"Free" Health Care

Avatar for schifferle
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Registered: 03-27-2003
"Free" Health Care
186
Wed, 07-21-2004 - 8:58am
http://www.townhall.com/columnists/walterwilliams/ww20040721.shtml

Free health care

Walter E. Williams

July 21, 2004


Let's start out by not quibbling with America's socialists' false claim that health-care service is a human right that people should have regardless of whether they can pay for it or not and that it should be free. Before we buy into this socialist agenda, we might check out just what happens when health-care services are "free." Let's look at our neighbor to the north -- Canada.

The Fraser Institute, a Vancouver, B.C.-based think tank, has done yeoman's work keeping track of Canada's socialized health-care system. It has just come out with its 13th annual waiting-list survey. It shows that the average time a patient waited between referral from a general practitioner to treatment rose from 16.5 weeks in 2001-02 to 17.7 weeks in 2003. Saskatchewan had the longest average waiting time of nearly 30 weeks, while Ontario had the shortest, 14 weeks.

Waiting lists also exist for diagnostic procedures such as computer tomography (CT), magnetic resonance imaging (MRI) and ultrasound. Depending on what province and the particular diagnostic procedure, the waiting times can range from two to 24 weeks.

As reported in a December 2003 story by Kerri Houston for the Frontiers of Freedom Institute titled "Access Denied: Canada's Healthcare System Turns Patients Into Victims," in some instances, patients die on the waiting list because they become too sick to tolerate a procedure. Houston says that hip-replacement patients often end up non-ambulatory while waiting an average of 20 weeks for the procedure, and that's after having waited 13 weeks just to see the specialist. The wait to get diagnostic scans followed by the wait for the radiologist to read them just might explain why Cleveland, Ohio, has become Canada's hip-replacement center.

Adding to Canada's medical problems is the exodus of doctors. According to a March 2003 story in Canada News (www.canoe.ca), about 10,000 doctors left Canada during the 1990s. Compounding the exodus of doctors is the drop in medical school graduates. According to Houston, Ontario has chosen to turn to nurses to replace its bolting doctors. It's "creating" 369 new positions for nurse practitioners to take up the slack for the doctor shortage.

Some patients avoided long waits for medical services by paying for private treatment. In 2003, the government of British Columbia enacted Bill 82, an "Amendment to Strengthen Legislation and Protect Patients." On its face, Bill 82 is to "protect patients from inadvertent billing errors." That's on its face. But according to a January 2004 article written by Nadeem Esmail for the Fraser Institute's Forum and titled "Oh to Be a Prisoner," Bill 82 would disallow anyone from paying the clinical fees for private surgery, where previously only the patients themselves were forbidden from doing so. The bill also gives the government the power to levy fines of up to $20,000 on physicians who accept these fees or allow such a practice to occur. That means it is now against Canadian law to opt out of the Canadian health-care system and pay for your own surgery.

Health care can have a zero price to the user, but that doesn't mean it's free or has a zero cost. The problem with a good or service having a zero price is that demand is going to exceed supply. When price isn't allowed to make demand equal supply, other measures must be taken. One way to distribute the demand over a given supply is through queuing -- making people wait. Another way is to have a medical czar who decides who is eligible, under what conditions, for a particular procedure -- for example, no hip replacement or renal dialysis for people over 70 or no heart transplants for smokers.

I'm wondering just how many Americans would like Canada's long waiting lists, medical czars deciding what treatments we get and an exodus of doctors.

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Avatar for independentgrrrl
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Registered: 03-26-2003
Sat, 07-24-2004 - 12:00am
Just picking your brains here:

Who does the majority, if not all, of the r and d on anything relating to heathcare (investing, especially)? I'd bet it's the US. Who wants to reap the benefits of all the hard work from the r and d department? Who wants to make a profit without shelling out the initial investment?

iVillage Member
Registered: 05-12-2004
Sat, 07-24-2004 - 1:33am
Thank you for saying what needs to be said. Beautiful, and correct.
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Registered: 04-18-2004
Sat, 07-24-2004 - 2:58am

INDEPENDENTGRRRL!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!


Welcome back!

Miffy - Co-CL For The Politics Today Board

Avatar for independentgrrrl
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Registered: 03-26-2003
Sat, 07-24-2004 - 3:21am
Hey yourself! :D I sure missed you all!

My computer was invaded by spyware and my hubby finally fixed it today. It had gotten to the point that whenever I logged on to iVillage, a billion pop-ups would freeze my computer and then crash it. So now, with new ad-blocking software, I can cruise on back to iVillage without the dreaded pop-ups. I'm back to participate in the debates. Looks like I've got a lot to catch up with. Kewl!

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Registered: 04-18-2004
Sat, 07-24-2004 - 3:47am
That darn spyware

Miffy - Co-CL For The Politics Today Board

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Registered: 06-17-2004
Sun, 07-25-2004 - 1:50pm

Hey, miffy, I ran across this tribute to WW by Thomas Sowell. It doesn't mention his wife, but I think it's a pretty good indication of what kind of man he is.


