Great post max.

I have been trying to get this across in a variety of ways in comments. To repeat - it matters very little whether the governemtn pays for something through taxes or you pay for it out of your own pocket unless there is an advantage in efficiency. In most cases, there is and the efficiency favors individuals making choices. However, in a insurance model, and empirically, efficency favors government payments.

To address parts of selfinterest's statement - socialized is a misleading term.

less remuneration for doctors, less research, fewer people entering the medical professions, universal - instead of localized - bureacratic delays)

less remuneration for doctors is probably true but should also probably be coupled with less med school loans, less time in medical school, etc. Countries with 'socialized' medicine pay doctors less, but get better results. So, yes reducing the cost of health care will most likely hurt the existing crop of doctors relative to what they have now, but there is no reason to believe that because of that the quality of care would go down. Because of unnecessary and restrictive professional groups and licensure, doctors have been getting monopoly rates on their services, which, as other countries have shown can be provided for less money without the increase in restrictiveness.

less research is not clear either, although Max's pal Dean Baker has pointed out many ways in which the current research funding is extraordinarily wasteful and poorly targetted.

fewer people entering the medical profession. Irrelevent and probably not true. A flattening of the rates paid to people in the medical profession would increase the number of people in the medical profession at a constant level of funding, but it is impossible to know what advances in technology and efficency will do to the requirements of healthcare in this country.

as far as delays, this is a bit of a red herring, but you would have to look to different countries data. I would assume, though, that the system would better off for those that currently do not have insurance. The bottom line is that the results would be superior and at lower costs than we currently have now.

 As far as values, I would prefer that a baseline be established that is indifferent to a person's wealth. Beyond that baseline if a person wants to spend their money on ineffective end of life care, then they are welcome, but your interests may vary.

Medicare was denounced as socialized medicine but hardly seems to have been that.  Why do we need socialized medicine?  Not to flog a dead horse but we do not need government doctors in order to achieve chearper healthcare.  We, as a rich country, can afford to pay more for healthcare.  The problem is the uneven delivery of that care. 

Going back and forth over the merits of socialized medical systems or Americas seems pointless.  The reality is that employers our getting out of the medicla insurance business.  Who and how health insurance is going ot be provided and how medicalcare is going to be provided are related questions but not the same one. 
Daniel A. Greenbaum

selfinterest made some factual claims that seem at variance with truth.

British system is perhaps the most socialized of them all, very stingy and with quite decent results.

 French have better results (perhaps because even their disadvantaged minorities eat mediterranean diet, but they do have them), and they spend less per capita.  Does selfinterest know for a fact that French doctors make less money?

 In any case, since our non-medical overhead is enormous and driving our health policies in wrong directions, eliminating it would be a worthy goal in itself.  Even if we do not decrease the rate of growth of medical expense, one-time cut of 20% is nothing to sneer about.  Trillion dollars there, trillion dollars here...

European and Canadian systems have been studied at length.  The trade-offs are as I've outlined although there can be legitimate discussion about their extent or degree.

Those who can afford our medical care do so.  We provide the best that money can buy. 

Countries do pay for healthcare as a nations wealth is not simply a product of individuals.  Entire societial systems going into the generation of income and wealth.

When you say we are at the limit of redistribution on what do you base that on?
Life may not be fair and the goal is not to make everyone equal but as wealth is increasingly going untaxed even as the wealthy's income grows disproportionately to the middle class why should some people have cadillac helathcare while others have virtually none?
Daniel A. Greenbaum

Twice in the past couple of weeks I have watched DHE on TV, and I came away thinking he was more outspoken back at the CBO. He strains to be even-handed or better to the current administration, almost like Greenspan was while in office.

Depending on the health care system, universal systems are getting better results generally.

Translated this means some are, some aren't.   It's true that universal system, if they're good, provide better care for low income folks with little loss in the middle and not too much more at the high end.  However, they remain very costly...and stresses placed on them by the global economy are resulting in longer waits and poorer care. 

You are just spouting ideological boilerplate which means nothing in this context.

It means nothing only to those who don't want to acknowledge simple truths. 

If we can do so with some new contraption that ensures perfect health for everyone, but only requires a single healthcare worker that would not mean longer delays and poorer service

If manna falls from heaven nobody will need healthcare.  I'm trying to deal with present realities.  Nothing like what yousuggest is even remotely possible.   Trends, if anything, are entirely in the other direction.  Better technology is resulting in increased costs because it increases people's expectations and demands.  

more socialized medicine = fewer doctors?

Lower pay equals fewer medical personnel generally if other less stressful, better paying alternatives are available.

 
the terms are imprecise, but, apparently the US is non-socialized and the rest of the world closer to medical socialism? the OECD reports that the US has fewer doctors than the OECD average.

See my previous response.  Cross country comparisons are tricky.  I'm a citizen-director at a small local hospital.  I rely on what my doctors and administrator tell me.  But I would like to see the statistics you quote.  Foreign doctors are pouring into the US as fast as they can while American doctors are not leaving so how can they be true? 

the single biggest reason for the gap between the US and other OECD countries in medical spending is that medical care costs more here.

While what you say is true, that's not how Krugman analyzes things.  But if it is true, why is it true?  And what's your solution?  How are you going to force down those costs? 

the "we're #1" meme in regards to advanced medical care is one that i'm going to have to get some proof on. it's said often, and supported almost never.

