The Joys of National Healthcare
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  • bpuharic

    I don’t see an effort to ‘centralize healthcare’ at the federal level. Most healthcare will remain as is. Moreover, there’s little proof our remarkably inefficient and outrageously expensive healthcare system does not, itself, have similar scandals.

  • ljgude

    Here in Australia where we have a dual public and private system the system is under a lot of pressure but each system is a safety valve for the other. When the Public system gets overloaded people take out private insurance and if the private insurance gets too expensive they drop it and rely on the public system. So far we have been able to avoid the kind of monoculture that causes the level of bullying and other institutional abuses that are referred to in this article. That said I remember a few years ago siting in a waiting room in a rural American hospital overhearing a doctor talking to a man dying of cancer. The point was simple – his cancer was treatable, but he had no insurance. The man took it with the stoicism and fatalism I remember old people had during my childhood who had been born in the 19th century. I hope I can face my end that well, But America has no excuse as the world’s richest country that its medicine costs twice as much as elsewhere and does not even cover everyone. The ACA is built on top of a sink hole that already eats 17.5% of GDP and the country is no longer rich but in debt. I would point out that the UK did universal healthcare in the late 40s, Australia in the 70s. So the UK needs reform. What else would you expect after 60 years? Australia worked hard to refine a universal health care system and both parties have made more improvements than mistakes and so 35 years it is still working. I think the US would have done much better to do it in the 90s under Clinton, but it was not to be.

    • bpuharic

      I think ljgude makes a number of key points. First is the fact we ARE rationing in this country, based on ability to pay. While Palin was screaming about non-existent ‘death panels’ in Obamacare, we have, as ljgude accurately points out, been killing people by rationing healthcare (one estimate puts the death toll at about 26,000/year…ironic in that most in favor of rationing call themselves ‘prolife.’)

      In addition, we ARE one of the richest countries on the planet and we CAN afford healthcare. We simply decided, primarily for theological reasons, not to.

      • Corlyss

        You must have missed the ridiculous drama surrounding that child with cystic fibrosis who was denied a set of adult lungs under the HHS guidelines. It’s a preview of coming attractions, wherein panels make life-and-death decisions based on cost and patient characteristics in which some will be winners and some, probably more, will be losers. It turns out that the guidelines were correct about the child’s ability to use adult lungs. If the parents hadn’t gotten the courts to intervene, the girl would be dead by now. That too is a preview of coming attractions. I don’t want any part of this system and I’m going to do everything in my power as a voter and activist to stop it from becoming my Brave New World future.

        • bpuharic

          Uh…that’s been going on for decades. I did my undergrad work at the U. of Pittsburgh where Thomas Starzl developed one of the world leading programs on transplants. There have ALWAYS been these types of protocols PRIOR to “Obamacare”. So your statement is a non sequitur.

          And what about the kid whose parents are the working poor? Right now your system lets them die.

          Any reason you defend that action?

      • BrianFrankie

        Trite observations. Economics is the study of the distribution of scarce resources. There has to be rationing no matter the system. If there wasn’t, then eveyone would have what they want because resources wouldn’t be scarce, and there would be no point to the conversation. But your preferred system, whatever it is, will have rationing as surely as any other system. For example, the UK NHS explicitly rations by “Quality Life Years”. If a medical treatment provides fewer QLY’s than another, it does not get approved. The outcome is that older and sicker people get less treatment. You can argue that this is a rational, even desirable, method to allocate care; you cannot argue it is not rationing.
        Your issue is that you don’t seem to like rationing by a price mechanism. Fine. Price mechanisms have both advantages and disadvantages. On the plus side, it allows greater individual freedom, and results in a more optimal global allocation thus giving the most people the best resutls. This is inarguable, both from theory, and from empirical observations. The downside is that some people get left out, not necessarily through any fault of their own. It may be more fair to ensure equal treatment for all, even if the overall society-wide results are not quite as good. There is no clearly “right” answer, and the balance you seek must be informed by your core convictions.
        As for your contention the US is one of the richest countries on the planet – ROFLOL. I live in Australia. Australia? Rich. The US? Poor. Bankrupt. The most poorest, bankruptest country in the history of the world. Your creditors haven’t quite figured it out yet. But your income statement is cash flow negative, and has been for many years, and your balance sheet shows liabilities that outstrip your assets by huge, enormous, mind-boggling amounts. Hundreds of trillions of dollars.
        As a going concern, the US still has lots of positives – good demographics, good education, energy resources, a vibrant entrepreneurial culture. Silicon Valley. A booming Texas. 310 million hardworking people. You can still turn it around. I hope you do, not least because I’d like to retire there. But your current path is not a good one, and adding new expenses won’t make it better.

