Comments on: Conservative Cognitive Dissonance on Public Healthcare

By: » Socialism Bound Ernest Koe

» Socialism Bound Ernest Koe — Wed, 12 Aug 2009 13:10:43 +0000

[...] Glenn Beck was TOTALLY right. God bless him for speaking the truth. Unless people finally learn to take some personal RESPONSIBILITY, we are headed straight for socialism!! Inspired by Daniel Miessler’s post – http://danielmiessler.com/blog/conservative-cognitive-dissonance-on-public-healthcare [...]

By: Peter Fleckenstein

Peter Fleckenstein — Tue, 11 Aug 2009 05:32:32 +0000

Hmmm seems like all your stuff is purely anecdotal. Guess, according to you,
thats made of fail. Thanks!

By: AJ

AJ — Tue, 11 Aug 2009 03:15:06 +0000

Nu-uh. Your Canada facts are made of fail. Purely anecdotally, I've never had to wait longer than 4 hours (for something non-critical but painful, in the ER) in my entire life. My parents both had heart surgeries done in the same weeks they were diagnosed. And you forget to mention that the people who go down to the US for treatment were SENT THERE by their doctors, and that the tab was picked up by their respective provincial healthcare agencies. I can personally name at least three expat Americans who moved to Canada as they admired our system of government, wanted accessible, quality higher education for their kids, and wanted some of that delicious socialist healthcare of ours. I'm sure they're not the only ones!

By: Rob Lewis

Rob Lewis — Tue, 04 Aug 2009 05:35:34 +0000

Canadian provincial governments try and contain spending, and the public pays through taxation if they don't, and it knows it.

Canadian hospitals are not profit driven, they are care delivery driven and their goal is to not operate within budget. Private American hospitals ARE profit driven. Only doctors are not on salary in Canada, operating most of the time for a fee for service with ceilings for billing per set period, also set by the government.

Rationalization is necessary in an environment where poor management does not optimize value for investment, and political interference by the party in power interferes with long term progress. But unltimately, we do have a " free and public basic level healthcare system." It is for the next levels of treatment that inefficiencies rear their ugliness.

By: jasonn

jasonn — Mon, 03 Aug 2009 11:30:45 +0000

First error, Americans don't go w/out healthcare because they can't pay for it. That's crap. Most cities (if not all) have public hospitals that are required by law to take patients regardless of ability to pay. And, ALL hospitals are legally responsible for life threatening treatments for all people that walk into them, regardless of financial compensation.

My baby daughter had a broken leg and they set it w/out any guarantee of payment. That required urgent treatment, surgical treatment and follow up work from the doctor. We were poor, destitute and had no way of paying the bills. The hospital and doctor did the work expecting to write off the entire expense and that was a private "for profit" hospital and doctor.

A friend of mine is an internist, and is required to do follow up work for any patient he receives in ER duty, which he has to do to keep privileges in the hospital for his insured patients. I know of one case where he had more than 50K in fees for a patient that couldn't pay his bills, and he was working to get other doctors to do work on him, which was also done without hope of receiving compensation.

SICKO took an opportunity to expose legitimate problems all Americans suffer and did what Michael Moore always does: sensatinalized propaganda.

Don't get me wrong. Insurance companies are not my friend. I've been stuck for tens of thousands of thousands of dollars in medical bills thanks to unscrupulous health insurance companies. But, I've never been denied healthcare, not even extremely expensive high quality care. Of all the poor and neurotic people I've known, I've never known anyone actually denied healthcare, even extremely expensive and advanced procedures.

America's biggest problem is a lacking free and public basic level healthcare system. We have a lot of mental illness suffering patients that clog the hospitals to seek drugs or attention, which would be far better served by wellness services and councilors. But, millions of them prefer dope and ER experiences.

In my home town we have a private for-profit hospital and a local humanitarian healthcare group that both offer virtually unlimited free services to the uninsured. And, if you live in America and you actually can't afford the $400 a month for family private health insurance, you can usually get on public insurance free. We have Medicaid fro children, disabled, poor and Medicare for anyone over 65.

People keep talking about America's for profit healthcare system. Who works for free? Do all the Canadian doctors, nurses, researchers and drug companies do all their work for alms? No. Everyone works for profit. In the US, providers often do work for which they're not compensated. In Canada, they state pays. Most people Iv'e talked to that use both systems prefer the US model.

It stinks. But, it's the best I've ever witnessed first hand.

