Wednesday, August 26, 2009

The “Lies” About Socialized Medicine

From Patrick McIlheran, who is responding to the claim of liberal Paul Krugman that horror stories about socialized medicine are “lies”:

You mean like this story, just to grab one from the headlines this week? “A young mother gave birth on a pavement outside a hospital after she was told to make her own way there,” the Daily Mail reported. Carmen Blake went into labor unexpectedly, the paper reports, and called for an ambulance. Walk, she was told, since it was only 100 meters. “Her daughter Mariah was delivered on a pavement outside the hospital by a passer-by, just before ambulance crews arrived.”

Or this story, surely a wholesale fiction, in the Telegraph, about the Alzheimer patient who couldn’t get a home health aide because “because her condition was a ‘social’ rather than ‘health’ problem,” authorities said. The family won reimbursement only after their mother was bedridden and her house lost.

And surely the Telegraph was making it up when it reported that thousands of emergency patients were left waiting for hours in ambulances outside emergency rooms. This wasn’t new: For years, hospitals are fiddling with their performance stats in this way, the Daily Mail surely lied.

Paul Krugman said it’s all false, so I’m sure it was.

He also said that Canadians are happier with their health care than Americans are. Well, no: In fact, they like the price but don’t like the waits. And if you try asking parallel questions in the two countries, you find that Canadians’ satisfactions about the quality of their care and their ability actually to see a doctor is much closer to that of uninsured Americans than to insured ones. Insured Canadians are only slightly happier about health care than uninsured wretches here.

And all that for a system that’s financially “imploding,” as the incoming head of the Canadian Medical Association put it the other day. “(Canadians) have to understand that the system that we have right now -- if it keeps on going without change -- is not sustainable,” said Anne Doig, a family doctor from Saskatchewan. “Our system is crumbling around us,” she told a newspaper the other day -- and she’s a fan of government-run care.

Krugman, of course, is just throwing up blather, utterly refusing to engage with facts. This is one reason Obamacare just isn’t flying with the public: So many of its advocates, first, can’t conceal that they’d really prefer a single-payer, straight-up government-run system. And then those advocates tell you that the news stories you’re reading about Canada having to fly mothers in labor to small-town Montana to find hospital space are just fiction.

It’s not loud dissent that’s sinking the president’s dreams; it’s the overwhelming sound of cognitive dissonance, instead.

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7 Comments:

Blogger Matt Wion said...

Your posts on Health Care systems around the world are loaded with a vast number of errors.

1) You never mention the MILLIONS of horror stories here in the United States. Stories of the Uninsured who cannot get care, of the fully insured who are denied life saving care by their insurance companies, and of the countless bankruptcies and home foreclosures even among the fully insured.

If you are going to honestly compare systems you need to fully document the data and the stories of the failures of all of them.

2) You use the erroneous claim that all other countries use "socialized medicine." By which I assume you mean the Beveridge model of the NHS and/or Canada's centralized Single-Payer system.

This claim is just plain false. Look at Sweden, Switzerland, Denmark, Japan, Germany and France. These countries leave hospitals, and GP practices in private hands and they are NOT even singe payer. They have private but non-profit insurance providers who must operate according to government laws.

3) Your horrors stories come from Canada and England which - though he data available shows them to provide better health care coverage than the United States - are not even close to the top systems. If you looked more carefully and Germany, France, and Sweden, you would see a far superior model. France and Germany use the "Bismark model" which is NOT single-payer. In fact on this model most people get insurance provided through their employer (like we do), the difference is that the insurance is provided by a non-profit private company which is subject to laws which require the company to cover everyone, only charge certain rates, cover every single claim, and forbid profit.

4) We actually have your feared "Socialized medicine" in this country. Medicare is a "single-payer" system and seniors like it. Unlike private insurance companies, no on on Medicare is denied payment. And the administrative costs of Medicare are far below that of private insurance. Also Veteran's care is precisely identical to the NHS - again no one would let you take this away.

