Should Wealth Determine Health?

Well Certainly! After all if God didn’t give you the wherewithal to become rich he didn’t intend you to survive.
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I am surprised that you even asked the question.

“By some important measures, the American medical system provides better and more advanced care for patients than systems in the countries also included in this report: France, Britain, Canada and Germany”
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Interesting point, it would be great to have a link to some of these measures.

Interesting article. I recall during the health-care debate that Republicans said nobody in the America goes without health care. It’s almost as if they were lying or something.

It’s quite simple; if you’re rich, you have good odds of surviving. If you’re poor, sucks to be you.

In a capitalist country with moderate and reasonable regulation and minimum govt intrusion, where freedom and liberty prevail, the economy is healthy and philanthropists support hospitals, just as they did in early America. Given that taxes are relatively low and reasonable, workers are free to work, work is available and they can afford health care. If health care providers advertised prices and were allowed to compete without govt interference and millions of freeloaders (aka Illegal aliens) didn’t put excessive demand on services, health care would be available and affordable for all.

I agree, that is an important measure.

Nice statement!
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Prove it!

Since you brought it up, isn’t it ironic that Repubs are falling all over themselves on immigration reform yet the rate of illegals entering the border has slowed to a trickle…under a “Democrat” adminstration, no less? So now the problem should be focused on what to do with those who are here illegally – and no, deporting ten to fifteen million of them isn’t the answer.

Let’s see. Put all of the dollars available into a big pie. Cut the pie into various segments to allocate for the various Government programs.
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No matter how you cut up the pie, it is still not big enough for most liberals who advocate for free government paid for services.
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Eventually what you have is a pie which you can no longer get anymore slices for people to eat. Some will have to do without or, imagine this, they will have to go out and work to get it themselves.
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So the moral of this story is, let them eat pie until there is no more pie to eat.

Should Wealth Determine Health?

Silly question. In the US, the push from the far right is to make wealth determine everything about one’s life, including health.

“By some important measures, the American medical system provides better and more advanced care for patients than systems in the countries also included in this report: France, Britain, Canada and Germany”

My (2007) data says the opposite, although I guess it depends on your measures. My measures are life expectancy and infant mortality. In the USA we pay nearly *twice* what Europeans pay for health care, and we have both higher infant mortality and lower life expectancy than most European countries. In the table below, im = infant mortality and L = life expectancy. See http://www.infoplease.com/ipa/A0004393.html for infant mortality and life expectancy; see http://www.oecd.org/dataoecd/46/33/38979719.pdf for costs.

United States — im= 6.4, L= 78.0, cost $7290, 16.0% of GDP
Canada ——— im= 4.6, L= 80.3, cost $3895, 10.1% of GDP

Austria ——– im= 4.5, L= 79.2, cost $3763, 10.1% of GDP
United Kingdom — im= 5.0, L= 78.7, cost $2992, 8.4% of GDP
Denmark —— im= 4.5, L= 78.0, cost $3362, 10.4% of GDP
Finland ——- im= 3.5, L= 78.7, cost $2840, 8.2% of GDP
France ——– im= 4.2, L= 79.9, cost $4763, 11.0% of GDP
Germany —— im= 4.1, L= 79.0, cost $3527, 10.4% of GDP
Greece ——– im= 5.3, L= 79.4, cost $2727, 9.6% of GDP
Italy ———– im= 5.7, L= 79.9, cost $2686, 8.7% of GDP
Norway ——- im= 3.6, L= 79.7, cost $4763, 8.9% of GDP
Spain ——— im= 4.3, L= 79.8, cost $2671, 8.5% of GDP
Sweden ——- im= 2.8, L= 80.6, cost $3323, 9.1% of GDP
Switzerland — im= 4.3, L= 80.6, cost $4417, 10.8% of GDP

USA has 36 days longer life expectancy than these two countries!
Ireland ——- im= 5.2, L= 77.9, cost $3424, 7.6% of GDP
Portugal —– im= 4.9, L= 77.9, cost $2150, 9.9% of GDP

According to David Frum (special assistant to president, 2001-2), between 2000 and 2007, the cost of the average insurance policy for a family of four doubled. See http://www.frumforum.com/the-bush-economic-record-blame-healthcare
(somthing is chopping URLs; this should end with /the-bush-economic-record-blame-healthcare)

This data begs the question “how is it possible that universal care can lead to lower overall costs?” The short answer is preventative care. Going in for regular doctor visits catches many diseases in their early stages before treatment gets expensive. Our system cause many people to forgo preventative care and wind up in the emergency room, where care is most expensive but costs can be shifted to the society at large.
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“…Our system cause many people to forgo preventative care and wind up in the emergency room, where care is most expensive but costs can be shifted to the society at large”
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But the alternative, Obamacare, is just plain evil!

