There were wide and significant variations in access and waiting times on multiple dimensions across the six countries. Respondents in Canada and the U.S. were significantly less likely than those in other countries to report same-day access and more likely to wait six days or longer for an appointment. At the same time, majorities of patients in New Zealand (58%) and Germany (56%), and nearly half in Australia (49%) and the U.K. (45%), were able to get same-day appointments. Waiting times for elective surgery or specialists were shortest in Germany and the U.S., with the majority of patients in both countries reporting rapid access.

This gives an overview of area's where the US system is lacking.

The US public expenditure on health is much higher than that of most OECD countries. And don't forget: If a treatment doesn't get covered by your health insurance that doesn't mean it is 'illegal', it just means you have to pay for it yourself.

We also have a two tiered (actually three or four tiered system) with those who work for companies offering group health plans in one, those who have to attempt to buy heath insurance on the individual market in another (I an with out insurance right now until my new jobs group plan kicks in because I simply cannot get covered at any price), and those who get covered by the government.

So the idea that health care is not "rationed" in the US is hoarse hockey, also the idea that we are not paying for the heath care of other though higher insurance premiums and higher medical costs is foolish. If we, as a society, decided that we will not allow someone to die on the street simply because they have no ability to pay for medical service then we are taxing ourselves to provide that care. Period ... full stop.

Which at its basic level is a smart idea - the problem is that the insulator doesn't reap enough of the long-term benefits. For instance, paying for good prenatal care would save you in the long-run IF you're still working for that company, and still on that health plan, down the road.

The insulator is often forced to provide such coverage either by gov't mandate (minimum length of hospital stay for pregnancy) or by corporate mandate (some level of basic minimum care enforced by employers; the real customers here), but either way, the uninsured person isn't getting it, and it costs us a lot more in the long-run, as with the knee surgery example given above.

So, no, I don't buy this common talking point that this so-called insulation is the root of our problems.

Speaking as somebody who hasn't had the same health plan for longer than 2 years in a row since the mid 1990s, perhaps I have a different perspective than you academics.

For situations like Jeff's example, the patient and the government are much better off than if the patient becomes disabled. The patient is not disabled, and can continue working, although he has a substantial loan to pay off. The government subsidizes the interest loan and bears the risk of default, but is spared the costs Jeff outlines.

By making this a loan rather than a handout, the program is much cheaper, doesn't encourage unecessary treatment as much, and doesn't crowd out private insurance for those who can afford it.

Uhhh... no. Kathy would go with the national health care, where I might have to wait a few weeks or months for knee surgery, depending on the results of a medical exam, but I would not have to wait indefinitely, which is what I'm doing now.

And I think a single payer system would be a very bad idea. Right now, many places in Britain are implementing mandantory wait times for various procedures to keep costs from rising so fast.

You're illustrating the point of my comment: Britain doesn't have a single-payer system or, more accurately, they don't only have a single-payer system. They have a fully-socialized system.

But there's another point to be made here. I wish that people would stop doing a bait-and-switch on this issue. Single-payer alone doesn't extend healthcare coverage one smidgeon nor does it reduce costs other than by reducing whatever proportion of costs are attributable to the delta caused by private insurance (and, as I noted, my casual estimates are that's about 10%—appreciable but not enough to cure our system).

You didn't address my core argument, so I will try to give a concrete example. Suppose an uninsured working class person develops, for example, a chronic joint problem. If he is treated, he will be cured and live a long productive life. If untreated he will be disabled within one year and will never work again. In our current system he is uninsured and cannot afford any kind of treatment whatsoever. His wait time for care is infinite. After a year he will be disabled and the cost to society will be 1) all his lost future work, 2) all future taxes on his earnings, and 3) his future health care expenses because once he's completely ruined social security will pick up the bill. How perverse is that?

Now imagine a national health care system which prioritized conditions like this one. He goes to a local clinic for initial examination and his case is assigned a certain priority based on a rational system. After a reasonable waiting period he arthroscopic surgery or whatever and after he recovers he goes back to work for the rest of his life.

