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FiftyTwo comments on Politics Discussion Thread August 2012 - Less Wrong
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Comments (166)
Government controlled healthcare is generally superior to private systems. *
Argument: The incentives of a government body that knows it will have to pay for the costs of future healthcare is radically different from private companies. They are more likely to take preventative measures to prevent future harms to a patient rather than waiting until the point where a condition is considered serious enough to be covered by insurance or bring people to an emergency room. They have incentives to make procedures cheaper and more efficient, and they also lack the perverse incentives to increase number and cost of procedures in order to maximise profit.
*[I'm basing this on knowledge of the UK system (free to all at the point of delivery, paid for by taxes, private healthcare/insurance can also be bought as a supplement.) I don't know enough about alternatives such as individual mandate to comment helpfully on them.]
Why is a government more likely to cover preventative care? If the argument is it's cheaper, a private insurer or individual paying out of pocket has just as much, if not more, incentive to pay for it.
If the benefits of preventative care are realized over the rest of the patient's life, then an insurance company is only incentivized to pay for it if they are obligated to insure you for the rest of your life. Which is true for gov't insurance, but not for any private insurance I am aware of. Even requiring any insurance company to insure any person in the group at any time they ask for it is not enough to change the insurance company's incentive: they would still be wise to "free ride" on any other preventative care payer than to pay for it themselves.
I think part of the problem here is that we do not, in fact, have health insurance in the US, but rather have healthcare plans.
Health insurance would be an insurance policy on your health - if your health declines, they pay out based on that. So if you come down with tuberculosis while on their policy, they pay you for the expenses of that (or possibly just pay out the average cost of tuberculosis treatment), even if you immediately drop your insurance after coming down with it.
What we have are healthcare plans we -call- insurance. And I agree that the incentives are screwed up with healthcare plans, but disagree that government is necessarily the solution. I'd prefer genuine health insurance, which would have much better incentives.
I have auto insurance. My car is worth much less now than when I originally insured it, 7 years ago. My auto insurance does not cover that change.
I have home insurance. The value of my home declined by many 100s of thousands of dollars in 2008. My home insurance did not cover that change.
Isn't there some relevant Eliezer sequence I should be citing on how defining things to mean things different from what they mean to virtually everyone else who might be in the discussion is suboptimal?
Well here is an Eliezer post arguing that using misleading labels is suboptimal even if everyone else is using them.
I meant what I wrote, exactly how I wrote it.
Car insurance doesn't cover the monetary value of your car; home insurance doesn't cover the monetary value of your home. If they did, they'd have covered those things. They cover the thing itself in both cases, provided you have full coverage auto insurance or live in a no-fault state. (If you have liability insurance, of course, something else entirely is being insured.)
You could be leading into something about old age, but unless there's a specific health concern related to old age that you don't think should be covered, I don't think there will be anything to discuss. If I had health insurance and my heart started to go out and they declared that the value of my heart has depreciated so it's not worth the cost of replacement... well, then they haven't insured anything at all. I think I'd have some strong words for my insurance agent.
Insurance isn't there to protect the value of your home, it's there to -replace- your home if it gets destroyed. Which means if your house got destroyed in 2008, odds are (although it varies by insurance policy and possibly jurisdiction), you'd get less from your insurance company than if it had been destroyed in 2007.
Similarly, insurance isn't there to protect the value of my health, but to provide me the ability to restore it in the event that it gets damaged.
By your definitions, EVERY country has healthcare plans and NO country has health insurance.
So why do you say that is the problem "here... in the US"?
Why would you choose to use language differently from everybody else, especially in a way that reduces the application of a phrase from 100s of millions of people to zero? I personally think this is a WAY sub-optimum way to use language.
Are you attempting to persuade me that we can't have rational arguments about politics here?
Because this is the second attempt you've made to attack the same comment on the basis of its semantics. The first I could get, because I saw a line of argument that might arise depending upon my clarification. In this case, you seem to be asking me to make broad generalizations.
An excellent question. I don't know if "we," meaning you and I in particular, can have a rational argument based on what you say in your this response. Maybe I should try harder.
I don't know, maybe I can't do it. The evidence is not strong that I can, that's for sure :)
It seems to me that your response proposes a form of private contract which does not exist at all in real life, and that you state a preference for this theoretical solution over any of the real systems that actually do exist.
So I guess if I were rationally arguing politically with you, I would say something like this:
Perhaps in some very long run, we might find health care arrangements would move in the direction that you like, that contracts such as the ones you say you would like will be offered, and will be purchased at the offered prices. But in the meantime, we have hundreds of millions of people in the systems that do exist. Does it make sense to take existence as evidence of possibility and plausibility, and emphasize in our arguments what we might do in the near term, primarily in terms of choosing among proven possibilities, to improve the health care system in the U.S.? In any case, that is what I prefer to argue or discuss politically.
