I replied to Steve's comment with 4 links and waited a few days. When it did not clear I reposted without the links and it still went to the moderation queue.

Can someone fill me in as to why I am getting hung up?

Actually, there haven't been the kinds of financial institutions we have today. Things like 401k's, Roth IRAa, and even the much hated MSAs can help people be prepared for health care insurance during retirement.

I'm not arguing for people to ignore their retirement, I am saying that if you leave healthcare and retirement funding up to individuals you will have large numbers of people doing without. Do you really doubt this? Or are you just willing to accept it?

I'm sorry, but such comparisions are meaningless until you account for differences in the populations. For example, Americans are supposedly some of the most overweight people on the planet. If we account for that does it reduce the difference? And you ignore completely the notion of non-monetary costs. Waiting 6 months for an operation that would repair a painful/debilitating but non-life threatening injury is a cost.

American has a higher infant mortality rate than any western industrialized nation. Do you really think that is a lifestyle issue rather than cheap or free prenatal care being available for all? Obesity is a growing problem in Europe as well, yet the health outcomes remain significantly better. Regarding wait times you have only provided anecdotal evidence. I have been living in Western Europe for a few years now and that is not my experience or the experience of anyone I know. My mother-in-law's brother recently had a severe stroke. He did have to wait about a week to be placed in long term care residence during which time he had to stay in the hospital. This is the longest wait time I have heard of from anyone I know here and I know a number of people with cancer and other serious health problems.

But you don't see it nearly as much with other large corporations, so I'm inclined to think the problem with HMOs is again due to regulations and laws.

I notice you provide no links. Lazy?

Bad news, the Netherlands has moved to institute more market based reforms in their health care in 2006.

There were some market based reforms, but health care remains universal and cheap due to continued government regulation. The health insurance for people in our family went up about 2 euro per month. Average cost for health insurance is about 80 euro per month. My wife and I pay about 120 euro per month for ours. Those who cannot pay are still covered without cost. Despite Gammon's hypothesis the costs are considerably lower than in the US.

Bad news, the Netherlands has moved to institute more market based reforms in their health care in 2006. Sorry. Looks like the reason for this...rising health care expenditures. Try again.

Oh and yes, I know the idea behind the Netherlands approach is to make sure health care coverage is universal, my point in asking ken for a single example, was a single example of government provided health care. The Netherlands is moving away from that approach, not towards it.

What consumption do you recommend they forgo?

Whatever they want. I don't care so long as they save more. Honestly, are you syaing you want people to save less for their retirement so that future workers can have a heavier tax burden? Really? What about the children? Isn't that the reason for fighting global warming?

That has been tried and proved an abysmal failure, thus our current system.

Actually, there haven't been the kinds of financial institutions we have today. Things like 401k's, Roth IRAa, and even the much hated MSAs can help people be prepared for health care insurance during retirement.

The Netherlands.

Really? I note no links, no analysis, nothing. But since you are lazy, I'll go see what I can find.

Many countries are having problems with health care costs, but the US pays more than half again what the next closest country spends and about double what the typical industrialized country with universal health care pays. What do we get for this? We get worse outcomes by virtually every relevant rubric.
Yes other countries have what amounts to rationing, but so do we. Not only do we have rationing according to ability to access health insurance, but our HMOs ration our health care to limit their costs as well. For every horror story about rationing in Britain or France there is an equivalent story about 'rationing' by Kaiser, HMSA, or some other HMO.

I'm sorry, but such comparisions are meaningless until you account for differences in the populations. For example, Americans are supposedly some of the most overweight people on the planet. If we account for that does it reduce the difference? And you ignore completely the notion of non-monetary costs. Waiting 6 months for an operation that would repair a painful/debilitating but non-life threatening injury is a cost.

Calling it a law does not make it so. At this stage of development it would more properly be called Gammon's hypothesis.
The definition he provides for bureaucracy and the evils he sees therein corresponds equally well to HMOs as it does to any government body. This is not a distinguishing character between public and private health care.

But you don't see it nearly as much with other large corporations, so I'm inclined to think the problem with HMOs is again due to regulations and laws.

Bithead, we have had a hybrid public/private healthcare system, under the control of a cartel of doctors, for more than a century. Whatever you might want we will continue to have some form of hybrid of public and private healthcare. A completely free market healthcare system (which would eliminate medical licensing and pharmaceutical patents as well as Medicare, Medicaid, the VA, and employer-sponsored healthcare systems) has almost no constitutency.

And, although I agree that our present mix has contributed mightily to the high cost of healthcare in the country, it isn't the only factor. Healthcare costs were rising sharply before Medicare and Medicaid were enacted. They were a consequence as well as a cause of rising costs.

The costs were not going up at nearly the rate, until such time as the Great Society (otherwise known as FDR lite) came along.

Sure there is, if you mean money for medical care.

If you mean we don't have enough money to meet the greed of certain for profit hospitals, insurance companies and drug companies then you have a point.

I suppose that it hasn't occurred to you, that profit is the reason that the hospital exists. That the quality of care there in that wouldn't be nearly as good without the chance for actually making a buck on it. You have immediately labeled the profit motive as evil, without fully accounting for the results of removing it.

Future Medicare/Medicaid enrollees are going to have to be forced to forgoe current consumption to save for their medical in the future. Failure to do so should carry with it extremely severe penalties.

What consumption do you recommend they forgo?

No, I can't speak for Bithead here, but for me it is a question of incentives. We want people to save for their own retirement which also includes health care.

That has been tried and proved an abysmal failure, thus our current system.

Please point to one sustainable example.

The Netherlands.

Better, cheaper, and safer. That is the experience of socialized medicine in other countries.

