Here's a letter to the editor of the Denver Post from Dr. Paul Hsieh, a libertarian M.D. in Colorado (and also the author of the fantastic GeekPress blog):
Health care is not a right, and it is not the proper role of government to provide health care for all citizens. Instead, this should be left to the free market. It is precisely the attempts of the governments of countries like Canada (or states like Tennessee) to attempt to mandate universal coverage which have led to the rationing and waiting lists for vital medical services. Similar problems are already starting to develop in the Massachusetts plan as well. Any plan of government-mandated "universal coverage" is nothing more than socialized medicine, and would be a disaster for Colorado.
Paul S. Hsieh, M.D., Sedalia
You may agree with Dr. Hsieh's view, or you may disagree with it, but it seems quite sane and calm for a paragraph-long letter to the editor (a hard format to shine in).
But according to Denver Post staff columnist Jim Spencer, it's the "craziest letter to the editor that [he's] read in some time" and a "rant" to boot:
The craziest letter to the editor that I've read in some time came from a physician who claimed that Coloradans have no right to health care.
Seems the guy not only forgot his Hippocratic oath but also the law.
If you're sick enough or badly injured, they have to treat you at the emergency room regardless of your ability to pay.
The doctor aimed his editorial rant against socialized medicine. But he wrote it because a state blue-ribbon commission is now cobbling together a plan for medical treatment and prescription drugs for Coloradans....
Oddly enough, I didn't see anything the Hippocratic oath about governmental obligations to pay for medicine. Nor is there much evidence that Dr. Hsieh has "forgot[ten] ... the law" about emergency room treatment requirements; in context, "[h]ealth care is not a right" sounds like a statement about moral rights, not statutorily imposed legal obligations.
But on top of that, let's shift for a moment from the Hippocratic oath to sensible journalistic standards, even for columnists. Is it good for a newspaper when its staffers (again, even columnists) treat thoughtful disagreement from readers as "craz[y]" and as a "rant"? Is such an attitude likely to lead the columnists to be thoughtful analysts? Should it instill confidence in their readers?
The desire of the poor to have their injuries and diseases treated need not be dismissed as clamoring for rights (in invisible scare quotes). Nor is the elimination of "waiting lists" for medical services an end in itself -- like reduced unemployment figures, it can have a number of connotations, good or bad. (Does it mean that more people are getting health care, or does it mean that there's no point standing in line for something that costs more than you can pay?) I'm not arguing the merits -- if I knew how to solve the health care crisis, I'd be polishing my Nobel now -- just explaining why somebody might object to the tone.
In fact, arguing that universal health care has been a universal success may come closer to arguing that the earth is flat.
If you want facts from a newspaper read the grocery ads. When a store says a soap is $1.19 you will find them selling it at that price.
Look. There exists tons and tons of real data, and real-world experience with socialized medicine programs from other countries. There is no need to speculate as to what the outcome will be. It is not all bad or all good, and there are a number or very difficult moral choices that are inherent to either side of the debate. Socialized medicine absolutely and unequivocally causes shortages of care, and waiting lists. Demonizing people who notice this is hardly helpful. Private market medicine results inevitably in people who lack access to the best care. The only way to balance the imperfections and "shades of gray" is to have an honest, clear-headed public debate. Unfortunately, I'm afraid that is the last thing we are going to get.
As it happens, today's on-line ABA Journal has two letters in response to the Journal's recent report about the Carhart case. The first analyzes the reporter's choice of words and laments that the Journal chose to demonize supporters of the ban and stifle debate (which, I will note, the ABA has done in the past) on the important and controversial issue of abortion. The writer is dispassionate, if disappointed, and analytical.
The second, briefer letter is from a woman who claims to be a "senior lawyer" and expresses her outrage that " group of conservatives have entered a woman’s uterus", and urging the court to amend its decision to order castration for any man who fathers a child out of wedlock.
The ABA found both letters worthy of publication, it seems. The second letter is unquestionably briefer. Which one qualifies as a rant?
Open Medicine, Vol 1, No 1 (2007)
Abstract
Background: Differences in medical care in the United States compared with Canada, including greater reliance on private funding and for-profit delivery, as well as markedly higher expenditures, may result in different health outcomes.
Objectives: To systematically review studies comparing health outcomes in the United States and Canada among patients treated for similar underlying medical conditions.
