10 Excellent Reasons for National Health Care

Honnête et Sérieux · Mar 23, 2009

honestly and seriously,
have you read the book? ten excellent reasons for national health care
http://www.thenewpress.com/index.php?option=com_title&task=view_title&metaproductid=1711
by motivating cooperation and shared responsibility rather than competition, a national health care plan promotes the collective health and well-being of all who live here. if, as nurses, we take our role to be patient advocates very seriously--meaning that we will advocate for our patients at the bedside to receive the best care, but we'll also advocate against insurance companies, hospital administrators, and hmos who focus on the bottom line at the expense of the sick and injured. we must be willing to speak out against politicians who are sacrificing our right to healthcare for the benefit of their corporate cronies: for-profit insurers and pharmaceutical companies. such politicians should be ashamed of protecting the gigantic insurance and pharmaceutical corporations, while abandoning a real concrete solution to protecting and ensuring the health and welfare of our nation's people.

you see, you were making somewhat reasonable points right up until the "right to healthcare" part, and sealed the deal with the shot at "pharmaceutical companies." first, aside from making certain kinds of healthcare illegal (such as when seeking private healthcare was illegal in canada), a politican is not "sacrificing our right to healthcare" just because they don't take money from one person to pay for another person's healthcare. they don't take money from one person to buy someone else's "free speech" or "freedom of religion" or their guns, but it doesn't mean those rights are sacrificed just because there isn't a gov't payor system for them.

and regarding the evil "pharmaceutical" companies...what if they were also developing stem cell therapies (and some of them are)? looks like we'd be demonizing them for developing drugs (which we wouldn't want to give them money for), but we'd simultaneously be showering them with money for stem cell research...kind of a dilemma?

only a publicly financed, publicly administered healthcare system can provide health care based on patients' needs, and make sure that every person has access to quality care by removing insurance waste.

this is pure speculation. i haven't seen any evidence to support this claim.

we are facing formidable opponents. healthcare corporations are making hundreds of billions of dollars in profit, and funneling it to politicians, because they want the status quo maintained. without single-payer health care, we will continue to waste money on administrative overhead, deny health care to millions, and cause many of the underinsured to go with out adequate treatment due to expensive co-pays or rising premium costs.

again i say...a gov't payor system will also deny care...to millions. and what is an expensive copay? mine are $30 bucks...slightly less than the cost of a psp game, yet some will consider a copay to be "too expensive" while expanding their psp library, leading to increased sedentary lifestyles, and a problem they want someone else to fix.

in the united states, we are paying for care that we're not receiving. insurers are ripping us off. ours is a system problem, not a money problem. we need to eliminate the for-profit insurance system that avoids sick people and reinvest the money currently wasted in administrative overhead, and use it to provide actual care for people. canada's medicare system may be a bit underfunded, compared to what we already spend for health care in the u.s., but it does fulfill its obligations to canadians by providing essential health care based on medical need, not on the ability to pay. the other important point to keep in mind is that there are no waits for emergency care and it is the patient's doctor who determines the treatment plan and prioritizes the patient's care, not some insurance company bean counter.

that is not entirely true; instead of the insurance company counting the beans, the gov't is counting the beans, and our gov't is terrible at math. it makes no sense to say that our politicians are improperly influenced by the financial contributions of insurance companies, so the solution is to just give all the money to the politicians to run the system. i suppose some would rather be "ripped off" by their politician instead of an insurance company...btw, i've never been ripped off by a health insurance company. i felt a little ripped of by the gov't when i received my last ss statement and it said that they anticipate only having the funds to pay for 75% of my benefits by the time i retire, but i applauded my health insurance company when my physician sent my labs to the wrong processor and my health insurance company not only refused to pay, they specifically told my physician that he was not to send me or anyone else the bill for his error.

and if there are "no waits for emergency care," (i guess an average wait of six hours is not really a "wait time"),then why the need for canada to establish a "wait times alliance?" why did ontario have to inject $109 million into their system to reduce ed wait times?

unlike outsiders who look at the us system with disdain (while millions of non-americans routinely access it and experience the benefits of it's innovation and humanitarian nature), i don't look as such upon the care provided in other countries. that said, i will exercise the privilege to be critical when such systems are held up as models of what we should pursue, because that is not what i think is best for americans.

good discussion.

