## July 30, 2007

### Sicko

My wife and I finally got around to seeing the Michael Moore movie.

Over dinner, she asked me, “So, do you think there’s any chance of ever getting National Health Care in this country?” I shrugged, “Sure. Why not? It happened in my lifetime in Canada.” Of course, the medical establishment fought it tooth and nail; in Québec, I recall, the doctors staged a Province-wide strike. But they came around fairly quickly, when they realized that the Government paid their claims promptly and in full, unlike the Insurance Companies, whose business model consists of denying claims and paying out the ones they accept as slowly as legally possible.

The only question, as I see it, is who’s going to play the role of Tommy Douglas? Douglas was mentioned in Moore’s film, as the father of Canada’s Medicare system, along with the tidbit that he has been voted the Greatest Canadian of all time. Moore notes that Douglas beat out such obvious candidates as Canada’s first Prime Minister and Wayne Gretzky, but never explains why.

In brief: as Premier of Saskatchewan, Douglas pushed through legislation, needless to say over the vociferous objections of the Medical establishment, to create the first prototype of the Medicare program at the provincial level. He went on to found the Federal New Democratic Party in 1961, and his program for universal coverage was enacted by his successor in 1962.

On the Federal level, with Douglas at the helm, the NDP campaigned tirelessly for a national version of the Saskatchewan program. It didn’t take long for this fringe left-wing idea to become mainstream. In 1966, the Liberal Pearson government1 enacted a Federal version of Douglas’s program.

The rest, as they say, is History.

In many ways, it should be much easier here. Unlike back then, there’s a broad consensus that the health care system in this country is broken. Forty years on, every American health care professional I’ve talked to (not least, my wife) is so fed up with the Insurance Companies that they’re more liable to embrace the change than to protest.

So the expanded answer to my wife’s question is: what we need is a successful implementation at the State level by some intrepid Governor, and then someone to champion making the program national.

The temptation, among our risk-averse politicians, is to “triangulate” and attempt to buy off the Insurance Companies. I don’t think this will succeed. If, on the other hand, one of y’all were to take them on and win, you’d stand a very good chance of being remembered as The Greatest American of all time. Something to think about, no?

