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July 03, 2007

Waiting Times

Richard Eskow says all that needs to be said:

Waiting times in the countries [Cato types] cite are sometimes acceptable and sometimes excessive. Waiting lists can be a form of rationing, but it’s far more humane than denial of treatment through systematic exclusion from most of the health system (which is what lack of coverage means). And while the authors observe that some people on waiting lists are in chronic pain, they fail to note that few if any universal coverage advocates believe that is anything other than a flaw that needs to be corrected.[...]

And let’s not forget that a study by the National Academies’ Institute of Medicine (warning: pdf) estimates that at least 18,000 people die each year from inadequate health coverage. That’s the the equivalent of thirty World Trade Center bombings in the years since 9/11.

It's fascinating how much more concerned conservative types are with a Canadian who had to wait 3 months for a hip replacement than with the 18,000 Americans who die each year because they lack access to quality medical care.

July 3, 2007 | Permalink

Comments

"while the authors observe that some people on waiting lists are in chronic pain, they fail to note that few if any universal coverage advocates believe that is anything other than a flaw that needs to be corrected."

Call me when it's corrected.

Posted by: ostap | Jul 3, 2007 4:36:41 PM

Another thing that should be pointed out is that the idea that there are no waiting periods in the U.S. is horseshit. I had to wait two years for a medically necessary procedure. My insurance denied me and the fuckers didn't finally approve the surgery until I hired a lawyer and filed a lawsuit.

Posted by: Kathy G. | Jul 3, 2007 4:37:01 PM

It's fascinating how much more concerned conservative types are with a Canadian who had to wait 3 months for a hip replacement than with the 18,000 Americans who die each year because they lack access to quality medical care.

It's fascinating how much more concerned liberal types are with the 18,000 Americans who die each year from a lack of health insurance than with the 435,000 who die from tobacco, the 400,000 who die from bad diet and physical inactivity, the 85,000 who die from alcohol consumption, the 17,000 who die from illicit use of drugs, and the hundreds of thousands of others who die from other causes.

When I see liberal types devote a proportional amount of attention to drug use, smoking, poor diet, etc., as they devote to complaining about the health care system, that's when I'll believe their concerns about people dying are sincere.

Posted by: JasonR | Jul 3, 2007 4:41:05 PM

Through a former HMO of mine (one generally considered quite good) I had to wait about a month to get an MRI to rule out a brain tumor. With my current dental insurance, I have to schedule routine exams and cleanings 3 or more months in advance. Maybe the wait times are longer in Canada or Britain--I don't know. But the comparable wait time in the US isn't 0.

Posted by: Elm | Jul 3, 2007 4:45:17 PM

Uh, Jason, are you really prepared to argue that liberals haven't spent the last few decades making war on Big Tobacco? You know about the smoking bans in place in most major cities? The lawsuits? The cigarette taxes?

This may be the single least supportable position I've ever heard.

Posted by: Ezra | Jul 3, 2007 4:48:47 PM

Waiting lists can be a form of rationing, but it’s far more humane than denial of treatment through systematic exclusion from most of the health system (which is what lack of coverage means).

No, that's not what "lack of coverage" means. Many people "lack coverage" either because they choose not to enroll in government health programs for which they are eligible (e.g., Medicaid), or because they choose not to purchase "coverage" even though they can afford it, or for other reasons that have nothing to do with "systematic exclusion." Furthermore, involunary "lack of coverage" is typically a temporary condition with a median period of five or six months.

And the claim that "waiting lists ...are far more humane" needs to be supported with evidence of the effect of waiting lists and insurance coverage on actual access to health care services. Simply asserting that waiting lists are more humane without any supporting evidence is worthless.

