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CNN headline this morning:
Trump’s shutdown win just landed Republicans with a huge political headache
...It’s the Trump ship that never sails.

The president was back at it on Monday, promising an imminent solution to America’s growing health care crisis — on which he has repeatedly failed to deliver in the past.

There is not a free market solution for healthcare
Most(all?) other countries have figured this out, along with the majority of Americans.
Alan

There is not a free market solution for healthcare
Most(all?) other countries have figured this out, along with the majority of Americans.

Some things in life don’t lend themselves to free market solutions.

Some things in life don’t lend themselves to socialist solutions.

Ideologues spend their lives trying to jam all of life into one or the other extremes, and usually end up on the rocks.

Wise rule learns to navigate between the rocks.

None of the socialist systems work particularly well.

Everyone else has figured this out except for liberals.

We kind of have somewhat of a combo system already what with Medicare, Tricare, Medicaid, and all the government subsidies (including tax deductibility of employer-paid health insurance).

The real issue is that 50% of all health care dollars are consumed by only 5% of the population per Kaiser Foundation.

50% of the population, conversely, consumes only 3% of total health care dollars. So, no savings there!

The other 45% consume about the same percentage in health care dollars.

It's safe to assume that the explosion in costs is not due to the presumably healthy young 50% of the population using only 3% of the dollars. Nor really to the people in the middle.

Nope, it's the chronically ill who consume unending amount of health care dollars. Old, sick, obese people with chronic illnesses.

Younger people (usually obese) with chronic illnesses like Diabetes II.

People on the left screaming for single payer and eliminating private health insurance entirely don't seem to understand is that health care expenditures will have to be rationed one way or another--if not by market forces, then by governmental fiat. But the rationing will happen because it has to. And the low hanging fruit is your Great Aunt Tilly. Death panels anyone?

n the left screaming for single payer and eliminating private health insurance entirely don't seem to understand is that health care expenditures will have to be rationed one way or another--if not by market forces, then by governmental fiat.

No, I think they understand that, and just don't like the market forces - as a sociopath runs that system.

Mr. Market is a manic depressive, not a sociopath.

None of the socialist systems work particularly well.

Everyone else has figured this out except for liberals.

Sorry, but non-partisan reviews show that Canada's system works better than ours does. And I like your 2008 book on innovation. Did you actually read it? Or listen to it?

Our biggest problem is the huge disruption it would take against powerful forces to do anything along the lines of single payer. And we have the problem of decent health care for rural areas, which we need to do.

Sorry, but non-partisan reviews show that Canada's system works better than ours does.

That explains why so many Canadians want to come down here for health care:

https://www.cma.ca/healthcare-for-real/how-many-ca...

Given Canada’s health care system’s struggles with doctor shortages and long waits for procedures, it’s believable. But do Canadians really go to the U.S. for medical treatment?

While it’s not known exactly how many Canadians go to the U.S. for health care, according to a poll conducted by Ipsos in March 2024, 42% of Canadians would go to the U.S. and personally pay for routine health care if needed. That’s 10% more when compared to January 2023. Of those who responded, 38% said that they would travel to the U.S. for emergency care, a number that's up 9% from the previous year.

As for the book, you shouldn’t read it. Basic concepts like supply and demand aren’t for people like you.

Some things in life don’t lend themselves to free market solutions.

Absolutely. Off the top of my head: police protection, fire protection, healthcare, prisons, and parks/recreation (e.g. national parks, state parks, forests, and the like).

Some things in life don’t lend themselves to socialist solutions.

Definitely. Manufacturing comes to mind (e.g. compare old Soviet automobiles to US, German, Japanese, etc).

The intelligent person recognizes that a hammer isn't ideal for driving a screw, or cutting a board. Ideologues only have hammers.

Sorry, but non-partisan reviews show that Canada's system works better than ours does. And I like your 2008 book on innovation.

I had a coworker from the UK (Scotland). He said that if you were rich, the US system was better. Otherwise, the UK system is better. So, for about -guesstimating- 10% of the population the US system is ideal. For the other 90%, not so much.

