The health systems in Europe are not radically different from the US system. The efficiencies of each are difficult to quantify without context. For example, the US invents most of the drugs and medical technology used by the world. Would this still happen if there was more invasive regulation? We can't know.
Besides all of this, think of every other area of the market where the government insinuates itself. Are public schools better than private schools? Almost never. Is the US postal system better than FedEx? Of course not. The government is not a commercial entity. The incentives and influences on it are not conducive to producing quality products at good prices.
Until recently. This means that all people can obtain health care regardless of their ability to pay, and that the system is flexible enough to continue to experiment with the ideal implementation.
Are public schools better than private schools?
Public schools are exactly 100% better than private schools for students who can't afford to attend private schools.
Is the US postal system better than FedEx?
They are if you want to get a letter delivered anywhere in the world cheaply.
You have made a lot of good arguments for socializing care here.
Some people are price sensitive. Cheaper is all they can manage to afford and are willing to accept less quality in return. As a healthy person I'd rather take a two percent annual increase in insurance premiums for lower quality of care since I do not have much need for services.
2. Your argument implies that there wouldn't be low cost schools in the absence of public schools. The evidence is overwhelming that the opposite is true.
3. I live in Panama. When I need something mailed here I use FedEx or DHL. The USPS is unreliable and takes far too long. If there weren't laws against private first class mail in the US they'd be undercut in that market as well.
"As a healthy person I'd rather take a two percent annual increase in insurance premiums for lower quality of care since I do not have much need for services." -- And I wouldn't. Why do your views trump others who disagree?
> Are public schools better than private schools?
Yes, they are far better than private school, for those who can't afford private schools.
> Is the US postal system better than FedEx?
Yes, it's far better than FedEx for those who live in place FedEx wouldn't and couldn't operate profitably because the postal system's aim isn't efficiency, it's coverage to "everyone" everywhere, something no market solution will offer because that's not a profitable mission.
So it sounds to me like you don't understand the purpose of government and don't understand why government is necessary in such situations, because you can't think outside of your own self and realize that markets don't serve everyone.
Exactly. Health care in Canada is a crap shoot. If you're in a major centre and are able to get a family physician I'm sure you think the system is great. Try being sick somewhere where the only option is an over-worked ER staffed by locums.
"Rights" are basically just freedoms we've decided we like a whole lot and want the government to guarantee, so that's not exactly a static category. So on the one hand we can just decide whichever rights are being violated are—at least conditionally—not rights. Boom, done.
On the other hand, is there any such thing as a government that does not force people to do things they wouldn't voluntarily do? I'm pretty sure if you take that away what's left has lost the single most important trait of a government, and what's left is... I don't know, a non-profit begging for money on TV and utterly incapable of fulfilling any of the usual roles of a government? In that case, the fact that single-payer would force people to do things doesn't per se remove it from the realm of legitimate government activity.
As for the utility of the term "single payer", I believe it's distinct enough from the much broader "socialized medicine", which could include things like seizing hospitals and making doctors exclusively state employees, to make it substantially more than just a euphemism.
Also, here in Connecticut (the place where the rich historically sent their kids to school), there are plenty of public schools that are at least as good or better than at least some nearby private schools. When you get into preschool, for instance, the public schools are a HUGE improvement over all but the top-tier private ones. Likewise, the "magnet" program schools are a public option that is as good or better than most private schools nearby (they are special, well-funded by the state, and use a lottery to get in, though).
This is coming from someone who agrees with you in principle, too. Reality is nuanced, though.
Firstly, diagnostic care is often privately managed throughout the provinces, so if you don't want to wait, you can often pay to expedite. It's about $900 for a joint MRI.
Secondly, if you really need an MRI for a critical diagnosis, as I once did in 2012 as a hospital inpatient, I got it within 2 days.
Canada's health system is a point of national pride.
How is that not the world we live in? What is the alternative? At some point someone's deciding what's a right and what isn't. Other people may disagree. Rights aren't a law of nature, they're a fuzzy category, subject to conditions and caveats and shifting over time.
> "is there any such thing as a government that does not force people to do things they wouldn't voluntarily do?" - no there isn't. That's why it should be limited to protecting other people's rights.
But a lot of the things government does that don't fall within that narrow limit really, really appear to make my life and the lives of the people I care about much better, at relatively little cost (for a broad definition of cost). Few or none of the OECD states seem too bad, to put it mildly. None are unqualified disasters, or even close. Meanwhile a "drown it in a bathtub" government coexisting with an advanced economy (correct me if I'm wrong) remains hypothetical—indeed, I think it's fair to call mainstream the view among experts that governments' special ability to overcome coordination problems and take action to nurture markets is vital to an advanced economy—as do the effects of such a system. So it's definitely going to be an uphill battle convincing me that our government "should be limited to protecting other people's rights", without some other state practicing that and full of citizens telling me "no, really, it's pretty great".
Will we ever see this in reality? No. But, the closer humans have gotten in history the better off they've been.