#### Update: Some Data to Ponder

Life expectancy versus healthcare expeditures in OECD countries (2003)
Country Life Expectancy (years) Total Exp. on Health/Capita (US$) Total Exp. on Health (% of GDP) Japan 81.821398.0 Iceland 80.7311510.5 Spain 80.518357.9 Switzerland 80.4378111.5 Australia 80.326999.2 Sweden 80.227039.3 Italy 79.922588.4 Canada 79.730019.9 Norway 79.5380710.1 France 79.4290310.4 New Zealand 78.718868.0 Austria 78.622809.6 Netherlands 78.629769.1 Finland 78.521187.4 United Kingdom78.522317.8 Germany 78.4299610.8 Luxembourg 78.237057.7 Belgium 78.1282710.1 Greece 78.1201110.5 Ireland 77.824517.2 Portugal 77.317979.8 Denmark 77.227638.9 United States 77.2563515.2 Korea 76.910745.5 Czech Republic75.312987.5 Mexico 74.9 5836.3 Poland 74.7 7446.5 Slovakia 73.9 7775.9 Hungary 72.411158.3 Turkey 68.7 5137.6 1 No doubt, it helped that Pearson’s was a minority government, supported by the NDP. Posted by distler at July 30, 2007 8:17 PM TrackBack URL for this Entry: https://golem.ph.utexas.edu/cgi-bin/MT-3.0/dxy-tb.fcgi/1374 ## 27 Comments & 0 Trackbacks ### Re: Sicko You did not say anything about the movie. Did you like it? Is it fair and balanced? I personally would not base the serious discussion of the important issue on the disingenuous misrepresentations of a radical. Posted by: Rufus Anton on August 1, 2007 6:51 AM | Permalink | Reply to this ### Re: Sicko Yes, I enjoyed it. Whether or not you agree with Moore, there’s no denying that he makes engaging and entertaining cinema. Was it “fair”? My father-in-law, a retired physician with Kaiser Permanente, warned us before going about one sequence he thought was unfair. Kaiser and, apparently, other hospitals in LA had made a standard practice of “discharging” their homeless patients by stuffing them into a taxicab, driving them down to Skid Row, and leaving them — some still in their hospital gowns, with IV tubes still in their arms — on the street corner. Moore make some quite gut-wrenching cinema which incorporates an infamous videotape of one such patient being dropped off. “Where do you send a patient who doesn’t have a home address? There’s no procedure for dealing with them.” said my father-in-law. He thought Moore was being unfair. Ultimately, the LA District Attorney disagreed. Moore covers the inequities and an inadequacies of the US healthcare system, focussing mostly on those who have health insurance. The horror stories ring true. Anyone who’s lived here for any length of time knows plenty more. He contrasts this with the experience of people in Canada (my home country), England and France. In the most controversial scene, he take a group of 9/11 First Responders, all of whom have been denied health coverage for the ailments they acquired at Ground Zero, on a quixotic journey to Guantanamo Bay, Cuba, where — Moore tells us — “Al Qaeda” prisoners receive free health care. They end up, instead, in a hospital in Havana, where they receive treatment (free, of course). I could have done without the Cuba sequence. It doesn’t add anything to the argument of the film. The US shouldn’t be comparing its healthcare system to that of an impoverished 3rd world country, even if that country is run by the Devil Incarnate. Posted by: Jacques Distler on August 1, 2007 9:37 AM | Permalink | PGP Sig | Reply to this ### Re: Sicko I think that this movie is fair. I watched it and I have one reflection. I prefer a healthcare system in Europe… Regards Rob Posted by: Robert on November 20, 2007 10:07 AM | Permalink | Reply to this ### Re: Sicko The election is now drawing closer, but solutions to America’s health care problems are not. In the meantime, Medical Tourism is the only solution for those without health insurance. People are also increasingly researching international medical options to eliminate long waiting lists for procedures at home, to gain access to world renowned specialists,or to have a procedure not approved at home but practiced abroad with excellent track records. For example, HipResurfacing is available in the United States, but it was only approved by the FDA in 2006. What does that mean for patients considering hip resurfacing, which is much less invasive and has a faster recovery time than hip replacement? It means doctors in the US don’t have anywhere near the track record of those in places like Belgium and India. Consider: A New Orleans patient went to Belgium to Dr. De Smet, who’d done over 2100 resurfacings. He was quoted$60,000 in the U.S., and had an all-expenses (medical, travel, recuperation, physical therapy) bill of $17,000. While he was there, his surgeon was training a U.S. doctor on the procedure. Another patient chose India over Belgium for his hip resurfacing, and had a surgeon with an equally impressive track record, Dr. Malhan. His total trip was$8,700 compared with $60,000 quoted in the US. Robbie NeelyWorldMed Assist, experts in facilitating medical travel for North American patients. Posted by: Robbie Neely on September 11, 2008 2:49 PM | Permalink | Reply to this ### Re: Sicko Thanks for the summary. Moore knows about dramturgy but he cannot be trusted on facts. I would not pay for any of his “documentaries”. The opinion of people like your father seems more relevant to me. I have lived both in Europe and the US for many years and I would not choose French health care over its US counterpart. Germany works well for the patients