June 4, 2007

Why Nationalizing Health Care Will Make Us Less Free

In the debate over health care, many people support the idea of a government-run, single-payor system that will supposedly guarantee equitable distribution of treatment. However, in granting government the authority to ration all medical care, we grant them the power to withhold it for whatever purpose they see fit. The British have begun to discover this dynamic, as the Daily Mail reports that the National Health Service will begin denying smokers access to medical care until they prove they have quit -- through a blood test.

At Heading Right, I note how this demonstrates the power we will grant government over the most personal of choices as a necessary end result. Where does it stop? Do we refuse service to the obese? To those who engage in sex without condoms? Every risk factor adds cost to the delivery of nationalized medical care, and at some point the single payor will start to act to reduce those costs and freeze out those higher-risk patients. Be sure to read the entire post.


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Captain's Quartershas a brief piece up (linking to a piece from Britain, as well as a larger piece from Heading Right) which discusses why nationalized health care will make us less free. Of course that's the case. The Democrats who [Read More]

Comments (47)

Posted by braindead | June 4, 2007 3:54 PM

People think that with the government paying the bill, they will get all the Health Care they "DESIRE". The analogy is if the government was in the car business, we should all get Mercedes.

However, what will happen is care will be limited - TO ALL. Using the transportation analogy, we will all get to ride the bus, on a given schedule.

Except congress and the President. They get their healthcare at Bethesda and Walter Reed.

Posted by Carol Herman | June 4, 2007 4:00 PM

It's the erosion of the marketplace.

Now, if you wanted cheaper health care? Just eliminate the lawyers;

Which would put pressures on the insurance companies. Who could care less if a doctor is innept. Or not. Because they're in the business of feeding their own. And, the attorneys that do this stuff; are a rare breed. (They work the court house. Usually handling either side. And, they work IN SPITE OF JURY TRIALS). Because 97% of all civil cases NEVER SEE A JUDGE! Or a courtroom.

But "health" is under the federal umbrella. It began growing in the 1970's. Pushed along by Medicare. Which puts procedures out of reach of most people's pocketbooks.

Like most detrimental systems, this was grew through congress. And, in the beginning? They were covering $15 office visits!

Today? You want health care? Why? You want MORE federal intervention? WHY? The government is proving over and over again. And, time and time, again. THEY CAN'T EVEN RUN TRAINS ON TIME! They have these gigantic pools of money. And, they're run amok.

Meanwhile, I don't see this as a "cry from the populace." But rather what happens when we send whores to congress. They're in business to "grow government subsidies."

And, they think they can get away with this stuff.

Yesterday, on Drudge, he said the congress-critters think the whole "amnesty kobosh" is just hooey. That MOST Americans don't give a rat's patootie. And, they'll vote FOR Ted Kennedy's bill, before they'll vote against it.

And, Bush? This animal talks about Americans not being open to diversity? Who stole that man's brains?

Posted by swabjockey05 | June 4, 2007 4:29 PM

"Where does it stop? Do we refuse service to the obese?"

Why stop there? Where's it written that people have a "right" to health care?

Couldn't you make the same arguments for the "right" to have a car? Or the "right" to live where ever you want? When's the last time anyone looked in one of the dirty alleys in Detroit...Chicago? Wouldn't the people trying to live in those Hell Holes be better off if the Government gave them a “free” house in Bloomfield Hills...or La Jolla?

Couldn't you make the case that their life expectancy would be increased much more with a move to a "better place" than with "free" healthcare? What the heck, why not give them both...after all it's "free"?

Posted by Saul | June 4, 2007 4:33 PM

"However, what will happen is care will be limited - TO ALL. Using the transportation analogy, we will all get to ride the bus, on a given schedule. "

This is precisely the mentality that drives policy here in Canada. If you want to see what nationalized health care would look like -- take a glance to your north, and only those who are the most obscenely radical would defend it without question.

Posted by TomB | June 4, 2007 4:36 PM

Limiting freedom is is only one side effect of the Government monopoly on health services. Another one is "rationalization of services" (read: long waiting lists, since we can't burden state with doctors and equipment "waiting" for patients). Just look at Canada's waiting lists for cancer diagnostics, or hip replacements. Still another one is unavoidable in such a situation line jumping for politicians and people who in general are "in". The list goes on and on.

Posted by exdem13 | June 4, 2007 4:39 PM

Always be careful what power you grant to the Government. You will not easily have it returned to you. Give 'em an inch, they'll take a cloth-yard.

Giving the Government under ANY administration is a fool's mission, 'cause anyone knows that trouble only comes from letting the government decide who gets what, and how much of it. Since the usual government model is "everything or nothing is permitted", you will get 2 choices. First is a full , free ride at the public expense. (If only 2% of the public would be doing it, that would be quite the expense.) Or you get no treatment whatsoever, 'cause you don't fit the official description of the benefit. Hope you don't die before you get sick enough, or get the right forms filled out!

People, this is your HEALTH we are talking about, not a tax credit from the IRS! Don't go down that path to Hillarycare, unless you want to give up a large portion of your decision on what you can/can't medically have done to yourself.

Posted by I R A Darth Aggie | June 4, 2007 5:05 PM

Why stop there? Where's it written that people have a "right" to health care?

Ummm...by the very people pushing the notion of socialized medicine? isn't that one of the hooks they play on to get your sympathy?

The one thing about the advocates of the single-payer system is that some of them gripe ferociously about HMOs, but they want to replace the whole system with a government run HMO? that can only be sued within limited sets of circumstances when its employees err in a reckless, incompetent or malicious manner.

Posted by Joshua | June 4, 2007 5:30 PM

Big business tends to be in favor of nationalized health care too, because it's cheaper for them than to have to pay for and in some cases even administer a private corporate health plan themselves.

Come to think of it, in light of the above I wonder whether the pro-nationalized-health-care movement isn't just another "astroturfing" job - a convenient alliance of corporate America and nanny-state true believers trying to create the impression of widespread public support for national health care.

Posted by Ennis | June 4, 2007 5:50 PM

Carol is right when she said that if you want cheaper health care then take the slimy ambulance chasing lawyers out of the equation.

