The Left Is Right on Health Care

Awhile back I wrote about rightie obliviousness on the national health care issue

… the Canadian Model is a bugaboo of the Right. Try to discuss national health care with a rightie, and the first sentence out of his mouth will be, “You mean like in Canada?” Then he will go off on a tirade about the problems with the Canadian system. (Unless you remind them of the underfunded British system, which is the other good “bad” example of a system with problems.)

Here’s a juicy example, although to be fair the rightie discusses the British system first and then switches to Canada. And then he throws in Cuba and comments,

The three socialized systems cited above are the cream of the crop when it comes to government controlled medical care. Clearly, your best bet is not to get sick.

Actually, they are not the “cream of the crop.” The British system has big problems, in large part because Tony Blair’s government is trying to get by on the cheap (see this PDF document, Figure One). The Canadian system also has some problems, which I discussed in the earlier post linked above. But there are several dozen countries with national health care; it isn’t just Britain, Canada, and Cuba. In fact, the only industrialized democracy in the world without national health care is the United States. In fact, just about every place on the planet where the average person owns a microwave has national health care, except the United States.

To righties, all of these systems are just one system, called “socialized medicine,” and they’re all bad, and they’re all just like Hillarycare. But in fact there are huge, whopping, substantial differences among the several systems.

There are some systems, like Britain’s, in which the government employs doctors and runs hospitals and acts as a “gatekeeper.” To use the National Health Service you go to NHS doctors, and since the Brits have very tight cost control some feel the “gate” can be a tad too narrow, as it were. Other nations have a mix of public and private systems. In France, for example, most of the doctors and hospitals are private sector. The government pays for health insurance that a citizen can take to the doctor of his choice to get basic care, and if he wants he can purchase private supplemental insurance to pay for first class treatment.

Righties seem to think that “national health care” means the British system, where you have to literally go to the government for treatment when you get sick. I personally would prefer something like the French system, in which the government doesn’t get involved in health care except to pay bills.

Last year Bradford Plumer wrote,

… the health care debate in America is never going to get very far so long as the conventional wisdom is that health care alternatives in other countries suck. Good point! But it’s also worth asking why this is the conventional wisdom. To some extent, it’s because conservatives, spearheaded by the insurance industry, have bamboozled us into thinking it’s so. … [But] Media coverage of national health care systems in other countries is dismal. … And, as a result, few Americans have even the vaguest idea of what French health care, or Canadian health care, or Swedish health care, is really like.

Recently at TPM Cafe, Matt Yglesias wrote that one reason we get nowhere in our health care debates is that the options presented to us are too limited and narrow.

Arguments against single-payer health care here seem to be two-fold. One, the idea is old and the debate about it therefore “stultified.” Two, the idea represents one pole of the debate and the name of the game is to find third way ideas. The first objection is obviously silly — that an idea is old has no bearing on its merits. The second objection, meanwhile, is easily met. Simply define the “left” pole in the debate as not something like the French or Canadian system, but something like the even more statist system they have in the United Kingdom. The “right” pole continues to be “veneration of free markets.” Ergo, the “center” position is now one in which the public sector provides health insurance but the private sector provides health care and we reject the “false choices” of those who insist we must choose between the NHS and and pure laissez faire.

Alternatively, you can define as your left pole a system like Canada’s where the government provides everyone with insurance and bans private health insurance, leaving the centrist alternative a system like France’s where the government provides everyone with insurance and then lets you buy additional insurance on top of the baseline from the private sector. Everyone can play this game.

France seems to fall between the poles either way.

“Hillarycare,” btw, was based on the German system according to Ezra Klein. It sounds way complicated.

Until we get a progressive majority in Washington ’twill all be but a dream. But in the meantime, just remember that it’s possible for a rightie to see the light and realize the U.S. system isn’t that great, after all. All it takes is for the rightie to lose his health insurance.

22 thoughts on “The Left Is Right on Health Care

  1. My wife and I just had a baby and the care we recieved during the pregnancy and for the birth was simply amazing.

    Because we’re older it was recomended by our doctor that we undergo a number of tests (chromosone etc.) to determine the health of the fetus which we did (she’s quite healthy).

    For the birth we had the choice of using a midwife an obgen or our family doctor, a home birth or hopital birth – whatever we wanted. the birth ended up being a hospital c-section.

    Because we chose to breastfeed we were provided with a lactation consultant and allowed to stay in the hospital until we were comfortable with breastfeeding (up to 5 days).

    At no time were we asked ‘what’s your policy cover?’

    Now that we’re home we’re allowed one year off work (paid for by employment insurance) which can be split between us as parents any way we see fit.

