Matthew Holt

Bill Maher explains why government-run health care is a good idea!

Maher’s being funny (at least he thinks he is!), but he’s tapping into a meme that I think that many in DC including any Democrats are missing. I was watching CNN on Sunday and Sanjay Gupta brought up the question to Bill Clinton and (and Bill Frist, John Podesta & Mehmet Oz) about whether single payer was really off the table. The answer is, it’s not if they get this wrong (and they will). If we have a mealy mouthed reform this time (a la Massachusetts) then single-payer will be back with a vengeance in a few years.

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41 replies »

  1. I love how Maher leaves out certain details to prove his point. Sure the post office is efficient, but it’s broke as a joke.

  2. hi..i read this blog and did not think a whole lot about it……..so…..yeah i think you might need to reread this and write it over again….

  3. I lived with government run health care for 5 years in Japan. I was in fear daily that a member of my family would need serious medical attention. Americans living in Japan would leave the country to find good healthcare when needed. I have stories that would curl your toes on how terrible the medical system is in a country with government run healthcare. I am mortified that this type of mediocre healthcare will exist here and I would love to spread the word. People need to know what will happen if Obamas plan passes!!!!

  4. Let’s hear all of the facts. The USPS recently announced that it expects to lose $6.5 billion dollars this year. There are no easy answers and the flippant humor of Maher offers nothing new to the table.

  5. Doesn’t this man work for one of those big bad corporations? These people make billions but its always other people’s money that’s bad.

  6. Healthcare Fraud! WellCare is Amazing! One of the stipulations with this web bases insurance company?, is their conditions of service which includes to never visit a website showing sexually explicit material, (where I already have a problem) Material? ya jes can’t get lipstick stains from a monitor, but and everyone has one! I have never signed with this company yet they have sent me their card to use through our California Social Security Service as free additional help? Finding me through my medical records or SSI office? Sending me page after page which I save every one never really understanding who they are really, still saved everyone since the first one that said right on it we just want to help and the service is free, has sent me a letter telling me their is an action against me for not paying my bill? I am being sued by my government for not paying my insurance premiums which I never ordered nor been able to log on to their website long enough to agree to anything. You think it’s not illegal? Listen to this, I called to find out what the yaknow, was is going on and I got a man with a Latin sound, and I could hear kids in the background asking for my personal information? This guy was rather insistent. He got my date of birth but when the recent cartoon (on the BillMarrShow),seen by my self popped in to my almost quite psyche I said to my self Dude! Desa Vu and started GoogleLing for what’s up. I found you, and almost felt compelled? To write this, look out old guys in America if your mate goes first and are or somehow have been told a website is suing you for receiving advertising mail? You have been alerted. I am not quite sure but I guess I will find out in court, how that works?

  7. Nate,
    he whole discussion about USPS is somewhat silly, and probably it should have never been started with that clip.
    The USPS is impacted by economic downturns (I provided some links above). They cannot do the cost cutting as they want to and as a private company could – that is why they currently ask Congress to eliminate one day of delivery. It’s similar to the police, they cannot simply leave certain areas uncovered or reduce services they are mandated to do.
    The propaganda that you read (and occ. copy&paste) on libertarian websites does not consider that USPS gets well into black territory again when the economy recovers.
    I think the funny clip is a bad one for THCB – it resonates well with me and many others (those who think that more public involvement is part of the solution), but it sends you into a frenzy. Therefore, it preaches rather to the converted and is not a good clip to start a discussion.
    The converted, however, are a very large group, and the private insurance camp is not really getting much traction, no matter how vicious the attacks are against USPS, Canadian healthcare, Western European Bolshevism
    http://www.harrisinteractive.com/harris_poll/index.asp?PID=620

  8. Wendell, Bill Maher, rbar, and assorted other liberals that still believe government is capable of running anything, do you still think the USPS is a good model?
    http://news.yahoo.com/s/ap/20090325/ap_on_go_ot/postal_woes
    Postmaster General John Potter said Wednesday the financially strapped U.S. Postal Service will run out of money this year without help from Congress.
    The only lingering question, Potter told a House subcommittee, is which bills will get paid and which will not.
    The Postal Service was $2.8 billion in the red last year and is facing even larger losses this year due to a sharp decline in mail volume in the weak economy.
    If this was Medicare or Medicaid USPS would use the power of Federal Law to dictate gas stations must sell gas to the USPS 10-15% below cost, as must all other suppliers. Congress would pass laws saying FedEx and UPS have to mail pointless letters to clients every year as well as dictate expensive procedures on how they deliver packages that USPS is exempt from.
    All the while Ezra and Maggie would wax poetic about how inefficient FedEx and UPS are and we should nationalize shipping and go USPS for all because they are more efficient on gas consumption.

