A topic requested by Bart.

Since the discussion was sort going along the "people from X got to Y for health care" stories, I figure I'll toss out a few examples I know of.

My parents go to mexico to fill their perscriptions, and to have their dental work done.  They live part-time in texas, in an area with a lot of retirees.  Many of the people they live around go to mexico for cheaper health care (though as far as I know, it's only for simple stuff like drugs and dental work), so have figured out what doctors/dentists are good, and let each other know.  From what they tell me, the doctors/dentists they go see primarily serve americans coming over the border.

On the other end of the country, my grandparents go to canada to fill their perscriptions.  They live in washington state, and often get together with a large group of friends, and make a day trip out of going into canada and getting their meds.

I now live in the UK, and haven't had to use the health care system yet myself, but my girlfriend has, and she says she's much more comfortable with the system here than in the states.  Some friends of ours who have moved to london from Illinois said the same thing when I saw them this weekend.

These are all just single examples, and I don't know how representative they are.  I think Falkus hit the nail on the head, though.  The US system works great for wealthy and upper middle class people.  It doesn't work well at all for people who are struggling to get by.  Like I've said a number of times now, the issue is whether you view health care as a right, or a luxury.  If it's a luxury, then it's not a problem that poor people can't afford it.  If it's a right, then it is a problem that poorer people can't get adequate health care.  If the goal is to get the best health care possible to those who can afford it, then the US system works well.  If the goal is to get adequate care to everyone, regardless of their past health or income, then it doesn't work well.

There are so many things influencing life expectancy and infant mortality, I wouldn't depend on that alone as a barometer for the health care system in general.  Maybe the US just has more violent crime, more extreme poverty, a poorer view on abortion, more problems with drugs...



Try looking into security.  Or moving.  There's plenty of work down in my area!



Part of the problem is our public hospitals are largely being swamped with illegal immigrants - people who don't exist, according to the system, can't pay and can't even be tracked down to pay, don't pay taxes and, perhaps most importantly, don't get any sort of preventative medicine.  In many ways, the US system is working poorly just because it has SO MANY people coming in, often-times using the wrong methods to do so.

I'm not sure I agree that this is the reason poorer people can't get as good health care in the US.  It's not because illegal immigrants (who often do pay taxes, by the way) are filling up the hospitals, it's because they can't afford it.  If it's considered a luxury, that's simply how it's supposed to be.  It's not a failure of the system, its an expected, predictable, (and presumably acceptable) outcome of the system.  It's no more of a failure than is the fact that poor people don't drive porches as much as rich people.  If you consider health care to be something that you get if you can pay for it, then people who can't pay for it shouldn't get it.

Again, the issue comes down to whether you think everyone should be able to get health care, or if you think it's a luxury that only some people will be able to afford.  Arguments can be made either way, and I'm not entirely sure where I stand on the issue, but I think that's the fundamental point of disagreement between the two sides.

If I'm a state government and I have say 100,000 people in a particular area.  I assume no more than say .01% will be in the emergency room at a given time (these numbers are all made up, BTW) and I have a set budget based on the concept of there being 100,000 people, I will make a hospital to support 10 people in the emergency room at a given time.

However, if I have 40,000 undocumented immigrants, my numbers are clearly very off.  And since these immigrants can't get preventative medicine, their rate of needing the emergency room will be well in excess of .01%.  Let's say it's .05% instead.  Now I'm looking at 20 people in the emergency room at any given time.  My emergency room use rate has just tripled!  However I'm not getting any further funding for that purpose.

This will clearly have more of an impact in some places more than others.

Another example, contrasted with say England, is a question of population density.  There are parts of the US where it's one person per hundred miles squared (or some similarly ridiculously low number).  It's simply not economical to build a hospital there and stock it for every possible eventuality.  Who wants to build a ten million dollar hospital to support a town of 100 people with no kids and a gross income of $200k a year?  It just doesn't make good fiscal sense.  The budget falls apart if you follow that thinking.  England does not have a lot of land with such low population densities, therefore this problem doesn't arise (similarly with education, coincidentally).