What everyone has to remember is that it is not nationalized heath care- it is nationalized triage.

Case in point:

I know a Canadian who developed a rather rare disorder. This person was always using the glorious Canadian health care system to bash me with on occasion. If treated quickly there is a good chance of survival-if not it was a slow, painful death. Well, when diagnosed he asked what they were going to do to treat it and he was told that seeing as he was 60 years old he would not "contribute" enough back into the system to justify the cost of treatment for him. This was their answer to him despite the fact that he had paid decades worth of high taxes to fund the system and had never used it for anything outside of routine illnesses or a couple stitches. In plainer terms they were going to let him die a painful death for "the greater good".

I asked him what he thought of his vaunted nationalized health care system after they told him that. He really didn't have a response. I pointed out to him that if he were on my heath care plan they would have treated him right away, and the money he would have spent for American health insurance would have been about half he spent in higher taxes to fund his blessed Canadian heath care system. I then asked him if he still thought the Canadian system was still so much better then the American system. He had no response to that, either. He bought into all the BS about how wonderful the Canadian system was compared to the American system until the Canadian system passed a death sentence on him.

Posted by Steve Skubinna | June 4, 2007 5:52 PM

Once the federal government takes responsibility for everyone's health care, then it becomes a "right." But it's a twisted view of rights - it's the difference between claiming the Second Amendment protects an already existing right to own a firearm, and that the government has an obligation to give you one free.

And oddly enough, gun ownership was the first example that came to mind - if Chuck Shumer or the CDC or the NYT editorial board had their say, gun owners would be required to disarm before getting access to the Free! HillaryCare Clinic.

Posted by Pat West | June 4, 2007 5:55 PM

The British Health Care System, which some of my family experience, is now a disaster. Our Canadian Health System, which was closely modeled on the British, is rapidly becoming a disaster, and a very expensive one. No sane person would wish a socialized medical system on the U.S. Like all forms of socialism, it doesn’t work!

Pat West, Toronto

Posted by Steve Skubinna | June 4, 2007 5:58 PM

And Ennis, I'd bet that your Canadian friend is now shopping around US clinics, isn't he? Well, remind him that once we go to his model sustem he won't have that option either.

Posted by hapmoorii | June 4, 2007 6:10 PM

The thing that continues to amaze me in these conversations is that conservatives (and I am one, btw) tend to believe that malpractice insurance is the only problem. We have a patent system abused daily by unscrupulous drug companies. Local, state, and federal government interfere with health care and insurance at all levels, and the entire system is so inefficient that it takes my Doctor 3 months to even figure out how much to charge me. That's not to mention small businesses are routinely screwed on rates, and private insurers won't even touch a cold, much less a real disease. What sense does any of that make? If you're against socialized care, great. I'm with you. Nevertheless, the "socialized" plans (as if we aren't already 3/4 of the way there) sound better right now than kicking a few ambulance chasers in the hind end.

Posted by docjim505 | June 4, 2007 6:25 PM

As I've written before, the average lefty who supports "free" health care is motivated less by altruism than by malicious hatred and jealousy. They'd be happy to settle for "1984"- style health care... so long as "the rich" suffer just as much as everybody else. "See that kid with polio? Yeah, well, his father's rich! But that didn't help his kid! The little rich bastard got polio just like all the other kids! BWAH-HAH-HAH-HAH-HAH!"

As for the arguments put forward that the systems in Canada and the UK aren't very good... Well, lefties STILL believe in socialism / communism despite tons of evidence that they don't work very well, either. You see, the problem is that "the right people" haven't been in charge. If only we'd put "the right people" (i.e. them) in charge, we'd have a health care system that would be absolutely perfect. Everybody would get the care they need the instant that they needed it. Airy, spacious, state-of-the-art hospitals and free clinics staffed with bright, dedicated doctors and nurses would litter our cities, towns, and rural areas. Nobody would have to pay anything for the new wonder drugs that would be discovered every day in labs across the country and would pour from the manufacturing lines. Diseases would be cured overnight by teams of the best researchers, all selflessly working for mankind's betterment instead of lining the pockets of corporate fatcats. There would be no malpractice lawyers because only the best people would ever be doctors, and they would NEVER make mistakes because "the right people" would see to it. It would be a utopia just like... just like... public education!

It's very easy to have perfect, free health care when all the problems can be solved simply by putting "the right people" in charge.

Posted by smylatu | June 4, 2007 6:55 PM

Anyone who thinks we don't already have a government run health care system is kidding themselves - Social security benefits, VA benefits, state Medicaid benefits. They, along with the lawyers and the cushy big-business employed patients with great benefits are all running up the prices. Problem with the gov't subsidized projects is that not everyone is eligible, so the college kids, the lower working class, and the not-so-successful self-employed go without because they can't afford the insurance or the prices charged. The solution is to have gov't subsidized basic coverage for everyone and people who can afford it can continue to bet against themselves by continuing to pay high health insurance premiums. Perhaps this would even the playing field for everyone and allow the market to determine health insurance prices and health care prices. I'm all for limiting gov't subsidized health care benefits for the dumb people who continue to choose to smoke, drink too much, have unprotected sex, etc. Why should my tax dollars go to subsidize their bad behavior? Medicaid pays for way too many (expensive) inhalers for smokers.

Seen it all (as a Pharmacist),

Posted by Joe Doe | June 4, 2007 8:49 PM

"Like all forms of socialism, it doesn’t work!"

Well, in Canada it does work quite well - for the doctors. Have you ever heard of doctors on strike? I watchem them downtown Toronto! They needed protection ...

Posted by Garrett | June 4, 2007 9:49 PM

Since Nationalized Health care is so good, why is there a thriving private healthcare system, whereve it is used?

Posted by Kestrel | June 4, 2007 10:13 PM

We have complete socialized medicine now.
The only ones who get it, however, are
illegal aliens. Think about that when you
write your politicians and tell them that
socialized medicine is a disaster.

You work your tail off, pay your premiums, copays,
and, on occasion, 20% while illegals get it all
for free. No premiums, no copays, no deductible,
zip, zero, nada.

