Cheeseburgers and death: de-socializing health care

By Edward Hadas
December 7, 2011

By Edward Hadas
The opinions expressed are his own.

Americans are both the fattest people in the world and the biggest spenders on health care. Both those facts can be traced, at least in part, to a common attitude.

First a few numbers. The latest global handbook from the Organization for Economic Co-operation and Development (OECD) shows that 34 percent of Americans are obese by the criteria of the World Health Organization. In health care spending, the United States leads with 17 percent of GDP. In both categories, U.S. numbers are almost twice as high as the average numbers of OECD members.

The extra fat accounts for only a small portion of the extra American spending on health care. Researchers recently estimated that the medical expenses caused by obesity, which is connected to problems such as high blood pressure, heart disease and diabetes, amounted to $147 billion in 2008. That number suggests that even if Americans were no fatter than the OECD average, they would only spend 3 percent less on health care than they do now.

I believe there is a more significant connection between the obesity problem and the amount Americans spend on health care than these numbers suggest. Both the choice to eat too much and the choice to pay up for almost everything labelled “medical expense” are spawned by an attitude which can be called health willfulness. The United States leads the world in this attitude, but it, along with obesity and health care spending, is probably on the rise almost everywhere. It helps explain why spending on health care increased from 4 to 10 percent of GDP since 1960 for the entire OECD.

Health willfulness is the belief that it is my right to decide what to do with my body. If I want to eat without concern for my health, so be it. When it comes to health care, I expect the modern medical system to satisfy my desires, whether for help in getting slim again or for heroic efforts to prolong my life. Money should not matter.

The attitude fits with the modern culture’s enthusiasm for individualism and consumer choice, but it has some unattractive consequences. The damage caused by a willful approach to eating is plain to see. The damage caused by willful health care is harder to see because it can be obscured by the sensitivity of life and death matters. Is it not better to favor life, whatever the cost? But the willful approach to medical care has made the American system sickly. Too much is spent on care that pleases vain or desperate patients and family members, without doing much for health. As much as one-third of total spending is dedicated to care during the last year of life.

There would be less to complain about if the high cost of these willful choices were born only by those who make them. But direct payments from patients account for only 12 percent of the total medical spending in the United States. The rest of the funding comes from society as a whole, through plans run either by governments or by heavily regulated insurers. In effect, health willfulness is usually an individual’s decision about how to spend everyone’s money.

The socialization of medical costs has much going for it. Both the mixed American and European systems and the more monolithic British arrangement provide the poor with care they could not otherwise afford. Socialization also spreads the burden of expensive treatments over a lifetime and the costs of sickness over well and sick alike. But the combination of medical socialization with health care individualism has increased total health spending and created involuntary subsidies from those who chose fewer interventions to those who choose more. In most rich countries, both the economy and justice would now be served by a partial de-socialization of health care.

How to do it? One approach is already standard practice in many American and European arrangements — make patients pay part of the cost. These plans would be more effective and just if the fees were calibrated to incomes, so rich and poor people felt the same economic pain. (Speeding fines are set this way in Finland.) Another approach is to allow people to opt out of the socialization of costs for selected treatments. They could choose an insurance plan which excludes, for example, serious operations for people over 80 or treatments for cancer which add less than one year to life expectancy. The frugal would pay less and get less. Alternatively, the standard health insurance policy could cover less than it currently does. Higher priced policies would be available so the most willful could still satisfy their health care desires.

The practical details of medical de-socialization — setting prices and dealing with late changes of mind — are tricky. But it’s worth a try. We’re more careful about expensive things when we have to pay for them out of our own pocket.

Photos, top to bottom: A cheeseburger is pictured at a Five Guys restaurant in Washington May 26, 2010. REUTERS/Yuri Gripas; A passenger waits for a delayed flight at Heathrow airport’s terminal four in London August 12, 2006. As healthcare costs in such heavyweight nations as the United States and heavy-smoking locations as Dundee keep rising, and as governments move to cut huge budget deficits, hundreds of local authorities, employers and health insurers – even the occasional former investment banker – are dabbling with health incentive schemes. REUTERS/Toby Melville

28 comments

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It seems your conclusions are irrationally biased towards a “free market” solution, however the narrative leading up to that conclusion in no way explores why the more socialized countries of Western Europe and Scandinavia have healthier people, better health outcomes and less cost than we do. As you present a counter-intuitive solution (more free market, when it’s been proven that less free market works better) I feel the essay needed to do more from a logical, as opposed to ideological, perspective to tell me why we should reject a system that works better than ours and instead move in the opposite direction.

