Some Sources

1
Some Sources

• The Healthcare Mess Julius B., Richmond,
  M.D., Rashi Fein, Ph.D., 2005
• Healthy, Wealthy, and Wise Five Steps to a
  Better Health Care System, Kogan, Hubbard,
  Kessler, 2005
• Can We Say No? The Challenge of Rationing
  Healthcare, Henry J. Aaron
• Business of Health,by Robert Ohsfeldt,John E.
  Schneider.
• Jesse Larner

2
Criticisms of SICKO Note criticism are in
black and responses to criticisms are in red

• Sicko doesnt say who will pay and falsely
  claims that British, French, Canadian healthcare
  is free

• Moore does in fact mention that the French are
  drowning in taxes and that single-payer
  healthcare systems are paid for by taxes.
• BUT Moore doesnt explain what percentage of
  taxes are used to pay for healthcare

3
Income Tax rates by Country based on Organisation
for Economic Co-operation and Development, 2005
data (includes employer payroll tax
contributions that some countries impose for
programs like social security and healthcare.
4
Criticisms of SICKOCheeseburger

• The U.S. cannot be compared to other
  industrialized countries
• We Eat More Cheeseburgers argument our
  unhealthy lifestyles offset our superior care
• Source Ezra Klein of The American Prospect

• the United States does not stand out in the
  quantity of care, as measured by such indicators
  as the number of physicians, nurses, and hospital
  beds per capita.
• Source Paul Krugman, The Healthcare Crisis NY
  Review of Books, 2006
• Nor does the US stand out in terms of the quality
  of care a recent study published in Health
  Affairs that compared quality of care across
  advanced countries found no US advantage. On the
  contrary, "the United States often stands out for
  inefficient care and errors and is an outlier on
  access/cost ba
• Source Gerard F. Anderson, Peter S. Hussey,
  Bianca K. Frogner, and Hugh R. Waters, "Health
  Spending in the United States and the Rest of the
  Industrialized World," Health Affairs, Vol. 24,
  No. 4 (July/August 2005),

5
(No Transcript)
6
Criticisms

• Sicko misrepresents the Canadian Medicare system
• Canadians endure long waits, 4.5 months for
  appointments
• Canadians endure waits of 4 to 12 hours for basic
  care
• Source California Association of Health
  Plans/Op-ed
• These long waits result in needless deaths (ie
  film regarding brain cancer patient)
• Increasing numbers of Canadian patients and MDs
  are now coming to the U.S. for treatment
  frustration
• My friend/relative (fill in here) lives in Canada
  and hates their system
• http//www.freemarketcure.com/brainsurgery.php

• Only 3 of Canadians suffer delays
• Source Gerald Anderson, Johns
  Hopkins Health study
• Longer lines/waits are, overall, a justified
  cost
• Long lines are evidence of Canadas moral
  commitment to serving all
• 24 of Americans simply avoid healthcare due to
  (vs. 5 in Canada and 3 in the U.K.)
• According to a Gallup poll in the Toronto Sun,
  only 2 of Canadians stated a preference for U.S.
  style healthcare

7
Criticisms of SICKO

• OMISSION - Europe is starting to move away from
  government healthcare
• U.K. is now privatizing surgeries, etc.
• Sweden will outsource 80 of its primary care and
  40 of its total healthcare dollars
• Germany has a universal but private insurance
  system

8
Criticisms of SICKO

• 12.5 in the U.K. wait over a year for surgery
• Wait times for care are longer elsewhere than in
  the U.S.

• Ranking for non-elective MD appoint wait-times (
  are for same day appts)
• 1. New Zealand
• 2. Britain 71
• 3. Germany 69
• 4. Australia 66
• 5. U.S. 47
• 6. Canada 36

9
Criticisms of SICKO

• OMISSION - Our drugs and technology are the best
  in the world due to market-driven medical
  innovation made possible by the Orphan Drug Act
  of 1983. This act uses tax incentives and 7 years
  of market exclusivity to incentivize drug
  production
• We in the U.S. benefit from new drugs we get
  first launches of drugs which cost approx. 1
  billion per drug.
• Source Manhattan Institute/Washington Post

10
Criticisms Moores worldview is anti-American,
socialist and dangerous to the U.S.

• Tony Benn is an old-school socialist
• Moore wants French freebies on the government
  dime
• Moore prefers class-conflict to American
  individualism and personal responsibility
• If se have socialized care, our society will lose
  it dynamism
• Moore is more French than the French even the
  French are abandoning their socialist ideas with
  the election of Sarkozy
• Liberals desire government programs because
  liberals want us to be weak and dependent on the
  government
• U.S. exceptionalism we are the greatest country
  and thus have the best healthcare system and thus
  Moore, by criticizing our system is un-American
• French protests are protests by privileged
  middle class sectors of society that seek to keep
  their cushy benefits yet exclude immigrants from
  Africa, Turkey, and those from the former eastern
  bloc
• Source Rich Lowry, National Review

11

• Response The argument that SICKO shows that
  liberals are are anti-American pinkos/commies
  is a strawman (the left does not agree) it is ad
  hominem (instead of addressing the issues he
  raises, conservatives such as National Review
  magazine simply resort to red-baiting or name
  calling and questionable premises (ie the
  French do not want to give up their socialized,
  single-payer healthcare)
• In regards to the strawman fallacy, even The
  Nation a well-known leftist, U.S. magazine
  criticizes Moores ode to Marx
• "The film's final half-hour, in which Moore takes
  9/11 rescue workers to Cuba, serves only to
  reinforce the decades-old slander that equates
  social democracy with repressive socialism. It's
  a major miscalculation and nearly squanders the
  first hour and a half of the film in which Moore
  so deftly guts arguments that socialized medicine
  represents the vanguard of Marxism. Source
  Christopher Hayes, The Nation

