Al Gore on Health Care
Health Care Is A Right: click for the one-minute video.
“I strongly support universal, single payer, government-provided or government-funded health care. It doesn’t mean that the government runs it. It can have competition among the different providers. But I just think that we’ve long since reached the stage that it’s immoral to put people in a situation where they cannot get the medical care
they need because their incomes aren’t high enough. I think that it ought to be a matter of right. And our current system just doesn’t work. It’s way too expensive. The quality of health care is excellent for those who have enough money to buy the very best, but lower-income and low-middle-income Americans are not getting good health care, and so many now cannot afford the private health insurance that they’re going without insurance - millions and millions of people. And I think that to eliminate the incredibly ridiculous costs of all of this unnecessary paper work, and different standards from different insurance companies, it is time to have universal health insurance.”
[...] Graham has a post up about Al Gore’s opinion on America’s right to healthcare. [...]
As much as Mr. Gore is admirable, I don’t know of a single government controlled enterprise that’s done anything other than become a bigger and bigger bureaucracy. I suspect government health care would be no different.
Bureaucracy sucks, Chuck, but even if healthcare did go that way, is there really any possible way it could be worse than the system we have now?
Yes, there is. Never underestimate, etc., etc. But what’s likely to happen is that the system will be cheaper and fairer and result in healthier people of all socio-economic classes
[...] The idea is ridiculous on its face. I no more have a right to health care than I have a right to Graham’s [...]
I’m intrigued by the emphasis on rights in this discussion. Whatever happened to ‘enlightened self-interest?’
Rights are more compelling. And ‘enlightened self-interest’ requires … nevermind.
And yes, HCBSBAAGNHBAHC, you do have a right to health care. Or, at least, you should. Admittedly most of my belief in that is rooted in deep do-gooderism, but it’s also that self-interest bit: when the population is healthier, individuals within it (including the upper classes who think they’re immune) are healthier. Plus, the economy runs better.
Michael, let me use another analogy that may illuminate the folly of your position: I have a “right” to Graham’s services in the same way a mugger has a “right” to his wallet.
I may need health care, and the mugger may well need money, but that doesn’t mean that either of has a “right” to pillage the good doctor.
Just how much healthcare does everybody have a right TO?
An immunization?
An entire series of immunizations?
A routine office visit for a checkup? How often?
An appendectomy? A cholecystectomy? How about a knee replacement?
Dialysis? Until what age?
What about a kidney transplant? In an IV drug user?
How about a liver transplant?
And don’t forget the immunosuppressive medication after transplant.
How about a repeat transplant after rejection? Even if the patient was noncompliant?
What about a femoral-popliteal bypass? In a smoker? Or maybe an amputation would be sufficient.
Rationing is hard, isn’t it?
How is there competition amongst providers in a single payer system? The whole idea behind competition is that the consumer will consume the resource that they find to be the best value (quality/cost). If the consumer isn’t fronting the cost, then there is no need for providers to keep prices low, and thus no competition for efficiency. The only limiting reagent in the equation is getting people to walk into your door, which won’t be tough for any doctor’s office to do.
The mismatch between consumers and payers is the reason we’re in the mess we are now! Single Payer only makes it worse…
Do all psychotic patients have a “right” to Geodon, or would Haldol be sufficient? How about Zofran, or would nauseated Americans only have a “right” to receive Phenergan (like Medicaid patients currently)? How about Remicade? Or Provigil? Or Viagra?
Probably not. So we’ll still have plenty of psychotic, nauseated, arthritic, sleepy, impotent Americans limping around complaining that we aren’t doing enough for them.
Hi, I’m a second-year medical student from Denmark who’s been following your blog for a while. I decided to speak up since I don’t understand why so many of those replying to your posts on universal health care claim that it will lead to a massive reduction in quality for the patients. I live in a country with free health care for everyone and I am appalled at the idea that this means we wouldn’t treat our patients to the utmost of our capabilities.
Scalpel asks how much health care everybody has a right to. The answer is, as much as they need. It’s as easy as that.
An immunization? An entire series of immunizations? Yes, all children are vaccinated against common and/or dangerous infectious diseases, as are the elderly against influenza, and anyone exposed to infection through their line of work or otherwise at risk.
