TCS Daily


Is Socialized Medicine the Answer?

By Arnold Kling - March 14, 2006 12:00 AM

"When you think of the problem of health care costs, you shouldn't envision visits to the family physician to talk about a sore throat; you should think about coronary bypass operations, dialysis, and chemotherapy."
— Paul Krugman and Robin Wells, "The Health Care Crisis and What to Do About It", The New York Review of Books, March 23, 2006

In fact, when you think of the problem of health care costs, you should think of MRI examinations for back pain, colonoscopies to screen for colon cancer, and non-emergency visits to cardiologists, gastroenterologists, and other specialists. These are expensive procedures that often do not affect the outcome for the patient. Advanced medical technology and referrals to specialists make up what might be termed "premium medicine."

Premium medicine often falls in a gray area that is in between unnecessary health care and acute care. The procedures have some medical justification, but they are not always cost-effective.

Krugman and Wells correctly point out that our health care financing systems, both public and private, are unraveling under the pressure of premium medicine. However, they make an unproven case that, in their words, "honest-to-God socialized medicine" would be so efficient that it would make premium medicine affordable, at least until technology and medical know-how expands even further. In the long run, they see health care rationing by government as the only solution for controlling health care costs.

Krugman and Wells point out that other countries use government-financed health care, and that in those countries health care outcomes are not notably worse while spending is less. They would have us believe that people in other countries receive the same treatment at lower cost.

In fact, Americans consume more premium medicine than citizens of other countries. To some extent, this may produce better results that are obscured in the data used to compare health outcomes on a national basis. Longevity, for example, is affected by many factors other than health care.

The main reason that other countries can spend less on health care is that the availability of medical services is limited by government policy. The health care rationing that Krugman and Wells believe is inevitable for the United States takes place today in other countries. Health care rationing is one way to try to cut back on medical procedures that are not cost-effective. However, it would represent a radical change for the American health care consumer.

Today, the United States has two large government health care programs — Medicare and Medicaid — that do not display the efficiency that Krugman and Wells ascribe to single-payer health care systems. In fact, Krugman and Wells admit that Medicaid and Medicare are in dire financial straits. Notwithstanding the allegedly lower administrative costs in government programs, and despite the government's use of its leverage to hold down the fees charged by health care providers, the spending by the U.S. on its elderly population, on a per capita basis, is as high relative to that of other countries as is spending on the under-65 population. In other words, our elderly are heavy consumers of premium medicine, so that within the United States there is no sign that single-payer health care can reduce health care spending.

Krugman and Wells write:

"The medical profession, understandably, has a bias toward doing whatever will bring medical benefit. If that means performing an expensive surgical procedure on an elderly patient who probably has only a few years to live, so be it. But as medical technology advances, it becomes possible to spend ever larger sums on medically useful care. Indeed, at some point it will become possible to spend the entire GDP on health care. Obviously, we won't do this. But how will we make choices about what not to do?"

They argue that eventually we will need government rationing of health care. But they say that this issue can be deferred, because in the short run the shift to a government-run health care finance system would save enough money to allow us to continue to afford premium medicine.

Krugman and Wells believe that the efficiency of socialized medicine is a sure thing, and that health care rationing is a far-off possibility. In fact, if the United States were to adopt government-financed health care, the results would be the reverse. Efficiency would fail to improve, and instead it would most likely deteriorate. Rationing would be a sure thing.

The opposite approach is to have consumers bear more of the cost of health care decisions, with a safety net consisting of long-term catastrophic insurance with very high deductibles. This would put an unfamiliar burden on Americans to assess the costs and benefits of our specialist visits, MRI exams, and so on. No doubt, some of us would make mistakes. But these would be our individual responsibility, not a collective crisis.

In my view, either single-payer health care or a return to individual responsibility represents a radical change. It would be more prudent to have individual states experiment with these alternatives before we commit to any single approach at a national level.

Arnold Kling is the author of a book on health care policy, Crisis of Abundance, forthcoming from the Cato Institute.

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56 Comments

Krugman
Krugman has a long history of assuming without evidence that govt is more efficient than any alternative.

