INTERNATIONAL: Rationing American style

I don’t approve of health care by anecdote, but there are plenty of loonies on the Canada bashing right who do. And some of them make movies to prove their point. I also think that taking individual stories out of context, compared to using data to describe the actual patterns of care, isn’t that valuable in an intellectual sense. But it sure seems to work in an emotive one.

But let me warn those aspiring Canada-basher film-makers. While you’re out raising your millions, certain pro-single payer groups here have beaten you to it. Apparently the bashers may not know this but there are both people who have problems south of the border, and others with video cameras who’ve met them. I’m awaiting the assurance that this is all the Canadians fault somehow.

The rest of you in the more rarefied crowd at THCB can go back to your regularly scheduled programming.

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10 replies »

  1. John. You’re right about the numbers and right about what Pauly says, even if you (and he) and I radically disagree about the conclusions he draws about the individual market.
    The issue is that the current individual market does not function–full stop, period. If you or Pauly disagree I suggest that you both quit your jobs, develop a chronic disease and try to acquire insurance in the individual market. (Google my take on the recent Rand study on THCB as to why they’re methodology was wrong)
    So for the 80 million if they have a health problem and no health insurance when the music stops, then they’re screwed in our current system. And that is the problem!

  2. Matthew, you state “80 million uninsured for at least 3 months in a 2 year period” but I can equally state that 3/4 of the 46 million uninsured will be insured within 12 months. So, you have significant numbers of people moving in and out of this status: a consequence of employer-sponsored health insurance, not private health insurance. Mark Pauly’s empirical research unambiguously supports the policy of guaranteed-renewable, individually-purchased health insurance – which is the same way the government allows pretty much every other insurance market to operate.

  3. That’s a sad commentary for a compassionate nation, jd. I have always supported free college education to any student in the sciences who maintained grades in the top 10%, regardless of his station in life.
    That said, our high costs are not because we have too few physicians and thus inflated salaries. We waste too much on our bureaucratic insurance system and we incentivize physicians to over order tests. We also have massive waste and fraud in the nursing home industry.

  4. The supply of physicians in the U.S. is most certainly limited. It is limited by admission to medical schools and residencies. These limits are influenced by the medical profession, which functions as a cartel to limit supplies and maximize income. They also come from the Federal government in the form of limits on the subsidies paid to hospitals for residents. Apparently, our fabulous free market, though it produces by far the highest medical costs in the world, can’t pay for residency programs. Hospitals would have to charge at least an additional $11 billion a year to do so. For more, see this article from USA Today, parts of which I’ve excerpted below.
    The predictions of a doctor shortage represent an abrupt about-face for the medical profession. For the past quarter-century, the American Medical Association and other industry groups have predicted a glut of doctors and worked to limit the number of new physicians. In 1994, the Journal of the American Medical Association predicted a surplus of 165,000 doctors by 2000.
    “It didn’t happen,” says Harvard University medical professor David Blumenthal, author of a New England Journal of Medicine article on the doctor supply. “Physicians aren’t driving taxis. In fact, we’re all gainfully employed, earning good incomes, and new physicians are getting two, three or four job offers.”
    Almost everyone agrees we need more physicians,” says Carl Getto, chairman of the Council on Graduate Medical Education, a panel Congress created to recommend how many doctors the nation needs. “The debate is over how many.”
    Getto’s advocacy of more doctors is remarkable because his advisory committee and its predecessor have been instrumental since the 1980s in efforts to restrict the supply of new physicians. In a new study sent to Congress, the council reverses that policy and recommends training 3,000 more doctors a year in U.S. medical schools.
    The marketplace doesn’t determine how many doctors the nation has, as it does for engineers, pilots and other professions. The number of doctors is a political decision, heavily influenced by doctors themselves.
    Congress controls the supply of physicians by how much federal funding it provides for medical residencies — the graduate training required of all doctors….Even doctors trained in other countries must serve medical residencies in the USA to practice here.
    Medicare, which provides health care to the nation’s seniors, also is the primary federal agency that controls the supply of doctors. It reimburses hospitals for the cost of training medical residents.
    The government spends about $11 billion annually on 100,000 medical residents, or roughly $110,000 per resident. The number of residents has hovered at this level for the past decade, according to the Accreditation Council for Graduate Medical Education.
    In 1997, to save money and prevent a doctor glut, Congress capped the number of residents that Medicare will pay for at about 80,000 a year. Another 20,000 residents are financed by the Veterans Administration and Medicaid, the state-federal health care program for the poor. Teaching hospitals pay for a small number of residents without government assistance.

  5. Indeed Jack, Mr Browning is a self-proclaimed rich guy who gives talks on this subject to association of underwriters, brokers and others who’s value add to the system is probably even lower than pundits, bloggers and consultants. And he does that and makes his movies because it’s just what makes him happy–I assume.
    And he’s right about 43 million being off by 10s of millions. It’s closer to 80 million being uninsured for at least 3 months in a 2 year period. (Essentially 25m are permanently uninsured and another 55m rotate through the process of being uninsured) But as Mr Browning says that doesn’t matter. At least it doesn’t matter so long as you don’t get sick, or mind dying earlier.
    But why take my word for it when you can listen to an executive of the leading for-profit insurance company saying the same thing much more forcefully.

  6. Jack –
    You’re off by 10s of millions if you are talking about the truly uninsured. I wouldn’t expect that you would have delved into the veracity of the uninsured propaganda you’re spreading.
    I’m not funded by anyone.

  7. And Stuart, I just looked at your website and I hope you will forgive my bluntness. You appear to be very anti-single payer. Are you funded in any way by the insurance or health care industry?

  8. Stuart–see some uninsured patients first before you start lecturing about what does and does not happen to patients in the US.
    The plural of anecdote is not data.

  9. The word “loonie” seems to appear in every post by Mr. Holt in which he discusses those whose ideas are in opposition to his. However, I would suggest that real “looniness” is on display when he suggests that there exists in America rationing of health care that in any way approaches in degree or kind the rationing that is practiced in Canada.
    That country’s government forcefully limits the *supply* of specialists, ORs, diagnostic machines and devices – this is not done in the U.S. My movie “Two Women” (http://www.onthefencefilms.com/video/twowomen.html) shows the results. A women needing a medical device implanted to stimulate her bladder to function had to wait YEARS for surgery because an arbitrary decision was made to perform only one surgery a month of the type that she needed. There were 32 people on the waiting list for an operation that was performed only 12 times a year. She ended up losing her bladder at age 39 and needing to wear a bag for the rest of her life.
    This degree of rationing does not occur here and to suggest that it does is blatantly dishonest. Mr. Holt is engaging in the lowest form of propaganda that he preposterously ascribes to his ideological opponents.

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