A routine office visit for a checkup? How often? As often as you like. You can go every day if you want to (although your doctor would probably prescribe a psychologist/psychiatrist to deal with your hypochondria.) Children are also regularly checked by a school doctor. Plus, there are all kinds of prophylactic screening programs for cancers, STDs, etc.
An appendectomy? A cholecystectomy? How about a knee replacement? Have all three if you like.
Dialysis? Until what age? Until it is no longer necessary. I know a patient, 63, who has been on dialysis for 30+ years and had two kidney transplants. They’re on the waiting list for a third. In the meantime they’ve been running marathons and done surveys on how to improve dialysis treatment; a chief complaint from patients was that the sandwiches offered during treatment were too flat.
What about a kidney transplant? In an IV drug user? How about a liver transplant? One condition for a transplant is that the patient is expected to be compliant in regard to further treatment and refrain from behaviour risking damage to the transplanted organ. A former drug user could receive a transplant, as could a former alcoholic, but if they relapse while on the waiting list they might be taken off it until they have proven themselves capable of abstaining from harmful substances.
And don’t forget the immunosuppressive medication after transplant. Provided by the hospital.
How about a repeat transplant after rejection? Even if the patient was noncompliant? If the patient is expected to be compliant this time around, yes.
What about a femoral-popliteal bypass? In a smoker? Of course. And help to make them stop smoking.
Or maybe an amputation would be sufficient. This isn’t the middle ages here.
As for psychiatric patients, they’ll get whatever medication works best for them, of course.
Ryan asks how there can be competition in a health care system funded by the state. Here in Denmark the patients can choose their own hospital, which is then paid for the patient’s treatment by the state. The more patients a hospital treats efficiently, the more money it will get. It seems to work.
I have never been hospitalised in the US, so I can’t compare the treatment there with the one here, but I have a couple of friends who’ve moved from the US to Scandinavia, and they much prefer it here. It really isn’t as bad as some of you make it sound. :/
~Cec.
So your country has “free healthcare for everyone?”
Oh, how I wish I were still so innocent and idealistic. Ask mommy and daddy how much taxes they pay.
(55% for all income above $80,000 or so in case they won’t tell you.)
No need to be condescending, it only reflects poorly on your online debating skills. I know very well that Denmark is infamous for our high taxation, but I’d have you know our ‘free’ health care system only costs 8% of anyone’s income. As a student that means I pay $65 a month for as much health care as I like, with no fuss and no paperwork. I spend more money taking the bus to school than I do on health care, hence why I think of it as ‘free’. Also, my aforementioned friends say they spent about the same amount of money on taxes and health insurance in the US that they do here in Scandinavia, so it doesn’t seem to be more expensive either way.
As for the 55% of all income, this is also incorrect. The Danish tax system is graded, so you don’t pay any tax off the first couple of thousands you earn, a little of the next, etc., until you reach a maximum of 59% of everything above $63,000. The more you earn, the more you pay. I admit it’s not a very American way of thinking, but it works for us here in Scandinavia. (and hey, an international survey concluded the Danes were the happiest people in the world, so it can’t be all bad.)
My own tax currently amounts to 38% of my income. On the other hand, my income is provided by the state, which pays me $800 a month to attend medical school, which is also free. I’m having a hard time seeing this as a bad thing. ;)
~Cec.
What about a public health perspective?
If somebody with a persistent hacking cough avoids the doctor is running around unknowingly spreading tuberculosis, it affects me. I have good insurance through my job. But because she didn’t have insurance, she avoided the doctor more than if she’d been insured. Now we’re all screwed.
Oh, so it’s even worse than I thought. Thanks for clarifying that for me.
you’re right cec, it does sound very good. as you can see here in the US many people are very resistant to ideas that would make conditions more equitable for other Americans.
Scalpel: I must admit I don’t see why the Scandinavian well-fare model disturbs you so much, what are you afraid of? Obviously it’s not all bad here or we would’ve got rid of that pesky universal health care years ago; we do have democracy, y’know. Yet somehow the Scandinavian countries always come out on top in every international survey on living standards; our countries are the richest, the most peaceful, the least corrupt, and the happiest in the world, and we far outrank the USA when it comes to overall healthiness, life expectancy, and infant mortality rate.