  9. Sorry you hate facts so much Wendell Murray that doesn’t make them disappear. You can bury your head in the sand, don’t expect the rest of us to follow your poor decision making.
    If you doubt USPS lost billions last year google it, allow me to help;
    From their own website http://www.usps.com/communications/newsroom/2008/pr08_118.htm
    The U.S. Postal Service concluded the 2008 fiscal year (Oct. 1, 2007-Sept. 30, 2008) with a net loss of $2.8 billion
    The ability of those on the left to deny facts has always amazed me, even more that you not only deny then but choose to go on a public forum and dispute them when the truth is a search engine and 3 seconds away.
    Know nothing right wing, I think we have dispelled that…
    “Pure nonsense. again no factual basis despite the first clause.”
    Except of course every CMS, GAO, Kaiser, Millimam, and other study done. Even the Boston Globe runs stories on how much more expensive MA is compared to the rest of the country.
    Just keep hiding out on these far left blogs and stay away from those hard to find stats and the truth will never find you.

  10. “Medicare for All” has about as much chance with Republicans as “The Fair Tax” has with Democrats.

  11. “unaware of the billions it bleeds every year”
    I doubt there are any facts to back up this assertion, but bringing the USPS into this kind of discussions is typical and typically counter-argumentative to those who introduce it. The analogy is always cited by the know-nothing right-wing. The USPS does in fact provide excellent service for the mass of users across the USA. It likely provides that service cost-effectively, but I am not interested to looking up the statistics.
    “To factually correct your statement almost every advanced industrialized country in the world provides better care more efficiently then Medicare, Medicaid, MA, and a couple other liberal states.”
    Pure nonsense. again no factual basis despite the first clause.
    More generally, single payer/insurer bills have been introduced into Congress periodically – the latest and greatest of course H.R. 676 – so there is certainly substantial awareness of the value of such a plan among at least some semi-movers and shakers.
    Who knows maybe one of the two people appointed to key healthcare administrative and policy positions in the new Administration will lead the charge to consider such a scheme. Every bit of evidence favors such a scheme. The current mish-mash of financing is nothing short of ludicrous of course.

  12. First up would be the fraud rate, you can’t lose 10 cents on every dollar, just not acceptable.
    Second would be slow evolution, no Rx coverage till 2006, not acceptable, things change and health plans need to change with them.
    Third incomptetent management. When Diagnostic spending exploded they drastically cut reimbursements. This means legit test where paid below cost while illegit ones where as well. Utilization problems are not solved by cutting reimbursements.
    fourth is service, Medicare nor it’s intermedaires are not known for great service, if your unhappy with it, to bad you have no option.
    Fifth, if you want to opt out of Medicare they will withhold your SS.
    Sixth cost shifting to private plans.
    Seventh the pot of gold effect it has on politicians, it’s a big pile of money for them to play with even as they show no regard for the damage it does and the lives it effects. Take Obama’s plan to make wounded soliders and their private insurance pay for war injuries.
    I had a longer responce but it got eaten by the kaptcha. I’ll see what you have to say about these.

  13. Nate,
    It is apparently not only the USPS’ deficit – which apparently turned into profit at the latest in 2004
    http://multichannelmerchant.com/news/USPS_profit_120705/ – that scares you, but the mere existence of a governmental agency that might be quite popular among users
    http://www.allbusiness.com/company-activities-management/operations-customer/5643843-1.html
    so scary that it makes you copy and paste your 2nd paragraph straight from the heritage foundation …
    But since this is thehealthcareblog and Maher’s comment rather a starting quip (about government possibly working) than economic analysis, let’s leave USPS behind and resume discussing healthcare, or, more to the point here, government run healthcare like medicare. I am genuinely interested in your concise and hopefully fact based analysis of the profound weaknesses of medicare compared to private insurance.