Posted by: JasonR | Jul 3, 2007 4:52:20 PM

Yes, the argument that "waiting lists" are different from "scheduling lists" is absurd. Many, many procedures--my mamogram? my colonoscopy? dental appointments? check-ups? routinely have "scheduling delays" that are quite striking. If I have to reschedule my annual dental visit I must wait six months to get in to see my dentist. Is that not a "delay in treatment?" If I need to change the date of my annual mammogram I am quite likely not to get seen for four months. And yet those don't count as "delays" because its not transparently clear that eveyrone in front of me is "on the same list." Because there is no "list" as such. But the delay remains the same.

aimai

And JasonR. No one died and made you arbiter of what is and is not "supporting evidence" or, indeed, evidence or argument of any kind. You are simply a very excitable, agressive, and thoughtless person with a lot of time on your hands. I'd advise you to go out and find something else to do with all that time because you are merely serving as a rather pathetic annoyance here. Of course, that might be your goal. In which case, have at it.

aimai

Posted by: aimai | Jul 3, 2007 5:00:29 PM

Uh, Jason, are you really prepared to argue that liberals haven't spent the last few decades making war on Big Tobacco?

No, I'm arguing that given the fact that tobacco kills 24 times as many Americans as the lack of health insurance, the amount of attention liberals devote to "universal health care" is out of all proportion to any benefit it is likely to produce in terms of reduced mortality. Even illicit drug use kills almost as many people as the absence of health insurance, yet liberals pay virtually no attention to that problem, just ritualized denunciations of the "War on Drugs."

You know about the smoking bans in place in most major cities? The lawsuits? The cigarette taxes?

What about them? Too little, too late. Tobacco still kills 24 times as many people as the absence of health insurance. Where are the demands from liberals for huge new government initiatives to combat tobacco use?

Posted by: JasonR | Jul 3, 2007 5:01:33 PM

People in the US still wait for different things even if they can pay, even if they aren't trying to see one particular doctor. There are a certain number of situations that are going to occur in any healthcare system just because human beings are fallible. What's frustrating is that when a tragedy occurs in a country that has socialized healthcare it's automatically counted as endemic to that system, the natural outgrowth of socializing healthcare. Here in the US, it's just a tragedy.

But the reality is exactly opposite. Countries with socialized healthcare have as their stated goal the provision of all needed care to every citizen - and usually every visitor as well - within their borders. They might not be good at it, or may make decisions which result in the lack of a particular technology or procedure, or which require people to wait or even forego certain treatments and procedures. But the system is designed, as well as they can do it, to provide healthcare to everyone.

In the US, however, that 18,000 people die every year because they lack access to healthcare means that our system is functioning exactly the way it's supposed to. People who don't have insurance or the ability to self-pay at 4 times the rate insurance companies pay don't deserve health care. They're supposed to die, because keeping them alive means the rest of us money lose money we shouldn't have to spend.

What I'd like to do, however, is challenge the readers of this blog to take a look at the rate health insurance and health care are increasing in cost, and compare that to their salaries. Is your salary increasing each year at the same rate? If so, you're already behind, because everything else gets more expensive too. Or if your salary is not increasing at a higher rate - with no end in sight - then you face the very real possibility of reaching a point in your life where you cannot afford the care you need.

Don't worry, though, I'm sure that's years away, so you'll run out of money about the time your medical costs really go up. When that happens, I hope you have the strength of character to die quietly and with dignity, the way you should.

'Cause this country ain't got room for people who can't pay their own way.

Posted by: Stephen | Jul 3, 2007 5:03:40 PM

I can only speak from personal experience. When I had to have an MRI done to assist my doctor in diagostics, I had to wait 6 weeks for the next available non emergency MRI. I have health insurance. Waiting is definitely a part of the American system from my experience. I also had to wait to find a specialist by the way.

Posted by: akaison | Jul 3, 2007 5:03:44 PM

the amount of attention liberals devote to "universal health care" is out of all proportion to any benefit it is likely to produce in terms of reduced mortality.

Right. You know, the problem is with the one who perceives things to be this way, not with the way it is.

It's fun to be liberal. We always get blamed whenever a city bans smoking, and now we're getting accused of not caring enough about tobacco.

And, JasonR, your characterization of the way liberals approach the War on Drugs is completely out of touch with reality. I don't know if you read my recent post on the subject, but what you say couldn't be further from the truth.

Posted by: Stephen | Jul 3, 2007 5:07:36 PM

Stephen,

Patient A dies from heart disease in Canada while he's on the waiting list for bypass surgery (or perhaps on the waiting list just to see a cardiologist for evaluation). Patient B dies from heart disease in the United States while he's uninsured.