Considering that the USA spends more money on health care than any other country in the world, I think you’re not getting your money’s worth. :/
~Cec.
Here’s the difference between our two countries: our country is trying to give welfare benefits to families earning $63,000/year, while your country takes well over half of all income from families earning more than that.
If your country isn’t spending those taxes on healthcare, what the heck are they spending it on? Pastries? Loudspeaker research?
Stiflingly high tax rates like that will ensure that your country will remain relatively inconsequential, but I’m glad you’re happy with it. Sounds like a nice place to visit, but I wouldn’t want to live there.
Cecilie,
Not that scalpel is going to wake up tomorrow and start agreeing with Michael Moore or anything, but maybe you could address some of the other things we commonly hear from opponents of universal healthcare, like “you’ll have to wait forever to get an operation”, and “No one will want to be a doctor and there will be a shortage because of low pay”.
Also, correct me if I’m wrong, but the high income tax is pretty much the only tax that you pay in Denmark, right? Whereas here we pay sales tax, property tax, estate tax, capital gains tax, etc. etc on top of our already substantial income tax. So comparing income taxes between the US and Denmark directly is not really even a relevant discussion
OK, I’ll correct you. You’re wrong.
Scalpel: This debate is on health care and not taxation in general; what else the Danish people choose to do with their own money has no relevance to whether or not universal health care is a good idea. The website you link to is obviously biased and hence not a trustworthy source of information, even less so when it contains so many erroneous claims about the Danish society. As for being inconsequential, we recognise our small size and would never aspire to be a great player on the international scene, and yet Denmark does actually have influence, politically, economically, and culturally, far beyond its borders. We like it here, and I really don’t understand why that pisses you off so much – does the suggestion that the American way isn’t the only way really warrant such aggressive response from you? I must say I’m amazed at your inability to conduct a rational and objective debate – then again, I’m sure you know what is said about arguing on the internet. ;)
Student Doctor: Well, we do have waiting lists for non-acute operations in some hospitals, though by law never more than four weeks from first contact with the GP to finished operation. Cancers are considered fairly acute; the most dangerous types have a 48-hour waiting list, the slowly-spreading types at most two weeks.
As for no one wanting to be doctors, there are usually three times as many applicants to the medical schools as there are available positions, and a fair number of rejected students travel abroad to attend med schools elsewhere in Europe and later return home to work. It’s true the pay isn’t fantastic though quite adequate, but on the other hand it’s impossible to be sued by patients (the state can be sued, and doctors can have their licence revoked by the state, but there are no lawsuits between doctors and patients.) Also, doctors have a 37-hour working week; additional hours are usually voluntary and either grant 150% pay or 1.5 hour of compensatory leave per hour worked. We also have at least 5 weeks paid vacation every year, plus paid sick-days, children’s sick-days, etc.
As for comparing taxes between Denmark and the US, I agree it’s difficult though not because of different systems; we too have sales tax, property tax, etc. However, there isn’t a very large gap between low and high income in Denmark, at most a couple of thousand dollars a month. The minimum wage in Denmark is $20, which is up to four times that in the USA, so even after all the taxes there’s still plenty left; the truism of socialism is that few have too much but fewer too little, and that seems to hold true here.
However, becoming a socialist nation is not a requirement for getting universal health care, so Scalpel need not fear. ;)
~Cec.
I thought I’d address Ryan’s contention that a single-payer system would somehow stifle competition.
First of all, I’d also like to point out that a single-payer doesn’t mean no competition. On the contrary - in a single-payer system, hospitals would still operate independently and would still compete with each other for patients. The difference would be that hospitals and health systems would begin to compete for formerly uninsured populations that are currently economically unattractive.
Furthermore: our current system isn’t as competition-based as one would think. It’s actually pretty rare that consumers themselves pick their health care based on things like price or quality - for example, in Cleveland, there was an initiative that evaluate the quality of health care of all the providers in the area. It turned out that the level of care is pretty comparable at the County hospital as compared to the Cleveland Clinic in many areas. But it didn’t matter: people from the suburbs still wanted to get their care from the place they *thought* would give them the best care, and that often had nothing to do with which place was quantitatively better, or cheaper.