    That’s the crappy Canadian system for you.


  2. Ah, you’ve fallen for the other part of the mythology: that you have no choice in Britain but to use the NHS.

    That’s not true. You can also buy private health insurance and you can get private medical care. That’s what “Harley Street” refers to – you have to pay for those Harley Street doctors, it’s all so upmarket.

    You have no choice but to contribute to the NHS – it’s available to everyone, whether you’re as successful as you hope to be or not – but you do have a choice.

    And, although the last three Prime Ministers have led the charge to “modernize” (meaning privatize) the NHS, and have therefore managed to screw it up, the fact is that it’s still pretty damned good. Certainly no worse than what you’d expect in America.

  3. The prime problem with our system is that there are way too many non-medical people making decisions on patient care. And, we know that that is solely for the bottomline. The examples above seem to demonstrate that non-medical people were not involved–at least to the degree in America–in the decisionmaking.

    And, the problem with the debate on health care is that it is not a true debate. It is only people shouting talking points at each other. We need to get our dictionaries out and reread the definition of a debate and take on the formal rules of debating groups. We need, also, to become civil and mannerly in these debates respecting each others point of view. Then, maybe we can have a discussion with some substance that lead to compromises and solutions.

    My hope that the righties can do that is dim. But, I know most lefties and moderates can do this.

  4. That’s not true. You can also buy private health insurance and you can get private medical care.

    Yes, I know that. I’m sorry I didn’t write a 3,000-word essay with all the details, instead of a two-sentence synopsis.

  5. Avedon beat me to the point that Thatcher started dismantling Britain’s NHS way back in the 1980s.

    I know the problems with Canada’s system are complicated, and yes, richer folks up there will go for costlier care “out of pocket.” Just like in the U.S., really– they too have vain morons asking their doctors about Botox cosmetic. At least the children in poorer Canadian families have health insurance. Ours have given it up, in order to contribute to Dick Cheney’s retirement fund at Halliburton.

  6. Hillarycare, the German system is not complicated.
    In the German system it is include in the (long word) Sozialversicherung. (Social Insurance ) It is a payroll deduction combined with retirement, unemployment and healthinsurance. The deduction for all three is about 12% and the employer equals it. It is like our social security deduction. Healthcare covers all dependents, everyone pays in as soon as they are employed. If you earn more than the cutoff you must take a private insurance. You may buy additional insurance which would not get you better medical care but yoy could have a more luxurious hospital room and not have to share with one or two people. The insurance also covers dental care, all maternity care, if needed a cure up to 4 weeks, includes of course prescription drugs and decisions are made by medical personell only. The treatment is what the Dr. of your choice says it should be. You can choose your hospital and in case of emergency you will be taken to the nearest one. My Dr. used to make housecalls every Wednesday. Her office was in my neighborhood, I could walk there, the pharmacy was across the street.

    One more thing, the insurance is effective the day you start a job and goes with you to any new job.

    If it is not a perfect system it sure is a lot better than our system.

  7. Maha,

    Thanks for pulling the red meat from my mostly real teeth. We all need a break from the insanity of war now and then. My opinions on health care are minimal at best. I am reminded of this unfortunate fact every time I look in the mirror. But as you well know all policy in this country seems to be controlled by corporate interests. That’s why many (including myself) believe we will have single payer health care soon. The cost of staying alive if you’re sick is rising so fast that even corporate America is looking at “socialized medicine”. Wal-mart figured this out years ago, they just let Medicaid pick up the tab. Hopefully when these policies are finally and finely crafted we will have a government that actually intends to make it work. If not it will be a government buyout of corporate “legacy” costs. I think it’s best if the prevailing attitudes in Washington ignore this issue for now. Better bad than worse.

  8. Maha, I saw your earlier posts on this subject and wanted to comment but I didn’t, so I will this time. The Canadian health care system has its short comings but that is the price that we pay so that everyone has coverage. I believe most Canadians are comfortable with our health care system even though many of them like to gripe and whine about it. They don’t know how good they have it because they’ve never been denied coverage. People who require hip or knee replacements have to wait. Some of them are my friends. There are some who say that is unacceptable. They would “improve things” by giving us a US style system with instant access at unsustainable cost. I needed by-pass surgery two rears ago. It was scheduled within 12 weeks. I was in the hospital for 6 days and the cost to me was zero. Yes- we pay higher taxes but that is for the privilege of receiving care without having to mortgage the house to pay for medical bills or worse, declare bankruptcy or be denied care because of inability to pay. We may not have the best health care in the world but it works and it is care that we can afford. We also have good sickness, maternity and family leave provisions with most employers. The most interesting comparison I’ve seen between the US and Canadian system is in regard to administrative costs. Canada could probably fund our entire system based on what the US spends on administration costs. I think it was Paul Krugman (or maybe it was Maha in an earlier post) that pointed out that the if the US system spent as much money treating people rather than finding ways to deny coverage there would be no uninsured population. Who would want a system like that? Krugman did a column about a year ago on Canadian health care and the competitive advantage that it gives Canada in comparison to the US. Ontario now produces more vehicles a year than Michigan. GM Canada is making money and not begging their retirees or employees to agree to health care cuts. Toyota just announced a new parts plant today here in Southern Ontario.

