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Britons Flee National Health System:

The Daily Mail reports:

Record numbers of Britons are travelling abroad for medical treatment to escape the NHS - with 70,000 patients expected to fly out this year.

And by the end of the decade 200,000 "health tourists" will fly as far as Malaysa and South Africa for major surgery to avoid long waiting lists and the rising threat of superbugs, according to a new report.

The first survey of Britons opting for treatment overseas shows that fears of hospital infections and frustration of often waiting months for operations are fuelling the increasing trend.

UPDATE: For those interested in some of the legal and policy questions related to "medical tourism," particularly by Americans, see this paper by Professor Nathan Cortez.

Preferred Customer:
And Americans go overseas because they are uninsured or underinsured. Which is worse? Dunno.

I cannot figure out how to link, but here's an article. Paste the URL and delete the spaces.
http:// abcnews.go.com/Business/IndustryInfo/ story?id=2320839&page=1">
10.29.2007 2:02pm
Arkady:
Google this:

americans go overseas for health care
10.29.2007 2:03pm
Rickm:
Happens in free market America too.


See Yglesias
10.29.2007 2:04pm
J. F. Thomas (mail):
And schools in this country are being shut down because of deadly staph infections.

My friend's father-in-law has waited over ten years for his hip replacement. My ex-mother-in-law died of a blood clot waiting for hers. Both live in the U.S. Claiming there are no waiting lists for surgery in the U.S. is a bald-faced lie. Here, the waiting lists are just based on your insurance coverage or ability to pay.
10.29.2007 2:10pm
guest (mail):
From:

Dental Tourism Destinations in a Nutshell

Medical Vacations Reduce Medical CostsAccording to the National Coalition on Health Care, more than 500,000 Americans traveled abroad to receive medical and dental work in 2006.” The most obvious reason Americans are taking medical vacations is affordability. For example, the difference in the cost of dental fillings between the US and many other parts of the world is quite substantial. Some of the more frequently visited dental tourism destinations include India and Thailand, but others (like Argentina, Israel, and Hungary) are quickly closing ground. India’s “economic boom” might be relatively recent, but its domination in the world of medical tourism dates back several decades.

etc...
10.29.2007 2:10pm
guest (mail):
Sorry, link in prior msg should be

medical tourism
10.29.2007 2:12pm
PLR:
Conspiciously absent from the list of destinations for health tourists: The United States of America.
10.29.2007 2:12pm
PLR:
Or, conspicuously. Must use handy preview function more often.
10.29.2007 2:14pm
WHOI Jacket:
Such a lovely system, let's copy it.
10.29.2007 2:18pm
Steven Lubet (mail):
How many Americans over age 65 (and thus eligible for government sponsored Medicare) travel abroad for health care?
10.29.2007 2:18pm
CEB:
Preferred Customer,

Quick HTML lesson: if you want to make a link (for example) to Volokh with the text "this blog," type {a rel="nofollow" href="www.volokh.com"}this blog{/a} but replace the }'s and {'s with >'s and <'s (I had to do that so it wouldn't actually come out as a link)

...or use the handy button at the top of the comment box ;)
10.29.2007 2:24pm
CEB:
oops, something got screwed up there...omit rel="nofollow" from my example
10.29.2007 2:26pm
ejo:
it's easy to have national health care. if you need an MRI, you won't get it today, however. you will get it in a couple of months. if you need anything, you will get it down the road sometime. if you need surgery "now", you will get it in six months-the heartless hmo's have nothing in comparison. be honest enough to accept the simple fact that health rationing is what comes next, for everyone.
10.29.2007 2:29pm
Preferred Customer:
CEB--thanks. I screwed around for about 10 minutes trying to get the "Link" button to work, but kept getting error messages saying that the "a href" tag was disallowed.
10.29.2007 2:35pm
PLR:

it's easy to have national health care. if you need an MRI, you won't get it today, however. you will get it in a couple of months. if you need anything, you will get it down the road sometime. if you need surgery "now", you will get it in six months-the heartless hmo's have nothing in comparison. be honest enough to accept the simple fact that health rationing is what comes next, for everyone.

Absolutely. That's not necessarily a bad thing for the population as a whole. It will be bad for the 90 year old who wants a new hip.
10.29.2007 2:37pm
guy in the veal calf office (mail) (www):
Is it possible that the numbers are goosed upward by interested parties? The article referred to cites a survey as "Research by the Treatment Abroad website", which would like to comfort its customers by saying, "well, everyone's doing it". Its easy to goose the numbers by asking, for example, "Have you ever received Medical treatment abroad?" which is not the same thing as going abroad in order to receive medical treatment.

I have the same skepticism about dental treatment. I cover mine out of pocket, have had major work and cannot believe its cost effective to travel far.
10.29.2007 2:38pm
Gregory Conen (mail):
This is still a cost issue. There are private clinics in Britain, too. But, like everything else, health care is cheaper outside the first world.

The bigger news is that people are unsatisfied with socialized medicine and that the same rising costs that are "killing" market-based medicine are "killing" socialized medicine, just manifesting as year-long wait-lists instead of high costs.
10.29.2007 2:39pm
Bpbatista (mail):
Only a Liberal would want to emulate a system that is chronically bankrupt and chronically under-performs every where that it is tried.
10.29.2007 2:50pm
JOe:
Only a progressive/ liberal/ socialist would want a system that is better for 10% of the population but worse for the remaining 90%.
10.29.2007 2:57pm
Temp Guest (mail):
To save Volokh readers time, it should be mentioned that the supposed links to sites dopcumenting that Americans go abroad for medical care are mostly advertisements from, e.g., Mongolia, suggesting that cheap care is available overseas if you apply here ...... I seriously doubt that any Americans except someone desperate for a dicey organ transplant, someone seeking risky experimental or quack therapies banned in the US, or the occassional dupe of Michael Moore actually woulkd engage in such a risky venture. On the other hand, I personally know a number of Canadians who might well have died had they not come to the US to receive care that is drastically rationed in Canada.
10.29.2007 3:09pm
J. F. Thomas (mail):
Only a progressive/ liberal/ socialist would want a system that is better for 10% of the population but worse for the remaining 90%.

Well, first off considering that more than 15% of the U.S. population are uninsured, any type of "socialized" system would be better for them. And then of course many people who do have insurance are woefully underinsured, so they would also be better off under a "socialized" system. Then of course a significant portion of the U.S. population (those covered by Medicare, Medicade, SCHIP, TRICARE, the VA and other government medical insurance programs) is already covered by "socialized" medicine (at least by your definition of the term) and gets along just fine.

Your claim that such a system would be better for only 10% of the population while being worse for the remaining 90% is patently absurd on its face.
10.29.2007 3:12pm
theobromophile (www):

I have the same skepticism about dental treatment. I cover mine out of pocket, have had major work and cannot believe its cost effective to travel far.

Depends on where you live. Some of my friends in San Diego go over the border for dental treatment - it's a mere 20 miles, and the only hassle is waiting in a 2-hour line on the I-5 to get back into the US. (Even that is optional if you taxi down and walk across the border.)
10.29.2007 3:15pm
J. F. Thomas (mail):
I seriously doubt that any Americans except someone desperate for a dicey organ transplant, someone seeking risky experimental or quack therapies banned in the US, or the occassional dupe of Michael Moore actually woulkd engage in such a risky venture.

Then I guess the stories I have seen on the news on just this topic are just more examples of the viscious left wing bias of the MSM (and the Americans interviewed in hospitals in Thailand and India just planted fakes duping credulous reporters).
10.29.2007 3:16pm
ejo:
I disagree with that premise. first off, uninsured and untreated are not synonyms for one another-illegals fressh off the boat get care and treatment courtesy of the taxpayer in Cook County. It is no different anywhere in this country. If you propose to people that, to help those uninsured, they will have to wait and wait and wait to get the care they need, how much you want to be that they won't sign up for it?
10.29.2007 3:22pm
Brian K (mail):
I seriously doubt that any Americans except someone desperate for a dicey organ transplant, someone seeking risky experimental or quack therapies banned in the US, or the occassional dupe of Michael Moore actually woulkd engage in such a risky venture.
Really? why do you doubt this? heart transplant surgeries done in india have the same or better outcome at about a tenth of the cost (and that's after you account for the cost of transporting an extremely sick individual half way around the globe).

My preceptor (MD, JD, chief of critical care at a medium sized hospital) is doing consulting work with a "large east coast insurance company" (his words) where they are looking into sending all of their heart and heart valve transplant patients to india...assuming of course that they can overcome any potential legal hurdles.
10.29.2007 3:29pm
Brian K (mail):
Your claim that such a system would be better for only 10% of the population while being worse for the remaining 90% is patently absurd on its face.