The US may have other mitigating factors making health care more expensive, too expensive to reasonably support with tax dollars.  Malpractice insurance is a great example.  If every doctor has to pay $50,000 a year in malpractice insurance, that means the taxpayer is now paying $50,000 a year for that insurance.  As people have pointed out, you can't very well sue your doctor for cutting off the wrong leg in Cuba.

Your hypothetical situation is arguing that the problem is too many people are going to the hospital.  That's not the problem, though (well, it's a problem, but it's a problem everywhere, and one that we shouldn't expect to go away entirely unless we want to spend lots and lots of money on it).  The problem is that poorer people can't afford health insurance in the US.  People with a past record of health problems have trouble affording it too.  They can go to the emergency room, true, but that's not what most people need in terms of health care.

Long lines when you go to the emergency room are not what most people are talking about when they say the US health care system isn't working as well as some other country's.  Long lines are a cost/benefit issue.  We know how to make them go away, it just an issue of whether or not it's worth it.  Having to wait 4 hours before a doctor can look at your broken arm may be very annoying, but how much are we willing to pay (in fees or taxes) to get it down to 3 hours?  two hours?  ten minutes?  That's just economics, and it's not a sign that the system is broken, just that we've made a decision about how long is an acceptable wait.  That can be debated, of course, but I think it's a side issue.

More important than waits for an emergency room, though, is whether someone has insurance at all, which makes it possible to go to the doctor without waiting until the emergency room is the way to go.  When people talk about the US system being broken, they're talking about the fact that some people can get health insurance, and thus health care outside of an emergency room, and other people can't.  They're talking about the fact that what kind of treatment you get depends on how much money you make.  It's not a complaint about efficiency of treatment, it's a complaint about a lack of treatment.  People talking about health care reform aren't talking about building a hosiptal in every tiny town in wyoming or whatever.  The issues you bring up are problems that any system, private, socialized, or otherwise has to deal with, and aren't the issues that health care reform is trying to fix.  The points you raise are all real issues, they're just not the issues that tell us which system is better, because both systems have to deal with them.  The costs of malpractice insurance don't disappear because we have a privitized health care system (in fact, I think malpractice insurance is higher here than elsewhere), so saying it's "too expensive" to pass on to taxpayers doesn't make much sense.  Tax payers are already paying for it, it's just not spread out evenly.  Likewise, getting people in low-population-density areas health care will be expenisive (perhaps too expensive) no matter which system is used.  The fact that it's privitized doesn't solve that problem, and neither would socializing it.  It's a problem that has to be dealt with economically either way, so it's not really an arguement for or against either system.  Same with illegal immigrants.  Under either system you have to figure out how to deal with that problem, and neither seems to have any particular advantage over the other in that respect.

Again, I think it boils down to how we view health care: is it a right that we are morally obligated to provide to all people, regardless of income, or is it a luxury like anything else?  More bluntly, do we think poor people should get medical treatments they can't afford?  Is health care more like voting (ie, everyone should be able to do it, rich, poor, or otherwise), or is it like a sports car (ie, you have to forgo something else in order to get it.  And if you don't have enough to forgo, you just can get it)?

Not precisely.  The problem is that too many unanticipated people are going to the emergency room, some because they're not documented, some because they aren't receiving preventative medicine.  In my opinion, we should offer undocumented people either FULL preventative medical coverage, including dental, or none at all, including emergency room services.  Going half way is just stupid, and it's going to kill us.



I would disagree.  If you die in the emergency room waiting in a line (which has happened) or there is no local emergency room available to you, I daresay that is a major lapse in medical services.  I would consider 'timely' a requirement as to whether medical services are appropriate or not.  My obstetrician being available tomorrow doesn't help me give birth today.

