patrick.net

AussieGothamite says

That wasn't too hard.

Maybe because it is not a citation to Einvestor's comments?

No system is perfect. I'll take a base public healthcare system with an ancillary private system every day over what I had in the USA before emigrating to Australia. My treatment here for the last eighteen years has been overwhelmingly professional, timely and eminently affordable. It's been the same situation for my kids. For those who want the additional benefit of greater choice, a private system also exists. The layers of bureaucracy, complexity and rent-seeking in the US healthcare system are outrageous. Billing practices are opaque and abusive. Some parts of the US system are beginning to incentivize preventative care and health outcomes rather than the cost-plus provision of sometimes unnecessary services. This is a good thing, and it should continue. If the pharmaceutical industry can also somehow be be brought to heel, a great improvement to the system will have been accomplished, even if single payer is never enacted. Inflexible ideology sometimes prevents a reasoned discussion of the benefits and drawbacks of change. We could all be doing a better job fighting those tendencies.

Once again citation please.

Once again whenever a goverment agency does not have to compete through price discovery, the increased cost will result in rationing.

Once again any imbalance will tend to paid for by inreased taxes.

How old is the Austalian system? Canada's is young, Britains is old and from what I hear is not good.

"It is approximately correct to state that when the perceived cost to the user approaches zero, the demand for services approaches infinity."

I've got some free kicks to the genitals to give out, how many do you want?

The availability of cost health services has not encouraged me to spend more time in the company of medical professionals than is absolutely necessary. There are likely a small percentage of the population for whom being prodded by doctors is an enjoyable pastime, but it's probably not sensible to believe that's particularly common.

The Oz system has been going, in some form, for about forty years. Who are you hearing about the UK system from?

I have to agree with favoring the single payer system with private add-ons/alternatives, at least compared to what we have now in the US, which is not a free market system at all - so it's not a real comparison between free market and socialized medicine. You can get top notch - possibly the best - care here in the US, but 99% don't have access to it. Plus it's a matter of pure luck if you get an MD and/or staff who actually cares. And while the overuse of antibiotics is rampant, simple and effective hygienic guidelines that are standard in other countries are completely ignored and you see hospital staff and MDs regularly partying or riding the bus in their work clothes. A base single-payer system with a voluntary opt-in for advanced private services and MDs may be a decent model, or a real free-market model if that can be achieved at this point (doubtful). A pure single-payer system without alternatives (i.e. prevented by law) I think is harmful.

AussieGothamite says

The Oz system has been going, in some form, for about forty years. Who are you hearing about the UK system from?

I don't know about the OZ systems' performance, but the UK system is very poor, this notion has been accepted not only by Americans, but also by their European peers. Most other northern European countries have better healthcare.

The aggregate financial cost of healthcare is going to depend heavily on demographics.

The US heathcare system went FUBAR with LBJ's dellusions, it is nothing but cronyism.

indigenous says

AussieGothamite says

That wasn't too hard.

Maybe because it is not a citation to Einvestor's comments?

You want a citation for the "it works" part? An analysis of that claim is going to depend strongly on what metrics you pick. Cost? Mortality rates? Patient satisfaction? And of course, there are artefacts and anomalies with any of this data. Some private healthcare advocates will point to the differing"survival rates" for prostate surgery in the US and UK as proof of the US superiority, neglecting to acknowledge that the evidence suggests far more medically unnecessary surgeries are performed in the US, rendering a direct comparison impossible (and that the incidence of death from prostate cancer is virtually identical in the two locations).

mell says

AussieGothamite says

The Oz system has been going, in some form, for about forty years. Who are you hearing about the UK system from?

I don't know about the OZ systems' performance, but the UK system is very poor, this notion has been accepted not only by Americans, but also by their European peers. Most other northern European countries have better healthcare.

Now it's time for me to ask for a citation.

indigenous says

The aggregate financial cost of healthcare is going to depend heavily on demographics.

The US heathcare system went FUBAR with LBJ's dellusions, it is nothing but cronyism.

I'm entirely willing to admit I don't understand what point you're making here.

AussieGothamite says

mell says

AussieGothamite says

The Oz system has been going, in some form, for about forty years. Who are you hearing about the UK system from?