Methods: We identified studies comparing health outcomes of patients in Canada and the United States by searching multiple bibliographic databases and resources. We masked study results before determining study eligibility. We abstracted study characteristics, including methodological quality and generalizability.
Results: We identified 38 studies comparing populations of patients in Canada and the United States. Studies addressed diverse problems, including cancer, coronary artery disease, chronic medical illnesses and surgical procedures. Of 10 studies that included extensive statistical adjustment and enrolled broad populations, 5 favoured Canada, 2 favoured the United States, and 3 showed equivalent or mixed results. Of 28 studies that failed one of these criteria, 9 favoured Canada, 3 favoured the United States, and 16 showed equivalent or mixed results. Overall, results for mortality favoured Canada (relative risk 0.95, 95% confidence interval 0.92–0.98, p = 0.002) but were very heterogeneous, and we failed to find convincing explanations for this heterogeneity. The only condition in which results consistently favoured one country was end-stage renal disease, in which Canadian patients fared better.
Interpretation: Available studies suggest that health outcomes may be superior in patients cared for in Canada versus the United States, but differences are not consistent.
Full article here: http://www.openmedicine.ca/article/view/8/1
Of course, the ABA went a step beyond that after their endorsement of abortion in the early 1990s, actively censoring any attempt to re-evalute the ABA's position or the way the position was adopted by the
Board Of GovernorsPlatonic Guardians with no input or endorsement from thegeneral membershipGreat Unwashed.So does socialized medicine; That's fundamentally a result of the fact that there aren't sufficient resources to give everyone the best care. Under the current circumstances NO system can give everyone the "best" care, save by artifically limiting what constitutes the "best" care to something far poorer than the state of the art.
Now that's a rant. Houston lawyer equates all advocates of universal healthcare with abortion proponents. They probably all have communist flags tacked up in their garages too and peel George Wallace bumper stickers from the bumpers of cars too. (For those of you too young to remember Google Charlie Daniels Uneasy Rider)
This ancient text is usually quoted by pols and pundits when denouncing physicians desire to be treated with respect in the modern world. That is an obtuse way of saying that we expect to be compensated in this world for our services.
Well yes, and no matter how you slice and dice the data or try and manipulate it, there is one inescapable conclusion. By all reasonable measures, the U.S. spends more of its GDP on health care than any other country in the world by a considerable margin (16% to 11% to the next closest country--France). Every other developed country covers its entire population, we leave 46--47 million completely uninsured. By every measure of health, we are at best middling. In some areas we are shockingly bad. We must be doing something wrong, while the countries with "socialized" medicine must be doing some things better than us.
I take Dr Hsieh also fell for it since he mentions the "rationing and waiting lists for vital medical services [in Canada]." In fact, if there is a rationing and waiting list in Canadian healthcare services (results are unequal from a province to the other), it has more to do with "secondary" treatments (principally surgeries), especially in the orthopedic field. As for vital surgeries and treatments, such as oncological treaments and heart surgeries, there is about no waiting time, although there have been, are, and ough to be in the future, few exceptional cases worth mentioning as well as discrepancies from a locality to the other. As an example, you'll wait longer for a knee surgery than for a vascular implant. But in overall, being granted the most important treatments in a short delay is not a concern for Canadians. Not at all.
To illustrate from my personal experience, while I suffered from a mild but chronic back pain that necessited MRI testing, I had to be put on a waiting list for six months before being tested. I then chose to spend the few hundred dollars in a private clinic for me to avoid that waiting period in the 'free' public system. But my mother, who had been diagnosed with breast cancer, was treaten and taken to surgery the moment the Dx was pronounced.
Actually, it's a little more complicated than that. What the most common ancient version of the Hippocratic Oath actually says is, "I will not give to a woman a destructive pessary (pesson phthorion)." It's clear that the "pessary" is an abortifacient drug, but it's not at all clear that the oath meant to outlaw mechanical methods of abortion as well. Hippocratic texts and Galen describe some such procedures -- usually early in the pregnancy, and often pretty bizarre (e.g., jumping up and down and striking your heels against your buttocks), but not treated as something unethical (not that this proves much about the Oath, which probably originated in a small group of doctors, and didn't become widely accepted until much later). The reason for banning "pessaries" might not have been any concern for the unborn (though there were ancient doctors who expressed such concerns), but rather for the mother: the drugs used to end pregnancies in antiquity, if they were effective at all, were very strong and did a lot of damage.