but is quite inefficient. I have not seen the movie but it seems Moore vastly overstates the differences. I wish the US would find a way of reforming their system without just copying the socialist approach from elsewhere. Is any of the presidential candidates serious about health care reform? I think Mike Huckabee made some interesting suggestions but he isn’t exactly a front runner. The democrats seemed more concerned with ideas like canceling NAFTA (Kucinich). At any rate, there are easier ways of doing something useful for the middle class than health care reform, like getting rid of that hideous alternative minimum tax. Posted by: Rufus Anton on August 1, 2007 11:05 AM | Permalink | Reply to this ### Re: Sicko Moore knows about dramturgy but he cannot be trusted on facts. He has plenty of detractors, avidly fact-checking every scene of his movies. I assure you they would eagerly pounce on the slightest inaccuracy. So, to the contrary, I think you can be pretty well-assured that the facts in “Sicko” are accurate. What conclusions one draws from those facts is a different matter. I have lived both in Europe and the US for many years and I would not choose French health care over its US counterpart. I’m not that familiar with the French healthcare system. But I would choose the Canadian one in a heartbeat. And the Brits I know (from the most ardent Thatcherites to the furthest leftists) swear by the NHS. Germany works well for the patients but is quite inefficient. No one’s is more inefficient than the US system, which devotes 16% of GDP to healthcare spending. I have not seen the movie but it seems … Maybe you should go see it. I wish the US would find a way of reforming their system without just copying the socialist approach from elsewhere. Y’mean the healthcare systems of every other industrialized country in the world? Is there a country whose healthcare system you would hold up as a ‘non-socialist’ model to follow? Is any of the presidential candidates serious about health care reform? I don’t think so. And, as I said, I don’t think any serious reform at the Federal level will succeed without a successful implementation at the State level to point to. The democrats seemed more concerned with ideas like canceling NAFTA (Kucinich). Kucinich is not a serious candidate. Posted by: Jacques Distler on August 1, 2007 12:00 PM | Permalink | PGP Sig | Reply to this ### Re: Sicko Jacques, I basically agree with you about the right direction for American health care. I may not (or may) agree with how to get there or why it’s a good idea, but that’s less important. But this is just nonsense: [Moore] has plenty of detractors, avidly fact-checking every scene of his movies. I assure you they would eagerly pounce on the slightest inaccuracy. This is exactly the same defense that Fox News makes for itself, usually correctly: We haven’t said anything false. Okay, so they haven’t. Even so, both Michael Moore and Fox News regulars resort to wild hyperbole that is neither true nor false, but does lead people to believe false things. For instance, there is this quote from Sicko: “Everywhere else, [people] seem to take care of each other.” Of course, there is nothing to refute or contradict in a statement like that. It’s too vague; it doesn’t rigorously assert anything. But it does insinuate that Americans as a group, or at least American institutions, are heartless compared to everywhere else. That insinuation really is unfair. Posted by: Greg Kuperberg on August 1, 2007 6:05 PM | Permalink | Reply to this ### Re: Sicko That insinuation really is unfair. It’s unfair in exactly the fashion my father-in-law suggested. Kaiser physicians are not heartless brutes, who would willingly have their indigent patients dumped on a street corner in Skid Row. I think the key difference between Moore and Fox News is that he doesn’t pretend to be “Fair and Balanced.” He is unashamedly engaging in advocacy, and I don’t think anyone goes to his films to see a dispassionate, impartial exposition. Posted by: Jacques Distler on August 2, 2007 12:33 PM | Permalink | PGP Sig | Reply to this ### Sloppiness I certainly don’t want a dispassionate or impartial exposition. Impassioned advocacy is just fine with me. The problem is that Moore, at least in specific example, is not only impassioned but also sloppy. Comparing the US as a whole — not just Kaiser but the whole country — unfavorably with “everywhere else” is just plain sloppy and unreasonable. The fact is that demand for health care is essentially self-perpetuating and unlimited. The more people go to doctors, the more they “need” them. In this respect, medical care is like roads and university education. It does not mean that we should just ignore problems; the US health care system does need to be fixed. It does mean that you can find tears, neglect, and heartlessness in any health care system. No problem in the US health care system is a uniquely American tragedy; the whole question is a matter of cost, red tape, or incomplete care on average. In fact, one of the problem with the US system is that there is too much gold-plated medical care for certain groups of patients who do have coverage — and not just millionaires. For instance, there are a lot of older men who get$20,000 heart procedures for relatively little medical benefit. This is not even unintentional callousness, it’s the opposite mistake.