If the issue is high costs and a poor national attitude towards health issues, a system that controls costs (the buyers market of nationalized systems) and cohesively works to standardize the type of care and promote advice that is provided by that system, with the option of supplemental and/or luxury care on the private market.

You fail to provide a reason why moving towards a proven solution is a bad idea, and thus why moving to your unproven solution is a good idea.

In the meantime, as someone on both sides of the fence – vegetarian (with all the health benefits) and cigarrette smoker (with all the health risks), I have no problem with surtaxing on a state or federal level, those products which are clearly detrimental to your health. If you are an occasional dabbler, you chip in occasionally, if you are a perpetual indulger you contribute to the costs your habits create.

I think it’s naive to say patients barely pay any of the costs, in a way, patients pay all the costs. I think the more infuriating injustice is that I as a a smoker can pay a private insurer extra premium through my healthy puffing away years, and then the costs of my lung cancer treatment fall on the taxpayer once I hit 65 and start suffering the symptoms (Same with you carnivores and your heart disease & diabetes).

Posted by ChevalierMalFet | Report as abusive

i love burgers… it is good for us… everybody should eat some… five guys rocks…

Posted by Ocala123456789 | Report as abusive

ChevalierMalFet is correct. We have been moving more and more towards a free market type of healthcare system and it is only getting worse and worse.

Prescription drugs with-in Medicare are provided by private market companies. Is it no wonder this is the biggest rising cost with Medicare?

And isn’t the objective of a private market insurance company to spread out the risk? Sounds like a free market nit wit trying to salvage the free market propaganda.

Maybe we should send the healthcare job market overseas to foreign countires. Perform the test here and send the results overseas to have a foreign doctor take a look at it. Just as with the manufacturing market, it will lower cost. Of course it will destroy jobs, but that doesn’t matter, those people can find a new field to work in. This always seems to be the answer with free marketers when it comes to manufacturing jobs. Get paid lower or lose the job.

The healthcare the military veterans get is the best in the world. Even better then France healthcare. Yet, it is completely socialized. Healthcare, insurance, doctors, and facilities are all provided by the big bad government. Now, that doesn’t sound correct, according to the article.

I know being educated is an evil liberal kind of thing, but could the conservatives please just get over it and move on with your life.

Posted by DanielLee | Report as abusive

The way to solve these problems would have been to expand Medicare to cover all people (in order to increase the pool to include younger participants with less problems), to put yearly and lifetime ‘caps’ on benefits, to require on-site co-pays (in cash – for all – so that they can ‘understand’ that costs are involved), and to have premiums with extra charges for those who are obese, smoke, engage in dangerous activities, etc. Then the fat, dumb, and unhappy might wake up, but at least will be paying their fair share to the risk pool. The rest of us should not be required to pay for their sins.

Posted by Eric93 | Report as abusive

The comment by ChevalierMalFet is right on the spot. This article seems to propose a solution that does not include the fact that some nations spend LESS on “social” healthcare than the US and have a HEALTHIER population (rich and poor). Part of it has to do with city planning and infrastructure. My parents live in The Netherlands and always bike or walk to stores. They are in their late 70s and in great physical shape (try walking or biking to a store in an average US town or susburb). Part has to do with the medical profession’s attitude to healtcare. In the US, a test seems to be prescribed for everything “just to be safe” to the point that it is just excessive and stupid, whereas in Europe, a general practician seems to have a lot more say and would defer to the patient to “keep an eye on it”. And cost of medical procedures are just ridiculous in the US. $6,000 plus for a simple breast biopsy, $38,000 for a kidney surgery, and $150,000 plus for a spine surgery are my first hand experiences. I bet these prices would be significantly less in other countries and perhaps the author should first figure out the root cause of WHY these costs are so high before figuring out how to pay for them. Thank heavens for insurance and Obama’s healthcare reform which made dropping of patients because of “pre-existing conditions” from insurance illegal.