        • bpuharic

          I agree there will be rationing for exactly the reason you say. You make a…ahem…trite point.

          But it’s ridiculous to give Paris Hilton unrestricted access to healthcare while denying it to the next Albert Einstein because Einstein happens to be poor.

          And how does rationing by price give freedom to those who can’t pay? That’s not freedom at all since there’s no choice.

          Where’s the proof we’re ‘adding’ expenses? We ALREADY have the most expensive system in the world or have you forgotten?

    • Corlyss

      “America has no excuse as the world’s richest country that its medicine costs twice as much as elsewhere and does not even cover everyone.”

      This is a popular fiction of the Left. We had a perfectly good system that covered most people. The fact that the government didn’t provide it as part of the nanny state doesn’t mean it didn’t exist. But the Progressives’ #1 wet dream for the last 100+ years has been that every western nation provide cradle to grave health care for everyone. Well, we’re about to get something that sold itself as state-run universal health care, but isnt’, and won’t be when employers get thru dumping their employee health care programs and forcing more people onto the government system. There seems to be some delusion among proponents that when health care becomes solely a government responsibility, it will magically become cheaper and better. I don’t know how these proponents can look at the VA, the Bureau of Indian Affairs, the Post Office, the IRS, and the DoD, not to mention the abominable record of Medicare waste under HHS and still support government run health care. Obamacare was never intended to be anything but a way station where the private health insurance industry is destroyed in order to make the institution of a true universal government run health program inevitable as the insurer of last resort. It is well on the road to accomplishing that goal.

      • bpuharic

        The right thinks the term ‘nanny state’ carries some significance when it actually is the difference between life and death. Moral values, to the right, are intrinsically linked to wealth as the measure of the worth of a human life

        The VA is fairly cost effective, as is Medicare. Our ‘free market’ system is inefficient and bloated. The right loves it because it threatens the middle class with loss of benefits unless they continue to prove their economic worth to the ‘free market’, no matter what the nature of that market is.

        • Corlyss

          “The right thinks the term ‘nanny state’ carries some significance when it actually is the difference between life and death. Moral values, to the right, are intrinsically linked to wealth as the measure of the worth of a human life”

          Where do you get this stuff? Out of OFA pamphlets? You need to broaden your reading material.

          • bpuharic

            Since the right clearly is against universal healthcare, and since that policy kills, the conclusion is self evident

            Except to the right.

          • Corlyss

            Only in your ill-informed kindergarten logic.

      • ljgude

        I don’t think the double cost of US healthcare is a fiction. I consistently read 16-17.5% of GDP for the US and 8.5% (2005) Australia and 11% Switzerland. I despise leftist tropes as much as anyone and don’t want to contribute to them. I also know that travel insurance to the US costs double.The Time article ‘Bitter Pill’ makes the same points about US healthcare costs. I actually strongly agree with the rest of your comment. I also agree that the ACA is not going to work on top of an already too expensive system. And I emphatically agree that when you look at the government health care we have, how can we hope that more of the same is going to work. I would expect we will still get a lot of people who do not insure, and businesses will drop employees below 30 hours a week to avoid having to insure them. With the cost already too high the ACA is headed for serious difficulties and looks to me like if will fail.

        • Corlyss

          “I don’t think the double cost of US healthcare is a fiction.”

          Regrettably I didn’t make my intent clear. The fiction is that the US’ failure to adopt universal health care is a disgrace. I agree that twice the health care costs is not a fiction – but then we have the cutting edge research into health precisely because it pays so lucratively. The rest of the world piggy-backs on our discoveries. I don’t mind paying for that. I object to paying the same prices to cover deadbeats while getting the kind health care that Sweden provides because it can afford to pay for more deadbeats because it doesn’t have to pay for research.

          Question: if we don’t do the research because we’re too busy paying for illegals and unemployeds, who will and won’t their health care costs explode if they do become the leaders in research?

