It should not be too surprising that an awful lot of people prefer stability, security and a promise of an okay economy to fairly abstract “freedom”. (Ie., until the oppression starts to actually hurt you, it’s very easy to ignore.) And this isn’t by any means a Chinese thing only; rather, it’s a very common thing throughout human history.
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Tiananmen Square. There aren’t more protestors because they have hard, incontrovertible evidence that the government of China will do anything to shut down resistance including mass murder.
The headline of this article proves that yes, there are stupid questions.
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It’s a better question because it’s more relevant to Americans. Why is that hard for you to understand? Are you Chinese?
I don’t disagree. Chinese and US healthcare systems have a lot in common. On balance, the US system is much better. In the area of cost, China is better than the US. I’ve paid for the same procedure in both. Big cost difference. Some of that is due to labor cost, some is due to cost cutting on quality. This is the industry I work in, so in my case I knew the cost cutting measure was actually a good one.
Superficially, the Chinese system is just like the European systems. Everyone is covered. But this is limited coverage. To Americans, the equivalent would be like heading to the free clinics here. One big difference is significant treatments require cash up front. No cash, don’t even walk in the door. Run out of money while in the hospital? You have to add more to your account or leave.
And this is where the US has an odd advantage. Yes, it’s expensive here. But by law, you can’t be kicked out. And the gap between cost and means of paying are not as stark here. That gap is closing though.
And there is the matter of quality. Quality of care at first tier hospitals would be similar to what you are familiar with in Europe. But not all hospitals are first tier. The rest are good, staffed with good, well trained people. But they server a different economic population and provide different quality.
And as much as we talk about problem with US healthcare, it really is very high quality. That’s part of the problem. We demand extremely high quality and end up paying for it. Americans are unhealthy because of bad behaviors (such as not going to the doctor often enough … because it’s expensive). For most treatments, I’d feel comfortable getting treated in China, Europe, the USA, Latin America, and so on. For exotic stuff, the USA (for all it’s flaws) usually has an edge. And that edge is expensive.
Don’t get me wrong. I’m a supporter of universal coverage. But I try to explain to people that universal coverage doesn’t mean things are now free. Some of the good things about the US healthcare system are what make it expensive. We need to be prepared to adjust our expectations.
Sorry. Post is getting too long. I’ll quit now.
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I don’t think that taking the profit motive out of health insurance will suddenly stop medical research and innovation or change quality of care much. I also think it’s fairly easy to explain, at a middle-school level of reading comprehension, that SPU is not cost-free. Unless you have the money to shell out for exotic, experimental treatments in the U.S. (we’re talking 6 figures cash, minimum) expectations won’t have to be adjusted that much.
The push for single-payer universal is getting so strong that I expect the GOP to “compromise” by offering something like the Chinese system of extremely limited bare-bones coverage for all (probably catastrophic but not preventative – does China cover both?) and requiring private insurance or cash payments for anything else.
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I wonder if your ire would have remained had you read the actual article as opposed to just reacting to the headline?
Indeed, for many Americans, the only relevant discussion is one that focuses on America.
Hmmm.
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I work in the middle of medical research and innovation. Eliminating insurance won’t change it. But cost controls from a single payer system will. The US high end is driven (indirectly) by litigation. No, not malpractice insurance. Not directly. Americans are directed towards more expensive treatments because if anything goes wrong (and no necessary anyone’s fault), doctors and hospitals often get sued. And the biggest stick the get hit with is “Why did you cheap out do this cheaper treatment? You were just trying to make more money, you evil money grubbing …” This doesn’t happen all the time, but often enough that doctors and hospitals routinely provide more expensive treatments.
Think about it: There is no penalty if they do it (and it can be rationalized as better) and a possible penalty if you don’t. The upside is gold plated medical treatments. The downside is it’s more expensive.
And medical research and innovation chase that money. It won’t disappear, but a huge part of it is driven by this extra money sloshing around the system.
And maybe it won’t change at all if a single payer is cool with continuing to pay for treatments that are more expensive but offer marginally better outcomes.
As for China, they don’t cover catastrophic. Some basic preventative. Much of what is provided is of the free contraceptives and antibiotics sort. Like a free clinic in the USA.
As for Europe, they are about to put a bullet in the brain of a lot of medical research and innovation there starting the new year. The new EU MDR requires new human trials testing, and doing this type of human trials in the EU requires a special certification. Only only one certified body even got permission to do certifications, and only months ago. Guess what! It’s British! So there only a couple places that can do the testing, none are certified, and no one can certify them. And even if they did, Brexit nullifies the cert.
The testing that needs to take place is common in the USA, doing the testing does not require EU MDR certification. Because profit driven innovation and the FDA worked out a system decades ago (Which also has BETTER controls than the old EU system or the new MDRs).
Geez, another overly long post. I need to stop avoiding work.
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It was informative, and I appreciate the detail from someone who’s in the trenches and who’s experienced the Chinese system.
Regarding litigation, that seems like a separate but related issue that definitely needs to be addressed in the U.S. I do think a SPU system, and its more transparent decision-making processes (AKA scary “death panels” that the private insurers have, too), will answer the question of “why did you cheap out?” to the point where attorneys will have a more difficult time making their case.
