All those countries that "get it right" are in the same boat we are in. Costs are rising too fast to sustain their programs. If that is getting it right you and Cohn don't know what the word "right" means.

I don't think rising costs indicate a system is "wrong" so much as it needs adjustment. By that I mean, while there may be things in the system that are creating deficits (very true) the idea of the system being there for everyone remains intact. France isn't looking to overhaul it's entire system. They are just make changes to reduce the impact of cost. People still get care more than Americans and that care still costs less overall.

But Dutch and French patients were far less likely to avoid seeing a specialist altogether - or forgoing other sorts of medical care - because they couldn’t afford it.--emphasis added

OK, still trying to unpack why you'd quote that. What I read is that even with longer waits, dutch and french patients still sought out specialists and did less "avoidance" of care because the costs were low. The next sentence then states that even with longer waits there's no evidence that care is less quality or less effective. So, I interpret that to mean that while the systems in place do make it harder to see specialists, the frequency and quality of the service remains high,effective and patients are satisfied with their care.

I don't see where that indicates "less care". Can you clarify? Did I miss your point entirely?

Mark,

All those countries that "get it right" are in the same boat we are in. Costs are rising too fast to sustain their programs. If that is getting it right you and Cohn don't know what the word "right" means.

But Dutch and French patients were far less likely to avoid seeing a specialist altogether - or forgoing other sorts of medical care - because they couldn’t afford it.--emphasis added

From the article you linked. Geez, I think I've been making precisely this point. That to truly get a handle on things we will have to have less care in this country not more. But no politician out there is saying this. None of them are being honest. Which of course re-inforces my dictum: Politicians--they all lie.

Michael,

How about we take the French system plus 20%? Hell, France plus 50% would represent a staggering windfall for us. In fact, we could buy France with the savings.

Going bankrupt at a slower rate is not a windfall.

C. Stanley,

I wonder if that comparison of lifespan takes into account the skewing of US lifespan from violent or accidental death.

No. Nor does it take into account other things like obesity. Granted a medical problem, but it isn't something that we should hope to address purely through health care. In fact, I'd argue that that approach would be the least cost efficient. Its a dubious statistic for making decisions about health care policy.

I would also throw in consideration of lifestyle- although I think the French are heavier smokers than we are so that might cancel out other negative lifestyle effects in the US like sedentary habits.

Being a smoker might actually save money. If a heavy smoker drops over dead at 50 due to a heart attack then he isn't going to live another 75 years and die of some disease that would kill him over the course of 5 to 10 years eating up a huge amount of health care resources--i.e. money. Also, all other retirement benefits and such would go unused which is a windfall for the rest of society. A bit macabre perhaps, but something to consider none-the-less.

The French have a diverse population, their population is actually older than ours, their people outlive ours, and they seem to like their system and yet they spend a fraction of what we spend.

I wonder if that comparison of lifespan takes into account the skewing of US lifespan from violent or accidental death. The general stats that are oft quoted about 'our healthcare system costing far more but with worse outcomes' does not, and the claim on this specific metric has been debunked. When you factor out the sizable number of US early deaths from homicide, suicide, and accident (mainly auto accidents), our lifespan is slightly higher than most countries'.

I would also throw in consideration of lifestyle- although I think the French are heavier smokers than we are so that might cancel out other negative lifestyle effects in the US like sedentary habits.

Brian, I think you're overestimating the power of preventive care. The mortality rate is 100%

My sources confirm this also.

We can't blame our diverse population. France has minority groups. France has illegal immigrants.

And I don't buy the "we do all the research" argument. The other countries on that chart are the other major medical research players. (Minus Switzerland.) It's not as if we're spending our research dollars just on cancer cures, we're working on diet pills and baldness remedies and variations on Viagra. We're not looking for cures for orphan diseases, we're looking for pills that will turn huge profits.

The French have a diverse population, their population is actually older than ours, their people outlive ours, and they seem to like their system and yet they spend a fraction of what we spend.

The only reason we can't do as well is that we don't want to do as well.

Mark, are you making an unstated assumption that everyone in these other countries is getting all the care that they are ggetting in the US, just for less money?

Yes. I think overall, they're probably getting more care than in the US given that it's provided without the same types of requirements (premiums, pre-screens, insurance approvals). But probably have (depending on the country) less access to specialists.

Whether you think it right or wrong, and whether due to policy or bureaucracy, health care is rationed outside the US.

yes but, I would say it's rationed here as well just called something different. Rather than rationing based on the available resources of the medical service, it's rationed based on the resources of those who can pay for the care they need or by the condition they have being "approved for care". I think in both cases (US and other countries) you have some form of rationing.

We don't have the same type of government? Are all governments the same? Or are some worse from a public choice perspective than others?

true. same in terms of waste? I'd say yes to varying degrees but that's an uneducated guess. I'd say yes to your last question but also, better. I read this: http://www.boston.com/bostonglobe/ideas/articles/2009/07/05/healthy_examples_plenty_of_countries_get_healthcare_right/?page=full and it sure sounds like they're doing many things right in these countries.

I just find it extremely hard to believe that we can't come up with a form of health care that is similar to those described in that article.

My critics will want me to explain why, then, Europe can do it cheaper. The answer is threefold. First, most European nations have better governance than we do--the American political system is a Public Choice disaster. Second, they pay people less money in a way that's hard to replicate here (and even if it wasn't, would be a one time savings that wouldn't check the rate of growth). Third, we're still driving quite a bit of product innovation. Our messy, organic, wasteful, unfair, irrational system allows experimentation, and they cherry pick the best results. If we stopped doing this, their system would stop looking so good.

Another factor: we're much, much more diverse than even the most diverse European country. That makes a difference when you're deciding what's acceptable to you and what's not.

Why is it then difficult to also say that our own govt run system would be as efficient?

We don't have the same type of government? Are all governments the same? Or are some worse from a public choice perspective than others?

2. Whether you think it right or wrong, and whether due to policy or bureaucracy, health care is rationed outside the US. You would expect to see divergent expense performance.

3. The pro-government health care folks fascinate me. In my experience they are almost universally the same ones who moan about wasteful Pentagon spending. Its as if there were two lines at the civil service employment site. Into line 1 go the lazy, wasteful and perhaps evil dolts who find their way to the Pentagon..........and into line 2 go the energetic and efficient workers who will populate whatever government program the left is advocating at the moment. This is a universe with which I am not familiar.

4. Broken record: reintro price into the doctor patient relationship; get back to real insurance, not health maintenance. But you've heard this before.....

Alas, luxuries become necessities. It is going to be very hard to stop anything that has already started.