5) You speak as if Obama really were proposing "socialized medicine." None of the 3 bills in congress or the HELP bill in the senate are proposing anything like the NHS. They don't even propose single-payer! And certainly the "gang of six" is not going to produce a bill calling for socialized medicine.

Yes I know Obama once declared himself a "proponent" of single-payer, but who cares? Obama is NOT writing these bills and nobody involved in this process is proposing anything remotely near single payer

Nor is the claim that the “public option” is some Trojan Horse for Single-Payer remotely plausible. This option as it presently exists in the bills before congress is forbidden to charge Medicare rates, forced to be sustained by premiums, and – according to the CBO – would cover only 10-12 million (yes I know all about the Lewin Group numbers, but since United Health Insurance owns the Lewin Group they have not authority on this).

In short it is either dishonest or foolish to argue about "socialize medicine" or act like anything like the systems in Canada and the UK are on the table.

You have a PH. D from Harvard and are a professor of Political Science. From what I hear you are a good scholar and a fine teacher, I would then you are capable of and should actually examine real data and actually provide cogent and rational arguments.

Your posts on this topic almost make you sound like one of those cranks at town hall meetings who scream about "Hitler" and "pulling the plug on grandma." And I am quite sure you are far more intelligent and informed than such people.

Perhaps you should stop spewing talking points and offer a genuine factual and rational discussion of the merits and faults of various health care systems.

1:53 AM  
Blogger John McAdams said...

You never mention the MILLIONS of horror stories here in the United States.

No, I rely on the mainstream media to do that.

Look at Sweden, Switzerland, Denmark, Japan, Germany and France.

The problem is that liberals aren't much interested in anything but Canada. They want single payer because they want control.

Actually, we have the best model here in the U.S. It's called the competitive market with government subsidizing care for people who can't afford it.

You are aware,I hope, that a large portion of the "uninsured" are voluntarily uninsured. They aren't poor (if they were they could get Medicaid), they just don't want to pay the premiums.

I'm all for forcing everybody to have insurance, since the uninsured are freeloaders. They get care, but everybody else pays.

though he data available shows them to provide better health care coverage than the United States

Uh, no. If you look at indicators that reflect the quality of care the U.S. does better.

Consider prostate cancer, for example.

We actually have your feared "Socialized medicine" in this country. Medicare is a "single-payer" system and seniors like it. Unlike private insurance companies, no one on Medicare is denied payment.

They like it because the care is "free." But they like Medicare Advantage better, and that's through private insurers, and Obama wants to destroy that.

And Medicare most certainly does deny certain procedures.

Why do you think so many seniors have "MediGap" coverage?

And when Obama gets through taking a half trillion dollars out of Medicare, there will be a lot more care denied.

VA health care is actually quite poor -- but, of course, people don't like "free" care taken away.

And certainly the "gang of six" is not going to produce a bill calling for socialized medicine.

I don't know. Clearly, the liberals Democrats want single payer, which is socialized medicine. They may fail, but let's be clear on what they want.

Obama is NOT writing these bills and nobody involved in this process is proposing anything remotely near single payer

Not true. "Public option" is a trojan horse for single payer.

Check out Barney Frank.

Obama may not now admit he wants single payer, but has he really changed his mind?

You don't understand the ideological drive to power that motivates liberals. They simply want control.

forbidden to charge Medicare rates, forced to be sustained by premiums, and – according to the CBO – would cover only 10-12 million

The CBO numbers are for the first two or three years, before a "firewall" designed to protect private insurance companies breaks down.

And the "forbidden to charge Medicare rates" rates thing is something that Republicans proposed in one committee, and Democrats voted it down!

Of course, anti-socialized medicine people may win on this narrow issue, but can any government-run operation be a fair competitor with the private sector?

And again, liberal Democrats don't want fair competition. They want the government to run everybody else out of the business.

12:10 PM  
Blogger John McAdams said...