  14. The more I think about this the closer I see the analogy between he two systems. As insurance becomes more expensive and congress passes more bills driving up the cost fewer people can afford it making it more expensive which means fewer people can afford it and thus a self perpetuating cycle till death.
    ” The U.S. Postal Service is having some serious financial trouble that could result in a 5% or 6% postal rate increase for magazine publishers next year. The USPS lost $1.1 billion in the third quarter and expects to continue losing until the year’s end.”
    It goes on to say the move to online editions and mail less which reduces USPS revenue more which means they raise rates more and fewer people ship and well looky here another self perpetuating cycle till death.
    Being in Vegas I’ve opened the line, 2 to 1 odds USPS crashes before Medicare, place your bets.
    A little something juicy for those conspiracy theorist;
    It seems every year Congress passes a law requiring Insurers to mail another notice to peoples’ homes. First it was COBRA, then HIPAA, then Women’s Health and now ARRA COBRA. No one reads these mailings, they just drive up the cost of insurance and add waste to our landfills.
    IS CONGRESS KEEPING USPS AFLOT WITH REGUIRED NSURANCE COMPANY MAILINGS????
    You heard it here first, if not for ever increasing compliance mailings the USPS would already have failed!

  15. The more I think about this the closer I see the analogy between he two systems. As insurance becomes more expensive and congress passes more bills driving up the cost fewer people can afford it making it more expensive which means fewer people can afford it and thus a self perpetuating cycle till death.
    ” The U.S. Postal Service is having some serious financial trouble that could result in a 5% or 6% postal rate increase for magazine publishers next year. The USPS lost $1.1 billion in the third quarter and expects to continue losing until the year’s end.”
    It goes on to say the move to online editions and mail less which reduces USPS revenue more which means they raise rates more and fewer people ship and well looky here another self perpetuating cycle till death.
    Being in Vegas I’ve opened the line, 2 to 1 odds USPS crashes before Medicare, place your bets.
    A little something juicy for those conspiracy theorist;
    It seems every year Congress passes a law requiring Insurers to mail another notice to peoples’ homes. First it was COBRA, then HIPAA, then Women’s Health and now ARRA COBRA. No one reads these mailings, they just drive up the cost of insurance and add waste to our landfills.
    IS CONGRESS KEEPING USPS AFLOT WITH REGUIRED NSURANCE COMPANY MAILINGS????
    You heard it here first, if not for ever increasing compliance mailings the USPS would already have failed!

  16. “statement reflected the fact that US mail is working quite well,”
    Add the U.S. Postal Service to the list of ailing businesses seeking help from Congress. The agency asked Congress last week to allow it to dip into a trust fund to pay for its retirees’ health care. In addition, the agency plans to cut 100 million work hours this fiscal year, its board of governors announced last week. Both steps illustrate the Postal Service’s dire financial condition: It lost $2.8 billion in 2008, despite slashing nearly $2 billion in expenses. Experts say the 2008 numbers underline the need for more sweeping changes.
    The USPS initially estimated its fiscal year (FY) 2001 budget deficit at $480 million, and this figure was approved by the USPS board in November 2000; then, just three months later, it grew to an estimated $2 billion-$3 billion. The next year, the Postal Service’s estimated deficit of $1.35 billion grew to $4.5 billion only six months later.
    So to critique a financially failing system he holds up as an example another financially failing system? We should replace our public health systems with their inefficency and lack of accountability with something more like the USPS with it’s inefficency and lack of accountability?
    Bill Maher’s statement was funny becuase he is illinformed and only knows the USPS to the point he drops his letter in the mail box and it magically shows up across the country a few days latter. Being unaware of the billions it bleeds every year and all the other systemic shortcomings he totally misses the real humor, another clueless progressive trying to be funny but only succeding in the irony.
    If you would like to explain how USPS is such a success I’ll humor you and listen but like a said before, anytime someone NEEDS a letter to be someplace they ship with UPS and FedEx, hardly the sign of a successful USPS.

