The Waiting Is The Hardest Part

(Thomas Eakins, The Gross Clinic, 1875)

A common objection to single-payer health care systems is the supposedly lengthy amount of time patients wait to get an appointment. Actually, this depends on the reason for the appointment.

Medical care divides into three tiers: primary, secondary, and tertiary. In America, primary care refers to the family doctor, pediatrician, or gynecologist who meet most medical needs. In most other wealthy countries, primary care begins and ends with the family doctor, and indeed some do not offer pediatric care as we understand it. Secondary care refers to hospitalization and outpatient services involving surgery or another significant intervention such as chemotherapy. Tertiary care involves a rare condition requiring a highly specialized intervention.

When a country makes a decision to offer universal access to health care to citizens, residents, and visitors regardless of their income, policy implementation inevitably focuses on the health of the overall population as opposed to marketing health care to individuals. Population-based health policy leads to an emphasis on preventive care both at the public health level and at the provider level. At the provider level, that means getting people into the system before problems develop, which in turn means emphasizing primary care over secondary and tertiary care. Primary care is also less expensive than secondary care, so the more that health needs can be met at that level, the lower the overall bill to taxpayers and the more affordable the system becomes.

In practice, then, countries that offer universal coverage -- i.e., all wealthy nations except for the United States -- have a high ratio of primary care physicians to secondary care doctors. And while this can result in a wait for treatment of nonacute conditions, well-off citizens in these countries can generally purchase supplemental insurance for reducing waits or buy into a national program. And note the distinction: Longer waits for nonacute secondary care are a function of policies that follow from universal coverage, not a supposed single-payer health care government bureaucracy or lack of supply created by a disincentive to become a physician. (Single-payer countries have no more or less doctors than any other developed nation.)

So, there is a tradeoff: In a universal health care system, individual patients with nonacute conditions either wait longer for treatment or purchase a place in line in exchange for universal coverage, cheaper health care, a longer life expectancy, and wide array of services for the population as a whole.

Is it a tradeoff worth making?...

Forever Young

France, 1916. A British Army sapper named Jack Firebrace sits on a trench step recovering from six hours of tunneling under no-man's land. His thoughts turn to his eight-year old son, whose birth and life awakened within Jack a poetry of parental warmth and perception that he had not thought himself capable of feeling:

Eight-and-a-half years earlier, when his wife had given birth to a son, Jack's life had changed.As the child grew, Jack noticed in him some quality he valued and which surprised him. The child was not worn down. In his innocence there was a kind of hope. Margaret laughed when Jack pointed this out to her. "He's only two years old," she said. "Of course he's innocent."

This was not what Jack had meant, but he could not put into words the effect that watching John had on him. He saw him as a creature who had come from another universe; but in Jack's eyes the place from which the boy had come was not just a different world but a better world. His innocence was not the same thing as ignorance; it was a powerful quality of goodness that was available to all people: it was perhaps what the prayer book called a means of grace, or a hope of glory.

Sebastian Faulks
Birdsong
1993

Rah Rah Ree, Kick 'Em in the Knee. Rah Rah Ralls, Kick 'Em in the...

Wall Street to Obama: "Okay, first you slap us in the face, now you kick us in the balls. Enough is enough. I mean, we’re done." If you can stand it, read this account of how the most politically tone deaf and gluttonous gang of thieves to ever curse the earth with its presence resents minimal requirements to clean up an act that came close to ruining the global economy. Not only that, the mildest rebuke of their obscene bonuses induces the thin-skinned tantrum of a five-year old who doesn't want to give back the ball he's stolen...

Paul Krugman writes that they don't want to pay their taxes, either? Well, you wouldn't, either, if you had to scrape by on an eight-figure income...

JUST A SONG: Los Tigres del Norte and "La Granja"...

Twitter updates from the Deepwater Horizon Joint Information Center here (thanks, Annette)...

Republicans say that Rand Paul is just a young guy, a regular Nuke LaLoosh who hasn't yet learned to keep his convictions to himself when being interviewed by mad dog reporters like Rachel Maddow. Says Sarah Palin (with a straight face):

...this lesson that I have learned and Rand Paul is learning now is don't assume that you can engage in a hypothetical discussion about constitutional impacts with a reporter or a media personality who has an agenda...

Once again, earth to SP: What reporter doesn't have an agenda, and when did you ever "engage in a hypothetical discussion about constitutional impacts" ("constitutional impacts'?) with anyone. I can just hear her in a dorm room at one of the many colleges she attended: "Let's not troll for just any group of guys when we go out tonight. Let's find some with whom we can have a meaningful hypothetical discussion about constitutional impacts. I so go for guys like that."

Notice that she's transformed a softball question from Katie Couric about magazines into an ambush by Mike Wallace about the nuances of the Constitution...

While the conventional wisdom has it that Arlen Specter's defeat in Pennsylvania represents a political setback for President Obama, history suggests otherwise. Setting aside 1998 and 2002, which occurred under unique circumstances, presidents have rarely displayed coattails in off-year elections. (It's an overrated phenomena anyway.) You have to go back to John Kennedy in 1962, when Democrats gained four seats in the Senate and held House losses to six, to see any evidence of coattails...