No system is perfect. All of them have flaws. Our flaw is that you have to be rich to afford care. Their flaw is that you may have to wait awhile to get non-urgent care, but you won't go broke getting well.

He said that if you were rich, the US system was better. Otherwise, the UK system is better. So, for about -guesstimating- 10% of the population the US system is ideal. For the other 90%, not so much.

I think if you are rich, you are NOT LIMITED by any system you are in. You can go anywhere in the world, get treatment, and pay for it. Perhaps for the upper middle class or the top 80-100% of middle class the US system fits that scenario.

I once thought one knee was going bad and I entertained the idea of getting the operation done and relaxing by the sea because it was cheaper - if I could get my plan to go along with it, they'd save money. But the pain in my knee went way, same with my hip pain. They've looked and I have plenty of cartilage in spite of walking for exercise all my life. Got surprised by HPV positive 16 cancer in my tonsils though. :)

So we need to fashion a system that works better for the not rich. As my father used to say - never worry about the cook starving to death. :)

You seem to be wrong, I wonder why?

AI Overview

While no exact, definitive percentage is available, a 2024 poll found that 42% of Canadians would go to the U.S. for routine healthcare and 38% would go for emergency care, provided they paid out-of-pocket. In contrast, the number of people ACTUALLY traveling to the US for non-emergency treatment is much smaller; a Fraser Institute study suggested it rose from about 1% to 1.5% of patients seen by Canadian doctors between 2014 and 2015, notes National Institutes of Health.

So it looks like they'd like to go, but in reality don't. This reminds me of the strategies I employed to see an Endocrinologist in So Cal. Calling 6-7 different ones, setting up appointments two months way, and then calling back looking for cancellations. It worked, got in in five days. Same thing when I needed a surgical ENT.

Weren't you the one insisting that the 11% inflation in the Arab Oil Embargo wasn't cost-push inflation, but was caused by the money supply? I must have missed the advanced course from MAGA U that explains that, or was it Prager U?

I noticed the audible version of that book is 13 hours. Thanks for pointing it out though - I'll put it on that wish list of books I never get to read, because... life.

Ooops - relaxing by the sea (in Costa Rica) because it was cheaper

Ooops - relaxing by the sea (in Costa Rica) because it was cheaper

Ha! That’s exactly what I read between the lines of your previous post.

You seem to be wrong, I wonder why?

Because reading plain English seems to be an issue for some.

So it looks like they'd like to go, but in reality don't.

It was a survey. Not everybody in Canada has the means. Here's where a lack of critical thinking skills starts to bite: Why would so many Canadians WANT to go to the US if their healthcare system was so Awesomely Awesome?

Weren't you the one insisting that the 11% inflation in the Arab Oil Embargo wasn't cost-push inflation, but was caused by the money supply?

Caused by many things. Glad you learned a new term from AI someplace, though.

Ooops - relaxing by the sea (in Costa Rica) because it was cheaper

Think you meant to post this under your other handle.
-dope, helpful.

Also, think about how many Canadians live close to the U.S. border vs. more remotely. I'll be if you just limited that survey to people who live near the U.S. border, the % who would love to be able to come to the U.S. for healthcare would be an even higher proportion.

People hold up Canada as a model, but rarely look beneath the surface:

https://www.msn.com/en-ca/health/medical/canadian-...

Issues in Canada:
-Nobody has a family doctor
-Wait times are becoming a crisis
-ERs are overcrowded
-Your records aren't necessarily transportable from province to province
-Lack of service in rural areas
-Slow adoption of new tech


How bad is the lack of a family doctor?
https://www.cbc.ca/news/politics/primary-care-cana...

The report found evidence of what it calls an "attachment crisis" — an estimated 22 per cent of Canadian adults (about 6.5 million people) do not have a family doctor or nurse practitioner they can see regularly.

The problem appears to be getting worse. In a 2019 Statistics Canada survey, 14.5 per cent of Canadians aged 12 and over reported not having regular access to primary care.

So Canada is having issues caring for its aging (and much smaller population).

Hey Dope1, it's easy to keep health care costs down if you can never get an appointment.

