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Once and for all: the waiting room question for soc. Health care

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The Texas Trigger posted on Fri, Sep 21 2012 4:09 AM

First, this is not a thread to say why or why not socialized medicine is good. I simply want to focus on the lines for care in this country (the U.S.A.) vs other countries with socialized healthcare. That said, I will expound.

It is often asserted by Americans who oppose universal healthcare that the lines are atrocious in countries with universal healthcare. In the tradition of Misesian Praxeology, this assertion makes sense to me; it seems valid and logical no matter what empirical proof one may offer to the contrary.

Here is what baffles me:

Of all the many different people I know that come from many different countries with socialized healthcare, I usually get the same two answers to the same two questions (Disclaimer: these answers are not ALWAYS the case, but IN MY EXPERIENCE, I seem to get these more often than not)

(Q1) Aren't the lines so long that you cannot really get care, even if it is "free"?

(A1) They aren't nearly as long as Americans say they are (or they aren't long at all)

(Q2) Do (did) you like having socialized healthcare?

(A2) Yes, it is mostly great! I prefer it to the American system. You guys should convert with the rest of modern human civilization!

 

Now, for why I think these answers are given.

It could be just a quasi-seen vs unseen fallacy. They simply don't know anything else (or better), and so they assume that everyone would be dying in the streets if government didn't provide the care. But, this reason doesn't explain the answer when given by immigrants who use our system now, having now had the opportunity to live under both and compare.

This leads me to the second reason these answers might be given. Because of our admittedly fucked up, fascist, non-free market system, it is perhaps true that the lines actually aren't much longer. I mean, our system's root problem (a third party payer which decreases consumer price sensitivity to cost of care, and other governmental regulations and incentives) is basically the same as that of universal health care's (a single payer which decreases consumer price sensitivity to cost of care and other governmental regulations and incentives). The only real difference with regard to the cause of costs is that in a socialized system, rationing occurs in a more centralized, direct way, increasing the amount of time needed to receive care. There is always present a system of rationing. In our system, rationing is handled marginally more by market mechanisms than by government means. What I mean is, the insurance company may decide not to pay for a particular procedure instead of a government simply rationing care all together. 

But, if this is the case, then from the average joe's perspective, our system really isn't much (if any) better, which isn't something widely asserted on these forums. While most here still hate our system, they will still claim it is better, even if just marginally. I belong to this camp of people.

Perhaps the final reason is because people want to believe universal healthcare is better because they think it is more humane than a free-market system. These answers come out of pride and not from real experience. 

However, despite all of this, it is widely asserted on these forums and elsewhere that the lines are, in fact, longer in socialized countries than they are here (I do not want to get into why actual free markets would be better than both systems; this has been established ad nauseam). There have been many compelling videos and articles asserting these facts with sources, but for every one of these, there is another that claims the opposite.

Now, either someone is wrong or our definitions of "long lines" are just very different. The reason this is difficult for someone like me to decipher is two fold. 

(1) If you have never had to wait for care in another country (I haven't), you must simply rely on second hand reports about the length of the lines for care (I do).

(2) If you do rely on these reports, it can be (but certainly not always) hard to verify the reliability of the sources that support such claims. 

  • For example, studies performed by source A say the lines in Poland are 10 days long to receive procedure X.
  • However, studies performed by source B say the lines in Poland are only 5 hours long receive procedure X.
  • If I have don't have either the time or the expertise to analyze each study's methodology for coming to each's conclusion (most don't), then I am kind of crawling in the dark, aren't I? 

Basically, I am just tired of saying "yeah the lines are fucking long." to which someone who has lived under the system replies "No, they aren't! I've lived in that system and I have waited in those lines. You just listen to people who hate on universal healthcare and their propaganda. Who are you going to trust: someone who has experienced them first hand or some dude you don't know who just claims the lines are long?"

Even if you don't believe them, everyone listening just assumes you are wrong, because, as a general rule, most will trust first hand accounts over second hand accounts. 

Just going off the logic of it, I think they must be, but I have to be honest with myself and say that in an argument like the one of above, I don't have much to come back with. I cannot really tell them, "No! Those lines YOU waited in are fucking long, and I know this even though I haven't waited in them myself and you have!" 

Thanks

"If men are not angels, then who shall run the state?" 

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I'm from the UK. Obviously, every system is different, so I can only really speak for the NHS.

But wait times, really, are quite wild in length. I hear of some people that get seen too immediately, whilst others have a long, long wait time. Obviously, this is all anecdotal, so you can't trust me any more (and certainly, less) than one of those scientific "studies".