Socialized Medicine- or what I like to call "God -help me" medicine
My wife is from Europe, and I lived there for a few years. What I have learned from that is that their medical system is very good for immediate care, IE colds, flues, broken bone ETC. Where they fall behind is in this very area of medicine. If you want/need a MRI, Cat scan or to see a specialist you had better be in good health so you can last the waiting period, or else you will be praying to stay alive until an opening comes up. There are a lot of problems with our medical system, but at least when my primary care doctor tells me I need a “specialist” I can get in before I die of old age.

$300 CAT scans
A service is being promoted for $300 diagnostic CAT scans. Most are not covered by insurance. They must be doing pretty good business.

Need medical price labelling legislation
I agree with moving in the direction of individuals buying their own health insurance instead of through third parties. This will certainly allow for more market oriented competition.

In my opinion to make it work, the individual health consumer must have knowledge of the prices of doctor visits, operations, tests, hospital stays, etc. At least initially I believe that the medical profession will resist this.

Therefore some sort of price labelling legislation might be needed to force all medical providers to clearly post their prices. I'm not talking about trying to set prices, just that the prices are readily available.

A MARKET Solution
“In my view, either single-payer health care or a return to individual responsibility represents a radical change. It would be more prudent to have individual states experiment with these alternatives before we commit to any single approach at a national level.”

There is another alternative to a Government solution to the “health care crisis”. It is called the Free Market…and it is not really so radical given that free markets account for the majority of US GNP.

What if the top 100 companies in the Fortune 1000 formed a Health Services Buyer organization? They would then negotiate with health care providers and insurance companies for cost effective and diversified health care products. In addition, any company could join the plan, or form their own plan with other companies. Even individuals could join. In the near future, Buyer organizations could come to represent tens of millions of health care consumers. This consolidated consumer clout would lead to minimized costs and widest possible range of plan choices.

Economies of scale and market based competition has not developed in the Health Care Industry in the US. On the other hand, one payer health systems (such as Medicaid and Medicare) have been around for years, and have a track record of less than optimal results. A market based approach could be initiated today by the private sector. The Government role would be to support this trend with modifications to existing regulations/tort-law that currently increase costs with little corresponding benefit.

Contemporary health care consumers and corporate decision makers are mostly not responsible for lack of optimization evident in the current US health system. However, they are the ONLY parties who can fix it properly.

Maybe cheap insurance that lets people die with a certain level of curable cancer or heart disease i
Cigarettes give pleasure to some, who if they get lung cancer they complain.

Once they have cancer they regret their decisions they discount all those pleasurable puffs for nothing but really they knew the risks and made their choice and those pleasurable puffs were worth something. What does this have to do with the topic of healthcare system? It shows that different people have different preferences and different time preferences and so some choose to not insure themselves. We need to accept that this is the right choice for them they get more pleasure from spending their money than they get from having health insurance. So a private system is always better. If we want to reduce cost we should deregulate allowing more people to practice medicine and allowing a lower level of care to those who choose it. Maybe insurance that lets people die with a certain level of curable cancer or heart disease is needed.




Krugman the incredible
How can anyone give Paul Krugman any credibility at all? I admire Mr. Kling for demonstrating patience with a man who still thinks that socialism is a viable solution, and in fact thinks that socialism if efficient. Incredible!!

My wife is French
And I have just the opposite observation. My inlaws get excellent health care and they get advance tests and diagnosis at a speed that is consistant with the severity of the health problem.

For what it's worth. And it is just a single observation.

Flaws in a free-market solution
I am self-employed and have an HSA for my family with a high deductible insurance plan. I like the CONCEPT (for us) compared to available alternatives, but I am unable to learn in advance the cost of any tests or doctors visit. I can ask about the cost of medicine before I buy it, but not when discussing options with my doctor. (Well, I can ask and do, but they can't answer). The pieces are not in place for free-market health care to work.