Hey Dope1, it's easy to keep health care costs down if you can never get an appointment.

Or if you guilt older/sicker folks into just suiciding themselves...

https://www.canada.ca/en/health-canada/services/he...

There is not a free market solution for healthcare

Sure there is. Just let the sick people die. It comes with a host of benefits: lower medical costs overall and Social Security Trust Fund lasts longer are the biggest two.

But consider that it will likely be rurals who die more often (there is already a gap, with rurals having less access to hospitals, advanced treatments, and, uh, unhealthy lifestyles) so Republicans will lose some of their base. Fox News will lose viewers. There will be more land opened up for data centers. Fewer meth labs will be operating.

I mean, the list is practically endless. Shame on Democrats for caring so much - and about people who hate them anyway!

Democrats don't care about squat.

Or at least ProGlibs don't.

I mean, they care about themselves.

Especially the boomers.

About 20% of Americans have the equivalent of universal healthcare (People over 65. Does MAGA want to make these people go on private insurance? I have not heard that they do want to cancel Medicare. Therefore, the discussion is about the extent that universal health care should be implemented. For 20% of the people - all sides seem to agree. 100% of the population, no agreement. Perhaps we could get to 25%(people over 55) of the population??

Imagine how the economy would boom with people starting companies and not having to worry about health insurance. I know, a silly left wing idea to encourage start=ups.

Aussi

About 20% of Americans have the equivalent of universal healthcare (People over 65. Does MAGA want to make these people go on private insurance? I have not heard that they do want to cancel Medicare. Therefore, the discussion is about the extent that universal health care should be implemented. For 20% of the people - all sides seem to agree. 100% of the population, no agreement. Perhaps we could get to 25%(people over 55) of the population??

Imagine how the economy would boom with people starting companies and not having to worry about health insurance. I know, a silly left wing idea to encourage start=ups.

My browser chose to crash and erase a much longer reply, so I'll summarize what I was going to say:

1. Health insurance /= health care. As a society we seem to believe we should pay nothing for health care.
2. Health care cost optimization is the problem to solve, not health insurance cost.
3. Patients should be expected to pay for small stuff out of pocket. $20 bucks for having somebody Ace wrap your sprained ankle isn't too much to ask.
4. The supply of health care needs to be dramatically increased by encouraging more front-line triaging to be done by nurse practitioners and Physician's assistants, who are more than adequately trained to diagnose rest and chicken soup for a sniffle.
5. Leave full-blown MDs and doctor's offices more free to triage, diagnose and treat more complex cases.
6. The supply model of (4) would be paired with published pricing for commonly available treatments, allowing for price equilibriums to take hold. As has been shown by a few hospitals now, advertising prices at places helps patients understanding pricing a lot better: https://oklahomahospitalpricefinder.patientrightsa...

...for starters.

At some point, people have to own their own health. This notion of 100% of health care is paid for by somebody else doesn't lead to math that works.

Does MAGA want to make these people go on private insurance?

I touched on Paul Ryan's scheme a while back. He advocated for Medicare to be nothing but "premium support", a voucher with some designated value to help, but not entirely pay for, the Proles buying insurance from private companies. Medicare Advantage was probably a half step toward that. How that scheme would go over with the crusty old phartz that are the backbone of MAGA, I don't know.

Steve

It was a survey. Not everybody in Canada has the means. Here's where a lack of critical thinking skills starts to bite: Why would so many Canadians WANT to go to the US if their healthcare system was so Awesomely Awesome?

No. You actually have to look at the questions and how they ask them. There are many reasons to visit walk in clinics in the US; I've done my fair share and paid out of pocket. Many reasons. I told you the advised method for getting an appointment with booked up specialists. I haven't been to Canada for forty years, so - do they have a lack of availability of walk in clinics? Is the main reason that lack of availability? So how do you get a round of diabetic meds, antibiotics, etc., if you find you need them, and quickly - and you can't wait til Monday? In the US it's easy - walk in clinics, open on weekends, and some actually take your insurance.