In the first scenario the public bore a huge cost. In the second scenario the public bore a small cost and reaped a large profit. This positive result is possible if we are willing to put the power of the public purse behind it. It's also possible by a second means: if the market were smart enough to recognize the opportunity to provide health care now in exchange for amortized future payments. But like in so many other examples in the real world, the market fails to recognize this opportunity.

Nowhere in your erudite exegesis of the cost savings or lack of cost savings between national health care and the system we have now is there any mention of the fact that 48 million Americans don’t have any health insurance at all. Add up that cost and tell me what you find out.

That health care spending will likely go up. And please, don't make the mistake that my view is that we should keep our current system (or you should go re-read my other posts on health care first before trying to pigeon hole me).

The waiting times argument is a complete misdirection. There’s no reason why we can’t have a national health care system (note the difference between this and national health insurance system) and a parallel private system where you can pay for lower waiting times. For Americans without health insurance the waiting time for basic health care is infinite.

Uhhhmmm no. England has a nationalized system and wait times are increasing to reduce costs.

As for a nationalized system and a private system that wont really work, IMO. All the healthy people would go with the national health care leaving only people like Kathy in the private market. That wouldn't help her because it would still a prohibitively expensive insurance policy.

M1EK,

Sorry, but that just isn't the case. We consume huge amounts of health care in this country. Part of the reason is that we have health insulation not health insurance. The former covers everything from pregnancies, to eye glasses, to triple by pass operations. While the demand for the last one might be pretty inelastic, the others are not. And if you look at Canada they are making certain "discretionary" procedures (think IVF procedures) illegal. Why? Because they are having a huge budget problem related to health care?

That’s one obvious low-hanging fruit out there. The other is that national health care could easily eliminate the incredible waste of having low-income people get deferred basic health care at emergency room rates which is then paid for by the public anyways.

Yes, but if you also give them health care like the rest of us have, then you'll have upward pressure on health care expenditures due to increased discretionary demand.

Dave,

I agree that part of the problem supply side, but there is also the burgeoning demand as well. I think both sides need to be addressed.

And I think a single payer system would be a very bad idea. Right now, many places in Britain are implementing mandantory wait times for various procedures to keep costs from rising so fast.

But those who advocate switching to a single payer system due to lower administrative costs never want to talk about issues like this.

This is where you go stupid. People talk about this all of the time. It's just a jab, and a half-hearted one at that, James. I'm surprised that you didn't throw in some "commie" slurs. It's below you.

At this point, I think it's really up to those who advocate sticking with the current system to prove why it is a better model than any of the dozen or so other 1st world models that provide better care (by any number of measures) and a much lower cost.

Viewed that way, it's pretty darn obvious that a health care system with more rigorous rationing based on medical need could in fact BOTH lower costs AND not significantly affect outcomes for those who are healthy today.

And the idea that we don't have to wait is just ludicrous. Each time I break in a new rheumatologist, it's typically 6 months before I can get in for the first appointment.

That's one obvious low-hanging fruit out there. The other is that national health care could easily eliminate the incredible waste of having low-income people get deferred basic health care at emergency room rates which is then paid for by the public anyways. IE, we're already paying for health care for the extremely poor, but we're doing it at far too high a premium.

The waiting times argument is a complete misdirection. There's no reason why we can't have a national health care system (note the difference between this and national health insurance system) and a parallel private system where you can pay for lower waiting times. For Americans without health insurance the waiting time for basic health care is infinite.

No kidding, Steve Verdon. I've been living with crippling joint pain for the past 10 years. I should have knee surgery, but I don't have health insurance and I can't afford to pay for the surgery. It's not waiting lists that keep people from getting medical care for "minor pain" or "limitations on mobility and/or lifestyle," it's lack of health insurance and lack of a personal fortune.

Nowhere in your erudite exegesis of the cost savings or lack of cost savings between national health care and the system we have now is there any mention of the fact that 48 million Americans don't have any health insurance at all. Add up that cost and tell me what you find out.