I'm fortunate enough to have above median income. I could simply not afford this with a median income. Even now we make choices that we would not have made when covered by a comprehensive, employer-provided group plan. (I know - economists think that is a good thing.) There is a basic problem for me with free-market solutions to something like health care, or basic nutrition, or gasoline to flee a hurricane. Everyone needs it. THe limits to what they will pay are not based on "how much it is worth to them". But the free market system "efficiently" distributes it to those with the most money to spend. Some things are needed equally and should be distributed equally. It seems this is a place for government, even if there are lots of details left to be worked out.

The reason why the free-market system won't work is that...
most people do not need insurance. In fact, 95% if those who have medical insurance pay for the 5% who are sick.

Health insurance is intrinsically socialist. f the healthy people dropped out of tghe program (or if the employer stopped paying insurance for everyone as a benefit) then the cost to the unhealhty would be just as much as it would be if they didn't have insurance.

Insurance companies are not in the business to lose money.

Anyone who needs to use ~60 word sentenses to make a point probabaly doesn't have one.
Could someone please explain to me what this means?

"Notwithstanding the allegedly lower administrative costs in government programs, and despite the government's use of its leverage to hold down the fees charged by health care providers, the spending by the U.S. on its elderly population, on a per capita basis, is as high relative to that of other countries as is spending on the under-65 population."

Does per-person health care cost more or less in the US?

No Subject
"Insurance companies are not in the business to lose money."

- Which is another reason why this may be an area for government involvement.

problem with health care and free market
The difficulty insurance works by spreading risk as widely as possible. But insurance companies make profits by avoiding bad risks.

Lots of people are obvious bad risks: preexisitng conditions and even, soon, bad genetic profiles. For profit companies will not want to insure them. They will not now. It's called adverse selection. With car insurance, it's present, but it's tolerable, because people are (usually) responsible for their own driving records. But people aren't responsible (to a firt approximation) for having cancer, or having a child with a developmental disorder.

Single payer gets around this by establishing one big pool. This also eliminates large insurance bureaucracies aimed at identifying bad risks. It's got problems, but it's better than what we have. But - why not a private for-profit single payer? If you trust a monopoly more than government sure -- but what leverage does anyone have over it?

Krugman is many things
but he is not a socialist. Why not deal with what he says, specifically, instead of labeling?

Socialized Medicine?
Who says there is a problem with our current healthcare system? I don't see a crisis?

Do you see a crisis?

A law could made to prevent the Insurance companies from discriminating against the unhealthy EOM
Fortunato, a law could made to prevent the Insurance companies from discriminating against the unhealthy.

Then why does he consistently favor socialistic solutions?
.

ah yes
I'm from the govt, and I know what's good for you.

So shut up, sit down, and pretend to enjoy it.

govt is not the answer to every problem
Self financing. Putting away money each year to cover emergencies.

People used to do that until govt convinced them that it was going to handle all bad things.

There's also charity for those who can't afford to self-finance. If govt weren't sucking up 40% of the average person's income, there'd be a lot more money available for charity.

Profit
All businesses exist to provide products and/or services and make money. Are you suggesting that any product or service that is profitable is an area for government involvement? How about we all just work every day, but not get paid, and the government will take care of all of our needs, as the government perceives our needs to be? Perhaps we could have lines to get into stores receive our food, or clothing, or gasoline, etc. That system worked in the USSR for a while, until it collapsed upon itself.

Economies of Scale, Competition and Health Care
“But - why not a private for-profit single payer? If you trust a monopoly more than government sure -- but what leverage does anyone have over it?”

The idea is NOT to have one monopoly single payer organization, but instead to have to 3-N large, competing Health Purchasing Organizations (HPO's). In this way, the consumer gets the benefit of both size and competition. HPO's would negotiate prices directly with Health Care Providers. In addition, they would purchase catastrophic insurance coverage and additional premium insurance coverage as requested by members. Membership qualification would be set by each HPO, but pre-existing conditions and bad risks would be handled by re-insurance and not by exclusion.

Efficient and competing HPO's will force national consolidation in the health care industry...including electronic records, standardized paperwork/terminology and the vertical organization of health care services (from doctors to clinics to diagnostic centers to hospitals). And with business organizations relieved of their role as health care decision makers, health care consumers can reassert direct control of their patient-provider relationships.