Posted by Bert2 | Report as abusive

This is the longest, most tedious way to say ‘co-pay’ that I have ever seen.

Any arguments against socialized healthcare also apply to private insurance. Private insurance is socialized healthcare. We all put our money in a pool and the sickest, fattest, heaviest smoker…. wins. Privatized insurance is just as socialized as anything in Europe, but far less efficient because you add duplicated layers of overhead, executive salary costs, advertising and need for quarterly-increased profit for those insurance companies. That’s why we spend more in America for healthcare than anyone else. Much of the money is not for actual medical expenses.

Posted by AlkalineState | Report as abusive

Excellent article, Mr. Hadas!

@ChevalierMalFet,

You exhibit an attitude consistent with a resident of Canada, Western Europe or Scandinavia. This attitude is not common or likely to be adopted in America.

Relatively minor changes to the American “system” could, in my opinion, make it much more cost-effective without losing the significant advantages it has over “socialized medicine”. The prudent person does not change cars even when a major problem is discovered if it can be fixed economically and they like the one they have.

I disagree with your suggestion that Mr. Hadas’ article is “counter-intuitive”. I think it entirely appropriate that patients pay more of the costs.

Currently those on Medicaid pay NOTHING. This is why they show up at the hospital EMERGENCY door for every sniffle, whether theirs or their children’s, clogging up the “system” for everyone else and necessitating “Triage” over “first come, first served” on medical priority there.

Posted by OneOfTheSheep | Report as abusive

Clever article. The efficiency of the American economy is driven by the incentives of free market economics as contrasted with more socialist economies which use taxes to castrate the incentive to innovate and the motivation to work hard. Employers are not going to pay us more simply because they give up providing health benefits… we will simply have to cover 100% ourselves destroying any quality of life we might manage to cobble together. A socialist solution would rip the motivation from the young and healthy who are still early in their earning ladder by forcing them to subsidize indolent hypochondriacs.

The real cost savings in the European systems are in standardization and simplification of health care management and economics. The American system is failing when you must write your name – by hand – multiple times for each time you visit a new doctor or change insurance carriers since all of this date is then typed in and/or faxed and/or printed and/or copied and/or… Furthermore the non-standard mechanisms for justification of coverage create a substantial work load across the board. Finally, free market economics are not working properly when insurance company executives and stock holder are making obscene profits. Price fixing and exclusionary laws and policies are clearly preventing the free market from squeezing out the excess profit from the industry.

Posted by JustRealistic | Report as abusive

Mr. Of the Sheep,

I think we have seen polling through-out the healthcare debate that shows anywhere from 45-55-75% of Americans support an actual national healthcare plan similar to Europe or Canada. I’ll take your point though, that certain very influential American people do not have that attitude :).

I do agree that we should explore other solutions while we wait for the business community and municipalities even in red states to pull it’s head out of it’s rear and realize that single payer is a great deal for them too.

Counter-intuitive in the analysis that he expresses two concerns, acknowledges the existence of a system that addresses both, and then suggests something that is in the opposite direction. If I see my one neigbor successfully putting out a fire with water, I am not going to imitate my other neighbor and grab more gasoline, even if he is a rugged individualist. I may even suspect he caused the fire in the first place.

Currently those on Medicaid pay state sales taxes on more than 100% (add borrowing) of their income (dedicated to consumption over savings), less any tax benefits they may receive. Most people on Medicaid (and other govt insurance) do have primary care physicians, and local clinics to utlize, it’s the uninsured who use the Emergency Room as their main source of triage.

Again, though Canada, England, etc… don’t have this problem at all.

Posted by ChevalierMalFet | Report as abusive

eat your burger live your life fully… and forget the rest…

Posted by Ocala123456789 | Report as abusive

So why do we continue to put people in prison for using marijuana, which does no provable significant physical harm, and we keep it illegal to boot? Since sweetened drinks clearly do cause physical harm, why do we tolerate Coca Cola Inc.? Because it makes a lot of money for powerful people? Why not outlaw sweetened (including “artificially” sweetened) drinks and foods? The analysis is clear that they are harmful. But the author would punish the users rather than the providers. Just as our system punishes marijuana users but leaves the providers alone, as long as they make payoffs (“political contributions”) for their territory. Then the system protects them, just as it protects Pepsi Cola Inc.

