It’s More Complicated

I really hope that, as we observe what’s happening in Italy and Spain, the “every developed country has better healthcare than the US” crowd just shuts up already. Some do, some don’t. Germany does, Israel definitely does, Canada doesn’t, Italy definitely doesn’t.

It’s an issue that is far more complicated than the superficial fantasies about “single payer,” which is a meaningless expression if there ever was one.

22 thoughts on “It’s More Complicated”

  1. For me, the single best macro argument in favour of socialized medicine is that it can control costs to the society as a whole. Put another way, the US health system captures a disproportionate share of economic resources that might be invested elsewhere more productively. And, while proportionately considerably more is being spent in the U.S. as a share of GDP, there are 30 million or so Americans uninsured – somewhat more than the combined population of Belgium and the Netherlands.

    https://www.statista.com/statistics/268826/health-expenditure-as-gdp-percentage-in-oecd-countries/

    But there are frustrating trade-offs for individuals in the sometimes lower standard of care delivery with state administered medicine – let’s not imagine otherwise.

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  2. In Germany (AFAICT) the healthcare system is run first and foremost as a necessary public service while in the US it’s primarily run as financial scheme for private insurers….
    I don’t know enough about the other countries mentioned… why do think Canada is so bad?
    My best guess about Italy is that it got hit by a perfect storm of factors, much of which no one wants to talk about and so they go off about smoking and stuff.

    “there are frustrating trade-offs for individuals ”

    All healthcare systems ration care in some way or other and Germany (for instance) is constantly fiddling with funding and insurance details. Healthcare funding can never exist in a static state and competing demands always have to be balanced.

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    1. “why do think Canada is so bad?”

      Lots of ‘progressive’ Americans, apparently, think that Canada has a model health care system.

      Well, it has a big plus, in that medical expenses, being supported by higher taxes and insurance levies, are more or less “free” to individuals.

      But the system is highly bureaucratized and has many inefficiencies.

      While one can readily visit first-come-first-served walk-in clinics who will refer patients to a specialist (their choice, no shopping around) or a hospital emergency room if necessary, perhaps as many as 5 million Canadians are without a family doctor. I, for example, haven’t had a family doctor in decades. Theoretically, I could apply to a bureaucrat to hook me up with a doctor but I will have no choice in their assignment and no access (it’s hidden) to a list of doctors who are accepting new patients. If one needs urgent care, it’s rationed so that, unless you are dying before their eyes, it will likely take several weeks even for something as relatively simple as an MRI. With some very minor exceptions, private doctors and private hospitals are forbidden by law.

      To generalize, patient demand drives the financial architecture of the American system while the Canadian systems (each Province has jurisdiction over the delivery of health care) are driven by their paymaster, government.

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      1. “I, for example, haven’t had a family doctor in decades”

        I didn’t have one in Poland for years and years (I was so used to being uninsured in the US I didn’t realize I had health insurance in Poland for a long, long time).
        When I needed one I called a place or two that didn’t want me and was about to use the university clinic when a friend suggested I apply to the family medicine center of a nearby research hospital. I called and after some confusion regarding my name and establishing my address they took me on and I’ve been happy with them.

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        1. In my Province, the procedure is exactly as I outlined. No choice whatsoever (assuming the bureaucrat can find you a spot.) And, no workarounds, unless you are personally connected to someone in the medical field or have an influential relative or friend who can somehow cut the necessary corners.

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          1. “private doctors and private hospitals are forbidden by law”

            That seems insane. I can understand making everybody pay into the state system but then to prohibit private providers is ….. Canadian, I guess.

            Poland has a private sector but it’s priced from the local economy and so doesn’t have the crooked mark ups from the US insurance system.

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            1. It’s this false egalitarianism that I really hate. Why should you be able to escape from this shitty system just because you have money? No, you should suffer like everybody else!

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              1. “No, you should suffer like everybody else!”

