From here: http://janegalt.net/cgi-bin/MT/mt-tb.cgi/8590 Poke holes if you can.

Matthew Yglesias snarks at CNN:

CNN's SiCKO analysis concludes:

As Americans continue to spend $2 trillion a year on health care, everyone agrees on one point: Things need to change, and it will take more than a movie to figure out how to get there.
Yes, it will. We could, for example, read the earlier sections of the article. For example:
The United States spends more than 15 percent of its GDP on health care -- no other nation even comes close to that number. France spends about 11 percent, and Canadians spend 10 percent.
France . . . Canada . . . cheap . . . but does their health care suck? Well:

Like Moore, we also found that more money does not equal better care. Both the French and Canadian systems rank in the Top 10 of the world's best health-care systems, according to the World Health Organization. The United States comes in at No. 37. The rankings are based on general health of the population, access, patient satisfaction and how the care's paid for.
So, okay, it's not that hard to figure out. France and Canada both have two difference systems of health care delivery both of which are cheaper than the US system and both of which are more effective. What's more, these aren't obscure countries. Lots of people have heard of France. Lots of people have heard of Canada. How hard is it for them to just write the words "Michael Moore is right; American health care would be improved if we adopted French methods instead"?

Forget, for the nonce, the pro's and con's of doing this; don't ask whether longevity statistics might be affected by factors other than the healthcare system. (Many of which, to be fair, Mr Yglesias probably also wants to change; but then you have to ask whether we shouldn't focus on doing those things, rather than mucking around with health care financing.) Just look at our spending patterns.

In the United States, government at its various levels now accounts for roughly 45% of health care spending. (And by "now", I mean 2004, the latest year for which OECD data are available. In 2004, of course, the government provided little prescription drug coverage. Remember that fact; it will become important later.) The United States spends about 15.3% of total GDP on healthcare. That means, for those following along at home, that government spending on health care consumes about 7.7% of GDP.

Canada spends 9.9% of GDP on healthcare. France spends 10.5% of GDP. What is the magic route by which we are going to cover all the people not currently covered by government insurance for 2.2-2.8% of GDP?

• Even as we walk through the fairyland of perfectly executed policy programmes, there are some magical byways that the Ogres of Reality have blocked off:
• We will not save massive amounts of money on prescription drugs--because in 2004, the year from which those figures date, the government didn't spend that much money on prescription drugs. So cutting the prescription drug bill will not help you reduce that 7.7% very much--which still leaves you with a paltry 2.5% of GDP to spend on the remaining 2/3rds of the population that currently enjoys health insurance.
• We will not "save money" by adding younger, healthier people to the government's insurance pool. We may lower the average cost of caring for them, but sticking the nation's 18 year olds onto the Medicare rolls will not lower one iota the amount it costs to replace Grandma's hip. Putting 18-year-olds into the insurance pool is a slightly nicer way of slapping them with a gigantic tax on their earnings in order to cover the old and six; it does not actually make the care any cheaper.
• We will not get huge savings from preventative care. Medicare, Medicaid, and the VA already have whatever incentives they are going to have to provide preventative care. They are still costing us 7.7% of GDP.
• We will not garner immense cost-reductions from administrative costs. Medicare, Medicaid and the VA already have European-style administrative costs.
• We will not realize fantastic cost benefits from bulk-buying. If you want French-style health care (this being the current favourite model of most progressives I talk to), that means that hospitals and doctors are private entities; they do most non-pharmaceutical purchases in healthcare. The centralized model enjoyed by Britain and Canada does provide such cost advantages, but it has severe drawbacks, which is why most progressives I talk to say "that's not what we want". Moreover, I find it exceptionally politicallyunlikely that any American system would ever operate along British/Canadian lines.

Now, I can think of several ways to reduce that spending. But they all have one of two problems: either they could (and should) be done right now; or they are not currently being done because they are politically inconceivable. For example, I could mandate electronic medical records at doctors offices. That might save money. (Might not, of course, but why not try?) But Medicare could do this right now, by the simple expedient of demanding that doctors keep records for Medicare patients using a system that complies with some sort of information standard. If you think that we could save money this way, don't wait for single-payer--go out there and do this right now! Then you can show everyone how awesome government payments systems are.

Aside from that, however, most of my ideas are simple, elegant, and doomed to die an agonising death in committee--like bringing back open wards, slashing the salaries of doctors and nurses, or denying expensive treatments to the elderly, disabled, and other severely ill people. If Matt has better ones for trimming down that 7.7% to a level where we might feasibly cover 200 million other people with what remains from France's spending, I am very interested to hear it.

Otherwise, it seems fair to say that, well, we still need to figure out how to get there.