What do the world's "laboratories of democracy" tell us about health care?
Republicans, at least rhetorically, claim to value federalism and to believe that the states can function as "laboratories of democracy"-- places where policy experimentation can take place. Through this process, flawed policies are exposed and voted down and newer, better policies are given a chance to prove themselves. Over time, the policies that prove to be the best are adopted by other states.
For some reason, though, the only laboratories of democracy that matter to Republicans are those located within the United States.
This is especially true when it comes to health care. The United States is not the only industrialized democracy in the world. We are, however, the only one that does not guarantee basic health care to all of its citizens. When Democrats propose relatively mild reforms to our current dysfunctional system, such as creating a public insurance option, Republicans flip out and suggest that doing so will result in some sort of socialized health care dystopia.
But we don't need to travel into some hypothetical world to understand what universal health care looks like. There are literally dozens of countries in the real world that have functioning universal health care systems. Indeed, the verdict of the world's laboratories of democracy is pretty clear. Virtually all of them produce better health outcomes at less cost while covering everyone. We're the outliers. We're the laboratory that's stubbornly refusing to acknowledge that its experiment has failed.
To adopt the Republican position on health care requires believing that every other country in the world is wrong, that their policy experts are misguided and their citizens confused. Indeed it requires believing that the American people themselves are wrong, that despite endless opinion polls to the contrary, people in this country really love the system we have.
You would think that, at some point, these lovers of federalism would ask themselves why it is that no country in the world currently has (or has any plans to adopt) the kind of health care system they're clamoring for. After all, if the ideal health care system is one in which the government plays the least active role and lets the free market work its magic, you would think that some country would have already tried that by now. Such a policy is, after all, much easier to execute and to fund. It's infinitely less complex and requires much less government spending, so you would think that at least some group of lawmakers somewhere would have given the "do nothing" approach a shot. And if the results were as great as the Republicans claim, by now most countries would be following such a system.
Of course, the reason no one follows such a system is because it doesn't work. As economists have understood for many decades, markets don't work very well in the area of health care, at least if the goal is producing a world in which most people can afford care. Indeed, the reason we have a patchwork system of health care in this country is precisely because the market doesn't work and the government has been forced to step in and remedy its most glaring failures. Under a free market system, most elderly people are priced out of the market (hence the need for Medicare). Under a free market system, the poor can't afford health care (hence the need for Medicaid). Under a free market system, children of those without insurance have no access to health care (hence the need for S-CHIP). Every health insurance regulation or government program currently on the books was passed in order to address a significant failure of the market.
Other countries have confronted the exact same issues, but instead of trying to solve these problems piecemeal, they have opted for a comprehensive approach. In an effort to discredit the far better approaches taken by other countries, Republicans like to cherry-pick stories of people who were denied treatment or had to wait for treatment under a universal system (while ignoring the very same kinds of stories in our country). But here are some numbers they ignore:
The number of people in other industrialized democracies who go bankrupt as a result of medical bills = 0
The number of people in other industrialized democracies who lack access to routine medical care = 0
The number of people in other industrialized democracies who feel trapped at their jobs for fear of losing their (or their family's) health insurance = 0.
That last number is particularly galling given conservative reverence for entrepreneurism. Though it's difficult to quantify, I would bet that our dysfunctional health care system, more than any other factor, discourages entrepreneurial risk-taking in this country. Which makes all this talk about free markets all the more absurd.
For some reason, though, the only laboratories of democracy that matter to Republicans are those located within the United States.
This is especially true when it comes to health care. The United States is not the only industrialized democracy in the world. We are, however, the only one that does not guarantee basic health care to all of its citizens. When Democrats propose relatively mild reforms to our current dysfunctional system, such as creating a public insurance option, Republicans flip out and suggest that doing so will result in some sort of socialized health care dystopia.
But we don't need to travel into some hypothetical world to understand what universal health care looks like. There are literally dozens of countries in the real world that have functioning universal health care systems. Indeed, the verdict of the world's laboratories of democracy is pretty clear. Virtually all of them produce better health outcomes at less cost while covering everyone. We're the outliers. We're the laboratory that's stubbornly refusing to acknowledge that its experiment has failed.