I'm having trouble figuring out how this doesn't still boil down to people making judgement calls on what is and isn't a right, just with a level of indirection, so maybe this other question will help me see what you mean:
> Will we ever see this in reality? No. But, the closer humans have gotten in history the better off they've been.
Do you have an example in mind of when and where we've come especially close to this ideal?
It seems like a standard is just a reason for choosing a given set of things to call rights and a given role for government, and we're all set to circle right back to where we were—the people with the power to affect government choosing those things, based on reasons (which was implicitly the case before, anyway). At some point there must be compelling evidence for selecting a given standard over any other, and one would hope that standard may change in the face of new evidence.
arches eyebrow
Is that not the poster child for extensive government intervention in markets and public/private partnership done right?
The will of the majority, and especially the super majority, is far better a thing to live under than the will of a handful of people from 238 years ago and any suggestion to the contrary is the definition of not thinking clearly.
People state this as if it's some obvious truth, and it makes no sense to me. My statement would be:
Government is a mechanism which we, as a group, have decided should handle certain functions of society.
It's the logical extension of a group of people in the jungle deciding "you know what, it would be awesome if we got together and built a trail between all our huts so we can visit each other."
Part of that agreement might be "hey, when these barbarians show up we should all protect each other", but to arbitrarily say that the only purpose of government is those kinds of agreements I think speaks to a very warped sense of community.
Over-testing and over-diagnosing are seriously harmful things that eg the US does far too much of.
http://www.cancerresearchuk.org/about-us/cancer-news/press-r...
http://www.nytimes.com/2012/11/22/opinion/cancer-survivor-or...
Having lived through the Ontario cuts in health care in the 90s ("the Harris common sense revolution"), I don't really think political reps Federally or Provincially had any say on quality of care or what hospitals we got, it was all redesigned top down (not all that different from an HMO really, in my experience). Did care access and waits times suffer at the time? Yes. Still wouldn't trade it for a private system.
The difference in access and amount of supply between a rural market and a city in Canada is not too different than in the US. There's a lot of land mass to cover in either country if you're not in a major population centre.
The Canadian system blows away the US system by an order of magnitude, IMO, in terms of what really matters - access and outcomes. Obamacare made the US a bit better, but that's not a tall order.
- Severe pneumonia (1 day in emerg, 9 days in ICU followed by 8 in an inpatient ward)
- Total pericariectomy (2 days in postop ICU, 3 days in ward)
Among other stays/issues prior to these.
The latter surgery was the culmination of outpatient medical care over 3 years with multiple specialists (cardiologist, internist, and cardiac surgeon), along with multiple CT, MRI, cardiac catheterization, countless blood tests, many of which were sent to Winnipeg (the equivalent of the CDC) for rare disease scanning, and over a dozen echocardiograms ... none of which I had to wait for longer than a day or two ... And none of which I had to pay for (just my medication through private insurance). In fairness the surgery itself wasn't critical, so I waited 6 months. They were willing to expedite if my condition deteriorated (it didn't). And after regular cardiologist visits , after I was stable, it could take 8-10 months. If I had an issue they'd expedite me in though.
I am not saying the Canadian system is ideal. Just that it is a reasonably functioning system.
There are some cases where it is both very frustrating and inspiring. I have a dear friend who has a child with a congenital heart defect due to an extremely rare genetic connective issue disorder that is similar (but different) to Marfan syndrome. The Canadian system has been fantastic to senior levels of provincial administration in managing this case, involving international hospitals, breeding zebrafish to replicate the specific mutation, working to manage the treatment of this complex child who is close to turning 5 but likely would have died in the first few weeks after birth in another era.
Keeping this child alive (he is in and out of the hospital about 50%) has easily cost a tremendous amount of public money, but the insurance system risk pool is designed to handle these sorts of outlier cases to ensure future cases can benefit and that this child can have (mostly) a good life in between and during hospital stays. This child gets world class care and has been kept alive due to the system mostly working.
That's the good part. The bad part is that managing complex care in general is a mess as in many health systems, making it a full time job for at least one parent to juggle the various specialists, appointments, tests, medications, history, etc... Which is difficult if you're a single parent. It's almost easier to go on welfare than to work if you are a parent to a critically ill child. So you can get nursing staff to help at home but it's debatable what is covered and what is not, medical expense deductions have some arcane regs like you can't expense a trip under 40km, yet this child has on average 280 trips to the hospital or a clinic a year... Adding up to a lot of expense. Some things like specialized child formula weren't covered by health insurance either until recently (which can cost upwards of $1400 monthly, really sucks when your child can't eat anything due to esophageal issues and has a G-tube and needs this formula to stay alive..)
So, not ideal... But Is this all socialized medicine ills? Sort of I guess? I can see the same problems in a private system.
You're a longstanding user and we've bent over backwards not to ban you, despite serious abuses on your part. The situation isn't going to stay this way.
As you seem to be dying to ban me, then ban me already; I'll just bounce through a proxy and open another account, you know as well as I do there's really nothing you can do to keep me off the site and that your best option is to keep me civil, which I've been doing for quite a while, so drop the empty threats please.