I also am of the opinion that there are some services we shouldn't be offering for free.  Sure, it makes sense to fix a broken bone for people who can't afford it.  But wart removal?  What about arthritis treatment?  Which of these do you go to the emergency room for?  It's precisely that decision to go to the emergency room which serves as the bar for me to determine what is a serious medical issue that needs to either be dealt with or prevented (example, a life-threatening abscess can be avoided by letting the guy get fillings), and what they need to cough up some money for.



But it does.  If the government cannot afford to pay for a service that rich people can afford, then the government can't afford it, and that's the end of discussion.  If malpractice insurance is too expensive for public hospitals, we either need to offer an alternative to the current insurance options, or reduce the liability of doctors at public hospitals.  You can't pay for something you can't afford.



Generally these people are supported by local doctors' offices, not hospitals.  However, these I think would be better supported by private members of the community, rather than a public servant who is posted there.

Even though I'm not sure which of the two option is best, I probably agree that those two options are better than the half-way solution.


True, but I don't view those as a difference between private and public health care.  Timely is a requirement for either system.  And the cost to provide timely health care to X people is the same whether they're paying for it with taxes or with their spending money.  In either system a decision has to be made on just how much "timeliness" we can afford.  I suppose that there is the difference in that a privatized system you can provide different levels of timeliness to different people, depending on what they're willing to pay.  But again, I think that boils down to the question of whether timely health care is viewed as a right, or a luxury.


That's fair enough too, but it can be implemented in either system.  Socialized health care doesn't need to be an "anything and everything is absolutely free" system.  I think it's entirely possible to have a public-funded system which only covered 'necessary' treatments.  That would be a case of some treatments being viewed as rights, and others as luxuries.


But we're already affording it.  We're already paying for it right now.  I don't see why it's going to cost more if it's a public system than a privite system.  The total cost for all the current doctor's malpractice insurance is already being paid for by taxpayers.  It's just being pay for with taxpayers spending money, instead of with tax dollars.  By spreading the cost out over all people, instead of just charging those who go to the doctor, it makes it possible for more people to see the doctor.


Okay, that seems like an argument in favor of socializing health care.  Or at least changing the private system we have now.




Why do you think that?  In the private case, the service provided depends heavily on how much the people in this small community can spend on it.  If it's one individual doctor in either case, how much difference does it make if his paycheck comes from the government, or from the people he treats?

You keep saying that things are the problem of privatized medicine as well.  However, we really aren't discussing privatized medicine; we all agree that in either the Canadian or the American system, someone with lots of cash will get good, timely medical treatment.  On the flip side, we all agree a private hospital in either situation that fails to provide good, timely treatment will go out of business.  This requires no artificial meddling.  We are, rather, discussing public hospitals, which may offer terrible, slow, overpriced service, but still stay in business, and a system which only offers slow, overpriced service is not meeting the needs of the people, and so is not really a valid solution to the socialized medicine question.




Here's the kicker though, if you raised my taxes to be equal to what I'm paying now in medical insurance and medical costs, and then expected me to go to some trashy government hospital, I'd move (well, probably not, but I would stage major campaigns against whatever politician made that decision).  Heath, who probably pays a lot more for his insurance, would probably have even more cause to complain.

And of course, the people on the bottom who get free medical care wouldn't have any incentive not to abuse it.  Have a migraine?  Hungry?  Want a wart removed?  Who cares, you're not paying for it!



No, I wasn't going for that as such, but imagine this.

We have the current system as it works now; people with jobs get health insurance, or pay out of pocket.  They have a wide choice of confusing health insurance plans, but basically most of their medical costs are taken care of.  If something goes wrong, they can sue the doctor and retire for life.

Medicare and the like are abolished.  The system is too complex and too expensive how it runs now.  However, the government owns public hospitals, and some private hospitals may voluntarily join in.  A person can walk into any of these hospitals, show some sort of proof of identity (to prevent scamming the system), such and so-forth, and you have a selection of services you can select from, such as emergency room services, vaccinations, general check-ups, dental check-ups, etc.  You can get all of these either for some reasonable co-pay or for free (and maybe tag something on the 'for-free' - things should have some cost, financial or otherwise, to prevent people from being wasteful).  HOWEVER, you can expect worse service, longer lines and, unlike the other place, if the doctor screws up, he has very limited liability.