So a doctor who strictly observed the most common form of the Oath today could still perform abortions, but would be prohibited from prescribing the morning-after pill.
I realize this doesn't have a whole lot to do with the subject of the post, but it's worth knowing.
Even if we eliminated the top 10 causes of death as it currently stands, there will be a new top 10 tomorrow. No matter how hard someone tries, the chance of death is always going to be 100%.
If the first sentence is true, the second sentence can't possibly be. Do you see why? (I also find it juvenile to feminize a man you disagree with by giving him the title "Mrs."; such tactics should be left to Rush Limbaugh and his ilk.)
I'm afraid that this is another one of those topics which the political Left plans to conquer via an emotional, rather than analytic, appeals. Thus, anyone who hesitates to support socialized medicine (or even uses the term "socialized medicine"!) will be tagged as a greedy, unhinged, heartless pawn of the drug and insurance companies.
This is truly classic. It's standard practice to use the derisive label of "socialist" to dismiss advocates of universal insurance coverage, but it takes a lot of chutzpah to turn around and complain that it is the other side resorting to emotion rather than reason. If you want to use a label that is nothing more than a slightly cleaned-up form of Red-baiting, you're in no position to claim that the other side is employing emotional appeals.
(Of course, I realize that many, if not most of the posters here have done as I did, deferred gratification to earn graduate degrees, then worked hard to get where we are. Rather, I am talking generically to the average person who is not insured).
Whenever legislators enact an "entitlement," they are realy enacting an obligation, or sets of obligations to be met by others.
The reason that's "Socialism" is that it is based on taking from some (those obligated) and giving to others (those entitled) on a format determined by neither the obligated nor the entiitled, but by others with differing motivations.
The doctor is right again
Ah, but you are already paying for their healthcare. ERs can't turn people away, but they have to get paid for services rendered and supplies used. Where does this money come from? Inflated costs charged to insurances companies or reimbursements from the state (i.e. taxes).
Private doctors have the same problem. For example, my cousin, an ob/gyn, is owed about a quarter of a million dollars that her patients refuse to pay. Yet she still has to pay staff, malpractice insurance, rent and her own salary. Where does this money come from? inflated prices charged to insurance companies or to customers who can pay it.
And if its not obvious enough, inflated prices charged to insurance companies = inflated premiums charged to you.
We will not reduce mortality by 50% if we change peoples habits. They will still die. We just change the date and cause of death.
How about if stupid reporters actually LEARN a little about things before they
writespew forth?Hardly a mistake. Health care quality in Canada has been declinine for the past two decades. Hardly a matter of US media. Canadian studies have consistently shown this decline. For one such, see: This study
Open Medicine, Vol 1, No 1 (2007)"
More direct measures are not so supportive. To quote the Canadian study I referenced above:
Why should the base level of anything not be based on how much you can afford to pay?
Replace "medical care" in your paragraph with "police protection", "fire protection", "public education", etc.
In those areas there's been a determination that a fairly high base level is essentially a "right." Is there a principled distinction to be made between them and medical care?
i guess a weird libertarian dystopia could exist in which doctors get trained in emergency medicine then rent out a store front and pass out business cards to ambulance drivers.
which is relevant to the larger point. the standard liberal critique of the american system of medical care is that it is incredibly inefficient and unnecessarily cruel.
dr. hseih is perfectly within his rights to advocate for a system of care in which the ability to pay is determined in advance of the provision of care and where neither medicaid nor medicare (nor the state equivalents if those systems are perchance declared unconstitutional) exist.
such a proposal might get the support of the majority of readers here. but nationwide? be serious. americans have too much compassion to support a system where uninsured victims of motor accidents are given a dose of painkiller and left to die on a gurney.
Are you saying that we should just let people die on the streets then?
And your post doesn't answer Philistine's question.
That is not to disparage genuine charity. Many charities do in fact provide free medical care. But charity based on tax dollars forced from my pocket, I do not approve.
