Boy I can't wait to see the libertarian/right wing spin on this one. *Get's popcorn*

Consistency doesn't seem to be a strong point among critics of the U.S. health care system.

Let's review. We are told both that:

"There is no systemized collection of data on wait times in the U.S. .... That makes it difficult to draw comparisons with countries that have national health systems, where wait times are not only tracked but made public"

And also that:

"A Commonwealth Fund study of six highly industrialized countries, the U.S., and five nations with national health systems, Britain, Germany, Australia, New Zealand, and Canada, found waiting times were worse in the U.S. than in all the other countries except Canada."

So which is it? We DO have reliable data on wait times in the U.S., and the Commonwealth Fund study used it to show that wait times are longer in the U.S.? Or we DON'T have reliable data, and the conclusions of the Commonwealth Fund study are therefore bogus?

They won't spin it. They will simply deny results.

Brennan also recalled that he had formerly spent much of his time as an administrator and head of a physicians' organization trying "to find appointments for people with doctors.

Also worth noting. When you can open up a succesful business who's service is finding available appointments with doctors, you know you're country's healthcare system has waiting line problems.

Oh- or do was Jason does- namely, try to throw in a bunch of red herrings and wait for the left to do its usual attempt to argue with his denials and red herrings. Meanwhile, by the end of it you are so tired and dejected you don't remember what the point was in the beginning.

by the way- I await the attempts and 50 responses later of watching people try to argue with Jason's logic.

Sigh. That's weak stuff Jason. In other countries, the government amasses data on all sorts of aspects of the health system, providing clear and continuous information on its workings. In our country, the best you can do are methodologically rigorous, but infrequent and narrowly-focused, studies conducted by private entities. It's not that there's no data, but that there's far less, and it doesn't exhibit trends nearly so effectively.

Errr, not to pick too much nit here, because it's a dandy post, but Brennan is CMO (chief medical officer) at Aetna. Ron Williams is the CEO. But good on him for coming clean.

U.S. wait times are definitely a bitch. My wife was going through menopause and had to wait four months for an appointment with a specialist after two other doctors (her OB/GYN and our family doctor) couldn't figure out how to control her night sweats and hot flashes. It ain't cancer, but it's still a pretty lousy thing to have to go through for that long.

And after our daughter was diagnosed with severe depression, it took nine weeks before she could get an appointment with a counselor (though the meds were prescribed very promptly, imagine that).

Sorry, Ezra, but you can't have it both ways. Either there's enough data to allow for a systematic, comprehensive comparison of waiting times between the United States and other countries, or there isn't. The Medical News Today article you linked to says there isn't. That means you cannot draw any meaningful conclusions about overall differences in waiting times from the Commonwealth Fund study.

But if you really believe that study is meaningful, here's another one, from the OECD in 2003. The OECD study found that waiting times are not a serious policy concern in the U.S., but are a serious concern in Australia, Canada, Denmark, Finland, Ireland, Italy, Netherlands, New Zealand, Norway, Spain, Sweden, and the United Kingdom. It also presents data showing much longer waits in other countries than in the United States for both routine health care services and serious ones, such as heart bypass surgery.

As for the claim that "most of the Canadian data so widely reported by the U.S. media is out of date," here is Statistics Canada's latest report on wait times in Canada. It found that median waiting times did not improve between 2003 and 2005, the latest year for which it reports data.

Oh, and here's a report of an independent study of waiting times in Canada. It found that waiting times have gotten worse there since 1997. Quote:

Wait times for health care in Canada have increased significantly since 1997 when the average Canadian could expect to wait 11.9 weeks from the time of a referral from a General Practitioner to the time a specialist delivered the treatment required. In 2006, the average Canadian could expect to wait 17.8 weeks, nearly 50 per cent longer.

The increase in the total wait time for treatment was the result of a 72.5 per cent increase in the wait time to see a specialist after referral by a general practitioner and a 32.4 per cent increase in the wait time to receive treatment after an appointment with a specialist.

One of the most stunning examples of how additional funding has not resulted in better care is found in access to MRI and CT scanner technology. New investments were made in these technologies that increased their availability. But despite increased availability, Canadians did not experience shorter wait times for scans in 2006 than in 1997. The wait time for a CT scan increased from 4.1 weeks to 4.3 weeks between 1997 and 2006 while the wait time for an MRI scan went from 9.6 weeks in 1997 to 10.3 weeks in 2006.

So if we do have wait times here. How are you going to make them go down by adding 45 million people to the system?

I'm sure there's wait times with HMOs, since HMOs are just privately run, small single-payer organizations of a sort.

But in the US, if you have the money you can get anything you want done today.

As for the lowest wait times in Germany, I'll buy that. Also notice that Germany is a mix of public and private, with the option to self-insure on a cash basis even being available if you have the means.

So much for the virtues of single-payer.

I agree a private/ public mix will be the only thing that flies here. No way will we want a system that Donovan McNabb has to wait 10 months behind Wally from the YMCA to get his knee fixed.