And how about a cheese and “cheese food” tax? Mandatory sidewalks? Equal spending on mass transit and highways? A limit on the number of cars allowed?

We have an obesity problem at least partly because it is profitable to some very powerful people.

Posted by txgadfly | Report as abusive

Health care costs so much in the US because most of the money goes to corporate shareholders and executives. After they have taken their cut there isn’t much left over for the sick people.

If Americans could get their heads out of their butts and look at how the rest of the civilized world provides superior healthcare for half the cost of the US the answer would be obvious. It ain’t gonna happen though.

Posted by Sinbad1 | Report as abusive

Growing up in the 1950′s, we went to the doctor only when “broken or bleeding”. Very few families had health insurance, and those that did tended to purchase coverage through non-profit plans like Blue Cross/Blue Shield. The doctors back then didn’t live in the lap of luxury, nor did most of them specialize; few, if any, people expected the health care industry (which was considerably less of an industry back then) to solve all their health problems.

Just as work expands to fill the time available, health care costs expand to utilize the cash available. Here is a radical thought: eliminate ALL health insurance, both public and private; force people to pay for their health care; and sit back and watch the immediate changes that would begin to take place.

Posted by yoresident | Report as abusive

@ChevalierMalFet,

You’re right…I had a mental short circuit when I said “…those on Medicaid…” when I meant those with low enough income and no insurance… My point was correct, however, in that those with no financial “skin in the game” clog our Emergency Rooms, etc. to the point of routinely impeding timely medical care for genuine emergencies.

Your “system that addresses both” has built-in delays which have adverse effect on patients. Yes, Virginia, there is a difference. Cancer patients, as an example, are sicker when finally treated. Their chance(s) of remission is/are reduced, and survival periods following treatment predictably shorter.

The equipment is not as modern, which directly reduces the patient’s quality of care and adversely affectstreatment “outcomes”. As scanning/X-ray technology continues to improve, radiation levels get progressively lower. “National Health Service” patients receive more radiation over the course of certain courses of treatment with older equipment than “covered” patients with access to the latest equipment.

Last but not least, in the U.S. we already seeing our physicians limit time with us to about fifteen minutes per visit. They see so many patients that it is impossible to schedule a visit (unless one declares an emergency) before a minor flu or virus has already run it’s course.

There is simply no way to quickly increase the number of resident physicians in the U.S. Adding another 30-40% patient load (estimate of presently uninsured in the general population) to the same number of physicians means that (1) we will then get ten minutes of time per visit, and (2) it will take three times as long to get in to see them.

Since the level of service of a majority of Americans would have to be cut in order to “cover” those presently uninsured, what possible incentive can you offer the considerable majority that have access to “push-and-shove” medical care to support a significant reduction in their current “level of care”?

Posted by OneOfTheSheep | Report as abusive

Socialised medecine in the UK has created a nightmare – I ought to know, I live there. Your average ‘visit’ to see your GP lasts 5 minutes. The wait for any non-emergency appointment is 3 weeks. The hospitals are filthy hellholes where patients are left to wallow in their own excrement, meanwhile nobody has time to give so much as a glass of water. Elderly women are embarrassed and sometimes assaulted on mixed sex wards. You have no choices, no dignity, and you pay a fortune for it in taxes. That’s the reality, and surely not what was originally intended. So please don’t imagine things are all in the garden lovely here – so very far from the truth!

We need a complete re-think, where people take responsibility for their own well-being, and doctors are re-trained to see human beings and not broken machines in front of them.Only when we accept the inevitability of physical breakdown and death can we begin to have a sensible debate about how much to pay, and how to pay for care of the sick.

Posted by macktheknife | Report as abusive

Perhaps when you feel the pain in your pocket, you may be more inclined to think about taking better care of yourself by making educated choices to eat better and exercise more. Insurance plans should offer discounts for people who do both because it is practicing preventative medicine. People would need to see doctors less often and avoid having expensive procedures done. Does that make too much sense?

Posted by alwayslearning | Report as abusive

Thank you, ChevalierMalFet, for your excellent comments, which are better than the article itself.

