JustOneDad, I wrote that in #116. I was responding to this statement:
And since the idea of “taking your business elsewhere” is a market idea, I said something about the health care system being treated as if it’s a market.
The free market assumes a lot of things which are not true of health care. It assumes the consumer has all kinds of information which we don’t have, or can’t get without a great deal of difficulty (just try asking the hospital how much your surgery will cost). It assumes the consumer can do comparison shopping. It assumes the consumer can move seamlessly from one seller to another. It assumes we have the time and the ability (e.g., not too ill or injured) to make rational decisions.
Another problem with the “simply go to someone with no wait” is that waiting times are to a large degree local/regional. If Dr. A has a long waiting list, it’s doubtful that you’ll be able to get a same-day appointment with Dr. B with the same specialty in the same town. Also, there’s the issue of medical records/history. All of my doctors are in one big medical group. When I see my allergist, he knows what test my primary ordered, and what my endocrinologist prescribed. If I decide the wait to see my allergist is too long, and I go outside the group, that’s a lot of time and trouble expended bringing the outside allergist up to speed. And then bringing my other doctors up to speed about what the outside allergist is doing. And finally, there’s the problem of insurance as we do it in this country. That doctor down the street whose waiting time is magically shorter than anyone else’s may not be covered by my insurance. (Of course, that’s a problem which would disappear if we had the option which must not be named, since there would be only one network and all providers would be in it.)
So, no, it’s not “simple” at all to just run to another provider if mine displeases me in some way.
First of all, this was about wait times. Please don’t try to expand it to “if mine displeases me in some way”.
Secondly, there are almost no specialists with same-day appointments available save for acute problems and waiting for a procedure of some kind isn’t acute, so we don’t want to confuse the issue by attempting to introduce that.
Third, there are more popular docs and less popular docs, even within practices and certainly within “regions”. A six month waiting list with one may be a two week wait with another.
I am an American married to a Canadian. We live in the US and have a house in Canada. I am not a doctor nor do I specialize on health care. However, I was on the board of a private Canadian health care company for at least a decade. I have been a consultant to hospitals corporations and health insurers in the US, the UK and Canada. In my experience, the problems that conservatives see in both UK and Canadian systems are real but vastly exaggerated. The same folks tend to ignore or diminish the problems with the US system. For the average person, I’d say either the Canadian or UK systems would be substantially better. For the elites, the US is probably better, but can be emulated in the UK with private health insurance at much lower cost. (Canada has private supplementary insurance as well, but my sense is that Canada doesn’t seem to have the great hospitals /medical schools of either the US or the UK.).
I interpret this as: The truth is somewhere between the extremes of these two camps, and both sides knowingly or unknowingly try to distort the fact to give themselves some advantage?
I’ve really grown tired of the “truth is somewhere in the middle” argument.
No, the truth in this case is pretty black and white. The only difference is your vantage point and what you choose to value (or not).
Like, it’s a fact that people die in the US because of lack of coverage- something unheard of in pretty much every other global north country. But if you’re never going to be one of those people then that truth is irrelevant.
Disagree, mcat. The facts are virtually all on the side of universal coverage. The objections to broader health insurance are based on something other than reality, and should not be given the same weight as actual facts.
Romani said it above, as she has several times on this thread: Lack of insurance can be fatal, and this is a problem unique to the US.
Do you agree that the very privileged are the ones who benefit from the existing system, including insisting on pouring the resources into innovation in medicine that will further enhance the quality of their health care that has already been pretty good?
I always remember what an older timer, BDM, once posted (although I could not remember the details of course): If you look at the health care need of the majority of population on the Earth, it is really neither a medical technology problem nor even a traditional medicine problem. It is an economic problem. The financial aspect of the society actually influences the well-being of the health of the majority of population on Earth more than anything else. They could not care less about the advancement or innovation of modern medical technology. By and large, in the modern history, it is the advancement of basic public health (mundane things like cleaner drinking water, better sanitary living environment, immunization, nutrition) that has improved the health of the majority of ordinary people more than anything else.
It is only the rich and the powerful in the society who care more about having the most advanced medical technology and its innovation. (Just like in the old kingdom where the king would send his people everywhere to find some “magic medicine” so that he could live forever. His life was worth more than others.)
@mcat2 Why don’t we just go to a two tier system? Under that plan, everyone could get what they want; universal coverage, albeit it at a lower level than state-of-the-art medicine, and the “rich and powerful” that you like to talk about would probably be happy to spend their extra money on continuing to boost the advancement of medicine, which would benefit everyone.
The voters of Colorado will get a chance to enact a single-payer healthcare system next November. So we will see if people want one or not. Vermont’s proposed single payer system crashed and burned before it ever got off the runway.
Since we’re Americans, shouldn’t we be able to do a universal health-care system better than anybody in the world, including Canadians? And if that’s true, why are we concerned about the minor problems their system has? We can just avoid those problems when we finally overhaul our obviously inferior system.
Let Coloradans try it. (This is why I like our federal system. One state can try an idea and if the experiment works then others can also).
We’ll see if Colorado employers stay or leave. If doctors stay or leave. If tax increases continue going up. If waiting lines for procedures are tolerated by people. Etc. Etc.
I don’t understand why Massachusetts merging into the national system counts as failure. As soon as the ACA was passed, wouldn’t it be the expected result that Massachusetts would merge in?
@LasMa There just aren’t that many things that are certain like that. What do you do with other worthwhile projects you need money for? Ask the relatives to take up a collection? Crowdfund it?
Presumably, a person who selected lower tier would have considered that relatively uncommon possibility long ago and would have come to terms with it.