Honnête et Sérieux · Mar 23, 2009

Unfortunately RN Canada , in the USA the attitude of why should I be responsible for somebodies mistakes is all too prevalent .
Those who hold that attitude seem to have forgotten , how insurance works ! . We buy liability ( car, house , health ) insurance to cover ourselves from the mistakes of others or ourselves .
So why is it that Americans accept , the risks of others through buying insurance , yet use accepting the risk of others ,as a reason not to accept UHC?

Clearly the workings of insurance have been forgotten.

We buy Liability Insurance NOT to cover ourselves from the mistakes of others, but to essentially provide a funding source for injury that we may inflict on others. Liability insurance does not provide us protection from ourselves.

And Americans purchase this insurance because we are generally obligated to by law, but here's a big difference; we get to buy it anywhere we want. We get to negotiate and control the price, and choose our preferred level of personal risk and subsequent cost. When we file a claim, we can expect our prices to go up. The insurance providers incentivize us with credit for good behavior, being less risky. They get to raise our rates if we get a ticket for speeding, even if there was no action requiring a claim. They get to deny our business if they decide we aren't good customers.

If we keep making these comparisons to the auto/home insurance industry, it must be in context.

And one key element is the element of competition; these insurance companies battle each other with price and advertising in order to capture our business...thereby keeping rates competitive. I don't see how this applies to a "single payer" system.

nicurn001 · Mar 23, 2009

" Those who hold that attitude seem to have forgotten , how insurance works ! . We buy liability ( car, house , health ) insurance to cover ourselves from the mistakes of others or ourselves ". I put mistakes of others in the paragraph , in reference to the uninsured , in which case I AM covering myself from the mistakes of others .

RN4MERCY · Mar 23, 2009

And if there are "no waits for emergency care," (I guess an average wait of six hours is not really a "wait time"),then why the need for Canada to establish a "Wait Times Alliance?" Why did Ontario have to inject $109 million into their system to reduce ED wait times?
Unlike outsiders who look at the US system with disdain (while millions of non-Americans routinely access it AND experience the benefits of it's innovation and humanitarian nature), I don't look as such upon the care provided in other countries. That said, I will exercise the privilege to be critical when such systems are held up as models of what we should pursue, because that is NOT what I think is best for AMERICANS.
Good discussion.

Wow, you practically made the point for me. Thanks for sharing the link regarding the increased public funding to reduce ER wait times in Ontario, Canada. Canadians love their medicare system; it's a matter of national pride. Because it's a transparent, publicly funded system, everyone has an interest in making sure that it works to meet their health needs. In the instance you've cited, the citizens are holding their government accountable and have made managing the queues a budget priority. The Registered Nurses Association of Ontario makes this statement: "Ontario's nurses advocate for healthy public policy. We strive to protect and expand our universal, publicly funded health-care system so everyone has equal access to comprehensive care."

According to Dr. Don McCanne, Sr. Healthcare Policy Fellow for Physicians for a National Health Plan, "The opponents of single-payer national health insurance claim that intolerable waiting times for health care would be inevitable. They use the experience in Canada as proof. Canada has had problems with excessive queues, but, as this report demonstrates, they are being addressed, and with considerable success. While Canada moves forward with queue management and fine tuning of capacity, we continue to hang our heads in shame over the financial barriers we place in front of tens of millions of Americans, which prevent access to the most generously funded health care system ever known. And we refuse to act because a humane system that covers everyone might expose us to the alleged threat of preventable queues?!"

It's a matter of your community values really, together with your committment to social justice, and your ability to appreciate the dignity and worth of every human being. No decent and compassionate society should fail to provide health care to its members when it has the resources to do so. Nobel prize winning economist Paul Krugman and Princeton economist Ewe Reinhardt have made the case that the numbers are easy. They've as much as said, tell us your values and we can design a health care system to reflect them. It's not good public health policy, economic, or social policy to ration health care only to those who can afford to pay for it.

At a time when the gap between rich and poor in our nation is at its widest ever, the greed of a few has jeopardized the social, economic, and healthcare security of all of us. There are several myths and lies that have been told so often about the Canadian system that they have been accepted as the truth here in the United States; you've apparently borrowed a page from Karl Rove and the Bushmen. The opponents of reform in the United States are driven by ideology. They will not allow health policy science to interfere with their anti-government message. They do not seek the truth. Instead, they craft messages that paint a terribly inaccurate picture of the Canadian health care system.