There's also a difference in wait times across procedures AND different parts of the country. The wait time in Location Y for procedure X may be different from Location Z for the same procedure. This is because the NHS is handled by different "trusts" in different parts of the country, and they have different priorities. The trusts also cover different things entirely, meaning if you have condition A, you may be shit out of luck if you're born in one town, compared to another... it's been dubbed the "post code lottery".

Also, you never have to wait more than a day to see your family doctor (called a General Practioner, or GP, here). Why? Because our last Government mandated it so. Of course, this means that if you call to book an appointment 20 minutes after the practice opens, you'll be told you cannot book an appointment, and will have to try again tomorrow.

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It may be information acquired by another party, but they have been doing this study for years. An individual may have an alright experience but statistically waiting times have gotten longer in Canada.

Waiting Your Turn: Wait Times for Health Care in Canada, 2011 report

Full study

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Most people don't understand that even if something is paid from their taxes it doesn't make it "free". Secondly people think that private health care is too expensive for the poor, and thirdly people think the US has free market health care.

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Also... when having this debate, you may need to qualify exactly what you mean by "wait time", for example...

A friend of the family was discharged from hospital last week, after undergoing surgery for pancreatic cancer... his wait times.

Between first going to the doctor and receiving diagnosis: 2 months.
Between receiving diagnosis, and being admitted into a hospital: immediately.
Between being admitted into a hospital, and being admitted into a hospital that can actually treat his condition: 3 weeks.
Between being admitted into a hospital that can treat him, and actually receiving the surgery: 10 days.

And this is for an extremely high-importance condition, in one of the wealthiest parts of the country (which means we should be doing "better" in our post code lottery).

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Answered (Not Verified) xahrx replied on Fri, Sep 21 2012 8:04 AM
Suggested by Autolykos

 

It could be just a quasi-seen vs unseen fallacy. They simply don't know anything else (or better), and so they assume that everyone would be dying in the streets if government didn't provide the care. But, this reason doesn't explain the answer when given by immigrants who use our system now, having now had the opportunity to live under both and compare.
 
The problem there is the comparisson is between a left wing socialist and a right wing socialist system, or socialism and fascism being the more common labels.  The US does not have free market health care.  Likewise, in some supposedly socialized systems people pay out of pocket for a good amount of services.  The only thing you can say about all the current health care systems is they are amazingl complex labrynthine bureaucracies on all counts.
 
The health care debate boils down to the first rule of economics: there's never enough of anything to satisfy everybody.  Scarcity means there will always be someone who didn't get what they wanted, or 'needed' if you prefer.  This will be true of every system, so specifically in every health care system you will be able to find horror stories and hard luck cases to argue for some opposing approach.  Socialism rations by politics, the market rations by price.  They both ration, people will suffer and die horrible, underseved deaths under both systems.  The market system in every other area provides lower prices and greater availability of goods and services, there is nothing magical about health care which expempts it from these free market forces.  The socialist system, right or left wing, will eventually collapse due to basic calculation errors and misallocations of resources, and during the length of its life will spread mediocre, declining levels of care to perhaps more people.  Neither a free market nor a socialist system will guarantee everyone long healthy lives, the free market system will guarantee the best chance for everyone to live long healthy lives.  That's why I favor the free market system for health care.
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Along with what Samuel Smith said, think about wait times at the local DMV office. They can have a wide variance. Maybe another way to attack the notion of nationalized medical care is on the basis of absence of competition. Just like people aren't allowed to open competing DMV offices that (try to) offer shorter wait times, people wouldn't be allowed to open competing medical offices under nationalized medical care.

If you think about it, government licensing of doctors, nurses, and other medical workers can be seen as an initial nationalization of medical care. This at least tends to lower the supply of those medical workers, which leads to higher prices for medical treatment (ceteris paribus). However, the argument for such government licensing isn't to make medical care more affordable or otherwise accessible to people. Rather, the argument is typically along the lines of medical care being too "important" to let just anyone provide, and "we" have to make sure that people get the "right" kind of medical care. Any lowering of supply and concomitant rising of price is thus an unintended consequence, but that's what gets the ball rolling.

The point behind nationalizing medical care is coercive wealth redistribution, plain and simple. People who support it make the argument that there are already people being coerced against, and therefore the coercive wealth redistribution isn't aggressive. But by their reasoning, if you don't help a drowning person (for example), that means you murdered him. To me that raises the question of just where the line should be drawn. If they don't make that kind of argument, however, then other people will see them for what they are - greedy.