One Question
How much of that care is provided using diagnostic and treatment equipment that's developed in America. Even if your anecdotal evidence can be extrapolated to be statistically valid-the part of the equation thats missing is the amount technical excellence thats incorporated only because its developed here.

Error Alert- The Problem with the Ignorance of the Free Market and Insurance
"The difficulty insurance works by spreading risk as widely as possible. But insurance companies make profits by avoiding bad risks."

No actually insurers make profits-by pricing their coverage according to the expected loss. Just as the chronic speeder pays more-so does the chain smoker-WHERE such things are allowed to be factored into the underwriting. Your car insurance is not valid because most states place limits on the amount of premium an insurer can charge and the worst drivers are entered into an "assigned risk" pool that the insurer must accept a portion of as a condition of doing business-so the worst offenders are not charged market rates-safe drivers subsidize them.

I love the blind faith socialized medicine-always pleasanty euphemized as "single-payer" and "universal". And whats really fascinating is that somebody who makes the statement "If you trust a monopoly more than government sure -- but what leverage does anyone have over it?", can't see how illogical it is to trust a monopoly just BECAUSE its government.

What poor unfortunato seems not to understand is that "power" over an insurer rests in two tools-the threat of leaving for another insurer and lawsuits-so your power is nil when the only plan is the government and it can assert sovereign immunity.



in simple terms
Health care spending is higher in the U.S. than elsewhere.

This is just as true for the over-65 population, where government controls the spending in the U.S., as for the under-65 population, where most of the spending is private.

Therefore, the evidence suggests that the differences between the U.S. and other countries have to do with how medicine is practiced here, not with how it is paid for.

nor is the market
I absolutely agree that government is not the answer to every problem. I do think it has it's place though, as a way to organize collective financing for items too expensive for individuals to handle independently. National defense is an example of one such expense that even libertarians agree should be shared in this way.

Health may be much more individual than defense, but it is not really an individual choice. We all face the risk of chronic or catastrophic illness, the expense of which may be ruinous to an individual. I may be healthier than most, but because a)I realize that "there but for the grace of god go I", and b)I risk running out of that particular sort of grace at any time, I see health care as an appropriate area for collectively sharing the expense (i.e. government involvement) though I admit the government (that is, we) need to be realistic and responsible in structuring the program. (That goes for defense, too).

As for self-financing - I'm both saving money and buying insurance via my HSA. It costs a lot of money! (If I were already sick, I wouldn't be able to afford the HSA.) If I knew I would be covered in the future if needed, my money could go to charity or taxes for people needing health care now. It seems that would be a more efficient allocation of resources.

Simpler Terms
"Therefore, the evidence suggests that the differences between the U.S. and other countries have to do with how medicine is practiced here, not with how it is paid for."

Also, I was thinking.

Or maybe more simply that us Americans are richer on average, even in the lower percentiles of income, and so more individuals have more money to spend on health care.

Income & wealth is distrubuted more evenly in the US than any other nation. It is also less expensive to live in many parts of the US than just about anywhere in Europe. It stands to reason that spending on all kinds of things would be greater here. Just makes sense to me. Doesnt mean it is more expensive or more difficult to acquire or anything like that. This is a direct result of the free market.

This is rarely mentioned if at all.

Whose"Ingorance"
reality check:

>What poor unfortunato seems not to understand is that "power" over an insurer rests in two tools-the threat of leaving for another insurer and lawsuits-so your power is nil when the only plan is the government and it can assert sovereign immunity.

1. What "power" does an uninsurable person -- someone with a chronic severe disease - have to leave an insurer?

2. Perhaps you're not aware that someone with a beef with social security (for example) can sue the social security administration.

Thanks for drawing attention to "ignorance," but it's yours.

please back up what you say

could be, but..
Here's the problem for insurance companies. Under this position, the smart move for an individual is to not get any insurance at all except perhaps a $10,000 trauma treatment policy until and unless you became seriously ill. At that point, and only that point, you'd march in ask for your policy and they'd have to sell you one. You'd create a situation even worse than now -- the only people buying insurance would be the severely ill.