Nor am I saying that Moore shouldn’t have shown the tears. That’s fine; the movie is better if it’s impassioned. The problem, again, is this bottom line that “everywhere else” people “take care of each other”; only America is in the moral gutter. At least at this point, Moore is more interested in a cultural indictment than in constructive advice, impassioned or otherwise.

Nor is it the only time. As it happens, I have followed gun control pretty closely, and I can assure you that I am on the side of reason on that issue. So I wasn’t impressed by Moore’s declaration in “Bowling for Columbine” that Canada has even more guns than the US, but less violence. That is another sloppy cultural indictment, moreover a factoid taken from NRA propaganda. Canada has more rifles per capita than the US, but far fewer handguns. The type of the firearm, and more systematic registration in Canada, makes all the difference.

Posted by: Greg Kuperberg on August 2, 2007 4:23 PM | Permalink | Reply to this

### Re: Sloppiness

Greg, I don’t think I disagree with anything you’ve written above. Indeed, my purpose in this post was highlight the similarity between the US and other countries (Canada, in particular), rather than the differences.

One of the (unfortunate) reactions one could have, after seeing Moore’s film, is despair that the US healthcare system is unreformable.

I don’t think that’s true. And what I wanted to do was point out that, while the transition to a more sensible system would be difficult, it is not impossible, as the Canadian experience showed.

Posted by: Jacques Distler on August 2, 2007 5:27 PM | Permalink | PGP Sig | Reply to this

### Re: Sicko

I agree with the first poster. European healthcare is often highly overrated in these sorts of debates.

Its not really the waiting time(s) that are bad, but rather the general quality of the visit which is far more rushed over there (theres also a tendency to overmedicate, since everything is free).

Also for important surgeries and so forth, many rich Europeans make a trip to America, even if it involves paying huge sums of money.

As far as Sicko is concerned, imo its most important and salient point was just how much the system costs, relative to the rest of the world. Thats clearly an innefficiency unique to America. Something is obviously going quite wrong with the lvl of competition which should be driving prices down, rather than upwards.

Also, there is somewhat of a paradox in healthcare. The more successful a system is at keeping people alive, the more it will cost (the immense majority of costs come from seniors past the age of 80).

Posted by: Haelfix on August 2, 2007 1:31 AM | Permalink | Reply to this

### Re: Sicko

Also for important surgeries and so forth, many rich Europeans make a trip to America, even if it involves paying huge sums of money.

Maybe at one time they did; not anymore. Instead, “medical tourism” from the US is growing by leaps and bounds.

Something is obviously going quite wrong with the lvl of competition which should be driving prices down, rather than upwards.

There’s a fallacy in your reasoning. I’ll leave you to contemplate the structure of the US healthcare “market” to figure out what the fallacy is.

Also, there is somewhat of a paradox in healthcare. The more successful a system is at keeping people alive, the more it will cost (the immense majority of costs come from seniors past the age of 80).

A naïve person might conclude that greater expenditures on healthcare would correlate with longer life-expectancies. As the table above shows, this just isn’t so. The US outspends its nearest rival, Norway, by 48% per capita. And yet it ranks near the bottom in life expectancy (and in every other benchmark of health).

Posted by: Jacques Distler on August 2, 2007 11:57 AM | Permalink | PGP Sig | Reply to this

### Re: Sicko

I don’t disagree with the reality of the situation. But like you said, the structure of the healthcare system in the US isn’t exactly what you’d want for a pure free market system. Not enough competition between insurance companies, as well as issues with respect to drug prices that tend towards the monopolistic side.

Just looking at life expectancy alone however is confusing correlations. For instance, consider already the amount of obesity in the US, surely that must render moot any apples to apples comparison.

One would really want to look at primary care across the globe for healthy/normal individuals past the age of say 75, and then track them over a multi year period. I’d be willing to bet that the US would still spend twice as much (b/c of the aforementioned innefficiences), but you would see a general pattern where lifeexpectancy would correlate with cost, and I suspect the US would, under these circumstances, have a pretty high life expectancy as the quality of the medicare system is still pretty good for seniors.

Posted by: Haelfix on August 2, 2007 1:53 PM | Permalink | Reply to this

### Free Market

But like you said, the structure of the healthcare system in the US isn’t exactly what you’d want for a pure free market system.

If you want competition among suppliers to bring down prices, you need price elasticity of demand among consumers. The whole point of health insurance is to insulate consumers from the direct impact of the price of healthcare.

There is a sector of the healthcare system which functions as you would like: the 1/6 of the US population that is uninsured.

Moore’s film opens with the case of one such person, who lost the tips of two fingers in a table saw accident. The hospital offered to reattach his middle finger for $60,000 or his ring finger for$12,000. As a good consumer, he weighed the benefits against the costs and decided to get just the ring finger reattached.

Later in the film, we meet a young Canadian, who lost all 5 fingers in a similar accident. Reattaching all 5 fingers entailed a fiendishly complicated operation, requiring a whole team of surgeons, working around the clock. The young man, being totally isolated from considerations of price, decided to go for the whole hand. Clearly, a market failure!