JF, I think he flipped the numbers.
10.29.2007 3:36pm
Anonymous Liberal (mail) (www):
Articles like this are so misleading. Let's consider some important facts:

1) Britain spends only 41% of the money we do per capita on health care.

2) There are private hospitals in Britain that, like here, will give you absolute top-notch care if you can afford it.

3) The reason people go abroad is because medical care is cheap in third world countries.

4) The number of "medical tourists" coming out of Britain pales in comparison to the number coming from the United States. We drive the medical tourism industry world wide.

5) Literally no one of any consequence on the left is advocating adopting an NHS-like system here in the U.S. None of the proposals being seriously considered (or offered by presidential candidates) are anything remotely like the NHS (and that includes Dennis Kucinich).

People who oppose universal healthcare should acknowledge these facts and stop pretending as if pointing out the flaws in the NHS is even a remotely compelling argument against universal care.
10.29.2007 3:36pm
AnonLawStudent:
@J.F.

Yes, TRICARE is such a marvel of modern medicine! It's great if you are a pilot or a diver, and have to be well in order to work, but for everyone else... wait three hours at cattle call for an E-8 to dole out an antibiotic and some nuprin (even though you actually have the flu), or, if you're lucky, see a flight doc who hasn't even had a residency (How many true G.P.s have you seen in the civilian world?).

There is substantial evidence that medical services need more exposure to market forces, not less. For superficial examples, note the rapid decline in prices for las*k and bre*st jobs. Maybe that 15% uninsured still won't be able to afford a heart transplant, but that hip replacement will be much more doable. As for me, maybe I would have cared that my last physical cost over $1K. But hey, I only made a $20 copay, so why should I care?
10.29.2007 3:37pm
Tony Tutins (mail):
I blame the mainstream media's ignorance of foreign languages for the fixation on Britain's NHS. The French health care system is excellent.
10.29.2007 3:41pm
Gregory Conen (mail):
J. F. Thomas:
Well, first off considering that more than 15% of the U.S. population are uninsured, any type of "socialized" system would be better for them. And then of course many people who do have insurance are woefully underinsured, so they would also be better off under a "socialized" system.
While JOe is certainly overstating his case, I'd like to point out that for certain classes of the population, being uninsured or "underinsured" is a rational choice. Young, healthy, but low-income adults may choose to risk going without rather than paying the premium. Socialized medicine would force them into the insurance system, though the payments would be in raised taxes rather than in direct premiums.

If you say "but rich people, rather than low-income people, would pay for the health care", then what you're really advocating is a specific form of wealth redistribution, which is a whole 'nother can of worms. And whose to say, if you want wealth redistribution, that in-king payment of health insurance would be better than actual money (whether a direct payment or cutting their payroll taxes).
10.29.2007 3:45pm
wooga:
Why do we want universal government run healthcare instead of the interim step of price caps and increased regulation? I thought progressives 'focus grouped' long ago to determine that price caps are more palatable than outright nationalization.

Oh wait, I know. It's because everyone but the mouth breathers learned long ago that price caps are economically retarded. So let's shoot waaay past the interim unsound policies, and go straight to the extreme "the public doesn't yet know how stupid this is" socialized lala land!
10.29.2007 3:49pm
Brian K (mail):
A small number of posters on this board are woefully uninformed and since we just had this same conversation about a month ago or so (IIRC) I'll post some interesting links that I dug up back then.

wait times in the US

comparisons of canadian and US wait times as well as concerns with the validity of the data.

------
Ejo,

if you need an MRI, you won't get it today, however. you will get it in a couple of months. if you need anything, you will get it down the road sometime. if you need surgery "now", you will get it in six months
there is not a health care system in the entire first world (at least none of the ones that we routinely compare ourselves to) that makes you wait for an emergency procedure. not canada, not england, or germany or france, etc


------
chronically under-performs every where that it is tried
hahaha...you must not read the news very often. a series of major reports contradicting this exact statement was ubiquitous last year.
10.29.2007 3:50pm
John V:
JF Thomas, you said


My friend's father-in-law has waited over ten years for his hip replacement. My ex-mother-in-law died of a blood clot waiting for hers. Both live in the U.S. Claiming there are no waiting lists for surgery in the U.S. is a bald-faced lie. Here, the waiting lists are just based on your insurance coverage or ability to pay.


Having a wife who is a medical doctor, I'll call your bluff on this one. Where in the US does your friend's family members live? There is absolutely no way that anyone can wait 10 years for a hip replacement in this country. Denmark maybe (they have (had?) a rule that mandates a 2 year wait for hip replacements since most of the patients die within two years anyway (of old age)).

We also treat non-insured patients in the emergency room all the time, regardless of their ability to pay. It's the law.

As for the 15% of the US population that is uninsured, a little less than half are illegal aliens (~30%), about 40% earn more than $50K a year, and about 20% are already covered by Medicaid and other government programs. Less than 10% of US CITIZENS have a real problem with healthcare.
10.29.2007 3:54pm
Brian K (mail):
sorry...i forgot to add the warning that the second link, "canadian and US wait times", takes you directly to a .pdf file.
10.29.2007 3:54pm
Aultimer:

Well, first off considering that more than 15% of the U.S. population are uninsured, any type of "socialized" system would be better for them.

Incorrect - a system where the uninsured receive free care is likely better. It allows the docs to leverage the paying customers' fees so that the non-paying customers get a high quality of care. Quality will inevitably suffer if you try to engineer market forces out of the system. Trust me, I used to lawyer for a health insurer.

Insurance is, by definition, risk sharing. Preventive care is, by definition, cheaper than the alternative. Both are good things that allow most people to get sufficient and good health care, but neither is the same as socialized medicine.
10.29.2007 3:55pm
JunkYardLawDog (mail):
The number of uninsured in this country is routinely reported at 45 million. That's roughly 15% of the population. 85% have insurance and like their medical care. Rationing of services (i.e. waiting lists for critical services) is always the result of government mandated universal health care. It will ruin the health care for the 85% in order to improve the health care for only a portion of the 15% uninsured.

Why do I say only a portion of the 15% will improve?

1. The poor qualify for medicare, Schip, free clinic care, and free county hospitals that are operated in most major metro areas.

2. The poor also go to emergency rooms for care and get free care because they never pay their bills.

3. Of the 45 million uninsured, how many are illegal aliens? 8 Million to 15 Million would be a conservative estimate. Why should legal citizens and residents with quality health care now, ruin there own care, be subject to rationing, in order to provide free health care for criminals in this country illegally. Its an insane idea that naturally only a dumb arse liberal could love.


So ruin the health care for the 85% in order to provide better health care to criminal aliens in this country illegally and the poor who don't qualify for the various free medical care programs. No thank you.

As for medical tourists from America, what's the percentage of these people seeking COSMETIC and DISCRETIONARY treatments versus people traveling for medically necessary and critically important care? Wanna bet the people traveling from Great Briton for care have a far HIGHER percentage of people seeking necessary non-elective non-cosmetic procedures. Same for those coming from Canada.

Pointing out that the rich in Briton can still get medical care as a defense for government mandated rationed piss poor care for the rest of us is so laughable, especially coming from liberals who otherwise hate the rich, the productive, the people who provide jobs in the real world, you know the capitalists and want to tax them out of existence.

Then there are the types of government rationed universal health care where its a CRIME punishable by JAIL TIME if you seek to pay money to jump places in line or to get care or to offer to provide care outside of the government rationed system. Hell in Canada its a CRIME to buy and try to operate an MRI machine for people unless you get the government's permission first, and the government decided that the number of MRI machines must be rationed and their locations dictated by bureaucrats in order to save costs for hospitals and clinics who would have to buy MRI machines in the first place.

Only a liberal without a clue as to how markets and prices work would think that the way to drive down the costs of something is to mandated less of it in the face of ever increasing demand. Then the liberals use price and wage controls to try and pretend they have prices under control, but the system automatically compensates by having these ridiculous decisions expressed in the marketplace as shortages, low quality care, no care, and rationed care.