Now, you could say that everyone had to have insurance. But then you'd be most of the way to a single payer system anyway,

Crisis mongering socialist control freaks
Great point dab. The cohort of the population that desperately wants control over the rest of us, always claims a catastrophic problem, whether it exists or not, and a coercive socialist solution.

The other venue of the argument, neglected by my hero Kling, is the relatively uncontrolled parts of our economy. Other market-driven products and services uniformly grow more efficient and less expensive and more available over time to ordinary folks, as knowlege is gained and technological advances are made.

Medicine is not "special" in this regard, it would also decrease in price if the control freaks would leave it alone. Two example of areas that have somehow escaped government control come to mind. 1) Corneal surgery to correct refraction problems that used to be corrected by glasses. 2) Cosmetic surgery. Neither is paid for by bureaucrats, both have decreasing prices and are becoming more affordable to us all. Cheers, Don V.

You get the prise for pointing out the only true free markets in medicine.
Don_V gets the prize for the only real evidence of the performance of cash bashed free market solutions to health care funding. That is the cosmetic and vision refraction businesses. These businesses have seen dramatic increases in the quality of their products and services (Cher for example) and DECREASES IN PRICE!!!!!!! Now parents in certain circles are buying their daughters breast enhancement surgery over a car because IT IS CHEAPER AND SAFER!!!

The US was founded on solving problems through free markets and private charities. Remember the local religious hospital that served people who could not pay? The US should be at its best driving down the costs of better technology that makes us healthier.

Now we have Medicare, Medicaid and worse the VA to heal us. Socialized medicine is not a solution, it is the real problem.

socialised medicine .......by northernguy
Canada has what is described as socialised medicine. Most doctors work on a fee for service basis for patients who choose their doctor in a free market system. Most of their fees come from government run agencies that cover a wide range of services. Most residents of Canada are covered by the fee paying agencies which are funded mostly from general taxes. Most hospitals and their associated services are funded entirely from government revenues with some supplements coming from charity type organisations. Most of the funding is routed through provincial governments from money raised through various tax sources.



For those interested in the putative _efficiency_ of socialised medicine I offer some examples of how government run single payer systems work in practice.



The doctors operate in a so called free market system but are all payed from a single payer according to a schedule drawn up by government appointees. In response the free agent doctors need reprentation to negotiate what they consider to be their interests. Consequently the medical associations in Canada have morphed into virtual unions. _Free agent_ doctors have labour negotiations complete with strikes, lockouts, rolling strikes and lockouts, work to rule (don't ask..hint..it's got a lot to do with paperwork), mass demonstrations and very expensive, high profile publicity campaigns from both sides. Sometimes settlements are effectively decided through the electoral process to almost no one's satisfaction.



Nurses are regarded as professionals so they have their own negotiating system which they accurately refer to as a union. As union members they are part of the typical labour negotiation pattern regularly employing the tactics mentioned in the previous paragaph. Their union negotiates wages, benfits and working conditions. Working conditions and wages are extended to include issues of status in the workplace and protection from perceived patriarchy. Additionally they set the standards for accreditation of nurses and have consequent substantial impact on training and even staffing criteria. Almost all clinics, hospitals and health units are publicly funded so almost all nurses are covered under a sector wide bargaining unit. Thus all the typical disruptions associated with labour upsets are inflicted on wide region affecting millions of people.



All non professional staff at the publicly funded hospitals, clinics and health units are covered under a seperate sector wide bargaining unit. Working in conjunction with the nurses union they are able to leverage the shortage of highly skilled technologists etc. into securing an amazing wage/ benefit/ holiday package even for the majority of hospital workers who are relatively low skilled. The natural outcome of a couple of months paid holidays per year for hospital workers is a decrease in the availability of already short specific skills required by the hospitals.



Even where the hospital workers union is not the same one as the public service union they certainly work together. An alliance of the hospital workers, nurses, government workers, teachers and possibly all the doctors is a very powerful force in society. It is a brave government that is willing to shut down modern society for any length of time no matter how valid their point is.



