My thanks to Raj Patel for adding some clarity to all of this madness about us about “free markets.” The idea is like a virus, or maybe a parasite, as markets may yet destroy their host … our habitat.
Patel introduced me to the concept of “exclusion,” probably well-known to anyone in Econ 101. But as he describes it, exclusion is the nature of the marketplace itself – without it, we have only commons.
Say, for example, a town exists around a well, and all of the townspeople depend on it for water. Suppose that the local merchant ropes off the area, sets up guards, gets a court order behind him, and prevents people from using the well without paying him. The well has become his “property”, and the towns people, now excluded, are “free” to engage in commerce to get water.
Before they lost access to the well, they were freer than after it was excluded from the commons. But in the Orwellian parlance of our time, that is actually supposed to be a net gain in personal freedom.
In health, insurance companies have roped off medical care to limit access, excluding the poor and already sick and charging everyone else. As a result, we are now subject to huge fees for common services, and insurers make money off of us by the simple means of placement, like the merchant and the well. They “own” what was formerly our commons, access to health care.
Again, the free marketers call this freedom. They stand logic on its head. Exclusion is at the heart of servitude. Governments, which do not exclude people from services, but rather collect taxes and disperse them without discrimination, offer more freedom than markets. But the notion that governments enslave us while markets free us, the curse of our times, is dominant.
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I was listening to Dr. Marcia Angell interviewed by Bill Moyers this morning. Moyers, who is soon to retire, did another excellent show on health care. Angell wondered out loud whether Anthem Blue Cross, which is raising its rates by as much as 39% in California, is gaming us.
She calls it the “briar patch” game, as in “please don’t throw us in there.” In the scenario, Anthem, oblivious to public hatred and criticism, is rubbing our face in rate increases as a way of angering us to the point where we turn to the government to pass the health care “reform” bill.
That would be a good deal for Anthem, as the bill that is on the table, the one that Obama is (finally) fighting for, will bring Anthem millions of new clients, billions in subsidies, and with no public option, no threat of competition. All wiithout cost controls.
Who knows. We are practically owned at this point by the public relations industry – the whole health care “reform” process has been a game. This might be the ninth inning. Key Democrats are being forced out of Congress, others are surely feel the heat. Dennis Kucinich, a holdout, will surely have to endure corporate attacks in his district in the wake of Citizens United.
But it’s hard to know. Anthem is raking it in in our current system, so can’t be hurt either way.
Piece of Mindful 
The water hog story is a good one.
How ’bout this one?
If you’ve received multiple heart bypass operations, chemotherapy and dialysis, yet you still won’t stop smoking three packs and eating a dozen Twinkies a day, will the government guarantee care for your “preexisting” conditions?
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You amuse me. I will keep you alive a while longer.
How about this one: You are born with a mild condition that gives you attacks of acid if you eat certain foods – perhaps you are part of two or three percent of the population that have this condition from birth.
You are denied private health insurance by all companies who sell insurance, as they have all agreed not to cover these people. Will the government guarantee care for that “preexisting” condition? You bet. The government doesn’t have to answer to the greedy mob that runs the health insurance business.
I am going to say this one more time, Swede, then I am going to beat you to death with a butcher’s maul. 37 other countries have outlawed for-profit health insurance, and either have government-run health care, single-payer insurance, or heavily regulated private not-for-profit insurance. They all manage to cover all their citizens for half as much as we pay in our for-profit system that excludes 45 million and underinsures just about everyone else.
Now, put your head on this block … think happy thoughts …
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And why is that coverage denied Mark? Did the parents decide to get health ins after the diagnosis? Did they choose to work for companies that didn’t offer ins? Did they work for themselves a independent contractors, making more money and delaying coverage while they were young and healthy?
Did the state in which they preside conspire with ins cos that provided more restrictive coverage?
Inquiring minds want to know.
And finally.
Health care is an infinitely complex series of transactions facilitated by doctors, nurses, pharmaceutical companies, insurers, hospital systems, brokers, third-party networks, caregivers, volunteers and others.
You want to nationalize this entire system, and set up small committees of central planners who will formulate all of the rules, set prices, dictate treatments, and proscribe the activities of every kind of market participant, including patients.
Much like the 37 countries you mention, with 3rd world care.
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Honestly Swede – you are a nice guy with a great sense of humor and an inquiring mind. But you haven’t thought anything through. Your reasoning for denying care to people with people with congenital conditions is contorted to the point where I think your mind is shaped like a pretzel.
And you have not even bothered to take a look at any of those 37 countries, and write them off as having “3rd world care” – with no knowledge, no inquiry – even a five minute Googlefest would set you straight. Isn’t that your specialty?
Your notions about small committees and central planners who set prices dictate treatments and activities for every market participant … good fucking grief! You have just unknowingly described private insurance companies!
It is your blissful ignorance that is your most attractive feature -because you simply don’t know stuff, it is hard to dislike you. You have no agenda, so I will let you live.
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Whose being ignorant? There’s thousands of ins cos and ONE federal government. That ONE govt which denies health care coverage on a daily basis to Medicare patients.
Was your mother ever denied care, Mark?
The ignorant are convinced that govtcare will exceed what’s offered now, at a lower rate.
The ignorant believe the WHO are agenda-less, fair and accurate in their rating system.
The ignorant believe that every day thousands of sick Americans board flights to escape our 37 rating.
The ignorant believe that the same people who bankrupted every endeavor will somehow get it right with health care.
Letting me live comment? I do have this nightmare of appearing before a health board for advanced approval for a hip replacement and I’m looking up only to see a panel filled with dem bloggers.
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Medicare patients are never denied coverage by Medicare, though some private sector doctors refuse to treat them.