Will those who supply us with a single payer
system be as generous to us as they are
now to illegal aliens?

Posted by Scott | June 4, 2007 10:49 PM

There is another aspect to this issue that I haven't seen tackled yet. We are already seeing the food-nazi's attack certain foods under the guise of keeping health care costs down.

That was the theory about the plaintiffs' lawyers going after tobacco companies on behalf of various states: cancer cost the state millions in health care costs, so tobacco must pay.

Now, translate that reasoning to a single payer system. Suddenly, the government will be tempted to regulate or ban anything that it thinks increases the costs of the health care it must provide. Or, worse, appoint plaintiffs' lawyers to safeguard those costs for us with a whole programme of lawsuits against McDonalds, Nabisco, etc.

Posted by Canuck | June 4, 2007 11:46 PM

Ed and others:

Whenever you debate health care in the US, remember these three points:

1) Health care in Canada is NOT better than in the US, it is worse. We had our first child in the US, second in Canada. No comparison at all. US 10x better. And the irony of it all? The doctor that tended to my wife during her pregnancy in the US and who delivered the baby was originally from Canada.

2) Specialists in Canada get paid truly obscene amounts of money, and do little for it. Many work 4 day weeks in the summer, many take 5-6 weeks vacation a year. I know of at least two, personally, who are incompetent yet they earn enormous salaries. That's what socialized medicine and a doctor's union gets you - ZERO accountability. Nothing. Zip. One of these specialists openly despises his patients and general practioners whenever I bump into him at parties. And he openly mocks the Canadian medical system as being nothing other than a bank that prints money - for him and his pals of course.

3) Whether you are competent doctor in Canada who works hard, or a useless doctor who couldn't care less, you get paid essentialy the *same amount.* Yes indeed, the hallmark of socialism.

I don't know what the right system is for the US going forward, but be very sceptical of those who point to Canada has having a system that is worth duplicating.

Canadians cling to their health care system for no other reason than because they think it differentiates them from the US. In Canada it has become very fashionable to dislike America, Bush, Americans, you name it, and in the usual insecure mindset here people think that by being different to Americans we are therefore better. Ha ha. They will wait forever for a key operation in a useless system as long as they can say they are different than the Americans. How foolish can you get?

The health care system in Canada would have been bankrupt long ago were it not for the fact that Canada has money coming out of the ground in terms of natural resources. Remember that fact too.

Posted by Kevin Fleming | June 5, 2007 7:03 AM

I spent about 4 years researching the examples of the problems people encounter under single payer systems like the UK 's NHS and Canada's Medicare.

It's at the Heritage Foundation.
High-Priced Pain: What to Expect from a Single-Payer Health Care System

Expectation #10: Loss of personal liberty.

"Indeed, a program of government surveillance of all children is being introduced in Britain: “a £224 million database tracking all 12 million children in England and Wales from birth.” Doctors, schools, and the police will have to alert the database for a wide variety of concerns, including information on whether children are eating five portions of fruit and vegetables a day. If a child fails to meet state targets, this could start an investigation. The infor­mation gathered “would include subjective judg­ments such as ‘Is the parent providing a positive role model?’, as well as sensitive information such as a parent’s mental health."

Posted by Geistmaus | June 5, 2007 8:19 AM

A few people get close and a few people get far.

As to the Right of healthcare: The only enumerated Rights you'll find in the Bill of Rights are those necessary to overthrow a tyrannical government. Much to Dr. Rush's chagrin health was not one of those things. But it was addressed.

If you haven't looked in on Rush's writings on the topic it really is instructive. Contra the EU and many others, in the US the unenumerated Right to healthcare is best summed up as the Right to seek whatever treatment you want from whatever source you desire. (Rather than the 'Right' to make a man your slave for sutures and aspirin)

On a separate point: Ambulance chasers are the least of the problem. There really are only 2 large problems, though one is straight forward and the other is quite painful.

The first is the price controls other countries place on drugs. Which is, of course, why it is cheaper to buy American drugs from Canada or Mexico than it is from the location it is manufactured. Call it right or call it wrong but it violates trade agreements. As much as I feel for the Canadians I feel they should share our pain. So to speak.

The second, and worrisome, issue is that of a head on collision between technology, hucksterism and acturial tables. Everyone here already knows that insurance is a risk pool. And they already know that risk pools require an accurate assessment of risk to be worth a darn.

The problem comes in when new "Greatest Treatment Ever!" claims come out on a daily basis that:

a) Aren't any better in either stat or balance based on side effects.

b) Those that fail a above actually do work and do extend lifespan. At a cost not foreseen in the acturial tables. At an increase of lifespan not accounted for in the acturial tables.

Granted there are other problems and granted that Insurers are merely the least detestable of the spawn of the Father of Lies. But it remains that you can only fault the pace of progress or the need for an insurer to keep apace of it and in the black.

Ignoring progress, if the government becomes the insurer then one not only gains the award winning efficiency and respect of one's betters but one also gains the same problems that current insurers face in the march of technology.

So what's the answer? We could stifle technology so that there is less structural inflation for insurers. Or ban the concept of risk pools on the concept of sanity. Or just suck it up and deal with realities.

Also, kill all the lawyers; and Candians that like to price fix one way but not the other. (Softwood anyone?)

Posted by dave | June 5, 2007 8:58 AM

It looks like nobody bothered to click on the Captain’s link. The UK is not requiring all citizens to quite smoking permanently in order to receive health care, but only for four weeks prior to a surgery. This is because recovery times after surgery are longer if you have been smoking. You can go right back to smoking after your recovery and still receive health care. Try reading.

Pat West:

“The British Health Care System, which some of my family experience, is now a disaster. Our Canadian Health System, which was closely modeled on the British, is rapidly becoming a disaster, and a very expensive one.”

