Rarely have I read in Slate so much garbage, half-truths, nonsense, and out right error packed into one tiny article.

First and foremost, the author tries to defend a market-based system for health care. The problem isn't, as he suggest, adverse selection, but a much broader problem. One can't create a free market unless both parties can withdraw from the market. For example, if I find the price of bananas too high, I don't need to buy a banana. I can either buy some other fruit or decide I am not that hungry (at some point, however, food does cease to be a free market). If I don't like the price of a High Def TV, I don't need to buy one. However, as I sit in the hospital with a ruptured appendix, I am not in a position to either shop around for a better price or withdraw from the market.

Second, the problem is the use of insurance companies at all. They don't add anything to the health care process. Their costs are nothing but a drag on the system. They add somewhere between 25% and 50% in additional administrative costs and are often as much 20% of the entire health care bill. Medicare manages to administer payments with about a 3% overhead, while even Kaiser needs about 17%.

The market place simply cannot provide a solution. Ever.

Moreover, the problem as Moore points out is, even with insurance, your coverage can and is denied. What difference does a rule against biased selection help, if I can be denied the coverage anyway? In state-run systems, there isn't a question of coverage. There isn't any time (and time is money) spent on deciding what is covered and what is not.

As for paying for all the additional health care, we don't need to spend any more money, we just to spend it not on insurance. The Federal Government ALONE pays some 75% of the health care tab through various programs and we pay some twice as much per person as even France, who have the finest health care system. They live, on the average, four years longer than we do (better outcomes), despite greater rates of smoking and drinking in the population, at about 60% of our expenses. If we instituted a state-run system similar to theirs and spent more than they do by 25%, we'd need only what the Feds spend now. The savings come from using heath care dollars on health care, not insurance companies.

Wages overall are slightly lower in Europe than here, but I haven't seen any evidence of any kind, beyond anecdotal, that doctors are paid significantly less over there than here with the exception of some specialties. Frankly, I know many doctors who would be happy with $200,000/year, particularly if we didn't require our students, medical and otherwise, to start their professional careers out with a butt-load of debt. If we instituted universal college education while we were instituting universal health care, we could fix this issue.

Then the author pulls out the old canard of tort reform. The one and only reputable study I've seen, based in New Jersey, found patients sued less than they should have given the error rate and were awarded less money than they should have. Our doctors and hospitals make more mistakes than in state-sponsored systems and we don't have a way to provide the needed, additional health care when mistakes happen. A universal system would lower our error rate and provide that health care. We absolutely, positively do not need to take away the one and only incentive doctors and hospitals have now to lower their astronomical error rates by letting them off the hook by making civil judgments even harder.

The author's foolish statement about "the drug companies would drive the costs up in the other markets rather than reduce them here" is hard to fathom. Yes, if we were to control prices, we would drive prices up elsewhere, but it would most certainly lower ours. That would be the point. The author seems to think we should continue subsidizing lower drug prices for the world, a task I don't see we have. Cuba may have to charge $1 for the nebulizer is we stop paying $100, but that is a price I am willing to pay.

I am also not convinced that people would hate having the government deny service more so than an insurance company. Each system would likely deny service to some people. Some people are denied service in France. However, at least the government is open to democratic controls. I can call my congressional representative and my Senator. Who do I call who cares at the insurance company. This denial of service argument is a compete fiction. We are already "accustom ... to a central decision-maker authorized to determine what procedures they are and are not allowed to get" only now it is a nameless, faceless, uncontrolled insurance company, as Moore's film points out.

Worst is the author admits "The emergency room is less crowded in places where everyone has health care," but then tries to say people will "waste" their free medical care. While this bloody shirt is waved at every discussion of health care, the truth is those in universal systems go more regularly and more appropriately than we do. They don't need to go to the emergency room for small matters, because they can see their regular doctor in a reasonable fashion. The fact is they use their heath care more judiciously and less expensively than we do. I know few people who like to go the doctor and I doubt many would take the time off of work just because the visit is now free.

Our old beige car of a health care system is already broken beyond repair. It has turned up its little wheels into the air, gasped out a belch of smog and is dying. The time has come to give it a burial and adopt a workable system. Market based systems with insurance companies don't work, have never worked, can never work, and are an evil. They should be ended and universal health care instituted.

I was happy to see you call tort reform a canard. The claim that medical malpractice suits increase costs for doctors is essentially a lie.

A couple of professors at the University of Texas School of Law tested this in Texas. Their findings? Malpractice judgments were essentially flat over a 15 year period ending in 2002, the number of claims has declined over that period, and malpractice judgments accounted for less than 1% of all the health care spending in Texas.

But at the same time, malpractice insurance premiums were still going up. So, turns out that med mal claims don't increase premiums. If doctors are forced out of practice because they can't pay for their insurance, something else is responsible (read: insurance company profit motives and business model.)

Here's a link to an announcement of the study.