How many people in the USA WITH INSURANCE are pulling out their own teeth because the waiting lines for people with insurance in Briton are too long and they can't take it? To compare to systems you have to compare those WITH INSURANCE in each system. In Briton and Canada, everyone has insurance, yet they are still pulling their own teeth, traveling abroad to get non-elective necessary medical care. The ones who can't afford that just get screwed by the system and die, but hey the liberals are happy so I guess their deaths and suffering is worth it right. Then compare those insured Britons and insured Canadians with those in the USA WITH INSURANCE and how many of them are pulling their own teeth and traveling abroad for necessary medical care because their insurance company insists on 6 month and 1 year waiting lists for critical non-elective procedures? The answer is NONE, because there are no waiting lists for medical care for people with insurance in the USA. The waiting lists for routine and non-routine for people WITH INSURANCE are reserved for the idiots who let liberals take over their economies and medical care.

Says the "Dog"
10.29.2007 4:09pm
AnonLawStudent:
@ BrianK

How about some references that are a little more reputable than "Business Week" or a medical student (who, btw, extensively cites a published critique of Canadian government statistics then proceeds to use those same statistics)? E.g.:

Coyte et al, 331 NEJM 1068-71 (1994) (consult to surgery median wait time for knee replacement was 3 weeks in U.S. and 8 weeks in Canada)

Kent, 162 CMAJ 547 (2000) (U.S. hospital marketing 2-day wait for MRI services to Canadian cancer patients who must wait 2 months for CT scan).

For those who would claim that "emergency" services are available without wait - if you are diagnosed with cancer, a CT or MRI definitely qualifies as an "emergency" service in my mind.
10.29.2007 4:20pm
theobromophile (www):
<blockquote>
4) The number of "medical tourists" coming out of Britain pales in comparison to the number coming from the United States. We drive the medical tourism industry world wide.
</blockquote>
Well, yes. There's also a lot more of us. The US has approximately 300 million people, and the UK has about 60 million.

----

Before Massachusetts reformed its health insurance laws, it cost a young, 20-something year old female about $300/month for insurance. (Been there, done that.) That did not include dental. Blue Cross of New York charges about $10,000/year. For many young or healthy people, going uninsured is a very rational choice. For families, it can be even more so (there is a certain amount of risk-sharing among the family; insurance premiums would cost about $12,000/year, and, over a few years, the money not spent on insurance is more than most procedures).

<blockquote>
As for the 15% of the US population that is uninsured, a little less than half are illegal aliens (~30%), about 40% earn more than $50K a year, and about 20% are already covered by Medicaid and other government programs. Less than 10% of US CITIZENS have a real problem with healthcare.
</blockquote>
Please add in the fact that few people remain uninsured for more than a year at a time. We may need better temporary, low-cost insurance to cover people and families in between jobs, or between school and the first job with benefits, but we do not need socialised medicine to scoop up people into insurance that are only temporarily uninsured.

Furthermore, about 8 million of the uninsured persons have family incomes of greater than $75,000/year.

<blockquote>
There is substantial evidence that medical services need more exposure to market forces, not less. For superficial examples, note the rapid decline in prices for las*k and bre*st jobs.
</blockquote>
Yes. Elective procedures (where people have to pay out-of-pocket) are highly market-driven. When is the last time you went into the doctor's office and asked beforehand how much it costs? Hell will freeze over before doctors start announcing their prices before patients have received care and a bill.
10.29.2007 4:28pm
dearieme:
"The reason people go abroad is because medical care is cheap in third world countries." Well they've been leaving here, Britain, for treatment in France and Germany, neither obviously Third World. The French govt has had to announce that it's closing its health service to retired British citizens resident in France until they turn 65. The combined sunshine/cheap property/superior NHS attractions have proved too expensive for the French state. If you chaps are going to copy someone's NHS, let it not be ours.
10.29.2007 4:34pm
Promethean:
Once you accept the premise that everyone should be provided healthcare any system will be subject to claims of draconian failures.

The real flaw of any gov't health insurance scheme is that it pillages people without regard to their judgment(i.e. their most fundamental humanity) while engaging in the pretense that it is somehow "helping" human beings.
10.29.2007 4:35pm
J. F. Thomas (mail):
Insurance is, by definition, risk sharing. Preventive care is, by definition, cheaper than the alternative.

Well the system you describe--where doctors pass on their unrecoverable costs through higher fees to their insured patients--is guaranteed to discourage preventative care. The uninsured are still going to get billed--at unrealistically high rates--and their credit worthiness will suffer. So they will be unlikely to visit the doctor until it is absolutely, and probably wait until after, necessary. Paying patients with good insurance will be hit with high copays and premiums as insurance companies try discourage doctors' visits and claims (so they don't have to pay for uninsured patients).

This is exactly what is happening now.

There is absolutely no way that anyone can wait 10 years for a hip replacement in this country.

Illinois and my ex-mother-in-law lived in TN. Of course if they could afford to pay for the surgery or had insurance they could get the operation right away. But they couldn't and are/were on the list for charity surgery.

And while it is true that emergency rooms must treat everyone (although they use all kinds of tricks to turn away uninsured patients), that doesn't mean the uninsured are treated free. The hospitals can and do bill their patients, and those bills can be economically devastating. Many if not most bankruptcies in this country are the result of medical problems.
10.29.2007 5:12pm
Andy Freeman (mail):
> Well, first off considering that more than 15% of the U.S. population are uninsured, any type of "socialized" system would be better for them.

Not so fast. "uninsured" is not the same as "gets no healthcare".

> Then of course a significant portion of the U.S. population (those covered by Medicare, Medicade, SCHIP, TRICARE, the VA and other government medical insurance programs) is already covered by "socialized" medicine (at least by your definition of the term) and gets along just fine.

If those programs are such a great deal, let's open them up to voluntary participation, at cost, for everyone.

Note that those programs are NOT producing the predicted savings. About half of Americans are in them now. They consume over 7% of GDP. The "socialized care" advocates claim that we can cover everyone for 10% of GDP, which means that those programs will have to cover 2x as many people with around 50% more money.

If you're going to argue that govt healthcare can be more efficent, please demonstrate that with the existing govt healthcare programs. Open them up to voluntary participation and watch all the folks flock to a better deal if you can deliver. If you can't make them work ....
10.29.2007 5:30pm
David M. Nieporent (www):
The ABC News article linked by Yglesias via Rickm is one of those bogus "trend" articles that Jack Shafer always dissects in Slate; it claims that something is increasing without providing any actual evidence that it is increasing.

In terms of hard evidence, it seems to be talking primarily about cosmetic treatments, which would not be covered under any national health care plan even if we had one.

In any case, the whole "Americans do it too" is not even responsive to the post. Of course some Americans would shop around and go somewhere else where treatment is cheaper. But that shouldn't happen in the alleged paradises of socialized medicine, where cost is no object and you get health insurance even if you don't deserve it.


As for JFT's cliched "15% of the population is uninsured," the number is bogus. The 45 million or 47 million or whatever the number du jour is is basically inflated and twisted in every way possible. For instance, it's only true if one counts illegal immigrants as part of "the population." And non-citizens here legally. And count people who are eligible for Medicaid but who haven't applied. And count people who are "uninsured" for a few weeks as they change jobs. And young people who are uninsured because they don't see a need to spend money on health insurance, since they're healthy. And wealthy people who don't need insurance. (Remember something liberals don't grasp: insurance is not care. Insurance is just a way to pay for care. If you're wealthy, you don't need insurance.)

In terms of the people who we'd ordinarily think of as representing a problem -- the alleged middle-class American families who the Hillary Clintons and John Edwardses of the world like to present as "typical" -- the number is closer to 10 million.
10.29.2007 5:49pm
David M. Nieporent (www):
Many if not most bankruptcies in this country are the result of medical problems.
And people who didn't read Todd Zywicki's posts might believe that.
10.29.2007 5:52pm
Aultimer:

Paying patients with good insurance will be hit with high copays and premiums as insurance companies try discourage doctors' visits and claims (so they don't have to pay for uninsured patients).

You really don't understand the current system. Premiums (and copays, which are essentially premium payments allocated to a particular time and actor) aren't set that way. Medical cost is mostly outside the insurers' control. Staff-model HMOs (Kaiser, CIGNA doc-in-a-box) are the exception, if any remain where you are.

Premium is set to cover medical cost. If you let providers refuse to give care to folks who can't pay, medical cost goes DOWN. Premiums would too. If you require more providers to give more care to folks who can't pay, medical cost goes UP, and so does premium.

If the folks who currently get "free" care got preventive care instead, medical cost would go down, with premium following. That should be the goal, but its proven difficult to implement. When you tell folks their preventive care will be "free" (or too cheap), they'll over-utilize, and increase medical cost. That's how we got where we are.
10.29.2007 5:56pm
J. F. Thomas (mail):
As for JFT's cliched "15% of the population is uninsured," the number is bogus. The 45 million or 47 million or whatever the number du jour is is basically inflated and twisted in every way possible. For instance, it's only true if one counts illegal immigrants as part of "the population." And non-citizens here legally. And count people who are eligible for Medicaid but who haven't applied. And count people who are "uninsured" for a few weeks as they change jobs. And young people who are uninsured because they don't see a need to spend money on health insurance, since they're healthy. And wealthy people who don't need insurance. (Remember something liberals don't grasp: insurance is not care. Insurance is just a way to pay for care. If you're wealthy, you don't need insurance.)