But if you really believe that study is meaningful, here's another one, from the OECD in 2003. The OECD study found that waiting times are not a serious policy concern in the U.S., but are a serious concern in Australia, Canada, Denmark, Finland, Ireland, Italy, Netherlands, New Zealand, Norway, Spain, Sweden, and the United Kingdom. It also presents data showing much longer waits in other countries than in the United States for both routine health care services and serious ones, such as heart bypass surgery.

Isn't that the same OECD report that said there were no noticable wait times in countries like Japan,Germany and France, the countries any US healthcare system will likely be modeled after?

Anyways, i'm not going to engage in your red herring debate. The fact is that more and more data is coming out saying that the US has waiting times just as comparable. The CMO from Aetnia isn't just pulling this out of his ass because it's good for business.

On what the American people will or will not accept:

http://www.emergingdemocraticmajorityweblog.com/donkeyrising/archives/001291.php

http://www.cbsnews.com/stories/2007/03/01/opinion/polls/main2528357.shtml

Don't confuse what the politicians will do and the insurance company will allow in terms of their lobbying dollars to pay off those politicians. Washington isn't the American people on this issue. It hasn't been for along time.

If serious conversation is going to happen- those interested need to start disquishing between what Washington says and does, and what the American people want.

What ever the data says, lets say they are comparable now. How will it not get much worse by adding 45 million people to the system when last time I checked it takes about 8-11 years to churn out a new doctor after college is complete. Most docs out now are maxxed out and going fast and furious with less and less time to spend per patient.

I'm sorry, Ezra, but for a self-described "wonk" who is obviously a pretty bright, inquisitive guy, you're getting to be way too cute. This post is all too typical. I don't believe that you honestly believe that waiting times in the U.S. are no better than in other industrialized countries. Relying on a couple of atypical studies is beneath you.

And when you write things that you know are not true, you know what that makes you.

and now the award for more bs- ostap- since it's the rights claim that the sole reason at this point we should keep this clunker of a system is that it has better wait times- not better results, just wait times- who should prove that it does or doesn't? I am sorry that the study isn't sufficient for you- but you would think if you were right about wait times it shouldn't even be a close call. Me thinks your problem is like most who bullshit is that you don't like what hte number say.

How about the issue of bankruptcy? My mother was diagnosed with osteoporosis by her doctor at a medical practice that announced bankruptcy a couple weeks later. To get her medical data and transfer it to a doctor somewhere else, she had to threaten to sue. Turns out the practice hadn't been paying the company that it relied on for data storage. She was given a set of keys and a pass code to a filing cabinet and instructed to enter an unheated, unlit warehouse with a flashlight to get her files herself. The company wasn't about to spend a dime more than legally required on a client with past due bills.

Her treatment was significantly delayed due to the bankruptcy. I can't imagine this scenario in a public system.

by the way-w hat did I tell you- denial and red herrings. thats all that got left.

I don't believe that you honestly believe that waiting times in the U.S. are no better than in other industrialized countries. Relying on a couple of atypical studies is beneath you.

Yeah, shame on you, Ezra, for coming to conclusions that contradict my preconceived notions of American healthcare supremacy. Also, shame on you for relying on radical left-wing biased sources like Business Week and that Troy Brennan guy.

Hint: It's where sauerkraut comes from.

New World Market at 21st & Geary? Huh. I never thought about going there for healthcare.

One should note that JasonR is citing "research" from the Canadian equivalent of the American Enterprise Institute as proof that the Canadian healthcare system is bad. It's amazing the results that conservatives can get when they pay for them.

A good poll would be this: Are you for a universal system if you have to wait 30-40% longer for a doctors appointment or test. No matter how you dice it times will go up that is a given. How much? Who knows? Physicians are a finite resource. Their time is maxxed out at present. It like having a Yugo that goes 0-60 in 10 seconds. You cant put 10 clowns in the backseat and expect it to do it again without some serious modifications. Unfortunately those type of modifications take about a decade. There is no guarantee any of our statistics will improve as long as we continue to be the fattest and laziest country in the history of the world.

Isn't that the same OECD report that said there were no noticable wait times in countries like Japan,Germany and France, the countries any US healthcare system will likely be modeled after?

Who says it would "likely" be modeled on one of those countries? I see very little discussion of the health care system of Japan, and not much more of Germany's. The ones most often talked about by American proponents of reform are Canada's and Britain's, although few seem to have much enthusiasm for Britain's NHS.

And the French health care system has very serious problems of its own.

One should note that JasonR is citing "research" from the Canadian equivalent of the American Enterprise Institute as proof that the Canadian healthcare system is bad.

Yeah, the American Enterprise Institute is hopelessly biased, whereas, say, the Economic Policy Institute (Ezra's favorite source of economic research. Sorry, I mean, "research") is a model of impartiality and balance.

dingo- why don't you just ask "when did you stop beating your wife?" it's about the equivalent of your push poll suggestion.

Tell me how wait times will decrease with universal coverage.

jason's only good for red herrings- i mean the comparator is business week, but somehow he tries to bring up an organization not part of the convo.

I really think Ezra needs to institute a Red Herring Award for best misdirection of a conversation.

