Trojan Horses
| Tue Aug. 11, 2009 9:27 AM PDT
Alex Massie writes about Britain's much-loved-much-loathed NHS:
There are, I think, two essential truths in international health policy. No-one sees fit to copy the National Health Service and no-one sees fit to copy the American system....
The relevance of the NHS to American health care plans seems pretty limited anyway since, as best I can tell (though I try not to pay too much attention to these things) Obama doesn't actually plan on copying the NHS.
That last sentence really is correct, by the way. It's true that some things aren't entirely what they seem: they're Trojan horses for something else, or maybe the camel's nose under the tent that will eventually lead to more fundamental reforms. Both sides do this on occasion. I, for example, happen to think that community rating (along with the cloud of regulations that accompany it) will eventually put private insurance companies out of business — or, at a minimum, turn them into little more than semi-public utilities. I don't know how many other people agree about that, but you could certainly accuse me of pushing for community rating not just because I like it as a policy, but because I think it will eventually lead to more systematic reform of the healthcare industry.
But with the exception of a few outliers, the liberal community really, truly doesn't want a fully government owned and operated healthcare system like the NHS. We want a government-funded healthcare system like Medicare or most of the world outside of Britain. And unless I'm mistaken, this isn't a ruse in any way. That's really what most of us want: basic care funded by taxes, with additional care available to anyone who wants to pay for more. France and Holland, not Britain or Canada.
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Comments
I just read on Nate Silver's
Submitted by Anonymous (not verified) on Tue Aug. 11, 2009 10:05 AM PDT.
I just read on Nate Silver's site that you're completely wrong to conflate the British and Canadian systems. Just so you know.
I think Canada goes in the other group
Submitted by Anonymous (not verified) on Tue Aug. 11, 2009 10:11 AM PDT.
Canada sounds like a Medicare type system to me with provinces kicking in a little and their version of private Medigap insurance to fill in coverage gaps.
Yeah, so much of the
Submitted by Matt D (not verified) on Tue Aug. 11, 2009 10:18 AM PDT.
Yeah, so much of the right/libertarian commentary I see on this issue (check out McMeagan's recent piece for an example) seems to rely on 2 assumptions:
1) We have a model-perfect free market in health care currently, and health care itself is the sort of commodity that thrives in a free market.
2) We're going, one way or another, to move to a single-payer system w/out any private insurers in the market.
Neither one of these assumptions is particularly accurate, but that doesn't seem to stop them.
". . . basic care funded by
Submitted by Anonymous (not verified) on Tue Aug. 11, 2009 11:16 AM PDT.
". . . basic care funded by taxes, with additional care available to anyone who wants to pay for more [, not like] Canada."
Huh? In fact, nearly 1/3 (www.cbc.ca/news/background/healthcare/public_vs_private.html) of health-care expenditure in Canada is for private care. The Canada Health Act forbids government subsidies to private care providers; but as long as they want to operate as true private businesses and not as leeches on the public purse, they're free to do it. And many do.
I know there have been a lot of right-wing shills, some of them Canadian, crying that health care in Canada is a government monopoly. But it's no more true than their rants about "death panels", and it's disheartening to see Mother Jones repeating it, eh?
you're wrong on Canadian health care, again Kevin
Submitted by optical weenie on Tue Aug. 11, 2009 11:18 AM PDT.
In Canada, basic care is funded by taxes and also by people paying a monthly premium.
And you can get additional care if you want to pay for it.
You keep propagating misinformation about the Canadian haeth care system - I'm beginning to wonder if you are a birther in disguise.
I admit the Canadian Health care system isn't perfect - but most people, > 95%, are satisfied with it.
Anonymous writes: "I just
Submitted by Anonymous (not verified) on Tue Aug. 11, 2009 11:21 AM PDT.
Anonymous writes: "I just read on Nate Silver's site that you're completely wrong to conflate the British and Canadian systems. Just so you know."
Kevin's not "conflating" Britain and Canada. He's quite rightly pointing out that both systems have attributes not considered desirable by the progressive community in the US: Britain's mostly government-owned and operated healthcare delivery, and Canada's sharp restrictions on "additional care available to anyone who wants to pay for more."
Neither approach is remotely politically feasible in the US, and neither approach is particularly popular even among American liberals.
Basic care? Please define
Submitted by Anonymous (not verified) on Tue Aug. 11, 2009 11:40 AM PDT.
Basic care? Please define basic care. I've seen things in the bill that would seem to go way beyond basic care. (Perhaps a bill funding basic care and basic care alone would stand a better chance, but that's what your prior post was about....)
Opticasl Weenie writes: "
Submitted by Anonymous (not verified) on Tue Aug. 11, 2009 11:53 AM PDT.