Alternatively, you could live in a country where people have better access to health care.
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Among Americans responding to the survey, they said, 26.5 percent reported reducing their use of routine medical care since the start of the global economic crisis in 2007.
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This proportion dwarfs the comparable numbers for other countries: 5.3 percent in Canada, 7.6 percent in Britain, 10.3 percent in Germany and 12 percent in France.

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Of course, the other countries mentioned are Maoist regimes, so there’s that.

More good news about ObamaCare.
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“Avastin, the world’s best selling cancer drug, is primarily used to treat colon cancer and was approved by the US Food and Drug Administration in 2008 for use on women with breast cancer that has spread.
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It costs $8,000 (£5,000) a month and is given to about 17,500 women in the US a year. The drug was initially approved after a study found that, by preventing blood flow to tumours, it extended the amount of time until the disease worsened by more than five months. However, two new studies have shown that the drug may not even extend life by an extra month.
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The FDA advisory panel has now voted 12-1 to drop the endorsement for breast cancer treatment. The panel unusually cited “effectiveness” grounds for the decision. But it has been claimed that “cost effectiveness” was the real reason ahead of reforms in which the government will extend health insurance to the poorest.
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If the approval of the drug is revoked then US insurers would be likely to stop paying for Avastin.

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Now what does this all mean?
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It means even if you have the money, and you can afford the more expensive policies, drug companies will not include these medications on the formularies because the FDA and ObamaCare Government types have determined “it is just too expensive”.
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No longer will people themselves with their doctor decide what is in their best interest, but it will be predetermined by some government bureaucrat and most likely some skewed study.
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The case for ObamaCare is clear. Should you be unfortunate and you get Cancer, your hope will be ripped out of your mind, and you will simply be told by our liberal friends……………
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“Your life is no longer of any value to the rest of us…………we simply want you to DIE QUICKLY”

Rusty, over the weekend: “How about this idea, why don’t you just simply eat $hit and die quickly???”*
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At least you’re consistent.
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*http://swampland.blogs.time.com/2010/08/13/obama-breaks-his-silence-on-cordoba-house/comment-page-1/#comment-189943

Kate Pickert:
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By some important measures, the American medical system provides better and more advanced care for patients than systems in the countries also included in this report: France, Britain, Canada and Germany.
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Which “important measures?” In which countries, specifically?
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We know (from you) all about the breast cancer statistics being worse for Britain –which has a completely different health care system than France, Canada and Germany, by the way– but what else are you speaking of?
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Ezra Klein’s November, 2009 piece in WaPo showed data demonstrating the vast discrepancy between what Americans pay vs what these other countries pay for the same unit of health care ( link to the WaPo price comparison column, one of the very few ) . In it, US physician visit fees range up to $151 vs Germany’s $22, US CT imaging scans range up to $1800 vs Germany’s $319, and US drug prices (such as for Lipitor) range from as high as $334 vs Germany’s $48.
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When you ask “Should Wealth Determine Health,” shouldn’t you really be asking “Should US consumers pay more than Germans for health care?”
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Are you making the claim that Germans somehow get “worse and less advanced care for patients” than Americans? In what way? Are their CT scans “worse and less advanced?” How about Germans’ brand-name cholesterol drug Lipitor, Kate Pickert? Is that less advanced, somehow, too?
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And are you making the claim that these countries have worse health outcomes than Americans receive overall?
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Please link to the source of your information, Kate Pickert, so that we may evaluate these claims against the actual data.
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Also, you write:
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Those most likely to cut back on routine medical care, according to the report, are the working poor, the unemployed, and young adults.
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This is the unlevel playing field the newly enacted health reform law is meant to address. The law will expand coverage to some 30 million more Americans and those will coverage will see their out of pocket expenses for preventive care reduced to $0.
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First, that the law was meant to address this aspect of health care, instead of fixing the US health care system so that we pay half the price –what France or Germany pay– and still get First World health care –what the citizens of France and Germany receive– is an amazing statement on your part. Isn’t the “unlevel playing field” really between the citizens of the rest of the First World, and the US tax-payer, who’s getting soaked by a system that eats up twice as much money as France, Germany, etc? Are the insurance needs of “young adults” really what this legislation was meant to address?
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Second, is “$0″ preventative care, e.g. colonoscopies, influenza vaccinations, quit-smoking counseling, really what “the working poor, the unemployed, and young adults” are desperate for?
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As the New York Times also reports:

“About 70 percent of hospitals report fewer patient visits and elective procedures as family budgets remain tight and patients continue to delay or forgo care,” the association said in June.