Someone mentioned cars, so consider the following. What if autos were sold in the following manner. Someone comes and carries you away in the middle of the night, either unconscious or in extreme pain and in fear of your life. They then pick out a car for you, their choice of make, model, color, options, etc. They then make up a huge and largely fictitious list price, and you negotiate from there. You get no warranty whatsoever. Oh, the car has serious safety defects! If you expect to live you, then need to come into the shop on a regular basis for more work at your additional expense. For months you get bills from mechanics you have never met saying that they inspected this or that and that their services were not included in the original price.

Well, that is pretty much how the health care market works, at least for the expensive items. Yes, when it comes to getting your flu shot or teeth cleaned, you can ask around for the best price or nicest waiting room. However, for anything that costs real money, it is pretty much like the analogy above. No one would claim the above constituted a fair market. I maintain that a free market has to be a fair market. There cannot be ever be a free market based on fee for service health care.

Posted by QuietThinker | Report as abusive

In the UK system prescription charges are applied to individuals (who are of working age).

Rather than desocialise the cost of all care, I would desocialise some treatments. i.e. only socialise the costs of a predefined list of treatments.

This would severely limit the ability of some people to choose significantly more interventions than others.

Posted by Dafydd | Report as abusive

We used to have a system whereby the insurance company paid 80% and the patient paid 20% – up to a specified amount. This method kept patients aware of the cost of their procedures because until the deductible was met, they payed 100% and after that, they still paid 20% of the costs. So, if an X-ray is 100$, you pay $20 – however, if your doctor says he wants to do an MRI instead, and you know that will cost you much more, you are more likely to ask why exactly the MRI is needed. Patients will choose a less expensive option unless the more expensive option is really justified.

Then along came the HMO concept; which was good in the beginning, a “Health MAINTENANCE Organization” which encouraged well baby visits and annual check-ups and vaccinations and routine preventative care. Except, that over time it morphed into a system where everything was covered with just a small co-payment. A doctor visit might be $10, no matter how much the bill; a specialist might cost $20, no matter how high the bill. This carried over into lab work and diagnostic tests; if an X-ray has a $0 co-pay and an MRI has a 0$ co-pay, more and more patients choose the MRI. If an X-Ray had a 0$ co-pay but an MRI had a $150 co-pay, we would see a decrease in MRI’s. Or at least more patients would question why they needed (not wanted) an MRI instead of the X-Ray.

Granted, obscene CEO and top executive pay for the big health providers is part of the problem. As is the realization by many doctor groups that they can have in-house labs and MRI’s and CT Scans and keep those profits in the group; the peddling of medical devices to these groups is a vastly profitable business for all concerned. So is the fact that our system of governmental subsidies is skewed towards the very foods that we should limit. If beef (and other meats) were more expensive and fruits, vegetables, and whole grains were less expensive, our eating habits would change and over time lessen the obesity epidemic. If HFCS was more expensive, perhaps it would not be in bread and nearly every other food on the market.

I would love to see a single payer system come to the US; a system where preventative care is covered and encouraged. Where the patients who work with their nurses, nurse practitioners, and doctors to improve their health and make positive changes pay less than those who refuse to participate. In this way, those with the ‘individualist attitudes’ are free to smoke, drink, and eat themselves into an early grave but they should pay the consequences of their choices in increased costs.

I did note that only end-of-life care for the elderly was mentioned in the article. The other end of that spectrum needs to be addressed as well; the reality is that not every baby will survive. Parents want to do whatever it takes; unfortunately, millions of dollars are often spent to keep one child alive, no matter the prognosis. Those millions could also help keep thousands of children healthy. At some point our society has to acknowledge that our resources are not unlimited; that we have to spend our public money on the care that will bring the greatest benefit to the most people. Individuals would be free to buy policies or use private money to cover million-dollar treatments that have little chance of extending life or restoring quality of life to any loved one. Yes, this would be unfair. Sometimes life is unfair; this is no different that it is now. Experimental treatments go to those who can afford them; those who have the money, can travel anywhere to get the very best care for their condition. The rest of us do the best we can with what we have available; I just believe the US can improve what that ‘best available’ is for all of our citizens.

