Saturday, July 21, 2018

Hey, post-America, stay way far away from that single-payer crud

Pacific Research Institute president Sally Pipes offers a grim picture of how it's working our in Britain:

The NHS is collapsing. Patients routinely face treatment delays, overcrowded hospitals, and doctor shortages. Even its most ardent defenders admit that the NHS is in crisis.
So why do so many prominent Dems forthrightly advocate it? The proof of what happens when it's implemented is there for all to see:

The NHS experienced these problems from the start. In its first year, the service went well over its budget. Prime Minister Clement Attlee even begged citizensnot to overuse health services. Staff shortages, caused in part by low pay, have plagued the system for decades. The NHS started recruiting doctors en massefrom India, Pakistan, and Sri Lanka in the 1960s to address the issue.
Nevertheless, shortages persist. One in 11 NHS posts is currently vacant. Four in five NHS staff worry that these vacancies jeopardize patient safety. The NHS has among the lowest amount of doctors, nurses, and hospital beds than any country in the Western world on a per-capita basis, according to a report from the King’s Fund.
Simply put, the NHS is unequipped to care for its citizens.
A simple influenza outbreak last winter plunged the system into chaos. The NHS canceled 50,000 non-emergency surgeries to make room for an influx of people with the flu. Still, nearly one in five patients had to wait more than four hours in the emergency room.
Such nightmares have grown routine. The British Medical Association recently reported that the NHS now faces a year-round crisis, with waiting times and hospital bed shortages at record levels. An NHS Improvement survey of data from the first three months of 2018 found that 2,600 patients had waited more than a year for elective treatment—a nearly 75% increase from the previous year. It’s no wonder that about 10% of Britons hold private insurance coverage. They simply can’t count on the NHS to deliver quality care in a timely fashion.
The NHS’s supporters claim that the system just needs more money. That was the rallying cry for thousands of Britons who took to the streets this past February and again in late June. 

But the British government doesn’t have unlimited resources. More funding for the NHS would require raising taxes. And Britain’s tax burden is already the highest it’s been in 20 years, according to the Adam Smith Institute.
Further, funding for the NHS is already at record levels. It’s projected to grow an average of 1.2% percent per year through 2020-21, to an annual tab of nearly $170 billion. Overall, government spending on health care has surged from about $340 per person in 1950 to $2,985 per person today.

You see, there is nothing that is going to work - for health care, or any other product or service one human being provides to another - except a free market:

Single-payer is fundamentally flawed. It relieves consumers of any obligation to pay for their care, at least directly. If the price of care is zero, then every patient can demand an infinite amount. The supply of care, meanwhile, is limited. And the amount of money the government can spend on health care is finite.
In a functional market, patients would demand care and providers would furnish it at mutually agreeable prices. If prices were too high, patients would demand less care, and marginal providers would exit the market. If prices were too low, patients would demand more care, and new providers would enter the market to supply it.
These basic market-clearing principles cannot operate in a single-payer system. Governments must forcibly cap demand at whatever level they’re willing to supply—that is, to pay for it. 
There's kind of a downward spiral that sets in, it seems to me. Care gets shoddier, consumers get more cynical, government shovels more money into the arrangement, and no one is talking about basic principles.

Now that the "A"CA's individual mandate (if there's any word that sets my teeth on edge, it's "mandate") has been 86ed, maybe we can proceed to its overall dismantling.

Widespread conversations about freedom, supply and demand must accompany that process, though.

 

24 comments:

  1. England's nightmare is certainly an important consideration as we continue to debate this issue, Canada too.

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  2. Yup. These various models don't exist as mere abstractions. You can see how they play out in the real world.

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    1. Yes you can...with Medicare -- the government's #1 most popular program -- and the VA, which despite the widely publicized administrative problems, still receives higher patient ratings for their service delivery than the private sector. Cheers. :o)

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  3. Medicare is going broke and the VA still pretty much sucks compared to private health care. The Dems blew the ACA from the get-go (without a single Republican vote)and had nearly 6 years to work to improve it. It won't be long until Medicare premiums plus the supplements eat up the entire average social security check. Come on, we're supposed to be exceptional, right? Can't we work together for workable solutions? That includes not just defaulting to the free market solution on "principle."

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    1. Excuse me, Mr Dingleberry, but surveys show customer satisfaction for both programs is significantly higher than the private sector (look it up). And any suggestion that President Obama is to blame for six years of Republican Congressional obstruction makes me jealous for whatever meds you are on. Cheers.

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    2. Proof's in the pudding Nr. Superscalfafragilistic. They blew it with no bipartisan support, basically thrusting it upon us, and even the initial digital implementation failed. Then admitting they lied about keeping our own plan. I was formerly an advocate of a universal plan, but now have serious misgivings

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  4. "Republican obstruction" . . . is that anything like doing everything possible to keep government from having any bigger role in the lives of American citizens?

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    1. I was referring in particular to the "nearly 6 years to work to improve it" comment, but yes, many truly dire issues have been ignored and left to fester in the current backward and regressive atmosphere (Flint MI, and it's role as the canary in the coal mine being an example that comes readily to mind).

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  5. When your house is on fire, you don't expect to comparison shop for the fire department you prefer...you just want your house saved, if possible. And you certainly don't want a fire department that, when called upon for service, devotes considerable resources to determining how your home can be excluded from the expensive personnel, equipment, and supplies needed to extinguish the conflagration. The demand for health care mirrors many of the inelastic properties of other essential services.