No. You actually have to look at the questions and how they ask them. There are many reasons to visit walk in clinics in the US

It is the left wing position that’s Canada’s system is superior to ours. According to your post that isn’t the case.

Is it the left wing position that Canada’s system is superior [to ours]?

I certainly can’t speak for ttge “left wing position”, but in many ways, yes, its better.

Granted, the following is an AI response to your question, reframed by asking to compare health outcomes:

Health outcomes are generally better in Canada than in the U.S., despite the U.S. spending significantly more on healthcare. Canada has higher life expectancy, lower infant and maternal mortality rates, and better health-adjusted life expectancy. However, the U.S. performs well on some specific measures, such as certain 30-day mortality rates for acute conditions, while Canada performs better in overall population health and equity.

Unmentioned are wait times, but that is addressed by outcomes- regardless of perceived wait times, Canada does a better job at keeping its population healthy, at significantly lower cost.

I’m sure you can pick around the edges, but Canada’s medical system keeps its population healthier than does the U.S, without bankrupting its citizens who need intensive intervention.

The US health system is top notch for those who have Cadillac insurance plans….. and not so great for those who can’t afford Cadillac plans.

It is the left wing position that’s Canada’s system is superior to ours. According to your post that isn’t the case.

According to my posts (plural), the contention that 30-40% would go the the US for health care, might be similar to this:

AI Overview
While it's difficult to pinpoint an exact number for those who would visit a clinic and pay out-of-pocket, a significant portion of Americans have skipped or postponed needed healthcare due to cost, with 36% of adults reporting this in the past 12 months. This includes both insured and uninsured individuals, with uninsured adults being more likely to face this barrier. Ultimately, the number would vary depending on an individual's financial situation, their insurance status, and the specific cost of the service needed.

Uninsured adults: This group is more likely to go without needed care due to cost. In 2023, three in four uninsured adults under age 65 said they had skipped or postponed needed care because of the cost. Over one in five uninsured adults reported forgoing care in the past year due to cost, compared to a much smaller percentage of insured adults (5.1% with private, 7.7% with public). END

And as Wzambon has pointed out Canada has better outcomes. So there's no need to go further.

The rich are not part of the equation.

Is it the left wing position that Canada’s system is superior [to ours]?

You can bypass the data that is skewed by entities with an agenda, and talk to people who use the Canadian system yourself. The old Fool hands remember Tim, in Halifax, who used the Canadian system, and wouldn't go near anything like the US system. Or, you could talk to a former coworker of mine, who lived across the river in Windsor. He wouldn't go near the US system either. He told me one day, how he has to keep his mouth shut at work. His podmate was fully indoctrinated about how the US system was wonderful and socialized medicine was terrible. He couldn't believe the lies she spouted about the Canadian system, but knew it was useless to try to inform her of the facts.

Steve

Or, you could talk to a former coworker of mine, who lived across the river in Windsor. He wouldn't go near the US system either. He told me one day, how he has to keep his mouth shut at work. His podmate was fully indoctrinated about how the US system was wonderful and socialized medicine was terrible. He couldn't believe the lies she spouted about the Canadian system, but knew it was useless to try to inform her of the facts.

For me, one of the most powerful “eye witness accounts” came with a discussion I had with a third year family medicine resident who trained in the University of Michigan Health Care System. She couldn’t wait to finish her residency and return to Canada.

Better for her. Better for patients, and the whole “wait time” argument was basically bogus.

“I like treating patients more than I like the endless hours of dealing with paperwork and insurance claims.”

You can bypass the data that is skewed by entities with an agenda, and talk to people who use the Canadian system yourself. The old Fool hands remember Tim, in Halifax, who used the Canadian system, and wouldn't go near anything like the US system. Or, you could talk to a former coworker of mine, who lived across the river in Windsor. He wouldn't go near the US system either. He told me one day, how he has to keep his mouth shut at work. His podmate was fully indoctrinated about how the US system was wonderful and socialized medicine was terrible. He couldn't believe the lies she spouted about the Canadian system, but knew it was useless to try to inform her of the facts.

Okay, great. Except this narrative is countered by the survey data that says 40-some percent of Canadians would use the US system if they could.