More for Matt,

Your posts on this topic almost make you sound like one of those cranks at town hall meetings who scream about "Hitler" and "pulling the plug on grandma." And I am quite sure you are far more intelligent and informed than such people.

You sound like somebody who gets all his news from the New York Times and NPR. Most of the comments at town hall meetings have been civil, and ask good questions.

As for "pulling the plug on Grandma:" do you know who Ezekiel Emanuel is? You need to find out.

Since you have broached the ad hominem, let me observe that as a philosopher, you tend to believe that it's just a matter of having good will and feeling an obligation to "help people."

But first, some people who use the rhetoric of "helping people" really have another agenda, and second, how one "helps people" often involves nettlesome empirical questions.

Government, operating on supposed good intentions (and you need to remember that intentions are always mixed at best) has often made things worse.

12:11 PM  
Blogger Matt Wion said...

Thank you for your replies here. I find them quite a bit more helpful then some of the posts.

I do know that Barney Frank and others would like Single-Payer or maybe even something like the NHS. I highly doubt this has to do with a great "lust for power." It seems to me they really think this is the best system.

I used to think the same about Single-Payer. But I have changed my mind. I greatly prefer the Bismark model found in France and Germany (and, in a watered down way) here.

I am the first to admit that some of my allies on the left don't face up to the problem of long wait lines and scarce resources in Canada.This really is a serious problem.

But your point that we do better with Cancer is a bit shortsighted. In some ways our system is preferrable to Canada's. Part of the reason they have a lower survival rate for cancer is indeed waiting lists.

What you fail to note however, is that Canadians have better overall health. Longer life spans, less infant mortality, and far fewer deaths from things like diabetes. We may be better for hip-replacements (which by the way are usually paid for by OUR single-payer system: Medicare) and some kinds of cancer ... but not really much else.

But again, look to France and Germany. They actually have shorter waits than we do.

Our model is not the best. Health care economics is very simply. A private-for-profit company exist for simply one reason: to maximize profits. If I actualy pay for every claim or offer good coverage to the seriously ill, then I cannot maximize profits. All the incentives are on the side of denying care.

What you say about the unisured just choosing to be that way is actually quite insulting and offensive. I know many people who simply can't afford the premiums because they are rising 2-3 times as fast as wages. Also, I know of legions of people who are not given health care because they have a "pre-existing" condition.

You champion a health insurance system in which people are regularly denied isnurance, forced to pay ever increasing premiums, driven into bankruptcy, and then denied claims whenever the insurance company can get away with it.

We don't have anything like the best system. Millions who can't get insurance - and yes it's reall CAN'T and legions who go bankrupt from medical bills - even when they are fully insured!! Is not the best system.

As for your greatly feared "Public Option." As I said before in other countries that use the Bismark model people are covered by private insurance companies. These companies are, however, non-profit ... the profit motive is the problem. Why? Again, I can't make profit if I cover really sick people, or pay every claim. This has bee known by health economists since the 1960s. And it's easy to see in practice.

The idea of the public option is to keep costs down and coverage of claims high by having for profit insurance compete with a non-profit insurance.

I'd be willing to drop the publi option only on one condition: that all private insurance companies be non-profit and all claims must be covered. Barring that, a public option is the only way to weaken the poison of the profit motive.

Study after study has concluded that the United States is far from the leader on health care coverage. You can't change the facts just to fit your free-market ideology.

12:33 PM  
Blogger Matt Wion said...

You wrote:


"The problem is that liberals aren't much interested in anything but Canada. They want single payer because they want control."

This is a silly claim. Once again you group all "liberals together, as if we all believe the same thing. This shows nothing more than the fact that you hate liberals and are biased against them.

I am a liberal and I do not think the Canadian system is the ideal. I greatly prefer the French and German models.

As for all Liberals craving power? Absurd! Some liberals surely do, some conservatives do, some don't.

People like Barney Frank or Bernie Sanders or Athony Weiner favor single-payer because they think it is the best Health care system. I think a bit differently then they do.