Roasting Walter Williams

http://www.jewishworldreview.com/cols/sowell091903.asp






http://www.NewsAndOpinion.com | At George Mason University, they are giving a "roast" -- that peculiarly American combination of praise and ridicule -- to Walter Williams, professor of economics and columnist extraordinaire. Although I cannot be there, let me participate vicariously with a few observations about Walter.


I first met Walter Williams back in 1969, when I was teaching summer school at UCLA and he was a student working toward his Ph.D. in economics there. Contrary to some accounts in the media, Walter was never a student of mine. Nor did he get his ideas from me.


The very reason Walter Williams dropped by my office that summer was that someone had told him that there was another black man who was expressing the same kinds of ideas that he had been expressing before I got there. To both our surprise, we discovered that we had in fact reached similar conclusions on a wide range of issues, especially those involving race.


In the years ahead these ideas would be called "black conservatism" in the media, though it is hard to imagine two less conservative guys. In the military, each of us had a brush with a court martial -- Walter in the Army and I in the Marine Corps -- because we did not conform. It should not be surprising that we did not conform to the racial orthodoxy of the 1960s.


Because Walter was tied up writing his doctoral dissertation, I was the first to go into print with ideas that we both had. One of Walter's earliest writings was an article explaining why "the poor pay more" in stores in low-income neighborhoods.

Some sociologists had written a book with that title but their explanations overlooked the economic factors behind high prices in ghettos and barrios. After Walter explained the economics behind these high prices, those who were now deprived of their all-purpose explanation -- racial discrimination -- reacted bitterly by denouncing Walter as a "white racist."


After Walter went on television, liberals had to come up with some new derogatory labels -- and they did. But these labels were like water off a duck's back to Walter Williams.


Walter was as undaunted by apartheid in South Africa as he was by lockstep racial rhetoric in the United States. Many economists have said that how much discrimination there will be depends on how much it costs to discriminate in the marketplace. But Walter was the only one to put it to a test by living in a neighborhood that the apartheid government had designated as "white only."


Not very conservative.


Out of this experience came a book titled "South Africa's War Against Capitalism." Over the years, I have used examples from that book in my own writings. This is as good a time as any to acknowledge my debt -- especially since our flawed legal system will not enable Walter to collect.


Another very enlightening book by Walter Williams is "The State Against Blacks." This goes into the many American government policies and practices which have had a major negative economic impact on blacks.


These include minimum wage laws, occupational licensing laws, and regulation of railroads and trucking. None of these is explicitly racial in intent but their actual consequences have included restrictions of employment opportunities for blacks, as Walter demonstrates with hard facts and figures.


Both these books are written in plain English, by the way, a rarity among the writings of economists. The ability to speak this rare dialect has also helped Walter during his appearances on TV programs and as an occasional fill-in host for Rush Limbaugh.


Walter Williams is the only debater to leave Jesse Jackson speechless. On another occasion, he flabbergasted Ted Koppel when a woman on welfare said that she didn't have enough money to take care of all her children and Walter replied: "Did you ever consider that you might have had too many children for the money?"


Although Walter often comes across as hard-boiled on social issues -- he once said that the government has no right to take a dime of his money to spend on someone else --the fact is that he has been very generous using his own money and his own time to help others. He just doesn't want politicians doing it and messing things up.


This is a long overdue tribute to a great guy.

Renee ~~~

Renee ~~~

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Registered: 04-18-2004
Mon, 07-26-2004 - 8:54am
Great article!

Miffy - Co-CL For The Politics Today Board

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Registered: 08-10-2004
Tue, 08-10-2004 - 2:24pm
I'm not sure if you know a lot about how higher education is funded. I happen to work in higher education and be married to a doctor. I can assure you, as we are in the process of paying back his nearly $90,000 of student loans, that while the education is paid for partially by government funding, a huge amount of debt is taken on by most medical students. The only medical students I know who do not have a huge debt are those who come from families who can afford to pay for the schooling or are married and the spouse earns enough for them to live on. So, in addition to the amount already taken out in loans, you are suggesting that new doctors pay back even more. Do law students or MBA students have to do this? The taxpayers pay for their education in the same way. Most residency programs pay the newly minted doctors about $33,000-36,000/year to work about 80 hours/week. We figured it out and my husband was making about $1.90 an hour, much less than the minimum wage and for having 8 years of college. Now, does that sound fair to you?

We are not complaining. It is a calling to be a doctor. Not many people want to have to deal with the amount of dedication and sacrifice they make. Now that my husband has completed his residency in internal medicine, he works about 12 hours a day, dealing with families who are making difficult life and death decisions, seeing 12-20 patients in the office each day; several of whom are seen for free or at much reduced costs, making necessary phone calls, doing dictations, seeing his patients in the hospital, supervising residents in the clinic, as well as many other tasks each day. This is typical of most doctors these days, not the glorified version we see on TV. Many doctors who work in a group private practice see a portion of their patients for free or reduced costs. I think if you actually calculated your suggestion of "figuring their educational cost in toto, subtracting the amount of tuition they paid, and requiring them to render services equal to the subsidized part" you would find that over a physician's career, many already do that.