“I like treating patients more than I like the endless hours of dealing with paperwork and insurance claims.”

It's funny how different people have different experiences. Both my brother (when he was in private practice) and my wife used to take Medicare patients but stopped because they were frustrated with dealing with the endless hours of paperwork and trying to get their claims paid through Medicare. My wife started taking Medicare patients again a few years ago, and dealing with them has easily been the single most frustrating part of her practice - vastly worse than any of the private insurers that she is on panels for.

Maybe Canada's system is much gentler on providers than Medicare is. Medicare's great for patients in terms of claims and paperwork, but at least anecdotally it's not always easy for providers to navigate.

Okay, great. Except this narrative is countered by the survey data that says 40-some percent of Canadians would use the US system if they could.

For several years, I thought I might move to Costa Rica after I retired. You might remember my few posts at the Fool to that effect.

One of the reasons was certainly the cost and quality of health care. Had I taken a survey at the time, I would have checked off the reason “I would use the Costa Rican health care system if I could”.

But I never did. I’m not sure of the value of a survey that basically measures wishcasting.

Certainly something to consider, but there are definitely better ways of analysing the comparative value/effectiveness of health care systems.

it's not always easy for providers to navigate.</>

Is your wife in a practice that has staff to manage some of that paperwork load?

Add that to the cost of health care- as well as the correlative staff in the insurance billing department that processes claims.

Physicians and other care providers in the United States are only the tip of a mighty long and hefty spear, and the costs of that long and hefty spear add up, and they also include the cost of stratospheric upper management salaries- stockholders as well, and big fancy corporate headquarters

Certainly something to consider, but there are definitely better ways of analysing the comparative value/effectiveness of health care systems.

I do remember you talking about that, yes.
And similar to this thought is giving the side-eye to a straight up comparison of health outcomes, because such an analysis rides on the assumption that the inputs to the health care system - i.e. the patients that use it - are the same between the US and Canada.

They're not.

https://www.worldlifeexpectancy.com/news/united-st...

Look at how much more lung disease and coronary heart disease Americans have. That's not because most of America works down in a coal mine or inhales asbestos regularly. Canadians live healthier lifestyles that we do - they get outside more, get more exercise and don't eat as much processed junk as we do.

Is your wife in a practice that has staff to manage some of that paperwork load?

No. She is a solo.

Add that to the cost of health care- as well as the correlative staff in the insurance billing department that processes claims.

Physicians and other care providers in the United States are only the tip of a mighty long and hefty spear, and the costs of that long and hefty spear add up, and they also include the cost of stratospheric upper management salaries- stockholders as well, and big fancy corporate headquarters

This is with Medicare, not private insurance. It was (and now is again) a constant struggle with them to get the claims paid. The private insurers are much easier to deal with.

“I like treating patients more than I like the endless hours of dealing with paperwork and insurance claims.”

The guy who used to be on the Fool board talked about how the French system wrung out the administrative overhead. I remember him saying that, when he went to the doc, the receptionist swiped his national health card, typed in a few codes for what the doc did, and the payment was in the doc's bank account, before he was out the door.

He also talked about how the French system made sure facilities were not laying idle. They would monitor wait times for a particular piece of equipment, for instance, an MRI, and wait until the wait time hit a certain level, before spending the money on another MRI for the district.

I wonder how much money is lost in the US system, to administrative overhead, and facilities sitting idle because hospitals are competing for patients so want to have all the facilities in house, even though another hospital a few miles down the road has the same sort of facilities.


iirc, Tim's gall bladder was yanked at something like 2 or 3am.

Steve

Okay, great. Except this narrative is countered by the survey data that says 40-some percent of Canadians would use the US system if they could.

Do I need to post, again, the "Yes Minister" bit that demonstrates how you can get the result you want from a survey, by manipulating the questions?

Or, you could read "How To Lie With Statistics".

Steve

hospitals are competing for patients so want to have all the facilities in house,

Here in A2 area, we have two competing, ginormous health care systems ~ UMich Health Care System (University of Michigan Hospital System with satellite clinics and regional hospitals), and Trinity Health systems {St. Joseph Hospital with satellite clinics).