          • bpuharic

            We don’t pay for illegals. We pay for TARP. We pay for the carried interest deduction. We pay for the low capital gains taxes for the rich while burying the middle class.

            The right wing whines and moans about the middle class and the poor while creating the biggest socialist paradise in the world

            for the 1%

          • Corlyss

            “We don’t pay for illegals.”
            More delusion. Of course we pay for illegals. The Feds mandated decades ago that hospitals could not refuse care to indigents because they can’t pay. So the hospitals have to recover their costs to service illegals and other indigents by spreading the costs to the paying patients and insurance companies by higher rates charged to everyone who can pay.
            You know, you’d know this stuff if you had even a comic book level of understanding about economics, never mind public policy.

          • bpuharic

            Wrong. We pay for emergency care, period.

            But it’s too much to expect from prolife conservatives that they’d be


          • Corlyss
          • bpuharic

            Hey Corylss

            That article confirms what I just told you

            Every hospital is required to provide

            EMERGENCY care to ANYONE who needs it

            I’m a volunteer EMT. I’m covered by the same act. I am REQUIRED under law to provide emergency medical care to ANYONE

            And that’s how it should be

            Thanks. I already knew what you were going to post

        • bpuharic

          You say Australia and Switzerland…govt healthcare…is cost effective

          And you say govt healthcare isn’t going to work because it’s leftist

          Folks, you can’t make this up

  • Andrew Allison

    Prof. Mead’s jihad against National Healthcare overlooks a couple of key points, the most important of which is that, in stark contrast to the US, everybody has access to healthcare. He also overlooks the fact that, as in Australia, the fact that this basic level of service is available to all keeps a lid on the cost of the flourishing private insurance sector. He also conveniently overlooks the horror stories arising from US healthcare, not to mention the fact that it is one of the least cost-effective in terms of outcomes of any developed country and that many unnecessary procedures being performed, see, e.g. The problem, in a nutshell, is that you can treat some of the people all of the time, and all of the people so of the time . . . .
    The evidence suggests that the optimal solution for society as a whole is a mix of public and private insurance.

    • bpuharic

      To tell you the truth I’m not sure why so many American elites think our rationed healthcare system is such a success. It has to be a ‘moral’ argument, in the sense that the poor don’t DESERVE healthcare, and that the threat of its loss helps to keep the middle class in line

      The US probably has the most developed mythology about what a meritocracy we are, and these types of narratives fit very nicely. The fact they’re all wrong? Well, never let the facts stand in the way of a good argument.

      • bigfire

        Nationalized Healthcare is great at creating Opiate addicts as it’s far cheaper to just dispense pain medication than to actual treat the underlying cause, and it takes far less time.

        • bpuharic

          Yeah our doctors never overmedicate, do they? We have the most expensive drugs in the world because of the American right wing…I’m a volunteer EMT and have seen more than my share of drug dependent patients…

          • BrianFrankie

            Americans do have the most expensive drugs in the world, in my experience. I can’t see how one can honestly pin this on the “right wing”, although I’m sure you have your reasons. Forgive me, but I suspect your reasons may have more to do with ideology than actual truth.
            More to the point, most other nations impose price controls and rationing on their drugs, and the controls are usually based on production costs. The majority of all worldwide drug R&D funding is provided by US drug consumers, with smaller contributions from WEurope and Japan. The US is subsidising drugs all around the world. The same is true for medical hardware and other R&D. Very generous of you. I appreciate it.
            The R&D subsidy. along with the US FDA controls (both drug approval and quality controls) imposed on the system, which are considerably more onerous than other worldwide regimes, account for most of the drug price differential.
            There is very little difference in the bottom line profitability or compensation line items of US and foreign drug companies, which is what you might expect to see if the US drug prices reflected company margins rather than actual underlying costs.

          • bpuharic

            The right has prohibited the US govt…one of the largest buyers of drugs…from negotiating prices with drug companies. It’s part of the Medicare D law and it was put there by the GOP as largesse for drug companies.

            And yes, you are right. The US taxpayer is bankrolling the rest of the world. Socialism for drug companies. Socialism for the rest of the world

            At taxpayer expense.