Opticasl Weenie writes: " In Canada, basic care is funded by taxes and also by people paying a monthly premium. And you can get additional care if you want to pay for it. You keep propagating misinformation about the Canadian heath care system - I'm beginning to wonder if you are a birther in disguise. "
Optical Weenie: While Canada's healthcare system is one of the world's finest, Kevin is not wrong to characterize it as he has: it IS different from, say, the French or Dutch or indeed British systems in that the law largely prohibits the existence of a parallel, private health insurance system for catastrophic illness, major medical etc. In Canada private health insurance pays only for incidentals or top-ups (a private room, say, or dental care). Even in the relatively "statist" British model, a non-trivial percentage of Britons (I think nearly ten percent) eschew the NHS and opt out with their wallets, so that private health insurance pays for things like heart attack treatments, or cancer, or what have you. Canadian law rightly or wrongly rather explicitly outlaws this approach for fear of allowing in a two-track medical system (that is, one for the rich or one for the poor).
In Canada, for the most part the only way to opt out of the public sector's monopoly in major medical health insurance is to take one's loonies out of the country.
I happen to think the Canadian approach has much to recommend it, but we shouldn't try to pretend it's something that it isn't.
It was true until June 2005
Submitted by Anonymous (not verified) on Tue Aug. 11, 2009 2:46 PM PDT.
It was true until June 2005 that in most Canadian provinces "the law largely prohibits the existence of a parallel, private health insurance system for catastrophic illness, major medical etc." But in that month the Supreme Court struck down the Quebec law, and insurance companies have been offering such policies.
If a Canadian goes to a private clinic or hospital (in Canada or elsewhere) for treatment covered by their provincial plan, the provincial plan will reimburse them -- but only up to what a provincial clinic or hospital would have charged. The private facilities are generally more expensive, and private insurance policies would cover the excess costs.
The joke, though, has been that (as of March 2009, anyway: www.cbc.ca/canada/montreal/story/2009/03/30/mtl-health-insurance-interes...) the total number of such policies sold was, umm, zero (count 'em, 0!). The coverage offered is so restrictive, and the prices so astronomical, that nobody wants it.
So if in your province it's not possible to buy such a policy, that's not because the law prohibits it, but because the insurance companies have given up trying to sell something that nobody will buy.
socialized medicine
Submitted by john sherman (not verified) on Tue Aug. 11, 2009 12:23 PM PDT.
By some accounts the VA is the best hospital system in the country, and it is about as pure an example of socialized medicine as I can imagine. It gets better results and is cheaper while dealing with what is often an expensive population.
Massie is wrong about the UK
Submitted by health policy bore (not verified) on Tue Aug. 11, 2009 12:35 PM PDT.
Fie on Massie! Lots of countries pretty explicitly copied the UK: Spain, Italy, a number of postcommunist countries, not counting former UK colonies. Scandinavians mostly have very similar systems. The "National Health Service" model is a perfectly common one in world debates, and countries considering health reforms routinely look to it for its appealing combination of integration, coherent priority-setting (compared to other systems), and tight budgetary control. It has drawbacks, but the only drawback from the US point of view is that too many people would resist the nationalization of health care facilities and the shift of money to general taxation. Those are political, nothing to do with the fact that foolish old Tories like Massie enjoy denigrating the NHS.
Oh and...there are people who want to copy the US system in the narrow sense that the world is infested with people selling business concepts that would make them as overcompensated and self-important as US health care executives. Just watch UnitedHealth poke around, or Allianz opening up in Russia (it's never pretty to watch Germans when they decide they can be as bad as Americans), or the UK's BUPA and everybody else going into Dubai. They are insidious, in that they are only selling luxury products, or niche products, but have immense resources, lobbying skills, and capacity to screw up a system. And many of them, in my experience, genuinely do manage to persuade themselves that they are not undermining health care.
Kevin,
I dunno if I am the only person to notice but your graphic image is awesome. Instead of the staff of Asclepious, the god of medicine, you use the staff of Mercury (protector of merchants and thieves) along with the red cross.
Brilliant!
Tripp
Drum could be a lot clearer
Submitted by Brett (not verified) on Tue Aug. 11, 2009 10:29 PM PDT.
Drum could be a lot clearer on the distinctions between Canada and the UK. While Canada has (or had) a "no-duplication" law on payment for services covered by the provincial plans (meaning that insurance plans couldn't cover the cost of the treatment), the Canadian system is still basically federalized Medicare (since most doctors are private businesses), whereas the UK is considerably different (GP practitioners as contractors, hospitals publicly owned).
The coverage offered is so restrictive, and the prices so astronomical, that nobody wants it.
It made my heart smile to read that. Especially since I remember a number of conservatard critics acting like the Chaoilli was some colossal, end-of-the-world thing for Canadian Medicare.
*****It was true until June
Submitted by Anonymous (not verified) on Wed Aug. 12, 2009 7:47 AM PDT.
*****It was true until June 2005 that in most Canadian provinces "the law largely prohibits the existence of a parallel, private health insurance system for catastrophic illness, major medical etc." But in that month the Supreme Court struck down the Quebec law, and insurance companies have been offering such policies.*****
No, anonymous, it's still true. The court ruling struck down a QUEBEC law, and the province subsequently passed a law allowing private health insurance specifically to cover three surgical procedures. So far there have not been substantive spillover effects to other provinces, although only time will tell if Canada's highly egalitarian system will remain intact.
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