Heck everybody is for everything when there are no strings attached. I'm for giving puppies to toddlers. Some of the nuts and bolts of the issue are these. Are you in favor of universal care if you have to pay higher taxes and wait longer to see a doctor. Even in the most utopian of plans these two events will occur.

Yeah, the American Enterprise Institute is hopelessly biased, whereas, say, the Economic Policy Institute (Ezra's favorite source of economic research. Sorry, I mean, "research") is a model of impartiality and balance.

Ezra actually cites a pretty broad range of studies in his discussions of health care. But setting that aside, here's a radical notion: instead of resorting to the lazy and superficial 'you say my sources are biased? well I say your sources are biased!' argument, how about trying to argue that the AEI's studies are more methodologically sound, or have better data, than the EPI's? That would at least be entertaining.

By the way, do you sell HSAs? Just curious.

...how about trying to argue that the AEI's studies are more methodologically sound, or have better data, than the EPI's?

I'm not interested in exploring the methodological soundness of either of those organizations in this thread. I'm just pointing out that the lazy and superficial "Your source is biased!" accusation is a two-way street. If paperwight thinks the independent study of waiting times in Canada I cited is seriously flawed, then he needs to make an argument for that belief.

Well, Dingo, if I had a choice between longer wait times to see a doctor and being tied to my employer for health insurance precluding me from every being self-employed or starting or working for a small business, I would choose longer wait times.

However, since universal health care generally results in shorter wait times, such as in Germany, it looks like I will have the benefits of both if we implement here in the USA.

However, since universal health care generally results in shorter wait times

Ha ha ha ha! Good one.

oh please- jason now you are lying- you aren't interested in any study that disproves your foregone conclusions, methodically sound or not.

I'd be surprised if JasonR doesn't get paid to post here.

I'm just pointing out that the lazy and superficial "Your source is biased!" accusation is a two-way street.

Except that there is extensive documentation of partisan intellectual dishonesty in AEI studies (at this blog, at TAP, and elsewhere); that's what Paperwight was referring to. If you choose not to be aware of this, that's your problem, not ours.

is it a given that wait times will go up? That would seem to depend on the reasons for wait times now. Some of the wait time now is likely due to having to get insurance company approval to see a specialist, followed by the waiting time to see one of the specialists accepted by your insurance company. Both these times would be heavily reduced under many universal care proposals. The amount of time saved could be sufficient to cover the newbies.

A bigger problem is likely to be that the US medical system has not prioritized primary care physicians 9certainly with respect to other specializations), so there would likely be a shortage of these unless we allow a larger number of immigrant doctors to pick up the slack.

JasonR, was the study peer reviewed by outside scholars or was it one of the think tank's many press-releases-masquerading-as-research document dumps? Because, you know, if they were decent scholars doing good research they wouldn't be at a hack think tank.

As for Ezra, is there a journal in which that Commonwealth Fund study was published?

Except that there is extensive documentation of partisan intellectual dishonesty in AEI studies

Except that since we're not discussing an AEI study here it is utterly irrelevant even if it's true.

Are you in favor of universal care if you have to pay higher taxes and wait longer to see a doctor.

Taxes will obviously go up, but the amount you pay for health insurance other than through taxes will go way down, won't it? There's nothing that says people won't come out ahead an overall matter; I certainly expect to come out ahead myself.

JasonR, was the study peer reviewed by outside scholars ...

I don't know. Were the Business Week article, the Medical News Today article, or the Commonwealth Fund study cited by Ezra peer reviewed by outside scholars? My guess would be no. Pot, kettle.

Question: Since most people who post here know that JasonR is simply throwing out red herrings, why do you engage him?

I’ve long stopped caring about wait times when it comes to comparing health care systems. It’s a form of rationing and rationing’s required regardless of the finance/delivery mechanisms if the system cares at all about its long-term finances. Free market solutions – which we are far from having her in the states– ration with price; single payer systems have wait times; our system, which anyone should recognize is convoluted regardless of your political bent, rations through non-coverage and wait times.

The "independent" study that JasonR cites is from the Fraser Institute, a right-wing think tank whose motto is "Competitive Market Solutions for Public Policy Problems". Still, that doesn't mean the Fraser Institute never gets its facts right. There is indeed a wait-times problem in Canada, but what JasonR fails to mention is that a major ten-year push to reduce wait times has begun, and preliminary indications are that it is having positive effects.
http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20070626/wait_times_070626/20070626?hub=Health

The main problem with wait times is financing. If the U.S. adopted a single-payer universal scheme, it could reduce overall expenditure and still have the best-funded health-care plan in the world. But that's not likely to happen: it would be letting the socialists win.

but what JasonR fails to mention is that a major ten-year push to reduce wait times has begun, and preliminary indications are that it is having positive effects.

Er, did you read the report? The conclusion of the Fraser Institute study is that waiting times have increased despite that push. The push hasn't just "begun," it's been underway for years.

Interestingly, JasonR, you never hear about any initiatives in the United States to reduce waiting times to see specialists, get MRIs, or get seen at the emergency room. And yet, significant waiting times exist.

