RE: pre-existing conditions. Isn't it the case that they don't cover pre-existing conditions for a set period of time? Like 12 months? At which point they start covering it? Just curious.

I overheard people having sincere conversations in England (re: not meant to be shocking horror stories) that made me fear socialized medicine. The one that seemed the most horrible, even though clearly it wasn't a medical emergency, was the guy who was lamenting that he had to wait 18 months before he could get a vasectomy. 18 months?

As per my understanding in England, the doctors make considerably more money treating paying customers and those with private insurance than they do treating the masses, so there's simply more slots open for the people with private insurance or their own cash. However, since there's universal-ish health care, unlike in America, people with good middle class jobs don't have any insurance through their employer and aren't able to afford the rich-person-surcharge that doctors can charge considering the supply/demand situation.

There are other tough stories, including one about someone CrazyMonk knows, that lead me in a similar direction.

Health care in America has enormous issues (I haven't yet seen the movie), but if/when I have real insurance, I really want some assurance that I'll be able to actually use it.

Morally barbaric? Yes. But so are poverty, illiteracy, racism, sexism...the list of social problems goes on and on. It would be Utopia if we could fix everything. Still, at some point I have to stand back and wonder whether resorting to the state to fix these problems is 1) a plausible response given the financial constraints on state and federal budgets; 2) a realistic response given the sheer size of our population; 3) a philosophically sound response given the nature of our republic and our limited government; and 4) an irrational response given the unintended but likely consequences of a dramatically expanded welfare state.

Does anyone else wonder why there is so little mention of private foundations (501(c)(3)s) that offer high quality healthcare to the neediest in this country? We have great philanthropists giving billions for worthy causes both in this nation and around the globe; yet there seems to be a lack of support (at least in terms of the leading philanthropies) for basic healthcare in this country. Given that health and social insurance originated from fraternal organizations, the lack of private charity raises some questions.

Ok, just read the Reason article, and (unsurprisingly) it reflects my basic understanding of the situation in Britain... and my basic fears about implementing such a system here.

"[I]f/when I have real insurance, I really want some assurance that I’ll be able to actually use it."

That is what Sicko is about -- that you may not, because insurance doesn't guarantee you full health care, especially if it hurts the bottom line. It doesn't really go into details about people w/ no health insurance at all, since that is pretty much self-explanatory.

Some guy has to wait a long time for (I assume) a non-health-required vasectomy surgery, as compared to the tens of millions of people in America who don't even have that choice? It's hard to say that that is worse -- I would have to see the numbers in the average case: what's the average wait in Britain, what's the average wait here, and how many people in America who want vasectomies are rejected outright?

Moriarty, all the problems you mentioned are also social problems, many of which already have government programs dedicated to improving them. (And with the case of public education, vastly improving them -- think how high illiteracy rates would be if education wasn't socialized.) Some of them, like poverty, I would agree with you that our response is often morally barbaric. But one of the worst aspects of poverty is not being able to get basic health care -- so it comes down to the same problem. (Sexism and racism I think are harder to address with government programs, but actively defending equal rights at the workplace and our schools has chipped away at the problem, albeit slowly.)

The fact is: we are the *only* Westernized country without health care for all, and it is clearly doable by all the others, even if not flawlessly. It affects far more people than the admittedly large problems you mentioned, and almost encompasses poverty as a whole. Yes, it is morally barbaric for the wealthiest country in the world not to guarantee health care for all of its residents.

michael moynihan is a hack, a paid shill and no serious attention should ever be given to him.

I'm not sure if he's a paid shill, but he makes some weak arguments. Take this line:

"And while bitterly lamenting the U.S. system of "wage slavery"—American students, Moore says, are saddled with debt and, thus, "won't cause [employers] any trouble"—he ignores a recent report from the British Medical Association suggesting that, by their fifth year of medical school, British students "have accumulated an average debt of" $39,000."

Ha! The average in the United States is over $100,000!

the argument that gets lost here is that we're already paying for universal health care, in the most inefficient and cruel way possible. hospitals are not supposed to turn away life-threatening cases, insurance or not, and we the taxpayers foot the bill for uninsured care: directly, via bankruptcy, and by the exacerbation of massively expensive illnesses that could have been effectively headed off with preventative care.