As for the operating costs you reference, most medical schools-both public and private, have an extensive research branch. This research is funded by government or private grants. These are the labs of the nobel laureates, high profile researchers, many of whom do not teach, but are employed by the medical school. Their salaries have to be paid, in addition to very expensive equipment and supplies. In addition many of the labs employ bachelors level technicians, who do much of the actual work, for very little money, about $20,000 per year to start. Medical schools are not organized for "not-for-profit" corporations any more than any other institution of higher education. If that was the case, then all students should have to pay for their entire education. I just don't see how plausible that is, especially when many students already have high loan debt and the job markets have been down significantly since 2000.

Medical education has to be funded somehow. Training to be a doctor is a highly technical process. These are the people we rely on to take the best possible care of ourselves and our loved ones. My husband is sometimes reimbursed at a rate of about $70-80 per hour. Initially, that sounds like a lot. But, how much do you pay to have your hair done? Some haircuts/color cost over $100. A hairstylist can make more per hour than a physician, who has gone to college for 8 years and been in residency training for anywhere from 3 to 12 years.

And I don't know about you, but I want my doctor to be getting the most cutting edge education possible. That takes money. I just think it's very interesting that people complain about how much doctors make, when a business person or a lawyer can make much more. And for those of us who don't want to make the sacrifice, aren't we glad there are those people who want to study harder than the average college student, hoping to get into medical school and having to make at least a 3.5 gpa, and then study even harder for 4 years while they are in medical school and living on student loans because you can't work while you are in school, then to enter a 3 year minimum residency program and make about $33,000(gross, $26,400 net) per year, while your loans are in repayment and paying about $1000 per month in loan payments, then to finish residency only to find out that you work even harder as a doctor in practice still have the loans to pay back and actually want to have a life? It's rather daunting to be 30 years old, just starting your first real job as a doctor and have about $90,000 of debt, not including car or mortgage. The average nationwide is about $60,000.

The health care issues are not simple, but passing the load onto already overloaded new medical students is not the solution. And I don't know about you, but here in Texas the legislature already cut the state support of higher education, so the schools raised tuition, so the students have to get more loans to pay for it. Please don't think we are complaining. It is a priveledge to be married to such a dedicated doctor, who still makes some house calls. I am very proud of him. I'm not sure what the solution is, but this is not it.

p.s. I am also a Licensed Professional Counselor and the state of mental health care in the U.S. is also in a mess.

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Registered: 04-18-2004
Wed, 08-11-2004 - 4:08am

Hey Monkeygoat!


Welcome to the board, and thank you very much for your input on doctors!

Miffy - Co-CL For The Politics Today Board

Visit My Website!

Email me!

Miffy - Co-CL For The Politics Today Board

iVillage Member
Registered: 03-26-2003
Wed, 08-11-2004 - 8:01am
3.5 grade average? You are being too modest. I don't think they let janitors work in med school who have a 3.5 grade average. 3.75 and that's marginal. I have a cousin who tried to get in. I've seen it.

But the tuition is part of my problem. Suppose we have a contract with a med student. Tuition paid, or at least part of it, in exchange for two years of work afterwards? Or even free education for four years? Think there would be takers? I do. And you're right, it is a calling, as are most professions. I know young lawyers who are getting out with $100,000 in student loans. It is like a long term mortgage.

But part of the problem is with the ABA. The ABA decides which schools get certified and which schools don't. By controlling the schools certification, they control how many new doctors can go into the profession in any given year. Why?

And, while not addressed to you, personally, there has been a lot of discussion on this board about the "horrors" of managed care, and I'd like to tell a little story a doctor told me.

My wife's gynocologist was an old Army "horse doctor" who retired from the Army after twenty years. At one point, he was in charge of most of the Army bases in the central part of the U.S. He said that in twenty years, he had seen one case of uterian cancer. He said the Army would announce a day when they would give free pap smears to all dependents of Army personel. "When pap smears are free," he said, "everyone gets one." The pap smears were taken by a med tech, the whole batch would go to the lab, and be tested. If something came up that was unusual, it was red-flagged, and a team would look at the results. If they felt more test were needed, they would order them. If there was a problem, the team would recommend a hysterectomy, it would be done by the local OBGYN, and that was that. Granted, this is an anecdote, but it was told by a man who had seen thousands of patients who got free health care over at twenty year period.

He also said that med techs do a pretty good job of sorting out the sick from the really sick. When the med techs were given a list of criteria to look for with people who came into the hospital, they did a pretty good job of sorting out who needed asprin and who needed something more.

Free health care can be managed like that. It doesn't have to be prohibitively expense. It can be done. And I can't help but think about this when people argue about how free health care would be a "budget buster."

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