By: Rob Lewis

Rob Lewis — Mon, 03 Aug 2009 07:11:57 +0000

@ Jsasonn,

WTF, are all Americans armchair medical economist experts on the Canadian health care system?

Canada's system is not broken, it only lacks certain ineffiencies at certain points of the system that are needed to deliver more bang for the buck.

It is not broken at entry level to the system. Every single Canadian can walk into a clinic or hospital and receive an initial diagnosis and initial treatment for acute symptoms. I seem to recall the figure that there are more Americans in TOTAL that can not do that then the total number of people in Canada.

It is with follow-on treatments that rationalization begins as a form to set ceiling limits for the totals being spent.

The American system for the most part, operates on an profit motive, and that is why one can receive services/treatment more quickly if one can afford to pay. I also believe that a two-tier system where those with money can go to other markets is fine, since it removes people from the line-up.

The double edge sword of that motive is that it also provides an incentive for private insurers to refuse treatment to clients who actually hold insurance. One might recall in SICKO the allegation that the majority of those forced into bankruptcy were holders of private insurance who were refused treatement, and why greedy executives from such companies make such obscene amounts of money.

There are advantages of early treatment of course, in terms of savings, so Canada wins there. The practioners have as their focus care of the patient. In Canada, it is cost containment by rationalization due to years of overall government waste and mismanagement that has squandered the taxpayer's purse. In the states it is so profit focused that hospitals spend much more on administrative costs for billing purposes (about 10 times or more).

Real cost efficient care of the patient will not occur unless the drivers become more balanced on both sides.

By: jasonn

jasonn — Mon, 27 Jul 2009 05:35:24 +0000

Ah, zero tolerance. It's the best way to avoid thinking.

By: jasonn

jasonn — Mon, 27 Jul 2009 05:34:50 +0000

I'll participate in this exercise once, but showing a study that says Canada has problems is just going to solicit a response that my study is performed by a bunch of politically motivated antiscientists, and only the group that agrees with you has good data. Fact: America's healthcare system delivers the best critical care in the world, and it fails to serve a substantial portion of the population even decently. Canada's healthcare system rations healthcare and forces people to wait, denying them the option of a private (more expensive) insurance option that would liberate them from limitations.

I doubt you'll have a hard time finding serious fault with Canada if you look at their system, not to mention realize that if it weren't for the overpowering expensive research done thanks to US spending, many modern medicines and treatments wouldn't exist. History indicates higher spending in the US' competitive medical development field results in many successful treatments that then distribute throughout the world. Everyone benefits from America's unbridled spending.

http://www.heritage.org/research/healthcare/hl8...

Yes, these are capitalists. But, it's a good read even if you burn Ronald Regan's picture in effigy while you read it.

There's a reasonably balanced report on Wikipedia that highlights some of the problems in both systems, but wait times for serious illness are the single largest complaint about the single-payer healthcare systems.

In the US, if you have private insurance you won't likely have to wait long for diagnostics or treatment for serious illnesses.

“For example, 21% of Canadian hospital administrators, but less than 1% of American administrators, said that it would take over three weeks to do a biopsy for possible breast cancer on a 50-year-old woman; 50% of Canadian administrators versus none of their American counterparts said that it would take over six months for a 65-year-old to undergo a routine hip replacement surgery.”

http://en.wikipedia.org/wiki/Canadian_and_Ameri...

The Wikipedia article cites reports, surveys and studies.

By: freakwent

freakwent — Mon, 27 Jul 2009 03:55:28 +0000

Broken? Can you please cite studies/sources that explain how it's broken?

By: jasonn

jasonn — Mon, 27 Jul 2009 01:35:24 +0000

Ah, zero tolerance. It's the best way to avoid thinking.

By: jasonn

jasonn — Mon, 27 Jul 2009 01:34:50 +0000

By: freakwent

freakwent — Mon, 27 Jul 2009 00:52:37 +0000

Peter that's true in a sense that forcing prices down is rationing, but the free market provides a rationing system too, based on price, supply, demand, you know the deal. I don't really see what your point is, it's not as though pfizer is going to refuse to accept the lower price.

Basically it would mean that any given grug would not be subsidised by the govt unless the govt got a decent wholesale price. It's got no effect on how many people in the system are allowed the drug, or how much of it, only on what price the govt is willing to pay. If the corp really thinks that this is unacceptable, they can take their drug to market at full retail price.