Aren’t these folks desperate for actual treatment, the kind that they will probably pay the enormous co-pays, co-insurance and deductibles built into the lowest-tier “bronze plan” –junk insurance– offered to them in the proposed Exchanges?
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You aren’t suggesting that actual medical care for those who require it is being subsidized, are you, Kate Pickert? You are aware that the subsidies are for health insurance premiums, most likely for “bronze plan” insurance which carry high deductibles for medical care, aren’t you?
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Look, if a citizen of Germany needs an MRI on their knee, they’re going to get one. If one of the “30 million more Americans” for whom the law will “expand coverage” requires an MRI, they will probably be required to pay a high deductible or co-insurance –sometimes hundreds or thousands of dollars– in order to receive that care. That means they probably will not get the treatment that injury requires. How is this a remedy for an “unlevel playing field?”
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At the very least, will you stop putting the question of health care systems as an either/or between Britain –with a completely socialized medicine system– and America?
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Why do you keep choosing the British as the counter-factual, Kate Pickert? Why don’t you select Germany for your comparisons?
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As the Times report states:

Among Americans responding to the survey, they said, 26.5 percent reported reducing their use of routine medical care since the start of the global economic crisis in 2007.
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This proportion dwarfs the comparable numbers for other countries: 5.3 percent in Canada, 7.6 percent in Britain, 10.3 percent in Germany and 12 percent in France.
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“Even in countries with universal coverage, individuals pay some medical care costs out of pocket,” the researchers noted.
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Cutbacks were generally correlated with the size of out-of-pocket costs, the researchers found. The proportion of people reporting reductions in routine care was smaller in Britain and Canada, where the co-payments are lower, than in France and Germany, where somewhat larger co-payments are required.

So that means the German system is more like the US system, doesn’t it? Higher individual co-pays mean a higher drop-off in “Discretionary health care,” i.e. avoiding what isn’t absolutely necessary to continue living and working.
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And yet, the Germans don’t have anywhere close to the over a quarter drop off in individuals seeking health care that we are experiencing. Why wouldn’t you focus on the differences between the privately based German system and ours? What are they doing right that we’re either doing wrong, or not doing at all?
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Why continue to frame the debate in terms of the GOP and conservative think tanks (more market fundamentalism), vs the Obama Administration and “center-left” think tanks (subsidies and coverage regulations for the system we have), vs “Socialized medicine, like they have in Britain,” Kate Pickert?
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I’m not saying that you’re literally cheerleading for the Administration, but you’re doing exactly what they do: framing the debate solely between their ideas and the GOP’s. Doesn’t this diminish the scope and quality of the discussion? Aren’t you essentially ignoring the rest of the evidence that’s out there?
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Aren’t you missing the real story, Kate Pickert?

“But it has been claimed that “cost effectiveness” was the real reason ahead of reforms in which the government will extend health insurance to the poorest
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A statement not fact! The facts are that the FDA has been lax in it’s oversight siding more often with the drug Co. them with public health; take Avandia for example.
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You base your whole argument on it has been claimed?

What your solution to the above problem?
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Regulating pharmaceutical companies? Can’t do that, it violates The Free Martket™
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Universal Health Care? Good Lord, No! Then we’d all be Socialists!
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Let private insurance take care of it? Well, that will only work IF you have insurance and IF the insurance companies don’t reject your claim. Which happens in at least 21% of cases in California (the ONLY state allowed to collect that data from the insurance companies).
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Or you could just die for having the temerity to get cancer when you make less than a million a year.
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What’s the right-wing, libertarian, neo-conservative solution, Rusty? All I’ve heard is “its the illegals fault” – a common refrain from your chorus.

That movie plays as a continuous loop in your head, huh, Rustcreep?

“But this better care – or any care at all – is sometimes based on income and wealth.”

