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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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Esuric replied on Fri, Sep 21 2012 4:47 PM

 This from someone who can properly define neither "slave" nor pure, organic "capitalism" in a coherent, meaningful form.

Prove it. 

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I don't think its logically necessary that universal healthcare would have longer lines. If healthcare were free, I probably wouldn't go any more than I do now.

"The limits of my language mean the limits of my world." ~ Ludwig Wittgenstein
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Fool on the Hill:

I don't think its logically necessary that universal healthcare would have longer lines. If healthcare were free, I probably wouldn't go any more than I do now.

Law of supply and demand says otherwise.

If the perceived cost is zero, demand will rise concomitantly. This is why any 'free' scheme contains 'cost controls' which are a polite way of saying price controls and supply controls.

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For me, going to the doctor is a relatively unpleasant activity. Free isn't enough. You would have to pay me to go more.

If the perceived cost is zero, demand will rise concomitantly. This is why any 'free' scheme contains 'cost controls' which are a polite way of saying price controls and supply controls.

Not necessarily true. The coffee in my office is free but there's never a line, and there are no price controls. Yet the Starbucks outside always has a huge line in the morning.  

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people often ignore that the us population is bigger than that of sweden, norway, finland, the places with government healthcare.

“Since people are concerned that ‘X’ will not be provided, ‘X’ will naturally be provided by those who are concerned by its absence."
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Fool on the Hill:

For me, going to the doctor is a relatively unpleasant activity. Free isn't enough. You would have to pay me to go more.

That's fine, but it just indicates that you value personal comfort over the good called medical service. Some people are lactose intolerant enough to turn down free ice-cream as well. I'm not saying that you personally would use more medical service necessarily, but your original argument contained an implied universal statement of how all people might act should healthcare be free.

You're right that even were it free, the annoyance of it will still drive many off. But when it does in fact become free, the medical institutionas will probably seek to make it many times more annoying, out of sheer defense of being overwhelmed.

Fool on the Hill:

Anen: "If the perceived cost is zero, demand will rise concomitantly. This is why any 'free' scheme contains 'cost controls' which are a polite way of saying price controls and supply controls."

Not necessarily true. The coffee in my office is free but there's never a line, and there are no price controls. Yet the Starbucks outside always has a huge line in the morning. 

You really don't see any hole in such a statement? The coffee in your office has sufficiently limited demand and abundant supply that it's effectively like water or air. But only because its demand is limited to those allowed into your office. If you opened yourselves up to the general public for coffee, supply would no longer be sufficient and you'd certainly have lines.

The law of supply and demand would take your coffee scenario and say that demand isn't elastic as the price drops but static. Thus, free coffee in your office doesn't result in massively more coffee consumption such that the company paying for it limits supply.

However, with health-care, the costs are virtually limitless. You could spend millions on a single person. And healthcare generally can be consumed in far greater amounts than currently were it 'free.' Which is to say demand is most likely quite elastic. The result can only be lines. This is why other countries have waiting times and mandatory tracks to procedures that the US does not have. And why there's no lines for your in-house coffee.

 
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You really don't see any hole in such a statement? The coffee in your office has sufficiently limited demand and abundant supply that it's effectively like water or air. But only because its demand is limited to those allowed into your office. If you opened yourselves up to the general public for coffee, supply would no longer be sufficient and you'd certainly have lines.

The law of supply and demand would take your coffee scenario and say that demand isn't elastic as the price drops but static. Thus, free coffee in your office doesn't result in massively more coffee consumption such that the company paying for it limits supply.

However, with health-care, the costs are virtually limitless. You could spend millions on a single person. And healthcare generally can be consumed in far greater amounts than currently were it 'free.' Which is to say demand is most likely quite elastic. The result can only be lines. This is why other countries have waiting times and mandatory tracks to procedures that the US does not have. And why there's no lines for your in-house coffee.