  9. Next time you debate a rightie who complains about socialized health care, ask them if they think it’s okay for the U.S. to effectively subsidize universal health care in Israel (some of the best on the planet).

  10. The lowest common denominator. Health Care. We all know we need it at some point. This topic frankly makes me “sick”, pun intended. Come on now. We have neoconsuperfratboys telling us that liberty means nothing if we are killed by “boogie men”. I say healthcare means nothing unless we have liberty. Health care is like the highway system, somebody needs to fix it, maybe just not today, focus, better bad than worse. Let’s save the constitution first.

  11. This is my first time ever posting on a blog. Let’s hope I add something to the debate. Btw, Maha, thanks for the insightful posts.

    I’ve lived most of my adult life overseas–four years in London, the rest in Japan. My first two sons were born in London. They were born in a private hospital rather than the NHS. As expats we had private insurance as well and this hospital was one of the best for natural childbirth. After care took place through the NHS. Within a week of being discharged (five days in hospital for a natural birth/seven for a C section) a midwife visited me in my home to check me and my son. Affiliated with local GPs are health visitors. The ones I met were former midwives. They had scheduled hours when they were free for mothers and babies to drop in and talk one on one about any problems or issues regarding the baby and or themselves. After my second son was born, the health visitor called me because she knew I had no family close by and simply wanted to check that I was doing okay and even came by to visit once. I wonder how many American women would benefit from that kind of after-birth support in place?

    Here in Japan, everyone is covered. I go to any doctor I want and pay 30% of the cost for myself and my sons. My husband pays 20% as we’re covered through his employment. You are either under health insurance provided by your employer or by the government. My municipality (home to Tokyo Disneyland, so a good corporate tax base) provides free health care for all children under the age of six. Prices are set for visits, treatments and medicine. A first visit to the pediatrician for strep throat for my 9yr. old this past Monday cost me 1,030 yen (less than $10). Follow up visits for the same condition will be about $5. Antibiotics for him for four days cost me 960 yen (about $8). My boys get sick, I go to the doctor the same day. It’s first come first serve but I’m usually out with in an hour or an hour and a half.

    My friend in San Diego broke his collarbone on a Friday while skiing in New Mexico. He’s CFO of a venture capitalist company, pulling six figures and living in La Jolla. At the nearest emergency care center, they packed his shoulder. While he made arrangements to fly back to San Diego (this was a holiday weekend) his wife called various orthopedic specialists in San Diego trying to get him an appt. She was told two weeks at the earliest. (Excuse me! He’s supposed to walk around with a broken collarbone for two weeks?) His boss pulled strings to get him into a top specialist on Tuesday. He then had to figure out how to get his insurance to cover it since this doctor didn’t accept that insurance. How can anybody claim America has the best system when stuff like this happens?

    Last, there’s my mom with asthma who couldn’t wait for Medicare to kick in at 65 since she paid $400 to stay insured with Kaiser and $200 plus for asthma medication. Too bad she only earns about $500 a month in social security.

    The American system is broken. There are better ways.

  12. “I believe most Canadians are comfortable with our health care system even though many of them like to gripe and whine about it. They don’t know how good they have it because they’ve never been denied coverage.”

    Amen to that.

    Without going into the particulars of my situation, all I can say is that I am thankful every day to be living in Canada and paying my taxes for decent medical coverage. This being said, there are stories every day in our papers about unacceptable medical situations that are attributed to our medicare system. However, I suspect that such situations exist everywhere, including in countries like France and Norway. I am also sure that many more people in the States live with sickness and die to due to a lack of proper medical care than anywhere else in the Western world.

    There are no foolproof solutions, but I think that the States has definitely shown the rest of the world which road NOT to take when it comes to keeping its population healthy.

  13. I wonder how many American women would benefit from that kind of after-birth support in place?

    We get none, of course. And the last time I was paying attention to obstetric practices (which has been a while), there was a big push from somewhere to shove women out of the hospital the next day after an uncomplicated childbirth. Back when I was having babies (my youngest is 21) the standard was 2 to 3 days, max.

