About health care, dispelling some myths.

Lately, we have had an influx of libertarians arguing that health care in the United States is bad, but not nearly so bad as in "socialist" countries and that what we really need is to allow the free-market to work. I know, seriously, have they been asleep for the last 8 years? Anyway, I wanted to dispel some of the myths that were brought up and also just talk a little bit about some health care facts. Warning, Giant Graphic after the break.


Uh-oh, data! Don't worry, it isn't as complicated as it looks. First things first, this data is a comparison of reported data from the OECD. What is the OECD?

For more than 40 years, OECD has been one of the world's largest and most reliable sources of comparable statistics, and economic and social data. As well as collecting data, OECD monitors trends, analyses and forecasts economic developments and researches social changes or evolving patterns in trade, environment, agriculture, technology, taxation and more.

The Organisation provides a setting where governments compare policy experiences, seek answers to common problems, identify good practice and coordinate domestic and international policies.

Therein is the first myth to be debunked, that Canada is the only health care system that to which we can compare ourselves. Let's just assume that Canada's system sucks, then only comparing ourselves to them would be the equivalent of Canada only comparing their energy regulation policies to those in California. To understand the problem, you have to look deeper. OECD gives us that ability.

The color code:

Yellow - United States of America
Red - Countries that perform WORSE than the USA
Green - Countries that perform BETTER than the USA

So, what does this data tell us? Quick take, the other countries are almost all better than us in almost every category. The USofA has lost its competitive edge.

Data Columns 1 and 2 are different ways of looking at how much we spend on health care relative to other countries. As you can see we spend from 1.5 - 2.0 times as much on health care as any other economically developed country.

Data Column 3 measures how much we spend publicly (that is government-financed) compared to the overall cost of health care. Notice here that NO ONE has a program that is funded only through the government. Also notice that we dedicate fewer government dollars to healthcare compared to the total cost, making us the MOST free-market health care system in existence.

Data Column 4 is the oft-mentioned infant mortality rating. Well, at least we are better than Mexico (look at that rate, and folks wonder why Mexicans flock to the US) and Turkey. Myth alert, free marketeers will tell you this number is inflated because we save more babies with high risk conditions, that die in the NICU soon afterwards. The problem is that we are also at the bottom of the list when you look at child mortality rates, which does not include infants. Face it, we kill off our children at a much higher rate and a part of that is attributed to being uninsured or underinsured.

Data Column 5 is an interesting statistic that I hadn't seen before. We spend 2X as much as anyone else on health care, yet we see health care providers less than almost any other country. Not included here is the data showing we are near the bottom of the scale when it comes to practicing physicians. My quick take on that data is that we've always been bottom 1/4th of countries when it comes to number of practicing physicians.

Data Columns 6 and 7 show the estimated life expectancy of girls and boys born today. As you can see, we do better than a few of the less wealthy, less economically advanced countries on the list - but basically we get our butts kicked by truly comparable countries like Switzerland, France, Japan, Iceland, Austria, Germany. Not included in here is the data that shows those countries also have fewer cases of diseases that make the end of life more miserable like lung diseases, heart conditions, and diabetes.

So, those are the facts. We pay more and get less AND we have 50 million people uninsured. Don't forget that those other countries pay that much per capita and have more or less FULL INSURANCE. They insure every person, they survive childhood better, they live longer, they live healthier, they see physicians more often - and they spend less using national health care than we do relying on the free market.

Waiting Times
The next myth you'll hear is that better care is all fine and dandy if you don't mind waiting around for it, because the US has no wait time and Canada has wait times so long they come here for care!!!

Well, don't believe it. First off, the US does not report wait time. So, there can't be a real comparison of wait time in the United States with OECD countries because we don't report it. Comparisons are only made based on scholarly research articles use telephone interviews or data mining; more on this in a minute. Second problem is that those horrible wait times in Canada are actually due in part to horrible record keeping in Canada. Again, why compare yourself to the worst system? It seems that Canadian hospitals did(do)not take patients off their wait lists if they: get the surgery at another hospital, decide not to do it, die, or for any other reason. So, average wait time is skewed by these outliers.

Wait times appear to be influenced by two things, number of beds available and the amount of money spent on health care per capita. There are exceptions, Japan spends almost 1/3rd that of the US and has wait times similar to ours. And, the United States has far fewer beds available/capita than other countries but does not have long wait times.