To adopt the Republican position on health care requires believing that every other country in the world is wrong, that their policy experts are misguided and their citizens confused. Indeed it requires believing that the American people themselves are wrong, that despite endless opinion polls to the contrary, people in this country really love the system we have.
You would think that, at some point, these lovers of federalism would ask themselves why it is that no country in the world currently has (or has any plans to adopt) the kind of health care system they're clamoring for. After all, if the ideal health care system is one in which the government plays the least active role and lets the free market work its magic, you would think that some country would have already tried that by now. Such a policy is, after all, much easier to execute and to fund. It's infinitely less complex and requires much less government spending, so you would think that at least some group of lawmakers somewhere would have given the "do nothing" approach a shot. And if the results were as great as the Republicans claim, by now most countries would be following such a system.
Of course, the reason no one follows such a system is because it doesn't work. As economists have understood for many decades, markets don't work very well in the area of health care, at least if the goal is producing a world in which most people can afford care. Indeed, the reason we have a patchwork system of health care in this country is precisely because the market doesn't work and the government has been forced to step in and remedy its most glaring failures. Under a free market system, most elderly people are priced out of the market (hence the need for Medicare). Under a free market system, the poor can't afford health care (hence the need for Medicaid). Under a free market system, children of those without insurance have no access to health care (hence the need for S-CHIP). Every health insurance regulation or government program currently on the books was passed in order to address a significant failure of the market.
Other countries have confronted the exact same issues, but instead of trying to solve these problems piecemeal, they have opted for a comprehensive approach. In an effort to discredit the far better approaches taken by other countries, Republicans like to cherry-pick stories of people who were denied treatment or had to wait for treatment under a universal system (while ignoring the very same kinds of stories in our country). But here are some numbers they ignore:
The number of people in other industrialized democracies who go bankrupt as a result of medical bills = 0
The number of people in other industrialized democracies who lack access to routine medical care = 0
The number of people in other industrialized democracies who feel trapped at their jobs for fear of losing their (or their family's) health insurance = 0.
That last number is particularly galling given conservative reverence for entrepreneurism. Though it's difficult to quantify, I would bet that our dysfunctional health care system, more than any other factor, discourages entrepreneurial risk-taking in this country. Which makes all this talk about free markets all the more absurd.
posted by A.L. at 12:29 PM
31 Comments:
bravo!
Let's not forget about the number of lawsuits that are needed in this country because people have no other way of covering their medical bills other than seeking redress through the tort system. This should be a concern for people who are supposedly worried that the trial lawyers are ruining America.
Personally, I think about all this talk about a free market system being superior and so forth is just a smoke screen. I think it's more palatable to make a hand-waving economic argument than say what many really feel- that some people don't deserve basic health care.
To many conservatives, even suggesting that any other country could do anything better than we do is unpatriotic and an outrage, hence the hostility to Michael Moore when he came out with Sicko. Have you noticed that since the Soviet Union no longer exists so calling Obama a Communist is no longer credible, they instead accuse him of attempting to introduce European-style social democracy -- and speak of Europe with the same sort of horror they once reserved for the Soviet Union?
So far as some people are concerned, if other people do it and we don't, that alone is reason for condemnation. I don't know how to deal with people like that.
I think this myopia has a lot to do with a broader US assumption that everything done in America is, by definition, the best anywhere. That presmption of superiority, coupled with a fairly unseemly nationalism, is what offends and concerns many of us who would otherwise be very pro-USA on most issues. It is amazing to watch the scales fall from the eyes of new US ex-pats arriving here in Australia as they realise that:
1. Healthcare is affordable and available to everyone here - and the standard of care rivals anywhere else in the world (yes, we have our horror stories but they are the exception, not the rule);
2. There are very few economic barriers to attending college - the Government run loan scheme is efficient and popular (ex-pats are also shocked to learn that many Australians are better educated than their peers back home);
3. Most amazing of all, Australian politicians spend very little time raising money.
Re "We're the laboratory that's stubbornly refusing to acknowledge that its experiment has failed."
That's because of the uniquely American character of our society which makes comparisons with other (successful) countries meaningless. At least that's what Giuliani told us last year.
