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July 13, 2007

And in France and Germany and Japan and Sweden and Australia, You Don't

Seriously, what's Megan McArdle's point here? When you've abandoned the argument that waiting times are unknown to America and retreated back to the idea that two of the dozens of national health care models we could choose from restrict patient autonomy, your ground is getting shakier and shakier. And, for that matter, sort of untrue.

"The difference," writes Megan, "is in a free market system you can go see a different doctor. In Canada or Britain, you just have to wait it out." It's nice that we've now made Germany and Japan and France into free market systems. They're horrified, I'm sure.

But that's the way these conversations always go, isn't it? Folks act as if the only two other countries in existence are the UK and Canada. It'd be like if I worked at Ford, and every time someone suggested that I make a better economy car, I pointed at some failed GM creation. Since when do policy discussions proceed by cherrypicking bad examples, rather than examining better models?

Wait, don't answer that.

July 13, 2007 | Permalink

Comments

I might be wrong, but I thought in Canada or Britain you could go see ANY doctor you want, anywhere in the country, at any time? If you need to wait 2 months for a procedure in London, drive up to Manchester if a doc is available.

Posted by: Tom | Jul 13, 2007 10:02:16 AM

"The difference," writes Megan, "is in a free market system you can go see a different doctor. In Canada or Britain, you just have to wait it out."

I knew that having only one doctor for the whole country would end up being a bad idea.

Posted by: Stephen | Jul 13, 2007 10:04:56 AM

My question, what kind of health insurance do these people have? I have UnitedHealth care and if I want them to pay for my visit, I have to go to one of the doctors in network. Before that I had Cigna and the same thing applied. And when you don't live in a big metropolitan area that doesn't leave you with a lot of choices.

Posted by: Sharron | Jul 13, 2007 10:07:10 AM

Tom, you are right and I suspect Megan is simply repeating the tired old myth of "In Canada, a bureaucrat assigns you a doctor and you have no choice in the matter".

Posted by: Paul Morphy | Jul 13, 2007 10:07:14 AM

Sharon,

I'm Canadian and there is a principle of "portability" in our Canada Health Act. This means that if you are an Ontarian, not only can you be treated by any medical institution in Ontario, but you can also be treated by any medical institution in Canada without having to pay up front. This is despite the fact that healthcare is a provincial jurisdiction in Canada, thus managed by each province (which means we don't have one Canadian system, but 13, one for each province and territory... The Canada Health Act brought forth some basic standardization)

And no, we don't need to ask for permission to any bureaucrat before going... :)

Posted by: Paul Morphy | Jul 13, 2007 10:15:38 AM

Ezra that drives me nuts too. I was reading an article on Yahoo from Powerline tool Paul Mirengoff and he approvingly cited an article about bad socialized medicine from the AEI. The article didn't even have the following words: "France", "Belgium", "Australia", "Japan", "Denmark", etc. It's like those countries didn't exist.

This is their tactic. We should get used to it.

Posted by: Joshua | Jul 13, 2007 10:16:45 AM

In America, you go see doctor. In Soviet Union, doctor sees you!

I'm still working the kinks out of that one. Forgive me, comrades.

Posted by: Yakov Smirnof | Jul 13, 2007 10:26:04 AM

Paul,
I was talking about our care in the US. Everyone keeps claiming that we Americans have complete choice but I don't think that's true. If we want our costs to be paid, we have to go to the doctors that are in network.

Posted by: Sharron | Jul 13, 2007 10:28:25 AM

> Everyone keeps claiming that we Americans
> have complete choice but I don't think
> that's true.

People who are paid $500,000/year on top of top-flight medical plans, and who collect $20,000/pop for "speeches" and other appearances - such as, I dunno, leading Radical Right pundits - have all the choice in the world. There are high-end practices and hospitals that cater to the rich and where there isn't going to be more than a few minutes waiting time. Or they can have their secretary call around to other cash-only doctors and practices until they find an opening then have the chauffeur drive them over.

The rest of us, not so much.

Cranky

Posted by: Cranky Observer | Jul 13, 2007 10:34:18 AM

Sharron, I realize that and wanted to contrast with the Canadian experience. From what I know of the U.S. system, most HMO are in-network and you pay a very large premium to have out-of-network care covered as well. But Americans would know better than me. :)

Posted by: Paul Morphy | Jul 13, 2007 10:35:03 AM

Ezra

we need to compile a "frequent myths" about universal health care into one centralized place. The archives here are a good start but everything is all over the place. If we organized it better it would help us have a quick reference to BS like this. Also it would make it easier to dispel these myths to other people who are simply uninformed.

Posted by: phil | Jul 13, 2007 10:39:41 AM

The point of these tactics is just to muddy up the water. Most Americans don't have any experience with foreign health services, and have no way of judging the validity of these claims.

Thus far the right haven't able to take any actual shots directly at the Edwards plan, for example, which I think gives lie to the conventional wisdom among some (ie Kevin Drum and Matt Yglesias) that to have plan is to invite attacks. The conservatives are even happier to take potshots at straw arguments than they are at any real plan. Telling people exactly what you are for may be the best innoculation to these kinds of foreign health service boogeyman stories.

Posted by: AJ | Jul 13, 2007 10:48:25 AM

As usual, two right-wing arguments completely contradict one another. They are:

1) US doctors are already worked to capacity, such that if we increase the number of people covered, we necessarily increase everyone's waiting time; and

2) If you don't want to wait in the US, you can just call another doctor!

