POLICY/INTERNATIONAL: More rubbish being talked about single payer and Canada by major newspaper columnist

I had hoped that when the Boston Globe gave Jeff Jacoby a chance to rant about Canada and single payer, and THCB was able to call bullshit, that I wouldn’t have to repeat myself quite so soon. But to no avail. The Chicago Tribune gives a columnist called Steve Chapman, who incredibly enough worked for the liberal  New Republic (although aside of that has a long list of writing for libertarian and conservative newspapers), a chance to spread way more disinformation.

It’s good to know that a serious newspaper can allow a leading columnist to write about Canadian health care using numbers about the length of Canadian waiting lists from hopelessly biased organizations like Fraser and Cato, but ignore the official statistics which indicate that Fraser is wrong on waiting lists by a factor of 4. And for that matter the average waiting lists quoted by Fraser of around 4 months for elective surgery aren’t that bad–yet somehow Chapman starts talking about two year waiting list because one orthopedic surgeon said so.

Chapman then goes on to cherry-pick different outcomes on cancer to show that American care is better. Of course he doesn’t bother looking at overall care in different countries. This article in Health Affairs did just that (and is one in a series). The result, as again commented on in THCB, is that overall there is no real advantage to being in America. We do worse on somethings and better on others, but the suggestion by the Canada bashers that we get what we pay for is well off-base. And we clearly pay a lot more than anyone else and the share of those costs borne directly by poorer Americans is much, much greater than that borne by poor Canadians (or poorer people in other nations).

And if you look at the Health Affairs study a little more carefully you come to the authors’ conclusions.  Remember this is a real academic peer reviewed study, not some rubbish that Fraser Institute made up to suit its political agenda.  Here are the conclusions:

Across multiple dimensions of care, the United States stands out for its relatively poor performance. With the exception of preventive measures, the U.S. primary care system ranked either last or significantly lower than the leaders on almost all dimensions of patient-centered care: access, coordination, and physician-patient experiences. These findings stand in stark contrast to U.S. spending rates that outstrip those of the rest of the world. The performance in other countries indicates that it is possible to do better.

There’s plenty wrong with Canadian health care–something I looked at in depth in my "Oh Canada" piece. I’m also pretty sure that it’s not a good model for America, whereas Germany, Holland, France or Japan might well be.  But I really wish that if right-wing know-nothing columnists are going to write about this subject, that they’d either learn something about it themselves, or try to abstain from feeding at the research trough of totally biased organizations like Cato and Fraser. I suspect though that I’ll be wishing in vain for a while, but shouldn’t the Chicago Tribune hold itself to a higher standard?

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  1. it says here http://www.moneysavingfreetips.com/401k-rollover-rules.html “Before the new law, investors could only transfer their retirement savings from one 403b plan to another 403b plan. However with the new law, the investors can transfer their funds from a 403b plan into a 401k plan, other 403b plans, 457 government plans, IRA or even profit-sharing plans with employers or other investors.”
    does anyone know exactly how it works? where can i find its paperwork?

  2. Don’t know about Canada, but in Mexico there is virtually no ability to sue for malpractice although illegal immigrants are pretty good at doing that once they cross the border into the U.S. Mexican law requires employers with 50 or more employees in a worksite to maintain a dispensary with a full-time nurse. Many companies also sign up for a “floating” doctor who visits every couple of weeks to provide immunizations, prescriptions, etc. to employees and their families to save them the wait at government facilities. Every worker gets government medical coverage through payroll taxes and some have other insurance coverage as an additional benefit. With no malpractice liability it is easy for employers to step up to plate and provide convenient healthcare support. In the U.S., you open the door to lawsuits doing that. I’m not going to say that the quality of Mexican health care is anything to brag about, but a lot of folks who fall through the cracks here are getting care there that actually ties to a cost structure that covers it. Here people are showing up at ERs and taxpayers and the insured pick up the bill or they are going without care. The unemployed in Mexico still fall through the cracks because the social security system which provides healthcare is tied to payroll taxes so their system isn’t perfect either.

  3. I heard on Dr Novack’s radio show that the average malpractice claim in Arizona last year was $2.3 million. I wonder what the average malpractice claim was in Canada or Mexico?

  4. In El Paso, the wait for a gastroentrologist can be as long as six months (and often requires a referral from the patient’s GP–not due to insurance but because the doctor wants to ensure that the visit is really needed because the schedules are so full) and for some pediatric specialties the closest Texas option is Dallas (note that El Paso is closer to LA than to Dallas). That’s with good insurance. I found one doctor who had less wait time, but he wanted patients to sign a document indicating they would pay any charges over the insurance company allowed reimbursement rate (his fees were 2-3 times that rate). He has subsequently been blacklisted by several major insurers and ceased practice in Texas (heard he started up again in Arizona). With Medicare or no insurance the options are even more limited. Our system is broken and using the excuse that other systems limit choice is becoming less and less of a reason for avoiding major overhaul. Many segments of our population currently experience less service access than found even in the worse government-run healthcare options. It’s pretty bad when a factory worker in Mexico has better access to routine healthcare than most of our minimum wage workers in the U.S.

