or
This is a medical weblog--a collection of thoughts about medicine, medical training, and health policy--written by a fifth-year medical student.
I recently stopped blogging, as I graduated from medical school and I'm now a physician in my residency training in New York City. But feel free to read and enjoy!
(To get rid of this thing, just wave your mouse over it. Ta da!
What Krugman fails to mention, but I will, is that 2003 survey and others find that support for national health insurance drops well below the majority mark if 1) Patients are limited in what physicians they can see and 2) Waiting times for elective procedures increase.
Both of these are inevitable in a single payer system.
That is the most concrete problem with such a system. Other problems include, but aren’t limited to, a significant decrease in physician compensation; over time and if such a decrease is significant enough fewer med school applicants which means a drop in the quality of physicians.
And finally, it’s simply, matter of fact, unethical. To support universal healthcare is to support the wealthy paying for the healthcare of the poor. What you are saying is that there is an inherent right to some subjective level of healthcare but not to property.
A single payer universal healthcare plan cannot guarantee the highest quality care for everyone. There will always be expensive elective procedures that would, not save lives in an emergent situation, but improve the health of some, which simply cannot be covered. So the level of care provided is subjective. Someone in some bureaucratic office says that if we cover such and such a procedure but not another, then we’ve fulfilled one of the basic human rights — that of healthcare. Sounds sort of absurd in those terms.
If you’re going to be subjective about what quality of care people are entitled to (and let me make it clear I don’t believe they’re entitled to any), then I say the quality of care the uninsured receive NOW is completely satisfactory. And that argument is just as legitimate and defensible as any other claim of what constitutes acceptable care.
This is why healthcare is not an inherent right. It’s an amorphous and ever changing thing, unlike say the right to speech or property or life.
Yeah, it’s so “unethical” to expect the more affluent to get off their asses and actually do something to help their fellow, less fortunate, man. (And by “do something” I apparently mean “pay taxes.”)
In a single-payer system, you can choose the doctor you go to. You have more choice than you do now in your HMO. And if we keep our level of funding the same, there’s not much to support elective procedure times increasing substantially. There’s also evidence that waiting times can lower costs as well.
Generalist compensation is similar; specialist compensation *will* decrease (but remember, so will physician costs).
I find it laughable that you consider health care for all “unethical,” and that the quality of the health care for the uninsured to be “satisfactory.” Clearly you’re either not in the medical field, or not in one where you deal with primarily uninsured patients.
Graham..How do you come up with “And if we keep our level of funding the same”?
With Single-Payer(the gov’t will be the single payer) costs will skyrocket. Have you ever known a gov’t run program to lower costs? Never.
And it is unethical to force by law someone to pay for someone elses healthcare. Just like it is unethical to steal.
BTW-I wouldn’t use Krugman as an expert. He’s been pretty unreliable in the past.
http://poorandstupid.com/chronicle.asp
I’ve read the reports of the Lewin Group, Mathematica, Inc, and several other analyses of possible single-payer plans. (These are independent analyses, not from pro-single-payer groups.) I’ve also read multiple journal articles and health policy reviews about single-payer funding; clearly you haven’t.
Oh, I see. You’re the libertarian breed where any sort of government taxes or programs or wealth redistribution is unethical. Roux, you clearly don’t understand the way health care works in the US today. We’re *all* paying for someone else’s health care. That’s how insurance works. Equating providing health care with stealing is the most ridiculous argument I’ve heard all week.
And I don’t use Krugman as an expert; I read plenty of material myself. He’s just a well-known figure that has finally shown his support for single-payer.
From James: “Yeah, it’s so “unethical” to expect the more affluent to get off their asses and actually do something to help their fellow, less fortunate, man. (And by “do something” I apparently mean “pay taxes.”)”
Have you ever even taken a rhetoric or logic course? I mean at least provide a retort that’s based in something cerebral. You’re thinking of the matter on a completely emotional and low level. But from a philosophical standpoint, I argue, you can’t (I’ll change the metaphor up) rob Peter to save Paul. Two wrongs do not make a right. I’m a libertarian but I do believe in human altruism; you should want to aid your fellow man but you shouldn’t be FORCED to.
From Graham: “And if we keep our level of funding the same, there’s not much to support elective procedure times increasing substantially. There’s also evidence that waiting times can lower costs as well.”