12
Some questions

• Should we ensure whether via free market or
  socialized care provide everyone with
  healthcare?
• Basic care? Elective surgeries? Non-elective
  surgeries?
• Is rationing of care ever morally permissible?
• Are we obligated to provide healthcare to those
  who have unhealthy lifestyles?
• Are all forms of insurance the same?
• Fire insurance
• Car insurance
• Medical insurance?
• Are healthcare products analogous to cellphones,
  etc?
• X-rays vs. automobiles, cars, cellphones

13
Some terms

• Socialized medicine version 1 government pays
  but the private sector delivers
• Socialized medicine version 2 government pays
  and government delivers (V.A.)
• Single-payer government pays one private
  sector insurance companies pays
• Free-market consumer pays, health provider
  delivers
• 3rd party (84 of U.S. costs) vs. 1st party
  payment/delivery
• taxes to 3rd party government
• premiums to 3rd party insurer
• Out of pocket payment at point of delivery to
  party healthcare provider by consumer
• Criticism of 3rd party payment MDs and patients
  dont act rationally in light of actual costs

14
Brief History of Health Insurance in the U.S.

• WW II due to labor shortage (and wage caps by
  govt), employers offered health coverage to
  employees in order to attract workers (a work
  around to price controls on wages)
• Health insurance was relatively inexpensive given
  low medical costs, technology, drugs, etc.
• Health insurance is a non-taxed benefit offered
  by employers which, if taxed like wages, would
  net 150 billion in additional tax revenues.
• Health insurance now costs employers, on average,
  10,000 to insure a family of four

15
Causes for rising costs in U.S.

• Fragmentation of healthcare
• Medicare (single-payer system for seniors)
• Medicaid (single-payer for the poor)
• Healthcare delivery systems private insurers,
  for-profit hospitals, govt
• 50 of spending is by U.S. govt, 50 by private
  sector
• 1960 5.2 of GDP vs.2004 16 of GDP
• New technology, drugs, therapies are costly.
• MDs paid much more in the U.S. than elsewhere
• 30 of each private healthcare dollar spent on
  administrative fees and profit
• Rise in MD insurance premiums (

16
Malpractice Insurance?

• Malpractice jury awards increased 4 percent
  annually between 1991 and 2003 or 52 percent
  overall since 1991, but only 1.6 percent a year
  since 2000.
• The increases are roughly equivalent to the
  overall rise in healthcare cost
• Malpractice insurance premiums for internists,
  general surgeons, and obstetricians have
  skyrocketed since 2000, jumping 20 to 25 percent
  in 2002 alone. Some specialists, such as
  obstetricians, now pay almost 100,000 annually
  for their malpractice insurance.
• Source Rising doctors' premiums not due to
  lawsuit awards Study suggests insurers raise
  rates to make up for investment declines by Liz
  Kowalczyk, Globe Staff    June 1, 2005

17
Malpractice Rates?

• Malpractice insurance companies have increased
  rates to compensate for falling investment
  returns (1998-2000) due to bond losses which make
  up 80 of their portfolio
• Malpractice insurance rates vary widely
• Dade County, Florida increased 75 (to
  174,300) from 1999 to 2000 vs. 2 (10,140)
  for the same specialty in Minnesota.
• Minnesotas largest insurer increased rates for
  the same specialty by 2
• Source The Health Care Mess Julius Richmond,
  M.D., Rashi Fein, Ph.D.

18
Adverse Reaction Cycle the problem with
Employer-based Health Insurance
19
Advantages of Single-Payer

• Its ethical no adverse selection all are
  covered.
• Removes competitive penalty on small businesses.
• Single-payer is more efficient
• Medicares administrative overhead is 2 of total
  costs vs. 13 of private insurance companies.
• Medicaid - 9,600 avg/person vs. 14,800 if in
  private sector. Source Medicaid A Lower-Cost
  Approach to Serving a High-Cost Population,"
  policy brief by the Kaiser Commission on Medicaid
  and the Uninsured, March 2004.
• Taiwan switched to universal, single-payer in
  1995 with better quality yet only slightly
  increased costs.
• Stronger drug-bargaining position (Medicaid
  V.A. get Canadian rates from U.S.
  pharmaceuticals)

20
Free-market voucher approaches?

• Proposals

• Questions

• South Carolina a free-market voucher system
• Consumer-directed approach eliminate 3rd
  parties whether it be insurance companies or
  government and instead let patients barter
  directly with physicians and hospitals with
  vouchers.
• Source Healthy, Wealthy, and Wise D.
  Kessler, Hubbard

• Who decides on voucher costs?
• Who provides (and pays for) the vouchers?
• Is healthcare consumption analogous to
  appliance consumption?
• How will patients shop around and compare
  during emergency situations?
• How will information regarding healthcare quality
  be communicated?
• Will vouchers address increasing costs due to
  technology, drugs, etc?

21
Free-market tax-credit proposals

• Questions

• Proposals

• Remove tax advantage that favors health insurance
  over out of pocket by taxing some employer
  based health benefits OR cut taxes on
  out-of-pocket.
• Tax advantage health savings accounts tax free
  shelter for healthcare.

• Do the wealthy need taxbreaks of this kind?
• Will this reinforce adverse selection? those
  who are healthy will adopt savings accounts and
  opt out of company insurance plans
• Rand study we dont make wise healthcare choices
  if out-of-pocket
• This will not address expensive treatment that is
  80 of costs