Like everyone else on this site, your statements against national health care consist of making unfounded statements off the top of your head, without giving any evidence other than anecdotal. This study compared the health care system of several nations, and they match your statements in one respect. The Canadian system rates equally as bad as the US system. Counter to what you say, however, at least their system is half the price as the US system. It is very well known that the US system is the most expensive. Also counter to what you say, the UK system rates very high:


Also, the Who has rated the healthcare systems around the world. The UK ranks 18, Canada 30, and the US 37. For comparison, Cuba ranks 39.

Kevin Fleming:
Wow. Somebody who actually gives a reference! And look at all the footnotes! And the reference is written by the poster!
I don’t have time to read the whole article, so I picked out one paragraph:

“In cardiovascular care, a comparative study of death rates from stroke and heart disease put Britain’s NHS 13th out of 15 European countries studied. In a 17-nation cancer study, the five-year survival rate for lung cancer in Britain was the worst of the 17; for colon cancer, Britain ranked 12th; and for breast cancer, Britain was 11th out of 17 (just above Slovenia, Austria, Estonia, Poland, and Slovakia).[22] In the early 1990s, Britain had fewer radiotherapists per capita than Poland and fewer medical oncologists than any country in Western Europe.”

There are three sentences. The first references a study, but gives no reference, so it is useless information. The second sentence references a 17 nation cancer study and gives the UK ranking for 5 year survival rates for lung and colon cancer. This is the link that is given for this information (reference 22):


I went to this link, and I am unable to find the information. I see nothing about 5 year cancer survival rates in a 17 nation comparative study. Can you show me?
As for the third sentence, again there is no reference. I don’t think I’ll bother reading the rest of your impressive article.

It took you four years to that? Wow. After all that time and research, were you able to get it published inn a peer-reviewed journal, or was the Heritage foundation the only place you could find to publish that garbage?

Posted by ahem | June 5, 2007 9:03 AM

A simple search of "NHS" at any of the UK newspaper sites (Times, Telegraph, etc.) will illuminate the darkness for anyone who has any lingering doubts about socialing health care. Just read the first few articles that come up. You won't believe your eyes.

Posted by LeaderAX | June 5, 2007 10:07 AM

Wow, Dave, you excoriate someone for using anecdotal information, without credible links, and then go on to use one of your own:
"Counter to what you say, however, at least their system is half the price as the US system. It is very well known that the US system is the most expensive. Also counter to what you say, the UK system rates very high:"

And just some quick questions for you, Dave. If you found yourself with a diagnosis of, say, cancer, in which country would you most want to seek treatment? And why? Where are you most likely to find the combination of well trained physicians,cutting edge diagnostics and therapies?

Posted by dave | June 5, 2007 10:26 AM

I gave a reference for the quote of mine that you site. The problem is, you have to click on it and actually read it.

Kevin Fleming:
I see now that you messed up your footnoting, and reference 22 should actually be this link:


After 4 years you should have corrected these types of errors.
First of all, you say that “the five-year survival rate for lung cancer in Britain was the worst of the 17”. This is wrong. The one year survival rate for lung cancer in Britain was the worst. The five year survival rate was 12th out of 17. You make this mistake because the other two ratings that you give for the UK are five year survival rates, and when you looked at the survival rates for lung cancer, you saw that the UK ranking for 1 year was worse than for the 5 year, so you just used that number instead, since you have an obvious objective in mind when looking at the data.

Using this study for an article highlighting the dangers of socialized medicine is ridiculous. The reason is that the United States is not included in the study, and it is impossible to compare the US system to Europe’s socialized systems by using this study, and to do so is simply misleading. For example, for the five year survival rates of the three types of cancer you mention, France rates in the top five for all three. Other top countries include Sweden, the Netherlands, and Iceland. Isn’t this evidence, then, that socialized systems result in the best survival rates when compared to the US? Of course not! Because the US is not included. Find a study that compares 5 year survival rates between the US and European countries, and then you have some evidence. Your misleading references only fool the idiots on this site.

At first I thought you were just making up references with nonexistent data, but what you are actually doing is not much better.

Posted by dave | June 5, 2007 11:19 AM

Kevin Fleming:
I looked through the paper that you referenced (cw55 ref above) that you say is evidence for the superiority of the US system, even though the US system was not compared. In it I did find that they referenced two other sources that did include the US in the comparison. Since we are talking about the US health care system, these are relevant, unlike what you quoted. So where does the US rank in your reference when compared to other countries? Figure 1 has these results:

Coronary Heart Disease death rates men aged 35-74
1) Japan
2) France
3) Australia
4) Germany
5) US
6) UK
7) Bulgaria
8) Lithuania
9) Estonia
10) Russian Federation
11) Latvia

The US ranks higher than the UK, but not better than other socialized systems such as France. Figure two has these results:

Ischemic Heart Disease death rate
1) France
2) Spain
3) Portugal
4) Greece
5) Luxembourg
6) Poland
7) Mexico
8) Netherlands
9) Canada
10) Australia
11) Norway
12) Germany
13) US
14) Iceland
15) Sweden
16) UK
17) Finland
18) Ireland
19) Hungary

Once again, the US rates better than the UK, but worse than plenty of other countries. So, using the only data in your reference that has any relevance, I see no evidence for the US system having any advantages. If I use this reference in my 4 year study showing how poor the US system is, I’ll make sure to cite you as the source.

Posted by Honky | June 5, 2007 12:10 PM

Socialized medicine will never discriminate against people who have unsafe sex. Look at the disproportionate amount we spend on AIDS research, and the move to call STDs "infections", in order to remove the stigma. We'll discriminate against smokers, seniors, and obese people, but never the promiscuous.

Posted by dave | June 5, 2007 12:35 PM

Kevin Fleming:
I now got around to looking at the paragraph that you quoted in your post above under the heading “Loss of Personal Liberty”. In the paper, the paragraph you quote above is found in the context of you discussing the UK efforts to promote a healthy lifestyle. Your quote, then, gives the impression that the UK government is spending hundreds of millions of pounds to build a database that will track all 12 million children in the UK for things like what they eat. This program, however, has absolutely nothing to do with health care. It is designed to keep children safe in general, and is a response to the death of Victoria Climbie. See



This story has nothing to do with health care, but you twist it in your paper to make it seem like it does. You must resort to the dishonest methods that I have detailed, because there is no way to be truthful and show that the US system is superior. You must lie. I am not surprised that the Heritage foundation prints your garbage.