Exactly how is the waiting list a "far more humane" form of rationing?

Posted by: JasonR | Jul 3, 2007 5:16:31 PM

Patient B dies from heart disease in the United States while he's uninsured.

Actually, you ding dong, Patient B in America is likely insured but isn't given treatment because her HMO determines that it's experimental, unnecessary, or the HMO withdraws its coverage because of a preexisting condition like, say, a yeast infection.

Ezra, you already know this, but I think Moore made the right decision by focusing not on the uninsured but on the insured and how they're getting screwed. So long as health care is run for profit, almost all of us lose.

And Jason: stop trying to blow smoke up our ass. To which politicians do tobacco companies give most of their money? Which President (hint: the current one) radically reduced the among big tobacco had to pay out when it lost a big lawsuit?

Posted by: Karl Steel | Jul 3, 2007 5:27:59 PM

No, I'm arguing that given the fact that tobacco kills 24 times as many Americans as the lack of health insurance, the amount of attention liberals devote to "universal health care" is out of all proportion to any benefit it is likely to produce in terms of reduced mortality.

I can choose not to smoke. I can't choose not to get hit by a car.

PS. Perhaps if we had better health care less people would die of Tobacco, Alcohol, drugs,etc.

Posted by: Phil | Jul 3, 2007 5:29:35 PM

No, I'm arguing that given the fact that tobacco kills 24 times as many Americans as the lack of health insurance, the amount of attention liberals devote to "universal health care" is out of all proportion to any benefit it is likely to produce in terms of reduced mortality.

Reasons that it doesn't necessarily follow that liberals (or anyone else) should focus more on promoting health than on promoting universal health care have already been pointed out to you in another thread, Jason. One is that mortality isn't the only relevant issue, as you know. There are various other reasons, including the difficulty and costs of achieving different goals and the current political situation, that it makes sense to focus on universal health care more than stopping smoking, for example. Unless, possibly, you have a tobacco program you think would be far better than what's currently being done that you think is realistic.

Posted by: Sanpete | Jul 3, 2007 5:39:20 PM

I can choose not to smoke. I can't choose not to get hit by a car.

You can't choose not to be the child or parent of a smoker. You can't choose not to pay the taxes that fund health care for poor and elderly smokers.

If our social responsibility to prevent premature death is reduced to the extent that the death results from chosen behavior, that implies a reduced responsibility not only to provide health insurance for those who lack it by choice, but a reduced responsibility to fund health insurance for choice-related illness in general.

Posted by: JasonR | Jul 3, 2007 5:41:05 PM

Jason, that last point is utterly incoherent. Try writing it over again in shorter, declarative sentences.

aimai

Posted by: aimai | Jul 3, 2007 5:46:19 PM

The reason mortality rates were brought up was an apples to apples comparison. When looking at the harms caused by wait lists and the like in countries with national health care, we have to look at the price we pay for our own system, including the 18,000 deaths each year from lack of coverage.

But no one is saying that the 18,000 annual deaths is the only reason why we care about national health care, or even the primary reason. Sure, if 18,000 deaths were the ONLY harm caused by our current health care system, then you could argue that it doesn't justify a massive legislative campaign. But of course, that's not even close to being the case.

Posted by: Steve | Jul 3, 2007 5:47:38 PM

sanpete,

Reasons that it doesn't necessarily follow that liberals (or anyone else) should focus more on promoting health than on promoting universal health care have already been pointed out to you in another thread, Jason. One is that mortality isn't the only relevant issue, as you know.

Ezra's claim was about mortality specifically, so this observation is completely irrelevant.

There are various other reasons, including the difficulty and costs of achieving different goals and the current political situation, that it makes sense to focus on universal health care more than stopping smoking, for example.

What difficulty and costs? What political situation? Show me the cost-benefit analysis by which you have concluded that a dollar spent on expanding health insurance will do more to improve health or reduce mortality than a dollar spent on cutting tobacco use, or cutting physical inactivity, or cutting consumption of unhealthy foods, or cutting alcohol consumption, or cutting any of the other behaviors that cause far more deaths than the absence of health insurance. Of course, you have no such analysis. Which is why you have no point.

