Sunday, March 01, 2009

Creeping socialism in America?

I don't agree with the gist of the message here - the US need a more inclusive healthcare system, probably need more public spending on education and the globe certainly needs US GGE controls to bring about an effective international agreement. But I enjoyed this cartoon that sums up the conservative view of Obamaism.  The right's paranoia is aired more explicitly here. again I disagree with the central message - it seems to me if you do wish to stimulate the economy do so in ways that provide a broad range of much needed social payoffs. You get a potential stimulus benefit plus a potential social payoff bonus.

Thanks JS for the story & Slate for the cartoon.

10 comments:

jc said...

Oh,

The US more spent on education? Harry it already has the highest number of graduates of per proportion of population of any industrialized nation.

Why do you need to nationalize health care in order to make it better?

hc said...

The US isn't terrible on education but it is falling behind. difficult because look where the main sources of US comparative advantage now lie.

When you have $50 million uninsured you need to move toward more social medicine. Obama is not proposing a NHS.

robert merkel said...

JC: the US spends far more money per capita on healthcare, and gets worse outcomes, than virtually every other western nation.

Yes, at least some of that is self-inflicted because of the obesity epidemic. Yes, the US probably does pay for a lot of the rest of the world's R&D. But even allowing for those factors, the American health system is simply not providing good value for money.

Even within the USA, the most effective parts of their health system are the nationalized bits, notably the VA system.

I can only conclude that nationalization can work effectively.

jc said...

Robert

I lived under the US system for 15 years. Nothing compares with it in terms of service and quality. It’s the best health care system in the world. You don’t have to go to a useless GP first in order to get to a specialist. You can go directly to the specialist yourself and the insurance company pays for the visit.

The Docs don’t order 3rd rate medications that are off patent, which is what we mostly have here and if it is on patent the Doc doesn’t have to go begging to a sniveling Canberra bureaucrat to allow the prescription.

Their testing is great and all the available machines are plentiful. Perhaps there is too much testing going on however I would much rather be over-tested than under as we have here.

However the paperwork is extremely cumbersome and difficult to navigate.

Here’s the thing though. The system is not a free market one as people like to suggest. There are an enormous number of mandates differing from state to state and the premium is paid for by employer, which in effect means no one gives a shit about cost control. The employee doesn’t as the firm is paying for it, the doc doesn’t and the insurance company doesn’t as all the insurance firm has to do is take a margin between the expected claims and the cost of those claims.

If the system went to single payer it would be much cheaper as it would introduce competition and cost control.

If you believe that the system has to be nationalized you should then prove that the demand curve in healthcare isn’t down sloping. If you can prove that then you have won me over. If you can’t then nationalization simply turns the US healthcare into a command control system with the obvious results.

Lastly the poor are fully insured in the US as Medicare covers them. So anyone peddling the idea that the poor are left at the door is talking nonsense.
The 11 million illegals are not covered however hospitals are required to treat them by law which further inflames the situation as they basically glom the system and the American taxpayer has to fork over the cost.


The US spends 16% of its GDP on health care, while we spend around 8.5%. I recall reading once that 4% of the US component is medical R&D. So that leaves 3.5% over the cost of ours as a proportion of GDP. However I wouldn’t be throwing out the baby with the bath water just yet. One of the objectives of the new administration is to screw down pharma costs. They can of course do that however I wouldn’t be waiting around for new drugs in a hurry as that sort of government interference will close the door on R&D in a second. Germany at one stage led the world in medical R&D and since it went for a nationalized system that’s gone down the toilet.

conrad said...

Actually -- I'm not sure if it matters that much if the US education system is falling behind a bit at the secondary or primary school level -- as long as they can still get the smartest people from around the Earth to do PhDs or science jobs there, they'll still be competitive (I believe Chinese nationals now earn more PhDs in the US than any other group, including native Americans). The big problem for the US will be if they start going home for one reason or another. However, even that is probably positive for the world. If they do and places like China can capitalize on it, it could be like the fall of Carthage, where large numbers of smart people are suddenly wandering around the group moving their new (or returning) countries forward.

conrad said...

Sorry, that should be fall of Constantinople, not Cathage! I think my brain is off at this time in the morning ;).

robert merkel said...

jc: yes, if you're part of the small fraction of people on an open access plan, you get that kind of coverage.
Any idea how much that cost your employer?

For most Americans, you have to get referrals from GPs just like here, and the the HMO also has "case managers" assessing your treatment to determine what they'll pay for.


In any case, there's little evidence to suggest that all of that testing actually makes you any healthier. Nor does handing out the latest drugs like they're candy; a lot of the time, they don't work any better than the earlier ones. That's why the PBS won't pay a premium for them.

jc said...

jc: yes, if you're part of the small fraction of people on an open access plan, you get that kind of coverage.

Is that why 89% of Americans were satisfied with their health care?

Only 9 percent of survey respondents were not satisfied with their health plan in 1999: 10 percent were not satisfied in 1998). [6,7] As seen in Figure A, the vast majority (89 percent) of respondents were extremely, very or somewhat satisfied with the quality of the medical care they received in the last two years. Further, 79 percent were satisfied with the general care received and another 79 percent were satisfied with the benefits package.




Any idea how much that cost your employer?

Yea, it's expensive.


For most Americans, you have to get referrals from GPs just like here, and the the HMO also has "case managers" assessing your treatment to determine what they'll pay for.

See the above satisfaction rate.


In any case, there's little evidence to suggest that all of that testing actually makes you any healthier.

Could you please show medical peer reviewed evidence that testing doesn't help?


Nor does handing out the latest drugs like they're candy; a lot of the time, they don't work any better than the earlier ones.

So pharma advancement is static is it, Robert?

That's why the PBS won't pay a premium for them.

Not sure I would be betting on that one.

Robert, I'm surprised quite frankly, at your unscientific approach to this issue when you're very quick to take out the peer reviews in other areas that seem to suit your bias.

robert merkel said...

jc: there are numerous studies that show that many standard tests and treatments are often worth having. To pick just one, the PSA test for prostate cancer.

And, yes, new drugs are regularly invented which are better than the old ones. But a fair proportion are no more effective, or even sometimes less effective, than existing drugs. But because there's no longer any money in it, Big Pharma obviously prefers to promote new and more expsneive drugs even when they're little or no improvement.

jc said...

jc: there are numerous studies that show that many standard tests and treatments are often worth having. To pick just one, the PSA test for prostate cancer.

Yes.



And, yes, new drugs are regularly invented which are better than the old ones.

You have any evidence this is a chronic problem?

But a fair proportion are no more effective, or even sometimes less effective, than existing drugs.

Like you with AGW, I show little patience with people who make claims that isn’t backed with facts. You really need to show this is an endemic problem rather than simply make a claim.