Wednesday, May 03, 2006

Universal health care. Way past time for US to adopt.

As I've been super busy with various litigation matters heading to trial, I simply not had the time to pay proper attention to the world. However, Kevin Drum (Washington Monthly) has been on fire on the health care issue.

See here.

See there.

See (well not everywhere, Sir Paul), but here, too.

I strongly recommend reading his links, especially to Ezra Klein.

My three cents:

1. The reason our system is worse than reportable is that our Balkanized system does not keep track of people who fall through the cracks, don't get the type of "maintenance" treatment they need, then have expensive treatment for a few days and die. We all know people (I do at least) who fit within this scenario. The reason most of these people don't get maintenance treatment has to do with the relative lack of access to medical care. What your typical right wing or libertarian fails to note is that nearly every French, German, British, Canadian, or Japanese citizen has a government-based paper trail that the wonks for the right/libertarian axis can use to highlight each person who may still fall through the cracks in each of those nations' systems. Isn't it interesting, per Ezra Klein, how Germany and France may not have long lines, per polling, but that it is difficult to track that in their particular systems. Each system has its particular blind reporting spots, which can be remedied more easily, one should note, in a universal coverage system. Again, that is why our system (calling it a non-system is too kind as there are inputs and outputs) is even worse--and costs twice as much as most of these other nations spend on health care per capita.

2. Next time someone tells you "If we adopt universal care (sometimes called single pay), then our taxes will go up," just say: "Only if you think your premiums you pay to rich bastard corporations are not taxes. Also, if we can save health care costs per capita by losing 1,200 different companies' lawyers, sales and marketing departments, accountants, and obscene sums for executive compensation, you'll pay less overall--unless you're one of those executives making obscene amounts of money."

3. Critics of the Canadian system love to talk about it having less CAT scans per capita than in California (Canada's population is about the same as in California). However, such critics often fail to note that, in Canada, the CAT scans are running throughout the day for use by its citizens, whereas in CA the many CAT scans will go unused throughout major portions of the day (bad allocation of resources, for you economists out there). Second, yes, it is true that Canada's system has not kept up in spending for its system, largely as a result of its losing national wealth from the decline in good paying jobs--it's lost over 400,000 manufacturing jobs and the replacements have been in lesser-paying service sector jobs. That is not a reason to blame the universal coverage system (the link is from Malcolm Gladwell, who has now changed his mind and supports universal coverage).

Finally, Canada's system of health care for many regions was non-existent before Canada introduced universal coverage in the late 1960s. Since then, Canada's universal coverage led to great technological advancements, including and especially in cancer treatment and kidney and liver transplants. I don't have the time to link here, but check out David Himmelstein's and Stephanie Woolander's work at the Harvard Medical School, where they studied this in the 1980s and 1990s.

Kevin Drum, in the second link cited at the beginning of this post, says it is a "mug's game" to try and defend the Canadian system, but I say we should do that, too. I do agree with Kevin, though, that our nation's focus should be on improving access and the health of our nation's citizens. Only through a universal coverage system will these improvements occur.

(Edited)

6 Comments:

At 10:07 PM, Anonymous Betsy L. Angert said...

Dear Mitchell. .

I love the idea of universal health insurance. I am glad that you and others are speaking of this.

I wrote of the issue a time or two ago. After reading your essay, I went to one of my older posts; I wanted to share the greatest article. It spoke of entrepreneurs supporting the idea. Unfortunately, that page has been removed. Nevertheless, I will share my treatise and this interesting link to Physicians for a National Health Program.

HEALTH INSURANCE CRISIS IS THE CATALYST FOR CONSENSUS? ©
http://be-think.typepad.com/bethink/2005/05/health_insuranc.html

Physicians for a National Health Program
http://www.pnhp.org/

If you have not yet signed one of the petitions circulating on the Internet, asking Congress to pass a bill that would cover the 46-50 million without health insurance, please do.
http://www.thepetitionsite.com/takeaction/406333309
or
http://www.healthcare-now.org/petition.php?sid=3&subid=11

Thank you for informing those that fear or believe the idea is awful. It seems many have little genuine information.

It is only the giving that makes us what [who] we are. - Ian Anderson. Jethro Tull . . . Betsy

 
At 7:52 AM, Blogger Adam Sullivan said...

Mithcell -

Universal health care is a reality now.