Well, let me ask a rather pointed question: Do you consider any existing successful healthcare systems undesirable?
Or, from the converse, is there any healthcare system which conflicts with your political beliefs that you regard as having been successful? Did you arrive at a healthcare system after formulating criteria by which you would judge a healthcare system acceptable, or did you formulate criteria which excluded healthcare systems you don't approve of?
(These are distinct questions; I'm not attempting to trick you with the second one.)
For your reference, my criteria for a successful healthcare system, in order of importance as I judge it:
Doesn't constrain individual choice
Encourages innovation and research
Provides affordable/accessible healthcare
A healthcare system which forces people to be vaccinated is undesirable to me. I don't argue with the efficacy of vaccinations, nor do I contest the safety of the common vaccinations; I simply believe that the volition of rational beings is more important than their physical well-being. This is probably a point we are going to disagree on, and hard.
Innovation is the delta of healthcare. In a choice between wider availability and improvement, I'll take improvement. You can't make nonexistent treatments more widely available. However, innovation cannot take place at the expense of somebody's volition; they cannot be forced to participate in a trial, for example, even if would be the only way a drug or treatment could be tested (say, there's a rare condition, and there aren't enough willing participants for the trial to be statistically meaningful).
And finally, affordability/accessibility. That this comes last doesn't mean it isn't still important; it remains one of my conditions of a successful system. However, it comes after volition and innovation. I will accept trade-offs favoring volition, and I will accept trade-offs favoring innovation. If something can only be made affordable by forcing people to engage in particular actions, it is acceptable to me that it won't be affordable. If something can only be made accessible by discouraging innovation, it is acceptable to me that it won't be widely available.
If it is "successful" how could it be "undesirable?" The answer is that you are using one set of value judging criteria to judge success and a different set of criteria for judging desirability.
So a slightly subtle answer to your question is, I use the same set of value judging criteria to rate something successful as I do to rate it desirable, at least in health care systems. And let me state what they might be:
provides the maximum effect for the resources used
maximum effect includes:maximizing average quality-weighted lifespan of the the population covered by the system.
lifespan metric is weighted by degree of full functionality, that is various deficits like unable to run, unable to walk, unable to talk, blindness, deaf, missing limbs, confined to nursing home, confined to hospital, would all and each reduce the weighting of years of life in the metric. So procedures which reduce functional deficit increase the success metric. Procedures which extend your lifespan increase the metric, but they don't increase it much if the lifespan added is spent confined to a hospital.
physical coercion or the threat of its use 1) provides a large quality hit when actually used, and 2) is only used when the quality of the lives improved are other lives than the person being coerced. So my system would allow for the requirement of vaccinations to reduce diseases that spread through the population, as a precondition for being allowed to associate with the population. My system would not attempt physical coercion to get the obese to lose weight, the smoker to quit smoking, or the racecar driver to slow down.
the general coercion of taxation is not part of the medical system but rather is orthogonal. If a society which is in some broad sense "democratic" is willing to vote itself in the taxes to try a particular medical system, and that medical system works brilliantly according to the metrics above, then I consider it a success and desirable. I'm not too concerned about some medically coercive dictatorship, so I'll concede all points that relate only to them to you right up front.
Note my success criterion doesn't include whether the system is national health or free market or individual choice. It primarily includes that it ACTUALLY results in better outcomes. So a brilliant system of exercise and vegan diet would only rate highly on this metric if it ACTUALLY resulted in people living longer higher quality lives. If it fails for any reason, it is not a success, whether it is because people refuse to eat vegan or because eating vegan doesn't have the health benefits originally thought.
I think it is remarkable that none of your criteria involve a metric of success in producing or promoting health. The closest you come is access to healthcare, which I am concerned means I can easily get procedures that may or may not actually help me, but whether they actually help me is irrelevant to whether the system is succeeding, as long as I can get them.
So are our values so far apart as to explain any difficulty we have even discussing this?
I don't have an objective mechanism of evaluating whether or not a system actually promotes health. The issue is exemplified in comparing Japan's health system to the US; do you compare averages of everybody, or just the averages of, say, Japanese-descended people living in the US?