You are being weird about subsidies; currently the govt pays over a third of all R&D costs anyway(http://blogcritics.org/culture/article/the-myth-of-high-drug-research/), that's not counting the millions of tax dollars spent directly on medical research, the patents to which always end up in private hands.

You are right that the consumer would be paying the difference, but what you miss is the possibility that the difference is in THEIR favour, so they'd be receiving the difference! At least, that's my proposal.

YOU said "Take a look at any country providing Public Health Care Services and I can show you in EVERY country how the society has experienced degradation in their quality of life."

I said Canada. You should show how SOCIETY has experienced a degradation becuase of the introduction of pub health care. Instead you showed how some individuals had a degradation because of getting ill.

Are you asserting that under the private system, someone on 50 grand a year with blue cross or blue shield doesn't have to wait a few weeks for treatment, or even that the hospital treatment for heart and cancer problems is affordable, even when insured? Of course you have to wait! At least in Canada you don't get denied the claim on some non-medical technicality; if that's not beaurocrats rationing health care, what is?
http://www.kaisernetwork.org/Daily_reports/rep_...
http://www.allbusiness.com/medicine-health/diag...

Nor do you get sick, get sacked, and lose the insurance you need for treatment!

Nor do you get flagged after getting sick, so that no employer can afford the extra massive premium that the insurers now attach to you.

The current USA health system is broken, if you assume that it's purpose is to provide health care for all sick Americans. Of course, that's not what it's been built to do.

Canada waiting lists:
Representative Dennis Kucinich, an Ohio Democrat, took Gratzer to task. Do you know what Statistics Canada, the analogue to the U.S. Census, says the median wait time is across Canada for elective surgery?” he asked Gratzer. “Why don’t you inform us, sir,” answered Gratzer. “It’s four weeks. And what does Statistics Canada say the median wait time for diagnostic imaging like MRI s is? It’s three weeks,” said Kucinich.

In the USA the ininsured can get dental care, if they wait for a YEAR.
http://www.huffingtonpost.com/louise-marie-roth...

As for travel, you are unfairly limiting the debate. This is not about establishing a public heart-and-cancer system, it's for all health care, including, as I said, more affordable drugs.
http://www.cmaj.ca/cgi/content/full/170/6/945?etoc

Besides, if you have cancer, and you can afford to travel to Canada for treatment, then you can afford to pay for it in the USA. If you can't afford treatment in the USA, HOW THE HELL are you going to pay for treatment in Canada? The argument isn't about what system provides the best results for millionaires, it's about how to best provide health treatment for most Americans; and most Americans will never own a passport.

Just have a look at the table at the bottom, if the current system is so efficient, why does it cost the USA double what it costs all the other countries, but with worse outcomes?
http://en.wikipedia.org/wiki/Health_care_in_Canada

And, if a private system works so well, why does 46% of the cost have to be paid by the govt in the current system?

You've got a system where the govt pays 46%, the consumer pays 54%, there's a massive chunk in duplicated beurocracies ( enough to cover the public system - http://www.medicalnewstoday.com/articles/8800.php), a big chunk in overhead and marketing and otehr unnecessary bullshit, an unkown amount of cream lifted off as profits. All this is fine and dandy, except when claims are routinely denied, or when so many thing aren't covered or need a hefty copayment.

Recenty a woman had her baby taken from here because she refused a cesaerian secion, and this was interpreted as neglect or abuse. I'd be very interested to know how much she would have had to pay for the C-Section, and if this was a factor in her decision.
http://www.huffingtonpost.com/louise-marie-roth...

I've spent time and thought on this, and backed my statements with sources for data or real, concrete examples. You've said things like "No Government Health Care plan has EVER reduced bureacracies.", and "in EVERY country [public health service means] the society has experienced degradation in their quality of life." but you've provided nothing to back your claims, and you expect others to run around to disprove you.

So does jasonn.

By: freakwent

freakwent — Sun, 26 Jul 2009 23:55:28 +0000

Broken? Can you please cite studies/sources that explain how it's broken?

By: Boris

Boris — Sun, 26 Jul 2009 02:38:01 +0000

The problem here is that public education is riddled with problems that are rarely solved because doing so would require changing the regulations for every such school in the country. As such, local problems are ignored or taken care of ham-fistedly (see: zero tolerance).

By: Peter Fleckenstein

Peter Fleckenstein — Sat, 25 Jul 2009 21:54:19 +0000

Jason,

The correct position is that a Government run healthcare system = no free
market. If you read the entire bill you will see that Obama and Dems, over a
period of years, through regulations and unfunded mandates seek to do
exactly that.

