Just To Be Clear

On the Sicko posts, I am trying to stir up some debate, discussion, and conversation about our health care mess. I haven't made up my mind on anything other than we can do better. So I'm in diligence mode and no I am not stopping after only talking to three Canadians. In fact I consider the 65 comments I've received on the two posts so far additional diligence. Count on more posts and more diligence. And thanks for being part of the discussion.

On the Marc/comments post. I am not criticizing Marc and Seth for turning off comments. Who knows why they chose to do it? They have huge audiences and the problems of managing community could be very different at that scale. I was just trying to say that I wouldn't blog without comments. I need the feedback to keep me going. And I am sorry to see Marc lose that wonderful aspect of blogging so quickly after only five weeks. I'll leave out the f word this time.

Comments

[NICCAI]

You should criticize them. They need to hear it from someone they might know - and not just NICCAI from Vancouver. They certainly don't need the traffic or the money, but they do need to realize that they are trumping the organic nature of the community. Giving people the opportunity to comment and contribute to your ideas is essential to fostering this community and to giving back. It's ironic that the founder of Ning doesn't see the social aspect.

[John Dodds]

Some further diligence this time on UK system from yesterday's Times

http://www.timesonline.co.uk/tol/news/uk/health/article2049245.ece

Make sure to also click though on the "related links" sidebar - the "from the heart" link details opinions of current and past workers and is very illuminating.

[Marc Rigaux]

There was a great article by Malcolm Gladwell a while back that touched on something Sicko didn't mention, which is the overemphasis of American policymakers on a school of thought called "moral hazard" - the term economists use to describe the fact that insurance can actually have the paradoxical effect of producing riskier and more wasteful behavior than if someone didn't have insurance in the first place.

From the article:

"If your office gives you and your co-workers all the free Pepsi you want—if your employer, in effect, offers universal Pepsi insurance—you’ll drink more Pepsi than you would have otherwise. If you have a no-deductible fire-insurance policy, you may be a little less diligent in clearing the brush away from your house. The savings-and-loan crisis of the nineteen-eighties was created, in large part, by the fact that the federal government insured savings deposits of up to a hundred thousand dollars, and so the newly deregulated S. & L.s made far riskier investments than they would have otherwise. Economists spend a great deal of time thinking about such moral hazard for good reason. Insurance is an attempt to make human life safer and more secure. But, if those efforts can backfire and produce riskier behavior, providing insurance becomes a much more complicated and problematic endeavor."

The entire article is here: http://www.newyorker.com/archive/2005/08/29/050829fa_fact.

This, I think - adds a new layer to the conversation, because when you focus on minimizing moral hazard, you are suggesting that the behavior changes we make when we have insurance are nearly always wasteful. Yet, as Gladwell argues:

"...when it comes to health care, many of the things we do only BECAUSE we have insurance—like getting our moles checked, or getting our teeth cleaned regularly, or getting a mammogram or engaging in other routine preventive care—are anything but wasteful and inefficient. In fact, they are behaviors that could end up saving the health-care system a good deal of money."

So it's really not just a debate about two ideologies - socialized vs. private medicine...it is a question on which school of thought you belong to when it comes to the role and consequences of insurance in the first place. Go check out the article, though...it's great.

[tghfbt]

What's the point to talk to Canadians?
From what I see in the movie their Hospital looks like Soviet Union one. Canadians who went into Elcamino Hospital was shocketd.

Brirish has good health care free for poor and expensive for reach.

Isn't it better to look at France, Germany, Sweden.

[Stephen L. McKay]

Fred,

I am no expert on the European, or Canadian health care model, but as one who travels to these places a lot, I find the majority consenses to be in favor of the programs currently in place (with a few gripes, of course).
I was in Quebec several months ago and had a very nice conversation with a lady bartender in the hotel where I was staying (will leave out her name, and the name of the hotel,out of respect for privacy). She told me that she needed a rather complicated surgery a few years back (she is about 45). The government paid for the whole thing. Plus, she recently bought a house in Quebec. How many Bartends do we know in NYC, that can buy an apartment, and servive major surgery to boot, without the help of family, friends, etc.
Of course this situation may not be the norm, and much tweeking is needed in any undertaking as massive as "universal health care", but if we don't explore the options, we are destined to continue to re-live the past. I like a dual (private insurance, plus government program) plan. We shall see...

[jackson]

Gotta say I'm not a fan of these recent concillatory back-pedaling clarification posts.

[Shripriya]

Fred, thanks for the clarification on the Marc post. A problem in the blog world is that we judge what we see - what the blog poster chooses to reveal. And there may be times where they only choose to reveal partial information and so get judged more harshly than they deserve.

I don't know if that is the case with Marc, but I agree with you that maybe we should give him benefit of doubt.

I'll now be reading him in my feed reader since I don't really need to visit his site to read comments! :)

[Ken Berger]

I've dealt w/ MarcA on a conference call coordinating an event. He quickly silenced all of our comments there as well. Broadcasting outward was the only way communication seemed to work.

Much as I love his blog content and buy his sentiments re comments, my experience suggests he's simply more comfortable this way.