Wait times for what? Elective surgery. When it comes to emergency surgery there are no wait times. We are talking about things like elective heart surgery, hip replacement, etc. So, why does the US have such short wait times with far fewer beds/capita? Well, we don't insure about 1/6th of our population so there is a good chance, I would say a great chance that those folks are not asking to use beds for knee replacement, cataract removal, breast augmentation, or rhinoplasty. Yes, they count. So, we have a better wait time and less beds per capita because 1/6th of our capita does not have access to elective surgery and another 15 or 20 million are UNDERinsured and don't have these procedures covered either.
In 2007, the Commonwealth Fund found:

In the U.S., 37 percent of all adults surveyed—and 42 percent of those with chronic conditions—skipped medications, did not see a doctor when sick, or did not obtain recommended care in the past year because of the cost. These rates are well above those found in the other six countries. Few people in Canada, the Netherlands, and the U.K. reported skipping care because they could not afford it.

Okay, so maybe our wait times are so good because we screw the uninsured when it comes to elective surgery, what about everything else?

Although the United States does not have long wait times for non-emergency surgical procedures, this does not appear to be the case for primary care doctor visits. In a survey of five OECD countries in 2004, U.S. respondents were the second-least able to make a same-day doctor’s appointment when sick and had the most difficulty getting care on nights and weekends. They were also the most likely to delay or forgo treatment because of cost.

Okay, so we finish 4th out of 5 when it comes to seeing a primary care doctor when sick and are the most likely to just skip it all together. So, looking at something that is a lot cheaper and in which the uninsured and underinsured are more likely to partake of, we stink. In other words, in a category where the full 300 million people in the United States are trying to use the system, it fails miserably compared to "socialist countries".

The long and the short of it is that health care in the United States is great, if you can afford it, which you can't. Health care in every other OECD country costs half as much and results in better health and longer life. So, how would socialized medicine work here in the United States?

The National Committee for Quality Assurance, meanwhile, ranks health plans on 17 different care metrics, from hypertension treatment to adherence to evidence-based treatments..."Winning NCQA's seal of approval is the gold standard in the health-care industry. And who do you suppose is the highest ranking health care system? Johns Hopkins? Mayo Clinic? Massachusetts General? Nope. In every single category, the veterans health care system outperforms the highest-rated non-VHA hospitals."
What makes this such an explosive story is that the VHA is a truly socialized medical system. The unquestioned leader in American health care is a government agency that employs 198,000 federal workers from five different unions, and nonetheless maintains short wait times and high consumer satisfaction. Eighty-three percent of VHA hospital patients say they are satisfied with their care, 69 percent report being seen within 20 minutes of scheduled appointments, and 93 percent see a specialist within 30 days.

Seems to me that socialism is alive and well in the United States and it works pretty damn well.


The free market.

The free market idea that something as vital as health care should be left to the whims of profiteering fat cats is not something with which I could agree. We've seen what happens. They drop your health insurance and you are left to fend for yourself. They dump you and let you get poor enough that Medicaid picks you up, thereby cherry-picking only the healthiest individuals for their policies.

Record profits, rising infant mortality.

"You could say, 'Look, is this guy, Laden, really the bad guy that's depicted?' Most of us have never heard of him before." John McCain, following Clinton's strikes on al Qaeda camps

Jesus Swept ticked me off. Too short. I loved the characters and then POOF it was over.

Of course!

You are so right calling doctors and others providers of health care, what was it you said? "profiteering fat cats" Do you have a job? Do you earn a living? Doesn't that make you a "profiteering fat cat" This name calling, emotionally charged rambling lacks coherence, logic and frankly, is pretty pathetic.


Do you have an education?

Do you pay any attention to what is going on around you? The profiteering takes place at the insurance companies, not in the doctor's offices. God, you are obtuse.

What lacks logic are your responses, which never deal in fact but only in fiery rhetoric.

"You could say, 'Look, is this guy, Laden, really the bad guy that's depicted?' Most of us have never heard of him before." John McCain, following Clinton's strikes on al Qaeda camps

Jesus Swept ticked me off. Too short. I loved the characters and then POOF it was over.

You are right

about profiteering taking place by insurance companies (HMO's)... that rely on the Health Maintenance Organization Act of 1973 for their existence. It is the government that created these fat cats. It is only government that will continue to allow their continued oppression. A voluntary free market would never spawn these institutional monstrosities.



that you spent your time making that post. The initial premise is false so the rest of the post is really irrelevant. No one is suggesting that socialized medicine is worse than the current system of health care in the US. The current system is a mess, because is a mix between socialized medicine and free market. It is neither free nor controlled. Either free market or universal single payer health care would be an improvement over the current system. We differ in our belief over which is the best, most efficient, and moral solution.

My grandfather has been a General Practitioner Doctor in a small town in Mississippi for over 40 years. Before the advent of Medicare, Medicaid and other government welfare programs, it was common practice within the medical community to give discount and often free care to those who could not afford. In fact, most patients eligible for Medicare would voluntarily chose to pay out of pocket. This is the testimony of one of the only doctors in a small town in one of the poorest states in the union.