In 2008 my wife had cancer and came very close to dying. I work for Uncle Sam and have pretty good healthcare coverage. One of the specialists she was referred to made her an appointment-four months down the road- because he was completely booked. I had to go outside of my list of providers and pay all of it out of my pocket because I wanted her to receive treatment while she still had a chance to make it. Luckily, I had the money and she got the care she needed.
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The care wasn’t cheap and came close to wiping out our savings. When you look at the co-pays, deductibles and the amounts that you have to pay before you hit your catastrophic coverage limits, it’s no wonder that many people want public options and nationalized healthcare like Canada. For several months my wife barely had the strength to make it from the living room to the bathroom. Fortunately, she made a complete recovery. We went all out on Christmas in 2008 because both of us felt she might not be around for the next one. If I hadn’t had the money to pay for some of the treatment myself, I don’t think she would be here today.
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People that didn’t have money in the bank might not have been so lucky. Money does mean the difference between life and death in many instances. It’s as simple as that.

Many people look at healthcare reform and a public option as going down the path to socialism and somebody getting something for nothing. I look at it as preventing an empty chair where your wife used to sit and watch a movie with you. Taxes and what percentage the goverment pays to hospitals and doctors are numbers. People’s lives are at stake.

Thanks for your story, sacredh.
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…it’s no wonder that many people want public options and nationalized healthcare like Canada…
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The thing is, though, is that we have more options than just our current system vs those, and many movement liberals are part of the problem of why we can’t have a public discussion that includes those options.
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It’s not only a choice between “nationalized healthcare” or Canada’s Medicare-for-all, and the system we have.
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The terrible situation that happened to your family is a not a significant problem in the big nations of Germany or France, and they don’t have a nationalized or single-payer system!
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I say “many movement liberals” because single-payer activists have dominated the debate on the left for years, and there’s no reason why that should be, given the policy choices out there. It seems like single-payer just sounds right to movement liberals, even though the single-payer system we have now –Medicare– is still prohibitively expensive compared to the private-based French and German systems.
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We’ve got a bunch of activists and apparently mindless followers on the movement liberal side yelling “government good, corporations bad” in response to the asses on the movement right yelling “government bad, corporations good,” and that’s not doing the debate any favors. Lots of folks aren’t apparently thinking or trying to find out what policy works where, and how to get it here. Ask many single-payer advocates “Why not the German system, when it’s better and so much cheaper than ours?,” as I have, and these folks have no answer. It’s like they’ve never even thought about it.
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The bottom line is that our choices are being restricted. Our information about what’s out there for us to choose from is being cut off. It’s making us stupid.
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That’s because, it seems, that movement conservatives, Third Way policy wonks, and movement liberals all see the problem in terms of a larger struggle for an ideological agenda, and this tends to play itself out accordingly in pieces like Kate Pickert’s, where the information we get is limited to who she hears about/from in her Beltway bubble.

newfree, if it’s been determined scientifically that the drug doesn’t work what is the point of spending $8,000 a month for it? Yes, hope is important, but at some point the terminally ill patient and his or her family has to say “enough is enough.” Why go into bankruptcy for a month or two of sedated “living”? Death is inevitable and sometimes it would be better to stop heroic measures sooner rather than later, and sometimes not just for financial reasons. Hospice can make people comfortable and sometimes keep them alive longer than if they’d been going from one ineffective treatment to another. There is an excellent article about this by Dr. Atul Gawande called “Letting Go” in the New Yorker: http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_gawande. (sorry, don’t know how to link)
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And this kind of rationing already goes on all the time by insurance companies. If you think it’s only going to start with “Obamacare” you’re crazy.

Britain also offers higher-quality private health care for wealthier patients. The difference is that the baseline level of health care provided to ordinary people is better and cheaper.
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My personal preference is for more egalitarian health care systems, but I have to admit that Britain does a great job of blending the strengths of the American system with the safety net offered by the French system. While spending much less money.
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I know links would be useful, but I’m very busy right now so I can’t provide them…

Thanks for your reply SZ. Your posts always give me something to think about. I agree that our system doesn’t have to be like Canada’s. It could be something better and more efficient. I think one of our major problems is that the other side will lie, distort and do anything they can to prevent any change at all that might affect profits. They’re terrified of any change at all and think that any ends justifys the means. I have no respect for them or their tactics. I look at them as a waste of human flesh.

Thank you for your post, stuart.
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If I may add a personal observation, having lived in Germany with my wife and children a dozen years ago:
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Q: How good is German Health Care?
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A: Two words: House calls.

