by Doctor Science
In the comments to my post on Why the Affordable Care Act is "socialism", McKinneyTX said:
BTW, the great fondness for nationalized healthcare in the rest of EU/Australia/Canada may be misplaced. If you think a one year wait for a hip transplant is a good thing, fine. You will change your mind when you actually have a broken hip and have to live with immobility and excruciating agony for a year.
evilrooster pointed out that
this is not at all hir experience in Scotland. liberal japonicus linked to
Explaining Waiting Times Variations for Elective Surgery across OECD Countries, which includes this chart:
This may be the source of McK's impression that socialized medicine invariably leads to long waiting times for surgery. You'll notice that the figure of "a year's wait" would only apply to England, and also that evilrooster's evidence suggests that waits for *emergency* hip replacements -- where "you actually have a broken hip and have to live with immobility and excruciating agony" are very short.
What you also have to bear in mind is that for the US, unlike all the other countries surveyed, the average waiting time cannot be calculated because some people wait forever. When researchers from Australia, New Zealand, the UK, and Canada compared waiting time strategies in different countries, they noted that
Waiting lists are not a feature in the United States, where uninsured and underinsured populations experience rationing through financial inability to access care, medical debt, and use of inappropriate services such as hospital emergency departments.
I wonder to what extent McK's fear of socialistic waiting times is because he's thinking of them as something they're not -- waiting for *emergency* care -- or because of another feature. A
study of waiting times in Sweden found that
Socio-economic variables were not consistent determinants of variation in waiting times
-- that is, in Sweden the rich do not habitually buy their way to the front of the line. If you're used to being at the front of the line, having to wait will indeed feel like a downside of "socialized" medicine.
I assume McK has "gold-plated" health insurance, because he said the ACA will be:
much more intrusive into the doctor/patient relationship and, generally, more oppressive than anyone can imagine.
"Gold-plated" insurance is any that you do *not* experience as oppressively intrusive into the doctor/patient relationship:
- lists of approved doctors, which may not include the doctor you've been working with for years
- shifting lists, so even if you've gotten used to going to a particular doctor under a particular firm, the relationship can be yanked out from under you
- Prior Authorization, which Medicare & Medicaid do, too, but much less arbitrarily than private insurance
- Delay, deny, defend is a core value for private insurance, because that's a major way they make their money.
- knowing that my doctors have to fight the insurance company to get treatments they think I need, and that it's an enormous drain on their time and energy
- feeling that I have had to fight for my literal life or that of someone I love, if the insurance company decides we're too expensive to be worthwhile
- watching insurance premiums for our very small business go up 20% per year or more, but knowing that switching companies is threatened by our pre-existing conditions -- which are almost inevitable for people in our 50s
Basically, if you aren't terrified of the power of life & death and suffering your medical insurance company has over you, you are young, lucky, or gold-plated. My experience is that the IRS is far more compassionate and forgiving of mistakes than a medical insurance company, and infinitely less likely to threaten me and mine with pain and death.
And if your driving worry is about costs, note that the Kaiser Foundation says:
On an average per capita basis, annual Medicare spending has grown at a slightly smaller rate than annual private health insurance spending
-- this despite the fact that Medicare patients are a good deal older and sicker than private insurance customers.
Furthermore,
Average annual growth in Medicare spending is projected to be 5.8 percent between 2012 and 2020, according to CBO, and 5.9 percent between 2010 and 2019, nearly one percentage point lower than projections for this period prior to the passage of the Affordable Care Act of 2010.
I honestly don't understand how the ACA can be so very frightening, when the
real lives of many real people will become *less* frightening, stressful, and anxious because of it.
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