Posted by MidwestVoice | Report as abusive

Socialising the costs of an armed forces, a criminal justice system, emergency services, infrastructure (sanitation, water supply, power, communications, roads, bridges, dams, dikes, the US Army Corps of Engineers, ports, canals, rail services, airports, air traffic control, security to guard against contraband smuggling, terrorist acts, and unauthorised immigration), a car-oriented transportation system (which has long necessitated a global military capacity to protect and maintain oil supplies), K-through-post-doc education, scientific R&D, parks and recreation, historical monuments, sports stadia, casinos, celebrations of major events and holidays (for which the public expects flyovers from the US Air Force, fireworks, bands, parades, sports, half-naked cheerleaders, cheeseburgers, beer, cannabis, Coke, coke, easy access to sex workers, etc), and much more, is acceptable, but Americans show their individualistic grit by drawing the line at socialising medicine, largely because half the people don’t want to contribute to the costs of abortion services while half the people don’t want to pay out-of-pocket for the costs of abortion services (which are a bargain compared to the costs of bringing another high-maintenance American into the world), except that all nearly Americans do expect to have medical insurance, so they do socialise that costs, but in the most inefficient way possible. Nice place to visit, but I wouldn’t want to live there.

Posted by CarlOmunificent | Report as abusive

4 problems in America – hospitals, insurance companies, doctors and Republicans – all trying to make a killing off the poor and middle class. Well, we’re almost dead. Thanks for killing the Golden Goose.

Posted by myownexperience | Report as abusive

This article is a refreshing breath of unpolluted by idealistic “fight for life” but have no responsibility to it drama air.

The Euro-style healthcare system is not a proven winner. I have met many Europeans who despise paying 70% of their income to taxes and mostly healthcare, government imposed taxes. They have no choice.

If my neighbor wants to eat garbage, smoke and drink alcohol to fuel his life and ambition, so be it. But do not ask me to pay for one penny of the consequences. This his choice. He has no right to make such a request.

Remember the end of Mickey Mantle’s life; he wanted a liver transplant due to the fact that he had destroyed his own through years of alcohol abuse.

Americans overeat and they eat garbage food; they lead sedentary lifestyles and they spend little time in meditation and quietness. They continually look for the “fast food cure pill.” That is why they are sick.

Through decades of prosperity and innovation in the dissemination of information, they have had every opportunity to reverse this path and fortunately, some have changed. But as demonstrated by statistical numbers and government legislation, irrational whining and begging is dominating discussion.

Obama once compared his mandated healthcare plan to the requirement of purchasing liability insurance for car owners. Car drivers are trained, tested and licensed; mandated healthcare insurance has no requirement of responsibility of actions to society. This is an improper mandate for a democracy. If you care so much about cheeseburgers and so little about anything else, you need to move to a socialist country. You will probably find cheeseburgers more expensive and difficult to obtain. You will certainly find an entirely different culture.

Posted by pepperspray | Report as abusive

@One of the Sheep

Generally the emergency room problem does not exist where everyone has basic primary care guaranteed and where alternatives such as smaller emergency clinics are available, which is a growth industry here in the US, which has emerged largely in response to that issue.

I will not dispute that the single-payer system does have it’s own defects as you mention, but I am always curious (and not singling you or the author out as I don’t know your positions in general) that when I hear conservatives and libertarians making those arguments, all of their vaunted American exceptionalism flies out the window. Who’s to day we couldn’t adopt a system that works better than ours, then improve upon it. Fake sincere politician voice: I for one, believe in America, unlike my opponent. As well, our current system is not immune from those defects and performs significantly worse in many other areas.

Of course there is a flipside to that weakness in that the NHS is less susceptible to costly medical fads and gimmicks and oddly enough, the sense of entitlement (or perverse incentives) as many other commentators and the author mentioned, i.e. where everyone needs an MRI for everything, 35 mammograms a year, rejects vaccination, buys into the “eat sh*t and live” diets, every tired old person is entitled to a Medicare scooter, etc…etc…etc… we need to keep comatose vegetable grandma on life support for 10 more years and never terminate a pregnancy certain to result in a severely crippled and perpetually suffering human being, because it will make baby Jesus sad if we don’t. Despite my cynical portrayal, those are the types of rights people should have, solely on their own dime, not on the taxpayers.