  5. 1. If the official government statistics on wait times were accurate and believable, it is highly unlikely that the very liberal Canadian Supreme Court would have essentially ruled that the current system violates people’s rights.
    2. For the people in healthcare– nurses, technicians, manufacturers and doctors– their careers are “for profit” in the US AND Canada.
    3. Remember that the US system is very far from free market– 50% of all healthcare dollars come from the government and most insurers tie their payments directly to the medicare fee schedule.
    4. Much like Social Security reform– up front costs to transform the Healthcare system will be high– but the costs of doing nothing are likely greater.
    5. Also– Consumer-driven healthcare and HSA expert Greg Scandlen will be interviewed live on the radio at 3pm this Sunday (check out site at http://www.ericnovack.com).

  6. Matthew, the New Republic is not a liberal publication. I don’t know if you were joking or not. Any publication that once had Michael Kelly as an editor is not liberal. Maybe it was once, but today it merely reflects the right-leaning dinner party centrism of Washington.

  7. The media censors the health care news and won’t run stories against their major advertisers or aganst their basic agenda. The St Petersburg Times will run every story of Paul Krugman but not one supporting Republican Health Care reform of President Bush or Governor Jeb Bush.
    That’s why if you want real information from someone that is smarter than a newspaper reporter you must find an alternate source than newspapers. Let’s face it, if one of those goofy reporters got too sick to work they would lose their own employer provided coverage. I don’t think you can find a newspaper reporter with 2 brain cells to rub together and get a spark on health insurance. They are all a bunch of W-2 employees who are on group health employee plans until they get fired. These guys are not the brightest bulbs in the pack.

  8. //401K you aren’t supposed to be touching it until retirement//
    As a person in her 30s who is currently living on the dregs of her IRA (part 401k rollover), I think personal retirement savings is a bad idea. I can’t touch whatever has been collected by social security, and if I go into bankruptcy, that social security money will still be there. People have to use whatever resources they have to survive at the moment, and I’m sure society would prefer that people use up all savings before they start standing on the corner and asking for handouts.
    Newt Gingrich made a political career out saying it was an insult to suggest people aren’t responsible enough to save their own money. My reply to that is that there are many ups and downs in life, and the only way people won’t use savings (including HSAs) to meet current needs and family responsibilities is if that money is “secured” in some way instead of left as a personal discretionary funds. Maybe I’m insulting people’s Pride in Personal Responsibility, but I really think it’s a problem that personal savings are vulnerable to personal catastrophes. It’s in the longterm of interest of all of society to set aside funds for general goods such as utiliies, education, health care, and eldercare in retirement – and not leave those things to the vicissitudes of personal fortunes.

  9. I’ve totally lost faith in the idea of media standards. In my own recent experiences, I’ve learned that TV reporters are allowed to creatively cut and stitch their material to get a story that will sell. Even journalists from what I had previously regarded as respectable newspapers won’t bother to correct errors. Even the good reporters who check their facts and get a broad range of comments often think the real story is “is too detailed for our readers”, and they will promote the story that will come across in a soundbyte, right or wrong.
    I’ve never been naive about the media: I understand the market pressures and that journalists are just human beings who make mistakes. However, I really didn’t realize we had gotten to the point where what looks like news could be pure fiction. I think part of what is creating the media credibility issue is that journalists are less willing to fix problems than they have been in the past and cynically regard their work as having a shelf life of five seconds. One actually told me that an article couldn’t be corrected once it had been posted on the web!
    I’ve honestly considered picketing the SF Chronicle, because I considered the Chronicle to be the paper with the highest standards in the Bay Area, and it was particularly disappointing to find out that they look for the sensationalistic spin and refuse to correct outright errors of fact. I’m not sure where I can go for actual information now.

  10. Great point, Rick. Keep in mind that with a 401K you aren’t supposed to be touching it until retirement and look at how poor the numbers are with no expense driver. With an HSA, you use that balance to cover medical expenses incurred as a result of having a high deductible plan. President Bush will have a six figure HSA because he has no out-of-pocket healthcare expense thanks to the great coverage we taxpayers provide for him and all the rest of our elected officials, but Americans actually depending on HSAs for medical coverage will be hitting the bank if they see a doctor.
    If politicians had to actually pay for their healthcare, we’d see reform. I’d love to see this discussion move back to the original point Matthew was raising, which is that statistics used to illustrate the poor performance of Canada’s healthcare system aren’t necessarily accurate. Even with a for profit, free enterprise system we are seeing long waits in areas where doctors don’t feel they get high enough reimbursements, so personally I think the “access to care” argument is questionable as an argument against single payer systems. The poorer parts of our population have a significan access to care wait time (as well as denial of service–many physicians in our area have signs in their waiting rooms indicating which insurance programs they won’t accept) and our underinsured or uninsured middle class may be denying themselves access to care. That’s a bigger problem than waiting four months for some procedures in a system where everyone has basic access to care.