Are there problems with universal health care? Of course. Are there problems in a free market system? Of course. But it is my strong opinion that in a free society, the cooperation between free individuals would solve these problems better than a bureaucratic agency hundreds of miles away shuffling through heaps of paperwork.

Either extreme, whether single payer or free market would solve many of the horrible problems in today's system. But unfortunately the only Presidential candidates that advocate either solution were Dennis Kucinich and Ron Paul. So it looks like at least for the next four years we are stuck with the same old thing.


our system stinks because of the free market interference

Those aspects of our health care that do not rely on the free market cost less and have high satisfaction. Those aspects that rely on the free market are failures. I don't expect you to believe the facts, zealots rarely do. As for family members in the medical field I have several, one has left for research and the other works longer hours for less pay. The old days you are talking about are long gone, Doc Hollywood isn't going to be trading pigs for service anytime soon.

"You could say, 'Look, is this guy, Laden, really the bad guy that's depicted?' Most of us have never heard of him before." John McCain, following Clinton's strikes on al Qaeda camps

Jesus Swept ticked me off. Too short. I loved the characters and then POOF it was over.

Oh really?

You mean medical aspects of the free market such as laser eye surgery, which are not covered by insurance and certainly not government welfare. Contrary to your caveman theory of economics the price, as this is completely free market should be rising. Its not! Competition within the medical community has forced the price down and it is continuing to drop, despite inflation.

I think you said it best:

I don't expect you to believe the facts, zealots rarely do.


If your argument is that the cost of health care is going down

then you really need to quit school and go out into the real world.

I did a quick Google search and see that all of y'all are hailing laser eye surgery as the tell all, be all about free market. Wow.

You come into this argument with a basic false premise, that making decisions about people's health, about their very lives, should be based on profit. I fundamentally disagree.

We won't see single payer in my lifetime I'm sure, but that doesn't mean it provides better care at a better cost.

"You could say, 'Look, is this guy, Laden, really the bad guy that's depicted?' Most of us have never heard of him before." John McCain, following Clinton's strikes on al Qaeda camps

Jesus Swept ticked me off. Too short. I loved the characters and then POOF it was over.

Deep breath, sorry folks.

People who think the free market would be good for health care just boggle my mind. I'm done feeding the libertarians.

"You could say, 'Look, is this guy, Laden, really the bad guy that's depicted?' Most of us have never heard of him before." John McCain, following Clinton's strikes on al Qaeda camps

Jesus Swept ticked me off. Too short. I loved the characters and then POOF it was over.

That's because

Laser Eye surgery is the only thing "free market" left because the government mandated HMO's don't cover it. And it is a huge success. It is a testament to the ability of a society of voluntary transactions, free from institutional and corporate interference, to drive down prices and make services and products affordable.

You have come to your conclusions based on false premises. What you think is free market ( viz. pharmaceutical industries, insurance companies ) is not free market! These institutions are supported by the state and are the creation of government legislation!



Some private insurers cover LASIK. Mine doesn't, so I got to pay almost 5 grand out of pocket (because my eye shape required that I had to get the fancy-ass custom intralase procedure or the risk of complications increased substantially.)

And that's with the price driven *down*? Sure, the procedure developed 20 years ago costs about a grand per eye, but it's not as good as the new one, and who wants to take chances on their EYES?

No, I bet those TLC Laser Eye Centers are raking in the dough, once they cover the cost of the fancy-ass new laser. Like my dentist is raking it in by doing Invisalign - which some dental plans cover under adult orthodontia (mine does), but not all and probably not most (since most don't even cover adult orthodontia.)

Great analysis, Robert.....

and the final 'nail' is the fact that no other country in the world is making any attempt to have a system like the USA!

bt y

wr n f ths kds n hgh schl wh dd stpd stff "jst cs vryn ls ws dng t"


Consider yourself


ad hominem

If you are really interested in constructing sound, logical arguments Indy, why not visit JREF Forum . This is a collection of some of the smartest critical thinkers in the world. At last count there were over 19,000 members on the forum. Please give it a go. Economics are discussed as well as a plethora of other popular topics. They welcome anyone and will help you learn to debate properly, construct sound arguments and learn how not to wallow in logical fallacies.

Of course, if you are here just to stir things, then you will not take this challenge.

Proud Educated Elitist With a Poison Pen

Proud Educated Elitist With a Poison Pen

Count to ten

If you had take a few seconds to check you would have discovered that denno is a retiree who is in danger of having medical benefits dropped arbitrarily from earned retirement benefits.

Consider yourself warned. When I get tired of disemvowelling your inane comments I will simply delete them without further warning.