You are a pathetic human.

Posted by dave | June 5, 2007 1:45 PM

On this thread we have a medical doctor from the Mayo Clinic that spent 4 years researching the issue of single payer health care systems, and he wrote a paper on it containing 200 references. Sounds like it should be a good representation of one side of the argument. I had time to look at two of the references, and found them to be a complete joke (I think if I look at all of them, I will find much of the same. In fact, I think I’ll do so and forward my paper to the Mayo Clinic and his colleagues). There are two possible reasons for this. Either the doctor is an imbecile, or he is being intellectually dishonest and a liar. Considering he got through medical school and got a job at the Mayo Clinic, I suspect it is the latter. But why does he have to lie? It’s because the US health care system sucks. The only way to defend it is to:

a)Find individual horror stories from other countries, extrapolate that one incident to the whole country, and then say the US is better.

b)Do the same as in a), but instead find a meaningless statistic that the US leads, and then extrapolate this to the entire health care system. The Captain took this approach with the number of prescriptions for Avastin that are written in the US vs other countries. To begin with, this is one tiny statistic, and it is ridiculous to claim that it represents an entire health care system. Also, the statistic itself proves the opposite. Which I showed:


c)Be dishonest, like the Mayo Clinic doctor.

Your position is indefensible. Show me one study that compares any aspect of the US system with European systems that show the US on top.

Posted by Kevin Fleming | June 5, 2007 2:11 PM

1. The internet sometimes changes web pages, thereby affecting references. Get used to it.
2. The WHO is biased towards socialist systems, and scores them higher per se. I therefore put little stock in their preferences, except when comparing similar systems.
3. If you had bothered to read the paper, you would have seen that I chose a study that faulted the UK NHS in comparsion to other universal systems. But the vast majority of other systems permit extensive private coverage, unlike Canada and to a lesser degree the UK. And they al do better overall.
4. My paper does not argue the superiority of the US system. You haven't read it, clearly.
5. Your statement that "This program, however, has absolutely nothing to do with health care." is entirely false. It has everything to do with health care.
6. You are flailing. I can always tell that when someone posts excessively and calls people "dishonest" it's a typical response from the left, however.

Posted by dave | June 5, 2007 5:22 PM

Kevin Fleming:

1) “The internet sometimes changes web pages, thereby affecting references. Get used to it.”
The internet can move references around within the body of a paper? Wow. That’s cool.

2) “The WHO is biased towards socialist systems, and scores them higher per se.”
Of course. They’re biased. The US system is really number one, but the WHO is biased, so the rate them 37th. I get it.

3) “If you had bothered to read the paper, you would have seen that I chose a study that faulted the UK NHS in comparsion to other universal systems…”

Examples of single payer countries are Canada, Denmark, Norway, and Sweden. Great Britain and Spain are classified by the OECD as having “national health services”.


Since your primary examples are Canada and the UK, I assume you are talking about both of these systems in your article. So why do you cite a study (the cw55 link) that compares the UK to other countries with universal systems? What does this show? Why didn’t you choose Sweden, which ranks near the top of your chosen stats? If you are trying to show that universal systems are bad, why reference a study that only compares countries with universal systems to each other? That’s like trying to show that American cars are better than Japanese cars by comparing Toyota, Honda and Subaru. It makes no sense. The most your cw55 link shows is that among universal systems, the UK does not rank well in a few areas. But when you compare the UK system overall, like my commonwealth link or the WHO data, you see that the UK system is still better than the US system.

3) “But the vast majority of other systems permit extensive private coverage…”
I don’t see the vast difference in the systems that you see:
All of the systems in Europe are similar, at least when compared to your idea of a tax credit system, which “would make no fundamental changes in the current structure of private insurance” (from your ref #3, “Insuring America’s Health”).

4) “My paper does not argue the superiority of the US system. You haven't read it, clearly.”

Bullshit. What about these quotes from your paper:

“In 2000, the NHS had nine critical care beds per 100,000, compared to 31 per 100,000 in the United States.”

“To make a living, NHS dentists see an average of 30 to 40 patients per day, compared with the 12 per day seen by dentists in the United States.”

“The United States is more productive in the treatment of breast cancer, lung cancer, and cholelithiasis than Germany and Britain.”

“Today, the United States has high neonatal intensive care capacity, with 6.1 neonatol¬ogists per 10,000 live births; Australia has 3.7 per 10,000; Canada, 3.3 per 10, 000; and the United Kingdom, 2.7 per 10,000. The United States has 3.3 intensive care beds per 10,000 live births; Australia and Canada have 2.6 per 10,000; and the United Kingdom, 0.67 per 10,000.”

“But waiting means a diagnosis delayed or deferred, ‘and Canadian patients may be more incapacitated before they receive the same high-technology care that they would receive in the United States.’”

“Further, much of the country’s diagnostic equipment is ‘so outdated it would be not be used by radiologists in the United States.’”

Don’t give me that crap that you’re not comparing national systems to the US. That’s exactly what you’re doing. You are simply unable to make any direct comparisons, because there are no direct comparisons that exist where the US comes out on top. So instead your method is to attack the other systems, without any direct comparisons.

5. “Your statement that ‘This program, however, has absolutely nothing to do with health care.’ is entirely false. It has everything to do with health care.”

Even more bullshit. Here is the article you cite:


Here are the related articles that the article above references:






THE ARTICLES ARE ABOUT CHILD ABUSE, NOT HEALTH CARE. Not a single article above even contains the term “health care” in it. But you say it’s about health care. What an ass.

6. “You are flailing.”
Right. If you’re an example of a typical health care provider in the US, my best proof of the state of health care in the US is your 4-year “study”.

Posted by Kevin Fleming | June 6, 2007 6:47 AM

It's been something short of a pleasure. You aren't here to debate anything at all, so I won't waste my time. Please declare victory and go home, I suspect that's your usual technique.