Just looking at life expectancy alone however is confusing correlations. For instance, consider already the amount of obesity in the US …

Obesity and other public health concerns are part-and-parcel of the healthcare system and its failures. You can’t just ignore them because the US fares badly…

One would really want to look at primary care across the globe for healthy/normal individuals past the age of say 75…

I don’t know about age 75. But the OECD does provide figures for life expectancy at age 65. They’re very similar to the life expectancy at birth figures above (which fold in the US’s abysmal infant mortality rate).

In the US, life expectancy at age 65 is 16.8 years for men and 19.8 years for women. In Japan (which, again, tops the list), they are 18 years for men and 23 years for women. As before, the US is well down the list.

The OECD also lists figures for mortality rates from respiratory disease, cardiovascular disease and diabetes. I can post those, too, if you are interested.

Posted by: Jacques Distler on August 2, 2007 4:28 PM | Permalink | PGP Sig | Reply to this

### Re: Sicko

“European healthcare is often highly overrated in these sorts of debates.”
By who? I’ve been living in Europe about half my life, the other half split between Thailand, Australia, New Zealand, Canada and the US - Europe usually comes out top for “If you have a health problem make sure you’re there.” Or for “If you don’t have money for heathcare, make sure you’re there.”

“Its not really the waiting time(s) that are bad…”
True, usually a few months for most operations.

“…, but rather the general quality of the visit which is far more rushed over there (theres also a tendency to overmedicate, since everything is free).”
I would say that the “quality of visit” has always been
top quality. Not as many options like TV and internet and choice of meals as the private healthcare will give you, but a high quality of care nonetheless. Also I would say there is not such a tendancy to overmedicate - a. the patient usually has to pay a contribution so there’s incentive from the patient to not request everything, and b. there’s not the ‘insurance company will pay’ - there’s government limits on what can be prescribed.

“Also for important surgeries and so forth, many rich Europeans make a trip to America, even if it involves paying huge sums of money.”
Maybe, but the vast majority of Europeans stay in Europe and make a point of not going to America if they have an ailment, in case they get hit with medical charges. The only cases of people going to the US from Europe for medical care that I’ve seen are for highly-specialised surgery - and there are also US citizens doing that the other way around. In Thailand I noticed a lot of US (and a few Europeans) going there primarily for a cheap (and yes, high quality) operation. The highest number was probably for eye operations (eg. lazer surgery) and dental operations (eg. capping).

“The more successful a system is at keeping people alive, the more it will cost (the immense majority of costs come from seniors past the age of 80).”
Not neccessarily - how about if healthcare is not looked on as a ‘fix’ but also as ‘preventative’. In that case a higher quality of life would lead to less healthcare being needed, and a lower cost.

Posted by: Bay of islands on August 21, 2007 3:28 AM | Permalink | Reply to this

### Re: Sicko

On your having states do it first idea: Ezra Klein explains the economic reasons ‘Why the “laboratories of democracy” can’t achieve universal health care’.

Posted by: Allen Knutson on August 10, 2007 11:31 AM | Permalink | Reply to this

### Re: Sicko

I think I disagree with Klein’s diagnosis. Most (maybe all) of the programs he describes were doomed to failure from the start (because they attempted the fruitless task of grafting universal coverage onto the existing system of private health insurers).

He’s right that these State programs failed more quickly than they would have, had the Federal Government enacted them (basically, because the States don’t have the deep pockets that the Feds have.

But I don’t think he makes the case that any of them would have succeeded on the Federal level. I contend they would simply have failed more slowly.

Posted by: Jacques Distler on August 10, 2007 11:17 PM | Permalink | PGP Sig | Reply to this

### Re: Sicko

“… unlike the Insurance Companies, whose business model consists of denying claims and paying out the ones they accept as slowly as legally possible.” So, so true! It makes one wonder what was allowed to happen since Mark Twain said about health insurance, “I have had people come to me on crutches with tears in their eyes to bless this beneficent institution.”

Posted by: What use is health insurance? on August 17, 2007 7:09 AM | Permalink | Reply to this

### Re: Sicko

Jacques,

It about their being a two tier system. One for the rich and one for the poor.

You have to read the story of Mouseland, and then you will get a sense of what was happening at that time.

Current struggles are being waged right now in Canada to progress to the American system. Many of us are fighting this. We believe it is every citizens right to recieve fair and equatible treatment no matter.

