16 July 2007

The Shrill One speaks

I can't add anything to this, so I present it nearly in the entirety. Krugman:

Being without health insurance is no big deal. Just ask President Bush. “I mean, people have access to health care in America,” he said last week. “After all, you just go to an emergency room.”

This is what you might call callousness with consequences. The White House has announced that Mr. Bush will veto a bipartisan plan that would extend health insurance, and with it such essentials as regular checkups and preventive medical care, to an estimated 4.1 million currently uninsured children. After all, it’s not as if those kids really need insurance — they can just go to emergency rooms, right?

O.K., it’s not news that Mr. Bush has no empathy for people less fortunate than himself. But his willful ignorance here is part of a larger picture: by and large, opponents of universal health care paint a glowing portrait of the American system that bears as little resemblance to reality as the scare stories they tell about health care in France, Britain, and Canada. The claim that the uninsured can get all the care they need in emergency rooms is just the beginning. Beyond that is the myth that Americans who are lucky enough to have insurance never face long waits for medical care.

Actually, the persistence of that myth puzzles me. I can understand how people like Mr. Bush or Fred Thompson, who declared recently that “the poorest Americans are getting far better service” than Canadians or the British, can wave away the desperation of uninsured Americans, who are often poor and voiceless. But how can they get away with pretending that insured Americans always get prompt care, when most of us can testify otherwise?

A recent article in Business Week put it bluntly: “In reality, both data and anecdotes show that the American people are already waiting as long or longer than patients living with universal health-care systems.”A cross-national survey conducted by the Commonwealth Fund found that America ranks near the bottom among advanced countries in terms of how hard it is to get medical attention on short notice (although Canada was slightly worse), and that America is the worst place in the advanced world if you need care after hours or on a weekend.

We look better when it comes to seeing a specialist or receiving elective surgery. But Germany outperforms us even on those measures — and I suspect that France, which wasn’t included in the study, matches Germany’s performance. ...

On the other hand, it’s true that Americans get hip replacements faster than Canadians. But there’s a funny thing about that example, which is used constantly as an argument for the superiority of private health insurance over a government-run system: the large majority of hip replacements in the United States are paid for by, um, Medicare.That’s right: the hip-replacement gap is actually a comparison of two government health insurance systems. American Medicare has shorter waits than Canadian Medicare (yes, that’s what they call their system) because it has more lavish funding — end of story. The alleged virtues of private insurance have nothing to do with it.

The bottom line is that the opponents of universal health care appear to have run out of honest arguments. All they have left are fantasies: horror fiction about health care in other countries, and fairy tales about health care here in America.


  1. I had a patient present to our ER, and I went down to do their vascular ultrasound (I think it was a carotid ultrasound, the patient had had a syncopal episode at a wedding).

    Anyway, the patient and her family were from Canada and they told me that they were amazed that it only took 30 minutes to get an ultrasound on a weekend. The patient's husband told me he had to wait 18 months to get CABG in Canada. I realize those are just anecdotes but it certainly paints a different picture that what Krugman is saying (That is not a little worse, that is god awful).

    Universal Healthcare will be vital though, but I would like to see more market based ones (or hybrids like Romney's Mass. plan). It might even improve physician morale. I spoke with a surgeon a week ago that said he operated all weekend and will probably make $500 because none of the patients were likely to pay. Certainly puts any med school aspirations in perspective. That sucks!

  2. Universal Healthcare is just like Environmentalism. There are just zero arguments on the other side. On the one hand is the morally superior and more efficient path, on the other hand is the stupid, immoral path. So, those opposed feel the need to argue against made up realities.

    I really don't understand it. Obviously, there will be disagreements about how to implement green living and universal health coverage. Sure. But the digging in that we see in some circles is so strange.

    My inability to understand the positions makes me ineffective in advocating for the right answer. And for that reason, I genuinely wish I could understand. But, I just can't.

  3. I think we also need to come up with some better regulation of the wording we use. I see "socialized medicine", "nationalized healthcare", "single payer" all out there. There are subtle (and not so subtle) differences to all. I personally do not believe a carbon copy of Canada or UK or anywhere will work here in US. We have our own challenges and mind-set. Also, those system have been around long enough for us to see the problems in them, but also the solutions. We need to look at all these system, then look long and hard at our own country, and devise an entirely new and unique solution that draws on the wisdom of those other countries and our own ingenuity. This current system is not sustainable and Americans will not pay 50% in taxes that it would take for 100% government funded healthcare. There is an answer out there, but we need a country committed to finding that answer.

  4. And another thing... there are arguments against it. We should not assume this is the one true and correct position for all people. That is an extremist attitude and that will end us up in trouble in the end. There is a lot to be said for people paying for their own healthcare. Not only will they benefit from the self-respect of paying for their own care, they will manage their own money better. That said, many people don't understand the importance of spending money on those regular check-ups that from which they see no immediate benefit. On the flip side, physicians (and nurses and all of us) need to rediscover the importance of service in our lives and return to donating some of our skills and time to help those patients that can't afford all our services. Each side needs to give.

    Well, I see I need to write a post about this because my comment box is going on and on. I will delete the rest and carry on this topic on my own blog... sorry for taking up all the words!

  5. And another thing... there are arguments against it. We should not assume this is the one true and correct position for all people. That is an extremist attitude and that will end us up in trouble in the end.

    There are arguments about how to change our health care system. There are not arguments that we have the best in the world. There are not arguments that our system is as good as it can get.

    Being closed minded gets us in trouble, but so does allowing fringe elements to be treated like they are not on the fringe.


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