Somebody whose lineage traces back to Japan does as well in the US as in Japan, is the issue. Comparing the two health systems of the basis of population health ignores that the healthcare system may represent only a minority contribution to the health of the population. It's not that I don't think it's an important criteria, it's that I don't believe I have any mechanism of reliably measuring it; to the extent that it can be measured, I judge it being measured in the "Innovation" column, which produces in successes a better healthcare system. (That is, I believe the metric of success in promoting health is better measured at the rate of change in the system's ability to promote health.)
I do agree that taxation is orthogonal to healthcare, which is why I'd prefer a national healthcare system with private options to the healthcare bill we got, which directly violated my #1 criteria.
It seems to me that this sort of procedure has some problematic consequences in how it ranks possible futures. Consider these two possible futures:
A. Alice, an able-bodied person, lives for another year as such.
B. Alice lives for another year but loses the use of her legs this afternoon.
This procedure (correctly, in my view) prefers A over B. However:
C. Alice, who is able-bodied, lives for another year; while Bob, who has no legs, dies this afternoon.
D. Alice dies this afternoon; while Bob lives for another year.
The procedure prefers C over D as well. It is not clear to me that this is obviously the right answer. The procedure is asserting that saving Alice's life is more worthwhile than saving Bob's, by dint of Alice having legs.
Moreover, for any degree of "weighting by full functionality", the procedure prefers to save the lives of a smaller population of able-bodied people rather than a larger population of disabled people. If the "weighting" for loss of legs is, say, 0.9, then the procedure prefers to save the lives of 901 able-bodied people rather than save the lives of 1000 legless people.
It seems to me that such a procedure will — given constrained resources — prefer to maintain the health of the healthy rather than ameliorate the condition of the sick and disabled. While obviously we do not want a medical decision procedure that goes around allowing people to become disabled when it could be avoided (as in A and B), I don't think that we want one that considers someone's life less worthwhile because that person has already become disabled.
Just to be clear... you are not saying only that for all rational beings H, H's volition is more important than H's physical well-being.
You are also saying that for any rational beings H1 and H2, H1's volition is more important than H2's physical well-being (and vice-versa).
Yes?
(Not planning to argue the point, just want to make sure I've understood you.)
With certain necessary limitations on the valid domain of volition (as otherwise volition becomes contradictory), yes. (Negative rights as a concept encapsulate these limitations pretty well for purposes of political discussion, although I'm not sure of their value in a broader philosophical sense; I consider legality a subdomain of morality, which is to say, law should be moral, but morality shouldn't necessarily be law. Negative rights address only the legal considerations of the domain of volition.)
The "preventative care saves money" meme is incorrect AFAIK. People massively over-consume expensive tests which check for conditions with extremely low base-rates of occurrence in the population.
example: "Think of it this way. Assume that a screening test for disease X costs $500 and finding it early averts $10,000 of costly treatment at a later stage. Are you saving money? Well, if one in ten of those who are screened tests positive, society is saving $5,000. But if only one in 100 would get that disease, society is shelling out $40,000 more than it would without the preventive care.
That’s a hypothetical case. What’s the real-life actuality in the United States today? A study in the journal Circulation found that for cardiovascular diseases and diabetes, “if all the recommended prevention activities were applied with 100 percent success,” the prevention would cost almost ten times as much as the savings, increasing the country’s total medical bill by 162 percent. Elmendorf additionally cites a definitive assessment in the New England Journal of Medicine that reviewed hundreds of studies on preventive care and found that more than 80 percent of preventive measures added to medical costs."
A number of people, myself included, find it suspicious that after years of advocating preventative medicine, a bunch of studies against it are coming out just after Obamacare was passed.
Prediction: If Obamacare gets repealed these studies will be refuted by subsequent studies, whereas if it stays on the books, these studies will become the baseline of a new consensus.
Studies against the effectiveness of preventative medicine aren't new, they have been published repeatedly for decades, I have read several myself as early as 1993. And of course the RAND study that Robin discussed repeatedly.
This appears to be the Circulation study that you cite: Kahn et al., 2008, "The Impact of Prevention on Reducing the Burden of Cardiovascular Disease". The full-text is free.
The authors of the Circulation study estimate that fully implementing all eleven prevention activities which they discuss would increase US medical spending by $7.6 trillion during the next 30 years, increasing medical spending on cardiovascular disease, diabetes, and coronary heart disease from $9.5T (their baseline estimate) to $17.1T (with $0.9T in savings from better prevention more than offset by $8.5T in new preventive spending). *
Note that these numbers are only for the effects of preventive care on medical spending; they do not include the health benefits of the preventive care. The authors also estimate that fully implementing the prevention activities would prevent 63% of all heart attacks and 31% of all strokes, increasing adult life expectancy by over a year. In total, the $7.6 trillion would buy 244 million additional quality-adjusted life-years, for an average cost of $36,380 per QALY.