But to get serious, I think A.L.'s observation that "Under a free market system, most elderly people are priced out of the market." is something that Republicans should convincingly deny (or defend). I would make that the starting point in any debate. Let Republicans defend a pure free market approach to health care for seniors.
The obvious question is why we can't just let the states each have their own health care system? If, as you postulate, government-run systems have an inherent advantage, one would expect that the states would move in that direction. Why not wait to see how, for example, Massachusetts' experiment works out before imposing it on the rest of the country?
MLS,
There's been a lot written by health policy analysts on exactly that point, so I'd encourage you to go find it. Long story short, there are a number of structural factors that prevent the states from truly experimenting in the health care policy area. It is much easier to work at a national level. The experimental conditions at the state level, at least on this issue, aren't well-suited to testing national policies.
Also, given that every other nation in the world has a functioning universal system, how much more experimentation is necessary? Can't we just look around and find the best policies and implement them? The longer we wait, the more costs go up and the more people go without insurance. We have decades to think about this. It's time to act.
AL- I am sure that if I had time to exhaustively research the subject, I would learn that all of the (nameless) experts in the field agree with your position. (This may be because the ones who disagree are, by definition, not experts). It seems like that is the case with every issue we discuss.
Unfortunately, all I have is a few minutes to google, in which time I found a debate between Ezra Klein and Meghan McArdle. Klein argued that the main reason state experiments don’t work is that they lack the power to deficit spend, and so they can’t afford to keep their systems when expenses outstrip revenues. McArdle responds: “the reason that they all failed was that they were incredibly expensive. Moreover, they were vastly more expensive than the planners had anticipated, which knocked budgets out of whack. This in spite of the fact that the programs were very well positioned to take advantage of all of the collective bargaining, administrative, and preventative medicine efficiencies that advocates of national health care keep promising us will shave the cost of such a system. Whatever those savings are, the evidence seems to be that they are outweighed by the fact that if you make health care free, and don't ration it, people use a whole lot more than you were expecting them to. Your costs, accordingly, shoot through the roof.”
Now I am sure that we are not going to make any progress on resolving this debate here, but let me just make this observation. If you are going to use the “laboratories of democracy” rhetoric and then claim (when challenged) that we can’t actually do any experimenting in our very own laboratories of democracy, I don’t see how you are going to convince anyone outside of the amen choir.
In an effort to discredit the far better approaches taken by other countries, Republicans like to cherry-pick stories of people who were denied treatment or had to wait for treatment under a universal system (while ignoring the very same kinds of stories in our country).
Cherry-pick stories. Well, this is a list of about 110 stories, since 2004, of huge problems with Britain's nationalized healthcare system. And here are 57 stories of problems, since 2003, with Canada's nationalized healthcare system.
Back in this post about the Uighers that were (are) held in Gitmo, A.L. criticized conservatives for describing terrorists as, quoting Jonah Goldberg, "fairly inhuman people". Here's what A.L. said following that:
This is not a joke. These are real people.
Those stories regarding the problems of nationalized health care that Republicans and conservatives supposedly "cherry-pick" are stories of real people. And there aren't just one or two or even a dozen stories; I've linked to a list of more than 150. That goes beyond cherry-picking; it indicates real problems. But to A.L., that isn't what is important. All that matters is the appearance of doing something for the elderly and the poor, even if the remedy makes things worse for all these real people and everybody else.
Steve, do you studiously ignore the health care news in this country. I guarantee you that for every bad story about some other country's health system, there are 10 more about our country. And instead of being about how a few people had to wait for something, they're about how tens of millions lack coverage altogether and tens of millions more have inadequate coverage. They're stories about people going bankrupt and losing their homes, by the thousands.
There are also public opinion polls showing that people in other countries are far more satisfied with their health care systems than people in this country.
It always amazes me when conservatives like yourself focus on the minor deficiencies in other countries systems while completely ignoring the much ones in ours.
If you are going to use the “laboratories of democracy” rhetoric and then claim (when challenged) that we can’t actually do any experimenting in our very own laboratories of democracy, I don’t see how you are going to convince anyone outside of the amen choir.
mls, that's not what I said. My point was that other countries are better laboratories on this particular issue. Individual states are much more constrained in what they can do, not only because of deficit-spending rules, but more importantly, because a huge percentage of health care spending is already done by the federal government. States can try to extent coverage but they have no leverage or ability to contain costs or make structural changes. They don't control enough of the system to do much in terms of comprehensive reform.