I don't know about the OZ systems' performance, but the UK system is very poor, this notion has been accepted not only by Americans, but also by their European peers. Most other northern European countries have better healthcare.

Now it's time for me to ask for a citation.

I don't have one. Growing up in Europe and having many friends over there this is simply my and their observation. You could go by life expectancy where it is at the bottom of European countries, although the differences are very slim and there could be other reasons. Two more reasons I could give is that they don't deal well with chronic, not yet well-understood conditions and have a very strong influence of the "psycho-babble" lobby, i.e. psychologists who know jack shit meddling with severely ill patients by promoting quack "therapies" such as CBT/GET instead of admitting that they simply have no clue about some conditions. By the way, even Australia has been very poor at this by - for a long time - simply denying the existence of Lyme disease. This is a severe flip-side of government-mandated medicine. Nobody in their right mind and without malicious intent would make such a stupid claim as denying the existence of Lyme disease.

mell says

AussieGothamite says

The Oz system has been going, in some form, for about forty years. Who are you hearing about the UK system from?

I don't know about the OZ systems' performance, but the UK system is very poor, this notion has been accepted not only by Americans, but also by their European peers. Most other northern European countries have better healthcare.

I know it's from the oft-derided Wikipedia, but those references have to come from somewhere.

http://en.wikipedia.org/wiki/National_Health_Service_(England)#Public_satisfaction_and_criticism

AussieGothamite says

You want a citation for the "it works" part? An analysis of that claim is going to depend strongly on what metrics you pick. Cost? Mortality rates? Patient satisfaction? And of course, there are artefacts and anomalies with any of this data. Some private healthcare advocates will point to the differing"survival rates" for prostate surgery in the US and UK as proof of the US superiority, neglecting to acknowledge that the evidence suggests far more medically unnecessary surgeries are performed in the US, rendering a direct comparison impossible (and that the incidence of death from prostate cancer is virtually identical in the two locations)

Fair enough, but from a common sense point of view, if you make something free the demand is going to skyrocket. The only solution to this is to ration. Not that you have produced any numbers, but if they do not reflect this they are bullshit.

The US system is jacked up as well, it is just that what you endorse, I can't see working for a much bigger country, that is exponentially more diverse. One thing that has been proven over and over is that when you introduce central planning into something it creates imbalances.

If you have more young people in Australia then it is much easier to make public healthcare pencil out.

I'm pretty sure it's the concept of "chronic Lyme disease" that's up for debate, and not just in Australia. That's probably not a useful point for criticism of single-payer healthcare. If you don't like psychologists, I'm not sure either system is going to be particularly appealing, but I think you're going to find more of them in the US, per capita.

Indigenous, we've got the same aging baby boomer issue as the US. I'm not sure there's a significant difference there.

The healthcare is not always free here, but it's certainly cheap. There are some waiting lists for certain elective procedures, is that the kind of rationing you're thinking of? I didn't have to wait long for my hernia operation a few years ago. I think the surgery was scheduled and completed within a month of diagnosis. Seemed fair enough. I was out of pocket about two hundred bucks, all up. The bed I slept in after the surgery WAS extremely uncomfortable. I will give you that.

Sooner this has to fall within the law of averages:

If you make something free the demand is going to skyrocket. The only solution to this is to ration. Not that you have produced any numbers, but if they do not reflect this they are bullshit.

Or the law of averages has not caught up to them yet but will.

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

Doth mine eye deceive me, or have a number of comments mysteriously disappeared?

For shame, Mish. Cheap and intellectually dishonest.

Here's one I saved earlier.....

"But seriously, to get away from egregious bodily violence. If you had to pay 100 dollars for a prostate exam, but they made you a deal when you went in that you could have one every week for the same price, how many times would you go back that year?"

indigenous says

AussieGothamite says

As I said, indigenous. I have some free kicks to the genitals to deliver. How many do you want? By your logic it should be an infinite number.

An assertion like this is, like the Laffer curve, superficially logical but not robust enough to hold up under scrutiny.

Back at ya, the logic holds up fine, unless I'm arguing with a liberal.

I'm not the one arguing that free=appealing. A kick to the genitals is not something I'm after, whether offered gratis or for a fee.