You're point of health care being largely paid by the public funds is
correct. Only 12% of healthcare is being paid out of pocket by consumers.
Which, correctly proves what I'm trying to say - We would be all better off
if government was limited.

It's very simple and proven over and over again - the more government
involves itself into our lives the worse are lives become.

The Obamacare plan isnt about healthcare at all. Its about control and
power. If that's not evident to everyone then its their duty to read the
entire bill as I have and see for themselves.

Additionally - You merely have to listen to Obama and his buddies themselves
tell you so - The Public Plan
Deception

By: Daniel Miessler

Daniel Miessler — Sat, 25 Jul 2009 21:39:21 +0000

Holy crap, that was awesome. Please come back often.

By: jasonn

jasonn — Sat, 25 Jul 2009 21:30:10 +0000

You don't disregard the failings in the Canadian system do you? Canada's system is state run, and it's broken. I think it's a fair example of what we could expect in America under a complete nationalized system.

By: jasonn

jasonn — Sat, 25 Jul 2009 21:28:31 +0000

Daniel, I think your point (in this blog post) is that Republicans that say public healthcare is a socialist pariah are inconstant when they support other public works but choose this line to draw in the sand.

Actually, that sounds like a good beginning for a much needed debate.

The question for someone who favors free market (making my own argument now) is that it simply does a better job. The problem is how do we choose a free market solution for everyone. The answer is you can't. That's the whole point of a free market solution. You must have the option of not buying it at all. So, insuring everyone with a private market solution is impossible. If you force me to buy it, it's not free market.

So, the debate continues.

A free market police or fire department may well provide better services as well. Crime goes up, a neighborhood fires the sheriff and hires a new guy. Houses burn to the ground every day because of lacking supply or planning at the public level. Crime prevention is miserably poor. And, do we need to debate public education. Fail, fail, fail.

The issue I would take with your example if that you provide two glaring examples of state failure.

Who wants to go to a cancer treatment facility with the success rate similar to that of crime prevention or the average fire? The average fire results in serious property destruction. So, like the CDC, we may stop your disease from killing others, but you're likely going to die or suffer permanent damage from any serious illness if that's the standard.

By: jasonn

jasonn — Sat, 25 Jul 2009 21:12:52 +0000

I just don't know how to address the idea that free market = free. Obviously, I'm talking about state paid solutions vs. private sector solutions. I doubt anyone reading this misunderstands the differences between free market and state solutions.

The erroneous position is that state paid health coverage = no free market. Such a plan is infected with the problems and personality of bureaucratic styled systems run from the state, but then so is everything in this so-called "free enterprise" driven society. America is not a "free market" country in a pure sense, not in the least.

We've not been a laissez' faire marketplace in quite some time. And, this is especially true when it comes to healthcare. Healthcare is largely already paid by public funds. Hospitals, training institutions and all sorts of medicine are delivered on the backs of taxpayers. Secondly, it's one of the most regulated services the private sector provides, to the point it's almost dishonest to call it private at all.

Conservatives call a national healthcare insurance program socialism and then call federal oversight of banking "regulation." It's the picking and choosing that the blogger takes issue with, and quite frankly I've yet to see a conservative squarely address the issue with sound logic.

To inform you, because you so badly misunderstand my position, I once would have called myself a "conservative." But, I've since developed a sensitivity that such a classification is tantamount to calling myself a religious Republican. And, I find myself more and more out of step with an increasingly anti-intellectualized party of emotion vs. critical thought politics. This is exactly what I disliked about the Democratic party.

Now, let me deal with your sound arguments.

1) Public insurance for people who can't care for themselves does not require an umbrella for the millions that can pay their own premiums.
2) Healthcare is a personal responsibility.

I wholeheartedly agree with both statements. And, you can defend those statements logically. But, the premise the blogger poses has yet to be defeated. You're just saying you believe in something. You're not addressing his claim that your position is inconsistent.

Why do you fail to do that? You allow him to keep his position when it is flawed. He's absolutely correct that many conservatives have no problem spending state tax dollars to fund state systems for the things they think are best run by the state. But, that's not an intellectual's position. It's a simple party position help by the masses.