Had you wanted an actual discussion on the merits of a single payer system, I'd be happy to oblige. But you strike me as the shrillest of partisans, unable to be civil for even a moment.

The US public may or may not prefer a single payer system. My paper attempts to explore the downsides to such a choice, aspects routinely ignored in these discussions. But you are incapable of having that debate, it appears, instead preferring the ad hominem to evidence. So be it.

Posted by dave | June 6, 2007 8:11 AM

Kevin Fleming:
“My paper attempts to explore the downsides to such a choice…”

And you do it by lying. Here are the two paragraphs that precede the paragraph you quoted above:

“In Britain, the annual cost to the NHS of diet-related diseases is estimated to be in excess of £15 billion. “Eventually, the UK will not be able to afford the health care made necessary by inappropriate lifestyles and diet.” Thus, the British are seriously entertaining a proposal for a “national nutrition strategy,” including an independent agency with regulatory powers. Quite beyond simple nutrition education, such a national approach would also consider a “fat tax” or imposing legislation on the food industry to achieve the desired product development, marketing, and pricing goals. This might include “using government purchasing power to expand the market for fresh healthy foods while counteracting the current subsidies supporting the ingredients in high fat/sugar/ salt products” and placing restrictions on “the marketing of junk food to children.” In addition, television shows and Internet sites would be altered “to ensure the support of active, healthy lifestyles.” This might also entail compulsory consumption of a specified diet or, as suggested in the NHS, population-wide use of a “Polypil” or even a “Polymeal” to reduce the national rate of heart disease. Expansion of government control over “transport and rural development policies” was also recommended to increase the level of physical activity.”

Here you are talking about the how the NHS sees inappropriate lifestyles, such as obesity, as being a drain on the health care system, and you talk about their plans to enact some regulations to address this that sound excessive. I have not had the time to check these references, but I will assume they are accurate, which is a big stretch.

Next comes the paragraph that you quoted above, which talks about a database costing hundreds of millions of dollars and “doctors, schools, and the police will have to alert the database for a wide variety of concerns, including information on whether children are eating five portions of fruit and vegetables a day. If a child fails to meet state targets, this could start an investigation.” In the context of the previous two paragraphs, it is quite clear that you are claiming that this is just another draconian measure being enacted by the NHS to monitor obesity. This is a deliberate lie. As shown in the links above, the database relates to an issue of child abuse, and has absolutely nothing to do with health care or obesity. You are a liar, and Alan Dershowitz would be proud of your ability to mangle and distort a reference to manufacture an otherwise untenable position.

“Had you wanted an actual discussion on the merits of a single payer system, I'd be happy to oblige.”

It is impossible to have a reasonable discussion with a liar. And when a liar gets caught in his lies, he takes the "high road", calls the opponent uncivil, and declines to defend his lies. It's the only response available. I don't think it fools anyone who cares to read your paper critically.

“But you strike me as the shrillest of partisans, unable to be civil for even a moment.”

I can be civil with people who have a different opinion than myself, as long as their position is sincere. Most people on this site are moral and honest, they have just been delude by hucksters such as yourself into believing things that do not reflect reality. It’s the people like yourself that make me sick, and I have no desire to be civil with you. You know that you are lying, and you don’t care because you are benefiting personally from your lies. That is what makes you disgusting.

Posted by Kevin Fleming | June 6, 2007 8:37 AM

"I have no desire to be civil with you ....I have not had the time to check these references ...mangle and distort ...a deliberate lie ...from your lies ...disgusting ... make me sick"

Res ipsa loquitur.
I wish you better days.

Posted by dave | June 6, 2007 9:45 AM

Kevin Fleming:
If you were ever cornered into defending your paper and its lies, you would look like a complete idiot, so I am sure you are grateful that I used the derogatory terms I did. It gives you an "out" by being able to make a response, no matter how lame it might be (and the Latin phrase was a nice touch). Your complete inability to address anything I said speaks volumes.

Posted by dave | June 6, 2007 10:16 AM

BTW, it took me about 20 minutes of reading to show that your 4 year project was garbage. Funny.

Posted by Kevin Fleming | June 6, 2007 1:52 PM

I would guess most people would judge you had made that decision well before reading only 20 minutes' worth of material, and you parsed those items that confirmed your pre-set bias. Your filter is a poor one, however.

You sound very much like the same "dave" at Althouse, BTW.

Posted by dave | June 6, 2007 3:02 PM

Could you please do me one favor? Your original quote relates to an article from the Telegraph that talks about a database that was started in response to a child abuse incident. The database was started to try to ensure that similar child abuse cases could be discovered before a similar tragedy could happen again. In one part of the Telegraph article, they mentioned tracking meals, and you connected that to your discussion on NHS monitoring obesity of UK citizens. Please, oh please can you explain to me how the Telegraph article that talks about a database created for monitoring child abuse relates to the NHS monitoring the obesity of its citizens, or how it relates to health care in general. I have said nothing derogatory in this post, and have said please twice. I am sorry, and I have changed my ways. Can you please explain to me?

Posted by Kevin Fleming | June 6, 2007 3:45 PM

Nutrition, weight, and "a parent's mental health" are cited in the article as areas for state concern; these are certainly medical issues. Moreover, it states that "Doctors, schools and the police will have to alert the database to a wide range of "concerns"." and "critics say the electronic files will undermine family privacy and destroy the confidentiality of medical, social work and legal records."

In the UK, Canada, and the US, child abuse has long been referred to as a health care issue, one that demands intervention from medical providers.

In addition, the point of that section was a reference to the tendency of the Nanny State to supercede private decisions in all aspects of life and call it "health care" or "safety" or whatever it chooses, but the primary goal is advancing control of the State over the Individual.

In parsing what is and is not "health care", you are missing the forest for the trees.

P.S. Are you dave©TM ?