That is simply not true at all. Every country is having problems with health care expenditure growing at unacceptable rates. Even in France, the darling of the universal health care crowd, had demonstrations about their health care recently.

Many countries are having problems with health care costs, but the US pays more than half again what the next closest country spends and about double what the typical industrialized country with universal health care pays. What do we get for this? We get worse outcomes by virtually every relevant rubric.
Yes other countries have what amounts to rationing, but so do we. Not only do we have rationing according to ability to access health insurance, but our HMOs ration our health care to limit their costs as well. For every horror story about rationing in Britain or France there is an equivalent story about 'rationing' by Kaiser, HMSA, or some other HMO.

Re: Gammon's Law
Calling it a law does not make it so. At this stage of development it would more properly be called Gammon's hypothesis.
The definition he provides for bureaucracy and the evils he sees therein corresponds equally well to HMOs as it does to any government body. This is not a distinguishing character between public and private health care.

The problem is that Medicare pays only $83 for a procedure that costs $125 to provide, said Weiner, who will introduce legislation to increase payments.

Perfect example of what we are talking about. A private insurance company pays less than cost and the public has no choice but to do without. With Medicare however we, as citizens, can choose to increase payments in order to provide coverage to those in need.

They ignore the evidence of very bad results from other countries nationalized healthcare programs.

They studiously ignore the failures of public healthcare programs in the US.

Here is another warning sign they will, no doubt, studiously ignore.

The Government and health care - 2 stories

Mammography centers in New York City are closing at an "alarming" rate, causing a 171 percent increase in wait times for the cancer-detecting procedure, according to a study by Rep. Anthony Weiner.

Since 1999, 67 mammography sites, more than a quarter of the city's supply, have closed, the Brooklyn Democrat found.

The problem? Price fixing at a lower level than cost:

The problem is that Medicare pays only $83 for a procedure that costs $125 to provide, said Weiner, who will introduce legislation to increase payments.

I guess the above example is another example of the better, cheaper, and safer ken talked about.

The government can't manage this simple task. In spite of the stacks of warning signs the various ignorant of the facts people continue to be driven to ecstasy at the thought of putting the government in charge of the entire healthcare system.

The mind boggles.

There isn't enough money in the world to provide everyone with what they "need." Never has been, never will be.

Sure there is, if you mean money for medical care.

If you mean we don't have enough money to meet the greed of certain for profit hospitals, insurance companies and drug companies then you have a point.

But the whole idea is that once we get the greed motive out of the system we will then be able to actually fund coverage for everyone who needs medical care.

You can get more accurate information on pharma R&D and marketing cost from a companies annual report than you can from some second or third hand source. Beside the companies are more likely to tell the truth in their 10Ks due to the SEC looking over their shoulder on everything they say.

I checked the Pfizer report and here is what I found out:

Pfizer spent around 32% of revenue on marketing in 2006 and around 15% of revenue for R&D. Years 2005, and 2004 had similar ratios.

If Pfizer has this kind of breakdown between marketing and R&D you can be sure the other pharma companies are the same. Check them if you want. All the information is on line.

I call BS on your calling of BS. Your calling of BS isn't supported by the studies you cite.

Let me see, we have spending on R&D and spending on marketing....hmmm, okay.

In 1998, pharma spent nearly $13 billion on advertising -- in the U.S. alone. Since then, advertising (direct and indirect) has increased substantially.

And so has R&D. R&D has grown, according to the CBO at about 8% per year. And your data on advertising is....?

In 2003, the pharma trade group claims to have spent $~30 billion on R&D, including the R&D outside of the U.S. The NSF, on the other hand, estimates that, in the U.S., hey spend half that amount. (Gosh, why would pharma exaggerate?)

There was no exaggeration in that the two measures were not measuring exactly the same thing. That is the Big Pharma trade association included R&D spending that the NSF did not count. The CBO report explains the difference and doesn't imply any exaggeration.

Anderson,

You can argue till you're blue in the face (thus becoming another failure of the system), but the bottom line is that tying insurance to employment is stupid, that the uninsured and underinsured are legion, and that the present system will not last.

I quite agree, but notice that when President Bush actually proposed a policy to eliminat or at least greatly reduce the tax benefit for employer provided health care those opposing Bush poo-pooed the idea, not because it was a bad idea, but because Bush proposed it.

Whatever the faults of universal care, and there will be many, they will be the faults of a system that takes care of everyone, instead of the faults of a system that cares only for some.

Charles is right. The rationing of health care will be done via the political process vs. the market process. Think about that, and the idea of a President like Bush. Does that give you warm fuzzy feelings?

I know, I know, you'll respond with something like "Well, we shouldn't have a President like Bush." Fine, but the probelm is we do, and there is damn little about the electoral process that ensures we wont have another President like him again, and I'm sure the conservatives would find the idea of somebody like Lyndon Johnson equally disturbing. So really, I see this as a pathetic answer.

15,000 per year? Adjusting per capita, how many *Americans* died during that period as a result of our healthcare system's failures (including lack of care due to lack of insurance)?

You can argue till you're blue in the face (thus becoming another failure of the system), but the bottom line is that tying insurance to employment is stupid, that the uninsured and underinsured are legion, and that the present system will not last.

Whatever the faults of universal care, and there will be many, they will be the faults of a system that takes care of everyone, instead of the faults of a system that cares only for some.

The idea that pure hearts and good intentions wil perform better than free markets and individual choice is rather ahistorical, to say the least. The perfect remains the enemy of the good. Or, to borrow an old joke do you strive for a system wherein everyone suffers equally?

I have no illusions that everyone can be taken care of according to their need. There will be rationing of medical care according to something. Should that something be dollars? Political connections? Height? Age? What? Exactly what?