Posted by: Plato on September 2, 2007 5:59 AM | Permalink | Reply to this

### Re: Sicko

the insurance and drug companies have created the most expensive health care system. i think the “triangulation” comes from the huge lobbying effort and donations these companies work with.

Posted by: tom on September 13, 2007 10:36 AM | Permalink | Reply to this

### Re: Sicko

I just took a look at the table wherein they compared life expentancies on certain countries and the amount they are spending on healthcare. Of all the countries listed, the United States has the most population so it is not a surprise to see it among those countries that spend a lot on healthcare. What made me shocked was that Japan, probably the second-most populous country on that listing only spend a fraction of what the United Stated is spending.
Maybe our government is spending too much on things that we could have spent less.
That’s what I have to say.

Posted by: Auto Parts Jock on September 25, 2007 1:17 AM | Permalink | Reply to this

### Re: Sicko

There was little to enjoy about Sicko, as with all of MM’s films.

Some facts, Some Fictions and some truths bent way way past the shape of the reality tend to be his M.O.

-Dave Dragon
Ride it like you stole it

Posted by: Dave Dragon on September 26, 2007 2:47 PM | Permalink | Reply to this

### Re: Sicko

The United States has a population of over 300 million, of which perhaps 20 million are illegal immigrants from Mexico who place a large burden on the U.S. healthcare infrastructure. No country on your list has a larger population than the U.S.. Indeed, the next most populous country on your list–Japan–has a population of approximately 128 million, which is roughly 43% of the U.S. population. And note that the Japan has essentially no illegal immigrants or other types of externally imposed health care burdens to deal with. After Japan, Germany is the next most populous, with about 82 million people, or roughly 27% of the U.S. population. And look at Denmark, which, with a population of about 5.5 million (or 2% of the U.S.), has the same life expectancy as the U.S. and yet spends 9% of its G.D.P. to do so.

Note, too, that the two models of socialized medicine–Canada and the United Kingdom–are both tiny compared to the United States: Canada’s population of 33 million is 11% of the U.S. population, and the United Kingdom’s population of 60.5 million is 20% of the U.S. population.

The notion that government-run healthcare will simply scale up appropriately to the United States is highly suspect.

Posted by: fooltomery on September 27, 2007 8:06 AM | Permalink | Reply to this

### Illegal Immigrants

First of all, you’re off by a factor of 2 in your estimate of the number of illegal immigrants in the US. Reputable sources put that number in the 11.5–12 million range.

Second, Germany also has a similarly high percentage of illegal immigrants (from the Balkans, among other places), but this has not lead to the collapse of their healthcare system.

Third, your argument that the US is larger than all of the other countries on the list, and hence national healthcare could not work here, is pretty dubious. Why do you think this particular function of government can only work in countries with populations smaller than some critical size (and what, pray tell, do you think that critical size is?), whereas other functions scale just fine?

Posted by: Jacques Distler on September 27, 2007 9:55 AM | Permalink | PGP Sig | Reply to this

### Re: Illegal Immigrants

You write:
“First of all, you’re off by a factor of 2 in your estimate of the number of illegal immigrants in the US. Reputable sources put that number in the 11.5-12 million range.”

Response:
I’m off by a factor of 2 in my estimate of the size of the illegal immigrant population in the United States according to the Pew survey. But the Pew survey that you cite is only one opinion, and it’s mentioned in the following Christian Science Monitor piece (written more than a year ago), but so, too, is my figure of 20 million (more than once):

Brad Knickerbocker, Illegal immigrants in the US: How many are there?

You write:

“Second, Germany also has a similarly high percentage of illegal immigrants (from the Balkans, among other places), but this has not lead to the collapse of their healthcare system.”

Response:

You’ll note that, as regards Germany, I mentioned only the fact that its population is not much more than a third that of the United States; I am aware (and was aware when I wrote my post) of the fact that Germany has a sizeable immigrant population. Further, I’m not sure what you mean by “has not lead [sic] to the collapse of their healthcare system”. If you mean that I was implying that illegal immigrants have caused the U.S. healthcare system to collapse, you’ll not find that in my post. Moreover, if you’re suggesting that the U.S. healthcare system has collapsed, that’s manifestly false.