This is another phenomenon of universal health care systems-- they concentrate on figuring out how to reduce wait times, while that doesn't seem to be a priority anywhere in the USA.

JasonR: The ten-year push I referred to runs until 2014 and was supposed to deliver meaningful results by March 21, 2007. The CTV story I cited, which reports some positive results, is dated June 26, 2007. The Fraser Institute report you cite has a base year of 1997. I wonder why?

mijnheer,

It might help the discussion if you would actually read the article I linked to instead of guessing about its contents. The FI study had a "base year" of 1997 because its purpose was to examine changes in the performance of the health care system over the past decade, after an infusion of an additional $36 billion in federal transfers.

The latest Statistics Canada report on waiting times, which I also linked to above, found no improvement in median wait times between 2003 and the end of 2005, the most recent period for which data is available.

JasonR: It would help if you actually knew something about recent developments in the Canadian health-care system, including the 2004-2014 plan and the latest (2007) statistics on wait times. Like you, however, I am suspicious of any plan or propaganda coming from the Canadian federal government promising to improve the country's universal health-care system. After all, they are Conservatives.

Stating that it will go down with nothing to back it up does not make it so. Patients wait 2 months to see me at present. The time spent waiting to see me is not insurance driven. Its volume driven. You call you get put on the list. I see 80-90 patients a day on my office days. 70% of my time is spent in the room with the patient. 20% is spent charting and dictating. My office is completely computerized and I deal with minimal red tape because my staff does it not me. There are only so many hours in the day and most physicians cannot see any more patients than they are right now. If you increase demand (uninsured) and you have the same supply (physicians) people will wait more.

a) what's your practice
b) if you can find a perfect solution let us know
c) not being smartass with b), but instead pointing out the reality. saying peo will wait when the whole system is broke is a bit bizzare. it's not just issue of 45 mil uninsured- it's not that prem are going up double inflation rates, its not that right now we are having comparative wait times, it's not that we have outcomes that are less than those of other countries , etc. it's all of these things together.

here's my problem with the things must be perfect argument. whether you intend that argument or not- its what implied.

no system is perfect. the goal of building a system is not to create a perfect system. the purpose of creating a system is to produce the best system possible.

it's like th at saying about democracy itself- it ain't perfect, but its the best thing we've been able to come up with.

by the way- i am a lawyer. this is one of those things they tell us in the first year. for example criminal law- we don't create criminal laws assuming we will punish all behaviors. we create it for the purpose of a better system than not. if idealogy is taken out of this- what is better than not here?

by the way- i think most americans get this- hence the polling. they are addressing these issues in abstraction- they are addressing them as bread and butter concerns.

"A Commonwealth Fund study of six highly industrialized countries, the U.S., and five nations with national health systems, Britain, Germany, Australia, New Zealand, and Canada, found waiting times were worse in the U.S. than in all the other countries except Canada."

I was reading another blog when I came across the below Commonwealth study:

http://www.commonwealthfund.org/usr_doc/site_docs/flash/chartbook_IHPSurvey.swf

Slide 16 addresses wait times. Not a ton of content, but this slide seems to contradict the statement I copied above. Is the article Ezra's cites incorrect, or is it referring to a different study?

I think the Commonwealth Fund study being cited is Taking The Pulse Of Health Care Systems: Experiences Of Patients With Health Problems In Six Countries. Based on the data I see in the study, the claim in the Medical News Today story is even more misleading than I thought. In fact, it's hard to know what statistic the author of that story was referring to at all. The study shows that the U.S. has much shorter wait times than all other nations in the sample except Germany on "Wait for specialist appointment" and "Wait for elective surgery," and shorter wait times than all other nations except Germany and New Zealand on "Time waited to be seen in ER." Canada also does much worse than the U.S. on "Ability to get an appointment to see a doctor" on the same day or next day, and on the percentage who had to wait more than 6 days for an appointment. I don't see a single wait time statistic supporting the claim that "waiting times were worse in the U.S. than in all the other countries except Canada."

Are you for a universal system if you have to wait 30-40% longer for a doctors appointment or test.

Well, since I keep hearing that we now have no waiting times to speak of in the US-- right? same-day MRIs, hip replacements in a week, unlike those evil Canadians & Brits-- than adding 30-40% should be a negligible cost, shouldn't it? Seven business days versus five, or something like that...

Funny thing about taxes vs. premiums... I did a quick calculation to determine just how much higher my income would have to be for a 3% tax increase to equal the cost of my current premiums plus deductible (individual, not family coverage)-- as it turns out I'd have to make around $175K or so. Not too many people would see a net loss, and I expect there would probably be an income cap like Social Security's anyway. I'm solidly middle-class, and there's no doubt I'd come out well ahead financially.