Since all the hospitals are government funded to provide essentially the same service with only minor variations it makes no difference which institution delivers which service for which cost. Hospitals are given block funding from which they are required to perform as a hospital. Hospital administrators spend the money given in such a manner as to satisfy the needs of their employees while maintaining a service level that the general public will accept. Eg: closing an emergency dept. will antagonise the general public. Destaffing an emergency ward but leaving a bare minimum of staff will only draw complaints from those who are inconvenienced. In such an evironment patient satisfaction is an unheard of concept. Hospitals neither know nor care how much a given service costs to deliver or how it could be done for less. Granted there are individuals within the system who care and are sometimes successful in modifying _best practice_. But for the hospital as whole patients are drain, down which resources flow but who never return any benefits to the institution.



Up until very, very recently it was illegal for doctors to charge patients for their services or for hospitals to provide services that required private funding. A few months ago the Canadian Supreme court ruled that it was unconstitutional to inflict pain and suffering and possibly death on Canadians by denying them a private remedy for a government failure. The court ruled that provincial governments must provide timely care or allow alternative delivery services to develop. The governments immediately agreed to a two year study to determine how long a wait could be included in the phrase timely care. After the study is complete they will propose the new standards, which, after discussion, are accepted, then failure to meet those standards will provide the circumstances under which private alternatives are permissable.



Wait time for many surgeries is a year. It's not unheard of to wait two years for orthopedic surgery.
Private clinics in some provinces are paid by the government to treat prisoners needing advanced care because it is considered cruel and unusual punishment to force them to participate in the public system against their will.



Need I say that it is a very expensive system compared to other health care systems. Canadians don't experience it as personally expensive because it comes out of taxes. Taxes are extremely high in Canada in part because of health care. Canadians support high taxes because they believe they are necessary to support the health care standards that they do have.



Candians didn't set out to create the system they have. They wanted a single payer system that _provided coverage for everyone_. After being in place for a while it became the _same_ coverage for everyone. Then it became _only_ a single payer system regardless of what an individual might want. Then it became a single payer system that provided the same coverage for everyone even if it was unsatisfactory to everyone but at least it was the same for all.

US Constitution
"I absolutely agree that government is not the answer to every problem. I do think it has it's place though, as a way to organize collective financing for items too expensive for individuals to handle independently. National defense is an example of one such expense that even libertarians agree should be shared in this way."

Libertarians and conservatives identify national defense as a responsibility of the federal government because the Constitution says it is. The Constitution does not deal with it as an expense which should be shared. Nice try though! The Constitution does not mention national health care, as I recall.

Local Religious Hospitals
...are closing because state governments require them to offer abortion services.

Catholic Charities in Massachusetts has ceased providing adoption services because the state requires them to process adoptions to gay parents.

What ever happened to the "separation of church and state" which isn't in the Constitution?

doesn't follow
while goverment contributes a lot to spending on care for over 65-year old, there's a huge amount of private spending on top of that.

Moreover the disparity between per capita u.s. spending and that in most other industrial democracies (50-100 percent) is so large that I don't thik distinctions like these capture it - not without lots of backup detail.

US Constitution - National Defense, and Health Care
"Libertarians and conservatives identify national defense as a responsibility of the federal government because the Constitution says it is."

OK - why do you think the constitution gives the federal government responsibility for national defense? The constitution did not drop out of the sky like some kind of divine law. THe writers of the constitution recognized that the market was not a solution for an effective, comprehensive program for national defense, therefore they devised a government solution for collectively sharing the burden of providing for national defense.

I conceded in my original post that health care is not just the same as national defense. True, it is not enshrined in the constitution, but neither is it prohibited. And if the collective approach to defense, coordinated by the government, is accepted as valid and even necessary, I would suggest that such a model should not be beyond (Careful) consideration in other applications that would promote life and liberty for the citizenry.

If you see collective responsibility for health care as a means of enslavement of the citizenry, well, you could certainly level that charge against our national defense system as well. Our constitution doesn't answer everything for us, our responsibilities for safeguarding life and liberty continue.