Those who are well informed on health policy are quite aware of the advantages and disadvantages of the health care financing systems in both the United States and Canada. Although the greater effectiveness and efficiency of the Canadian single payer system are well understood by supporters of a national health program in the United States, the Canadian financing system is better equipped to address those problems than is the dysfunctional, fragmented U.S. financing system.

You don't identify yourself as a nurse, but with all due respect, it appears to me that you are one of those idealogues who support the position that the bureaucratic private insurance, pay-to-play system in the US offers more choice and a better quality of care that saves the public money. You're entitled to your opinion, but it's not well-informed. Your messages are based on exceptions or on minutia that may represent a real problem, but you shouldn't present those facts as if they taint the entire system.

Maybe I've missed it, but you haven't offered your plan for reform, which leads me to believe you may work for an insurance company and you've jumped in here to hijack the thread because you have a vested interest in seeing to it that the status quo is maintained in this country. Your reluctance to discuss the positive features of the Canadian experience as an example of what we could achieve here intrigues me. Why do you believe single-payer is "not what's best for Americans" ?

RN_Canada · Mar 23, 2009

first off let me say that this type of open and forthright discussion is good and quite stimulating!

are you familiar with the cambie surgery center? the private facility owned and operated by brian day (president of the canadian medical association)? is he operating his facility illegally?

yes - dr. brian day does not advocate for privatized health care - he is in support of a private/public system that works together, with the government paying privately run facilities to provide services for their insured patients, for medically necessary services.

unfortunately, because of the canada heath act governments cannot engage in this kind of an arrangement because they will lose their funding from the federal government.

i happen to be a big fan of dr. brian day and i think he has a valid and well supported argument with good evidence to show that this kind of system can work well. but the canada health act strangles any type of innovation like this and to change a federal law requires consensus of all provinces and i don't think that quebec has even signed onto the consitutional agreement for these type of legislation changes (sorry i am not a constitutional expert!)

just a couple of things to consider in this discussion:

every single piece of data we have, regardless of the country and what type of health care system they have, shows that health is not created by a health care system or even individual decisions, it is created by social determinants.

having a publicly funded health care system motivates governments to socially engineer policy that will create health because they have a vested interest to do so. i am talking about things like education and housing which are closely tied to health.

a really good example of this is the canadian success story with tobacco. over the last 2 decades the national prevalence rate for smoking has decreased from about 30% to below 18%. it is the government's best interest to help people "not to smoke" and many pieces of legislation have been passed to make it harder and harder to smoke. public advertising campaigns have been successful in portraying smoking as undesirable and mandatory curriculum in the education school on tobacco education have all been worked together to bring about this result. without the incentive to reduce the costs of smoking on the publicly funded health care system the government has no incentive to carry out such programs or pass and enforce such laws.

(btw - the highest rates of smoking are among the uneducated and lower income groups including the unemployed populations.)

governments that accept the moral obligation to provide health care services to citizens are not providing a commodity like cars, they are investing money that will create future returns in increased productivity and increased wealth.

this is not socialist propaganda, even the private sector has recognized that their investments in the education, training and well being of their employees is cost effective.

the message of publicly funded health care is quite simple. if you want to create health you need to create systems that create health.

there are several myths and lies that have been told so often about the canadian system that they have been accepted as the truth here in the united states; you've apparently borrowed a page from karl rove and the bushmen. the opponents of reform in the united states are driven by ideology. they will not allow health policy science to interfere with their anti-government message. they do not seek the truth. instead, they craft messages that paint a terribly inaccurate picture of the canadian health care system.

canadians are equally guilty! there is nothing that will strike fear into the hearts of the canadian public faster than talk of an "american style system". politicians use that rhetoric all the time when they are campaigning for votes. unions also use it to scare people into thinking that anything "private" in health care is evil.

the reality is that the system is not the travesty that everyone propogates it to be.

the same for the canadian system. you only hear about the worst of the worst.

personally my family and i have never ever, had a problem getting timely health care when we need it. that includes access to specialists, prescriptions, doctors appointments and even emergency care, so my impression of the system is quite good. but if anybody has a different experience i suppose they would trash the system, and blame it on a publicly funded health care system.

like i said. i hope the us does it, but i hope they do it better than anybody else.

allnurses Guide · Mar 23, 2009

clearly this is a problem that must be addressed. canada is dealing with it.