A) Orthopedics
B) I agree every system has its evils. I don't necessarily agree that our system is broken. I think it serves a large portion of our population very well. If me or anyone in my family was injured or sick there is nowhere in the world I would rather be. I donate 100,000 dollars worth of care for free every single year. If anyone has a right to complain about the current system its me. My point is this what does any of this thread have to do with reforming our system. Would it matter if we were dead last in current wait times? The real question is what will happen if you funnel 45 million into an already overloaded system is the point I'm trying to make.
The most concerning access issue is 1/3 of physicians are over 55. If the politicians don't get this right, access problems will be compounded by adding 45 million and subtracting a significant amount of physicians by retirement. Everyone has to have a seat at the table and unfortunatly whether you or I like it or not the insurance companies will have theirs. If UHC can give their CEO a 100 million dollar bonus, what will the entire industry do if their livelyhood is at stake, 500 million, 1 Billion? They will have their spot at the table thats guaranteed. Everyone knows money equals votes.

latts,

I did a quick calculation to determine just how much higher my income would have to be for a 3% tax increase to equal the cost of my current premiums plus deductible

Huh? Where does the idea of a "3% tax increase" come from? What is its relevance? Which tax are you talking about? Income tax? Payroll tax? Total taxes? Or what?

If anyone has a right to complain about the current system its me.

A little reality check. You promote and perform procedures that offer little clinical benefit and cost billion of dollars a year-- because your incented to do so. Let's start with arthroscopic surgery for your specific discipline and we can move from there. Physicians are among those with the least right to complain.

The most concerning access issue is 1/3 of physicians are over 55.

Very overstated. A confluence of factors would suggest that health care in the future may not need the same level of physicians-- health IT, evidence-based medicine/use of treatment algorithms, increasingly educated patients, greater use of specialized non-MDs that provide similar quality at lower costs (e.g. nurse anethestists, nurse practitioners as PCPs) growth of retail clinics for basic sick care, etc.

If I give no benefit why is my waiting room full. If you had a bucket handle tear you'd be begging for me? Arthroscopy is great for mechanical symptoms, not for arthritis everyone knows that and that is all the NEJM sham surgery study proved. If you were going to reform education you wouldn't listen to teachers? Get real.

I am a doc, my friend.

Arthroscopy is great for mechanical symptoms, not for arthritis everyone knows that and that is all the NEJM sham surgery study proved.

Everyone knows that? So who is doing the procedures on patients with OA that have a system cost estimated at more than $1 billion a year?

If I give no benefit why is my waiting room full.

Ever hear of something called placebo effect? I didn't claim that everything you did had no benefit. But orthopedics is at the topic of medical specialties that promote a number of procedures that have demonstrated little clinical benefit in clinical trials. You don't hear orthopods clamoring for more data to justify their own profession, just like you don't see them not performing arthroscopic surgery on patients who don't need it.

Dingo one way we could address the lack of doctors is to do the "free market" thing and import more. If we did this than US doctor's pay could come in line with pay elsewhere in the industrialized world (currently docs make about twice as much here as they do anywhere else). I'm sure we could get many extremely intelligent doctors from India, China or elsewhere to help with our lack of doctors problem. And if we internationalized doctor certification the way we did textile, food and most other things made by the working classes, im sure there would be no drop of in quality of care.

greater use of specialized non-MDs that provide similar quality at lower costs (e.g. nurse anethestists, nurse practitioners as PCPs)"

Let me just say one thing about this. America uses more "non-doctors" than any other nation on earth in its healthcare. Germany, UK, France, etc dont have nurse practitioners or physician assistants AT ALL.

My point is that this aspect is just about maxed out. It wont begin to touch the specialist side of things. Patients might accept being seen by an NP or PA for basic primary care stuff, but no way in hell will they accept it for specialized care.

When a PCP refers somone to a specialist, the expectation is that a doctor will see them, not a nurse and patients will revolt if you try to force them to see nurses.

For primary care its an entirely different ballgame.

One more note about NPs and PAs. They can already bill Medicare for the same activities that a doctor does.

Has this resulted in lower costs for Medicare? Absolutely not, because the overall effect is MORE BILLINGS by providers, not less. Adding more NPs and PAs wont change this, it will make costs go up, not down.

Its even worse in the UK, where they allow people like acupuncturists and homeopathists direclty bill the govt for bogus services.

You have to kill the fee for service system, it wont work, no matter if its a PA, NP or MD who is the "provider." WE need a flat salary system so that bogus procedures are eliminated and people only get care that they absolutely need.

I'm confused are you saying its maxed out, or only that it could impact PCPs.

If you're saying the former-- just look at the growth of retail clinics-- something the AMA has been considering what lobbying/regulatory hurdles they can put up to stifle growth.

If its the latter, I'd agree that PCPs are at much higher risk-- but specialists are at risk too. Anethesiologists I mentioned before, ophthalmologists' turf is being encroached upon by optometrists, other specialties will see similar pressure.

Anesthesiology is a separate animal because they are really technicians with no real "patients." Similar to radiologists. PCPs dont send their patients for anesthesiology consults, the gas doc comes with the surgical package.

Psychiatry is under siege by psychology in several states, but its not clear at all that will save costs. In fact, it will probably cause costs to go UP, because now you've got psychologists billing the federal government in addition to the psychiatrists.

