you're responding to; Brian B. just had a similar response."

I know... I'm using the MetaFilthy FF extension, and didn't check carefully to see who it was attributing the comment to.
posted by dirtynumbangelboy at 6:33 AM on November 11, 2006

But in Canada, the provincial divisions have lead to uneven care across the country, slowed down the sharing of new technologies and new treatments (like children with spina bifida dying in Nova Scotia in the 80s, while they were treated successfully in Ontario at the same time), and gaps in health care coverage every time you change province (up to 6 months before you can get OHIP after moving to Ontario).

So I would say that it's not a good thing to have our healthcare managed by province - though it might be necessary in the States to do it by state, because of the constitutional relationship between the states and the federal government.

I actually think the provincial differences are a good thing. That way the different outcomes can be compared and the better methods adopted all around. One giant monolithic system could easily have resulted in universal spina bifida deaths.

But what about when you move back from other countries? My husband is Canadian, but has been living in the UK - and he'd been told he'd have several months when he would have to buy private insurance or something after he returned.

Also 3 months.
posted by srboisvert at 8:55 AM on November 11, 2006

for OHIP at least
posted by srboisvert at 3:09 PM on November 11, 2006

We Need a "Can-Do" Attitude on Health Care
posted by homunculus at 12:32 PM on November 15, 2006

The best things in life are free ... (but war and health care are not)
posted by homunculus at 7:39 PM on November 26, 2006

Rep. Dennis Kucinich Tackles Healthcare
posted by homunculus at