Posted by: JasonR | Jul 3, 2007 5:50:13 PM

Exactly how is the waiting list a "far more humane" form of rationing?

It's uncomfortable to think about, but in your fantasy scenario the person in Canada is going to be far more comfortable than the person in the USA.

Here's the central fact: No healthcare system is perfect. The question before us is whether we can do better. That something bad happens in another country shouldn't disqualify that country's approach entirely; if bad things happen less often in that country than in this one, then we should take a good look at how they do things.

And then we should see how we can improve on their system.

Posted by: Stephen | Jul 3, 2007 5:51:28 PM

But no one is saying that the 18,000 annual deaths is the only reason why we care about national health care, or even the primary reason. Sure, if 18,000 deaths were the ONLY harm caused by our current health care system, then you could argue that it doesn't justify a massive legislative campaign. But of course, that's not even close to being the case.

So what are the other reasons? Let's examine them.

Posted by: JasonR | Jul 3, 2007 5:52:35 PM

Show me the cost-benefit analysis by which you have concluded that a dollar spent on expanding health insurance will do more to improve health or reduce mortality than a dollar spent on cutting tobacco use, or cutting physical inactivity, or cutting consumption of unhealthy foods, or cutting alcohol consumption, or cutting any of the other behaviors that cause far more deaths than the absence of health insurance.

No, you show us. You're the one making the claim that telling people to be healthy will make them so.

Posted by: Stephen | Jul 3, 2007 5:52:59 PM

No, I'm arguing that given the fact that tobacco kills 24 times as many Americans as the lack of health insurance, the amount of attention liberals devote to "universal health care" is out of all proportion to any benefit it is likely to produce in terms of reduced mortality.

Wow. JasonR is really trying hard with his 'look over there!' act. Nice attempt to hijack the thread, though.

Another thing that should be pointed out is that the idea that there are no waiting periods in the U.S. is horseshit.

Oh yeah. Let's just say that I've never known an NHS practice stipulate a two month wait to get a first appointment with a general practitioner. But heh, there are clinics in the US that will see you this afternoon if you pay all the cost up front.

Furthermore, involunary "lack of coverage" is typically a temporary condition with a median period of five or six months.

Gosh, it's so useful that we can schedule our medical needs, isn't it? For example: my wife's sister had to cancel one of her pre-natal scans because her husband changed jobs, his new insurance didn't kick in for a few months, and the state wouldn't provide.

So when the median period of five or six months falls, say, during a pregnancy, people are presumably supposed to find one of the supposedly abundant cheap or free clinics that JasonR continues to pretend exist. Or suck it up, which is really what he's saying.

You know what's good about universal coverage? It's that you don't have to play amateur doctor and make decisions on whether you need to see a doctor and risk having your record marked with something that's often more costly than a criminal offense. You go and see a doctor. And doctors, surprisingly enough, are fairly good at telling people to address potential long-term health threats like smoking and obesity.

Posted by: pseudonymous in nc | Jul 3, 2007 5:54:48 PM

Warning: Conservative health-care propaganda ahead.

http://www.conservative.ca/EN/2692/41643

http://www.pm.gc.ca/eng/media.asp?category=1&id=1611

Posted by: mijnheer | Jul 3, 2007 5:59:35 PM

Stephen,

No, you show us. You're the one making the claim that telling people to be healthy will make them so.

But you're the one making the claim that the lack of health insurance is a bigger problem and deserves more attention and resources than smoking, poor diet, alcohol consumption, etc. Even though the latter cause far, far, far more deaths. So it's up to you to show why all the attention on health insurance is justified.

For example, if you're claiming that we've already done just about as much as we can do to get people to quit smoking and drinking, and that any further investment of resources would produce little or no benefit in those areas, then you need to substantiate that assertion with evidence. Remember, tobacco alone kills 24 times as many people as a lack of health insurance, so even just a very small reduction in the rate of smoking would save as many lives as "universal health care."

Posted by: JasonR | Jul 3, 2007 6:10:13 PM

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