Arnold Kling’s response to Holt, Havighurst, and Cohn is up at Cato Unbound. You know that I and Jon Cohn are going to largely find fault with Arnold Kling, while Clark Havighurst is a fellow traveler who actually says very sensible (but probably unrealistic) things about the tax treatment of health benefits.
In his response Kling agrees with my premises but doesn’t agree with my conclusions. Fancy that! Still go over there and read all the essays, because it’s good stuff!
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OK Stuart I’m back from the weekend. Let me guess that you don’t think humans are a signifigant contributor to global warming? That we shouldn’t act because we don’t have enough direct evidence yet? That Rush Limbaugh is right? That’s the impression I got from your answer about life expectancy and single pay. By the way, just ask my wife if I beat her, I’ll give you her email if you want. All I was saying was that complaints about single pay, that it degrades healthcare, do not seem to stand up to the facts, at least in Canada. So if healthly populations exist in single pay countries and the U.S. system then what should we be talking about? What type of evidence are you looking for that single pay can work.
About wait times in Canada. Yes there are wait times, just as there are wait times here in the U.S. Are the wait times in Canada longer than the U.S.? I would yes but if you looked at the link I left (did you look at it?) it’s not as easy as it seems to calculate. Here is another link to the Canadian Institute For Health Information study of wait times. You’ll need Power Point and it has some interesting comparisons and numbers mostly in graphic form. When is a wait time an inconvenience and when does it endanger health?
http://secure.cihi.ca/cihiweb/products/Waittimes_presentation_e.ppt
As for the general discussion on wait times and single pay have you seen the reports about the dismal condition of many U.S. emergency departments? Under staffed, overwhelmed, wait times. What about the wait times for the uninsured who wait until the condition is critical before seeking then expensive care. What about wait times in rural U.S. where people have little of no access to GP care. In Canada where the tax payer is supporting healthcare, allocation of resources (cash) is restricted to control costs. If there were no restrictions who would you say would then be irrespnsible with tax dollars? Canadians are working through this and are aware of it. Maybe you are just saying, “I’d have to wait”, when determining if single pay is not the best “solution” for controlling spiraling costs here. How long do you think this system can sustain double digit inflation of health costs? How would you control costs?
Peter – you said:
“As to data on life expectancy being due to single pay, well it doesn’t seem to be hurting. Do you have evidence that without single pay life expectancy would rise?”
Well geesh, Peter, no I don’t have evidence that single-payer financing *doesn’t* lead to a rise in life expectancy. Neither do I have proof that you *don’t* beat your wife.
Again and again the ridiculous assertions that higher life expectancies in various OECD countries are due to government-financing of health care are found on this blog’s comment section – and unfortunately – also on the pages of the New York Times.
Stuart, I don’t have much time now to discuss fully on wait times but please look at this link. Hope it works.
http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=media_07mar2006_e
As to data on life expectancy being due to single pay, well it doesn’t seem to be hurting. Do you have evidence that without single pay life expectancy would rise?
Peter – two comments on your post.
1. Canadians certainly can choose their own doctor. However, I should point out that Canadians cannot see a specialist of any type (not even an OBGYN) without a referrel from a GP. This translates into long waiting lists to see a doctor when you are actually sick. Interestingly, I’m even hearing of waiting lists (kept by GPs) to get on specialist waiting list. So – the whole “choose your own doctor” line that we keep hearing from the single-pay folk is not meaningful.
2. Your statement that Canada’s longer life expectancy is due to their single-payer system is one that is not supported by any proof that I am aware of. Is this merely a baseless assertion or can you point to evidence that would backup your claim?
I found Arnold Kling’s response interesting but self serving, and his reference to the “Two Strategies for Avoiding Truth” seemed to be an attempt to make himself the all seeing, all knowing, arbitrator of reason. Please Mr. Kling tell me the meaning of life.
I agree that the general public follows a “low-investment strategy for avoiding the truth” in that they go by feel when voting. But as time passes they also see if their selective knowledge vote was correct. As is the case with the present voter disatisfaction with Iraq and the Bush Administration. Certainly a better informed and perceptive public would have made a better decision in the first place. I think this is also true with healthcare reform. The public (or experts) cannot know all the indepth and intricate knowledge needed to make a truly informed decision on what reforms will work. Only by living the reforms can they see if the promise lives up to the reality. But how have we come to the present realization that U.S. healthcare is no longer working the way patients and premium payers think it should work – by living the reality.
So what is the reality of single pay. Mr. Kling trys to box single pay into 3 packages; “doctor-friendly,” in which government picks up the check, but otherwise plays no role in medical decision-making, “doctor-hostile,” in which government forces providers to offer the same services at lower prices and “doctor-limiting,” in which the government acts like a managed-care company, controlling cost by limiting access to medical services.
The system in Canada for which I have actually used is not that clean cut and I would suspect that no other single pay system is either. In fact the Canadaian system is a little of all three, not necessarily by policy but by intent. People are free to choose their own doctors, doctors negotiate with provinces on fees and there is limiting access to medical services because budgets are set to control expenditures. That’s how Canada is able to produce a healthy population (average age 80) with greater unrestricted access to healthcare and do it for about half of what the U.S. spends. That’s the reality, and it’s a work in progress.
In the continuing debate about U.S. health reform the single pay opponents are attempting to keep the same dollars flowing in the same system, while adding more payers and keeping the same choice for mostly rich people who don’t need single pay anyway. Can this utopia be achieved – I don’t believe so. Do I believe this as someone with a low investment strategy for avoiding the truth, no. I believe this from living the reality of the U.S. and Canadian systems and by relying on my 50+ years of observation. The mistake that people make is saying how their way will, “solve” the present or growing crisis. Canada’s single pay system solves many things but is not a solution. It does however give a better chance at better ways by using a whole system approach of managing a necessary but scarce resource that does not fit well into the free market forces of true choice with winners and loosers. For any system to truly control costs it must produce healthier people that don’t need healthcare, especially when we are living longer and wearing out bodies that were never intended to last this long. But society is fighting a loosing battle if we do not get the food industry to produce healthier foods, to get general industry to keep our environment clean, and get people to lead healthier lives. The ag industry now has no stake in helping us curb bad habits any more than the drug industry has a stake in reducing drug use and costs.
I don’t think the U.S. is ready for single pay just as it was not ready a couple of years ago to admit that GW Bush was an incompetent leader. But as time passes and experience of events shows the truth, single pay will become more possible and necessary – I think.