Optholmology and optometry is the same deal, except in that case its EXTREMELY limited. There is only one state that allow optometrists to do any kind of optho work at all (Oklahoma).

At any rate, letting in all these other "providers" will cause costs to go UP, not down. You cant assume that they are all going to be competing against each other.

Bear in mind that anesthesiologists income has gone UP since nurse anesthetists came into the picture. Gas docs make a TON of money from their services.

Bear in mind that anesthesiologists income has gone UP since nurse anesthetists came into the picture.

This is true for other specialties as well-- those that have moved to a model where one doc is supervising a number of non-MDs. In the short-run, they have been able to increase their patient volume. In the long-run, though, payers will catch up-- more providers for the same level of patient demand will lead to lower costs.

Huh? Where does the idea of a "3% tax increase" come from? What is its relevance? Which tax are you talking about? Income tax? Payroll tax? Total taxes? Or what?

3% of my total income. I doubt that anything higher would be passed or necessary... probably not even much. IOW, I just pulled a number out of my ass as a hypothetical, a practice with which you seem familiar. Bottom line: it would take a substantial tax increase on a higher income than I currently earn to even equal the cost for my current, employer-provided coverage, much less be a net financial loss.

Simple enough for ya?

latts,

IOW, I just pulled a number out of my ass as a hypothetical

Yes, I thought so.

honestly dingo- don't this personally, but I know longer care whether folks like you, Jason etc get that the system is broken. We don't have time to wait around for you to figure it out. No more than I would have time to waste with soemone who believes the earth is flat.

sorry for my usual horrible grammar and typos

JasonR,

Takes one to know one, I guess.

Medicare tax is 2.9%, btw.

Who says it would "likely" be modeled on one of those countries? I see very little discussion of the health care system of Japan, and not much more of Germany's. The ones most often talked about by American proponents of reform are Canada's and Britain's, although few seem to have much enthusiasm for Britain's NHS.

And the French health care system has very serious problems of its own.

Who say's it would be based on a private/public mixture in the US? Well every serious political proposal since 1994. The only reason Canada and the UK are brought up so often is because it's the easiest to bash. Duh.

But my point remains. You were very disingenious with your citing of the OECD data. You picked the "worst" countries with waiting times and left out the good ones.

Why is a system like France, Germany, or Japan bad. I want you to tell me why the US system is preferable to all three. And not just a flaw in each give me comparative analysis why the US system is better than all three. If you're really against all form of universal health care and the US system is better then this should be easy

A good poll would be this: Are you for a universal system if you have to wait 30-40% longer for a doctors appointment or test. No matter how you dice it times will go up that is a given.

Why? Because theres more people is not an answer. It's a warrantless assertion.

Furthermore, I would contend that for many American's the waiting time is infinite. If you don't have the money to get treated you usually wait forever, or until you get the money. Many times if youre lucky enough to get the money or find a job with decent coverage you it's too late to treat or the diagnois is worse. Furthermore how long do you have to wait in the US if you're medically disqualified for most insurances? Oh and how long do you have to wait if you're insurance company nickels and dimes you by trying to avoid approving your treatment.

But let's look at this your best case scenario and my worse case scenario. We'll assume that you have perfect, zero waiting time, non shitty insurance. Are you telling me that you would prefer to keep your perfect insurance while 45 million people go without treatment because you don't want to wait a month for hip surgery or some other non emergency treatment?

I agree every system has its evils. I don't necessarily agree that our system is broken.

You basically claimed, point blank, that the health care system would be unable to handle a situation in which everyone had health care coverage, implying that the system only works when tens of millions of people go without. That sounds like a system that is broken to me!

Phil,

But my point remains. You were very disingenious with your citing of the OECD data. You picked the "worst" countries with waiting times and left out the good ones.

I didn't "pick" any countries. I quoted verbatim the list of countries that the OECD reported to have a serious problem with waiting lists.

Why is a system like France, Germany, or Japan bad. I want you to tell me why the US system is preferable to all three. And not just a flaw in each give me comparative analysis why the US system is better than all three.

Sorry, but I'm not the one proposing dramatic reform of our health care system, so I don't have to give you an analysis of anything. If you are proposing such reform then it's up to YOU to make a case for it. And since health care is a huge part of our economy and is very important to people's lives, it had better a strong case. A case that your proposed alternative would be clearly better.

"Why is a system like France, Germany, or Japan bad."

In my opinion, they're bad because they do a pour job at controlling cost growth, which is really an issue with all systems, our current one included.

By no means am I saying our current system is great; but I see no compelling reason why a national healthcare system, or any of its variations, is the solution. When we start to make changes to our system, access and cost growth control need to be the prime objectives.

more providers for the same level of patient demand will lead to lower costs."

No way, because healthcare is not a free market in which consumers cause provider competition based on cost.

Take a look at New York City for example. NYC has BY FAR, the highest number of providers per capita of anywhere in the world. The number of doctors per capita in Manhattan alone is more than 5 times the national average.

Under your model of providers competiting against each other, doctors in NYC should make lower incomes, but thats precisely the opposite of whats really happening. NYC doctors HIGHER incomes than doctors in other similarly large cities such as LA, Miami, Chicago, etc.