Well, there are all kinds of half-truths and lies in this paragraph. First of all, uninsured people will burden the system if they end up in the hospital regardless of their status, so if they are uninsured, no matter the reason (granted, except those who are wealthy and foolhardy enough to not need medical insurance), they are a cause for concern and cannot be dismissed easily.

Isn't one of the constant complaints about illegal immigrants that they burden our medical system. But now that is not a problem, I'm confused. As for non-citizens here legally, why on earth wouldn't they need insurance (my parents, who are 75 and 77,live in England and somehow manage to survive and thrive under the NHS, buy tourist coverage when they visit here)? It is nice to pretend that young people are healthy and don't need insurance, but one ski trip can quickly change that. An ACL repair (the most common major ski and knee injury) will set you back $50,000 or more--not to mention the couple weeks of missed work. I know this from personal experience. Even the most routine ER visit is $2000. God forbid your healthy young person gets testicular cancer (the most common cancer in young men).
10.29.2007 6:15pm
J. F. Thomas (mail):
Medical cost is mostly outside the insurers' control.

If you believe this (at least in the case of large insurers) I have a bridge I can sell you.

The large insurers negotiate prices with providers which are much lower than the "published" prices. Which means the un- and under-insured are screwed twice because they end up paying the higher price the hospital or doctor charges in order to make up for both uninsured non-paying patients and the "underpayment" he receives from insurance companies.
10.29.2007 6:20pm
springjourney (mail):
Health care is a one of the basic human rights. So Health Care system in U.S. contradicts to basic Declaration of Human Rights.
High cost of services causes delayed treatment a.k.a faster death, fear of medical bills bankruptcy killing millions.
This is not a civilized society that allow their citizen to die.

http://www.un.org/Overview/rights.html
Article 25.
(1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.
10.29.2007 6:37pm
jimbino (mail):
As I've mentioned here before apropos medical tourism, there is no provision for Amerikan expatriates, dispite the fact that they have paid lifelong to fund the Medicare and Medicaid system, to get medical evaluations, treatment, med script or the meds themselves where they live overseas. They are forced to be medical and dental tourists! Thank Darwin that all of those are far cheaper, and often better, where Amerikans like to retire, like Brazil, Mexico, Thailand, India and Costa Rica. A pox on this country and its socialism!
10.29.2007 6:40pm
wooga:
springjourney
I will start taking the UN seriously as to what constitutes a "basic human right" when they first acknowledge as a "human right": the right to private land ownership, and the right to private gun ownership. Absent those two basic rights, you are denying the poor of the ability to accumulate and protect wealth, thereby consigning them to a lifetime of poverty and its associated health problems.
10.29.2007 7:22pm
Passing By:
So we are discussing medical procedures that are available in the U.K. through the private system, but people travel to obtain them at a lower price and because they're afraid private hospitals have germs. Is this a warning about Newt Gingrich-style plans, which would reduce insurance coverage and force U.S. consumers to choose between expensive domestic procedures or the substantial cost savings they would derive from health tourism?

The knee-jerk retort that "all stories about U.S. health tourism are fake"? One hardly knows what to say to people who have so little interest in the facts. Plug your ears, cover your eyes and hum....

As for travel to a third world hospital out of fear of "superbugs", is there actually some evidence to back up the idea that hospitals in the developing world catering to health tourists are cleaner than hospitals in the developed word? That sounds like wishful thinking of the worst sort.
10.29.2007 8:16pm
Jimmy S:
1) Are the British health tourists and American health tourists driven largely by the same motive? If not--eg Yanks seek cheaper care, whereas Brits seek better care--then using American health tourism to debunk claims of superior health care quality in the US seems unreliable.

2) [Quote]First of all, uninsured people will burden the system if they end up in the hospital regardless of their status, so if they are uninsured, no matter the reason (granted, except those who are wealthy and foolhardy enough to not need medical insurance), they are a cause for concern and cannot be dismissed easily.

JF, you can't have it both ways. Either universal health coverage will provide medical care to those who aren't already getting it (in which case there will be significant social cost), or providing universal coverage will not be terribly costly because most uninsured people already shift the cost of their medical care on society by getting treatment for free at their local emergency rooms (thus throwing doubt on your postulate that large numbers of people who need care don't get it)

[Quote]An ACL repair (the most common major ski and knee injury) will set you back $50,000 or more.

Somehow, the thought of being forced at the point of the government's guns to subsidize the natural consequences of someone's risky behavior on the ski slope (or on the football field, or at the liquor store, or at the fast food joint) doesn't encourage me to support universal health care.

3) [Quote] Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family . . .

And for my daughter's health and well-being, it is essential that she be given a free pony immediately.

But seriously, have you noticed how that standard cuts both ways? The UN graciously gives us the right to subsist, but we may succeed (or even be merely comfortable) only at its whim and pleasure.
10.29.2007 8:27pm
Andy Freeman (mail):
Under socialized medicine, will overweight people pay more? How about smokers? Will they be denied treatment?

Right now, they do pay more. We can argue about whether they pay enough more, but they do pay more.

If they're not paying more, then they're going to be subsidized unless they're denied care, which guts the ethical/moral arguments of the single payer folks.

Since current govt healthcare shows that they can't deliver on the financial angle either....
10.29.2007 8:58pm
Smokey:
J.F. Thomas tells his story:
My friend's father-in-law has waited over ten years for his hip replacement. My ex-mother-in-law died of a blood clot waiting for hers. Both live in the U.S. Claiming there are no waiting lists for surgery in the U.S. is a bald-faced lie.
Ah! But J.F. Thomas doesn't mention [until much farther downthread, when he has to explain] that the wait for a new hip was because the guy was a freeloader who would rather spend his income on other things besides his own health care. And if JFT's friend's father couldn't 'afford' routine health care premiums, why didn't his friend [the guy's son] pony up and help out? Or did he enjoy seeing his dad suffer for ten years? We don't even know the guy; why should we have to pay his freight? It's not as if he couldn't afford it. Well, JFT got to tell his story; here's mine:

Last week my wife had her third hip transplant [unexpected complications from the first one resulted in two more]. So I know something about private sector care and hip replacements. One thing I know for a fact: none of the three operations took more than thirty days to schedule and perform. And I know this, too: people who think health care will improve at all when it is administered by a new layer of unaccountable bureaucrats is living in a utopian dream world.
10.29.2007 9:04pm
Promethean:
"Health care is a one of the basic human rights. So Health Care system in U.S. contradicts to basic Declaration of Human Rights."

Uh... well if someone wrote it down somewhere and a bunch of thugs voted on it, then it must be so.
10.29.2007 9:13pm
Brian K (mail):
AnonLawStudent,

My anecdote was given to counter an opinion that was not backed up with any evidence. He intuitively knows things to be true, and I personally know people that say something different. If your going do demand statistical proof of every statement you can at least try to be a little objective about it. This is especially ironic since you didn't provide any proof for your own claims concerning TRICARE. Why should I assume that you are more reputable than businessweek?

extensively cites a published critique of Canadian government statistics then proceeds to use those same statistics
I wouldn't characterize posting a link to something as "extensively cites". I am also not naive enough to think that a single article is going to get people to stop using wait times as data, esp. since it forms the majority of peoples' arguments against universal/single payer healthcare. I posted it in an attempt to get people to take wait time statistics with a (large) grain of salt. The referenced article also doesn't say that the wait time values are completely useless, just that they are not as accurate as some people seem to think they are and, like a lot of data out there, have some problems.