My argument against state run anything is the state does a terribly ineffective and inefficient job doing anything it does. Sometimes, a state system is the most efficient because as a public service we can agree to the inefficiency and bureaucratic costs since publicly funding and managing a single source makes more sense. This is true for roads, public water works, sewers, etc. But, would you let your local water board make your healthcare decisions? What if they had medical degrees? No, we can afford for water to be overpriced and badly managed. In most cases we don't notice. Roads are the same. No road system is well managed. They run like crap, run over budget, typically involve pay offs, over pays, and millionaire cousins. But, we all benefit so much from the relative cheapness of a public road system that we tolerate the bureaucratic costs.

Healthcare, on the other hand, is quite another animal. In a pure free market economy, the costs would plummet. Much of the rise in cost is regulatory and public fund related. If it weren't for Medicare how much of the extreme costs involved in later life care would still cost what they do, and perform as poorly as they do? There is zero market force involved in late life care today, because the free market doesn't negotiate price or quality, government does. If you want to see how a government run system will work for all of us, just go to the local VA or hang out with your favorite 70 year old. But, even that is somewhat effected by the private market forces because they use facilities and doctors that fall under private market pressures.

So, the truth is this is an extremely complex debate. It won't fit into a neat 5 second snippet that some polished nubile Fox News anchor can slather between shows, nor does it fit the rhetoric of some angry CNN correspondant. It's a legitimate conversation that should have taken place decades ago about how public systems most often encourage corruption and waste and private systems leave many people uncovered.

If you were a free market purist, you wouldn't suggest we have any public coverage. What's wrong with that? Well, we seem to agree that old people shouldn't be left out of the system just because the free market doesn't offer a present day solution to provide them services they can afford. And, that's factual. Without government insurance, most people over 65 wouldn't have adequate healthcare.

It's broken. I think we all agree on that. But, it's not so broken that it doesn't continue to serve most of us pretty well. The big question is how do we stop it from bankrupting our country? Medical costs soar. People continue to lose coverage. Nobody wants to discuss making healthcare insurance portable, so when we lose our jobs we often lose our access to any form of coverage. Instead of screaming "commie!" or "stupid!" we may want to sit down and rationally negotiate a better solution.

By: Peter Fleckenstein

Peter Fleckenstein — Sat, 25 Jul 2009 19:26:24 +0000

Well then I didn't miss the whole point. You stated that health care is a
moral & societal obligation. I disputed that. The health and care of an
individual's own health is their own.

You stated that the difference between public fire service and public health
care is nothing. I disputed that as well.

By: Daniel Miessler

Daniel Miessler — Sat, 25 Jul 2009 19:02:18 +0000

The exact opposite of the quote of yours I posted.

By: Peter Fleckenstein

Peter Fleckenstein — Sat, 25 Jul 2009 18:46:51 +0000

Then by all means, what was your point?

By: Daniel Miessler

Daniel Miessler — Sat, 25 Jul 2009 18:24:11 +0000

"Finally, most people have forgotten that health care is a personal
responsibility and not a right."

Somehow you missed the entire point.

By: Peter Fleckenstein

Peter Fleckenstein — Sat, 25 Jul 2009 18:12:00 +0000

freakwent,

Refusing to accept Pfizer's drug into a government plan unless they sell it at a price you want to pay is price rationing.

No Government Health Care plan has EVER reduced bureacracies.

Subsidizing anything means someone else is paying the difference and that always translates to the consumer paying the difference one way or another.

Canada? You've got to be kidding? Let's just use Canada's wait lists as an example. Wait listing is one form of rationing. There are many examples of cancer patients, heart patients, etc., waiting for treatment. During their wait, everyone one of those people experience a degradation in quality of life.

BTW, you see many Canadians come down to America to get health care services that they need. I can't find one American cancer patient or heart patient that has gone up to Canada for health care.

By: Peter Fleckenstein

Peter Fleckenstein — Sat, 25 Jul 2009 17:59:43 +0000

Jason,

I'm stating the blogger is comparing apples to oranges.

My idea, that you incorrectly stated, is this: The patient and the doctor are the ones that can most effectively deliver quality health care. It's NEVER been a Government.

You are confused about what free market is. Free market does not mean that the service is free. Free market is a market based solution with the least possible government regulation and interference as possible. Should we have smart regulations? Absolutely. For example a huge reduction in the cost of health care can be accomplished regulating malpractice, thus reducing insurance costs for everyone.

For the people that can't afford health insurance because they can't work or are incapable there are solutions that don't involve putting all people under a Government Health Care plan so a few have it.

Finally, most people have forgotten that health care is a personal responsibility and not a right. If you practice unhealthy habits in a market based solution, you as an individual have the personal responsibility of bearing that financial burden.