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Monday, October 10, 2005

Medicare And Universal Health Care

Lord, I hate stupidity. I hate debates conducted without respect to reality.

QandO (a libertarian blog I really like) has a post up about the resurgence of the plan to accomplish national healthcare by extending Medicare to all. Now they have good arguments, but they don't address the basics. First, Medicare is the budget-buster, the off-the-waller, the OMIGOD we're bankrupt program. In an attempt to control costs, what Medicare has accomplished is to shift costs onto the rest of us. That was followed by the big insurance companies negotiating for similar rates, which shifted costs even more. Now it is the people who don't have insurance or have only limited insurance who bear the brunt of the costs. So if we extend the system to everyone, the cost per patient is going to go up markedly.

Find a doctor. Ask him if Medicare reimbursements usually cover his costs. He'll tell you they often don't, which is why some patients find it hard to find a doctor who will accept Medicare. Don't even ask about Medicaid. You don't want to know.

But still, our current system is much better than most of the socialized ones. One thing about the post really irked me. It was a quote by Ezra Klein:
In other countries, the idea that your "insurance" even can be denied simply doesn't exist. ...when you enter the waiting room, the only talk is about your ailment and how to treat it, not a word is said and not a thought thunk as to how you'll pay for it.
Yeah, well, that isn't really so. First, half a thought would indicate that in England, for example, the fact that many companies pay for private healthcare insurance would indicate that there is a problem with the care provided by NHS. See this explanation of how it works:
The private healthcare sector is much smaller than the NHS and does not have the same structures of accountability. It mirrors the NHS by providing GPs (many doctors in the NHS also have private practices), nursing homes, ambulances, hospitals and medical specialists, but it does not have to follow national treatment guidelines and health plans and it does not have responsibility for the health of the wider local community.

Private health insurance: Membership of health insurance schemes, such as BUPA, accounts for a large proportion of private health treatment. Many employers offer membership of such schemes or people pay for it themselves.

Secondary care in the private sector: Secondary care, which refers to more specialised health treatment such as hospitals, mental health provision and care for the elderly, is well served by the private sector. While people may be registered with an NHS GP, the private sector is often used for secondary care such as:

* Diagnostic tests for certain conditions
* One-off specialist treatment, such as visiting a dermatologist
* Specific operations in a private hospital
* Non-essential treatment such as cosmetic surgery
* Treatment for addiction or rehabilitation

Private hospitals: There are over 300 private hospitals in the UK. Private hospitals are provided by private hospital groups and the NHS also provides a number of private patient units within its hospitals. Private hospitals are licensed by the local healthcare authority, which conducts two inspections a year. They are not regulated by the national inspection bodies that monitor NHS organisations.
You pay for all of that yourself. The pay-for-service customers go in front of the line for many services. This is a page about selfpay services provided by a private healthcare organization:
In practice, private medical treatment is used for acute, elective surgery, that is conditions requiring a specific operation and where there is some discretion over timing. People who do not subscribe to health insurance schemes now realise that they can obtain private treatment on a one-off basis if the need arises and the NHS cannot respond within an adequate time period.

Many people are surprised to discover that the NHS is one of the UK's largest providers of private medical care. Many NHS Trust hospitals include a dedicated private patients unit, which offers private rooms with ensuite facilities and hotel services. In fact, NHS Trust private patients units offer a wider choice of locations (88 are listed in the CareHealth Directory) than any of the private hospital groups (the three largest have about 40 hospitals each). NHS private patient units tend to be smaller than private hospitals (they typically have ten beds) and the private hospital groups tend to offer more beds overall than NHS Trust private patient units.
Get that? Acute elective surgery? The other use is for older people, who are denied services. Maybe you think this is not happening. Perhaps you'll believe the president of the British Medical Association:
Sir Anthony, who became a consultant general surgeon in 1965 and has held many posts in the BMA, said: "There is much good in the NHS but there are also terrible problems."

It was unacceptable to have one million people facing long waits for operations, and for elderly people to be using their life savings to pay for private operations, he said.

"Looking at this lowest third of NHS performance, we are in terms of availability verging on third world medicine in what is one of the most affluent countries in the world," he said.
Here's a retired UK doctor who suggested outright killing disabled children. No kidding. If you want to know what is really happening in the NHS, try NHS Exposed. This is a website started by doctors and nurses to let people know what is happening. Perhaps socialized health care enthusiasts would find this story of an older man in the hands of the NHS enlightening. Yes, this really happened. The man survived because his daughter demanded that he be given the antidote to diamorphine. .