"By no means am I saying our current system is great; but I see no compelling reason why a national healthcare system, or any of its variations, is the solution. When we start to make changes to our system, access and cost growth control need to be the prime objectives"

The goal of a nationalized or semi-nationalized system is at its core an attempt to provide access for everyone. And most other industrialized countries have succeeded. They've also succeeded at keeping down costs relative to private schemes like we have in America. Even Medicare has seen a slower cost growth than the US private system, and by and large its population is older and less healthy than the total USpopulation. Also it has the least expensive bureaucracy of any health plan in the US at just 2 percent of spending. (So much for that whole efficieny of the private business canard). Here's the link to the story

http://www.prospect.org/csnc/blogs/beat_the_press_archive?month=07&year=2007&base_name=michael_gupta_says_medicare_is

sorry about the spelling errors, and my lack of html skills

Joeblow,

You keep talking about the present, and I'm talking about the future. My response here was in context to Dingo's statement that we will have a doctor supply problem in the FUTURE, not present.

The costs are not sustainable. One of two things WILL happen: the government will begin lowering compensation levels of physicians in a single-payer system/hybrid system, or there will be consumer competition where physicians are chosen on the basis of easily understood quality and cost measures.

there will be consumer competition where physicians are chosen on the basis of easily understood quality and cost measures.

Wrong. There will be insurance-company-based competition where insurance will not pay for the services of certain physicians and physicians will not accept patients covered by certain insurance companies. We have some of that now, in fact.

Tyro,

Careful with your use of "wrong"-- particularly when you are. If you look at proposals for increasing consumer control of health care, there are multiple methods of having consumers make these tradeoffs, the simplest to explain would be similar to a tiered formulary-- i.e. low-cost/high-quality doctors have the lowest co-pay and high-cost/low-quality doctors with the highest co-pay. Others, like Obama's health care proposal, are simply looking for freedom to choose your physician along with data transparency on cost and quality to allow consumers to make better choices.

In other words, I'm not aware of anyone advocating for a greater role of insurance companies driving competition in health care-- except those that defend the status quo.

Sorry, but I'm not the one proposing dramatic reform of our health care system, so I don't have to give you an analysis of anything. If you are proposing such reform then it's up to YOU to make a case for it. And since health care is a huge part of our economy and is very important to people's lives, it had better a strong case. A case that your proposed alternative would be clearly better.

HA. Exactly what I thought. You cherry pick results from a study and tell us why the bad countries are bad but you refuse to tell me why the "good" countries on the study should also be rejected as a form of universal healthcare.

The fact is, that Ezra has documented time after time why socalized medicine is better than the US system. Many times he's specified how different types of systems are better than the US, the French system especially. He's even written whole articles on the subject. You have the burden of rejoinder in this debate. Seeing as this is a blog that largely deals with advocating universal healthcare it's your turn to present arguments for why the US system is better.

In my opinion, they're bad because they do a pour job at controlling cost growth, which is really an issue with all systems, our current one included.

By no means am I saying our current system is great; but I see no compelling reason why a national healthcare system, or any of its variations, is the solution. When we start to make changes to our system, access and cost growth control need to be the prime objectives.

How much do we spend on healthcare in comparisons to other countries? Yeah, I thought so. Furthermore, cost growth is a pretty damn weak argument against universal healthcare. Ohhh, it might be expensive. Ohhhh. Lame. Give me your alternative then.

wiswon, you claimed that only ONE of TWO things would happen, and claimed that it was going to be a tradeoff between government driving down costs by reducing compensation or the magic of consumer-directed health care. "Consumer-directed" health care isn't going to happen because patients are not consumers, and you completely ignored the role played by insurance companies of reducing their own costs by reducing payments to doctors and restricting physician choice.

As I said to someone else earlier, I'm talking about the future, not present. Restricting physician choice and negotiating with doctors are things that happen now-- they are not discussed as future solutions by anyone. I'm clearly aware of them, I've actually dealt with them. Read the whole thread, as you're taking one comment of mine out of context.

Just in case.

Well, giving the AMA a monopoly and letting them cut down on med school admissions in the 80s and 90s worked really well, didn't it. Frankly, I'm going to take it with a grain of salt when a doctor starts telling me how the healthcare system should be organized. They've had 80 years and extensive powers to make their ideas work. It's time to try something else.

I am a little skeptical about the value of reducing waiting times to get into an overpriced system that produces not-very-good results. Sounds kinda like choosing the all-you-can-eat restaurant because there are no lines there.

Still, it's interesting to see the "no waiting" argument knocked down, and I suspect more research will confirm what I can see around me- that people who can afford healthcare wait about two months to see a doctor.

And yes, if you haven't already, read a few of the pieces Jason suggests, so you can confirm for yourself that they are total bullshit and ignore him from that point on. He's just the blog equivalent of static on the radio or the old hiss and pop of the 78.

Go play outside, Jason, the sunlight will do you good.