Bill deleted them, because he realized I would scold him for his specious comments on economics.

One complaint I do hear about is wait lists for hip replacement surgery, which is a growing issue with the baby boomer demographic. Low urgency cases can and do face extended waits. Here's some information about that:

http://www.health.vic.gov.au/oahks/background.htm

http://performance.health.vic.gov.au/Home/Report.aspx?ReportKey=41

Looks like the median wait time is a little over a hundred days. That might seem barbaric to an advocate of private systems.

Not that the above are in the correct order, at this point. Neither do we have the original comments to which they are a response. Will they remain this time?

Bill deleted comments I made? How is this so?

Mish

Doesn't care what we say.

In which way does Mish not care? Doesn't care about my criticism of the deletions? Or doesn't care about the direction in which the discussion is going?

I think the problem is pointed out here:

/?p=1275124

EInvestor says

ALL developed countries have single-payer system and it works at 8% of their GDPs vs 17% of GDP in USA

Yeah, but if implemented here, a single payer system would somehow manage to spend more that 17% of GDP.

indigenous says

Fair enough, but from a common sense point of view, if you make something free the demand is going to skyrocket. The only solution to this is to ration. Not that you have produced any numbers, but if they do not reflect this they are bullshit.

Ridiculous even for you. People go to the doctor because they are sick, not because it's free. It's not free in any of the public health systems anyway. There's a charge everywhere I know of. No one is getting gall bladder surgery or hip replacements they don't need just because it's free. What a stupid idea. Being libertarian rots your brain.

Maybe a little rationing might not be such a bad thing in the states. Look at how much surgery with very dubious necesity is performed. Especially on very old, very sick people who are frequently terminally ill already. Please, please do everything for grandma, she's only 98. Other places don't have that. People are allowed to die quietly in comfort with dignity. It's not considered rationing. I've lived in there and seen it. They think the US system is barbaric.

bob2356 says

Ridiculous even for you. People go to the doctor because they are sick, not because it's free. It's not free in any of the public health systems anyway. There's a charge everywhere I know of. No one is getting gall bladder surgery or hip replacements they don't need just because it's free. What a stupid idea.

Right, you can't be that ignorant. Here is an excerpt from the first story in a google search:

And that story is about a safety-net hospital bursting at the seams trying to care for people with no insurance and, often, the kinds of ailments that could be managed or treated with the kind of regular medical care none of them can afford.

http://ripr.org/post/waiting-room-system-broken-so-many-places

The other anecdotal was from a Mexican I know who did just what I said costing at that time $60,000.00.

indigenous says

And that story is about a safety-net hospital bursting at the seams trying to care for people with no insurance and, often, the kinds of ailments that could be managed or treated with the kind of regular medical care none of them can afford.

What does this have to do with the price of tea in china? They went for medical care because they were SICK. They didn't go just because the ER was free. The only place they could get treated in the states was at an ER because in the states they couldn't afford any other option. If everyone had basic medical care they would have went to a doctors office not an ER. The same number of sick people will exist and be treated no matter what. How exactly will demand skyrocket? There won't be millions more sick people if the US went single payer tommorrow. Your libertarian mind just can't grasp that rather simple concept.

indigenous says

The other anecdotal was from a Mexican I know who did just what I said costing at that time $60,000.00.

WTF does that mean? You've babbled a lot of nonsense, which part is your mythical mexican referring to?

bob2356 says

They didn't go just because the ER was free.

Sure they did, they could have gone to a low cost care place.

bob2356 says

How exactly will demand skyrocket?

Because the cost is almost zero for low income people who will then act as with any commons they will abuse it. Which will result in rationing.

bob2356 says

WTF does that mean? You've babbled a lot of nonsense, which part is your mythical mexican referring to?

Nothing mythical about it, he got 60 k worth of surgery for free.

?indigenous says

bob2356 says

They didn't go just because the ER was free.

Sure they did, they could have gone to a low cost care place.

and where is this mythical low cost place at? obviously you've never been to an immedicare center. they were still treated. someone would have treated them no matter what. there wasn't any increase in demand, never mind your skyrocket. if everyone were covered under a public health system then the demand would be exactly the same. people wouldn't nned to go to er's for routine care. thanks again for proving my point.

indigenous says

bob2356 says

How exactly will demand skyrocket?