There may be reports of exceptions (such as "patient dumping" by LA County hospitals), but Doctors are ethically complelled to treat someone regardless of their ability to pay. My sister is a trauma surgeon and fixes up plenty of gang bangers who show up in the ER with gunshot wounds for no pay. They have never turned any away (except to send them to another hospital if they can't be treated immediately).

As you know, Southern California health care providers provide a great deal of free care to the indigent in proportions far in excess of the rest of the country - a symptom of illegal immigration. The various counties in Southern California must spend billions a year covering this cost with little assistance from the Federal government.

As for Universal Health Insurance, I agree that this does not exist. However, I don't think the obstacles are purely political. As a practical matter, labor costs in health care will continue to climb for the simple reason that health care is intrinsically labor intensive. Productivity growth that graces the rest of our economy doesn't and won't ever grace medicine (at least any humane medicine - I am not sure I want to pull up to a computer, drop my drawers and "cough"). So as product delivery costs decline relative to inflation in other parts of the economy, it won't in medicine.

Add to that drug therapy costs, related r&d, patent defense and litigation costs and you see even more labor intensive (by highly specialized labor, no less, that have expectations of rising incomes) and you will never see an end to medicine gobling up a higher percentage of costs relative to other things that we like to spend money on (all of which see "more for less" value evolution via productivity growth).

The only thing that competes with medicine in seeing no benefit in productivity growth (and therefore ever rising costs relative to all else) is government - another labor intensive activity.

I frankly think people should acknowledge these economic realities and stop framing the issue with the expectation that the cost of health care will ever go down relative to all else. Without a radical change in computer technology (and I do mean radical - existing binary architecture on which all is built can't ever duplicate a doctor's intuition or wisdom, nor can it ethically put a life at risk with an intervention), this will remain. Universal Health Insurance won't lower the cost, nor keep it down unless it resorts to rationing - which is the practice in places like Canada and England.

 
At 9:29 PM, Blogger Mitchell J. Freedman said...

Adam, we ration now according to money. That was my point about how our system doesn't have a way to really report how often that truly occurs.

And it is not a good allocation of resources to wait until someone is in the emergency room to be first seen by a doctor.

There are savings from most national health insurance plan around the world. If we spent what we spend now in a national health insurance program, there would be more efficiencies and cover more people.

I don't see why we have to go to "Dr. Computer" either. In fact, one sees in various nations that have national health insurance a rise in the doctor who makes house calls. It is probably hard here due to road structures and car culture, but again, computer doctors is not a necessary requirement. Let's just try out the universal health coverage plan and work from there. This current system we have is wasteful, harmful to health and human compassion, and overly complex.

 
At 6:00 PM, Blogger Adam Sullivan said...

Mitchell -

I am not sure we disagree in the broadest of strokes - my point is that there claim that we, or any society short of the "euthenasia" prone third-reich, can expect to lower the cost of health care relative to everything else. Yet that is how Universal Health Coverage is being sold.

It is a lie. An utter lie.

If you want health care at 1950's prices, you get 1950's medicine. We all expect 21st century medicine, and the San Diego area that you and I live in is strewn with research facilities creating the next generation of medicine.

Life extending technologies that we now have simply mean that the average consumer will consume more health care in his/her life time. Completely inelastic - the demand will escalate by the demographic facts that there are more people getting older and living longer. Couple that with the capacity of our "current system" to generate more treatments (despite being "wasteful, harmful to health and human compassion, and overly complex") and you are facing a reality that no one wants to address.

Universal health insurance will not cut the cost of health coverage - it will regulate the demand. It will do the things that are done in England, where back surgery is scheduled 6 months in advance. Except, of course, for those who can afford private treatment. So you see, even then money buys the best treatment - just far fewer can afford it.

 
At 9:51 AM, Blogger Mitchell J. Freedman said...

Adam, I agree that inelastic demand is an issue in any system. However, under our current system, more people die than in a universal coverage system as more can't afford health insurance at all--or work in places where health insurance is not a benefit provided with wages.

 
At 9:55 AM, Blogger Mitchell J. Freedman said...

And let me remind ourselves where we began: Our current system is woefully inefficient in terms of duplication and allocation of resources. That is where savings are, and will continue to be in a single, government sponsored universal coverage system.

That is why I don't think it is an "utter lie" to say there will be savings in the sense of allocation of resources and more people covered for the same price under the universal coverage system. Save that phrase of "utter lie" for the Worst President and his crew!

 

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