    And while it is so surprising to hear of complaints about the UK's NHS, given the natural tendency of human beings to never complain about anything, I have yet to see ANY reports of a keen desire on the part of the Brits (or any other single-payer nation) to move to a US-style healthcare arrangement which devotes 27 cents or more out of every dollar to a health insurance industry that brings no added value to the table.

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    1. Nobody's saying our current system works all that well, just that Britain & Canada's have serious shortcomings we should consider, unlike the Dems who shoved their plan up our posteriors and then gravely failed to execute. Only excuses now, blaming Republican obstructionism that should have easily been foreseen.

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  6. The VA was a total cluster during the Nam era on into the 90s but has admirably come a long way. Perhaps Canada and Britain can work similar magic. We'll be watching.

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    1. Canada is fine, thank you, and the only real thing required to fix the NHS is a return to Labour government. Sure, you have to wait a minute for a hip replacement (but not for preventative or emergency care), but you won't have to mortgage the farm to pay for it, either.

      And obviously, if we switch to a single payer system, the VA and all it's issues can disappear entirely.

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  7. Actually I cannot find any real dirt on the Canadian plan, the people love it and are very proud of it. Maybe bloggie can come up with some reason(s) beyond the principle of the matter as viewed from the exceptional states beneath them.

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  8. https://www.nationalreview.com/2017/04/canada-single-payer-health-care-system-failures-cautionary-tale/

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  9. https://www.forbes.com/sites/theapothecary/2014/06/13/if-universal-health-care-is-the-goal-dont-copy-canada/#470eee878d58

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  11. NR article pretty damning; Forbes' less so. Let the debate proceed. Ugh, again...

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  12. Interesting that the NR article refers to the US healthcare system as acting as a buffer or overflow, if you will, for those Canadians seeking specialized and/or swifter treatment. The per citizen premium (of course it's collected from taxes and the citizens never see the med bills)is over 10K annually. The debate is dreary, the issues are complicated, and there is a lot of misinformation out there. Ugh!!!!

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  13. I realize we must all move on to rail against other subjects we have absolutely no influence over, so I have no expectations. But if you get a chance, some further reading you may find of interest:
    http://www.theamericanconservative.com/articles/the-conservative-case-for-universal-healthcare/
    http://theweek.com/articles/695767/conservative-case-singlepayer-health-care
    http://www.pnhp.org/gop

    Cheers. :o)

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  14. This Chase Madar doesn't isn't very convincing that he's in a position to make a conservative case for anything. He's written a lot more articles for The Nation than he has for The American Conservative. Ans anybody who dismisses free-market champions as "Hayekian fundies" is pretty far from any recognized definition of conservatism. Then there's the book in which he attempts to make the case that Bradley Manning deserves the medal of Freedom.

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  15. Here is the correct link for the other article written by Matthew Walther. What damning can you do him? He's Asst. Editor of The American Spectator? http://theweek.com/articles/695767/conservative-case-singlepayer-health-care

    Money line: " Meanwhile, conservatives insist on getting rid of the only good part of the legislation: the expansion of Medicaid. This is not because it hasn't worked but because it conflicts with Republicans' increasingly ethereal principles. Put aside for a moment the question of whether it would be desirable to return to those halcyon days when simple country doctors gave big bills to the rich, smaller ones to ordinary people, and treated the poor gratis. Is it even possible, much less feasible? No one, not even Tea Party members during the movement's heyday, has been clamoring at the door to get rid of Medicare. Even if their wildest dreams came true and they managed to get government out of health care altogether, what would happen to people in the meantime while their hypothetical army of altruist medicos mustered its forces? The solution should be obvious. Single payer is the only way forward."

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  16. Walther is an entertaining and talented writer. He's particularly insightful when writing about music. His pieces on Judy Collins's first album and on George Jones's gospel output come to mind.
    But a lack of depth becomes discernible when you take in the sum of a his stuff. He likes to come up with caricatures based on sweeping generalizations. For instance, in the piece in question, he constructs this image of the kinds of people Republican members of Congress most like to meet with: "defense contractors, up-and-coming fracking magnates, lawyers, purple-tied megachurch pastors," and to embody the kinds of Americans who don't have much money to spend on health insurance he offers this: "What is a 25-year-old making burritos at Chipotle for Heritage Foundation bros at $12 an hour supposed to do with the chance to funnel an unlimited amount of his meager wages into a tax-free health-savings account? Pay the rent with catheters? If he saved diligently for two or three years, he might be able to buy himself half a blood test."

    Yo, Mr. Walther, the proverbial Chipotle guy is supposed to aspire to a better-paying (and more fulfilling) job within your three-year time frame.

    But Walther really exposes how completely full of shit he is with this line: "Conservatives in this country should get used to the idea of being prudent stewards of the welfare state, not its would-be destroyers."

    And no actual taking on of actual free-market arguments. His type never does.

    And those who trot this kind of stuff out, just as in the case with the Madar piece, are basically screaming to the world, "I have no credibility and I really don't even understand the basic principles of any ideology whatsoever."

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  17. You can stay in your corner all you like, but it appears others are coming out of it. The debate rages on. That's all folks....

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