                But we all know that they don’t. Truly rich Canadians can go anywhere in the world for their medical treatment. Canada’s political and bureaucratic elite can and do find the necessary connections to jump the queue and will, in turn, use these connections to help their families, their close friends and the famous.

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              2. Don’t know if it’s still the case, but in the 80s our local hospital (in Florida) put itself in the black every year by doing routine non-emergency surgeries for cash-paying Canadian snowbirds (people who come stay for the winter months, then go back up north). They found it easier to drive their Winnebagos all the way down from Canada, and get surgery here, than to get through the waiting-list process in Canada.

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              3. It’s not that hard to find a doctor in most of Canada. It’s a pain in the ass, but if you ask around and make a few phone calls, you can usually find someone, or you can put your name on a waiting list and use a clinic in the meantime. As for private hospitals/choice: you can travel the one hour to the US border and go to a private hospital.

                There are plenty of problems with the Canadian healthcare system, but unlike in America, I don’t know a single person who’s been ruined by a medical emergency or avoided a doctor over fears about payments. We don’t have repo men pounding down our doors to take our furnishings because a complicated pregnancy came with a $20K medical bill. Our family would have been ruined last year when my son needed surgery on his badly broken arm, because neither my wife nor I work in fields that provide private insurance. Instead, he was operated on by a surgeon at one of the best children’s hospitals in North America. Total cost: $35 for a purple cast and extra sling.

                I agree with many of your opinions, but this sounds like a self-serving argument from someone with a good health plan. My mother’s eleven older siblings, all who lived through the Depression, had plenty to say about the Canadian healthcare system before universal healthcare, none of it good.

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  3. Canada has the worst healthcare system comparing to almost all Europe countries and Australia/NZ/Japan/Taiwan/Hong Kong/Singapore.

    Too much public money, not enough private money here.

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    1. I wish somebody listened to actual Canadians like you, me and others in this thread. I love Canada. There’s a lot that’s fantastic about Canada. But the healthcare system is very imperfect. It’s not horrible, it’s definitely not the worst in the world. But it’s not great either.

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      1. “not the worst in the world. But…”

        Sounds about right to me. But the thing about Canada is that it’s ruling elites never listen to anybody but themselves and on this issue they are so full of self-congratulations on how they are morally superior to Americans.

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          1. “They reek of insecurity.”

            Perhaps, but I’d say it was actually the opposite. Secure under the shield of the world’s most powerful Empire, the elites of the British North American colonies looked with condescension on the rapidly growing republic to their south certain that the political instability at its heart would lead inevitably to civil war. Turned out there was a civil war. Canada’s current elites have inherited a similar patronizing view of the United States. In a curious way, they view Trump’s Presidency as proof positive of Canada’s moral superiority. Scratch many, if not most, non-elite Canadians and you’ll find the exact same attitudes reflected towards the U.S.A. – we’re just nicer, more polite, more generous, etc. etc. etc.

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            1. “we’re just nicer…etc.”

              jimmyg65’s post above is a textbook example of how Canadian moral superiority vs. U.S.A gets applied to the subject of socialized medicine in Canada.

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    1. Spain and Italy have gone through a decade of austerity that shredded their healthcare system and gave them very weak economies. I’m really surprised nobody is seeing a connection between austerity and what’s happening in these countries right now. Everybody goes on and on about cheek-kissing instead. As if Spain hadn’t spent a decade exporting all of its doctors to richer European countries.

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      1. I agree that the austerity has been horrible for many countries in Europe (also the UK). But the hardest hit region in Italy, Lombardy, is rich and apparently has a quite good healthcare system. In Switzerland, we have weird trend too: Our Italian and French regions have a higher death rate than the Northern regions. And we have an excellent health care system everywhere. I am not saying that the condition of the health care system is not playing a role, but I would be careful at that point to blame things on it. I would guess the most important factor is the initial reaction of the country and how much they are able to keep the virus from spreading especially among the elderly. They made some terrible mistakes in Northern Italy early on in the process.

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