But other countries do. Not only that, but they've been providing universal health care for decades, so their experiments are much longer and provide much more useful information.
Claiming that we need to do further experimentation within the states is a pure cop out, and excuse for delaying addressing the problem.
A.L.:
It always amazes me when conservatives like yourself focus on the minor deficiencies in other countries systems while completely ignoring the much ones in ours.
I don't ignore it. I, like you, believe it is a real problem. Where I disagree with you is that what you call minor deficiencies aren't minor at all, and more widespread than you'd be willing to acknowledge; and, the solution offered by the left won't work. Because the U.S. isn't other countries.
SteveAR,
When the USA was a fledgling democracy, in a world of monarchies and colonies, it was certainly true that the USA wasn't other countries. In 1950, for example, a majority of the children born were born in small towns or into farm families.
As the population has grown, and as the cities and suburbs have expanded, and as the rest of the world has become more democratic, more industrial, and more technological, the difference between the USA and other countries has dwindled.
Now the main differences appear to be that the USA is sliding backward into fundamentalism, anti-intellectualism, and economic stagnation, while the rest of the world marches forward.
None of those trends are a bar to whether universal health care, as implemented by other countries, will work. Anti-intellectualism, however, may make it difficult to enact, as exemplified by your unreasoning refusal to admit that the current system is broken.
mls said... McArdle responds: “the reason that they all failed was that they were incredibly expensive….
The problem is mainly that state governments have to present a 'balanced' budget so in recessions, they are forced to cuts; and because of Republican ideologues, the first thinks that are generally cut are health and human services. Compassionate means Screw the People in GOP terminology.
Here's an article on Massachusetts health care reform
http://en.wikipedia.org/wiki/Chapter_58
SteveAR said... Well, this is a list of about 110 stories…
All of which are dwarfed by the horror stories about the lack of health care in America.
Clean up your own act before whining about others.
http://www.nytimes.com/2009/07/01/business/01meddebt.html?ref=business
Mike
AL,
I absolutely think that studying other countries is instructive. It's, for example, interesting to me how Canadians have to wait for care in their country or how the average British person's teeth looks like a rat's nest. I don't, however, know how you arrive at this statement:
Virtually all of them produce better health outcomes at less cost while covering everyone. We're the outliers.
What are the better outcomes? Please don't tell me life expectancy, which plenty of literature will tell you is not an indicator of a health system.
Some suggested reading on that point:
http://www.udel.edu/educ/gottfredson/reprints/2004fundamentalcause.pdf (page 181)
Also, this: http://www.usatoday.com/news/health/2006-09-11-life-expectancy_x.htm
Jonathan Skinner of Dartmouth says much of the variation depends on such individual factors as diet, exercise and smoking, not health care. "Yet we spend much of our attention and 16% of our national income on health care," Skinner says. "There's no way that differences in the quality of health care can explain 20-year gaps in life expectancy."
The best predictor of longevity in America is not income but race, with Asians living the longest at 85. Coincidentally the state with the highest life expectancy is Hawaii, which also has the greatest percentage of Asians. Native Americans live two years longer than urban blacks despite having a per capita income that is $4K less.
In any case I am glad to see that you are as upset as I am about the insane link between employment and health insurance, which of course is a product of dumb government policy rather than the free market (of which there is little in health care).
"Which makes all this talk about free markets all the more absurd."
A.L., that 'free market' pablum has been conservative bullshit for a long time. It's fine for taxpayers to ante up to corporate coffers via tax breaks and subsidies, cons don't interpret that as 'welfare'. That is touted as capitalism at its finest.
Colin, one place you could start looking is the WHO ranking of the world's health systems.
http://www.photius.com/rankings/healthranks.html
The U.S. comes in a solid 37th. You can quibble with the metrics all you want, but the bottomline is that a lot of other countries manage to cover all of their citizens and produce outcomes at least as good as our (if not better) while spending far less money.