2. As for Philistine's question: no one has a "right" to police or fire protection either. I happen to not mind being taxed to provide these services, although some extreme (in my view) libertarians think these services should be privatized as well. However, a gun for personal self defense can do a lot more than the police in many situations. My home is actually served by a volunteer FD, which is once again, genuine charity. I have donated to them, which I prefer to being taxed. As for education, definititely not a right in my view. I'm afraid I fall into the "extreme" libertarian camp on that issue--along with the pre-"compaasionate conservative" GOP, which advocated abolition of the DOE. I'll take my voucher (better, tax credit) to put toward my sons' private school tuition anyday. And no, neither should the childless be forced to pay for other people's kid's education. Not to say they can't donate if they want--but the distinction between genuine charity and a tax supported welfare state will always be lost on some. But we (libs) can dream.
Are you one of those communist hippie-type pinko fags? Do you even have a garage? Maybe I should ask your wife...
Apparently, you assume that people are uninsured because they don't work as hard as you, not because society doesn't value their work, even though it may be backbreaking and absolutely vital, as highly as your profession. Or that they may have a chronic condition that makes them uninsurable. Or maybe they are so ill they can't work. But I guess people like you and Spartacus will just step over the bodies of such people in the street.
I wonder, if the day comes and there is a pandemic caused because a critical mass has been reached where the spread of disease is caused by the lack of access to medical care, whether Spartacus will regret his lack of concern for others.
and maybe I'll go to LA via Omaha.
1) It would be more accurate to describe my outlook as "Objectivist" rather than "libertarian".
2) Also, given the constraints of the Letter To The Editor format, I had to be brief (as some of the other commenters noted). I've written more about this in my online post "Socialized Medicine in Colorado - An Open Letter to Colorado Physicians", which includes numerous references. I've started circulating this amongst the medical community in Colorado.
3) One reference in particular that I'd like to highlight is the essay by Dr. Leonard Peikoff, "Health Care Is Not A Right", in which he makes the fundamental philosophical case that a "right" to health care does not exist and that any attempt to create one necessarily leads to disaster, because it runs antithetical to the genuine rights that were recognized and codified in the Constitution by the American Founding Fathers. (Some could also frame this in terms of "negative" vs. "positive" rights.)
3) I'm not sure why you are you relying on a philosophical argument. There are equally valid arguments that make the claim that health care is right. The principles set forth by Beauchamp and Childress in their biomedical ethics text can easily be used to make such an argument. (Being a textbook, I don't think they actually make the claim there although I know Beauchamp has written elsewhere on the topic). Not to mention the fact that Peikoff's article is not particularly well thought out and makes several illogical leaps of assumption. For example, it does not necessarily follow that just because hair cuts are free that hair replacement must also be free or that fancy eyebrow pluckers must also be free.
Just becuase supply and demand meet at equilibrium does not mean you do not have rationing. It just means that you do not need non-price rationing, because price rationing is determining who can consume services.
Tell someone who doesn't have money that they don't need to get tests for cancer (while some rich snob pays for a boob job that) there is no rationing.
This sort of argument pathetic -- I have noticed that many libertarians foolishly seem to believe that there is no rationing if supply and demand meet at equilibrium. And you wonder why you should listen to them about anything else if they are that dumb about this.
Where exactly did I say anything about Rand? Until you mentioned it, I had no idea that Rand had anything to do with the publication. I knew FIRM had something to do with it...but I have never heard of that organization before and did not bother to check out anything about them. I have also never heard of Peikoff before today. Perhaps instead of dismissing my criticism, you should actually say why my criticism is unfounded. Ironically you accuse me dismissing his argument.
Perhaps I thought Peikoff's argument was weak because, well, it IS weak? did that thought ever enter your mind?
Tell someone who doesn't have money to get tests for cancer (while some rich snob pays for a boob job that) there is no rationing in the "free" market.
I appreciate it if you thought Peikoff's argument was weak, but you did not specifically state why. Stating that it is weak becuase "well, it IS weak" similarly is not an explanation. A cannot refure criticism that states no basis--that would amount to bolstering the argument you simply state "is weak," not refuting your criticism.
Viscus: Well, whatever else the physician is, he is a moron.
Now that's civil. To your point, though: calling a natural limitation (or equilibrium) of supply "rationing" is quite Orwellian. Rationing is human control over (e.g.) food. Starving in the desert is not a form of rationing.
Or I could tell someone who doesn't have money that they don't need to buy a car while some rich snob is buying a Mercedes. Apparently unless everyone everywhere has everything they could possibly want we are "rationing" (and the term is meaningless).
The better question is in what manner the federal / state / local governments should fund the provision of health care.
