patrick.net

Medicare for all simply refers to the payment mechanism. For people under 65 it could be set up so that it's basically "major medical" and even that could have significant copays.

People would have supplemental insurance if they want every little medical issue covered.

but you omitted a discussion of the variation of demand in relation to the cost. It is approximately correct to state that when the perceived cost to the user approaches zero, the demand for services approaches infinity. This is the crucial flaw in all "government-funded" single-provider programs. The demand for "free" services is impossibly huge.

This just gets more and more stupid. You're selling a straw man mish, that you're too smart to believe. That's unethical.

There are doctors who believe in Flat Earth, and Moon Landing Conspiracies. So they are not all whizzes in everything. Odds are 50% your doctor is "below average" anyhow.

Mush regularly hits the bottom of the barrel for his link blog. Anything to avoid admitting his economic analysis is nearly nil.

This is very simple stuff that is empirically true.

The further the healthcare system gets from the price discovery the more it will create rationing.

Single payer will be the pinnacle of this dysfunctional system, as the author said a time honored tradition of promise everything and deny almost everything via ques.

E.G. a friend of mine's daughter has asthma, while in England needed a prescription to buy an inhaler, she was denied, their recommendation was to inhale steam from a boiling pot of water.

indigenous says

needed a prescription to buy an inhaler....

That's much of the problem right there. If you end the Rx requirement, inhalers would become so easily accessible almost nobody would worry about the cost. Instead America has a lemon socialist system designed by the revenue recipients (PhRMA, AHA, etc.) to maximize revenues, which everyone else experiences as spending. At least the British system costs less than the American system.

Anyone in the UK who views single payer as inadequate can purchase private medical insurance. Friends in Canada love their single payer system.

curious2 says

At least the British system costs less than the American system.

Yup, as they have more dead people?

Blurtman says

Friends in Canada love their single payer system.

That's anecdotal, their system is relatively new, but it does not give good results even at that.

indigenous says

E.G. a friend of mine's daughter has asthma, while in England needed a prescription to buy an inhaler, she was denied, their recommendation was to inhale steam from a boiling pot of water.

Anecdotal.

Blurtman says

Anecdotal.

Yea but a far cry better than my friend like it...

ALL developed countries have single-payer system and it works at 8% of their GDPs vs 17% of GDP in USA ! There are NO medical bankruptcies in any of those countries and NOBODY goes without medical care ! They may get it a little late but they do get the medical care needed. It's cradle to grave medical system in ALL other developed countries where their citizens don't have to worry about choosing between food and medicine as in USA!. The only losers will be medical professionals who are charging obscene amounts in USA and insurance companies as medical insurance will NOT be required as payments to medical practitioners/care givers are paid by one central govt pot.

EInvestor says

ALL developed countries have single-payer system and it works

Citation please

EInvestor says

There are NO medical bankruptcies in any of those countries and NOBODY goes without medical care ! They may get it a little late but they do get the medical care needed.

Citation please

indigenous says

Blurtman says

Anecdotal.

Yea but a far cry better than my friend like it...

OK. My friends in Canada have no fear of catching a cold as they love their single payer system.

Surprisingly attractive for Canadians, are you sure they are Canadians?

indigenous says

EInvestor says

ALL developed countries have single-payer system and it works

Citation please

EInvestor says

There are NO medical bankruptcies in any of those countries and NOBODY goes without medical care ! They may get it a little late but they do get the medical care needed.

Citation please

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

That wasn't too hard.

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?