And please stop talking about the UK. Literally no one is suggesting moving to an NHS like system. That's a ridiculous straw man. And if you want to talk about lines in Canada, it's probably also worth noting that 1) most Canadanians get prompt, quality care and like their system (waits are limited to certain procedures), and 2)many people face the same sorts of waits here (it all depends on what kind of insurance you have).
It's probably also worth noting that Canadians spend way less than we do. If they spent the same per-capita amount that we do, they wouldn't have any waits for anything.
The bottomline is that conservative scare tactics are just that. They make it like providig universal care will result in some sort of horrible dystopia, when the reality is that there are plenty of very good universal systems all over the world.
Finally, while we agree that it is absurd to tie insurance to employment, your solution would make the problem worse. Employers have much greater bargaining power than individuals, which is allows them to negotiate lower prices and ensure that all of their employees will be covered. Individuals will always be jerked around and cherry-picked by health insurers because they lack the bargaining power of a company or a government.
Well, yes, the metrics used by the WHO study are ridiculous and are designed to give universal systems a higher rank. Or, who knows, maybe they are right and Colombia really does have a better health care system than us.
I also like how the left runs around talking about medical bankruptcies but when the right responds with talk of wait times well that's just a scare tactic.
Right, got it.
Your logic in the final paragraph, meanwhile, doesn't mesh with the evidence. Are individuals currently jerked around for home or auto insurance? Why would health insurance be different? Currently I buy my own health insurance. I went on ehealthinsurance.com and picked out a plan. It was no big deal.
Do you find yourself jerked around for most products you guy? Or do you have to band collectively with others to obtain a good deal?
Your theory seems more rooted in doom-mongering than observable reality.
Your logic in the final paragraph, meanwhile, doesn't mesh with the evidence. Are individuals currently jerked around for home or auto insurance? Why would health insurance be different?
Look, Colin, if you don't realize how silly a question this is, there's probably not much point in continuing this discussion. I'd encourage to go read or think about the myriad of ways in which health insurance is different than car insurance.
For starters, you might want to consider the sources of risk that contribute to premium prices. With car insurance, safe drivers can count on being able to purchase insurance at a reasonable rate. And unsafe drivers? Well, we don't feel so bad about them paying more because they choose to be unsafe drivers.
But with health care, you generally don't choose to be diabetic or get cancer. And once you have something like that, no company will offer to insure you for the costs associated with it. It's like trying to buy car insurance to cover the costs of an accident that already happened. So you're screwed.
In the health care arena, the factors that contribute to your insurance risk are generally not things within your control. The result is that consumers don't have the bargaining power or control over their fate that they do when it comes to other forms of insurance.
This is just one of the many differences that make business models for home and care insurance not work very well in the health insurance context. There's all kinds of literature on this if you're actually interest talking policy instead of making superficial (and very weak) comparative arguments.
One final question. Do you really think that, absent Medicare, most elderly people would be able to afford medical care? Do you really think private insurance companies would offer affordable policies to elderly people? Really?
But with health care, you generally don't choose to be diabetic or get cancer. And once you have something like that, no company will offer to insure you for the costs associated with it.
Well, of course -- which is why you buy insurance before you develop cancer or diabetes. After all, that is the whole point of insurance, to guard against the unforeseen, not what is currently happening.
In the health care arena, the factors that contribute to your insurance risk are generally not things within your control. The result is that consumers don't have the bargaining power or control over their fate that they do when it comes to other forms of insurance.
The biggest risk factor is age. This is not unique, with life insurance also functioning the same way. There is a way around this, however. Many companies allow you to lock in low rates provided that you buy when you're young.
One final question. Do you really think that, absent Medicare, most elderly people would be able to afford medical care? Do you really think private insurance companies would offer affordable policies to elderly people? Really?
Again, they would if you would start paying premiums when you're young. Really.
But then again, I'm not here to defend the insurance model. As you noted with the Chris Rock quote, insurance is for "in case s***." Routine care doesn't qualify. Why we use insurance to pay for such services is bizarre.
The rather simple solution is to eliminate the tax break for insurance, which would promote fee for service while leaving insurance for catastrophic and emergency care.
Becoming elderly isn't unpredictable. It happens to everyone provided they live long enough. People should save money for this eventuality so they can pay for their medical care.