Comparing the health care system of Denmark (population 5.4 million) to that of the U.S. (population 300 million) is ridiculous. The U.S. is 60 times larger, much more culturally diverse, and has a tradition of individualism for which Denmark has no analogue. Implementing the Danish health care model in the U.S. would be like putting a ballerina’ s pointe shoe on Godzilla.
Catron: I never did suggest that the US implement the Danish welfare model, I’m merely arguing that universal health care isn’t impossible or dangerous as otherwise suggested. If you want a proper analogue to the US, consider the European Union as a whole: a population of 729 million, and all of them can get free health care in any country in the Union. If it’s possible in Europe, it should be possible in the US as well.
~Cec.
“If it’s possible in Europe, it should be possible in the US as well.”
Even if Americans could acquire the European taste for servility vis-à-vis the state, the social democratic model that currently dominates the EU is unsustainable. Most EU members already have double-digit unemployment rates, sluggish economies, and entitlement commitments that cannot possibly be met given current demographic tends.
Catron: I wonder where you get your information; of the 27 nations forming the European Union, only one has an unemployment rate in the double digits: Slovakia, with 11% unemployment. The overall unemployment rate for the EU is 6.7% and has been steadily declining the past few years. In Denmark we have the lowest unemployment rate in 30 years, a whole 1.3% lower than the US unemployment rate. As for economical imbalance, nine of the world’s ten richest countries are EU members (the tenth being the US) and all the Scandinavian countries are in the top ten. Denmark has never been richer than it is today.
As for our welfare model being unsustainable, I’d have you know the first ‘free’ hospital was built in Denmark in 1757, 19 years before the USA even existed as a nation. The Germans got universal health care in the 1880s, the British were first with tax-funded universal healthcare in 1948, and today there’s not a single country in Europe that doesn’t have publicly sponsored and regulated health care; in fact, of all the countries in the Western world, the USA is the only one without universal health care. Obviously, if universal health care was unsustainable, we’d have found out by now, so your scaremongering has no basis in fact.
~Cec.
Even conceding your 6.7% rate, the EU average would still be more than 30% higher than that of the U.S.
But, getting back to the topic under discussion, your examples relating to sustainability are not very serious. A single hospital hardly constitutes a health care system (BTW, our first free hospital was founded in 1751) and the German system under Bismarck was not universal. As to modern “universal” systems:
The British system is in a permanent state of financial crisis:
http://www.guardian.co.uk/frontpage/story/0,,1969153,00.html
The French system is on the verge of collapse:
http://www.guardian.co.uk/france/story/0,11882,1130186,00.html
The Swedish system is reverting to privatization to remain viable:
http://www.nationalcenter.org/NPA555_Sweden_Health_Care.html
Germany has had to restructure its financing system, and is still in trouble:
http://news.bbc.co.uk/2/hi/europe/5409014.stm
The examples go on and on, and the facts are indeed scary.
Taxes in Denmark are ONLY 59% because you don’t really have to spend much on defense. How high do you think taxes would be if you didn’t have the great Satan providing a lot of your security?
What’s with all the irrelevant criticism of my country? This is a discussion of universal health care and the possibility of implementing it in the USA, not an argument on what the Danish people democratically choose to do with its own money.
Even so, I consider the latest comment a low blow. Denmark has always been a staunch supporter of the USA; our soldiers followed you into Afghanistan and into Iraq, we provided you with crucial locations for your missile defences on Greenland, and during the Cold War we were your first line of warning against Soviet’s Atlantic submarine fleet – the Cuba Crisis? You wouldn’t even have known those nuclear missiles were en route to Cuba if it wasn’t for us. NATO works both ways.
Also, I get the feeling that the use of ‘great Satan’ to describe the USA should somehow reflect my opinion of your nation, and yet I have never exhibited any hostility towards your nation – in fact, I have never even once declared that your nation should implement universal health care nor that you were lesser for not having done so! All I’ve been saying is that universal health care can actually work, so scaremongering needn’t and shouldn’t be used in your debate.
