Mr. Chuchundra,

So far, and as government programs go anyway. Drug prices are low, signups are high, and complaints few.

Vinteuil is comparing the cost of treating the Medicare population (apples) to the total per capita cost of Canada's health system (oranges). He's comparing the per-person cost to treat everyone in Canada with the per-person cost of treating the neediest & most expensive population in the US. I hope you can both see that the comparison is bunk.

If there's a way to break out Canada's retired/disabled population and make a direct comparison system-to-system, fine. (I don't know of a way to get that data.) Likewise if there's a way to compare something like cost-per-procedure between Medicare and private US insurers, that might be a valid starting point.

Otherwise, the idea that the Medicare system, which treats the neediest subset of US healthcare consumers, is in any way "scalable" or homologous to a system that would theoretically handle all US consumers, is utterly flawed from the outset.

The only valid comparison between the US & Canadian systems is apples-to-apples, that is, total per-capita costs for each. I made that comparison, and showed that overall, as a percent of GDP, Medicare costs are a low percentage of total healthcare costs per capita, and indeed that they scaled below total costs per person nationwide (27% of people account for less than 27% of total costs). And, of course, as we all know, the US spends over 16% of its GDP on healthcare, which is completely off the charts of any comparable system in the world. I say again: Medicare ain't the problem (nor is it a model for a solution).

P.S. -- apologies for the slow response. I'm on jury duty here in NYC, and the courts still frown on blogging during testimony.

I've got my own agenda. Not Schumer, or Spitzer. I went to the trouble of getting a bipartisan bill putting up award money for hydrogen power, largely through convincing nuclear and coal proponents it was a smart move for both. You, by contrast, seem to have done a lot of work around power plants, and have done nothing except whine about Liberals. And make money from it all.

I've done plenty. You've done nothing. You hate Liberals, on principle, you say. I'll respond in this wise: you have no principles, if you feel you can lump me in with Schumer and Spitzer. So much for your much-touted civility.

Mr. BlaiseP,

Which I take to mean to treat existing Medicaid etc. as block grants. I don't see a promise to add extra funds.

the DoD health care plan run by Humana and others.

You're missing the point, treating them elsewhere is not the issue -- whether many should be getting treatment from the VA at all is one aspect; another is whether others should be able to use MediCare (and/or Tricare) when that's advantageous or get treatment from the VA when that is. The VA for example will give you eyeglasses and hearing aids, the others do not. The VA cannot do some things that MediCare will do; TriCare will not do somethings either will do but will do some things they won't do. All are virtually no cost to anyone who is a qualified veteran and to many who really aren't -- like the adult children of combat disabled veterans...

You also seem to think I'm complaining that the VA has excess money. Not so. My comment was "The VA needs to stop spending money on people who don't need it, they need means testing far worse than Social Security or MediCare."

The real issue IMO is whether the VA returns to its roots as a care system for combat disabled veterans or continues serve everyone who can remotely claim to be a veteran or in some cases, merely related to one. A secondary issue is why should the VA spend tax dollars to provide excellent care to people who can afford equally good private care and use the money thus saved to enhance their Estate or by a new Maserati. Or use the VA for free when they have MediCare and TriCare who between them will pay virtually everything.

(One answer to that, BTW, is that many doctors and Hospital won't accept TriCare because their payment scale is the lowest around and TriCare does not have the MediCare law that says the payment is all that can be charged or else...)

This goes back to Bill's original comment. That guy was denied a needed bed in a facility. There is every possibility that the "No Vacancy" sign went up because the facility was providing treatment for some folks whose qualification for care is tenuous at best.

computer nerd version... :)

Both the generalization and the extension have applicability in health care provision.

With respect to your comment above, I meant it in the sense that we could adopt universal health care (unlikely soon and I certainly hope not in my lifetime) but that neither the current MediCare bureaucracy nor the VA system is at all likely to disappear; thus you'll be confronted with competing bureaucratic systems and probably achieve liitle if any saving of GDP devoted to health care.

I, BTW, am opposed to single provider health care due to almost 30 years of living with such a system. The system will pay providers and one will have choice eventually and then the choices will decline and eventually, you'll have an incompetent provider. It is not the panacea many think...

...that opponents of Universal Care say is that if health care is free, then people will over consume it. Like, who the hell goes to the doctor if they don't need to. Even people like me and PM who have decent health insurance often don't go to the doctor when they should. My fiancee knew just how sick I was about a month back when I asked her to take me to the doctor.

I remember a similar discussion last year on Crooked Timber when a free marketeer claimed that if health care was free, people would go to the doctor for a hangnail. The funny thing being, people should go to the doctor when they have a hangnail. A five minute office visit could prevent a serious infection or worse. If people saw their doctors earlier and more often then the cost of health care in the aggregate would go down because people would get treatments that would prevent serious conditions later on.

I meant the Canadian government was trying to head off the insurance morass we have down here.

Due respect, but I have brought two separate events to lawyers where they agreed that the actions were egregious and probably actionable, but that because they merely unnecessarily endangered my life and long-term health -- and caused months of unnecessary suffering -- they were not awful enough to likely produce a jury award large enough to justify their time.

I don't buy that the problem is malpractice premia.

say business has been very bad for many, many years. Juries in Illinois have become quite stingy for at least a decade, maybe longer.

"It's all the trial lawyers fault" is an old canard that is no longer true, if it ever was.

= = =

I used to handle the occasional accident case, but no longer. Too much work for too little money. And Med-mal? No way.

I think it's simply ridiculous that we as a society tolerate a product that slowly kills people at enormous financial and emotional cost to the rest of us.

To head off the inevitable objections or counter-examples, alcohol used in moderation is not inevitably harmful (it may actually be beneficial). Smoking in "moderation" kills. Yes, I'm ok with banning trans fats.

... okay "design a system". Whatever.

State-paid (Blue Cross equivalent);
"Average HMO" (Kaiser) - about $300/mo per person or $4-500/family but must use their facilities;
"Premium HMO" - Can use doctor/facilities of your choice - about $600/mo per person and $800 and up per family.

Costs of these vary within about a 20-30% range depending on risk group assignments. Kaiser has a somewhat high reputation for malpractice; you are on your own at the "premium level" AFA this issue is concerned because no one picks for you. There are rarely delays at that level IME.

Which raises another question: what is the equivalent cost, in USD/mo, that an average Canadian worker is "paying" in health care costs there? I know ther is no direct equivalency, but someone must have come up with this number for comparison purposes.

Anyway, I still say that if you have a life-threatening problem (which you won't know until you see a doctor if it's asymptomatic), it's immaterial whether you get bad service on time, or good service when it's too late to help you.

And we should take full advantage.