My mother is on Medicare and is never denied care, never has been, though she has had heart attacks, strokes, cancerous lesions, broken bones.
Our only reason for us thinking that the government could do it for less are those 37 other countries where it is done for less. Silly us.
Many Americans have left this country and gone to Mexico for better care, to the point where it is straining that system. On the other hand, the only documented case study of Canadians, for instance, coming here for care found the number to be statistically insignificant – too few to matter.
No endeavor that I am aware of done by eh government is “bankrupt”. Get it straight – the talking-point word you are suppose to use is “unsustainable”, which is also false.
Virtually all hip replacements done in this country are for senior citizens, and are done courtesy Medicare, and there are no panels to deal with other than the doctors doing the work.
This is humorous! Every single statement you just made is wrong, and you are calling us ignorant!
Maybe I will kill you after all.
Hey – do me a favor – before you spew out any other nonsense here, pick one country, any country that has socialized medicine or single payer, and read about it, study it in depth, and report back. Maybe the best would be Taiwan, where they just recently switched from American-style to single payer. See how it worked out for them.
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Profit over health is an easy choice for some to make. They have never met “the beast” eye-to-eye with no private-insurance tooth fairy to protect them. Their day is coming with mandated private premiums.
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Sick of typing, so I’m pasting.
By: Richard G. Fessler, MD, PhD
The media and political community have made a big deal out of the fact that the U.S. ranks 37 out of 191 countries on the World Health Organization’s Health Care Ranking System. Is this tool a credible way to compare quality health care delivered in the U.S. vs the rest of the world?
Let’s be perfectly clear about this, the United States Health Care is second to none! Ask the tens of thousands of patients who travel internationally to the US every year for their health care. As an example of the quality of health care delivered in the US, Americans have a higher survival rate than any other country on earth for 13 of 16 of the most common cancers. Perhaps that is why Belinda Stronach, former liberal member of the Canadian Parliament and Cabinet member (one of the health care systems touted as “superior” to the US) abandoned the Canadian Health Care system to undergo her cancer treatment in California.1
But to understand how WHO derives this misleading statistic, which has been ballyhooed widely by both the media and politicians alike, you need to understand how it is created. WHO’s health care rankings are constructed from five factors each weighted according to a formula derived by WHO. These are:
1. Health Level: 25 percent
2. Health Distribution: 25 percent
3. Responsiveness: 12.5 percent
4. Responsiveness Distribution: 12.5 percent
5. Financial Fairness: 25 percent
“Health level” is a measure of a countries “disability adjusted life expectancy”. This factor makes sense, since it is a direct measure of the health of a country’s residents. However, even “life expectancy” can be affected by many factors not related to health care per se, such as poverty, homicide rate, dietary habits, accident rate, tobacco use, etc. In fact, if you remove the homicide rate and accidental death rate from MVA’s from this statistic, citizens of the US have a longer life expectancy than any other country on earth.2
“Responsiveness” measures a variety of factors such as speed of service, choice of doctors, and amenities (e.g. quality of linens). Some of these make sense to include (speed of service) but some have no direct relationship to health care (quality of linens). These two factors at least make some sense in a ranking of health care, but each is problematic as well.
The other three factors are even worse. “Financial fairness” measures the percentage of household income spent on health care. It can be expected that the “percentage” of income spent on health care decreases with increasing income, just as is true for food purchases and housing. Thus, this factor does not measure the quality or delivery of health care, but the value judgment that everyone should pay the same “percentage” of their income on health care even regardless of their income or use of the system. This factor is biased to make countries that rely on free market incentives look inferior. It rewards countries that spend the same percentage of household income on health care, and punishes those that spend either a higher or lower percentage, regardless of the impact on health. In the extreme then, a country in which all health care is paid for by the government (with money derived from a progressive tax system), but delivers horrible health care, will score perfectly in this ranking, whereas a country where the amount paid for health care is based on use of the system, but delivers excellent health care will rank poorly. To use this factor to justify more government involvement in health care, therefore, is using circular reasoning since this factor is designed to favor government intervention.
“Health Distribution and Responsiveness Distribution” measure inequality in the other factors. In other words, neither factor actually measures the quality of health care delivery, because “inequality of delivery” is independent of “quality of care”. It is possible, for example, to have great inequality in a health care system where the majority of the population gets “excellent” health care, but a minority only gets “good” health care. This system would rank more poorly on these measures than another country that had “equal”, but poor, health care throughout the system.
In summary, therefore, the WHO ranking system has minimal objectivity in its “ranking” of world health. It more accurately can be described as a ranking system inherently biased to reward the uniformity of “government” delivered (i.e. “socialized”) health care, independent of the care actually delivered. In that regard the relatively low ranking of the US in the WHO system can be viewed as a “positive” testament to at least some residual “free market” influence (also read “personal freedom”) in the American Health Care system. The American health care consumer needs to understand what the WHO ranking does and does not say about American health. Don’t be fooled by “big government” politicians and the liberal media who are attempting to use this statistic to push for socialized medicine in the United States. It says essentially nothing about the delivery of health care or the quality of that delivery in the US. It does say that, so far, the American health care consumer has at least some personal freedom to seek the best health care available, and is not yet relegated to the “one size fits all” philosophy of government sponsored health care systems.
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Odd as it may seem, I am aware of the total controversy around the WHO study, and don’t even care. It is hard to quantify things. However, and please take this to heart – the cost of our system, the number of uninsured, the number of under-insured, drive down our quality of care, and those things are in fact real issues that you must sometime deal with if you are going to be at all objective about this subject.
After all, what good is an MRI if you don’t have health insurance?
So what to you think about the Taiwan system?
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