When you look at the co-pays, deductibles and the amounts that you have to pay before you hit your catastrophic coverage limits, it’s no wonder that many people want public options and nationalized healthcare like Canada.

Touching story, sacred.
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Coincidentally, my wife was shredding a bunch of old paperwork the other day and ran across the +$50K worth of bills for my heart surgery a few years back. We had catastrophic coverage at the time (in both meanings of the phrase), which took a chunk out of our savings as well.
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Interestingly, we did not have too many acquaintances at that time who could relate to what we were going through, insurance-wise. But with the high number of lay-offs over the past 4 years, quite a few families have learned first-hand that:
– COBRA is d*mn expensive
– cheap insurance doesn’t cover much, and
– decent family coverage is also expensive.
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If there is a bright spot to the recession and high unemployment rate, it’s that many more people will have been through the Private Health-Care meatgrinder and will willing to consider a public solution to this problem.

Actually I like the Japanese system the best if we are going to go for a Goldielock’s zone for healthcare reform. However, I also believe with even more people to put into the big pot, we could have an even greater impact if we also pass legislation which promotes free market competition within not only the healthcare providers but the insurance companies and drug companies too.
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Government to pass regulations to put caps on the amounts of procedures, cost of drugs, and how much insurance can bilk out of us as consumers.
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Couple that with free market competition and you have a winner every time.

I look at it as preventing a system where millions must put off routine heath care because of cost/access issues and then wind up being treated in an (expensive) emergency room for a serious (expensive) illness later. Add that to list of reasons we spend more than everyone else in the word with worse health to show for it.

elw00dblues: Thanks for the data I was too lazy to look up.

“Touching story, sacred.”
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I’m very grateful that mine turned out so well. It’s the people that lack the coverage and resoures that I worry about. When she was very ill my heart would skip a beat every time the phone rang at work because I was afraid that it would be “THE” call. My story turned out well because I did have some money. Many people don’t and I’m sure they have stories that make mine sound like a “happily ever after tale”. Much of this entire healthcare debate is just an esoteric mental exercise for them because they do have good coverage and the financial resources to cover the gaps. Other people are just screwed and have to watch their loved ones fade away.
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I don’t buy the whole theory that competition in the free market will bring down costs. They’ll just keep the costs high and make the money off the people with good coverage and money. The rest of the folks will just have to pray and hope for a miracle. It’s a “for profit” system and they’ll squeeze every last f**king dime they can milk out of it. If we’re waiting for the goodness of their hearts to shine through, we’ll have an extremely long wait.

Believe me when I say gingerpye, I have witnessed what you said not only with my own Father and his struggle with “letting go” as well as I have worked with well over 10,000 patients in my career thus far who have also faced that final decision in life.
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Some folks however have a hope even until their last dying breath for a miracle to stay alive, when all things have been tried and failed. But who the hell are YOU to judge when I or anyone else should stop hoping?
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Disgusting to say the least.
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But, my very deep disgust with not only liberals who are proponents of the ObamanationCare is that you called out people like me who said “watch in a year or so they will have dealth panels set up, and they will have to ration care despite the lies they are telling you now”. People like Barack Obama who said just in September, 2009, “there are people out there who will tell you that there will be death panels. They lie”.
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If my doctor says there is only a 1% possibility this medication would help you live longer, are you going to be the one who says “well based on this study (which is probably wrong anyways), this drug has the likelyhood of not working therefore we will deny you the coverage for it”. Is that going to be you, gingerpye? Or will you simply sit back like most liberals do, shout out from your keyboard, but when the tough decisions are at hand to be made you are no where to be found? How will it be gingerpye?

My understanding is that these numbers are not entirely comparable.

One way to look at this information is to compare infant mortality as a function of birth weight, ie comparing 7lb, 6lb, 5lb children across all countries. In the one study I’ve seen comparing US to Canadian, when you adjust for that, the rates become statistically identical except in one category: the US registers more low-birth weight babies than Canadians and so that increases the overall child mortality rate. The reasons for that are less than clear. It may be that life style of the mothers causes more low-birth weight babies (how can we tell and should that reflect on the health care system?) but a more subtle information gathering problem complicates this further. The viability of low birth weight babies are subject to different standards in different countries. In Canada (as well as Japan and most European countries), the criteria indicates any breathing baby at birth, while the US criteria is that the child may exhibit any signs of life. So, a child who dies with only a pulse at birth would be a perinatal mortality in Canada but classified as an infant mortality in the US. How does Canada compare to the US perinatal mortality rate? Tough to say because there’s many variables and comparison data hasn’t been released by the WHO.