  11. Rick,
    The early MSAs already have $40,000 balances. Now people can deposit more. We talked to a 24 year old single employee today that has $600 HSA balance after just 3 months. What do you expect families to have after 8 years?
    Sure he can take money out of his HSA and buy beer but he will have to pay taxes on the money plus pay a 10% penalty. People hate taxes so they just let it keep growing and growing and growing. I will admit that the 10% penalty is cheaper than the 15.3% combined FICA tax the Feds are not collecting on normal beer money, paid in his paycheck. So yes, the Feds collect less tax on HSA money, used to purchase beer, than they would collect on payroll beer money. But we never point that out to young people.
    Yes, you are correct that 401Ks are old taxed accounts. You forget that HSA funds can be used for any reason, after the age of 65, by paying ordinary income tax, exactly like a 401K. So at worst the HSA is taxed like a 401K in retirement. If a couple has an HSA balance of $100,000 they will probably dedicate it to 30 years of retirement health care costs. I don’t think they will be using the money to purchase a 36 foot boat. But if they do, that’s their right.
    I would point out that a couple on Medicare could have $7,200 a year out of pocket, just on RX, if they purchase the new Rx benefit for $70 a month. I can easily see how $100K is not enough at 65 years of age for a couple. I would advise them to let it grow and try and get $200,000 by the time they are 75 years old. Shoot, a 50 year old couple can have a $100K balance at 65. Imagine if someone starts at 30 years of age and then has the magic of tax free compounding coupled with tax free withdrawals. Savvy young people can have a mountain of money dedicated to retirement medical, vision and dental expenses plus other qualified HSA expenses, all tax free. I would have your financial guru bone up on HSAs so they can give you the lowdown.
    You know that old saying, “Money that is never taxed will last longer in retirement and make American citizens better prepared for 21st Century Medicare.”

  12. The idea of six-figure HSA balances is fantasy. The average 401(k) at maturity has just $42,000 in it. 401(k)s were supposed to see us through retirement, so if people haven’t saved for that, why would they save twice as much for healthcare? As the old saying goes, “There’s no there, there.”

  13. You’re right Matthew, when reporters quote President Bush’s advisor, Dr. Goodman, they better get additional information. I remember in the 2000 Presidential race Al Gore was talking to the National Newspaper Editors’ Association and was complaining that Governor Bush’s $3,000 refundable tax credit wasn’t enough, and they should investigate because he said health insurance costs $6,000 a year per family. Doctor Goodman said, “Health insurance costs $4,000 per family.” I couldn’t believe my ears. Way back then, a 30 year old couple and 2 children could get MSA health insurance for $1,000 a year in Des Moines. I thought boy, Dr. Goodman is such a Liberal. How could anybody be off by 300%!! With friends like this the MSA needed no opponents.
    The Canadian courts ruling that banning “private” health insurance is unconstitutional is a proper ruling and is a knife to the heart of those who wish to Socialize American healthcare. That’s something that even the dumbest Republicans can scream to voters.
    In Canada the system is called Medicare. I think a good arguement is that today in lansing, MI a family of 4 can get HSA health insurance in the free and open market for just $150 a month (30 yr. old couple and 2 children). Now that we can sell in Canada that cost will probably be cut in half because those Canadian doctors don’t charge much. Heck, if we restricted them to a Canadian PPO with only Canadian doctors and hospitals, it would probably be cheaper yet. It makes you wonder why those Canadians pay so much in taxes just so the government can create an Unconstitutional Medicare.
    I think the best way to reform the Medicare problem in Canada is for the government to give vouchers for people to purchase private insurance in the free and open market, as an option, and of course the tax free HSA should be enacted there too. Otherwise those poor Canadians are going to feel pretty bad when Americans have six figure HSA balances and they have zero. Education is the key.

  14. It will be interesting to see what our cancer survival rates look like in the next 10 years with the number of un- and underinsured rising. Early diagnosis doesn’t happen if you are avoiding doctors because you don’t have adequate insurance and while the poor aren’t concerned about hitting the ER for care, most middle class underinsured will simply avoid incurring cost because they recognize that they will have to pay the bills. Particularly for the middle class that translates to higher likelihood of serious, unaddressed health problems.
    For some classes of specialists in our area, even with good insurance it is not unusual to see wait times of 6-9 months for appointments. The best doctors cluster in areas with high reimbursement rates. Our part of Texas has a population with poor insurance coverage (high use of Medicare/Medicaid, CHIPs or no insurance) and the end result is limited access even for those able to pay. Our politicians are trying to get a four-year medical school in the hopes it will increase the population of available doctors, but I will be willing to bet that even with a four-year medical school, most doctors will beat feet to areas where they can make more (unless we lock them in for a decade in exchange for admission).

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