However, I’m fast realising the difficulty in having a proper debate on the subject when supporters of the current American health care system can’t even construct a rational argument in favour of their opinion but must resort to name-calling and slandering. Is your position really that indefensible? Or are you just incapable of participating in intellectual conversation? Either way, I roll my eyes at you.
~Cec.
Cec, you missed USC’s point. He highlights one of the most important European (and Canadian) strategies for health care financing. Because Denmark allows the U.S. to pick up the tab for “guns,” your country (along with other EU nations) is able to spend its money on “butter.” In other words, I (along with USC and other American tax payers) am paying for your Lilliputian health care system.
Don’t be ridiculous now, NATO has never been called to defend Denmark against an enemy and we have contributed continuously throughout the existence of the alliance. Do you really think abolishing NATO would save the US any money? On the contrary, the USA would suddenly be without the surveillance, military facilities, additional equipment and soldiers provided by the other NATO nations and would have to spend even more on the military than is already the case. The USA needed us in Afghanistan and Iraq, not the other way around.
Furthermore, the USA spends only 3.7% of its GDP on the military but a staggering 16% on health care, as opposed to the 9% of Danish GDP spent on health care here. If anyone’s wasting your money, it certainly isn’t us.
~Cec.
[...] health care. A typical example of this condescending attitude can be found in the comment stream of this post at OVER!MY!MED!BODY!, where a Danish student offers the following: Today there’s not a single [...]
[...] health care. A typical example of this condescending attitude can be found in the comment stream of this post at OVER!MY!MED!BODY!, where a Danish student offers the following: Today there’s not a single [...]
If the health care system in Denmark is as good as Cecilie says, then it seems to me that Canada and the UK could learn something from it. Those countries are notorious for long waits to see specialists, have diagnostic tests, and to get needed surgery.
Cecilie, if we Americans seem a little defensive, it’s because our system is attacked all the time both from within and without, even though most Americans get very good medical care, either through private insurance or public programs like Medicare and Medicaid. (We also have the option of paying cash.) Much is made of the uninsured, whose number is greatly exaggerated. But even the truly uninsured have access to care in emergency rooms — ask any illegal alien.
I guess what I find most ironic about this debate is that the supporters of the current American health care system feel so offended when these very same individuals initially were the ones to criticise universal health care based on misinformation and scaremongering. I never attacked the USA; I never said the USA should change its current health care system or that universal health care was better. I only said it wasn’t necessarily worse, and deserved due consideration.
I have done nothing but correct misinformation in an attempt to ensure a fair debate. In return my country is slandered and I’m being quoted out of context in several blogs and accused of being condescending and moralising by someone who in the very next sentence proclaims America’s superiority and demands that the entire world grovel in gratitude before this nation. I’d say this is more than a little defensive.
Actually, I guess it’s rather amusing, in a paranoid megalomaniac kind of way. *Roll eyes.*
~Cec.
None of this is worth getting upset about. It’s just an internet debate (and we know what that means).
The original question was about whether there is such a thing as a “right” to health care. My position is that no one can have a “right” to someone else’s labor or resources, and that (it seems to me) is always the end product of mandatory universal health care.
I’m sure Denmark’s system has many fine qualities. I’m less sure that such a system would work in a country as large and diverse as ours.
The mere mention of “national”, “universal” or “free” healthcare always sparks intense rage. Despite all the smoke and mirrors b.s. about tax the truth is the physicians want to secure their currently high incomes. The alternative to the current system, is unthinkable. Anyone who proposes a solution is labeled socialist or community.
Its only a matter of time my friends. After Bush and all his corrupt Republican cronies get thrown out of DC, Hillary’s administration, Senate and Congress will pass it. ENJOY THE CURRENT SYSTEM WHILE IT LASTS CAUSE FREE HEALTHCARE WILL BE HERE IN 5 YEARS.
Meanwhile, the U.S. has become a huge joke to the international community. Its no wonder that London is RAPIDLY overtaking New York as the financial capital of the world, yet we mock the NHS and claim that free healthcare will derail the economy. Get real and wakeup.