Your right, a single-payer system would not decrease the physicians a person could see. I was merely pointing out that the figure, of 70-something percent support for universal healthcare, the NYT op-ed quoted was very conditional. In that same survey if people were limited in what doctor’s they could see in a single-payer system or had increased waiting times for elective procedures then support dropped below 50%.
As for longer waiting times, there’s plenty of evidence up north. After the two-week old Court verdict up there allowing private insurance, wait a couple years and I would bet anything waiting time’s decrease. It’s a managed care system, plain and simple. The beaucracy inherent in it causes waiting times.
As Canada has learned, single-payer systems introduce the same inefficiencies and poor performance which have led to the collapse of centrally-planned economies around the world.
From Graham: “I find it laughable that you consider health care for all “unethical,” and that the quality of the health care for the uninsured to be “satisfactory.” Clearly you’re either not in the medical field, or not in one where you deal with primarily uninsured patients.”
I’m a medical student. In the fairly poor southern area of a border state. I mean Stanford Hospital has got me all the way on reputation and all sorts of things and I certainly didn’t have the GPA or ECs to get into Stanford Med but I promise you our primary teaching hospital probably sees a higher percentage of indigent and non-payment cases, just because of where it’s situated.
My viewpoint is real simple: I want to help these people and I am personally very charitable with my money and my time but I shouldn’t be forced to.
From Graham: “You’re the libertarian breed where any sort of government taxes or programs or wealth redistribution is unethical. Roux, you clearly don’t understand the way health care works in the US today. We’re *all* paying for someone else’s health care. That’s how insurance works. Equating providing health care with stealing is the most ridiculous argument I’ve heard all week.”
You’re too blunt; you’re not refining your viewpoint. The difference that’s being missed here is that insurance is voluntary. It makes all the difference in the world. And it’s not a ridiculous argument to say that tax dollar funding for other people’s healthcare or welfare is almost akin to theft.
I don’t want to lable my philosophy but from a rhetorical and ideological viewpoint, libertarianism is the only set-up that seems to be logically sound.
It has a simple, logical, persassive voice. It is legitimate and certainly was in the eye of our founding fathers to say, “make your own way, take care of yourself, do as you will, as long as it doesn’t actively hurt others.”
Obviously it’s not viable in this political climate. Indeed as the last election cycle showed, people seem fiscally liberal but conservative on social matters (the latter being what exit polls showed carried Bush back into office…I personally voted for Badnarik). Sort of the exact opposite of the libertarian viewpoint.
I somehow doubt those of greater income will give money for healthcare for all simply to feel warm in their gooey places. While those of certain, er, persuasions, may not need to be forced to do so, many do. Nice libertarian advert, by the way.
cson’s arguments against single-payer crumble quickly. Most existing systems cover the bottom and allow supplimental insurance to cover the top, which incudes selecting physicians and electve procedures. And the argument that lower physician pay means lower quality care is absurd. Inflated physician pay is an American exclusive. And yet quality healthcare is certainly NOT. cson is a member of the group that pushed us toward the system we have now. The expectation is you have to play the stock market to recoup some of the money that was stolen from you by the healthcare industry and others. THIS is the American way.
To say that we all have the right to an infinite amount of something scarce is absurd. Limited things (such as health care) can only be distributed in 2 ways – through the market (cost, prices, income, supply & demand factors) or through rationing. The whole entire reason why Economics exists is due to the thing called, Scarcity. We live in a world of limited resources…
Read the chapter on “Rationing Health Care” from the ‘Economics of public issues’ By: Roger L. Miller, Daniel K. Benjamin, and Douglass C. North
The liberal in this argument obviosly isn’t sound in the world of Economics. My field of study is in Economics. I have currently taken the class, “Economics of Healthcare.” I want to know what you study. It’s probably something useless, like Women’s Studies or Peace Studies.
“There’s no such thing as a free lunch.”
-Milton Friedman
Also a free healthcare system…
“The inherent vice of capitalism is the unequal sharing of blessings; the inherent vice of socialism is the equal sharing of miseries.” – Winston Churchill
“Socialism is the philosophy of failure, the creed of ignorance and the gospel of envy.” – Winston Churchill
Again Matt, see my comments above. There are clear economic analyses that indicate that a single-payer health care system would be economically feasible.
You clearly haven’t spent much time in the health care arena; if you don’t know that we already ration health care in this country, you’ve got a lot to learn.