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Esuric replied on Fri, Sep 21 2012 8:14 AM

 In the tradition of Misesian Praxeology, this assertion makes sense to me; it seems valid and logical no matter what empirical proof one may offer to the contrary.

This is where I stopped reading. 

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@xahrx

I would even argue that whether a death is "undeserved" is a matter of opinion. A person who wants something really badly, and is willing to coerce others who haven't already coerced him in order to get it, is just being greedy IMO. That's why such a person typically spends so much time trying to paint the people he's aggressively coercing as the greedy ones. It's also why I ask people who advocate "socialized healthcare" what entitles them to continue living. IIRC, I've never gotten a straight answer to that question, which I think proves my point.

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xahrx replied on Fri, Sep 21 2012 9:56 AM

 

I would even argue that whether a death is "undeserved" is a matter of opinion.
 
I wouldn't take on the mantle of judge for that one.  My point was more though that people will suffer for lack of treatment when they could have potentially recieved palative care, or even have been cured if someone forced the redistribution of the needed resources.  That's the seen cost in the eyes of people arguing for socialized care, not all of whom are simply 'greedy'.  They are more often than not mistaken pure and simple.  They think command and control of the resources is all you need to stop the sufferring.  They don't consider the unseen costs, which is also prolonged sufferring and death, of command and control health care management.  And in some instances they may just disagree with the idea of price rationing, preferring a rationing system based on assessed need and potential for recovery.  But even then there's no reason why the free market wouldn't necessarily deliver that to those who wanted it.
 
It's also why I ask people who advocate "socialized healthcare" what entitles them to continue living. IIRC, I've never gotten a straight answer to that question, which I think proves my point.
 
I'm entitled to live because no one is entitled to kill me.  My life is my ultimate property to develop.  That doesn't give me the right to hurt others to keep it going I'll admit, but I'll also admit that given scarcity as a rule of nature.  That being said, I would also find it hard to walk into one of those hard luck/horror cases where everything has gone wrong and charity failed to step in for whatever reason, and say some kid is about to die of a treatable disease, and tell his mother and father that they'll just have to wait for enough capital to accumulate for people to give a shit enough to save their kid.
 
The laws of supply and demand hold true at the extremes of human existence, but that's also where the norms of morals and ethics most people hold break down easiest.  And if it was someone I loved whose life was on the line, I'd happily break some bystander's legs to help them if I had to.  The difference between me and most people though is I'd also happily submit myself for punishment for the offense once I was sure my loved one was okay.  But the end result is that I'm a bit more forgiving toward those who think, however incorrectly, that all we need to solve health care issues en masse is more government.  These people aren't being 'greedy' in the every day sense of the word.  There's a difference between coveting someone's yacht and coveting someone's pain killers because you're in pain.
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xahrx:
The problem there is the comparisson is between a left wing socialist and a right wing socialist system, or socialism and fascism being the more common labels.  The US does not have free market health care.  Likewise, in some supposedly socialized systems people pay out of pocket for a good amount of services.  The only thing you can say about all the current health care systems is they are amazingl complex labrynthine bureaucracies on all counts.

Yes, I know. I tried to make that knowledge very clear. I know that we do not have a free market. If you had really read my post then you would also have noted that I used the exact same terms that you did to describe our system and universal systems, fascism and socialism, respectively. What I was asking there: is the reason you hear so many claim that the lines in universal systems aren't that bad because by comparison to ours, they aren't? LIKE I SAID, it seems to be fairly commonly asserted (or perhaps implied) on these forums that the US lines are nothing compared to universal systems. I will repeat, I am in no way asking if lines will be shorter or quality will be better in a free market compared to universal care. I know they will be. For this thread, we are comparing the pre-Obamacare U.S. system with universal healthcare with regard to line length and waiting times. I hope that clarified everything.  

 

xahrx:
The health care debate boils down to the first rule of economics: there's never enough of anything to satisfy everybody.  Scarcity means there will always be someone who didn't get what they wanted, or 'needed' if you prefer.  This will be true of every system, so specifically in every health care system you will be able to find horror stories and hard luck cases to argue for some opposing approach.  Socialism rations by politics, the market rations by price.  They both ration, people will suffer and die horrible, underseved deaths under both systems.  The market system in every other area provides lower prices and greater availability of goods and services, there is nothing magical about health care which expempts it from these free market forces.  The socialist system, right or left wing, will eventually collapse due to basic calculation errors and misallocations of resources, and during the length of its life will spread mediocre, declining levels of care to perhaps more people.  Neither a free market nor a socialist system will guarantee everyone long healthy lives, the free market system will guarantee the best chance for everyone to live long healthy lives.  That's why I favor the free market system for health care.