    • Corlyss

      “Australia, this basic level of service is available to all keeps a lid on the cost of the flourishing private insurance sector.”
      Perhaps for now. But your system too is unsustainable. You guys just haven’t come to that realization yet. Keep taking in those worthless expensive Asian refugees who land up on your shores because you have better nanny state services, and you’ll get there sooner than later.

      • bpuharic

        Uh, what? Unsustainable? And how sustainable is our system, the most expensive in the world?

        • Corlyss

          Well, until Harris Wofford made it a big issue in the 90s, most people were quite happy. Employed people had health insurance; the government mandated hospitals to accept patients regardless of ability to pay; and poverty programs took care of most everyone else, either thru Medicare or Medicaid. Then politicians found a non-problem, claiming that many went uninsured (as opposed to untreated). Suddenly, the 86% that were happily insured began to worry about the people who were uninsured (as opposed to those who were untreated). And now we got this godawful mess that’s going to deprive more people of the cheap insurance they used to have. I don’t mind paying my fair share if my share has been rated too low. I sure as heck don’t want to pay for someone else’s share more than I already do thru higher premiums. But that’s most likely going to be the result of Obamacare.

          • bpuharic

            Hospitals do NOT have to provide care regardless of ability to pay. The Hill Burton act required hospitals that received federal funds to provide SOME medical care to the poor (I personally received care under that law when I was younger) But there is NO care for chronic conditions, no follow up, no preventative care, etc.

            And THAT is one of the most expensive ways to run healthcare. Again, a conservative plan that is penny wise and pound foolish, merely because of ‘moral’ concerns about the poor that conservatives seem not to have about the wealthy.

      • Andrew Allison

        Don’t assume. I spent most of my first three decades under the aegis of the NHS, and the latter four-and-a-half in the US. It’s not rocket science: the only way to provide the best healthcare for the most is means-tested high-deductible single payer. Permit me to provide a concrete example of how completely screwed up our present approach is. I am, as the foregoing makes clear, on Medicare. The annual premium for my $2000 deductible Medi-gap policy is less that the monthly premium for a $250 deductible plan. In other word, a single year of coverage pays the deductible. How can this possibly be? The answer, as Prof. Mead has pointed out more than once, that low co-pays and deductibles invite unnecessary expenditures, as does forcing the uninsured to the emergency room.

        The”worthless immigrants” comment is not merely objectionable, but nonsensical: Australia’s biggest problem is that it lacks the population with which to capitalize upon its resources. Texas and California, both of which are soon to become white-minority states, have a different problem, namely that social implications of the decision to utilize low-cost (not low-wage but, thanks to not paying benefits, low-cost) labor. I don’t pretend to have the answer, but I think that in order to find it we must be honest about the questions.

        • Corlyss

          I am very interested in the fate of our deputy sheriff, a fellow anglosphere nation, if you’ll excuse the reference to “deputy.” If facts prove me wrong in my expectation that your health care model is unsustainable, I’ll not hesitate to admit it. But it will take facts, not hope or charges that I’m mean (I used to get that a lot on other boards).

          Your expectations of Texas and California becoming with minority states may be true in terms of gross numbers but when you account for the fact that the non-white population doesn’t approach the white population in terms of voting, it will be a while before any impact is seen, esp. if they can keep the illegals from voting (never a good bet).
          The Asian immigrants I referred to are the ignorant, illiterate, unskilled boat people who flock to Australia’s shores and get on relief as refugees as soon as the Labour government can sign them up. You’ll not convince me that those are a good thing for Australia; I get reports from an Aussie friend. They are a consequence of the open borders plague visited on the developed world by the human rights and refugee lobbies in the West, which give refugees and asylum seekers greater standing than native populations. I was not referring to the educated and desirable Asians, regardless of origin.

          • Andrew Allison

            Although I’m a naturalized citizen of the USA (and there’s nobody worse than a reformed Brit), I must take exception to your characterization of the primary source of US culture as “deputy”. No argument that the UK is a junior partner in the anglosphere, but hardly a deputy.

            With regard to your expectations for the NHS, I’ll simply point out that this month marks the 55th anniversary of providing a decent level of medical to everybody, and that’s a fact.

            Another fact in which you may be interested are that roughly 80% of adult Hispanic citizens voted in 2012, versus 61% of whites.