Your take on this tells me that you really have very little insight into how health systems and the providers who work in them function. Every observation made in this article rings true to physicians, nurses, administrators, & on down the line.

Americans are going to be unwilling to accept the trade offs involved in single payer plans to accept Moore's solution. "Universal" Federal medicare-like progams with a healthy supplemental market is the logical compromise likely to be eventually enacted in the US.

In contradistiction to the study you point to, there is very compelling data clearly demonstrating the drag of our tort climates on health care costs

I'm throwing the bullshit flag on your "very compelling data." Show me a study.

First, I would like to point out that Goolsbee's observations, namely how our current system is malfunctioning, have not come under criticism here. It is his speculations on proposed solutions that are in dispute, and here he is dead wrong. You say "Americans are going to be unwilling to accept the trade offs involved in single player plans." Huh? What trade offs are you talking about? Unwilling to get better health care at lower cost? Why on earth would Americans reject that option? Countries with single-payer plans deliver better health care at much lower cost. The data is simply irrefutable.

One would hope that with all the money that insurance companies make from the suffering of average Americans they could provide their toadies proper spell-check software. I've actually become more enraged by this article the more I've read it. Complete and utter bullshit.

I retain hope that Slate will find a real "expert" - say one from the healthcare industry - that will refute the nonsense of profit driven healthcare.

The trade-offs with these other systems are real. They are much better about ensuring basic primary care needs are met, but they do worse on a number of indicators of tertiary care. In addition, funding for these systems has been dodgy in areas and created a number of secondary markets.

Using the North American Association of Central Cancer Registries data, regional comparisons between the United States and Canada revealed worse outcomes for breast, prostate, colon, and other cancers in the Canadian system. In addition, the group noted that in some provinces Canadians can wait up to 10 weeks longer than they would in the United States for radiation therapy.

A few years ago data was also reported that suggested 6 in 10 British women diagnosed with breast cancer would be alive after 5 years, compared to nearly 8 in 10 in the United States and that only 15 to 30 percent of British patients with small-cell lung cancer will survive for two years, compared with 40 to 50 percent in the US.

These are just isolated disease process, but I think you get the idea. There is no free ride & I just don't think we're going to be as willing to give up some of the expectations for access to specialized treatments and treatment on demand that we've become accustomed to.

From The Daily Telegraph

A NHS surgeon today exposed how cash-strapped hospitals were being barred from operating on cancer patients who had not waited long enough.

Wayne Jaffe laid the blame for the appalling state of affairs at the feet of Tony Blair, with his vision of reduced waiting times and 24-hour surgery. In a withering assessment of the financial management of the health service, Mr Jaffe said that doctors were being restricted in getting waiting lists down by financial limitations and ever-changing targets.

The consultant plastic and reconstructive surgeon, who specialises in skin cancer and breast reconstruction, said he and his colleagues are being prohibited from operating in non-urgent cases unless the patient has been waiting for a minimum of 20 weeks

You're using cancer registry information? Did you work with those datasets yourself, or are you able to identify "the group" who noted the findings?

The US has very aggressive breast cancer screening programs, both publicly and privately funded. Early screenings confound the life expectancy results, since someone screened early will have more years of life diagnosed with cancer than someone who has been screened later in the disease.

Using yor isolated cases, I do get the idea. Perhaps we should redirect to the recent Autism and Vaccination article, where there is a discussion of confirmation bias.

You are, of course, right to demand the study. I can't find a non-subscription site for it, but there is this article from the NY Times that discusses it: <link> I also found this paper, that seems biased, but also has references. <link>

"Americans are going to be unwilling to accept the trade offs involved in single payer plans to accept Moore's solution. "Universal" Federal medicare-like progams with a healthy supplemental market is the logical compromise likely to be eventually enacted in the US."

That sounds like the system Nixon tried to give us in the early 70's ...except he was impeached.

Nixon was not impeached, though he likely would have been. He resigned, though neither had anything to do his actions with regards to health care.

I had to comment on the supposed efficiency of medicare you're referring to... "Medicare manages to administer payments with about a 3% overhead", and your statement that in a state-run system, there isn't any time spent deciding what is covered and what is not.

I was discussing the issue with my boyfriend, who's currently a medical resident, and his response was "yeah, they're efficient because they don't pay for anything. we all hate medicare".

so, it turns out that state-run systems don't have any problem denying people coverage. in fact, he had to do an emergency c-section on a woman at 3 in the morning last night, and why? not because she needed it, but because the only way medicare would pay for her tubal ligation was if she had it at the same time as a c-section. a c-section she didn't even want, for the record. and according to him, medicare is constantly sending them new regulations and paperwork, and is basically a giant bureaucratic mess. so, I'm not going to argue the merits of the present system, but it doesn't sound like medicare really has the situation in hand either.

also, saying france has superior health care because they live longer, on average, is ignoring the fact that 1/3 of americans are big fat fatties.