For those who would claim that "emergency" services are available without wait - if you are diagnosed with cancer, a CT or MRI definitely qualifies as an "emergency" service in my mind.
I've yet to meet a doctor that thinks so in all but a rarity of cases. Where is your data to show that canadians are dying in droves waiting for these CTs?
10.29.2007 9:31pm
Elliot123 (mail):
There is little reason for a healthy 25-year-old to carry his own medical insurance. All those uninsured we hear so much about include millions of people who can afford the insurance, but choose not to have it.
10.29.2007 10:15pm
Clayton E. Cramer (mail) (www):

Isn't one of the constant complaints about illegal immigrants that they burden our medical system. But now that is not a problem, I'm confused.
The point is that if we actually enforced our immigration laws, instead of bringing in cheap, easily scared labor to make corporations happy and punish unskilled U.S. citizens and legal residents, much of this uninsured problem would disappear.
As for non-citizens here legally, why on earth wouldn't they need insurance (my parents, who are 75 and 77,live in England and somehow manage to survive and thrive under the NHS, buy tourist coverage when they visit here)?
Because if I travel to Britain, the only medical care that I am entitled to from the NHS is emergency care. Anything else, I better have my own health insurance when I go over there. Ditto for anyone visiting the U.S. They better make arrangements for health insurance. It isn't free. If you are a tourist, you can't really complain about being poor. (Well, you can, but then you sound like J.F. Thomas.)
10.29.2007 10:28pm
Clayton E. Cramer (mail) (www):

There is little reason for a healthy 25-year-old to carry his own medical insurance. All those uninsured we hear so much about include millions of people who can afford the insurance, but choose not to have it.
Yes, there is a reason. Because perfectly healthy 25-year-olds sometimes get something perfectly awful, and they end up with an $80,000 hospital bill. The odds are small, but when it happens, it's bad.

Of course, when one of these irresponsible free spirits gets a bill like this, he'll bankrupt, or just skip town. The hospital then has to raise prices for the responsible sorts who have insurance or enough character to try and pay their bills.

I am not thrilled about the government being in the health insurance business. If they do, I insist that everyone that gets covered should pay for their coverage to the extent that they can. This SCHIP veto really shows the irresponsibility of the Democratic Party. If you want the government to help the poor, okay, this was supposed to be a Christian commonwealth, and that includes, as Blackstone's Commentaries observes, a provision for the needy from the most opulent. But at $83,000 a year, this isn't the poor that SCHIP was going to help. (Perhaps compared to J.F. Thomas's family, that is poor. Not to the rest of us.)

A lot of the currently uninsured can afford health insurance. They just choose not to do so.
10.29.2007 10:33pm
AnonLawStudent:
Brian K,

While it depends on type and agressiveness of cancer, it seems rather well established that delays in treatment correspond to higher mortality. This is (or at least should be) a data driven debate. Good for you to demand it! That being said, I hope you don't need me to track down something that says a surgeon won't operate on you until he has imagery of the tumors. [And I would suggest that you talk to those doctor friends you cite.] But see, e.g.:

(1) Chang, "The adverse consequences of delaying radical cystectomy" 3 Nature Clin. Prac. Urol. 300-301 (2006), which studied increasing wait times and mortality for a particular type of bladder cancer in Quebec. Although the statistics aren't the best, the study of 1,592 patients found a relative risk of 1.2 for preoperative delays > 12 weeks (95% CI 1.0–1.5; P = 0.051)

(2) Richards et al, "Influence of delay on survival in patients with breast cancer: a systematic review," 353 The Lancet 1112-13 (1999), a meta-analysis of 87 studies, found patients with delays of 3 months or more had 12% lower 5-year survival than those with shorter delays (relative risk of death 1·47, 95% CI 1·42–1·53) and those with delays of 3–6 months had 7% lower survival than those with shorter delays (relative risk of death 1·24, CI 1·17–1·30).

As for my argument regarding TRICARE, it's purely anecdotal experience is based on the 6 years I wore various insignia on my collar, including a nice 7 month TDY as a young ensign working in a military hospital. Military doctors are often very high quality, but stretched quite thin. The care-provider analogy would be a civilian receiving primary care services from a LPN, with a doctor available (in most, but not all, cases) by phone. The point being offered in rebuttal to JF's assertion that TRICARE is so fantastic. Corpsmen are among the brighter enlistees, but I don't know many people who would trust a 20 year old kid with a few months of classroom training + some OJT to treat their two year old.
10.29.2007 10:45pm
J. F. Thomas (mail):
Somehow, the thought of being forced at the point of the government's guns to subsidize the natural consequences of someone's risky behavior on the ski slope (or on the football field, or at the liquor store, or at the fast food joint) doesn't encourage me to support universal health care.

The point is that someone pointed upthread that 25 year olds don't "need" health insurance of course they do. And one way or another, the consequences of their bad decisions will be borne by society as a whole.
10.29.2007 11:35pm
Jimmy S:
Because perfectly healthy 25-year-olds sometimes get something perfectly awful, and they end up with an $80,000 hospital bill. The odds are small, but when it happens, it's bad.

I'm one of those healthy 25-year-olds (well, I'm actually 27). At this point in my law school career, my wife and I have saved around $15,000 by electing not to get health insurance. In that time, we've incurred about $3,000 in medical costs.

In my view, it would be sublimely "irresponsible" to rack up another $12,000 of student debt in order to pay for health insurance when mine and my wife's medical histories, our family medical histories, our lifestyles, and statistical evidence were all warning that health insurance premiums would most likely be money down the drain.

I agree that there's a major problem in this country with people who a) refuse to purchase health insurance, and then b) still expect someone else to pay for their medical care. But for those of us who understand the risks, who wish to reap the savings and are willing to live with--or die by--the consequences of foregoing health insurance, I think there should be an opt-out provision in any universal health care plan offered.
10.29.2007 11:57pm
Jimmy S:
The point is that someone pointed upthread that 25 year olds don't "need" health insurance of course they do. And one way or another, the consequences of their bad decisions will be borne by society as a whole.

Which, as I said above, implicitly suggests that these people are getting health care anyways.
10.29.2007 11:59pm
theobromophile (www):

It is nice to pretend that young people are healthy and don't need insurance, but one ski trip can quickly change that.

Young people could purchase catastrophic coverage only, which would cover everything over $10,000, for a very small fee (something in the range of about $15/month, IIRC).


One thing I know for a fact: none of the three operations took more than thirty days to schedule and perform.

Now, I'm too young (hopefully) for hip replacements, but have had more than my share of the medical system. My ultrasounds usually took a week, at most, to schedule. Some were that day (for potentially life-threatening issues). I once waited four months for surgery, but that was so it could be scheduled over winter break (the other option would have been to miss a week of school).


There is little reason for a healthy 25-year-old to carry his own medical insurance. All those uninsured we hear so much about include millions of people who can afford the insurance, but choose not to have it.

Well, some 25-year-olds get sick, or have accidents. They should carry some sort of insurance (at least catastrophic care, in order to limit their exposure to something that could be put on a credit card or paid off over many months), but there is no need for them to spend thousands of dollars per year.

Now, if there were really a free market for health care, healthy 25-year-olds would be able to get insurance for a pittance. The fact is, though, that some states set insurance rates which have younger, healthier persons subsidising older, less healthy persons; in other states, regulations on health care mandate that coverage include in-vitro fertilisation or the like, which does nothing to help a 25-year-old avoid crippling debt as a result of unforseen circumstances.

Yes, health care is a basic human right. So is freedom of the speech and of the press. Now, would you please have the government pay for my Washington Post?

Rights are almost always in the negative: we have the right to seek health care, free from government interference. That does not equate to the right to subsidised care.
10.30.2007 12:01am
Tony Tutins (mail):
As someone who has gone to the emergency room a couple of times, the idea that anyone could use it for a source of medical care boggles my mind. The triage system means even people with a broken bone sticking out of their arm have to wait ninety minutes. And the first step is always to fill out the insurance forms.
10.30.2007 12:51am
07 JD:

"health care is a basic human right"

I am glad to be an American and not a human being.
10.30.2007 1:22am
~aardvark (mail):
There are so many falsehoods behind the "medical tourism" claims from the Right, it's hard to keep track of all of them. There are plenty of "medical tourists" in the US--both going out of the country for cheaper and readily available treatments that have been denied here for a variety of reasons, and coming into the country to find privately performed procedures to bypass insurance systems. The latter are usually people who can afford private health care that involves no insurance of any kind. The former are generally victims of quacks and charlatans.

It is quite ironic that Britons are fleeing the perception of lethal superbugs in the local hospitals to expose themselves to hospitals in Turkey and Malaysia. Just think about that one for a second.

I also know first hand (through relatives who have followed several steps in the process) that private clinics in Turkey and other third-world countries (yes, Turkey is still third-world as far as I am concerned) offer to accelerate access to rationed procedures such as organ transplants. What happens here is quite interesting--one can be effectively on a list and pay less in these hospitals compared to a privately done procedure in the US or they can pay the same amount that they would pay here and get a transplant faster. Who said that there are no organs for sale! Plenty of kidneys in Turkey and South Africa, apparently.