  17. Doesn’t Maher understand why insurance companies control the money? Because the government gives it to them via employers using the tax code. I don’t recall him endorsing the McCain health proposal, but his remarks indicate he should have.
    Also, I wish the folks who endorse government-monopoly health insurance would make up their minds: Do private insurers in the U.S. pay for too much health care, or not enough? The evidence (See Shannon Brownlee “Overtreated” leans strongly towards the former.)

  18. Nate,
    I think Bill (not Maggie) MahEr’s statement reflected the fact that US mail is working quite well, arguably better than US healthcare as a whole. That means, a statewide monopoly actually might work, or at least it is unreasonable to discredit it by saying: look how bad US mail is. It is a statement of political comedy and a little more intelligent than the (conservative/libertarian) argument it adresses. Not more and not less.
    So, what is so bad about medicare, except medicare fraud? The price explosion is a systemwide phenomenon reflecting doctor’s ordering habits, which I believe are influenced by unrealistic patient expectations and our dysfunctional tort law. Don’t forget that medicare covers the elderly, people who do actually need medical care in high percentages.

  19. “While none of these systems are perfect, in almost every measurable way (and certainly every moral way), they take better care of more people for less money…”
    Except they don’t. Are the multiple British Trust single payor? Aren’t 7 of them bankrupt? Are you suggesting we implement a system we know ends in bankruptsy?
    To factually correct your statement almost every advanced industrialized country in the world provides better care more efficiently then Medicare, Medicaid, MA, and a couple other liberal states. Our employer based systems, there is no such thing as “The American Health Care System”, it’s an aggregation of thousands of systems, most of them good, the few public and progressive ones VERY VERY bad. We know what American single payor would look like, it’s exemplified by the public failures we suffer through now.

  20. Jonathan – the system you seem to be describing is socialized medicine, where all of the hospitals and clinics are government owned and operated, and all of the care-givers are government employees. Hence your rather ill-informed remarks about not trusting the guy who gets paid a couple bucks to read your MRI, and health care becoming like the post office.
    Actually, I wish our health care system were half as efficient as our national postal system! But that’s a different story – lets not confuse the issue too much 😉
    No, the system you are describing is akin to what they have in the UK. Single-payer is not that. Under single-payer, the majority of care is delivered by private entities, just as it is now. Doctors are not employed by the government under single-payer, and the government does own the hospitals. Single-payer simply means that there is a single entity that pays the medical bills – namely, a national health insurance administered by government and funded by our taxes.
    We don’t have to imagine what this would look like, or worry that this is a hopelessly utopian vision – almost every advanced industrialized country in the world uses some variation on the basic single-payer concept. While none of these systems are perfect, in almost every measurable way (and certainly every moral way), they take better care of more people for less money…