BTW- I highly doubt that the U.S. hosts a more more diverse population that England.
As far as healthcare being a right? Yes, there is an international lobby to make it a right.
Walrustooth, what are you basing your claim of London taking over NY’s position? Just want to know where the quotes are coming from.
As for UHC, what’s with all the rage here? The real problem is that over here, we get this free pass and , really, any sort of regulation by people who don’t understand what healthcare is all about is always something that, I think anyone, will want to avoid. Say, you replaced all insurance overhead with the government, what’s really changed? There is no real competition in medicine anyways, ask some random hospitalist if they know what the cost of the visit or respective treatment was, they won’t know because we’re not suppose to care, just worry about the patient and that should be enough. If we had UHC, we’d have to start caring about pricing and stuff. Each individual model works because you have smaller economies handling the costs of smaller, more manageable systems. It’s true, if you were going to take the US pop and added it to Denmark, I could guarantee that it would be messy you can act like it wouldn’t be, but with huge volume comes lots of red tape. I guess what this means is that even a European model wouldn’t work, it would have to be designed in a completely different way, which in itself would cost tons of money and lots of red tape. It’s definitely not something that’ll change in a heartbeat even if we did get it. What you are seeing in the states is positive, cheaper change which is driving costs down by having smaller, cheaper clinics and very intimate patient-physician relationships. Not that any of this is fast. I know lots of people like free things, and UHC would be awesome, but you guys talk about this like it’s the flick of a switch, and, viola ! health care ! This however, isn’t an excuse. It’s going to be harder, but it’l be worth what’ll get berthed in the process.
As far as drugs are concerned, that’s a different story. Almost all the innovative drugs come from the states, there aren’t many outside of GSK that do the same as say, merck, and the logic makes sense: we try making 10 drugs, 9 of them don’t work, market the 10th like nobodies business. True, they could cut the prices down overall, but then, what about rebound research costs which brings up my next question, does the gov’t pay for drug research? The NIH seems to, but there isn’t much that’s awesome that comes out of that. What I want to know is that if that’s the reverse in Denmark and/or the UK etc.
Thanks for the replies and have a good one.
P.S. pardon the syntax
Walrustooth, what are you basing your claim of London taking over NY’s position? Just want to know where the quotes are coming from.
As for UHC, what’s with all the rage here? The real problem is that over here, we get this free pass and , really, any sort of regulation by people who don’t understand what healthcare is all about is always something that, I think anyone, will want to avoid. Say, you replaced all insurance overhead with the government, what’s really changed? There is no real competition in medicine anyways, ask some random hospitalist if they know what the cost of the visit or respective treatment was, they won’t know because we’re not suppose to care, just worry about the patient and that should be enough. If we had UHC, we’d have to start caring about pricing and stuff. Each individual model works because you have smaller economies handling the costs of smaller, more manageable systems. It’s true, if you were going to take the US pop and added it to Denmark, I could guarantee that it would be messy you can act like it wouldn’t be, but with huge volume comes lots of red tape. I guess what this means is that even a European model wouldn’t work, it would have to be designed in a completely different way, which in itself would cost tons of money and lots of red tape. It’s definitely not something that’ll change in a heartbeat even if we did get it. What you are seeing in the states is positive, cheaper change which is driving costs down by having smaller, cheaper clinics and very intimate patient-physician relationships. Not that any of this is fast. I know lots of people like free things, and UHC would be awesome, but you guys talk about this like it’s the flick of a switch, and, viola ! health care ! This however, isn’t an excuse. It’s going to be harder, but it’l be worth what’ll get berthed in the process.
As far as drugs are concerned, that’s a different story. Almost all the innovative drugs come from the states, there aren’t many outside of GSK that do the same as say, merck, and the logic makes sense: we try making 10 drugs, 9 of them don’t work, market the 10th like nobodies business. True, they could cut the prices down overall, but then, what about rebound research costs which brings up my next question, does the gov’t pay for drug research? The NIH seems to, but there isn’t much that’s awesome that comes out of that. What I want to know is that if that’s the reverse in Denmark and/or the UK etc.
Thanks for the replies and have a good one.
P.S. pardon the syntax