in the u.s. ers are closing. we are all at risk when ers close. both due to transport time and longer waits. even the best insurance can't help when there is insufficient staff or adequate room/supplies.

united states:

http://www.cbsnews.com/stories/2008/07/02/national/main4227468.shtml?source=rssattr=u.s._4227468

http://www.blisstree.com/articles/woman-dies-of-heart-attack-in-er-waiting-room-50/

http://abcnews.go.com/health/story?id=5884487&page=1

http://www.msnbc.msn.com/id/19207050/

http://www.lasvegassun.com/news/2008/aug/24/patients-paperwork-came-first/

http://www.redorbit.com/news/health/293524/st_louis_hospital_liable_for_death_in_waiting_room/

http://www.abcactionnews.com/content/taking_action_for_you/investigations/story/florida-patients-waiting-hours-to-see-e-r-doctors/klnlm0sfu0ah2d19lhuc8q.cspx

http://lansing.injuryboard.com/miscellaneous/waiting-rooms-tragedies-and-the-need-for-universal-health-care.aspx?googleid=250902

canada:

http://www.cbc.ca/health/story/2009/02/12/sinclair-inquest.html?ref=rss

http://www.calgaryherald.com/health/wait+times+soar+calgary/1417933/story.html

http://www.caep.ca/cms/%7b547a1a00-3c2a-4ace-9131-2e2df5d62d99%7d.pdf

closing emergency departments:

http://www.redorbit.com/news/health/420629/er_closing_broke_state_regulations_health_agency_says_banner_shutdown/

although typically americans have greater and more rapid access to surgical procedures than people in other countries, we do not possess a uniform superiority in the speed of health care access. one excellent example of this is visiting the emergency room. er wait times have been increasing steadily over the last decade as indicated by wilper et al. publishing in the journal health affairs.

wilper et al. performed the best and most comprehensive analysis to date of wait-time in ers around the country. the looked at wait-times from 1997 to 2004 using the national hospital ambulatory medical care survey (nhamcs) database.

what they found was that wait times have been slowly increasing over the last decade. ...

http://scienceblogs.com/purepedantry/2008/01/americas_er_crisis.php and it continues.

RN4MERCY · Mar 23, 2009

The wealthy will always have the ability to pay more for a commodity. But markets are a lousy way to provide health care as evidenced by population-based outcomes and commonly accepted health indicators. The commodification of health care is poor public policy from an economic standpoint as well. We would lose the benefit of group purchasing discounts and fail to reap the savings from lower administrative costs if private insurers are allowed to compete with a single payer system. We can't sell off or allow private insurers deplete the resources from the public risk pool and then call it a failure. Indeed, that's exactly what the insurance industry is so afraid of: they know they can't compete with a well-run publicly financed system. They've called it "unfair." I call it social justice!

Private insurers spend more than 30 percent of the money they collect in premiums on administrative costs. By contrast, Medicare spends about 3 percent. Part of the insurers' administrative expenses go toward marketing - an expense that's unnecessary in a universal Medicare system. Insurers have resorted to inhumane and deceptive mechanisms for either keeping sick people from being insured, or finding ways to deny coverage for expensive care, and they make large profits by doing so. Naturally, profit-maximizing insurers devote substantial resources to trying to avoid ways to provide health care to people who need it.

As a society, in terms of social goods and services, we have an obligation to insure there is a standard of public health and safety in place, so that we can meet everyone's basic need for access to medically necessary health care. In an egalitarian society, we must insure equitable access and share the responsibility for supporting the provision of that care, just like we seek to insure the provision of other socially beneficial services such as police and fire protection, access to education, public utilities, and the judicial system.

In Canada, there's not a system problem per se, like in the United States. Most economists and health policy experts agree that the so-called "wait times" for elective procedures would all but disappear if Canadian spending on health care was even a fraction more than what they're spending now, and they can do that without even coming close to the amount in terms of GDP that the U.S. is already spending for health care. We're being ripped off in terms of paying for health care that we're not receiving. We have the highest per capita spending on health care in the world. In terms of the World Health Organization's leading health indicators, the US system falls miserably short, and leads the world's industrialized countries only in the category of DEATHS from preventable causes. Of the top 19 industrialized nations, the US is the only one without some form of single-payer, universal health care access.

In a survey, conducted by Lake Research Partners, 71% said they favored "access to affordable, quality health care for all Americans even if it means a major role for the federal government." After the last Presidential election in this country, it seems as though the political will is in favor of genuine single-payer reform. Now we just have to go out there and make sure that our newly elected President stays on track.