  21. “Medicare was passed in 1965 mainly because the elderly were being impoverished by medical bills when they inevitably got sick and the insurance industry could not afford to cover them”
    I would disagree with this, Medicare was passed as a means of Washington getting it’s hands on billions of dollars and a first step to taking over the entire healthcare system. Democrats have been very clear about that since before it was even introduced. If you go back and read Ted Kennedy’s statements through the 70s the liberals have always wanted control of the money, the wanted a handful of large national carriers regualted at the federal level. As time has shown they have been willing to destroy the current system to justify it, even if it meant people dieing like they did at the hands of HMOs.
    Congress act first and formost for the benefit of congress, Healthcare reform is to benefit politicians not the general public.
    Hospital reimbursements, in the markets I either had a contract or was paying claims flucuate on outside forces not inflationary pressure. We would go years where per diem charges would not increase, then Medicare would cut funding and all of a sudden they would jump 10%. If you where to remove the cost shifting of public plans onto private plans hospital reimbursements per unit have not increased at all I don’t beleive and have certainly tracked lower then CPI.
    “The routine office visit and the occasional Rx are not the problem whether patients pay for those out of pocket or not.”
    If we could cut 10-15% of the base cost tomorrow with no adverse effect on patients or rationing any care that would translate into a 12-18% reduction in insurance premiums. That would be a major deal to many individuals and small businesses. This is the problem with today’s argument about reform, a bunch of jokers with no experience in HC or clue what they are talking about are making all these proposals that will drasticially increase the cost of healthcare while there are 100 simple fixes we could make tomorrow that would have no negative impact on consumers. While politicians, propogandist, and wankers debate single payor or Obamacare we are needlessly paying 12-18% more then we need to. If they would fix the public cost shofting that could save another 20%. Would anyone out their not like to keep their current coverage with a 32-38% discount over current cost?If 80% of insured like their coverage as is they sure would like it 38% cheaper. Not to mention with that reduced cost millions more could afford insurance and businesses afford to offer it again.
    Almost the entire drop in employer benefits is attributed to small businesses. It is these businesses who are hurt hardest by regualtion and “reform” Large employers can self fund and enjoy ERISA protection from legislative ignorance. Take Ohio for example, group health plans, except those self funded, have to cover disabled dependents of employees. Why is it the responsibility of mom and pop small employer to pay the healthcare expenses of a 28 year old adult who doesn’t work for them? To save the public plan money they shifted the cost onto small employers. Laws like that are why employers stop offering insurance. One ex client of mine is stuck paying 250K a year for an over age dependent. This is what the public doesn’t understand, government is killing healthcare, not evil insurance companies, not for profitism.
    The question people need to be asking is if government takes over the whole system, like many progressives dream of, who do they shift cost to then??? Rather it’s over age dependents or Obama wanting injured soldiers to pay for their own care government can’t afford the promises they have already made, when they can’t afford the promises they are making today who will pay?

  22. Nate,
    I agree with you on the 99213 office visit increasing only in line with inflation or less over the last 30-40 years. Moreover, I’m not a fan of Bill Maher, nor do I want to see a single payer system.
    That all said, I think hospital price increases, especially list prices but prices paid by insurers as well, have increased materially faster than the Consumer Price Index over time. To give you (and others) a flavor for what we’re dealing with here in NYC, a colleague of mine required hip replacement surgery a few months back following a slip and fall accident. The well known academic medical center where she was treated billed $130K for the entire episode including $78K for a six day hospital stay, another $25K for 8 days in their rehabilitation center, and the surgeon billed $17K for a procedure that took about two hours or a bit more. Insurance paid about half of that. Another colleague required hip replacement surgery about a year ago. His surgeon also billed about $17K and insurance paid $11K. In late 2005, I was sent for angiography following an adverse change on a stress test. At a different NYC academic medical center, a blockage was found, a stent was inserted, and I was kept overnight and sent home the next day at around noon. The hospital billed $31K with insurance paying about $19K. The interventional cardiologist billed another $5K for a procedure (angiogram + stent insertion) that took about 30 minutes at most. Nobody but the very wealthy could afford to pay these bills out of pocket.
    Advances in medical technology make it possible to treat conditions that would have been a death sentence 40 years ago. Heart disease and many cancers are now treated and managed, albeit at high cost. I needed bypass surgery in 1999 even though I never smoked, maintained a normal weight and had cholesterol within the normal range. I need to take five prescriptions plus aspirin forever. Forty years ago, I most likely would have died of a heart attack in my early 50’s.
    Medicare was passed in 1965 mainly because the elderly were being impoverished by medical bills when they inevitably got sick and the insurance industry could not afford to cover them, even with high deductible plans, and make money at a price low income elderly people could afford. Rapidly rising costs for care related to episodes that include a hospitalization or outpatient procedure, faster than inflation price growth for brand name prescription drugs (especially specialty drugs) which have patent protection, the exploding use of high tech imaging, unrealistic patient expectations and defensive medicine, among other things are all contributing to the high cost of both health insurance and healthcare. The routine office visit and the occasional Rx are not the problem whether patients pay for those out of pocket or not.

  23. “I’m sure most of you would be shcoked to learn the reimbursement for 99213 or any other office visit has risen slower then inflation.”
    I guess that’s why primary care has been falling behind.
    “What we pay per unit of care is not the issue”
    Really? I guess what we pay for cancer treatment is not the issue, just what we pay for multiple treatments of cancer. Tell that to the patients paying the bills.