Anyway, I wouldn’t take the numbers you presented as absolute. Since the US uses a stricter criteria for viability, it should be obvious that we’d have a higher infant mortality rate. Not that we can’t or shouldn’t improve, of course.

Might take a look at, http://www.oecd.org/health/healthataglance
especially, Table 4, 5, 32, 33, 36, 40, and 45. I use this information to show my students the wonders of the American healthcare system. I suggest that they contributed to the issue, by being laggards in getting drunk at age 15, Table 10.

According to my daughter-in-laws family, her family lives in Germany, one can enter a spa w/ a referral from one’s doctor. I’ll check w/ my primary care provider to see if it’s part of my plan and I just overlooked it. I’m hoping the next year I enter Medicare, it will be included.

Since the US uses a stricter criteria for viability, it should be obvious that we’d have a higher infant mortality rate. Not that we can’t or shouldn’t improve, of course.
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Even if we were to assume that the infant mortality rates weren’t quite as high as these numbers indicate, I guess the obvious question would be about why our health statistics weren’t twice as good as every other OECD nation, since we spend twice as much as the average.
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It’s not that we should improve, it’s that we shouldn’t have to improve, given that we’re spending 16 percent of GDP, or $7290 per person, as opposed to Germany’s 10.4 percent of that nation’s wealth, or $3527 per person.
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Why aren’t we getting better results for all of that money?

Hey, I’m with you there, that we need to get health spending under control (I tend to be an admirer of the Singapore model), but we’re better off not using the numbers as blunt instruments without better understanding what they mean, otherwise you end up comparing Macintosh apples to Granny Smiths (they may all be apples yet still not quite the same). So, if the only numbers that matter to the original poster are infant mortality, lifespan, and costs, and we see that there’s issues in the infant mortality numbers, we begin to get the idea that there’s more going on under the hood than just those three numbers.

It’s been a year since I last checked these numbers, but if you have cancer, you’re better off in the US. Men have a 66.3% survival rate while in Europe it’s at 47.3% (If you are in Europe, you want to be in Sweden and definitely not Britain). Now, the US is amazing at dealing with prostate cancer because of the frequent use of the prostate-specific antigen test, and this bumps our survival rates much higher than in Europe where this has been adopted more slowly. Removing this one factor, though, the US still does better at 46.9% US to 38.1% in Europe. Now, certainly our numbers are dragged down due to unequal access to care, but even so, if you’re going to get cancer, you’d prefer to be here. Oncologically speaking, we’re paying a premium but we are getting more.

Now, this is one part of modern medicine which accounts for 10% of all health costs. What is the cost we Americans pay for our obesity? What is the cost we pay for the 2nd amendment? How do we treat end of life compared to other nations? What is the cost we pay for administration(including insurance)? All of these contribute in some ways to lower lifespans and/or higher medical costs but I gave up looking for reliable statistics, let alone valid comparative analysis between nations. All I know is that when you can do a Macintosh to Macintosh comparison in outcomes between the US and any other country, America holds its own. So I tend to think that our higher costs have more to do with gold-plating our health care than with waste, fraud, and abuse. Maybe the trade off to reduce costs really will be between paying more versus lower survival rates. Not that he’s an expert on the subject but Dean Kamen said, “The reason 100 years ago everyone could afford their healthcare is because healthcare was a doctor giving you some elixir and telling you you’ll be fine… We now live in a world where technology has triumphed, in many ways, over death. The problem with that is that it’s enormously expensive.”

To be honest, even after the last year or two of debate on the health care industry, control of costs was seldom a matter of discussion. My feeling going in to the debate was “if you can fix the cost side of the problem, it makes it easier to improve access, so focus on the cost side first.” That’s not what happened, though, so costs will continue to go up and may not be fixed because no one is eager to re-open the health care debate again any time soon.

The difference between the US and the British/Canadian healthcare systems is like the difference between two cities built on the precipice of a canyon. Both recognize the problem, but one chooses to buile a 4 lane highway to the bottom of the canyon and put the world’s best ambulance at the end of the highway. The other puts a fence along the edge of the cliff. Which is the US? Which is smarter?