It can be very dangerous for a disabled or older person to go to a hospital in the UK. Olwen Gibbings was an 86 year old admitted for an ulcer to her leg. As part of her treatment she was given a high dose of diamorphine, which killed her. Read about it.

David Glass was a 12 year old with disabilities when he was admitted for a chest infection and was given a high dose of diamorphine to kill him. It was in his medical chart. His mother protested his euthanasia when she realized something was wrong and turned off the diamorphine pump. The doctors attempted to turn it back on a and a physical fight broke out. David Glass survived. His mother was arrested for causing a disturbance.

Patient abuse? Try this BBC news article. How bad is the drive to clear beds? Patient Protect has a warning about how to detect when your relative is being starved to death and a warning about diamorphine. See some personal accounts of neglect and abuse.

Don't go bringing facts into the argument. They aren't needed. You see they already know the truth so they don't need the facts.
I had to get my appendix out earlier this year and so I saw first-hand some of the very real problems we are currently having with health care in this country. But I've also lived abroad and seen their problems: long lines, medieval treatment, lack of facilities, bureaucratic run-around. Nationalization is not the answer. The only reason the NHS is holding on at the moment is because it gets a free pass in the media and because they can import cheap doctors from (and schooled in) Bangladesh, Pakistan, and India. Doctors from UK med schools are increasingly AWOL; since the system can't/won't pay for them, they go into private practice. And anybody who has enough money travels to the US for the really technologically advanced and cutting-edge surgeries and procedures anyway.

If in our discourse we could get beyond an either-or silliness in which we have to ignore the very real problems with socialized health care in order to score political points (and vice versa), we could come up with some really good and innovative options. The Economist did a good profile a few months back on the Kaiser Permanente model of health care, which seemed to provide lots of clues as to where our current system might want to go. You won't find me defending the current HMO system very passionately, but why should reform in this country necessarily mean bankrupt HillaryCare socialism?
I think the problem with our medical system in the US is the unneccessary high cost. One should question why every other products and services are getting cheaper every day but not healthcare.

It is my hypothesis that it is due to the inefficiency in the market. This inefficiency is due to over-regulation and a litigious society. If a physician has to pay an average 50,000 dollars a year to malpractice insurance; healthcare cannot be cheap.
Pedro, your point about importing docs (and nurses) is a good one. I read a lot about it when I was reading about the NHS.

You are right that there can be a different way. I would like to see a realistic debate.

Minh-Duc, the price of healthcare for privately paid things like laser eye surgery is dropping. My brother just had his done the Cadillac way, and it was only a few thousand dollars. I think our problem is that we have created perverse incentives and knocked all the competition out of the system.

As for inefficiency, part of the problem is the amazing amount of difficulty doctors and hospitals have collecting from insurance programs. That is not cost-effective.

Our current system of providing health care is superb. Our system of paying for it seems utterly perverse.
Medicare has never paid the right amount to doctors and hospitals. A medicare patient is a losing account to them.
Medicaid which everyone seems to ignore is the biggest supplier of drugs to the drug dealers and it (tax payer money of course) pays hugh amounts for the drugs.
Medicaid patients make every excuse in the world to make an ER visit and they don't mind calling 9-11 and wasting $3-700 per call to pay the ambulance charge. It's gets them streight into an ER bed. So what, they've never paid taxes so it's not their money. Hauled hundreds of the phonies...scrapiron
I personally know docs--and patients--who have fled socialized medicine in Europe and in Canada. Once the system is socialized (i.e., government controlled), bad care follows.

If you think our system is expensive now, try socializing it and see what happens. It won't be pretty.
Thanks, ScrapIron. I appreciate the firsthand knowledge. That's part of my point - people are claiming that we can nationalize the whole system under Medicare and preserve the current system, but nothing could be further from reality. Right now Medicare costs are subsidized through taxpayer funds AND through all the costs of medical care that are shifted onto other payees. If you covered everyone, the cost per person would go up sharply.

The second point you are making is just as valid. If no one has to pay, the incentive to conserve resources is lacking.

Always On Watch, I have personally talked to a number of doctors who have worked in various European socialized health care systems. They were not impressed. I heard things like "If you don't have someone to watch out for you in a hospital, you can literally starve to death."

I think Americans aren't getting the real story which is why I wrote the post.
Universal health care can be a great impact on health care system. It is unfortunate to hear so many lack health insurance. We really need to improve our health care system. Health insurance is a major aspect to many and we should help everyone get covered.
Great blog I hope we can work to build a better health care system. Health insurance is a major aspect to many.
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