One option is, of course, not at all. You may believe that health care consumers who cannot pay for their own care, whether out-of-pocket or through insurance, must rely solely on private charity. And you are welcome to advocate for that position. but the opponents of that viewpoint will argue that you believe that those who cannot pay should be denied service -- and therefore die prematurely -- if the hospital doesn't have sufficient charitable contributions that week.
Given the enormous popularity of Medicare/Medicaid, including part D, I suspect you will find very few takers for the position that government should not help pay for the provision of health care on a societal level.
So the only remaining question is whether the current system is fair and adequate. Many people believe that it is not -- emergency rooms are overcrowed with people not needing emergency or even urgent care. lack of insurance causes unnecessary stress and misery and interferes with entrepreneurship.
In comparing US care to Canada, specificaly William Oliver's post above, even his link admits that Canadian healthcare is (a) insufficient, and (b) an outlier in that is does not (i) require any fees to see a doctor (one of the most useful and efficient ways to limit abuse of the system) and (ii) makes it illegal for doctors to practice outside the sytem.
I may be misreading you, but are you aware that the vast majority of doctors are not "employed" by the hospital they work in? Doctors (with some exceptions) are more like independent contractors than anything else. And in fact, there is a great competition between hospitals for doctors.
Just trying to clear things up.
- Alaska Jack
In the last 10 years there are two ( and only two) areas in medicine where costs have gone down simultaneous with outcomes getting better.
1. Lasik eye surgery
2. Cosmetic surgery
common factor: no third part payments in either case.
The problem is not just mediacare medicaid, it is the whole insurance scheme we have set up, third parties being the payers will always lead to waste and fraud.So any rational soultion has to be a free market based solution.
Universal coverage/socialized medicine is one of those things that sounds great, like mom and apple pie - but the inevitability of unchecked escalation in costs -in the absense of severe rationing - is logical expectation.
Health care is a right- pshaw-. well why not unrestricted acces to legal services civil as well as criminal- to be paid for by the state at a rate determined by the state. Why stop there, I want the state to provede for my plumbing, my electrician, my gasoline, my house, my vacation. In fact if I am sexually deprived maybe the state can provede me with a sex worker at taxpayer expense as well.
and Spartacus don't mind viscus too much, his comments across the board have lumpen proleteriat ring to them. Given his nom de plume- i would liken his comments to the matter inside a hollow viscus.
Whenever legislators enact an "entitlement," they are realy enacting an obligation, or sets of obligations to be met by others.
In other words, what the legislators are doing is imposing an unchosen obligation, i.e. a *duty*. It's the same principle underlying conservative rationalizations for the military draft.
The difference between government rationing and capitalist "rationing" is called "individual rights". As in, government rationing brushes that aside, while capitalist "rationing" is a sum result of free decisions by free actors.
On one level, there is no such thing as a non-philosophical argument; there are simply those which are aware of their philosophic base and those which are not.
That being said, the reason why Dr. Hsieh's argument is philosophical is because that is where the root differences are. It isn't a political, but moral issue.
Do you hold individual rights as an absolute or not? If so, why? If not, why? What exactly does "absolute" mean?
That's a philosophical question -- but if you don't know where you are on that question, Dr. Hsieh's position won't make any sense to you. If you don't deal with that question -- if you don't bother dealing with fundamentals -- then you won't ever "get it".
You end up being so blinded you can't even tell the moral difference between free market "rationing" and socialist rationing.
Well, there are several problems with that analogy.
First is that you are lumping in proper government functions ("police protection") with illegitimate ones ("public education")... but then that gets down to the nature and purpose of government, one of those pesky philosophical arguments that so many people don't seem to think is even relevant to the issue (!).
But even so, the "fairly high base level" of service does not in fact extent to specific individuals as regards t least police services (Warren vs. DC is the case, I think, but IANAL).
If you think your HMO doc is impersonal now, just wait until he's held to that "fairly high base level".
No, they aren't. And that's where one of those supposed "unintended consequences" take hold: many of our most brilliant minds take one look at the bureaucratic and moral nightmare that is our *current* medical system, and choose another field entirely. Doctors in Canada are pretty scarce -- apart from those skipping the field, many are drawn south by the freer and better paying U.S. market. The situation would be worse if not for foreign immigrants filling many of the empty slots.
As a result, your system selects not for those best adapted to be doctors, but those best adapted to be politicians -- who can handle the paperwork, regulations and Little Dictators who run things.