Meanwhile, the introduction of a free market system would drive down prices and expand affordability.
One final point: Just about every significant government social program we have is a failure. Medicare and social security are unsustainable (Medicare more so than SS). The rise of the department of education has corresponded with a decline in academic performance. Public housing is synonymous with all manner of social ills and the latest fad is tearing such projects down. The war on poverty has not met with success. AFDC fostered dependence on the government.
Indeed, the biggest public policy success of the past 15 years was reducing welfare and scaling the program back.
Think about that -- every program meets with failure. It's like government has the opposite of the Midas touch -- everything turns to crap. And yet the solution to health care is MORE government? Really?
I love the way libertarians can so casually declare SS and Medicare to be failures. Do you have any familiarity with history. SS is the most successful government program of all time. It, virtually single-handedly, ended the widespread problem of elderly poverty in this country. Things were REALLY bad before social security. You really should read your history on this subject. Moreover, SS requires only minor tweeking to be solvent over the long term. The projected shortfall is small and easily correctable. Hardly worth scrapping such a successful program.
As for Medicare, it too has been remarkably successful. As I said, most elderly people lacked access to health care before Medicare. The insurance model is simply unrealistic for elderly people. It is economically unfeasible and it is completely unrealistic to expect all or even most people to buy and keep an insurance policy their whole lives. And, by the way, if you think policies are expensive now, imagine if the premiums factored in coverage after age 65 (currently covered by Medicare). They would be astronomical.
Medicare's problem is due almost entirely to an externality, rising health care costs. When Medicare was passed, no one knew that costs would rise so dramatically. And that externality is straining the private insurance system just as much as the public insurance system. It's not unique to Medicare. So the problem isn't Medicare, it's health care costs generally. If we solve that problem, Medicare will be fine.
Colin,
I asked this on the other thread as well: what companies allow you to "lock in" a price for health insurance? I'd really like to recommend some of that for a young friend, but nobody but you, apparently, has ever heard of it.
Colin said:
Your logic in the final paragraph, meanwhile, doesn't mesh with the evidence. Are individuals currently jerked around for home or auto insurance?
Are you kidding? Of course we are jerked around on auto insurance. That fact that I have to buy insurance against uninsured drivers is just one example of that.
We could easily ensure that every driver has liability insurance by putting a tax on fuel at the pump (probably for less than we pay now, those of us who actually buy it). Everyone would have liability insurance and then could decide whether they wanted medical, comprehensive, or collision. But insurance companies hate that idea because they would lose profits from not selling liability, and they couldn’t sell uninsured motorists policies anymore.
The for-profit insurance companies aren’t in business to cover people, they are in business to make money. They cherry-pick in all of their businesses, if allowed to. That’s why you have to buy flood insurance from the government, because private companies don’t think they can make a profit on it.
Though it's difficult to quantify, I would bet that our dysfunctional health care system, more than any other factor, discourages entrepreneurial risk-taking in this country.
Agree. I personally have four pending opportunities to do interesting and productive contracting work and cannot because I need health insurance.
As to long waits in Canada, I live in Virginia and had a recent cancer scare. I have good insurance. It took me nearly eight weeks to get to see the specialist. Not so good.
Wow, conservatives seem to be utterly unable to conceive of someone having circumstances different from theirs. "they should save money for these things" have you ever been poor? Lots of people live paycheck to paycheck and the minuscule savings that some are able to achieve is usually eaten up by other eventualities.
It's like you can't imagine not being white, insured, well employed, and no history of chronic illness.
The variety of situations Americans grow up in are so diverse that this narrow "everyones life is like mine" thinking is ridiculous. And I am getting sick of this nationalistic shit about how america is so special and that somehow the richest country on earth can't manage to provide health care for everyone even though it already pays through the nose for this scam of a system. It's like conservatives get mad at the mere idea of people being less oppressed.
Sorry if the typing and wording was sloppy. I was angry and sleepy.
Colin -
how the average British person's teeth looks like a rat's nest.
You seem like someone who really knows what he's talking about instead of indulging in cheap stereotypes (/sarcasm), but while it's true that British dentistry IS substandard, it's actually because the vast majority of British dentists have OPTED OUT of the NHS, and are therefore horribly overpriced. British dentistry is probably the only aspect of UK health care that's remotely similar to America's.