Honnête et Sérieux · Mar 24, 2009

I put mistakes of others in the paragraph , in reference to the uninsured , in which case I AM covering myself from the mistakes of others .

Understood...but that's not Liability Insurance. In this case, the kind of liability insurance that would 'protect' you would be liability THEY had purchased in case they made a mistake that resulted in harm to you.

In reference to the uninsured, your own liability insurance wouldn't protect you, but an "uninsured" addition might. Of course, in many places, this is optional, and you only pay for your own. If you don't pay for it, you don't get it, so in general, there is no systemic supplementation of people who don't want certain kinds of insurance.

In general, the insurance comparison doesn't really work that well in a discussion of single-payer health coverage.

Honnête et Sérieux · Mar 24, 2009

Wow, you practically made the point for me. Thanks for sharing the link regarding the increased public funding to reduce ER wait times in Ontario, Canada. Canadians love their medicare system; it's a matter of national pride. Because it's a transparent, publicly funded system, everyone has an interest in making sure that it works to meet their health needs. In the instance you've cited, the citizens are holding their government accountable and have made managing the queues a budget priority. The Registered Nurses Association of Ontario makes this statement: "Ontario's nurses advocate for healthy public policy. We strive to protect and expand our universal, publicly funded health-care system so everyone has equal access to comprehensive care."

I don't present information to support incorrect points. It seemed you were suggesting that there were no wait times in Canadian ED's. It would seem the intellectually honest thing would be to acknowledge that it's not true...if it were, then the system wouldn't require additional legislation and huge injections of money.

It doesn't seem to be reasonable dialogue to try and pretend that someone supported a point you never made when they were pointing out an incorrect assertion.

It's a matter of your community values really, together with your committment to social justice, and your ability to appreciate the dignity and worth of every human being. No decent and compassionate society should fail to provide health care to its members when it has the resources to do so. Nobel prize winning economist Paul Krugman and Princeton economist Ewe Reinhardt have made the case that the numbers are easy. They've as much as said, tell us your values and we can design a health care system to reflect them. It's not good public health policy, economic, or social policy to ration health care only to those who can afford to pay for it.

It's disingenuis to try and sell it with emotion. It's also not so easy as the generalizing that Krugman and Reinhardt used. Krugman's primary tool is ideological hyperbole, Nobel prize notwithstanding. Would you recommend advice on international peace from Nobel winner Arafat?

It's also unfair to suggest that a free-market system is void of community values, social justice, or that it does not appreciate the dignity and worth of every human being.

At a time when the gap between rich and poor in our nation is at its widest ever, the greed of a few has jeopardized the social, economic, and healthcare security of all of us.

No it hasn't. Costa Rica supposedly has a superior distributive socialized health care system, but their income gap is almost .49...higher than the US. Canada's income gap is getting wider as well. Does that mean the system should become more socialized? Just trying to put together it seemingly unconnected items here.

There are several myths and lies that have been told so often about the Canadian system that they have been accepted as the truth here in the United States; you've apparently borrowed a page from Karl Rove and the Bushmen. The opponents of reform in the United States are driven by ideology. They will not allow health policy science to interfere with their anti-government message. They do not seek the truth. Instead, they craft messages that paint a terribly inaccurate picture of the Canadian health care system.

Please share what I've said about healthcare that matches anything that Karl Rove and Pres. Bush said. Meanwile, in a time when people keep demanding respect for Obama, I wouldn't mind seeing the same being extended to all presidents.

And it's just as unfair to say that "opponents of reform are driven by ideology" as it would be for me to say that "advocates of a UHC/Single-payer system are driven only by ideology." When it comes to truth, I have not said one thing untrue, but I read false comments and unsupported speculation all the time about the status of our current system.

And if folks don't want the flaws of the Canadian system to be revealed, then they can't keep injecting it into the discussion; if someone wants to talk about the stuff they think is good, they can't then just disqualify anything that isn't.

Those who are well informed on health policy are quite aware of the advantages and disadvantages of the health care financing systems in both the United States and Canada. Although the greater effectiveness and efficiency of the Canadian single payer system are well understood by supporters of a national health program in the United States, the Canadian financing system is better equipped to address those problems than is the dysfunctional, fragmented U.S. financing system.