Because of the limited liability, you're going to get a lot more trashy doctors.  You will have poor people who need some serious surgery, it goes wrong, and they don't get $10M out of it, but instead maybe $20k.  But at the same time, they at least get surgery they might not have had an option for otherwise.  Meanwhile, I, as a rich person, can elect to go to the free place to get my checkup done (which I probably won't because there are sick people there), or to my nicer place, but regardless, my costs don't go up significantly.

That sounds acceptable to me.  It also sounds like socialized health care.  Maybe the disagreement is more over what we should call it ("socialized" "public" "whatever") than what we'd like to see?

I think there is also an assumption that if doctors are getting their paycheck from the government, then automatically the service they offer is going to be substandard, slow, etc.   I don't think that necessarily has to be the case.

Imagine there are two hospitals, one that'll pay doctors $200k a year, but expects you to never mess up in a surgery or diagnosis, and one that pays $100k a year, but understands if you make a mistake now and again (or maybe even expects it), where will you be going if you're a skilled doctor?  Where will you go if you're a lousy doctor?

I think the problem with my idea is, right now, poor people expect to have the same quality of health care as rich people, but without the cost (because they can't afford it).  And that's what the current medical program attempts to provide (and of course, necessarily fails at).  If we say 'well, we can't provide that level of quality at that price', then at least we can provide something to help the problem without bankrupting the system.

I thought it might help to add some infomation. As a social worker, I'm a little too familiar with federal policy on health care. Now, keeping in mind that individual states can add services, but not subtract them, this is the essential facts on health care.

Children under 19 and preganant citizens are eligible for fundemental medical care, including doctor's visits, three prescriptions, and some testing. It will pay for birth and some necessary medical proceedures. It does not pay for anything elective. Only certain doctors, clinics and hospitals are available and that on a first come first serve basis.

People over age 60-65 (depending on social security issues) are eligible for limited medical care, usually suppliments to medicare.

Men and women between 19 and 65 are not eligible for medical assistance unless they a)have children B)are disabled AND fall within income restrictions.

So, no. Poor people do not have the same options as anyone else and are well-aquainted with the idea that their care will not be as good. The rules for unnaturalized citizens are different, but more difficult. The thing about emergency rooms is 'some' not all, are required to help in event of emergency care. That's why there are overpopulation issues, because that is the only health care some people can ever get. Generally, it is a long wait for a spotty bit of doctoring.

I disagree.  It's not an issue of getting the same health care, it's getting any health care.  Poor people aren't saying "I expect to see the top expert in the country, and I'll settle for nothing less!"  They're saying "I've got no insurance.  None.  Zip, nada.  What can you do for me?  Nothing?  Crap."  It's not a quality issue right now, it's a quantity issue--meaning the poor get zero.  Not lower quality, none at all.  Or next to none at all.

As for the two hypothetical hospitals, I think that's intentionally set up to fail.  Why offer them half of what they make in the private sector?  Why not make it competetive?  Either through comparable pay, or by offering better benefits, or whatever?  Yes, it'll cost more, but that's an economic decision that can be made.  We don't have to set it up from the start as a second-rate system.  The thing is we're already paying more than it costs for that kind of system for our current system.    Again, it comes down to whether it's a viewed as a right or a priviledge.  If it's a luxury, there's no reason rich people should pay for poor people's medicine (and no reason anyone should--poor people will go without, just like they go without fancy cars and caviar).  On the other hand, if it's a right, it's something we need to pay for.  We need to cough up the money, and make a viable, decent system.  Not one that's half-way there and done on the cheap.  If all we consider to be a "right" is a half-trained, unethical quack who screws up every other time, fine, we can institute that kind of system, but I don't think that's what anyone is aiming for.