  24. The comparison to the post office is a false one and not at all logical. You can’t compare the per capita spending on healthcare to the cost of mailing one letter. An accurate comparison would be the cost of mailing one letter to incurring one office exam. I’m sure most of you would be shcoked to learn the reimbursement for 99213 or any other office visit has risen slower then inflation. What we pay per unit of care is not the issue, it is the number of units we consume.
    We have gone from 8 Rx per year to over 11. We see the doctor more often and have new expensive test.
    As typical of Mahar his simplicity is compeltly inaccurate and misleading. I beleive the Post office is currently a couple billion in the red? And twice in the last month on Yahoo news were stories about letters being delivered decades late. If that is what he wants for a HC system then let him have it, I’ll stick with my freedom of choice. Like mailing a letter if I absolutly need something to get there I don’t use the public USPS I go to a private for profit solution like FedEx or UPS. Cheaper and you know it will work. Not to mention if they screw up you get your money back, ever try asking USPS for a refund?
    Public solutions are livable if the outcome doesn’t matter, you can never depend on them though and they are always in financial duress and inefficient.
    How do you think Mahar would react to his doctor cutting a day of work out per week to save money?

  25. Since 1971, when the United States Postal Service became an independent agency and was expected to cover its operating costs from its own revenue, it has done a very satisfactory job in holding price increases, at least for first class mail, to about the level of general inflation as measured by the Consumer Price Index. Specifically, the cost to mail a first class letter was raised to 8 cents on May 16, 1971 from 6 cents which was the rate in effect since January 7, 1968. The 6 cent first class rate was clearly insufficient to cover the cost of providing the service at the time, but the Postal Service was not expected to cover its costs out of postal revenue alone before 1971. Believe it or not, one could mail a letter for 3 cents between 1932 and 1958! On May 11 of this year, the first class rate will rise to 44 cents (from 42 cents) or 5.5 times the 1971 rate, about in line with the increase in the CPI during the same period. As we all know, the prices for most medical services on a like for like basis increased far faster than general inflation over the same period and continue to do so. I suspect that third party payment which largely insulates the individual from the cost of care is at least partly responsible for this phenomenon.

  26. I agree with Dustin Lipson,
    Who pays doesn’t mean much- What we pay for does!
    Re-Mahar -yes he oversimplified this issue but since childhhod I’ve always been amazed that for the price of a postage stamp a letter that I wrote could go anyway safely in the US 🙂
    Dr. Rick Lippin
    Southampton,Pa

  27. If single-payer, single pool healthcare is the socially responsible thing to do, we need to acknowledge the fact that taking care of ourselves is also the socially responsible thing to do. I do not want to be in a pool with people that neglect their health or have 14 children like OctoMom. In a single payer world, it’s difficult to argue that that is socially irresponsible. Unfortunately, things like obesity, teen pregnancy, and gun violence are more prevalent in the US. That’s why we can’t make the leap in saying that if it’s good for France and Germany, it’s good for us.
    While I am slightly right of center on this issue, I am willing to have a good discussion about single-payer. Unfortunately, major details continue to get left out such as 1) holding people responsible for not driving up costs, 2) how much is the transition to single-payer going to cost?, 3) how long will it take?, 4) what methodology will be used to set the universal budgets I keep hearing about? etc. Maher was simply speaking in soundbites. He’s a funny guy, but I don’t think we should be consulting him on health policy issues.

  28. “Private insurance payors in the United States have for years been maximizing profits with their incentive to delay or deny coverage.”
    Greg Pawelski do you have even one study to back up any of that? First off your not even using the proper terms you mean insurance companies which are not the same as payors. Do you even know what insuranc company profits are?
    “Those that can afford and pay exorbitant prices for health care are not miserable.”
    Any proof of this? 80% of people are happy with their insruance coverage and don’t want to lose it.
    “Doctors can’t practice the type of medicine they’re trained for because of HMO-based evidence and pharma-based evidence in medical care.”
    With 75% of people not in HMOs how does this magical HMO based evidence have such an effect? If HMOs are so bad why did Ted Kennedy make it a Federal Law employers had to offer them?
    “when 2/3rds of the American public wants single-payer reform”
    care4all 2/3rds of far left progressives you polled on your way to the organic garden? 80% of those insured don’t want to lose their coverage making it mathmatically impossible that 2/3rds want single payor.
    Speaking of false information Fred;
    “where 52M people are not covered, people can be rejected for prior conditions, most people can’t afford the copays for serious illnesses, etc.”
    Try 46 million last count which was down from 47. HIPAA makes it illegal in most cases to reject someone for prior conditions and can you cite anything to prove most people can’t afford the co-pays for serious illness? Seeing as how co-pays generally range from $5-$150 I find it hard to beleive co-pays are an issue.
    Ill and Uninsured in Illinois no for a fact most people don’t put up with that now.

