Re: Public vs private healthcare (was: RE: [CNN] Bush 2,909,465; Gore 2,907,722.)

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From: Matt Jensen (
Date: Fri Nov 17 2000 - 22:28:11 PST

Lisa, thanks for lots of useful, new bits on this. Some comments:

> So, take your pick. Either your government unfairly taxes corporations to
> pay for socialized medicine, or your government unfairly regulates
> corporations to pay for somewhat privatized medicine. ...

Tangentially, I'm interested in how you define "unfairly" regarding
corporate taxes. In the U.S., 75% of tax revenues come from workers, and
11% comes from corporate profits.[1] Is the corporate rate in Canada very

> - I guess you could attribute the "tainted blood" scandals to public
> medicine. Since the Cdn gov't has the monopoly on the blood supply, people
> had no choice where to get their blood.

There are a lot of assumptions in that hypothesis. By "people" getting
their blood, I presume you mean how hospitals get it. In the U.S., half
the blood comes from the American Red Cross, and half the blood comes from
America's Blood Centers, an association of nonprofit community blood
centers[2]. While they both tout their emphasis on blood safety, it's not
at all clear that their vigilance is due to having a (nonprofit)
competitor, as opposed to public pressure and government regulations.

The industry does not seem to race ahead of the government in safety;
often it is governmental vigilance that improves the supply's safety[3].
So perhaps Canada needs better regulations?

> ...Alberta's premier tried to introduce some private clinics that
> could offer medical procedures without waits for those who could pay.

While that's controversial in Canada, I think it would be politically
impossible in the U.S. to do away with private health care. But it
doesn't have to be either/or. When Clinton was considering health care
reform in 1992, it came down to two choices:

1. Single Payer. Health care providers stay the same, but you expand
Medicare to cover everyone, and insurance companies go away (from
healthcare). This would require a tax increase, but we wouldn't have to
pay insurance premiums anymore for basic coverage.

2. Managed Competition. You keep insurance companies in healthcare, but
government regulates things more precisely, to try to manage costs.

Clinton preferred Single Payer, but the small chance of getting a tax
increase for it led him to push Managed Competition instead. But under
Single Payer, contrary to rumors the Republicans spread, you could still
buy additional private insurance if you wanted to. Everyone would be
covered with basic health care, but if you wanted a non-essential MRI for
your knee, you could pay for it yourself if you had the money[4].

> For anybody who's gotten this far, I'd like to raise the debate a level:
> why is health care getting to be a bigger and bigger issue, in Canada/US/UK,
> even as standards are rising and more helpful procedures and medications are
> available? I see:
> - boomers are rich and aged & concerned about healthcare in those countries
> - New procdures & medications are expensive & costs are rising at least as
> much as quality is rising.
> - We're so well-off we don't have anything else to worry about.

In the U.S., I think it's a big issue for the poor, the working poor, the
working class, and the middle class because all of them have trouble
affording and getting access to health care.

It's a big issue for everyone, including the rich, because of the
spiraling government costs. Medicare and Medicaid are the fastest-growing
parts of federal, state, and local budgets[4]. I think some reasons are:

- New procedures & medications, as Lisa notes, are more expensive.

- The uninsured usually get no treatment unless they go to the emergency
room. This means that instead of giving them a relatively cheap
examination early on to nip a problem in the bud, we all end up paying the
high cost of their ER treatment.

- Bureaucracy. To process a single transaction through our current system
(e.g., bill you for an exam) costs around $10. A convincing case can be
made that a Single Payer system would streamline this and save money[5].


[4] "Breaking the News", James Fallows, 1996 by Pantheon. All of Chapter
[5] Fallows, 1996 says the current burden to doctors of processing
Medicare claims is far less than the burden of processing claims through
private insurance and HMOs.

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