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    Last week I got a rare critical link. Very exciting–there are few things I like better than a good argument! And there are few better argument-starters than health care. His post is thoughtful and full of good points. I still don’t think he’s persuasive on his main point, though:

    The health care system in Japan does have it’s problems, just like all systems. But on a whole it’s superior to the States. And that’s based on my anecdotes from living and experiencing the health care here in both countries over a period of many years.

    Well, all right, but plenty of us have anecdotes. There was the dentist here who gave me a root canal (over four visits, of course) and left a live nerve fiber dangling there. It made its presence known with a vengeance a few months later.

    There was the doctor I visited about a sore throat, explaining that I’d already tried aspirin, it wasn’t working, and I couldn’t afford to have my throat feeling raw for a presentation at the office the next day. He gave me powdered Tylenol and Chinese herbs.

    There was the dermatologist at a major research hospital who looked at my skin condition and declared she’d never seen anything like it. The next dermatologist I went to (Japanese but trained in the Netherlands) listened to my story and said, “Huh? This is one of the most common conditions any dermatologist sees!”

    There was my friend who came back from a trip to Thailand with a major fever and a wacked-out white cell count. The doctors told her she might have leukemia. Maybe. Almost certainly. Uh, more tests, maybe? A week later, she suddenly started feeling fine. Oops. Guess it was just one of those infections you sometimes get when you visit Southeast Asia. Our bad, said the hospital.

    I’m not saying that I’ve proved that National Health is awful. I don’t believe that at all. It’s just that we can fling anecdotes back and forth like ping-pong balls without making generalizable points that should drive public policy. My teeth aren’t any less instructive than JST’s.

    He seems to think that Americans should be dissatisfied with our health care system because WHO wants us to be. But there are compromises to be made. The Japanese system guarantees familiarity and stability at the cost of innovation and flexibility. It also, in putting lots of power in the hands of government bureaucrats, creates an incentive system for bribery and back-scratching. I doubt Americans, even those who have had bad experiences themselves, would think that trade-off was a good one. I’m no lover of insurance companies or HMOs, but I’m not convinced that getting Washington involved in managing the system would increase the overall saintliness of the enterprise, while driving costs down and without impeding the implementation of new treatments.

    4 Responses to “Health”

    1. John says:

      Sigh. There’s good an bad points to both. For routine check-ups and prophylactic care, the Japanese sytem is better, but if I were really ill, I’d be heading off to the States. And trauma care is much better in the States, crowded ERs or not.

      The WHO is full of it, though. They focus on the wrong things, wanting to bring the US system down to say, Britain’s level based on a univeral access to mediocre healthcare, rather than having some centers of excellence that you can fight to get into, as in the US. Last time I was in Britain, people were going to France for hip replacements becuase of the NHS waitlist.

      We get better therapies sooner and more choices in the US than the UK becuase there is no NICE gumming up the works. Even in the UK, private insurers now make up the difference. And anyone who’s worked with Medicare or the VA (I have) should immediately see the disadvantages Uncle Sam will bring in the US.

      What the US really needs is an incentive program for the HMOs to fund better screening. The way the US system works now, most people change insurance every 4 – 5 years, so there is no incentive to pay for screening that will prevent problems down the road, because will be someone else’s problem.

    2. Sean Kinsell says:

      How’d I know that this post would draw you out, there, John? :)

    3. Sean Kinsell says:

      Oh, just wanted to say about this, John:

      “They focus on the wrong things, wanting to bring the US system down to say, Britain’s level based on a univeral access to mediocre healthcare, rather than having some centers of excellence that you can fight to get into, as in the US.”

      Yes. The Japanese system is designed to do everything it needs to to keep you from being dead before you’re eighty; the problem is, most Americans just don’t view health care that way. Perhaps it’s sententious to refer to WHO’s criteria as “the wrong things,” but it does acknowledge that the definition of health depends at least in part on what you value.

    4. John says:

      Even if you value that, the WHO recommendations won’t get you there. I’m being serious when I say that they focus on the wrong things. but then I’m a libertarian with a multi-decade view of this stuff.

      The WHO is focused on their idea of scoial justice, which means parity for everyone, no matter what the overall outcome. The Japanese have a special focus on quality that even Europe lacks, therefore the Japanese socialized healthcare system (like their nationalized train system) runs pretty well for a government monopoly. Even I have to give them that, but there is no other country in the world with Japans nitpicky culture, either. No socialized healthcare system in Europe can match Japan’s, and the US would never even come close, given our population and geographic spread.

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