You wrote

"Actually, we have the best model here in the U.S. It's called the competitive market with government subsidizing care for people who can't afford it."

You are either being dishonest or you are simply not very informed. A vast number of studies and a great deal of Data are clear on this. Most other industrialized countries do far better on health factors: life-span, infant mortality, treatment of preventable disease.

You are saying that a system that leaves millions unisured, allows private companies to deny coverage of bills even to the fully insured, causes most of our bankruptcies and many home foreclosures, and costs us more per capita and more % of our GDP ... is the best system in the world. That is, frankly, Stupid.

Ah but you reply:

"You are aware,I hope, that a large portion of the "uninsured" are voluntarily uninsured. They aren't poor (if they were they could get Medicaid), they just don't want to pay the premiums."

I am not aware of it because it is not true. Premiums are rising 2-3 times the price of wages. I know of many who simply cannot afford insurance. It is very hard to get medicare. Many people are dirt poor and still don't qualify. In 43 states you can be totally broke and still not qualify.

Also, I know many people who have pre-existig conditions and are not therefore allowed to buy private insurance.

This is not "the best system."

The reason for our problems is that for profit insurance must deny care to make a buck. Why? You cannot maximize your profits if you pay every bill or the most expensive bills. So Insurance companies regularly don't pay these bills.

This has been known by Health care economists since the 1960s. To pretend it is not true is to either refuse to accept the truth because of one's free market ideology or to just be uniformed.

The point of a "public-option" is to offer a non-profit health insurance alternative. If private insurance companies want to compete with a non-profit plan, they must lower prices and deny far fewer claims. Since the chief problem with our system is that for profit companies MUST deny care to maximize profits for their shareholders, this can only be a good thing.

2:27 PM  
Blogger Nathan M. Blackerby said...

This blog post is quite reasonable. It doesn't equate the public option with so-called socialized medicine; the citation provides clear counter-evidence to Krugman's claim that the horror stories about socialized medicine are lies. To be sure, many opponents of any form of public care may engage in hyperbole a bit when they use these horror stories as examples. But that doesn't change the fact that they are still horror stories, examples of certain negative consequences that follow from adopting a single payer system. Of course, this is not sufficient evidence to altogether dismiss the single payer approach. The benefits of such a system could still outweigh the costs, but there is certainly no sin in pointing out the costs.

Your rely to Matt isn't altogether unreasonable either. Canada does have funding problems with their health care system, and their citizens struggle with longer waits (another negative consequence of a single payer system) compared to insured Americans. There are are also numerous drawbacks to Medicare and VA.

However, the following notions, 1) that the public option is nothing more than a Trojan horse for single payer, 2) that all liberal Democrats are after is control, and 3) that liberals are only interested in Canada because they want single payer, amount to nothing more than speculation. I'd like to see better,

4:05 PM  
Blogger Matt Wion said...

Nathan Blackerby wrote:

"that doesn't change the fact that they are still horror stories, examples of certain negative consequences that follow from adopting a single payer system"

Correct.

And this is how one rationally considers health care systems. THEY ALL HAVE NEGATIVE CONSEQUENCES. No system is perfet.

We should look at various models in various countries and carefully determine which health care system is better than the others, and how well it is likely to work in our country.

I have come not to prefer single-payer, and I think an NHS model is even less desirabe. But I did not assume this from the start, I read about and observed various systems.

What we cannot do is simply point out failures of single-payer systems, pretened that our system does not have such "horror stories" and then create a false dilema by saying that "there is just free-market health care on the one hand, and "single-payer" on the other."

But this is what many do ... and it is absurd.

As for the author mentioned in the post who argued against Paul Krugman. That author has either never read Paul Krugman or he is just lying. Paul Krugman does not think or argue as that author said he does. Krugman has NEVER claimed that "all criticisms of single-payer systems are lies." Krugman has said that there are many lies about such systems; and there are.

7:03 PM  

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