Colin, you ask "What are the better outcomes [in other countries]"?
Since you won't accept life expectancy or infant mortality, how about the following, from Jonathan Cohn in today's Boston Globe:
Overall, the US actually fares poorly on measures like “potential years of lives lost” - statistics compiled by specialists in an effort to measure how well healthcare systems perform. In a 2003 ranking of 20 advanced countries, the US finished 16th when it came to “mortality amenable to healthcare,” another statistic that strives to capture the impact of a health system. The Dutch were 11th and the French were fifth. These statistics are necessarily crude; diet, culture, and many other factors inevitably affect the results. But, taken together, they make it awfully hard to argue that care in these countries is somehow inferior. If anything, the opposite would seem to be true.
More here, if you care.
Though the model could be greatly improved, there are fundamental strengths in the NHS. In case of catastrophic illness or accident, everyone is covered. Wait times for, and rationing of elective procedures is balanced by a high rate of quality of and guaranteed access to emergency care. The majority of the stories of rationed care, waits for doctor visits, and the like are for elective or routine care for which employers are required to make allowances for necessary absences.
Rationing is a problem and should certainly not be a part of an American system, but rationed care is already a fundamental part of the existing insurance system. The purpose of an insurance company is to collect money for policies without having to pay out. Since everyone is going to need health care, this is impossible on the health care model.
Conservative 'free market' solutions often carry a deep, dark secret... the private sector is unable to compete with public health care services in places or demographics where they exist. The Republican plan endorsed by conservative worthies such as Judd Gregg explicitly includes a carefully worded mission statement of gutting Medicare by raising prices and rationing care to force seniors into the 'free market.' This is actually IN the plan.
Think about that. If Medicare were really a 'failed' program, would that be necessary?
I live in Tennessee, which had a very successful public health system... which was gutted because the state is unwilling to impose any state income tax. Sure, that's great for people who never need any kind of public services ever. For ninety percent of the population, it's not so great. It means a regressive sales tax and sin tax system coupled with expensive point of service fees at government offices. People with lower incomes are affected the most and the richest are affected the least.
On top of that, TN is one of the few states that allows hospitals to sue individuals for medical bills, creating a huge economic disaster with the gutting of the public option... which was overburdened because it delivered much better service than private health providers and everyone who could qualify jumped on as a result.
The public option offered better care at better rates, so everyone who could used it. Consider that.
When conservatives say that 'a public health option means the end of private health care', there is a reason they believe so. They know the private health /insurance/ industry cannot compete with genuine health /care/.
You can point to what you might see as silver lining to health care in other countries, but when people around the world need quality care and they need it fast, they predominantly come to the U.S. Many people that don't come to the U.S. buy their own supplemental health coverage because the "free" health care is lacking in some way.
And while everyone might have som level of "health care," far fewer people have a job. While you may say that you'd rather have health care than a job, you're most likely saying that as someone who has a job.
Growth in high-tax countries is also severely reduced. That is not a coincidence. Reduced economic growth limits the very possibility of individuals becoming self-sufficient and being able to purchase the quality care they might want and need.
The elderly can afford health care as long as they've been fiscally conservative throughout their lives and saved appropriately. Government subsidies of healthcare for the elderly are precisely due to people living non-conservative lives and running out of money...
... Just like the government is going to run out of money.
The bottom line is that there's no free lunch.
To all the defenders of conservative / Republican / Libertarian ideologies:
If your system is so good, WHY is it that the States who tend to vote Republican are also the states who tend to receive more "welfare" from the Federal Government?
Is that because 'conservative' people save for the future?
Is that because 'conservative' people stand for taking personal responsibility?
Is that because 'conservative' people don't believe in Federal Government?
Is that because no Republican voter is benefiting from Social Security, Medicaid, Medicare?
The list can go on... The point is that most people who vote for Republicans are too dimwitted to understand their own personal situation, and are easily swayed by pie-in-the-sky promised made by their heroes.
As A.L. has pointed out numerous times... Any of the complaints about other country's troubles regarding health care, happen here as well, but at a much larger scale. Yet you keep ranting about it. that's called Cognitive Dissonance.
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