Posted by dave | June 6, 2007 4:26 PM

Parsing what is and is not health care is not the issue. The issue is that when you talk about the database for preventing child abuse, you give absolutely no indication that that is what the database is for. You spend two paragraphs talking about the NHS monitoring healthy lifestyles and obesity in UK citizens, and then you start the next paragraph with:
“Indeed, a program of government surveillance of all children is being introduced in Britain…doctors, schools, and the police will have to alert the database for a wide variety of concerns, including information on whether children are eating five portions of fruit and vegetables a day.”
By using “indeed”, you are specifically linking what you were talking about previously with the idea of a database monitoring if children are eating fruits and vegetables. You deliberately make it sound like the NHS is keeping track of every child in the UK and whether or not they eat vegetables in order to keep track of their lifestyles as related to obesity. You give no indication that the database relates to child abuse. Don’t you think that is an important detail? Do you deny that you omitted it intentionally? Do you think a reader might think differently about a database depending on whether it is being used to track obesity or if it is being used to monitor child abuse? Don’t you think people would view these issues differently? In your original quote on this thread, where is the mention of the databases relation to child abuse? We both know what you are doing. I just want to hear you claim that you had no intent to relate the database to your previous discussion on monitoring child obesity. It will be entertaining for me.

I do not know what althouse is.

Posted by Kevin Fleming | June 6, 2007 5:28 PM

The NHS is keeping track of every child in the UK and whether or not they eat vegetables in order to keep track of their lifestyles as related to obesity, partly under the guise of "child abuse".

In fact, the UK is keeping track of all its citizens on many levels, including cameras in the streets and via doctors, nurses and social workers in the NHS who keep government databases on children in order to monitor "parenting skills" and "abuse".

This points out the connection between statism and government use of health and police agencies to monitor its citizens and thereby deprive them of liberty.

Posted by dave | June 6, 2007 6:52 PM

“The NHS is keeping track of every child in the UK and whether or not they eat vegetables in order to keep track of their lifestyles as related to obesity, partly under the guise of ‘child abuse’…This points out the connection between statism and government use of health and police agencies to monitor its citizens and thereby deprive them of liberty.”
Hilarious. An even more entertaining answer than I expected. In response to the Victoria Climbie abuse case, the UK government sets up a database in order to try and prevent future cases of child abuse. But in your view, that is not really what they are doing. What they are really doing is monitoring the children in order to find out if they are getting obese, so then they can deny them coverage. That’s quite a good conspiracy theory you got there. Do you also think that the UK government was responsible for Climbie’s death? Maybe the government killed her as a pretext for setting up this database? Awesome. You should have included that insight in your paper.

I also have a question about the following paragraph of your paper:

“Traditional medical ethics are likely to be subordinated to political fashions. For example, euthanasia is often promoted by its champions as a last resort to alleviate suffering, but the Netherlands already has moved “from assisted suicide to euthanasia, from euthanasia for the terminally ill to euthanasia for the chronically ill, from euthanasia for physical illness to euthanasia for psychological distress and from voluntary euthanasia to nonvoluntary and involuntary euthanasia.”[194] Such “termination without request or consent” has been applied to Dutch infants as well. The concern has been that public health system rationing may exert pressure not just to limit spending on certain individuals, but also, either subtly or overtly, to coerce them to be euthanized.[195]”

First of all, your reference for number 194 cites an oversite hearing held at the House of Representatives. Hendin actually did not testify at that hearing, but his paper was entered as a statement. The paper is from “Suicide and Life Threatening Behavior”, Spring, 1995, 25(1), page 193. Citing the article directly instead of a congressional hearing that Hendin did not even speak at would make the reference easier to find, unless you don’t want people to find it. Anyway, your quote is wrong. The part where you say “from euthanasia for physical illness to euthanasia for psychological distress” actually reads “from physical suffering to mental suffering”. Maybe the internet changed that, huh.

Anyway, your quote relates to euthanasia, and whether it can be abused under a national health care system more easily than in a private system. If the US adopted a universal health care system and kept euthanasia illegal, then this issue you bring up would be moot. Couldn’t we just do that? Maybe you are worried that if the US adopts a national health care system, the evil Democrats would attach a rider on the bill making euthanasia legal. In that case, you are worried about the consequences. Seems like a stretch, but let’s consider it.

So is euthanasia more liable for abuse under a national health care system or a private system such as the US has now? Interestingly, the article you cite (Hendin “Suicide, Assisted Suicide and Euthanasia in the Netherlands: Lessons from the Dutch”) addresses this very issue. It says:

“Virtually all Dutch advocates of euthanasia familiar with the United States see our legalizing euthanasia as unwise for a variety of reasons…They cite social and economic disparities in health care as another source of contention and recognize that without comprehensive care for the sickly poor and elderly, euthanasia will tend to become their only option. The Dutch believe their hospitals are not subject to the economic pressure to get rid of the terminally ill that would be present in this country. The relative absence of the family doctor, the core of medical practice in the Netherlands, eliminates what the Dutch perceive as a major source of patient protection. Further contaminating the process in the United States would be the difficulty of preventing the profit motive from making euthanasia and assisted suicide a lucrative business.”

So the article you cite says that euthanasia would be more of a problem in a private system than in a universal system. It seems strange that you would cite an article that makes the opposite claim than what you are trying to make. I certainly see why you did not quote that passage.
(BTW, that same article you cite also says “Care for the terminally ill is better in the Scandinavian countries than in the United States and in the Netherlands”. Interesting.)

You also cite Congressional Testimony from Lonnie R. Bristow to support your case. Strangley, you do not have any direct quotes from him, however. In Bristow’s testimony that you cite, he says:

“Health coverage is universal in the Netherlands, the prevalence of long-term patient-physician relationships is greater and social supports are more comprehensive. The inequities in the American healthcare system, where the majority of patients who request physician-assisted suicide cite financial burden as a motive, make the practice of physician-assisted suicide all the more unjustifiable.”

Again, you cite an article that says the exact opposite of what you claim. You seem to have a habit of making a claim, and then giving a reference that makes the exact opposite claim. This is a strange and baffling practice.

There are also no quotes from the Lancet article that you cite. This is probably because that article makes absolutely no mention of relative risk of euthanasia abuse depending on the type of health care system. I guess you included that ref because the Lancet is a fancy sounding journal.

Any comment?