Great post

This is exactly what we need right now. Clear, level-headed discussions concerning what we should be planning for. This and Dan Besse's post have made for excellent reading. Arguing with true-believers is difficult, and you guys have made the best of it despite the nasty turn! Cheers.

The Libertarian free-market model for health care would be ruinous, because to truly take care of all people in a way that considers high quality preventive and emergency care will never be profitable. Highly elective non-preventive non-emergency procedures however *are* profitable, and they occupy interesting, but irrelevant to serious health demands, marketplace territory. The unnecessary profit motive has stood in the way of real progress on health care in this country, period. Let's hope that we can finally get together, fix this mess we're in and avoid the pitfalls of depending on industry and the market to solve all our problems.

I'm not so sure about his dad....


Vote Democratic! The ass you save may be your own.

Heh heh :)

Hell, I'm not even sure about his dad, which is...somewhat disconcerting.

Very good data.

I always appreciate your and scharrison's posts on issues because you provide genuine research to explain and back your arguments. This is a good example on one of the most timely of topics.

Dan Besse

Dan Besse

I am but a shadow of Robert,

and many others here (including yourself).

But the shadow knows! What he knows, I have absolutely no idea...


"You could say, 'Look, is this guy, Laden, really the bad guy that's depicted?' Most of us have never heard of him before." John McCain, following Clinton's strikes on al Qaeda camps

Jesus Swept ticked me off. Too short. I loved the characters and then POOF it was over.

Silly Argument

Everyone wants health care, and we have the technology to provide it, but unlike every other service or product it is impossible to make a profit providing it at an affordable price? Give me a break.

If the profit motive is so evil, why don't we just get rid of all industries? I guess government should be in charge of creating our art and music, since we wouldn't want some fat cat artists being creative to pay their light bill. Government should farm all of the food - can't rely on some fat cat farmers to provide something as essential as food!

We can't trust the profit motive of private individuals, but we can surely trust the benevolent motives of our loving government which has proven itself time and time again to have the interests of the poor at heart. If you object to being taxed by the government to pay for the health services of others, you are selfish and greedy. Now give me my free health care.

Only libertarians have good enough eyesight

To see the benefit of the invisible hand.

"You could say, 'Look, is this guy, Laden, really the bad guy that's depicted?' Most of us have never heard of him before." John McCain, following Clinton's strikes on al Qaeda camps

Jesus Swept ticked me off. Too short. I loved the characters and then POOF it was over.

Do you wear glasses or contacts?

If so, it's hard to understand why you wouldn't also be able to see the benefit.


Please have your eyes checked, PaulM.

Proud Educated Elitist With a Poison Pen

Proud Educated Elitist With a Poison Pen

Maybe not so silly...

I believe, similar to Adam Smith actually, that when a market is consumed by externalities, the government should intervene (and I think its an understatement to say healthcare seems outside of the grasp of the invisible hand). I don't believe anyone said that the profit motive was "evil".

We should really get some diehard socialists around here to argue with the libertarians, as it might make things more interesting. Hopefully they'll be just as sarcastic.

So go follow Rothbard

You LP libertarians need to get back to Rothbard.

The book's called For a New Liberty.

Police services, fire services, the courts, and the military—all on the free market.

No government whatsoever.

Once you justify the existence of a government, let alone government monopolization of any of the above, it's just a slippery slope to things like health care. "Pragmatists", even some who trumpet their membership in the Libertarian or Republican parties, will (if no one with dreadlocks or nipple rings is in earshot) admit ruefully to you that the free market "fails" for certain very specific needs, essential to an "orderly" society.

Don't buy it. They're being free marketeers, all right—in the heroin-dealing sense. The first hit's free. But once you get a sample of that stuff, in no time you'll be nodding along to regulation of financial markets and wringing your hands at the prospect of cuts to programs that give inner-kids hot breakfasts at their crumbling schools.

That way leads statist damnation.

Stay pure, boys. Stand up for the Free Market, and picket the police department. You're not gonna let those pigs monopolize criminal apprehension services, are you?

No retreat, no surrender! Take your party back from the spineless compromisers and careerist moderates who have delivered you into the hands of the Democrats! Create facts on the ground. Organize a tax strike. Privatize a section of the nearest Interstate, and charge tolls to all comers.

Have no fear, for after but a moment of confusion, people will realize that you're striking off their chains—the dreaded State will have no hold on them.

You will be greeted with flowers, as liberators.

recently transplanted from Indianapolis, IN to Durham, NC

I wouldn't recommend drugs, alcohol, violence, or insanity for everyone, but they've always worked for me. -- Hunter S. Thompson

Garner, NC

I wouldn't recommend drugs, alcohol, violence, or insanity for everyone, but they've always worked for me. -- Hunter S. Thompson