And I’m not exactly expressing these things myself– I understand the tradeoff of increasing access and decreasing quality of care for the currently insured, and I’m not against it. But the tradeoff is real, and ignoring it is a big barrier to building the political will to getting healthcare reform done.

Anyway, I got the point of the DKos story– which is why I kept making caveats about how you have to have good insurance, first, and people in a charge-the-employer-more-next-year situation… don’t. The system’s grant of access is totally sick, but there are entrenched interests here by more than just insurance companies, and that needs to be acknowledged– that otherwise perfectly decent people will get worse care because of healthcare reform. It might be worth it for you, and for people who have bad insurance or no insurance, or for anyone who feels generous on this subject, but for a lot of those people, it isn’t worth it, especially if they have a chronic condition for which they’ve gotten outstanding care.

Like I said, my datum about life expectancy was from a law school professor… but the stat isn’t just “life expectancy”, it’s “life expectancy for people at age 85″– it’s only the life expectancy for people who have already lived to age 85. you’re right that the U.S. is way behind on other life expectancy lists, in large part because the only people who live to age 85 are people who have good insurance, so they just keep on chugging with their better-than-medicare coverage.

With that said, you and I are always going to be talking past one another on this issue. You seem to be overly concerned with “ohmigod, I’ll never get to see a doctor if those proletarians are clogging up the waiting room!!111!!!” I don’t see this as a problem, but for those who do, there is already a “solution” in operation: concierge care. You and your wealthy friends merely pay a premium charge to a physician who is on retainer. That physician will then see you, with no fear of having to rub elbows in the waiting room with anyone not of your station. Think of it as belonging to a country club. Meanwhile, with universal care with the public option, mere working people like me won’t be without. I’m working right now, so I have insurance. It’s pretty damn expensive (I’m a union member; it’s a negotiated benefit). The time will soon come when we—the union members and contractors who have formed the self-funded insurance plan—will no longer be able to deal with the high cost of insurance. Then the lion’s share of us will not have insurance. We’ll be planning our funerals in the event of cancer, instead of our regimen of treatment. You can’t host enough spaghetti dinners to cover that cost (though people try—sometimes they get a really good turnout and even clear a thousand dollars!).

I can’t help but notice that the only thing you took away from that story on DKos is the issue of quality of doctors. You completely glossed over the job loss, the common occurrence of firings to save on health insurance, the effect that those things have on the lives of people. That wasn’t an abstract story; a person is connected to that story, and she isn’t the only one.

When I look at our current system of delivery for healthcare, I can’t help but see it as a building that is in the process of falling down. An old, dilapidated building that has cleary seen better days, and still has remnants of beauty and function that are still visible, but whose foundation is badly damaged. It’s only a matter of time. And it doesn’t have to be this way.

And….what Meowser said. A major contributor to the high cost of healthcare here is lack of access to basic healthcare at the beginning stages of a disease or condition, that cause that disease or condition to advance to the point where it is more difficult and expensive to treat. Uninsured people can only receive care at the emergency room, which is more expensive than at a clinic. The question is: do we want a modern society with a modern economy or not? If the answer is “yes”, then we need a public option. If we want a feudal economy, then we just need to let the current course proceed.

One more thing for Flash—where are your statistics for the U.S. being number one in life expectancy? All the graphs I’ve seen show the U.S. as being somewhere between the mid-thirties and low forties among a list of nations. The only consistent statistic I’ve seen on the U.S. is that we spend the most, yet don’t see results consistent with that spending. And Flash? Brevity is a virtue.

I just don’t see how people can run around swaggering that “WE’RE NUMBER ONE!” and then turn around and say we’re the only industrialized nation on earth that can’t manage to make healthcare available for everyone who needs it. That’s just ridiculous. And yes, there will need to be increases in primary care providers especially, but nurse practitioners can do that job just as well as MDs or DOs, and they can be trained a lot faster, too.

Healthcare costs that insurance companies are most scared of are from chronic conditions. Unlike a broken bone, these costs are there for years and usually get worse. A major contributor to chronic conditions is obesity which is far higher in US. Even worse, it is higher in the poorer sections of society which will be added to insurance rolls (public or private) if some of the plans pass and no insurer would like to have them.

And, even setting that aside, doctor quality isn’t the only factor influencing outcomes or infant mortality– those are driven by access to care, resources available in the course of care, genetic diversity in the population (we’re much, much more diverse than any of the countries discussed. And if you want to see how genetics drives those statistics, consider the case of Utah, with about the highest life expectancy in the U.S.– it’s not just because Mormons abstain from alcohol. It’s environmental and genetic. Utah is 95% white.), etc. Doctor quality isn’t really an issue until you get to tricky stuff– like how, in that story you linked to about the woman with leukemia, her doctor told her she should, no-way, no-how, go to a local or regional hospital, but had to go to a research hospital. So, a) she had a very good doctor at that moment, and b) he knew the other doctors in his area weren’t good enough.