And of course, just east, and overlapping both Trinity and UMich- Henry Ford System, and in Detroit- Wayne State.

Meanwhile, up north, my wife had a health care emergency at our cabin two years ago and the ambulance ride to the nearest emergency room took an hour.

Do I need to post, again, the "Yes Minister" bit that demonstrates how you can get the result you want from a survey, by manipulating the questions?

Or, you could read "How To Lie With Statistics

Do I need to explain what an anecdotal fallacy is?

Henry Ford System, and in Detroit- Wayne State.

And the former Botsford, in Farmington Hills, and Beaumont, in a number of locations, which have been folded into "Corewell".

Corwell has a building about two miles from casa del Steve, with an ER, lab, and a clinic where my GP works, at the corner of Warren, and Canton Center roads. Corwell also has an "urgent care" clinic at Canton Center and Hanford Rd, maybe a mile from the first place. Three miles down Canton Center, is a big Trinity facility: urgent care, allergy, physical therapy, lab, and more. Then there are a flock of "urgent care" places all over. Asking Google Maps for "urgent care, Canton" brought up 7 other places, besides the two Corwell and one Trinity, in the Plymouth/Canton area. Two of them, Henry Ford, and "Doctor's Urgent Care" are on Ford Rd, only half a mile apart. How much time are those facilities, doctors and nurses, idle? vs a rational approach where they were concentrated in a couple of places, that would still be less than 5 miles apart?

Steve

Do I need to explain what an anecdotal fallacy is?

I read that book too.

Flaws and Fallacies in Statistical Thinking
by Stephen K. Campbell

https://www.amazon.com/Fallacies-Statistical-Think...

Steve

Okay, great. Except this narrative is countered by the survey data that says 40-some percent of Canadians would use the US system if they could.

No, it doesn't say that, here's what it says:

I would go to the United States and personally pay for
more timely routine health care if I felt I needed it

That's a huge difference, and precisely my point - I go places and pay out of pocket when I @#!%$# need it. (Emphasis mine) Tell me you haven't gone to a clinic and paid out of your pocket Dope. Or used your insurance if they took it.

So you altered what they said - which is typical.

https://www.ipsos.com/sites/default/files/ct/news/...

OK, focus on one, coronary heart disease, the Canadians have less. Now the Canadians should have more, because a good chunk of the year is cold and snowbound, less movement, so what counteracts the environment

"lower smoking rates, greater emphasis on preventive care and universal healthcare access, and potentially different lifestyle and socioeconomic patterns."

So if you lived in a ghetto, those ghettos would likely have better access to preventative care and universal healthcare. They also might pay attention to preventative care and universal healthcare whereas USians are more likely to be suspicious, certain that the government or alien overlords are trying to change there DNA and enslave them. Lower smoking rates helps a lot. Genetics can play a big hand for some people.

That's a huge difference, and precisely my point - I go places and pay out of pocket when I @#!%$# need it.

So when they can't get an MRI or see somebody in Canada, they're going to want to head to the US. What's wrong with that, exactly?

Tell me you haven't gone to a clinic and paid out of your pocket Dope. Or used your insurance if they took it.

LOL. If somebody didn't take insurance, I paid for it. I've also never touched a single out of all the money I've parked in my HSA over the years. Why would I? Leave it there for a rainy day.

What's wrong with that, exactly?

"If they needed it" means they don't think they'll need to, but if they do, they'll do it.

"If they could" makes it sounds like they'd prefer the American system, which is a misrepresentation.

I entertained the idea of getting the operation done and relaxing by the sea because it was cheaper

I ruptured a lumbar disc.

There was a neurosurgeon in Beverly Hills who also had a clinic in St. Petersburg where said he could do the same discectomy for half the cost of having it done at Cedar-Sinai.

Hmmmm. On the one hand, $25K could buy a lotta vodka and caviar while holed up with a young Russian nurse for a week in a 5 star hotel overlooking the Neva ..... on the other hand, something going wrong in St.Pete.

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