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October 01, 2009

[Podcast] Journo: I love my "socialist" kidney

Most people think of single payer health care in America as something akin to science fiction--a bold idea that might be possible someday, but certainly not an option in the here and now.

Journalist Jennifer Nix points out that the U.S. already has single payer care, not only for the aged (Medicare) and the poor (Medicaid) but also for patients with end-stage renal disease (kidney failure) who need dialysis or a transplant.

Nix has a unique perspective on Medicare ESRD, as the latter program is known. It saved her father's life in 1973 and her own life this year. Nix found out in 2008 that she inherited the same cystic kidney disease that put her dad on single payer dialysis in the seventies. Medicare ESRD covered a stint on dialysis, her kidney transplant, and anti-rejection drugs for a limited period after surgery (her private insurance covers them now).

Since its inception, Medicare ESRD has enabled over 1 million people survive regardless of their ability to pay. If your kidneys failed tomorrow you won't be left to die because you can't afford dialysis or a transplant. Wouldn't it be nice if all Americans could enjoy the same level of security for their hearts and other organs?

Here's my podcast interview with Nix at the Daily Pulse.


And we give our veterans a British NHS-style Beveridge system with the VA, because their care is too important to us to be left to the vagaries of the market.

Veterans care too important to be left to the vagaries of the market? Hah. It's more likely that, after soldiers have had bullet wounds, been exposed to close proximity to nuclear devices, Agent Orange, and particles from depleted uranium ammunition (and who knows what else) no private insurer would be willing to cover them, or else would often find cause to deny coverage due to pre-existing conditions from their military stint. How many people would volunteer for the army if it was a one-way ticket to a lifetime of no medical coverage?

And we give our veterans a British NHS-style Beveridge system with the VA

Yes, and this health care is terrible, Krugman's homilies notwithstanding. A family friend who used to be a VA doctor explained to me how the VA collects the people who are too poor to afford private insurance, and gives them basic-level care; she brushed off Krugman's statistic saying the VA has the highest patient satisfaction in the US by saying the people on it wouldn't be able to get health care otherwise.

So, Alon, you've got anecdotal evidence that people aren't really satisfied with the VA and Krugman has empirical research. You're the one offering homilies here.

Even if you're right about the VA collecting the poorest people, why does their satisfaction count for less? The opposite might even be true. Poorer people tend to be sicker. To me, the satisfaction of a heavy user of a health system is more meaningful than that of someone who has never gotten sick. A lot of people with private insurance say they're happy with their coverage until they actually need care.

Just because the VA is someone's only option is no guarantee that they're going to be satisfied with it. A lot of people gripe even more when they don't like their only option because they resent not having a choice. If the VA users are satisfied, that's a vote in favor of the system regardless of their socioeconomic status.

The VA hospitals are free for veterans with 10 % or more disability. I have access to the VA and also have private insurance, and I have made use of both type of facilities. I would use the private facilities any time and for any medical problem over the VA. For people with no other choices it's a godsend, yet my belief is that Alon is correct. Why do you think veterans that retire(20 years or more service) have a whole other system of care if the veterans system is so good? The answer is obvious.

Krugman has empirical research showing that the VA has the highest customer satisfaction rate. What I have is an alternative explanation for it.

Alon: My father has VA care for issues acquired in US miltary service, and Canadian coverage for everything else. He's happy with both. He's also had long conversations with our various relatives in the US, who have the usual stupid hassles. He's not moving south.

It's better to have a system that everyone can afford and hates than a system no one can afford but would theoretically love.

And yes, I intend "everyone" and "no one" as illustrative hyperbole.

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