If people want to talk 'efficiency' and 'private market,' let's be clear abot the goals. in the health care system, the "product" is health. The free market, then, should compete efficiently to offer competitively priced access to health. by offering federal laws that allow for and even incentivize the opposite (sky-rocketing premiums paired with blackouts on preexisting conditions, retroactive attempts to gut coverage for major expenses), we end up with the worst system possible: a monpolized and state-coddled "free market" system that is both MORE expensive than the socialist systems (we pay more per person) and LESS able to produce the best product (our health sucks balls). What is does do is create obscene profits for unnecessary elective drugs and services that do not advance health, but produce disproportionate wealth for CEOs who fail to provide the 'product' the system is based upon. ANY libertarian should be outraged by this system, which is the direct result of government corruption and corporate welfare.

so, if you're going to cling to free market ideals, let's at least be clear that our system 1. isn't really an example of that and 2. has fucking failed us.

and all that is beside the fundamental question of whether something so basic as human rights, your right to live, should be subject to the "free market" (again, I can't bring myself to write that phrase non-ironically under our current "government" structure) - which of course, I don't believe it should.

I admit that, as a libertarian, I have no functional idea as to how health care should be handled.

Health care will never work in the same way that other products too. We can't, for example, over produce health. The cost of health is not affected by supply and demand in the same way that the cost of pizza is. The cost of health goes up with new discoveries, rather than going down... there's no real option for people to chose a less expensive alternative to health... dying is not a viable option in the same sense that not buying pizza would be. Prices will always be as high as they can conceivably and functionally be, because people will always pay whatever they need to pay to gain health and they will never perceive that not paying is a viable option.

One hundred years ago, the best thing you get was a surgeon with a hack saw and a bottle of ether... so you paid whatever you could to get that surgeon and his hacksaw. Today the best thin you can get is a professionally staffed operating room... nobody is willing to say that there's a viable choice between choosing the best old option (hacksaw) and the best new option (professional surgery). You HAVE to pay.

Additionally, unlike other services, it's difficult to compete in health care, especially emergency health care which is going to be some of the most expensive. If I'm in a car crash, I don't have time to find what the cheapest hospital is going to be, I go to the closest hospital. There's no options... and if the closest charges outrageous prices because they're the only hospital near the freeway, then so be it.

There's no obvious free market solution to this other than to let poor people die somewhat gruesome and predictably very public deaths. Nobody likes that option. And so we're stuck. I fear what I saw, anecdotally, of socialized health care in the UK. I fear that what little cost incentives we HAVE built into the system will be lost and we'll quickly be overwhelming the medical infrastructure that we've established (going to the doctor for checkups costs SOME money, so I don't go every time I have a cold... but if it was free, I'd probably always go). I fear that those who need health care and are not the very wealthy and are not the very poor will be worse off than they are now.

I fear.

And I offer no solution.

This is my position. And it's a crappy one. So I'm willing to listen. And I'm willing not to fight too hard against anything, because I can't offer anything better. But I think every solution is bad... so I don't know what to do.

Why do you think every solution is equally bad? Do you take no stock in the WHO ratings for health care, which rank France as one of the best in the world, and the United States at #37? Isn't it worth following other successful examples?

I like the idea of Universal Healthcare here, but I wonder if it will really work. Do we really want the same people who are running our educational system (which is producing less impressive results the more money we dump into it) running our healthcare? And one thing that Moore doesn't address in his film: lifestyle differences. I have traveled in Europe, lived in France twice (short-term) and see a major difference in the way we live. Americans are an excessive bunch. The average American eats too much, wants all the newest everything--including pharmaceutical products, does little to maintain health (massive fast food consumption, little physical activity), yet is the first to run to the doctor for every little thing. Our emergency waiting rooms are overflowing, and half of the people there have no emergency. I'm just very concerned about how we will pay for all this, and effectively administrate this. Americans are known for taking advantage of government services, at least in my community they take advantage. How on earth is all this really going to be affordable?

I do agree something must be done though. Our healthcare system is out of control.

But, I guess we should be encouraged, even Moore (on Larry King tonite) said that our healthcare is "quality" and "we have some of the best doctors in the world."

Check out "will s | June 29, 2007, 5:06pm | #" in the discussion forum attached to the Reason article. This person describes the German Healthcare system which is "universal" but not single payer.

Fascinating!!

Moynihan is on the payroll of Timbro, a Swedish right-wing "think tank" that is funded by the pro-business lobby and regularly publishes political propaganda poorly disguised as "research".

My foreign familiarity is mostly limited to the British system. Pitch me the French system?

Hmm, that's an interesting description of the German system, Angela. I'm pretty certain that a new health care system in America will realistically have to be a mix of both private and public, and it's worth looking at other countries that already have that.