Let's face it--these reports are a combination of sensationalism and propaganda at their worst. There is no substance behind this story. Jonathan, with your expertise you should be analyzing the data, not copying snippets from the Daily Mail.
10.30.2007 2:13am
Brian K (mail):
AnonLawStudent,

but I don't know many people who would trust a 20 year old kid with a few months of classroom training + some OJT to treat their two year old.
so that fact that your what a 27 year law student makes your anecdotes more relevant or more trustworthy? From your story it appears i've spend more time working in hospitals than you have. But it its acceptable for you to reply to an anecdote with an anecdote but its not okay for me? At least my first anecdote was a direct relay of information from someone well accomplished in the field of medicine. And my second anecdote is derived from what i'm told by my professors. A CT/MRI are good (and in some cases necessary), but are not "emergency" procedures.

While it depends on type and agressiveness of cancer, it seems rather well established that delays in treatment correspond to higher mortality...That being said, I hope you don't need me to track down something that says a surgeon won't operate on you until he has imagery of the tumors.
Several points about this:
1) you are exactly right that it depends on the type and agressiveness of the cancer, this essential moots any debate we can have without more detailed information on the wait times. Do the most serious ailments go first?
2) The studies show increased risk of poor outcome after 12 weeks at the least and 6 months at the most. While the information you provided shows that the wait is 2 months in canada.* The studies don't apply except in the larger theoretical sense that waits are bad. This goes along with (1).
3) there are other ways of performing imagery besides CT and MRI scans that doctors can use to operate. There are also other ways to treat cancers besides surgery. but again, this depends on type of cancer.
4) All of the studies I've seen show that the US has approximately the same cancer mortality rates as other countries. (sorry no data for this one...i'm not on my usual computer due to a cooking fire in my dorm and i can't seem to open pdfs on the computer i'm using now). so the increased waiting times are probably not having a significant impact on prognosis.

*U.S. hospital marketing 2-day wait for MRI services to Canadian cancer patients who must wait 2 months for CT scan
if the summery of the article is accurate, then this comparison is kind of useless. a hospital marketing a 2 day wait list says nothing about the national or even regional wait times (e.g. are they bumping uninsured/underinsured people for people paying top dollar out of their pocket?). It also says nothing about the wait times in canada. (e.g. is that the national average? is that this highest regional average? is like the "up to" that is common in advertisements?). Then there is the problem of why are they comparing CT wait times to MRI wait times? while there is some overlap in what they can diagnose, they are not the same tests. (some or all of these question may be answered in the article, but i'm hampared by my inability to open it right now.)

In any case, I believe the eventual solution to our healthcare problems should provide the best possible healthcare for the greatest number of people. Would any increase in cancer mortality due to increased wait times be offset by an increased number of people have access to basic cancer treatments? I don't have the data to draw a conclusion on that question, but if the answer is "yes" then I think we should switch to a more universal healthcare system.
10.30.2007 5:02am
David M. Nieporent (www):
Isn't one of the constant complaints about illegal immigrants that they burden our medical system. But now that is not a problem, I'm confused.

The point is that if we actually enforced our immigration laws, instead of bringing in cheap, easily scared labor to make corporations happy and punish unskilled U.S. citizens and legal residents, much of this uninsured problem would disappear.
That may be true, but that wasn't actually my point. My point was that no national healthcare plan is actually going to cover illegal aliens, so counting these people among those uninsured whose lack of coverage justifies socialized medicine is misleading. (If any politician announced that their plan would, it would get approximately 4 votes in Congress.)


I'm one of those healthy 25-year-olds (well, I'm actually 27). At this point in my law school career, my wife and I have saved around $15,000 by electing not to get health insurance. In that time, we've incurred about $3,000 in medical costs.

In my view, it would be sublimely "irresponsible" to rack up another $12,000 of student debt in order to pay for health insurance when mine and my wife's medical histories, our family medical histories, our lifestyles, and statistical evidence were all warning that health insurance premiums would most likely be money down the drain.
Keep in mind that precisely because of that statistical evidence, health insurance for healthy 25 year olds would be very cheap, so it wouldn't be "money down the drain." The problem is that leftist politicians promote insane ideas like "community rating," which essentially means that the rates you pay for insurance have nothing to do with the risks you face. Insurance for 25 year olds would cost precisely the amount of money that made sense -- except that you're forced to subsidize unhealthy and older people who are higher risk.
10.30.2007 7:52am
Aultimer:

Medical cost is mostly outside the insurers' control.

If you believe this (at least in the case of large insurers) I have a bridge I can sell you.

The large insurers negotiate prices with providers which are much lower than the "published" prices. Which means the un- and under-insured are screwed twice because they end up paying the higher price the hospital or doctor charges in order to make up for both uninsured non-paying patients and the "underpayment" he receives from insurance companies.


Since I've actually negotiated some of those agreements, my belief might count for something more than your bridge. Yes, there's a market for in-network provider services. The providers don't have to agree if they don't like the fee. I've never met a working MD or hospital administrator who couldn't make his mortgage or car payment, so I'll assume they're making a reasonable profit above cost, and that cost inflates annually.

The majority of insurance participants have out-of-network coverage. No negotiated rates there. Rx cost is the fastest growing piece of cost, and is many times higher than it was when I started out.
10.30.2007 10:21am
springjourney (mail):

I will start taking the UN seriously as to what constitutes a "basic human right" when they first acknowledge as a "human right": the right to private land ownership, and the right to private gun ownership. Absent those two basic rights, you are denying the poor of the ability to accumulate and protect wealth, thereby consigning them to a lifetime of poverty and its associated health problems.

Sorry, U.S. signed under that declaration, subsequently recognizing that very basic human right.
All monetary problems will be solved once government stops protecting Health Care monopolies.
10.30.2007 10:33am
springjourney (mail):
Government doing thing like capping number of doctors in the country, enforcing drug importation ban etc.
10.30.2007 10:33am
springjourney (mail):
It is all about economics. Government sponsored artificial limitation on number of doctors in this country as well as protection of drug companies from competition destroys the whole Health Care supply demand economy principles.
Are not we a country with market economy? Not in the Health Care business.
The fact is - we do not have true private Health Care, it is the same socialized medicine but extremely expensive one.
10.30.2007 10:34am
J. F. Thomas (mail):
Keep in mind that precisely because of that statistical evidence, health insurance for healthy 25 year olds would be very cheap, so it wouldn't be "money down the drain." The problem is that leftist politicians promote insane ideas like "community rating," which essentially means that the rates you pay for insurance have nothing to do with the risks you face. Insurance for 25 year olds would cost precisely the amount of money that made sense -- except that you're forced to subsidize unhealthy and older people who are higher risk.

Well no, that is the purpose of pooled risk (and why most industrialized countries cover all their populations at a lower cost--by at least 50% less--with generally better outcomes than the U.S.). By spreading the risk among a large population, you are able to cover people with chronic diseases (say 25 year olds with MS or cancer along with 50 year olds with heart disease) along with healthy 25 year olds who tear their ACL skiing.

I've never met a working MD or hospital administrator who couldn't make his mortgage or car payment, so I'll assume they're making a reasonable profit above cost, and that cost inflates annually.

The issue is not the how much MDs or hospital administrators make but what they charge un- and under-insured patients to make up for the prices negotiated with the big insurance companies. Likewise, the negotiated price of pharmaceuticals versus the retail (non-insured) cost of the same drug is staggering. Again the drug companies are shifting the cost of drugs onto those without Rx coverage.
10.30.2007 10:44am
J. F. Thomas (mail):
The point is that if we actually enforced our immigration laws, instead of bringing in cheap, easily scared labor to make corporations happy and punish unskilled U.S. citizens and legal residents, much of this uninsured problem would disappear.

So are you saying we need strong unions that will insist on worker protection, decent wages, legal workers, and adequate employer provided health insurance like we used to have in this country before the Reagan NLRB destroyed collective bargaining in this country?
10.30.2007 10:49am
Aultimer:

J.F. Thomas:

Paying patients with good insurance will be hit with high copays and premiums as insurance companies try discourage doctors' visits and claims (so they don't have to pay for uninsured patients).



The issue is not the how much MDs or hospital administrators make but what they charge un- and under-insured patients to make up for the prices negotiated with the big insurance companies.