Again, not what I ask, and we know. But, I do appreciate your response, nonetheless. 

 

@Esuric

This from someone who can properly define neither "slave" nor pure, organic "capitalism" in a coherent, meaningful form. Your posts never answer my questions. they deflect with half-assed snobbery; it's not even clever.  

 

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bloomj31 replied on Fri, Sep 21 2012 10:23 AM

The Texas Trigger:
 For this thread, we are comparing the pre-Obamacare U.S. system with universal healthcare with regard to line length and waiting times.

What are we supposed to use as source material to determine the actual differences between line lengths and waiting times?

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xahrx replied on Fri, Sep 21 2012 10:55 AM

 

What I was asking there: is the reason you hear so many claim that the lines in universal systems aren't that bad because by comparison to ours, they aren't?
 
In your original post you said:
 
this is not a thread to say why or why not socialized medicine is good. I simply want to focus on the lines for care in this country (the U.S.A.) vs other countries with socialized healthcare.
 
And my point was that the question is irrelevant and a ridiculous sideline in this debate to get drawn into.  Comparing the lines between the two systems is irrelevant when they are the same system.  What knowledge or conclusion would you hope to draw from an analogy of two different DMV offices and their waiting times?  Or the Medicare vs Medicaid office?  Or the DMV vs Medicare?  The point itself is like arguing over the method of execution in a death sentence debate; what does the method tell you about whether or not it's right or wrong to kill someone?
 
So my point would be to stay on point.  You will find success and horror stories, and long and short wait lines, in both systems.  You will find this because people will always try to better their situation in life regardless of the prevelance or lack of bureaucratic hoops to jump through.  The point of any debate of health care systems should be which system offers the best chance for everyone to purchase what the want and need in terms of health care in the short and long term.  This is an especially important point because a reversion to full on socialized health care in the US could potentially lead to short term improvements in care for a lot of people, and they know this which is why some of the are pushing for it.  They would be screwed in the long term though.
 
For this thread, we are comparing the pre-Obamacare U.S. system with universal healthcare with regard to line length and waiting times. I hope that clarified everything.
 
For the purposes of what?  the waiting times vary anecdote to anecdote, study to study, depending on who you hear it from.  There's a trillion ways to qualify the study of such a subject, a probably more confounding factors than can ever be controlled for.  So again, what's the point and why should anyone give a shit about the lines?  Some people get fast, timely service in Canada, some people wait a long time in the US.  It's a statistic that tells you nothing in the end.
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xahrx:

For this thread, we are comparing the pre-Obamacare U.S. system with universal healthcare with regard to line length and waiting times. I hope that clarified everything.
 
For the purposes of what?  the waiting times vary anecdote to anecdote, study to study, depending on who you hear it from.  There's a trillion ways to qualify the study of such a subject, a probably more confounding factors than can ever be controlled for.  So again, what's the point and why should anyone give a shit about the lines?  Some people get fast, timely service in Canada, some people wait a long time in the US.  It's a statistic that tells you nothing in the end.

Finally, we actually get an answer. Am I right that you are basically saying that there is no clear or definitive evidence to turn to to say that lines and waiting times are much (if any) worst in universal countries than they are compared to the Current U.S. system. The reason I feel this is important is because (I WILL SAY IT ONE MORE TIME) many on this forum seem to imply (and many neocons explicitly state) that lines and waiting times in universal systems are longer than they are here in the U.S. currently. I don't see how it can be debated that this assertion is BY FAR the most widely utilized critique of socialized healthcare in defense of the current system. If it isn't true, then I want to know so I don't end up making such claims and can go on to better evidence. This is why it is important. 

 

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It's not just wait times, there's hidden "waiting" you could say.

Like, there are rules and regs that certain procedures can't be done until you've done x, y, and z. And that only the absolutely neediest can have X done.

So, ultimately it's gov making decisions for doctors and patients, and actually removing control from patients by disallowing what doctors can offer to patients and when.

So, often the patients won't even realize they're receiving substandard care because the doctors are responding to incentives and force applied to them by the gov, thus hiding the coercion from the patient.

In terms of market distortions, it's exactly that, and directly impacts care.

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