Is that the skillset you want in your doctor?
I'm not sure where most of your post comes from, but you've obviously read way to much into those two sentences. I'll also note your confusing what I said with what other people said...I never said anything about rationing at all. I'll ignore your ad hominem attacks and elaborate on what I said.
Arguing for or against universal healthcare based on a whether or not healthcare is a right is not really productive. If it is a right, then the government should, but doesn't necessarily have to, provide for it. However, if it is not a right then it doesn't necessarily mean that the government should not provide for it. After all we don't have a fundamental right to libraries yet the government pays for those. There are also equally valid philosophical arguments for or against healthcare as a right. This last point was what I was trying to get at with my sentences. Basing your against universal healthcare solely or mainly on a philosophical argument is not very useful because it can be countered with one of the many philosophical arguments that conclude the opposite.
My apologies too. I as overly harsh in my reply.
The main problem I have with Peikoff's reasoning is essentially this quote (which he uses as an analogy to government run healthcare):
His characterization of what universal health care would be like is quite frankly absurd. He has taken the most ridiculous way of running the program and used that as a reason why we shouldn't even attempt universal healthcare or incorporate aspects of it into our current system. It is nothing more than unfounded speculation and is not backed up with any proof or evidence. What I alluded in my earlier post was his slippery slope argument. If we give out free haircuts then we also HAVE to give out hair replacement and HAVE to use super fancy eyebrow things. One does not follow from the other. He also assumes that things will happen (peer review boards) that have already happened...they're called morbidity and mortality meetings and other examples of peer review exists. To me making sure that no one is too busy or unbusy is good sense...it ensures an efficient distribution of doctors. why would we want to pay a doctor for sitting on his butt all day? but there is no reason to assume that the government would force a doctor to give up patients...it can just as well offer incentives to encourage doctors to move into areas that don't have enough doctors. (this too already happens...rural doctors get major perks provided for by the local government that aren't offered to other doctors.) It goes on and on like this...I don't have the desire to write about the other errors of reasoning.
"Public education" is an "illegitimate" government function?! Haven't our courts said exactly the opposite on a number of different occasions, e.g., when Front Royal, Virginia closed its public schools rather than integrate them?
* It starts out problematically enough, by aggregating the amount spent and claiming "we" spend that much, as if the fact that John Edwards spends $500 on haircuts and I spend $10 on haircuts means "we" spend $510 on haircuts.
* It then confuses insurance with care. How many people are "uninsured" -- and the number you cite is inflated, because it counts people insured at any point during the year -- has nothing to do with the question of how many people get care.
* It assumes that "measures of health" are comparable from country to country.
* It then mistakenly assumes that "measures of health" measure health care, rather than health. If someone dies "prematurely", it can be because he didn't get sufficient health care. Or it could be because he drove drunk (or just carelessly), or because he smoked, or ate too much fast food, or because he got into a shootout with a rival drug dealer. Assuming for the sake of argument that Americans do more of these things than people in other "developed countries," we would come out worse by "measures of health," but that wouldn't say anything about our health care.
* It assumes that "measures of health" measure what we spend our money on. If we spend a lot of money on quality of life (whether it be cosmetic surgery or allergy medication or Viagra or hip replacement surgery) rather than the things that your statistics "measure," then we'll come out worse in this comparison, but it won't say anything about whether we're "doing something wrong."
So rather than just critiquing my point, tell me how you would compare delivery of health services between countries to get a reasonable comparison of the effectiveness of health care systems? Because the argument against "socialized" medicine seems to be the conclusory one of government = bad or government provided = less efficient than market, as if that ends the argument.
And let's address your points one by one:
* I assume John Edwards is one of us (i.e., an American) since he served in the Senate and last I checked, that requires one to be a U.S. citizen. Why does it matter if some people spend more on health care than others. The fact remains 50% more of our GDP is spent on health care than the next nearest country.
* Whether or not the numbers are inflated, the fact remains that at any one time a huge proportion of this country are subject to potentially devastating consequence if they are struck by a serious disease or injury while practically everyone else in the world doesn't have to worry about the financial consequences of such a thing.
* Since such figures are compiled by the WHO and other international organizations I assume some effort is made to normalize the data. Do you have contrary evidence.
* This is partially true but also mostly untrue. It is true measures of health reflect a lot of things about a society, but it is a very good indicator of the effectiveness of its health care system.