Ingen, I don't know the French system well, but here's what I found: http://www.medicalnewstoday.com/medicalnews.php?newsid=9994, http://news.bbc.co.uk/2/hi/health/799444.stm. I kind of like the idea of elevated co-payments (for non-emergency services) for all but the poorest. There needs to be somewhat of a disincentive of people abusing the system like, say, going to the eye doctor once a month. Also, I don't think we should copy the French system wholesale. America is a different country than France (most importantly, the population is much more spread out), and whatever system is designed here needs to account for that.

Well said flea.

From lurking on freelancers' mailing lists, I have discovered that this varies from state to state and between employment situations. I believe in California, you're legally protected from having group healthcare membership (through your employer) denied because of a preexisting condition, but self-employed people like myself are out of luck.

It doesn't even have to be a real preexisting condition; I applied for a new health care plan recently and had the premium jacked up beyond the original quote because they found out that I had been to the doctor to have a benign fibrous cyst in my boob looked at. I don't have breast cancer or a family history of breast cancer, but because I followed the medical establishment's advice to get preventive care, I got financially penalized. I can only imagine what fun it would be to deal with insurance if I actually DID have cancer.

Anecdotal bitching aside, Ingen, if you are willing to concede that the free market essentially forces poor people to die in the streets, why would you continue to advocate it? Health care should not be profit-driven.

Sorry; that was a reply to Ingen's very first comment. I expected threading.

This has threading, but I don't really like threading. Plus, the theme I modified doesn't visually represent it, so I turned it off, sort of. I guess I should get rid of those 'reply' links.

I saw 'Sicko' on Friday, and thought it was pretty well-done and thought-provoking and the rest, even if the portraits of other systems were kind of laughable and the Gitmo section kind of deplorable.

But leaving aside the substance of the debate, I had a weird experience at the theater and wonder whether this is being replicated anywhere else.

On the sidewalk outside of the theater, people were leafletting and such, trying to persuade passerby to go see the movie. And, when you left, they were out there trying to flag people down to fill out surveys, essentially like exit-polling in mainstream politics. Not surprising, given that PR for the film is avowedly being run on that model (including pass-through calls and blast-texting, CM, as I'm sure you've read).

But what was weird was this. At the very end of the film -- literally as the last word was uttered and the quick cut to the credits happened -- there was tumultuous and instantaneous applause and shouting from one section of the mezzanine level where I was sitting. Now, when I saw Fahrenheit 911, there was also applause -- but it had a spontaneous feel, like people were genuinely cheering. In this case, I got the distinct impression that the people who started cheering -- in a fairly empty theater, and all from one section -- were doing so for the express purpose of getting the rest of us (a pretty small group) to cheer. And it fucking creeped me out. It felt like a huge set-up ... and, given the small showing, it felt like they were trying to trick me specifically.

Of course, that's insane. I guess they were die-hards who viewed "persuading" us to applaud a tactic akin to leafletting. But the effect was to emphasize the polemics and half-truths of the film in the "audience" itself. I can guarantee that this weird feeling of being targeted and ultimately had is what I'm going to remember about the movie.

That's very weird, ludditerobot. I saw the movie at a premiere screening, and the studio passed out surveys, so 1) the crowd was already sympathetic, and 2) they probably weren't interested in biasing the surveys. In any case, is it possible that the people who applauded loudly were an interest group of sorts like, say, a nurses union?

They were roughly six 20-something scruffy males and one woman. I guess they could have been nurses, but I'm guessing not.

I'm always late on catching up with (and posting on) your blog, Marco, but thought you might find this proposal from Physicians for a National Health Program interesting: http://www.pnhp.org/facts/single_payer_resources.php

I also think it's worth noting that over 25 cents of every private insurance healthcare dollar goes to overhead compared to something like 6 cents of every Medicare/Medicaid dollar (I wish I could remember the exact number). So the general impression that state-run programs are more bogged down in bureaucracy while private systems are more efficient is certainly not true in this case. One should also consider that other countries' issues with their healthcare systems are largely a function of two problems: money shortages and doctor shortages, which would arguably be less of a problem here given that we already put so much more money into our healthcare system than the European countries - it just needs to be reallocated. If you look at the proposal by the PNHP above, it's really not likely to affect doctor's salaries in this country, so we'd still be able to attract and retain the same number of doctors we have today (of course, we do have areas of underserved, etc - this would obviously still be a problem).

Ok, now I have to get back to writing a paper on resources available for uninsured patients in NYC - a sad topic to say the least...