Are you conceding my point that "patients with good insurance" won't be "hit" then?
10.30.2007 12:42pm
Henri Le Compte (mail):
I think this topic is one where liberals and conservatives get to show their "true" colors. The fact of the matter is that health care will be rationed-- to some degree-- under almost any system. Liberals favor a system where the rationing is "equally" distributed, and not influenced by such sullied notions as "ability to pay." Conservatives say "Fine. Ration if you must, but at least let me be in control to the degree that I can. If I want to spend a big amount of money for something, let me."
I might also add that the capitalist, free-market model also automatically allocates more resources into healthcare (increased demand creates increased supply). Also, the free market offers everyone at least the chance of getting health care whenever they like-- they just have to be willing to pay/sacrifice for it.
Oh, and for you free lunch types, yes... you most certainly will suffer for it in socialized medicine. Only there will be nothing you can do about it. No reward for your years of hard work. No reward for your years of frugality. No reward for any behavior of any kind. Need a hip? Go to the back of the line, right behind that drug addict there. The guy who never contributed a red cent to the system... yep, him. And wait.
Which system is more "just"?
(And, yes, it is a fact that wait times for many procedures and tests are currently much, much longer in socialized systems like Canada and England than they currently are in the US. Know why? Because the US already spends far more than they do on healthcare! Know why? Because of the free market choices of Americans! Wow!)
10.30.2007 1:32pm
Jimmy S:
No reward for any behavior of any kind. Need a hip? Go to the back of the line, right behind that drug addict there. The guy who never contributed a red cent to the system... yep, him. And wait.

What worries me--and I realize this is something of a slippery slope argument--is the possibility that government-sponsored healthcare will begin rewarding certain types of behavior by moving people who demonstrate that behavior to the front of the health care line. Those who fail to demonstrate such behavior will inevitably wind up at the end of the line, and voila! You have a government-enforced, passive euthanasia program for society's "undesirables".

Triaging patients according to their ability to pay for treatment is dirty business, but there are worse ways to do it. (Anyone remember the Star Trek Voyager episode with the planet that dispensed health care to its citizens based on each citizen's "social value", which was determined by computer?)
10.30.2007 2:03pm
advisory opinion:
Sorry, U.S. signed under that declaration, subsequently recognizing that very basic human right.
Sorry, that declaration is non-binding, so the U.S. is subsequently free not to act on it.
10.30.2007 2:22pm
Aultimer:

passive euthanasia program for society's "undesirables".


Also known as "natural causes". I can't figure out how liberals reconcile the idea that withholding healthcare from born people is immoral when aborting them isn't. I'm pro-choice, but I'm also ok with the death penalty and "passivie euthanasia".
10.30.2007 2:38pm
springjourney (mail):

Sorry, that declaration is non-binding, so the U.S. is subsequently free not to act on it.

It does not matter, as long as U.S. recognizes that right, that right exist. So we are fighting for that our very basic right. And we will win, you know that.

Wait for five more years. Percentage of retired baby boomers will double at least. At the same time cost of government supported monopolistic business called Health Care will triple or quadruple. So! Retired baby-boomers are going to have a choice either to fight against the system or go bankrupt and die slowly without necessary medication.
Those elder baby boomers will vote for Democrats and democratic health care reforms, so it is a matter of time before we have a very bad socialized Health Care, Democratic congress and democratic president for next 50 years.
10.30.2007 2:38pm
springjourney (mail):

Which system is more "just"?
(And, yes, it is a fact that wait times for many procedures and tests are currently much, much longer in socialized systems like Canada and England than they currently are in the US. Know why? Because the US already spends far more than they do on healthcare! Know why? Because of the free market choices of Americans! Wow!)


Any system is just, as long as it is not monopoly. If government allow to apply limit on number of health care professionals (especially doctors). If government protect Pharmaceutical companies from competition, while other industries are not protected. We going to have most unjust system in the World.
10.30.2007 2:42pm
advisory opinion:
It does not matter
So why quote it?

I just find it amusing that you would quote something with approval, and when it turns out that it refutes rather than supports your point, you say it "doesn't matter".

Nice flip-flop. It also means I'll take you less seriously now. Ciao.
10.30.2007 2:54pm
markm (mail):

Anonymous Liberal (mail) (www):
Articles like this are so misleading. Let's consider some important facts:

1) Britain spends only 41% of the money we do per capita on health care.

2) There are private hospitals in Britain that, like here, will give you absolute top-notch care if you can afford it.

So, there are indeed Britons that willingly pay for what their government supposedly provides as a "human right".
10.30.2007 3:03pm
markm (mail):
"It is quite ironic that Britons are fleeing the perception of lethal superbugs in the local hospitals to expose themselves to hospitals in Turkey and Malaysia. Just think about that one for a second."

Perhaps not that ironic. Control of cross-infection in hospitals is not a high-tech problem, but a labor &finance problem - you've just got to have a large enough staff cleaning continually and obsessively. In relatively high labor cost countries like the UK and USA, that means you need to spend a lot in wages. Malaysian hospitals might hire several times as many cleaners, at wages high enough to inspire them to work very hard, and still spend less. US hospitals spend the necessary money for good cleaning because it's cheaper than lawsuits (and I wouldn't be surprised to find illegal immigrants working their tails off in those jobs). British hospitals have less money to spend and fewer concerns about lawsuits...
10.30.2007 3:13pm
springjourney (mail):

Nice flip-flop. It also means I'll take you less seriously now. Ciao.

Yes Good Buy! I do not see any arguments no logic.
It does not matter whether U.S. bound or not bound to Declaration of Human Rights. As long as it recoginzes a right for Health Care as a Human Right we (the people) have legitimate cause to fight for that Right.
10.30.2007 3:22pm
markm (mail):
The Dog: "As for medical tourists from America, what's the percentage of these people seeking COSMETIC and DISCRETIONARY treatments versus people traveling for medically necessary and critically important care?"

More to the point: How many of them are people seeking necessary care who either (1) have insurance and were denied coverage, or (2) were too poor to buy insurance. I suspect group 1 is small, and group 2 only includes people living near the Mexican border - since if you can't afford insurance, you can't buy a plane ticket and have enough left over for even a third-world doctor.

So I think most Americans traveling for necessary care are either (3) relatively well-off people who chose not to spend their money on health insurance and now that they're sick have to shop for good deals, or (4) insured people who've persuaded their insurance company to finance a foreign vacation + medical care at a package cost lower than treatment in the USA. Finally, there are a few cases (5) where Americans can get better care by traveling, since the best doctors and surgical teams for a few conditions live in other countries.

The same would apply to British medical tourist, except that if I understand the British system properly, no British citizen can be in group 2, 3, or 4. So, when a Brit becomes a medical tourist or goes to a private British provider for necessary treatment, it's either because national health care does not provide the treatment in a timely manner, or because the treatment available outside their system is so much better that it's worth paying their own money for...
10.30.2007 3:29pm
J. F. Thomas (mail):
Oh, and for you free lunch types, yes... you most certainly will suffer for it in socialized medicine. Only there will be nothing you can do about it. No reward for your years of hard work. No reward for your years of frugality. No reward for any behavior of any kind. Need a hip? Go to the back of the line, right behind that drug addict there. The guy who never contributed a red cent to the system... yep, him. And wait.
Which system is more "just"?


Well, this is a nice sentiment--if all bad health and inability to pay for health care could be blamed on the individual behavior, laziness, or stupidity. But of course it isn't and can't. Are you really going to tell a child with cancer or diabetes, "hey suck it up kid, you just haven't worked hard enough or been frugal enough." How about people, who through no fault of their own, have chronic diseases--some of which can start fairly early in life--like MS or schizophrenia, that simply prevents them from working hard?

And of course in the completely market driven system you all (probably all very healthy) look forward to, these are exactly the type of situations where insurance companies are going to refuse to cover. Why on earth would they take on a chronically ill person at any price?

Are you conceding my point that "patients with good insurance" won't be "hit" then?

Indirectly they still are. The cost of healthcare has risen so much in recent years that even the best plans have seen rising copays and costs (both to employers and employees). And look at the new UAW contracts if you want to see an example of patients with good insurance who have taken a hit.
10.30.2007 3:45pm
Richard Aubrey (mail):
Young folks without health insurance aren't necessarily without health insurance. If working, there's workers comp. Auto insurance usually has medical benefits. If it's an accident, said one attorney, there's got to be somebody you can sue. Slip on a grape at the grocery store. Wouldn't be your health insurance paying, anyway.
10.30.2007 3:55pm
J. F. Thomas (mail):
If it's an accident, said one attorney, there's got to be somebody you can sue.

Gee, that's an efficient way to deliver medical care.
10.30.2007 4:03pm
Smokey:
springjourney says:
All monetary problems will be solved once government stops protecting Health Care monopolies.
Really? Name a current monopoly outside the gov't. And when Hillarycare II arrives, Big Government will be the only monopoly. All other health care providers will be jailed. Think I'm making that up?