Because the cost is almost zero for low income people who will then act as with any commons they will abuse it. Which will result in rationing.

Because they will get sick more often or just go to the doctor when they have nothing else to do that day? How does that work? I'm still waiting for an explanation. Not that I'll ever get one from you.

indigenous says

bob2356 says

WTF does that mean? You've babbled a lot of nonsense, which part is your mythical mexican referring to?

Nothing mythical about it, he got 60 k worth of surgery for free.

and how did this still mytical mexican get 60k worth of free surgery.

bob2356 says

and where is this mythical low cost place at? obviously you've never been to an immedicare center. they were still treated. someone would have treated them no matter what. there wasn't any increase in demand, never mind your skyrocket. if everyone were covered under a public health system then the demand would be exactly the same. people wouldn't nned to go to er's for routine care. thanks again for proving my point.

Not true they would have not gone to the ER for a cold if they had to pay.

I have used urgent care places plenty of times, they are quite common.

bob2356 says

Because they will get sick more often or just go to the doctor when they have nothing else to do that day? How does that work? I'm still waiting for an explanation. Not that I'll ever get one from you.

The people go because it is free. This is called the tragedy of the commons:

"The tragedy of the commons is a dilemma arising from the situation in which multiple individuals, acting independently and rationally consulting their own self-interest, will ultimately deplete a shared limited resource even when it is clear that it is not in anyone's long-term interest for this to happen."

bob2356 says

and how did this still mytical mexican get 60k worth of free surgery.

He went to the ER and got diagnosed and operated on. Upon seeing my disgust he said hey "I did not make the rules."

indigenous says

bob2356 says

and how did this still mytical mexican get 60k worth of free surgery.

He went to the ER and got diagnosed and operated on. Upon seeing my disgust he said hey "I did not make the rules."

Total bullshit. Unless he was hit by a bus or was about to die from a heart attack he didn't get diagnosed and operated on in the ER He got diagnosed and referred and the operation wasn't free. Very convenient to have this "mexican" friend that shared his experiences with you. Do you have lots of imaginary friends?

Still waiting for any sort of explanation of why there would be an explosian of health care under a single payer system. Lets' say god clicked his fingers and america woke up tommorrow with the australian system for example where you just go to the doctor and pay your 20 bucks (sorry about your continuing delusion seeing a doctor is free everywhere else, perhaps a phsych consult is in order) and that's it. Go to the hospital if you need to and just get treated. No insurance premiums, deductables, paperwork, etc.,etc.

How exactly would there be this alleged explosion? Are you saying people would pack up the kids and spend the day at the doctors rather than hitting the beach? Lots more entertainment at 20 bucks a head I would think. Instead of hitting the bars for a couple drinks after work people would go to the doctors instead? After all 20 bucks is only 4 drinks. A rectal exam would be so much more fun for the money. oh right I forgot (warning delusion alert)

indigenous says

The people go because it is free.

not because they are actually sick. why didn't I think of that? After all it is only after rationally consulting their own self interest that people decide to go to the doctor.

Don't let facts interfere with it's true because I believe it should be true. The US has the second highest number of doctor visits per person in first world. http://www.nationmaster.com/country-info/stats/Health/Consultation-with-doctors Going back to australia, the us has twice as many hospital admission for asthma, copd, diabeties, heart failure, and hyertension per capita. Five times as many mri's machines and 3 times as many scans. Etc. etc., etc. Yep those free health care systems sure to have an explosion of services don't they? Not at all like fee for service where doctors are never influenced (ok maybe a just a little teeny tiny bit) by what they would be paid.

No they go because it was cheaper, i.e. free, than the care facility that was cheap.

The Mexican may be bullshitting but what motive would have to do that.

https://www.youtube.com/watch?v=q2jijuj1ysw

mell says

A base single-payer system with a voluntary opt-in for advanced private services and MDs may be a decent model, or a real free-market model if that can be achieved at this point (doubtful). A pure single-payer system without alternatives (i.e. prevented by law) I think is harmful.

This is a decent compromise and it in fact exists in many European countries. In some ways, it is more free-market driven than our fascistic healthcare.