As noted above, the GOP will probably reverse that formula in its “compromise”: SPU for catastrophic only. They certainly won’t be handing out contraceptives. Their main goals are: 1) preserving the for-profit insurance industry as a necessity for any American who wants to remain in good health; and 2) letting the “undeserving” (those who are poor or who aren’t white) die as quickly as possible “to decrease the surplus population”.
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I did read the article. It’s wrong because it focuses too narrowly on purely economic factors, which are basically self-centered concerns about one’s personal welfare, and glosses over the wider ramifications of the HUGE difference between the systems of belief which obtain in China and the USA. It totally ignores both the well-known willingness of the Chinese government to commit genocide against its own population, and the fact that the people of China have had thousands and thousands of years of being indoctrinated with the idea of the moral correctness of obedience to the leaders, and the idea of a familial relationship between governors and governed - that the government is patriarchal and the people are, spiritually, children who owe allegiance and fidelity to the pater familias/governors.
And as for Americans thinking the only relevant discussion is one that focuses on America, you think that’s different for anyone else anywhere else? You think there are more Chinese who give a rat about the USA than about China? You think there are more Germans who give a rat about the USA than about Germany? You think there are more Nigerians who give a rat about the USA than about Nigeria? You’re wrong. Think again.
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“Manifest destiny” has worked out in reality to mean “It belongs to the guy who is strong enough to take it.” Just another restatement of the basic rule which has been the foundation of all property laws since time began.
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So we’re agreed that the answer to the question is a skosh more complicated than “Tiananmen Square.”
And your response to my other point indicates that you may not quite get what I was criticizing. I am not saying that people in other countries should or do care more about the United States than their own countries. Or, to put it in your terms, I’m quite sure that most Chinese people “give a rat about China than the USA.” [sic] What I am doing is criticizing the knee-jerk need, quite often prevalent among Americans, to see any event in the world as an opportunity to discuss ourselves rather than consider other points of view.
I don’t know what the GOP would go with, but when talking to conservative friends, they are very open to a universal basic healthcare system. It aligns with more of their ideals.
First, define basic healthcare as vaccinations, checkups, antibiotics, setting broken bones, prenatal, childbirth, glasses, and a few others. I make the point that these are not expensive and have an excellent cost benefit ratio economically. Healthier Americans are more productive, so this pays for itself. Bread and butter basic healthcare. Sort of like schools and roads and sewers are good basic spending that has benefits greatly exceeding the cost. And by delivering it universally, we can cut out bureaucracy and save money.
Second, take what should and shouldn’t be covered out of the hands of politicians. They can budget a lump sum, but no earmarking. It’s harsh, but keeps focus on delivering as much as possible for the money available. Brutal utilitarian analysis from bureaucrats is what this means. But again, it’s all about doing the most possible. Want more? Fund more!
Third, everything else can be covered under insurance just like we are familiar with.
But for goodness sake, don’t tell them how this is similar to anything in other countries. Just don’t do it. No need, and at best it’s a distraction and at worst, creates resistance.
Surprisingly, every conservative, from GOP sympathetic, to Tea Party, and beyond, has been rather receptive. Point 1 saves money while doing good. Point 2 keeps it from getting out of control. Point 3 retains the free market features they want.
I’m talking more about the conservative leadership in the U.S., which has other priorities as described above. And while the conservatives in your circles may be more educated and informed, the GOP still can rely on 27% of the total electorate to be ignorant suckers.
I agree completely with this, especially it will be taxpayers and voters demanding this from a single payer beholden to them rather than customers begging this from for-profit corporations beholden to shareholders.
That’s the European model, which is fine with me.
I don’t know, Americans seem pretty envious of the systems in other OECD countries when they’re described to them.
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Yeah, I understood you meant the conservative leadership vs conservatives I might know. But I still like plantitng seeds of ideas both with liberals and conservatives. And I wouldn’t quite say the 27% are ignorant suckers … they just work from a different set of assumptions. Knowing them (and not parodying them) makes it easier to find common cause.
As for not telling people about other countries, I was referring to talking conservatives. It’s those assumptions. You assume Europe is a good example. They assume Europe is a bad example. In reality, it doesn’t matter. It’s not about “Let’s copy Europe.” or “Let’s not copy Europe.” It’s about cheaper healthcare. And to be fair, if we can’t make the case for a better system without saying “And this is what they do in XXXX”, then we don’t really have much of case.
I can’t agree here. A more effective use of time and resources is to convince conservatives and independents like the ones you (and I) know.
I understand. I would agree that trying that with the Know-Nothing 27% won’t get us very far, but there’s not much point on engaging them. Other, more reality-based conservatives, will demand real-world examples of SPU in action, of which there are plenty to point to in other Western countries.
I follow China pretty closely. Kaiser Kuo runs a podcast called Sinica where he regularly discusses Chinese politics and current events. He’s incredibly knowledgeable about China and is one of the sinologists I trust most to have a good pulse on China and Chinese opinion.
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