You write:

“Third, your argument that the US is larger than all of the other countries on the list, and hence national healthcare could not work here, is pretty dubious. Why do you think this particular function of government can only work in countries with populations smaller than some critical size (and what, pray tell, do you think that critical size is?), whereas other functions scale just fine?”

Response:

The comment you’re replying to was phrased quite circumspectly: “The notion that government-run healthcare will simply scale up appropriately to the United States is highly suspect.” I don’t find this statement dubious at all. The United States is not just larger than all of the other countries on the list you posted, it’s much larger (and, no, there’s not a ‘critical size’). Where are the really large countries with government-run healthcare that works even nearly as effectively as privately run healthcare works currently in the United States? They don’t exist, nor have they ever existed in the history of the world. Our healthcare system has grown organically over centuries; I, for one, am not convinced that Hillary Rodham Clinton or Barack Hussein Obama or any others of our current crop of political hacks are wise enough or smart enough to reboot this system while it’s running. And if you’ve ever tried to discuss a difficulty with the I.R.S. or some other government-run entity, I’m surprised that you would be willing to entrust your health to one.

Posted by: fooltomery on September 29, 2007 5:22 PM | Permalink | Reply to this

### Re: Illegal Immigrants

But the Pew survey that you cite is only one opinion, and it’s mentioned in the following Christian Science Monitor piece (written more than a year ago), but so, too, is my figure of 20 million (more than once)

Did you actually read the article you cited? The Pew Study is, indeed, only one of several estimates.

Based on the national census in 2000, the US Census Bureau puts the estimate of illegal immigrants at 8.7 million. As of 2003, the US Citizenship and Immigration Services put the number at 7 million. Since then, United States immigration officials have said the number has grown by as much as 500,000 a year.

Those closest to the fight to protect US borders say the figure is higher. The US Border Patrol union Local 2544 in Tucson, Ariz., says the total number of illegal immigrants in the US today is between 12 million and 15 million.

These estimates (figuring in the dates they were made) are all roughly consistent with the Pew Trust estimate.

The 20 million figure (who cares how many times it appears in the article?) is from a study by “researchers at Bear Stearns.” Perhaps Bear Stearns is right, perhaps they’re wrong. But, since they came up with a figure significantly higher than any of the other estimates, one ought to be a little sceptical.

Particularly so, since — unlike the methodology used by the Census Bureau and the Bureau of Labor Statistics, which are heavily scrutinized — the methodology used by the Bear Stearns “researchers” has, to my knowledge, never even been made public.

If you mean that I was implying that illegal immigrants have caused the U.S. healthcare system to collapse, you’ll not find that in my post.

No. I thought you were implying that the the burden of caring for illegal immigrants would cause any system of national healthcare in this country to collapse.

I find that dubious, both because of the German example and because, in reality, the US healcare system already bears a burden of treating the uninsured (a small, but significant fraction of whom are illegal immigrants) who, when they are sick enough, end up in an Emergency Room somewhere. National healthcare would not change this.

If that’s not what you meant, then please explain what was the point of bringing up the level of illegal immigration to the US, in this context.

Where are the really large countries with government-run healthcare that works even nearly as effectively as privately run healthcare works currently in the United States?

The same place as all the other industrialized countries with populations comparable to that of the US.

Given that the US is considerably larger than any other industrialized country, one could make all sorts of spurious arguments that what applies in every other industrialized country can’t apply here. You’ll need a little evidence for this particular one.

And, since one might reasonably expect such a system, like the Canadian national healthcare system, to be administered by the States, I think your evidence on this point is pretty weak.

And if you’ve ever tried to discuss a difficulty with the I.R.S. or some other government-run entity, I’m surprised that you would be willing to entrust your health to one.

Evidently, you haven’t spent much time tangling with this country’s private health insurers. I would trade the healthcare system in this country for Canada’s in a heartbeat.

Posted by: Jacques Distler on September 29, 2007 7:31 PM | Permalink | PGP Sig | Reply to this

### Re: Sicko

Definitely, medical tourism is on the rise. You can go overseas and get a hip replacement, knee replacement or any other medical procedure for a fraction of the cost in the US. I know of one place in Thailand that gets you in and out within days. I won’t post the name of the facility on here though.

Posted by: Hip Replacement on November 1, 2010 1:39 AM | Permalink | Reply to this

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