Recall that Hillarycare depended on the big stick: any M.D. providing health care of any kind outside of the government's monopoly would be guilty of a felony.

Want to lower health care costs? Get the government completely out of the doctor business! When RK and laser eye surgery was introduced, the cost exceeded $5,000 per eye. Medical insurance did not cover any of the cost. Simply by competition alone, the free market has pushed the cost of laser eye surgery down to less than one-tenth its original cost. Over the same time frame, the cost of government subsidized medical care has increased far above the rate of inflation.

If you want an army of nameless, faceless and unaccountable tenured bureaucrats running interference between you and your doctor, government heathcare is your answer.
10.30.2007 4:40pm
Smokey:
J.F. Thomas:
The cost of healthcare has risen so much in recent years that even the best plans have seen rising copays and costs... look at the new UAW contracts if you want to see an example of patients with good insurance who have taken a hit.
Well, yes, let's look at the UAW/healthcare situation.

The direct cost of healthcare is added to the cost of every car made under UAW union contracts: $1,600 per car -- vs $200/cars made by in this country by Toyota.

Maybe it's about time that the union takes a hit. Or maybe you enjoy personally paying for the healthcare coverage of someone in Detroit whom you will probably never meet. Better that money goes into their pockets, rather than benefitting your family, huh?

This situation is still infinitely preferable to the government running the doctor business; you don't have to buy a car made by UAW union members.
10.30.2007 4:53pm
J. F. Thomas (mail):
The direct cost of healthcare is added to the cost of every car made under UAW union contracts: $1,600 per car -- vs $200/cars made by in this country by Toyota.

Well of course the reason Toyota doesn't have that crushing burden is that it doesn't have an army of retirees it has to pay healthcare benefits for because, you guessed it, its employees in Japan are covered by the government, not private industry. The way healthcare (and you can argue til you are blue in the face but the rest of the industrialized world spends a lot less and gets as good or better healthcare results--even awful old Britain--while covering everyone, than the U.S.) has been traditionally provided in this country, has left the U.S. at a competetive disadvantage.
10.30.2007 5:41pm
J. F. Thomas (mail):
Recall that Hillarycare depended on the big stick: any M.D. providing health care of any kind outside of the government's monopoly would be guilty of a felony.

You have been listening to Rush Limbaugh too much.
10.30.2007 5:43pm
J. F. Thomas (mail):
If you want an army of nameless, faceless and unaccountable tenured bureaucrats running interference between you and your doctor, government heathcare is your answer.

As opposed to an army of nameless, faceless, insurance company bureaucrats accountable to a board of directors who see every claim paid as a hit to profits?
10.30.2007 5:46pm
Thoughtful (mail):
"A CT/MRI are good (and in some cases necessary), but are not "emergency" procedures. "

I'm a radiologist. The above claim is not quite right. Whether an imaging study like CT or MRI is an emergency procedure or not is a function of the indication. If it's being done for a 6 week history of abdominal pain, it's not. If it's being done to rule out acute appendicitis, it is. But in the latter case, it's usually being ordered in the emergency room, either directly or because a doctor sent the patient to the emergency room with a request to get it. In such cases of true emergency, these studies are available within the hour in virtually all hospitals in the country. Electively scheduled CTs and MRs are available within a few days via imaging centers or hospitals seeing you on an outpatient basis. If your doctor calls and pushes, it's done the same day. It's too competitive an environment to not squeeze the patient in. Given that we can't price compete and given that the quality of the interpretation is not a competitive factor (you can't bill more for high quality interpretations, and if you perform below a certain minimum you simply don't get any business), the main competitive thrust is providing a good experience to the patient and seeing them as quickly as possible.

Many posters here are making ignorant statements comparing medical systems in different countries without a clear understanding of how things work, here or there. For example, people in America and people in Britain both seek medical care abroad. In Britain it's because a system one was forced to pay for is mandating an unacceptably long wait time. Here, it's because responsible people who won't shirk their bills seek a lower cost option. They could have the surgery here immediately. They could even have it here for "free" if they chose to declare bankruptcy or simply not pay their bill. They could negotiate the fee down after having the surgery. They choose instead to engage a contract more to their liking. There is an obvious difference between the choice of medical tourists from America and from Britain or Canada.
10.30.2007 6:10pm
Brian K (mail):
Thoughtful,

The above claim is not quite right

You're right. I should have elaborated more than I did.
10.30.2007 10:04pm
springjourney (mail):

Really? Name a current monopoly outside the gov't. And when Hillarycare II arrives, Big Government will be the only monopoly. All other health care providers will be jailed. Think I'm making that up?

American Medical Associations, Medical Board etc. They regulate a market of medical services, by preventing many fully qualified doctors to start practicing medicine.
One of their ways to keep number of doctors limited is to establish a quota for medical residencies. That is called monopoly.
Pharmaceutical companies are protected by ther government from competition abroad and from within the country. That is called monopoly.
10.31.2007 9:31am
David M. Nieporent (www):
Well no, that is the purpose of pooled risk (and why most industrialized countries cover all their populations at a lower cost--by at least 50% less--with generally better outcomes than the U.S.). By spreading the risk among a large population, you are able to cover people with chronic diseases (say 25 year olds with MS or cancer along with 50 year olds with heart disease) along with healthy 25 year olds who tear their ACL skiing.
Well, no. Insurance involves pooling risk -- not subsidizing it, which is what community rating is. Yes, you spread the risk among a large population... of people with similar actuarial risks.

25 year olds share a risk with other 25 year olds, because we don't know which will tear ACLs or get MS or cancer. (Except that we do know that 25 year olds that smoke have a higher risk, and they ought to be charged more.) They don't share a risk with 50 year olds with heart disease.

That makes no more sense than charging the same rates for earthquake insurance for people in California and in Minnesota. Maybe there's a policy argument for doing that, but it isn't insurance. It's welfare for Californians.



If it's an accident, said one attorney, there's got to be somebody you can sue.

Gee, that's an efficient way to deliver medical care.
Once again, the confusion between health care and money. Doctors deliver medical care; lawsuits, welfare, and insurance deliver money.
10.31.2007 11:40am
Aultimer:

JF Thomas -

As opposed to an army of nameless, faceless, insurance company bureaucrats accountable to a board of directors who see every claim paid as a hit to profits?

The insurance company bureaucrats don't see claim payments as a hit to profits. Can't imagine why? Look up "experience rated" and "administrative services only(ASO)" in your insurance dictionary and then look at any big insurer's Ks and Qs for the amount of each kind of customers. It's mostly employers who are stuck with paying claim dollars (and employees as the employers increasingly pass the burden on).
10.31.2007 11:42am
theobromophile (www):

Well, no. Insurance involves pooling risk -- not subsidizing it, which is what community rating is. Yes, you spread the risk among a large population... of people with similar actuarial risks.

Ditto that.

If people are not required to buy health insurance, they will not do so if it is too expensive. Only the sick, accident-prone, or risk averse will purchase it. Then you end up with mostly sick people buying it, because it is only a good deal for them. The price goes up to cover them, which further discourages healthy people from insuring themselves. So the death spiral continues.

There are two ways out of the death spiral: mandate that certain people pay for others; or allow pricing to reflect relative risk.

New York has community pricing for health insurance. If you've ever wondered what that does to the price of insurance and the aforementioned death spiral, look no further.
11.1.2007 1:49am
Aleks:
Re: 25 year olds share a risk with other 25 year olds, because we don't know which will tear ACLs or get MS or cancer. (Except that we do know that 25 year olds that smoke have a higher risk, and they ought to be charged more.) They don't share a risk with 50 year olds with heart disease.
That makes no more sense than charging the same rates for earthquake insurance for people in California and in Minnesota.

This is an astonishingly ignorant statement-- for the simple reason that no one stays 25 forever. Unless s/he dies first, every 25 year old is going to become a 50 year old. So your analogy with Minnesota and California's earthquake risk is absurd: Minnesota will not become California (at least not on any humanly meaningful time scale). Ultimately all human beings face equal risk of morbidity and mortality (which is to say 100% for the later and approaching 100% for the former). Unless we are "lucky" enough to die of some sudden trauma
we will all face chronic health problems and very high healthcare bills. That's the moral justification for community rating: we're all in the same boat. There's also a practical justification too though, not yet mentioned. The larger the group the more certain its aggregate health spending will be, due to the law of large numbers. Predicting whether one person will get cancer is largely a guessing game. Predicting the cancer rate and resulting expenses of a million people is not: one can do so with considerable confidence.
11.1.2007 10:14pm