Well, that's my point. You can't simply say that since the price goes down, demand must go up. You have to look at the particulars of the situation. It's quite possible that in the case of healthcare the lines could increase. But we can't simply dismiss any empirical evidence that lines aren't longer. The empirical evidence tells us whether there are limits to demand in each particular case. In the case of the coffee, the empirical evidence tells us that there are limits. In the case of healthcare, it sounds like it is a bit more debatable.

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I think the biggest problem is that people think our fascist healthcare system is "free market".

 

“Since people are concerned that ‘X’ will not be provided, ‘X’ will naturally be provided by those who are concerned by its absence."
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Fool on the Hill,

 

This article might interest you :
The introduction of Medicaid and Medicare in the United States during the 1960s soon led to the poor making as many physician visits per year as the non-poor, but large class differentials in health remained — even when the poor began to visit physicians at a higher rate than the non-poor (Rundall & Wheeler, 1979, p. 397). Great Britain and other countries that had expected to break the link between class and health by providing universal health care were dismayed when the disparities in health not only failed to shrink but even grew (see The Black Report by Townsend & Davidson, 1982; also Link & Phelan, 1995, p. 86; Marmot, Kogevinas, & Elston, 1987, p. 132; Susser, Watson, & Hopper, 1985, p. 237).
 
… equalizing the availability of health care does not equalize its use. Perhaps most importantly, less educated and lower income individuals seek preventive health care (as distinct from curative care) less often than do better educated or higher income persons, even when care is free (Adler, Boyce, Chesney, Folkman, & Syme, 1993; Goldenberg, Patterson, & Freese, 1992; Rundall & Wheeler, 1979; Susser et al., 1985, p. 253; Townsend & Davidson, 1982, ch. 4).
 
Second, greater use of medical care does not necessarily improve health (Marmot et al., 1987, p. 132; Valdez, Rogers, Keeler, Lohr, & Newhouse, 1985). To illustrate, when a large federally-funded RAND-conducted randomized controlled experiment tested the effects of subsidizing health care costs at different levels in six cities across the United States, participants with free care used more medical care than those with only partly subsidized care, but their health was no better after two years. Participants with free care had indiscriminately increased their use of inappropriate as well as appropriate care (Lohr et al., 1986, p. 72).
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xahrx replied on Sat, Sep 22 2012 10:37 AM

 

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.
 
No idea.  Every 'free market' think tank who has looked at it says the socialized lines are longer, every left wing think tank says they are comparable or shorter.  It seems to be an issue where depending on how you look at the info, you can get the answer you want.  And again, it's irrelevant.
 
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.
 
So because some people mistakenly argue over irrelevanies, so should I?
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This article might interest you :
That does look interesting, thanks.
 
I've also been wanting to read this book.
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xahrx replied on Sat, Sep 22 2012 1:44 PM

@Fool on the Hill

Do you know of a convenient spot that offers Illich's books in eformat for free?  I'm not sure of their copyright status and Amazon charges for them, but I've seen them charge for works not under copyright and I'm just making sure before I order.  Obviously this one seems to be free at the site you linked to but it's just listed as out of print, not public domain.

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You mean like for an ebook reader (excuse my technological ignorance)? This site has a lot of them as online html, and this site has some available for download. I'm not sure what the format is of the latter. At least some of them do appear to be in the public domain.

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The Texas Trigger:
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.

This is an error.  Praxeology tells us a free market in healthcare - and everything else - will more efficiently satisfy consumer demands than a regulated market or socialised market in healthcare.  It doesn't tell us waiting lines will necessarily be longer with socialised healthcare.  Imagine if government spent it's whole budget on healthcare - they may be able to lower waiting times practically to zero.  The question you should ask anyone claiming low waiting lines under socialised healthcare make socialised healthcare preferable is: at what cost?

The UK government spent £119bn ($192bn) - 18% of it's budget - on healthcare in 2009.  That is about £1919 ($3111) per person per year.  Out of curiosity, how does that compare to the American regulated market?  (See Jack Roberts' post describing what we get for that.)

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