            I’m glad to see that you were not referring to the large number of immigrants who actually want to contribute. With all due respect to your Aussie friend, it is well- documented that Australia opened its borders to Asians in order to populate the country. I suspect that the number of dead-beat Asians in Australia pales into insignificance compared to the number of dead-beat immigrants in the USA. Nevertheless, it’s become difficult for non-Asians to get into competitive schools.
            None of which has very much to do with how to improve healthcare.

          • Corlyss

            “the primary source of US culture as “deputy”.

            I’ve never heard the UK referred to as “deputy sheriff.” The term is used here to refer to Australia because the US and Australia often partner to sustain the international system in the Pacific, much like we partner with England to maintain the system elsewhere.

            “this month marks the 55th anniversary of providing a decent level of medical to everybody, and that’s a fact.”


            I would question the “decent level” when wait lists for routine treatments marry up with poorer outcomes as compared to similar stats in the US. Your fondness for it notwithstanding, I still maintain it is unsustainable over time. The UK government hasn’t been anxiously circling the NHS for decades because the outcomes have been so great for the patients or the cost so great for the taxpayers. When something can’t go on forever, it won’t.


            “Another fact in which you may be interested are that roughly 80% of adult Hispanic citizens voted in 2012, versus 61% of whites.”

            At the risk of seeming flippant, so what? Even if I accept your stats without citation to a source, which I don’t because the census bureau shows Hispanics voting at only 48% (, that’s 80% of the 10% of the electorate ( versus 61% of 74% of the electorate. Conservatives have a lot of time to win over Hispanics; they are naturally conservative. They’ve been seduced into liberals’ sociological sinkholes disguised as welfare. If they ever become taxpayers in large numbers, we’ll get ’em back.

          • Andrew Allison

            Get your facts straight. Outcomes in the UK are at the EU average ( ,outcomes in Canada are marginally better than in the US (

            The FACTS are clear: US care is much more costly, doesn’t serve the entire population, and has worse outcomes than many, if not most single payer systems.

          • Corlyss

            Thanks for the link. Interesting site.

            However, I punt to a more comprehensive analysis I’m not going to try to paraphrase.


        • BrianFrankie

          I like your answer. I think the “single payer” line is a red herring – I don’t see the advantages. But I am in full agreement that means tested high deductible insurance is the best way to protect the most people from cripling medical expenses for the least cost.
          This is one of the major reasons I oppose ObamaCare – it intentionally eliminates this option in order to expand comprehensive care, which is precisely the wrong direction. In effect the law is trying to turn the medical insurance system from “insurance” to “prepaid medical care”. This will not work well.

          • Andrew Allison

            Thank you. No question that high-deductible would go a long way toward solving the problem. But the most bang for the buck comes from eliminating private insurance for basic care. The insurance companies are siphoning off roughly half the premium dollar. Medicare spends 97% of its income on care.

          • BrianFrankie

            I must dispute both your facts and your comparison.
            Large private insurance companies pay out about 70 – 85 cents in medical expenses on the premium dollar. Admin, overhead, and profit amount to no more than about a quarter. I’d like to know where you fnid the information claiming that half the premium dollar is spent on non-medical expense items.
            More to the point, the comparison to Medicare is fallacious. Yes, they pay out 97 cents on the dollar, but the comparison to private companies is not equal for several well-known reasons. For example, most of Medicare admin expenses are handled by other agencies. Premiums are collected and eligibility determined by the Soc Security Admin, not Medicare. Eligibility is, by itself, much cheaper and easier to determine for Medicare, as they do not need actuarial analysis or to worry about pricing – the benefit is automatic. Fraud and enforcement of Medicare is done by the Dept of HHS and FBI, not by Medicare.
            And then you need to address the issue of fraud. Medicare does a uniquely bad job of finding fraud. EStaimtes are that at least 10% of Medicare, and perhaps as much as 20% are spent on fraudulent claims. This is at least 5 times as high as estimates of private insurance. But fraud alone means that MEdicare is not spending 97 cents of the dollar on medical care, but more like 77 – 87 cents.
            The final variable to consider are the price controls Medicare uses. They set reimbursement rate, rather than negotiating with medical providers. This actually does keep medical expenditures down for Medicare, but it does not make the expenses incurred disappear. What providers do is transfer expenses to higher rates for private insurers. In effect, private companies provide a considerable subsidy for Medicare.
            To conclude, Medicare is no more efficient than private, and I suspect, and there is some evidence, that it is less so. But even assuming equal efficiency in dollar spent per dollar collected, Medicare counts on substantial price distortions from the private market. If you eliminate the private market and move to Medicare, then either rates go up dramatically, or availability and quality decrease. Probably some of both. But you are imagining things if you believe single payer will increase efficiency.

