Medical Opinion
Dave Price
Dr. Paul Hsieh of GeekPress on socialized medicine in Colorado:
I completely oppose any form of socialized medicine, regardless of whether it is called "single payer", "mandatory universal coverage", or anything else, because I believe it would be bad for both patients and doctors. Years of experience in the US and other countries have shown that these programs will hurt patients and even cause their deaths. As costs inevitably spiral upward, bureaucrats will ration medical services. Eventually, physicians will be forced to practice against their best medical judgment. This is a violation of the fundamental rights of both doctors and patients.I know it's a bit old, but it's a well-argued piece and I've been meaning to link it for a while.
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Although I agree that there are genuine problems with the current system, more government interference in medicine can only make things worse. One basic principle we all learned in medical school was, "First, do no harm". This applies as well to politics as it does to clinical practice. Most of the problems of the current system have been the result of bad government policies. Adding more government bureaucrats to the mix will only make things worse.
In my opinion, it is not the government's role to guarantee health care for all Coloradoans, any more than it is the government's job to guarantee all citizens a car or a job. It is morally wrong and economically unsustainable. Doctors and patients ought to be able to freely contract for medical services to their mutual benefit without interference from the government. It is precisely the attempts by the governments in Canada and Great Britain (or states like Tennessee) to guarantee universal "cradle-to-grave" coverage that has led to the runaway costs and rapidly deteriorating health care in those places.
1) Socialized medicine drives up costs in a way that is supposedly unsustainable
2) Socialized medicine is essentially antagonistic to the right of individual doctors and individual patients to negotiate private business relationships.
The first point is fact-free. Canada has had fully socialized medicine for over four decades, and per capita medical expenditures there are less than half of what they are here. With better average outcomes. While costs have certainly increased there, their system seems far more stable and effective than our own.
As for the second point, sure. But there are plenty of times in democracies when the majority takes action to enforce their well-being against the will of the minority. If the voters of Colorado wish to use their government as a purchasing co-op in order to lower per-capita medical costs, that's their prerogative. Freedom of enterprise is essential to our liberty, but that does not mean it should be without limit.
Assuming that Dr. Hsieh was educated in the United States, his medical education as a resident was subsidized to the tune of $80,000 per year. His current income is subsidized, not merely by the $.60 of every healthcare dollar paid by government in one way or another but by licensing requirements and other barriers to entry in the medical profession. Is that or is that not socialized medicine?
IMO rather than a fruitless, strawman argument for or against socialized medicine we should be engaging in a serious discussion of what sort of socialized medicine we will have.
That doesn't mean they cost less, that means they're SPENDING less. This is not an outcome that is good for the patient.
With better average outcomes.
Not true. They're just living healthier. Lower dialysis mortality rates reflect a diet with less refined carbs.
While costs have certainly increased there, their system seems far more stable and effective than our own.
Sure, until you have to wait six months for a treatment available on-demand in the States.
Although I agree that there are genuine problems with the current system, more government interference in medicine can only make things worse.o
Total waiting time between referral from a general practitioner and treatment, averaged across all 12 specialties and 10 provinces surveyed, fell from 17.9 weeks in 2004 back to the 17.7 weeks last seen in 2003.
Among the provinces, Ontario achieved the shortest total wait in 2005, 16.3 weeks, with Manitoba (16.6 weeks), and Alberta (16.8 weeks) next shortest. Saskatchewan, despite a dramatic 7.8 week reduction in the total wait time, exhibited the longest total wait, 25.5 weeks; the next longest waits were found in New Brunswick (24.5 Weeks) and Newfoundland (22.3 weeks).
Health care spending is irrational in the U.S., as Kling has pointed out, because patients and doctors are insulated from cost decisions by insurance. MRIs are prescribed at 10 times the rate of Canada. Still, even if premium care delivers relatively small returns on investment, most patients are loathe to give it up.
Where has this guy been? From what I've heard this is already commonplace.
I have to agree with Tom Strong on this.
Diagnostic options are not.
Arnold Kling and Hsieh have it right: we need less government intervention and insulation from costs, not more. If people want premium medical care, with diagnostics that are not rationally determined on a cost-benefit basis, they're going to have to pay for it.
According to the articles I have read, the patient checks in,and gets a hand held beeper (same as the ones you find at busy restaurants or the instore Cost Cutters).
It will be interesting to see what the long term effects will be, healthcare should be more competitive,not less.
Just like after Hurricane Katrina, it's the hated super marts that are smart enough to see how they can fufill a demand, leaving government bureaucracy out of the process.
I also wonder how much medical innovation is brought about by forces generated by multi-payer market places, is shared with single payer systems,but is not factored out of assessments of the quality of single payer systems.
I'll happily grant that the Canadian system is grossly inefficient when it comes to wait times. I'm not touting it as a perfect system or even a particularly good one. It just happens to be better than our own when it comes to meeting the needs of most citizens.
In return, I'd like to see you substantiate Dr. Hsieh's claim that "socialist" systems are so cost-inefficient and fiscally unsustainable relative to our own (or even relative to more libertarian systems). With numbers, please.
"Health Care in a Free Society: Rebutting the Myths of National Health Insurance".
(The weblink goes to the abstract; that page also includes a link to the full PDF file.)
The specific myths he discusses include:
Myth #1. In Countries with National Health Insurance, People Have a Right to Health Care
Myth #2. Countries with National Health Insurance Deliver High-Quality Health Care
Myth #3. Countries with National Health Insurance Make Health Care Available on the Basis of Need Rather Than Ability to Pay
Myth #4. Although the United States Spends More per Capita on Health Care Than Other Countries with National Health Insurance, Americans Do Not Get Better Health Care
Myth #5. Countries with National Health Insurance Create Equal Access to Health Care
Myth #6. Countries with National Health Insurance Hold Down Costs by Operating More Efficient Health Care Systems
Myth #7. National Health Insurance Would Benefit the Elderly and Racial Minorities
Myth #8. Countries with National Health Insurance Have Been More Successful Than the United States in Controlling Health Care Costs
Myth #9. Single-Payer National Health Insurance Would Reduce the Cost of Prescription Drugs for Americans
Myth #10. Under National Health Insurance, Funds are Allocated So That They Have the Greatest Impact on Health
Myth #11. A Single-Payer National Health Care System Would Lower Health Care Costs because Preventative Health Services Would Be More Widely Available
Myth #12. The Defects of National Health Insurance Schemes in Other Countries Could be Remedied by a Few Reforms
Of course we all lose our tempers now and then. Dean freely admits to being imperfect in this regard, which is why regulars to this establishment will generally be cut more slack than people who we don't know very well.
Still: behave like an adult, or go find somewhere else to play. Thanks.