  29. Does anyone have a source for healthcare costs/outcomes broken down by income level? In education circles, I see lots of data that shows that middle and high income kids perform as well as or better than their international counterparts, but the poor kids do significantly worse, thus bringing down the average. Is this effect at play in healthcare as well?
    I ask because it seems that the real issue in the US is poverty and the disappearing middle class. If changes could be made so that a smaller percentage of our citizens lived in poverty, and therefore could afford decent medical care and could have the time and energy to invest in their children’s education, then we could truly compare ourselves to our neighbors. Ultimately, we need to address the two class system in the US to see the societal benefits we are hoping for.

  30. Dr. Sucher, I can easily compare nearly a decade of US experience as a nonsurgical specialty physician with years in Germany and a good half year in France.
    The truth is, peak care (Mayo, Cleveland, Mass. Gen.) is about equal in all three countries. You can have exceptional care in all countries, although you probably have to look most closely in Germany where you go to because physicians standards are somewhat uneven (and there is no one institution that is really strong on almost everything like Mayo). In France, you will get excellent care at many academic facilities (at least).
    Now looking at bottom quality care, I met very few if any truly incompetent physicians in the US, esp. not specialists due to the usually hard boards exams. There is a substantial minority of poor quality physicians in Germany, and I don’t know enough about France.
    Long story short, I do not see a direct correlation of money spent with physician quality (neither peak nor bottom) in western developped countries. Pay physicians well and set high standards (both issues that are neglected in Germany and better in France), and you’ll have decent quality (your peak quality comes automically if you have strong academic institutions).
    And in general, consider the bang for the buck. I think it’s like making a car safe … at a certain level (after you have covered airbags, ABS, good crumplezones etc.), you don’t get much improvement for the car safety dollar. The US is already past that level, either spending too much on “quality” or at least not spending it at the right places.

  31. One real problem is that we somehow need to separate the two issues within the “healthcare argument”. That is, the business of U.S. healthcare is catastrophically broken. However, the sophistication and quality of U.S. healthcare is high and continually improving. We somehow need to focus on the the former and fix this issue of how we pay for healthcare in America, while improving on the great quality.
    JFS

  32. “I (as an immigrant) wonder where this contempt for the US mail comes from … ”
    I agree rbar, I think the U.S. postal system is great, but I’ve lived with Canadian postal workers and service, so I have something to compare it to. Most Americans haven’t been outside their own county, let alone the country.
    If you attempt to compare the DMV to single-pay healthcare you are missing the reason for the long lines and poor service at the DMV. Most DMVs charge enough money to provide great service and short lines, but the government drains DMV taxes/fees to support general fund expenditures, and intensionally starves the DMV of funding. The DMV is usually a cash cow for the general fund. In NC I’ve had pretty good service from the DMV. I renew plates on-line and have never waited longer than 30 minutes for a driver’s license re-issue; I can even make an appointment which saves the line. If you want better DMV service get your politicians to start doing truthful budgeting that doesn’t involve robbing peter to pay paul. And for that matter, how long have you waited in the for-profit ER for service, I bet at least an hour if not 2-3, unless you near death.
    “The answer is, it’s not if they get this wrong (and they will).”
    Exactly, but they WILL get it wrong, we all know that. There will definatly have to be a paradigm shift in politics and healthcare expectations for us to get single-pay, as well as single-pay that works.