In fact a unified single payer system is more able than the free market system to shut down these fads and incentives before they cost society billions with no discernible benefit besides placebo effects and wallet-padding and on the flip-side of that, more able to circulate actual innovation and best practice throughout the system.

The availability of PC Physicians or GPs is a universal problem across all health systems, I think the simplest solution is full tuition/expense reimbursement to those who will commit to spending their ten of their post-internship years as a sufficiently well-paid GP or a solution along those lines. Again this is the type of solution a national system can put in place which a free-market system can not so easily.

I am not totally sure what you mean by “push & shove” medical care, assuming private insurance, but will dispute the point anyway. Practically all children are now covered by SCHIP (thanks Obamacare!), all elderly & disabled are covered by Medicare, most poor are covered by Medicaid and most Veterans are covered by Tri-Care. Almost all workplace injuries and auto injuries and a significant portion of premises injuries (I fell down in your store) are covered by various liability insurances (none of these factored into the well-cited statistics of this debate), with work comp and auto effectively already mandated by almost all 50 states. This leaves a much smaller universe of people and scenarios where private health-care insurance applies, then we usually consider. As disappointed as I am that Obamacare didn’t ultimately include at least a public option, I feel it moved the ball steadily downfield towards that goal, and that even before it, we were about half-way there anyway.

I think a single-payer system which allows (like many of the current systems do) for a private market for “Cadillac Care”, reduces costs across the board due to negotiated rates for everything from visits, to medicine, to surgeries, to equipment, to administration, to real estate and provides everyone a baseline of quality care which can only be improved through collaboration, cooperation and innovation. Let’s face it, like it or not, we are all one big “risk pool”, we just divide up that pool in an extremely inefficient way right now – 50 different states, 50 different systems – high risk/cost (elderly/poor/veterans/kids) segregated from no risk/low cost (everyone else, etc…- no logic to annual insurance renewals when health is a lifelong concern – and all the advantage of the sizes and spending power of those various pools tends to go to shareholders rather than stakeholders.

Going back to the article, my original criticism was that it was not very convincing given my position (a literary critique), and sorry to make you anti-OWS folks out there cringe, it’s getting a little grating to keep having the mouthpieces of the 1% continue to Scroogily defend their money-piles while oh-so-helpfully suggesting that the middle-class, working class, poor, sick and desperate chip in a bit more, so they don’t have to scrimp on caviar and yachts. As Homer Simpson said “The Less Fortunate…? They get all the breaks!”

Posted by ChevalierMalFet | Report as abusive

@One of the Sheep

Generally the emergency room problem does not exist where everyone has basic primary care guaranteed and where alternatives such as smaller emergency clinics are available, which is a growth industry here in the US, which has emerged largely in response to that issue.

I will not dispute that the single-payer system does have it’s own defects as you mention, but I am always curious (and not singling you or the author out as I don’t know your positions in general) that when I hear conservatives and libertarians making those arguments, all of their vaunted American exceptionalism flies out the window. Who’s to day we couldn’t adopt a system that works better than ours, then improve upon it. Fake sincere politician voice: I for one, believe in America, unlike my opponent. As well, our current system is not immune from those defects and performs significantly worse in many other areas.

Of course there is a flipside to that weakness in that the NHS is less susceptible to costly medical fads and gimmicks and oddly enough, the sense of entitlement (or perverse incentives) as many other commentators and the author mentioned, i.e. where everyone needs an MRI for everything, 35 mammograms a year, rejects vaccination, buys into the “eat sh*t and live” diets, every tired old person is entitled to a Medicare scooter, etc…etc…etc… we need to keep comatose vegetable grandma on life support for 10 more years and never terminate a pregnancy certain to result in a severely crippled and perpetually suffering human being, because it will make baby Jesus sad if we don’t. Despite my cynical portrayal, those are the types of rights people should have, solely on their own dime, not on the taxpayers.

In fact a unified single payer system is more able than the free market system to shut down these fads and incentives before they cost society billions with no discernible benefit besides placebo effects and wallet-padding and on the flip-side of that, more able to circulate actual innovation and best practice throughout the system.

The availability of PC Physicians or GPs is a universal problem across all health systems, I think the simplest solution is full tuition/expense reimbursement to those who will commit to spending their ten of their post-internship years as a sufficiently well-paid GP or a solution along those lines. Again this is the type of solution a national system can put in place which a free-market system can not so easily.