Phil,

Quick distinction: I’m talking about year over year cost growth. Yes, our current system does not do a good job managing this, but neither do the systems Ezra often espouses, but this is rarely discussed. Ezra’s favorite metric is healthcare spending as a percentage of GDP. But what never gets discussed, because it’s a weak spot for his, and others, position, is that healthcare spending as a percentage of GDP is increasing for all western countries, and Japan, at a rate greater than GDP.

A system that has costs growing in excess of GDP year over year is unsustainable in the long run. Have you ever looked at a chart mapping Medicare spending as a % of GDP over time?

Please, don’t view this position as an advocacy for the status quo. One can be for change and still not want a nationalized system.

"Well, giving the AMA a monopoly and letting them cut down on med school admissions in the 80s and 90s worked really well, didn't it. Frankly, I'm going to take it with a grain of salt when a doctor starts telling me how the healthcare system should be organized. They've had 80 years and extensive powers to make their ideas work. It's time to try something else."

Check your facts, jack. The number of med schools was NEVER reduced in the 80s or 90s. The last time hte number of med schools was reduced was in the 1920s as a result of the Flexner report which showed that the vast majority of med schools were shams producing docotrs who were quacks.

In fact it was the balanced budget amendment of 1997 that did the most damage to the supply of doctors in this country, because it does not allow the creation of new residency programs funded by Medicare GME. No residency programs = no doctors.

Currently, there are 27 new or planned medical schools in the United States.

Also, the AMA doesnt control the # of med schools. In fact, they have no say whatsoever. Thats why Florida just added 3 new med schools DESPITE the fact that the AMA came out in opposition to them. You can build as many med schools as you want provided you pony up the cash.

You also ignore hte impact of DO schools of which there are about 30. They have absolutely nothing to do with the LCME that accredits MD programs.

You also ignore the impact of NPs and PAs. They are allowed by law to do 95% of what a doctor can do. The only thing they cant do is run surgery cases solo. I see no reason to give htem that power, the USA already gives more power to NPs and PAs than any other nation on earth.

Less than 20% of doctors are members of the AMA. Its a dead organization with no teeth. AMA came out strongly against Medicare in the 1960s, and you see how that worked out.

Insurance lobbyists run healthcare policy in Washington, not doctors. Insurance lobbyists outnumber doctors groups by a 100 to 1. Read that again, 100 to 1.

The reason socialized medicine wont pass Congress is not because of doctor lobbying, its because the insurance industry would go out of business overnight and they know it. They will spend their entire budget buying off Congress to prevent this from happening. They've already bought off Hillary Clinton, which is why she has since abandoned her single payer "HillaryCare" program.

"Joeblow,

You keep talking about the present, and I'm talking about the future. My response here was in context to Dingo's statement that we will have a doctor supply problem in the FUTURE, not present.

The costs are not sustainable. One of two things WILL happen: the government will begin lowering compensation levels of physicians in a single-payer system/hybrid system, or there will be consumer competition where physicians are chosen on the basis of easily understood quality and cost measures."

Now you are bringing up an entirely different argument. I agree that a single payer model will arbitrarily ratchet down doctor incomes. But that has NOTHING to do with providers competing against each other. My point is simply that your scenario #2 will NEVER happen in ANY kind of healthcare system, becasue healthcare is not a free market.

Medicare already controls 50% of all healthcare dollars in the USA, and thats projected to increase to 75% by 2020. Even if we maintain the status quo, Medicare controls so much of the market that its impossible for private insurance OR consumers to induce provider competition to reduce doctor incomes. It simply wont happen.

As I have stated many times, the best case scenario is a single payer universal system that pays doctors a flat salary. Its the only way to get off the fee for service whirlwind where the # of procedures doubles every year with no impact on improving overall health.

Joeblow,

What's wrong with the Kaiser staff model?

My point is simply that your scenario #2 will NEVER happen in ANY kind of healthcare system, becasue healthcare is not a free market.

Take a look at consumer-directed health care proposals.

Whats the "kaiser staff model"?

Kaiser is a health insurance company. In certain regions, they own hospitals and clinics and employ physicians directly who serve patients covered by Kaiser.

Kaiser's system would be fine if it was run by the federal government.

How much profits do Kaiser skim off the top? 25, 30 maybe?

How many millions did their CEO make last year?

Point is we dont need them to make hte system work. Far better to remove the middle man and have doctors as flat salaried employees of the federal govt.

You're entitled to that opinion-- just recognize that flat salaries for physicians does not require a single-payer system-- your desire for this type of system is instead based on other factors, as you mentioned.

Private Health care Systems and The Capella Group, Civil Action No. 106-176 (S. Dist. of Georgia, Augusta Div. 2007), the Plaintiff physicians sought damages in tort against a Preferred Provider Organization (“PPO”) with whom they had entered provider contracts and a discount card company who had purchased provider information and discount data from the PPO. The physicians argued that their agreements with the PPOs did not contemplate the sale of their information to a purchaser who was not an insurance company and that the sale of such information was a breach of privacy or of some other kind of tort arising out of the contractual duties created by the physicians’ contracts with the PPO.