So the factor that often indicates “quality” when you’re dealing with fields that depend on research and development is frequency of citation. The U.S. leads that in spades, even if you account for population size. You can see total citations for all scientific papers here: http://sciencewatch.com/dr/cou/2009/09janALLPAPRS/

And see what the most-cited papers in medicine have been, lately, here: http://sciencewatch.com/ana/hot/med/09sepoct-med/
http://sciencewatch.com/ana/hot/med/09julaug-med/

I did my homework on those papers that are indicated as being international, and almost all of them are dominated by U.S. authors.

and

And then, of course, the doctors aren’t as good

Can you refer me to a link that shows that what is offered as “general public” healthcare is substandard? Or that demonstrates some objective parameter for your assertion that the doctors aren’t as “good”? (not as well educated? not as well trained? poorer patient outcomes than in the U.S.? what?) I ask because the only statistics that I’ve seen are the general ones that reference life expectancy and infant mortality rates, which are better than in the U.S.; that leads me to believe that the physicians must be more than adequate and/or that the way the heathcare system runs is superior.

In France, there’s this: More than 92% of French residents have complementary private insurance. This insurance pays for additional fees in order to access higher quality providers. Private health insurances makes up 12.7% of French health care spending. These complementary private insurance funds are very loosely regulated (less than in the U.S.) and the only stringent requirement is guaranteed renewability. Private insurance benefits are not equally distributed so there is, in essence, a two-tier system… Which is what I was proposing. But can you sell a universal healthcare package that’s, you know, crap? If we make it cheap enough, you’ll be able to just keep everyone on life support, I guess, sort of. We’re bigger than France and have twice as large a portion of the population (France’s 6% to our 12-17%) living below the poverty line and therefore not paying in.

Also, in France, billing and recordkeeping are organized by the government. We don’t have this because of, among other things, privacy concerns; in the 90s, non-centralized and highly-private record keeping became a big deal in the U.S. because people didn’t want their employers to know they had AIDS. Also, people applying for all sorts of insurance policies– not only health, but also life– want these records to be kept secret. So, things are different in France because the costs are spread out among more people and there are systemic differences that make healthcare cheaper. These might be some of what the President is referring to when he talks about limiting inefficiencies in the current system, but he needs to make that clearer. Also, French doctors earn about 40,000 Euros/year, which, even if you turn that into dollars at roughly $80,000, is a lot less than what U.S. doctors make. This is partly okay because French medical school is free, while U.S. medical school is not, so French doctors don’t have 100,000 Euros of debt to pay off. All the same, you lose the support of the U.S. medical community the second you start talking about changing compensation or practices.

Switzerland has, essentially, no poor people. Only 3% of the country relies on government assistance. when everyone works and pays in, it’s easy to have good healthcare, because there’s plenty of money around to provide the right incentives. It’s great to be a doctor in Switzerland. If you can motivate more brilliant people in the U.S. to become doctors by increasing compensation, you can have broader medical coverage. Also, in Switzerland, healthcare is all private; the companies are just prevented by law from making a profit on basic coverage, but still have to compete against each other to get basic coverage customers, so they can convince some of their basic coverage customers to buy the profit-permitted add-on coverages, for things like, uh, dentistry. you can picture how this would play out in the U.S.; the profitable coverages, and the basic coverages, would all put their focus on getting the people who have health insurance now anyway (i.e. people who can buy the add-ons), while people in communities without coverage now would be getting, you know, half-hearted motions in the direction of coverage. this is partly because of how dramatically economically segregated we are in this country.

And then, in Japan, the hospitals are all going bankrupt.

So there’s the reasons why European plans wouldn’t work here the way they do over there. Part of it is BS cultural posturing (why NOT have centralized recordkeeping and take that item off hospitals’ budgets? Privacy seems to be in the same category as those accusations of haughty individualism the Europeans like to throw at us), part of it is economic (i.e. we all know the U.S. is lousy with economic disparity, so there would be a higher percentage of the population not paying in, and a lower percentage paying in), and part of it has to do with the medical profession as it exists in the United States (insurance companies pay for doctors’ education, sort of. Also, we respect our doctors more.).

But what if you expand the ranks of medical schools by 20%, and then create a two-tiered system where the bottom 50% get put into the public insurance system, and the top 50% go into the private insurance system, which would address the issue of doctor quality for people getting private insurance, would expand the resources of the system to accomodate more participants (over time; this would take a decade to really hit), and would keep compensation and quality of care options for medical professionals available to enough of them to make it a real possibility.