  33. Roy Blunt was using a similar scare tactic the other week, comparing government-run health care to the DMV — “Lines, paperwork…” Like most people don’t put up with that for health care now?
    My response: http://illinillinois.blogspot.com/2009/03/even-ryan-could-run-better-health-care.html Illinois’ last Republican governor went to jail for taking bribes for drivers’ licenses, and even he could run a better health-care system.

  34. Whilst I typically love the humor of Bill Maher, this clip does more harm than good. The issue of access and rising cost is not solved by changing who pays the bill (as much as I wish it would). One of our biggest problems has been treating healthcare as if it is a commodity when it is anything but. Groups bargain for the lowest prices shifting cost back and forth from provider to government, patient to government, insurer to patient and so on. Shifting cost does not improve the quality of care at a given price. Understanding medical outcomes achieved at a particular price (i.e. understanding value) is the only way to make progress. By measuring value we will empower better decision making by all involved–payers will know what kind of care they get at what price, insurers can be clear on what level of value they are willing to cover and what they arent (Is a $1B treatment worth an extra day of life?), and providers can improve their offerings based on competitive advantage. A metaphor for the existing situation would be going to a car dealership and being offered three cars that look the same on the outside for dramatically different prices and being told that you can have no information on safety, gas mileage, drive quality, longevity, etc. and oh by the way, while I can tell you that the prices are dramatically different, I can’t tell you the actual prices for the various cars. You pick one and I’ll give you the bill. How can any participant in healthcare be expected to make informed decisions without access to the most important information–quality of care and cost? Oversimplification of the issue and continued cost shifting will only continue the downward spiral.

  35. Jonathan’s comment repeats the false information that litigation is the ’cause’ of the current escalation in costs, or has anything significant to do with the current health care situation where 52M people are not covered, people can be rejected for prior conditions, most people can’t afford the copays for serious illnesses, etc. In fact the $ amount of litigation claims paid has gone down over the last 20 years (despite the vast increase in health spending) and YET the cost of malpractice insurance has gone sky high. Also the gov’t subsidizes most of medicine in one form or another, and the idea that a system that brings us to the cost of most other first world countries with their level of care would cause doctors to ‘strike’ or we would get 2.50/hr people reading MRI’s is simply scare tactics in the hope of seeing the current 2.5T health care bill rise to 4T without any improvement in the health of the American population.

  36. Private insurance payors in the United States have for years been maximizing profits with their incentive to delay or deny coverage. Doctors can’t practice the type of medicine they’re trained for because of HMO-based evidence and pharma-based evidence in medical care. Everyone in America is not equal when it comes to health care. It is not equal in the “miserable” index. Those that can afford and pay exorbitant prices for health care are not miserable. Heartless and uncaring is a perfect attribute of the for-profit U.S. health care system.

  37. Problem is, health care won’t ever function like the post office. Unlike mail carriers and most other post office employees who could easily be exchanged for someone else, health care providers require a lot of training and take a lot of risk in assuming their profession. These are intelligent people. If the appropriate compensation for the amount of time and energy they invest in their education and training is not given, most of them will simply choose another profession. Then what happens to this government-run health care that people are so eager for? The quality of care drops dramatically. You’re probably going to get a tiered system where the only place you’ll get a decent medical opinion will be to pay a ton for it. But hey, the government is covering the basics, right? Having the government run things might be “cheaper,” but can you really trust the guy they paid $2.50 to read your MRI?
    You want to know a better, easier way to make health care cheaper so that everyone can afford it (if they want it)? Pass some better legislation for reducing the wasteful litigation prevalent in today’s medical community so doctors don’t have to practice such defensive medicine.

  38. Great video! Maher is right.
    I don’t understand why, when 2/3rds of the American public wants single-payer reform, that it’s not seriously on the table.

  39. Bill Maher is, as so often, right, and his wording is simple, witty and yet precise. (He just should stop talking about how you can avoid all disease by eating healthy and other lifestyle choices.)
    I (as an immigrant) wonder where this contempt for the US mail comes from …

  40. Why is it that the most clear statements about society lately. First John Stewart on financial reporting and now Bill Maher, speaking the truth about what has to happen to our healthcare system if we are to claim to live in a civilized society.

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