* As for this, all I can say is obviously you don't know anyone who has needed hip replacement surgery or you wouldn't lump it in with Viagra and cosmetic surgery.
You'd look at those numbers and say that the US is doing something wrong because "we" spend much more than Canadians but get worse haircuts. But that's not what's happening at all. "We're" not spending more; Edwards is. There's no collective haircuts. There's individual spending and individual haircuts.
* The number being inflated was a lesser point. The greater point was that health care and health insurance aren't the same thing. I didn't know that not only was there a right to health care, but there was a right not to worry about the financial consequences of illness.
* No effort is made to normalize data; it's gathered by the countries and reported by WHO. We know that infant mortality -- one of the measures of health often cited in these international comparisons -- is defined differently from country to country, in such a way that the U.S. numbers are higher without representing higher fatalities.
* At the extremes, it is. Obviously we know that the difference in quality of health care between Zimbabwe and Sweden is directly related to their different rankings in various health measures. But we're not talking about the extremes; we're talking about narrow differences between high-ranking countries. And when you're in that narrow band, these things make a big difference. We drive more than other countries -- and driving disproportionately kills young people, which has a disproportionate effect on life expectancy figures.
* I "lumped them in" as treatments that are quality-of-life rather than quantity-of-life. If you measure infant mortality or life expectancy, no matter how much we spend on viagra or allergy medication or cosmetic surgery or hip replacement won't affect our ranking in these metrics. If Canada has a policy of handing wheelchairs to injured 70 year olds and we have a policy of replacing their hips, then we'll spend more on care, but it won't make us look better by these common measures.
Actually, hip replacement most definitely will. People who don't get hip replacements (and my ex-mother-in-law, who could not afford it and thus was on a unwritten waiting list is a perfect example) are unable to walk and are subject to all the various hazards of an extreme sedentary lifestyle. This can include the formation of blood clots in the legs that can travel to the heart or brain that can be instantly fatal (which is exactly what happened to my ex-mother-in-law).
We drive more than other countries -- and driving disproportionately kills young people
Driving alone is not the pertinent factor. Rather it is the injury and death rate from transportation accidents. And by that measure the U.S. is actually pretty good (mostly because our roads are relatively uncrowded).
We know that infant mortality -- one of the measures of health often cited in these international comparisons -- is defined differently from country to country, in such a way that the U.S. numbers are higher without representing higher fatalities.
I have often heard this stated, but never seen any evidence that it is true. Where is the proof for this "known fact", and does anyone know what the normalized figure is?
Of course there are many obligations which legislatures can enact in conformance with our (and other) constitutions. However, there are other obligations amongst us (while recognized and accepted in our social order) to which our Constitution denies a role to the legislature, or to any others desiring to use the mechanisms of any levels of our governments to define or enforce.
Here's an illustration of the difference between mortality and quality of life, from the post by Abandon at 4.27.2007 2:29pm above:
That is, it treated a life threatening condition promptly, but for a merely crippling condition it delayed even testing to determine the proper treatment so long that the patient finally paid for it on his own. And I have to presume that if many patients didn't go outside the system and pay for such treatment themselves, the waiting lists would be much longer. (I've got no statistics, but I know clinics in the USA near the border that do a large portion of their business with Canadians for cash.)
What's the point of staying alive if you cannot enjoy life because each movement causes pain? IMO, a health system that keeps everyone alive for as long as possible but does little to treat merely painful and crippling conditions is barbaric - but the way most health statistics are collected, this would look as good as a system that treated all conditions.
But the point is that getting an MRI in Canada has nothing to do with your ability to pay. If you have chronic pain in this country and need an MRI and don't have insurance or the $1500 plus or so it costs to get an MRI, you are simply not going to get it. So the "waiting list" becomes the time it takes to save up the money to pay for the MRI.
And say you max out your credit card to pay for the MRI and the results come back and the doctor informs you that you need a $50,000 operation plus months of physical therapy afterwards to alleviate your pain--oh and you'll have to quit working your construction job while you recover. Or maybe you have chronic migraines and Topamax is a wonderful drug that will control them. Of course Topamax costs $400 a month (and the Imitrex for the occasional residual migraine is $150 per month).
Now, do you really want to tell an uninsured person in this country how much better off he is than an average working stiff in almost any person in any other developed country because we have the best health care system in the world?