No Subject

constitutional powers
If a power isn't specifically granted under the constitution to the Federal Govt., then that power does not exist.

apples & oranges
Funny message:

> Two example of areas that have somehow escaped government control come to mind. 1) Corneal surgery to correct refraction problems that used to be corrected by glasses. 2) Cosmetic surgery. Neither is paid for by bureaucrats, both have decreasing prices and are becoming more affordable to us all.

heart transplant surgey is also not paid by government bureaucrats, and is also not under government control, except with regard to safety. Do you really not see a difference between optional voluntary , luxury procedures that must be sold to invidual consumers and therefore must compete on price; as opposed to medically necessary, live-or-die choice operations?

No actually the ignorance is yours.
Since I have well over a decade in the insurance industry, having demonstrated my knowledge by earning several professional designations AND worked as a government healthcare auditor-I'm pretty well versed in the workings of the subjects at hand. Surfing and regurgitating Krugman columns makes you an ideologue, not an expert.

In many markets, there are barriers to exit-it will only take the movement of others in relatively good health to impose the invisible hand on an insurer. In any case, you advocated a single payor-so you would eliminate ANY competition for any insured making alternatives not different but impossible. Congratulations on reminding me of David Frost's observation of a liberal being a person who refuses to taking his own side in an argument.

You can sue the Social Security administration proves what? Are you proposing Social Security admininister healthcare? Has somebody else -in their right mind?

A little civics lesson -you can bring suit against SS only because the federal government allows you too (primarily because there's good money in suing them for well-heeled and well represented trial lawyers). Even there litigation is difficult, time consuming and costly. The government could assert sovereign immunity tomorrow

A little piece of advice-try not to pick a fight when your best weapon is a pea gun.

You'd do well to take some elementary undergraduate economics, philosophy and rhetoric classes. Add epistimology as you can. The problem with arguments that are formed primarily in the viscera is that they lack factual merit, sound reasoning and clear and convincing exposition. Then again, I'm not sure I see any evidence here from you of proper of proper prepararation or aptitude for university level work.








One other thing
What "power" does an uninsurable person -- someone with a chronic severe disease - have to leave an insurer?

If the person you describe is eligible for Medicare due to their chronic and severe disability-they have all the power in the world to change insurers for the SUPPLEMENTAL PORTION of their insurance. A requirement of med supp policies is guaranteed acceptance.

Vision correction is a luxury?
You can't be serious. Correcting impaired vision is luxury? You are more screwed up than I thought.

Cost and value
Best advice I ever got in grad school-beware of those that know the cost of everything and the value of nothing.

an operation to correct vision
rather than glasses? Yes, it is is luxury.
But if you don't think so, talk to your health insurance company.

live or die choices
How long will you live without food

No. That is known.
The fraction of personal income spent on health care is about the same in EU as in the US.

So that's not why it costs more here.

France
I can’t talk of France, never spent much time there.

I have spent time in Great Britain, Germany, the Netherlands and Bosnia. From the information I have seen it does not surprise me that their system is some what different then all the others. Out side of the Scandinavian government systems they seem to be the most “socialized” of the European socialist systems.

The Scandinavian systems are very good, but have been showing signs of collapsing under the costs. The tax rates in those countries are skyrocketing and they still are having problems funding the programs. I have not read anything directly pointing at France having similar problems, but then it is one of my least favorite European countries so I don’t keep up on all the news there.

That's hard to asnwer
But, next time you go to your hospital, look at the major equipment like CAT scanners, X-Ray, MRIs, etc. You will find that many, if not all, are made by Phillips, Thomson-CSF, etc.. These are European companies. There are also some Japanese brands, JEOL, etc.

Most pharmaceutical companies are international. Many have their origins in France, Grermany, Switzerland, etc. Pfizer, Boiron, Bayer, Merck, Hoffman La Roche, BASF, etc.

In fact, European medicine is more advanced than in the US in many areas.

Your response is pretty typical of americans who have been listening to the ntional image propaganda without question.

If we Amricans are going to survive the future, we better open out eyes.

Well, of course this is a problem throughout EU as well as the US
The problem has much to do with the aging population, lower tax base, corporate feudalism, and saturated markets.

The crisis is that health care cost inflation far exceeds most every other index
We also have an aging population that, historically, society has taken care of.

If we decide to not take care of the aging, then there is no crisis.

One man, one vote.

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