Posted by dave | June 6, 2007 8:17 PM

I see your going to be on CQ radio tomorrow. Hilarious. Maybe you want to save your answer about why your references say the opposite of what you do for the show.

I think I'll start working on looking at the rest of your "study". This is really getting fun.

Posted by dave | June 6, 2007 10:02 PM

I have another question. At one point in your paper you give some statistics for neonatal intensive care capacity where in both categories, the US comes out on top, and the UK comes out on the bottom. You then say:

“While American ‘overinvestment’ in lifesaving of premature infants may come at the expense of proportionately less support for preconception and prenatal care, British neonatal intensive care capacity is far below that found in nearly every other Western nation.”

First of all, the study in your “Pediatrics” references includes the US, UK, Canada, and Australia. There are considerably more than 4 Western nations, and to reference a study of 4 nations and conclude that the British capacity is “far below nearly every other Western nation” is quite a stretch. Also, I think you understate the key findings of the study, which are the following:

“…our data show that the relative emphasis toward neonatal intensive care resources in the United States is not associated with better birth weight-specific survival” and “…this study questions the effectiveness of the current distribution of US reproductive care resources and its emphasis on neonatal intensive care.” And finally, “...as the current study shows, the outcomes of the total US birth cohort lag behind similarly developed countries, despite the best funded system of neonatal intensive care in the world.”

So you say how great the US is for having such great neonatal intensive care resources, but what the study finds is that this does not make any difference. That kind of ruins your stats, huh. They also found this:

“One unexpected finding of our study is that the US infant mortality rate for infants greater than 2500 g is significantly higher than those of the other 3 countries. If the United States were able to reduce mortality in this group to the rate in Canada, (2.6–2.3 per 1000 live births) this would prevent almost 3000 deaths.”

I must say that its rather impressive to take an article that is generally critical of the US system, and makes no criticisms of the UK system, and somehow make it sounds like it says the opposite. Quite impressive.

Posted by dave | June 7, 2007 8:01 AM

Another question. In your article, you say this:

“Cost constraints in Britain mean that the NHS does not pay for newer cancer treatments that are widely available in the U.S., including colon and breast cancer chemotherapies.”

For breast cancer, you give this reference:

This article is from February 15, 2006. At that time, Herceptin was approved by the NHS for late stage breast cancer, and you article shows a woman who lost her court case to try and get the drug approved and covered for early stage breast cancer. Let’s first compare the situation for late stage breast cancer. At that time, Herceptin was approved by the NHS for late stage breawst cancer, and was therefore given to UK patients free of charge:


Herceptin cost about $36,000 a year in the US. For people without insurance, it is highly likely that they won’t have the money for it, so they don’t get it. And even for those with insurance, copayments can still be quite high. This woman who has insurance still pays $9,600 per year out of pocket for her Herceptin:


So far, the UK system sounds pretty good. But what about early stage breast cancer? By June 9, 2006, the NHS had accepted Herceptin for early stage breast cancer:


So even for early stage breast cancer “…all women will get treatment free - probably in England and Wales, and most definitely in Scotland. When the NHS watchdog, NICE, recommends something, it means approving a treatment to be provided by the NHS, which is free.


So what was the situation in the US for early stage breast cancer? It was not until November 16, 2006 until the US approved Herceptin for early stage breast cancer:


So Herceptin was not approved in the US until 5 months after the NHS had approved it. And remember, US patients have to pay a high price for it, even if they have insurance. Not quite the picture you painted, is it.

But what about off-label use? Even if Herceptin was being prescribed in the US off-label for early stage breast cancer, I doubt if it is accurate to call off-label prescribing being “widely available”. One reason is that “without FDA approval…the drug may not be covered under your health insurance”:


So even if you could get it prescribed off-label, you still will probably be paying $36k a year for it. Another factor that most definitely limited its off-label use was that the FDA “…effectively [issued] a warning on an off-label usage” of Herceptin for women with early stage breast cancer. I think that an FDA warning probably put a big damper on doctors prescribing it off-label.

Overall, I think the NHS fairs rather well in this comparison. Certainly better than your description.

For colon cancer, the article you link to is about Avastin. While it is true that the NHS does not cover Avastin, there is a good reason, which I detailed here:


In the last paragraph of my post there, I said “In Europe, this is the approach that would be taken”. This turns out to be true. The NHS has approached Avastin for macular degeneration. For that indication, NHS get Avastin for free, and Avastin is at least as expensive as Herceptin. In the US, however, Avastin is not approved for macular degeneration, because Lucentis is instead. Lucentis is no better than Avastin for macular degeneration, but it costs 40 times as much. For that reason Genentech will not even apply to get Avastin approved for that indication. So for macular degeneration, NHS patients get it for free, and US patients must use a drug that costs 40 times as much and does not work any better. They must also either pay for it if they have no insurance, or at least pay the copay, which for this drug, is substantial.

Posted by dave | June 7, 2007 11:52 AM

Your report says this:

“Proponents often tout the Canadian focus on preventive health care, but the truth is that key services such as immunizations for children, routine eye exams, and physiotherapy services are only partially funded.”

This is incorrect, I suspect intentionally. What your reference says is:

“In an implicit tradeoff for funding new immunizations for children, services that were
previously partially covered by the Ontario Health Insurance Program were scheduled to
be de-listed in the upcoming year. These services included routine eye exams, partial
payment of chiropractic visits, and those physiotherapy services that remained publicly

So you are correct that routine eye exams and physiotherapy services are only partially funded, but this was done in order to pay for immunizations. Immunizations are covered. I am sure that was an honest mistake, huh. So things like routine eye exams are only partially funded. How many people in the US get fully funded eye exams?

Then your paper says:

“Provincial governments are mandated to fund only a partial list of ‘medically necessary’ services universally, while essential items such as insulin for diabetics or ventolin for asthmatics are often not publicly insured, but instead must be purchased privately.”

For insulin, what was delisted was insulin detemir. See:


There is a reason for this, however. Here it is:


The reason is that the clinical benefit of insulin detemir does not justify the additional cost in comparison to NPH insulin. NPH insulin, however, is still fully covered.