I am not totally sure what you mean by “push & shove” medical care, assuming private insurance, but will dispute the point anyway. Practically all children are now covered by SCHIP (thanks Obamacare!), all elderly & disabled are covered by Medicare, most poor are covered by Medicaid and most Veterans are covered by Tri-Care. Almost all workplace injuries and auto injuries and a significant portion of premises injuries (I fell down in your store) are covered by various liability insurances (none of these factored into the well-cited statistics of this debate), with work comp and auto effectively already mandated by almost all 50 states. This leaves a much smaller universe of people and scenarios where private health-care insurance applies, then we usually consider. As disappointed as I am that Obamacare didn’t ultimately include at least a public option, I feel it moved the ball steadily downfield towards that goal, and that even before it, we were about half-way there anyway.

I think a single-payer system which allows (like many of the current systems do) for a private market for “Cadillac Care”, reduces costs across the board due to negotiated rates for everything from visits, to medicine, to surgeries, to equipment, to administration, to real estate and provides everyone a baseline of quality care which can only be improved through collaboration, cooperation and innovation. Let’s face it, like it or not, we are all one big “risk pool”, we just divide up that pool in an extremely inefficient way right now – 50 different states, 50 different systems – high risk/cost (elderly/poor/veterans/kids) segregated from no risk/low cost (everyone else, etc…- no logic to annual insurance renewals when health is a lifelong concern – and all the advantage of the sizes and spending power of those various pools tends to go to shareholders rather than stakeholders.

Going back to the article, my original criticism was that it was not very convincing given my position (a literary critique), and sorry to make you anti-OWS folks out there cringe, it’s getting a little grating to keep having the mouthpieces of the 1% continue to Scroogily defend their money-piles while oh-so-helpfully suggesting that the middle-class, working class, poor, sick and desperate chip in a bit more, so they don’t have to scrimp on caviar and yachts. As Homer Simpson said “The Less Fortunate…? They get all the breaks!”

Posted by ChevalierMalFet | Report as abusive

Sheep’s car analogy does not work because mechanics have the luxury of turning emergency customers away. Or holding the fixed car until the owner pays up.

Doctors don’t have that luxury. They pretty much have to treat the sick and injured regardless of income or insurance status. As long as that treatment mandate is in place (and clearly it’s not going anywhere), then a mandate for all households to be paying into the pool…. makes sense. Couple that with the co-pays and deductibles that already accompany insurance plans…. and you begin to have some controls on the slacker ER walk-ins you described earlier. Hey, what do you know! We just re-invented the Affordable Care Act! Other than coming from Obama, and people love to whine about Obama… it’s really not that radical of a law.

Posted by AlkalineState | Report as abusive

@ChevalierMalFet,

My basic “thrust” has been that socialized medicine for all is increasingly economically unsustainable for any nation. Today’s article about the National Health Service is much more specific than I have been:

http://apnews.myway.com/article/20111211  /D9RID8800.html

Posted by OneOfTheSheep | Report as abusive

@AlkallineState,

I said “The prudent person does not change cars even when a major problem is discovered if it can be fixed economically and they like the one they have”.

It would appear your response was to QuietThinker’s post, whose comments I agreed with up to the last sentence.

@QuietThinker, you stated: “There cannot be ever be a free market based on fee for service health care.”

The only reason “we, the people” cannot get a straight answer from our “medical providers” is that we meekly accept the current practice (adopted progressively over recent years without our consultation or agreement) whereby charges unidentified of unknown and unagreed amount spring forth from multiple doctors, technicians, labs and facility businesses (all different legal entities with different errors and omissions insurance) through the course of any but the most simple “procedure”.

Without a single responsible entity which which to negotiate, no single entity is “set up” to talley the undisclosed fees and “materials”; and so each can credibly claim ignorance when we ask in advance for a total price before proceeding. It should be obvious that a patient should not be legally bound by such “blank check” means inasmuch as it is clearly a financially uninformed decision, but is today the “standard practice”.

Posted by OneOfTheSheep | Report as abusive

Hamburgers,hot dogs,pizza,chesse,and ALCOHOL Make people FAT TOO

Posted by Notthetruth | Report as abusive