In reality, either there's some slack in the system or there isn't.

Posted by: Steve | Jul 13, 2007 10:50:34 AM

"The difference," writes Megan, "is in a free market system you can go see a different doctor. In Canada or Britain, you just have to wait it out."

Just as a personal Canadian experience, about eighteen months ago I had a medical issue that required me to see a urologist, then in turn an andrologist (a medical specialty I didn't even know existed until I needed to see one, which is comforting in retrospect but not so much at the time).

My GP - who was my GP by choice and I could have switched to another GP at any point, considering there are about twenty family practices within biking distance of my home currently accepting new patients - referred me to the urologist he knew best, but also offered me a second option if it proved necessary. (Which it didn't, as his choice turned out to be a great doctor.) The urologist in turn referred me to the andrologist, and I admit there I didn't get a choice, but then again there aren't a whole lot of andrologists period.

Posted by: mightygodking | Jul 13, 2007 10:52:21 AM

I've been covered under an HMO plan that required me to select a primary physician. I needed the HMO's approval to select a different primary.

Plus, I wasn't allowed to see a specialist without seeing your primary first. So tell me, where's the so called freedom in the free market system?

Posted by: FS | Jul 13, 2007 10:53:38 AM

FS, in all honesty, in Canada too we usually needs to see a primary who then refers us to a specialist, but it rather makes sense. There are more general practitioners than dermatologists, and the rash you are experiencing might not need the attention of a specialist. A GP is a decent gate keeper.

This said, I don't need to ask anyone's approval to switch GPs.

Posted by: Paul Morphy | Jul 13, 2007 11:06:56 AM

You often must wait to see a doctor in the US. I have an appt that is 4 months out. Can I go see another doctor, no since my insurance requires that I stay in plan. This is for a chronic foot problem. I may need another surgery and that will likely be scheduled for 4-6 months after we make the decision.

I am getting a second opinion on this from a specialist in LA. This is on my own dime. There are 5 people in the US I tried to see totally on my dime. The LA doctor was one of two that would take me at all, the other not for 6 months.

This notion of wait times not being part of the US system is plain wrong.

Posted by: George | Jul 13, 2007 11:19:56 AM

Just got back from taking my kid to the dermatologist. She left our insurance plan in the middle of his treatment. Now insurance pays zip, we have to fork over payment at each visit, credit card payment only.

Next myth please wingers. Keep 'em coming.

Posted by: Klein's Tiny Left Nut | Jul 13, 2007 11:26:49 AM

I a problem with the health care debate in the US is that many people don't actually see doctors. They have insurance but haven't experienced actually used the health care system. They just assume that its easy and they could get an appointment whenever they wanted.

Posted by: crack | Jul 13, 2007 11:33:52 AM

Ezra

it might also be a cool idea to compile a source of ancedtoal experiences with the health care system in the US and in other countries

Posted by: phil | Jul 13, 2007 11:39:35 AM

Crack, the same can definitely be said in Canada by those who whine about waiting times and belittle our system. More often than not, they never had to deal with a doctor or if they did, are infuriated because they can't access him within two hours. We do have a supply problem with family physicians, but it's largely due with a volontary public policy decision in the early 90's when most public policy thinkers thought we were going to be experiencing significant and costly over supply.

The silver lining of this problem is actually that it channels innovation. I wrote a post to Megan about two of these innovations, and a third consists in promoting teamwork, where doctors are matched with nurses and where the latter have a more active role with the patient roster. This contributes significantly to preventative medicine, especially in regard to chronic illnesses like diabetes and asthma and reduces costs to the system.

Posted by: Paul Morphy | Jul 13, 2007 11:51:11 AM

I suspect Canada and the UK come up a lot for the simple reason that their media is in English.

Posted by: SamChevre | Jul 13, 2007 11:53:12 AM

I think it's time to look from the opposite side: what foreigners presume about the American healthcare experience, i.e. if you're poor, you're screwed; if you break your ankle, you'll be billed $20,000, etc. And see whether they are a closer fit to actual experience than McArdle's increasingly desperate cherrypicking.

I'm also intrigued by the fact that of all the medical dramas on TV, the only one currently showing that's paid decent attention to the question of costs and insurance is... 'Scrubs'. (For instance, there's an episode where the doctors treat uninsured patients by sticking the costs on the bill of someone in the morgue.)

I suspect Canada and the UK come up a lot for the simple reason that their media is in English.

And Australia, New Zealand?

Posted by: pseudonymous in nc | Jul 13, 2007 12:47:01 PM

When you've abandoned the argument that waiting times are unknown to America and retreated back

Yes, that's right Ezra. She "retreated" from a position she never took in the first place. No one is saying that waits are "unknown" in America. The point is that they are much, much worse in other countries, specifically Canada and Britain.

Posted by: JasonR | Jul 13, 2007 1:19:03 PM

As usual, two right-wing arguments completely contradict one another.

Seriously. Do conservatives have a problem with short term memory that they can't see the inherent contradictions in their arguments, or do they just figure everyone else does? See also:
1) We're bringing peace and freedom to the Iraqi people vs. We're turning their country into a war zone so that we don't have to fight them over here; and
2) The surge is WORKING! vs. How can you evaluate the surge when we haven't even got everyone over there yet?!

Posted by: Seitz | Jul 13, 2007 1:28:05 PM

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