          • Andrew Allison

            “Large private insurance companies pay out about 70 – 85 cents in medical
            expenses on the premium dollar. Admin, overhead, and profit amount to
            no more than about a quarter.”
            Check their financials: They pay out about two-thirds of the premiums premia, and insurance processing cost the providers about 25% of their revenue. The fact that physicians who refuse to accept insurance can halve their charges is evidence enough of this.

            You suggest that 10% to 20% of Medical claims are fraudulent, which I don’t dispute, but recent reports suggest that 30-plus percent of all insured medical procedures performed are unnecessary. Seems to me that the private sector is out-defrauding Medicare providers by a wide margin.

            You also overlook the fact that (low deductible) insurance encourages abuse. I provide an actual example of the result of this.
            Bottom line: whether the insurance companies are adding 25%, 50% or more to the cost of healthcare is irrelevant. It’s money that could and should be spent on healthcare.

  • lukelea

    With a little research you will see that similar things happen in US hospitals, in big city emergency rooms especially.

  • Joseph Blieu

    With respect to the bullying of personnel think that bullying is the
    standard tool of government including IRS, FBI, EPA, Dept. of Ed., DOJ,
    zoning boards, and the Military with respect to other countries.

    find it easy to believe that the government officials who control
    healthcare under the new regime will use power for the whim of control
    and to win petty battles with citizens for personal pleasure (I have
    seen these types in the IRS, who enjoy inflicting suffering, they

    Don’t say that the government won’t have this power, he
    who pays owns the title. Now insurance companies have to satisfy
    customers, and Fortune 500 companies get real mad when they see employee
    complaints, at least the ones I deal with.

    • bpuharic

      The masters of the US healthcare system are the healthcare providers. In any area, these groups form consortiums that squeeze out competition driving up the cost of healthcare. Insurance companies have little leverage with them. It’s one reason the GOP ‘plan’ to allow cross state competition wouldn’t work. More insurance companies would still be up against the healthcare networks.

      • Andrew Allison

        I beg to differ. The masters of US healthcare are the insurance companies, who not only siphon off about half the premiums but use their profits to ensure that our reprehensatives keep the money flowing by not passing coherent reform. All that’s needed to put an end to the State-by-State “regulation” of insurance (which artificially inflates its cost) is a basic Federal insurance for all. In general, I’m a proponent of States rights, and all that I’m suggesting is something to keep the States, and the insurance companies they regulate, honest.

  • BrianFrankie

    VM – thank you for this post. As one who lived in the UK for four years, I can anecdotally verify both the abhorrent conditions and the bullying in the NHS. My dealings with the NHS were, quite fortunately, somewhat limited. I visited Hammersmith Hospital, which has one of the best reputations in all of the UK, a number of times, and found conditions to be utterly appalling.
    I’ve lived and worked in numerous places, both first world (US, UK, Australia) and third world (quite a few in Asia and Africa), and enjoyed both public and private systems in a number of places including the UK and Australia. My experience is that the UK public sector is absolutely the worst medical system I have ever encountered, anywhere. UK private system is actually quite good, although very expensive – far more than I have found in the reputedly high-cost US. That the NHS retains high public approval ratings (order of 70% approve, although it must be noted this is considerably lower than other first world health care system approval ratings) is one of the mysteries of life I cannot fathom.
    The US medical system is unquestionably the highest quality I’ve found in the world, although can be expensive. Australia is also quite good.
    There are no perfect answers for health care delivery. Balancing access to care with cost and quality is a job that will remain eternally beyond the ability of humans to resolve to satisfaction of everyone. But this I know – any move along the path that leads toward a NHS-style system is a very, very misguided direction.

  • Boritz

    ***Britain’s National Health Service has had a pretty dismal track record lately.***
    Not so. It looked marvelous at the Olympics pre-game show, and when you look marvelous, you are marvelous.

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