I have a lot of wealthy European friends...and I talk to people from all over the Western world about it.   If that's not satisfactory you're going to have to find your own proof. 

a really good speech about how the federal budget problems in the long-run were all about medical costs. in the WaPo piece he goes back to lumping Medicare and Medicaid in with Social Security and talking about growth in entitlements.

It spells trouble either way. 

Oh please. You sir make make many more unsupported assertions as Mr. Sawicky.

I have friends, real people, that live in France and Canada that are very happy with their health care, and it costs them half of what our system does. They report no delays, except for elective surgeries. And there are some things that are not covered, like boob jobs.

Structural reform means either socialized medicine (less remuneration for doctors, less research, fewer people entering the medical professions, universal - instead of localized - bureacratic delays)

So give me evidence that this is true. That is not what people I know have said about their health care in Canada. 

This is false. No European, Japanese, Taiwanese, South Korean or Singaporean patients ("those who can afford our treatment") elect to come to America for treatment. Far more Americans elect to travel to Singapore for care than go the other way around.

One reason why almost no Europeans or East Asians come to America for care is that multinational insurance plans which cover many European and East Asian countries do not cover treatment in the U.S. That is because care is so much more expensive in the U.S., for the same procedures with the same level of doctor expertise and the same results, that multinational insurance companies refuse to pay for it. I know this to be a fact because I am on such an insurance plan myself; it covers full treatment, with no deductible, anywhere in the world except the U.S. and Switzerland. (Switzerland, like the US, has an almost entirely private medical insurance system, and is therefore the only country in the world where the price of health care is even close to the price in the U.S.)

France is good but I know many people in Canada and England who've had rotten experiences.  A normal range of experience, given the large number of people invovled.

So give me evidence that this is true

I've already provided the logic.  The evidence comes from my experience as a hospital director, and from what I hear on the street and among friends - not from large scale studies...but then you're evidence is no different.

I said those who can afford US care do so.  Your evidence doesn't refute that.  Au contraire, you merely ASSERT that the quality of care is the same as in other parts of the world while costs are much lower.

Opposed, I know wealthy Europeans who can afford health care anywhere. They chose America.  I'm not knowledgeable about the far east. 

Your thoughts?

Engage to your hearts delight.  Maybe I'll learn something which will help me to keep my small rural hospital afloat.  Almost all like us are in bad trouble...and many big city hospitals as well.

Start by telling me how I can make my emergency room profitable.  It looses between a quarter and a half million a year.  If we close it we must close the hospital.  We pay minimum acceptable wages to our ER docs and half our patients don't pay which is typical (but we must see them).  Docs want better wages, not worse, because after many years of schooling and an accumlation of a huge debt they want to start families and live well in exchange for doing difficult work and accepting huge responsibilities.

Then tell me how to get qualified nurses at reasonable wages.  Their numbers have shrunk in recent years so they hold the upper hand and often will accept employment only on a temporary basis because that way they can get much higher salaries and still get all the work they want.

Meanwhile insurance rates, and equipments costs, and all other costs are going up and government reimbursement is going down. Somewhere - over the rainbow - a single-payer (or double payer, or triple payer or socialized medicine) system might show up which improves things but not anytime soon...because, on the conservative forums, people from all parts of the world tell much different stories about their experiences under such systems than I'm hearing here (stories that many of my docs and my friends confirm)...AND THEY VOTE.

Again, let me emphasize these are stories about European and Canadian systems.  I've heard good stories about Taiwan but too few of them to understand the systems or form opinions 

I forget a very important point - Europeans rarely, and I mean rarely, sue their health care providers.

Selfinterest, I work at a biotech lab providing highly advanced diagnostic services - the very kind you claim "socialized medicine"  would squelch.  As you're doubtless aware, the lifeblood of such a business is reimbursement.

I can tell you that your assertion that a "socialized medicine" as a gross concept will block innovation is totally unfounded.  Private payers presently have very little of the kind of responsiveness to customer interest that would prompt paying for our services.  Would an HMO accept an expensive cancer test presently?  Hell no.  The major hurdles in reimbursement are:

a) getting BCBS to pay you (these are weird quasi-government entities, so it's hard to call them exactly private)

b) getting formulary coverage from Medicare.

 
That formulary care sets the amount of coverage and price level (since nobody can pay less than Medicare).  Until then, it's all about trying to get a few payers around the edges to pay for you.

What will introduce delays and reductions in service is cost containment, whether that happens via private payers (remember the hated HMO rules) or via public funding.  Either somebody's gonna pay for advanced services or they ain't.  As it happens, I share your concern that the few (mainly folks near death) are consuming vastly more than the many, and thus view cost containment as a critical element of healthcare reform.  And that will always involve the unpopular process of drawing a line between established, formulary care and "advanced" or discretionary care.

Basic, routine care should never be addressed by "insurance", as the care is not stochastic in the least - it's highly predictable, and therefore in a functioning market would be commoditized immediately.  So to prevent a rapid drop in quality (you probably know firsthand what happens when the market moves towards low-cost, low-quality medical employees), you will need government intervention at the low end.  And lo and behold, for formulary care government systems like Medicare and the VA have unparalleled satisfaction metrics and track records.

Leave aside the tiresome and dated socialism-bashing - nobody here's asking the government to provide the services, they're asking who's paying and under what rules.  The key discussions that needs to be had are:  how do we provide humane basic care to people (and guard against public health threats) at low cost, and how do we draw and enforce the line between that basic care and discretionary expensive care.