Is it too much to ask that the discussion not be presented in unqualified assumptions?

A fragmented system is one that has to export their patients to another country for healthcare. That would be Canada, not the US. And if Canada was "better equipped" to address their problems, they wouldn't have to outsource their care. An efficient system is not one where barriers are placed to private care while 15% of it's population can't find a primary care provider.

You don't identify yourself as a nurse, but with all due respect, it appears to me that you are one of those idealogues who support the position that the bureaucratic private insurance, pay-to-play system in the US offers more choice and a better quality of care that saves the public money. You're entitled to your opinion, but it's not well-informed. Your messages are based on exceptions or on minutia that may represent a real problem, but you shouldn't present those facts as if they taint the entire system.

I refuse to engage in any practices in this discussion which involve speculation about the nature, background, ideology, or character of any of it's participants. I think it's insulting, arrogant, and generally mostly inaccurate to do so, and serves only as a false crutch to prop up the otherwise weak perspective of the person who uses the tactic.

If the items I present are inaccurate, then simply present evidence refuting them; it serves no purpose to speculate about the 'ideology' of someone when you are discussing an issue...not the person. I promise to never speculate about you and your character or ideology.

Maybe I've missed it, but you haven't offered your plan for reform, which leads me to believe you may work for an insurance company and you've jumped in here to hijack the thread because you have a vested interest in seeing to it that the status quo is maintained in this country. Your reluctance to discuss the positive features of the Canadian experience as an example of what we could achieve here intrigues me. Why do you believe single-payer is "not what's best for Americans" ?

Single payer is not the best because it reduces "choice" which is important to Americans, and someone is not obligated to present an option just because they can see and point out the errors or flaws in the ideas that were presented. That said, I think the first thing is to adequately present the issue, which means stop propogating false numbers such as the myth that there are 45 million uninsured Americans. Implementing Tort Reform, which ironically the political advocates of socialized systems seem to oppose. Adequate tort reform would alleviate MOST of the problems related to the delivery of healthcare in the US...some are so focused on the system, they don't realize that it may be an ideal system if it were assaulted on a daily basis simply because of ideology.

If you want me to advocate a universal system, I'll submit this; the Singaporean model. Definitely not the Canadian.

Honnête et Sérieux · Mar 24, 2009

The wealthy will always have the ability to pay more for a commodity. But markets are a lousy way to provide health care as evidenced by population-based outcomes and commonly accepted health indicators. The commodification of health care is poor public policy from an economic standpoint as well. We would lose the benefit of group purchasing discounts and fail to reap the savings from lower administrative costs if private insurers are allowed to compete with a single payer system.
This is completely untrue; private systems can take utilize systems of group discounts, and in fact Singapore is a perfect example of where costs are driven down when private insurers compete with the gov't system. Healthcare as a portion of their GDP is among the lowest in the world, and they enjoy better outcomes on many of the benchmarks that UHC advocates use to promote system reform...whether those benchmarks are actually relevant or not.
We can't sell off or allow private insurers deplete the resources from the public risk pool and then call it a failure. Indeed, that's exactly what the insurance industry is so afraid of: they know they can't compete with a well-run publicly financed system. They've called it "unfair." I call it social justice!
"Well-run" being the key words. So far, few of the universal programs are run well. And if privatized programs were so incapable of competing with a "well run" Canadian system, then the gov't would have to put so many legislative restrictions on them...their 'incapacity to compete' would simply float the gov't system to the top. That's not "social justice," that's dictatorial justice.
And I'd like to point out that private insurers are allowed to compete with a public system, and those countries again score high on the same benchmarks (i.e. Singapore, France).
Private insurers spend more than 30 percent of the money they collect in premiums on administrative costs. By contrast, Medicare spends about 3 percent. Part of the insurers' administrative expenses go toward marketing - an expense that's unnecessary in a universal Medicare system. Insurers have resorted to inhumane and deceptive mechanisms for either keeping sick people from being insured, or finding ways to deny coverage for expensive care, and they make large profits by doing so. Naturally, profit-maximizing insurers devote substantial resources to trying to avoid ways to provide health care to people who need it.
And I say again...publically financed programs DENY COVERAGE for EXPENSIVE CARE. Folks need to stop pretending like it's only private insurers who deny care.
I would like to take a moment to share a somewhat anecdotal item; we were all denied raises this year where I work (a non-profit regional tertiary hospital). One of the reasons cited was because the number of public finance patients (i.e. medicare, medicaid), increased by about 10%...meaning our reimbursements DROPPED. An expansion of publically financed care has harmed our facility and our capacity to provide care (and we turn no-one away). If just a 10% increase has halted pay raises (and cut travel/education/incentive), can you explain what a complete change to the lower reimbursement levels of a publically financed system will do? It will deincentivize employees (and potential employees), reduce our capacity to continue training our employees, reduce our capacity to conduct research, and reduce our capacity to absorb uncompensated care.
As a society, in terms of social goods and services, we have an obligation to insure there is a standard of public health and safety in place, so that we can meet everyone's basic need for access to medically necessary health care. In an egalitarian society, we must insure equitable access and share the responsibility for supporting the provision of that care, just like we seek to insure the provision of other socially beneficial services such as police and fire protection, access to education, public utilities, and the judicial system.
People obviously don't think this through when they make comparisons to police, fire, education, utilities, and the judicial system. We don't all have the same access to police and fire, and the provision of security in this country is largely privatized, not public. The majority (70ish%) of fire protection is volunteer, and the person who lives in rural Wyoming doesn't have the same access to fire protection (apparatus, hydrants, personnel) as the person who lives in downtown Houston across the street from a hydrant or fire station. And the public school system comparison is one that never ceases to surprise me; our 'publically financed' school system is highly inequitable, and I doubt we'd tolerate the same outcome based results from our healthcare system as we do from our public school system. Not to mention, we don't cry "unjust" when people refuse to use the public school system and put their kids in a higher quality private school (like Obama did). Public utilities? Everyone pays a utility bill based on usage, and if they don't, the utility is shut off. And it's laughable to think that our judicial system treates everyone the same.
In Canada, there's not a system problem per se, like in the United States. Most economists and health policy experts agree that the so-called "wait times" for elective procedures would all but disappear if Canadian spending on health care was even a fraction more than what they're spending now, and they can do that without even coming close to the amount in terms of GDP that the U.S. is already spending for health care. We're being ripped off in terms of paying for health care that we're not receiving.

