What If They Had Asked the Question This Way?

A CBS poll says about 2/3 of Americans think the government should provide health care for all.  Many in the poll think the government would suck at it (about half said the government would do a worse job, and less than a third think it would do a better job). 

Given how important health care is to people, I find it hard to reconcile these two opinions.  If I had to guess, most people who say they are for government health care implicitly imagine a two-tier system, where they would still get the good care they have today, but poor people who people imagine are without care today (actually they tend to be without insurance, not without care) would get a suckier second tier of health care run by the government.

But I don't think this is a realistic view of what they will get with universal health care.  No government-run universal health care system is ever going to be politically stable with two tiers.  You are going to have to end up with a system that some poor people get better care but the rich and middle class end up with a worse system.  That is the reality of every government run health care system in the world.

I would love to see the answer to this poll question:

"Would you support a system of government-run universal health care that guaranteed health care access for all Americans, but would result in you personally getting inferior care than you get today in terms of longer wait times, more limited doctor choices, and with a higher probabilities of the government denying you certain procedures or medicines you have access to today."


  1. Jim Morse:

    Or, "Would you support a system of government-run universal health care that works like Walter Reed Hostpital?"

  2. logipundit:

    Yep...you got it. This is why I really hate political polling in General. It's all in how you ask the question. I've even been suspicious of how referendums are worded on ballot initiatives. It's really hard to word these things neutrally.

    BTW, I'm adding Coyote Blog on my list of "Arizona Blogs", a list of Blogs on Logipundit who are up on State and Local issues in their respective locales. It's a sort of ad-hoc "Senate."

    Come see us.

  3. CRC:

    Or perhaps an even better, more succinct question(s) might be:

    "Would you like the government to make the choices about your personal health care?"

    "Would you like the freedom to make the choices about your personal health care yourself?"

    I don't think that people see (or perhaps care) the issue of freedom/liberty that is at stake with things like this. Ultimately a state take over of the health care system is a recipe for outright totalitarianism. What is more fundamental than people choosing to decide what they can or cannot do with their own person/body? If anyone believes that this is ridiculuous there is not a difficult path to draw in which we see the government doing things like telling you what you can/cannot/must/musn't eat...what types of physical activities you can/cannot/must/musn't do. Does anyone in their right mind think that giving the state control (through payment) is not an expressway to control over how that money is spent on and what?

    I think people see the statistics and they think "It's unfair". Wait until we get to "unfree" and we'll see what people think then.

  4. michael:

    What if ...your robbed and hit on the head, no ID, some short term memory loss, do we let you die on the street?

  5. saurabh:

    Well - a few years back I was unemployed. Lucky for me I'm young and healthy. It was frightening enough, and the one time I DID have a minor medical emergency (conjunctivitis), my uninsured ass got saddled with a $500 bill for one measly visit. Needless to say, that wasn't exactly the sort of thing I could afford. So, your equation doesn't really apply to me - I wasn't getting superior care, and I don't have to trade down for inferior care. There's tens of millions of uninsured in this country, and I imagine they'd feel the same way.

    As to a two-tiered system not being viable - why not? That's exactly what exists today with Medicaid. Seems to exist okay...

    I'm uncertain about longer wait times - I've frequently seen this claimed, but I dunno any studies demonstrating longer wait times in, say, Canada compared to the U.S.

  6. Max Lybbert:

    A quick Google search turned up this study ( http://www.fraserinstitute.ca/shared/readmore.asp?sNav=nr&id=753 ):

    "The amount of time Canadians have to wait for surgical and other therapeutic treatment increased slightly in 2006 and continued to hover near the 18 week mark first reached in 2003. ...

    'These waiting times are the second-longest Canadians have ever experienced, despite record levels of health spending and numerous commitments made by provincial and federal governments,' said Nadeem Esmail, Director of Health System Performance at The Fraser Institute and co-author of the survey."

    I've had to get surgery before, and in my case (not life threatening), I believe I waited four weeks. Although I could have scheduled it within a week or two of diagnosis; I waited so that I could schedule it with my work as well. Eighteen weeks is four-and-a-half months.

    People also are not aware that the courts have decided that states have a Constitutional duty to provide emergency care to everyone; and while they can send bills later, they can't refuse to give people emergency treatment at public hospitals even if it's obvious they can't pay (of course, the hospitals and the states aren't happy about this).

    conjunctivitis probably doesn't fall into life-threatening. But, on the other hand, a $500 medical bill isn't much different than a $500 credit card bill, and I've had to deal with those when I was unemployed.

  7. Jesse:

    "Are you too lazy or irresponsible to deal with your own medical care?" That pretty well sums it up.

    It doesn't matter who the check comes from, top notch medical care is expensive and we will have to pay for it. Medical care is far cheaper in many other countries because they settle for the last generation of medical equipment and are willing to wait for procedures. The United States health care consumer is the Technology geek who has to have the new G7 Computer Chip the day it comes out and throws it away a month later for the G8... that's expensive.

    - Jesse

  8. The Dirty Mac:

    Where does the Walter Reed Medical Center debacle fit into the discussion of the benefits of government run health care?

  9. Dan:

    I've found it interesting to ask people who are in favor of government provided healthcare if they would be willing to give up their private insurance and voluntarily go on Medicaid, assuming that all income restrictions were removed and that they could pocket their portion of their current insurance premium.

    I think that I've had only one person think that that was a good idea in the past five years.

    Basically, everybody seems to think that government healthcare is good for other people, but somehow they're different.

  10. Matthew Brown:

    I suspect that it's like the original post says: people are in favor of government healthcare over no healthcare. They don't like the idea of the poor not getting healthcare; they don't like the idea that a temporary lapse in coverage could really hurt them.

    And these are, indeed, problems, and there are more than that, and it would be good if we could find a sensible way to help with them

  11. markm:

    Matthew: Actually, we do have a workable system in place for people too poor to buy insurance at all, not to mention Michael's question, "your robbed and hit on the head, no ID, some short term memory loss, do we let you die on the street?"

    1) Hospital emergency rooms treat anybody with a medical emergency and worry about payment later.

    2) Medicaid provides controlled-cost healthcare at least as good British or Canadians get, but not as good as you can get if you can pay for it.

    It's the rest of us that have a problem. We can pay for the world's best healthcare, but balk at the cost. Besides that, we've routed most of the money through "insurance" channels that both impose a high overhead cost, and don't necessarily make cost/quality decisions the same way you would make them for yourself.