  14. Unfortunately, the public discussion quickly degrades into war-by-anecdote. It’s a numbers game — one in which U.S. health care is plainly overpriced and under-covered — but in general the public doesn’t do numbers. Given the vested interests involved, who will spare no expense in marketing their point of view, I’m pessimistic that any sort of sane solution will emerge. The drug/insurance/doctor/lawyer lobbies will corner the dialog using even more misspent healthcare dollars.

  15. I’ve lived in Britain for 13 years. For all but the first two years (when I was an expat employee on private insurance) my health care has come exclusively through the NHS. I’m not going to say it’s perfect but I’ve had some health issues over the last couple of years and when I’ve really needed it the care has been there and it’s been excellent (as long as you can handle a ward with 4 – 8 beds. Yes. I once had to wait 4-5 months for non-emergency knee surgery. Yes. I had to wait 3 months to have a cyst taken out of my eye.

    But there is something to be said for never making a payment, never filling in a form. When you go to hospital they put you on a ward with only your name, address and Dr’s info. When you leave you just ring a cab.

    And it’s truly universal access.

  16. Again (I’ve mentioned it before) my experience with the Canadian helathcare system comes from my girlfriend’s family. Her mom fell, broke her hip and was at the time so decrepit she wasn’t able to leave the hospital for the rest of her life — 5 years, round the clock care, physical therapy, etc. Cost $38 for the ambulance ride (and try riding an ambulance in the USA for 6 miles for $38).

    Her son needed a hernia operation and was checked into a specialty clinic within a month and the operation was done. Total cost: $0 (and that’s Zero Canadian dollars, which is even cheaper).

    I have good US medical insurance through an extremely large pension plan with mega clout — as a result I can go to a limited number of doctors and after my $3,000 dollar deductible I “only” have to pay 20%.

    Oh yeah, Canada’s system sucks… sure it does.

  17. Re waiting lists — there are waitings lists in the U.S., too, for many non-emergency procedures. Around here there’s a 4- to 6-month waiting list for mammograms, for example.

    Once I was put on a six-week wait to get a fibroid tumor removed (that’s a girl thing) but in fact did not wait the six weeks because I started to hemorrhage after five weeks and needed emergency surgery.

    When woke up a nurse was leaning over me. “Lady, are you lucky,” she said. I couldn’t ask her what she meant because of the dadblamed breathing tube, but I have my suspicions.

    I wouldn’t have blamed “the system” for the delay because usually fibroid tumors ain’t no big deal, but during the wait I had called the doctors a couple of times because of excessive bleeding and was told I still had to wait the six weeks.

  18. The three socialized system the rightie mentions includes Cuba.

    I don’t know the cuban system, I do know Cuba is poor and America is rich and Cuba has a lower infant mortality than the USA and has enough physisians to send thousands to Venezuela and Pakistan. To Pakistan to help earthquake victims.

    And we do know under the Batista regime the Cubans were as illiterate as other South American people. Now they provide doctors and teachers to other poor nations.

  19. To start off with, I am not a proponent of single-payer healthcare.
    If the politics in medicine (what’s behind the scenes of the American public) were to be eliminated, then the prices would go down. As one Dr. James Carter once stated, “if a doctor dares to use a medical therapy [on a patient] no matter how inexpensive or safe,, organized medicine can target this doctor for revocation of his/ [her] license.”
    Introduce alternative therapies–homeopathy, chiropractic, naturopathy, colonics, acupuncture, EDTA chelation, to name a few. Relax the state boards and the FDA’s “gestapo” tactics towards alternative therapies, begin teaching their legitimacy in medical schools. Let the competition (alternative therapies) into the medical realm.
    Alas, I don’t foresee any of the aforementioned ever happening–not because the said therapies are “unscientific” (as many mainstream medical professionals slander them), but rather that there’s NO money in them. (And that loss of money translates into taxes that government could have received.)
    So the politicians (proponents of “universal” health care) who say they “care” about the public make me wonder if they do indeed care about us at all.
    Yes, the idea (universal health care) is a noble one. Take the almighty dollar away, though, why would government even consider implementing one? But the ordinary J. Q. Public must remain forever ignorant.

  20. but rather that there’s NO money in them.

    That’s absurd. There’s plenty of money in them, which is why they flourish underground and across the border. Private insurance won’t pay for most alternative theropies because most (with a few exceptions, possibly) of ’em don’t work beyond a placebo effect.

    Your theory needs work.

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