I'm not.
We have the highest per capita spending on health care in the world. In terms of the World Health Organization's leading health indicators, the US system falls miserably short, and leads the world's industrialized countries only in the category of DEATHS from preventable causes. Of the top 19 industrialized nations, the US is the only one without some form of single-payer, universal health care access.
The WHO indicators are garbage, and include benchmarks that have nothing to do with the function of a healthcare system. The WHO had to modify their standings after their bias and flawed methodologies were revealed, and there is a reason why they don't perform these rankings anymore.
In a survey, conducted by Lake Research Partners, 71% said they favored "access to affordable, quality health care for all Americans even if it means a major role for the federal government." After the last Presidential election in this country, it seems as though the political will is in favor of genuine single-payer reform. Now we just have to go out there and make sure that our newly elected President stays on track.
He has no idea what he is doing, as evidenced by the fact that he is still campaigning, and he can't seem to find two people to put on a committee that haven't cheated on their taxes.

RN_Canada · Mar 24, 2009

Single payer is not the best because it reduces "choice" which is important to Americans,

I am not getting this and I hear it a lot from the anti- publicly funded crowd.

Just HOW will a universal health care system reduce my choices as I have never had this experience and in fact I have found individual choices to be not only respected but encouraged.

it is my understanding that managed care reduces choices as the insurance company will only pay for services that are provided by their contracted professionals.

Am I wrong about that?

RN4MERCY · Mar 24, 2009

It's also not so easy as the generalizing that Krugman and Reinhardt used. Krugman's primary tool is ideological hyperbole, Nobel prize notwithstanding. Is it too much to ask that the discussion not be presented in unqualified assumptions?

The thread is titled, "10 Excellent Reasons for National Health Care." I believe reason number 2 is listed at the beginning of the thread--'It costs less and saves money'. I think it's perfectly reasonable to accept the analysis, rationale, and studied opinion of Nobel-prize winning economist Paul Krugman, together with that of Dr. Ewe Reinhardt on the subject. Hardly "unqualified assumptions" the way I see it. The best you can do is to stray off-topic. "Arafat?"

I'm done. I guess we'll just have to agree to disagree. Thanks for offering up the Singaporean system. I know they have a thriving medical tourism business. Got money, get care! That's no solution. Alas, you've tipped your hand. The facts speak for themselves.