* I notice that I am confused: the number "162%" appears in the paper in reference to this spending increase, but I can't figure out what it refers to. Going from $9.5T to $17.1T is an 80% increase.
Working with your example: If we assume the government health service is behaving in its own self interest, why would it spend money on test that it knew not to be cost effective? Whereas if the incentives are split between a Dr ordering a test and an insurance company paying for one wouldn't they disproportionately order tests?
More generally, even if its true for particular testing procedures theres lots of low hanging fruit for intervention before things get severe. The most obvious examples would be schemes to get people to stop smoking or lose weight, that the government provides freely because they are less expensive than the projected cost of the illnesses that would arise without such intervention. Also the ability to see a general practitioner more regularly than if you paid per visit means symptoms can be picked up earlier (e.g. if someone has a mild symptom but has to pay to get it checked they are disincentivised to get it checked until it becomes severe.)
Again, AFAIK smokers and the obese are cheaper in the long run because they die faster.
Given they way other government services tend to behave this is highly dubious.
The problem is that the way these kinds of schemes tend to work in practice has a lot more to do with whatever the currently fashionable moral panic is than any rational analysis.
Of course finding cancer early while it can still be operated on is VASTLY more expensive than letting people die untreated. Not only do you pay for the tests on the people that don't have it, you pay for the tests on the people that do have it, and you pay for the treatment once it is discovered.
Perhaps there is some other benefit to preventive care that makes it worth more money? How does the health of someone who has avoided a heart transplant through early detection and treatment of heart disease compare to that of someone with a heart transplant, for example? How does the lifespan compare?
WIthout putting a price on the BENEFITS of the different mix of outcomes, it is impossible to know whether the COSTS of the preventive approaches are worth it or not.
No, preventative medicine does not save money, and there were people who believed that. But it may save some lives and improve many more lives. That has to be studied (and if already studied, discussed) before preventative care is tossed as a waste of money.
No one is advocating tossing preventative care. The problem is that preventative care is treated as a monolithic entity rather than a collection of things, a small subset of which is responsible for most of the benefits.
I agree with the first half, but how sure are you that it's a small subset which is responsible for most of the benefits?
~85% confidence that <=10% of preventative care is responsible for >=66% of the savings.
I'm guessing you made up those numbers?
"Where do priors come from?"
I should have asked "Why do you think it's a small subset?"
Problems:
1) the same argument applies to private insurance companies.
2) governments try to maximize votes in the next election which really isn't conducive to long term planning.
3) There's still the perverse incentive to encourage people to die in cheap ways.
My understanding is that US insurance companies pay for some treatments but not others depending on the cost of the insurance?
True. The times where this would be relevant tend to be questions of "should we treat illness X", often 'photogenic' illnesses get disproportionately treated (e.g. breast cancer). But I would imagine similar issues exist in terms of customer demand and legislators forcing insurers to pay for treatments (which you mentioned above). Also, given the choice between a mild bias to popularity and a heavy one to wealth in spending distribution I thought have thought the former would have better outcomes.
General infrastructure planning tends to be decided on long term efficiency as its not a day to day political issue.
Possibly, but the dead don't tend to pay taxes, I would imagine other than in the very last stages of life a living citizen is more valuable than a dead one.
Interestingly the NHS spends a lot of money on people in the final stages of their lives, while they could save a lot money by legalising or enforcing euthanasia, so that seems a counterexample.
What planet do you live on?
Neither do retirees. Furthermore, anyone with a chronic illness, or anyone who isn't rich for that matter, is a net drain on finances. But this analysis implicitly assumes that governments are run to maximize revenue which is blatantly false, at best some department might have a fixed budget and might try to figure out how to spend it to maximize some metric.
Being that explicit about it would loose them votes; however, at the margin such things do happen.
This is never a convincing argument...
Neither is the raw assertion it was responding to.
You could easily have said something like, "this is not obvious, please provide the evidence which caused you to believe it." FiftyTwo's statement required support, but yours sounded mindkilled. And even if your mind isn't, that sort of statement will make it extremely difficult for an average person to continue having a productive dialog with you.
I'm remembering why we avoid political discussions. Questioning my credibility is not a counter argument.
At its most simple organisations with a set of goals they have to achieve and which know their budget in the future will tend to minimise the cost at which they achieve those goals, so they can either save that money for the future or spend it on secondary goals. Additionally goals can be set on the basis of improvements in efficiency etc.
Unfortunately, the goals of the organization do not necessarily align with the goals of the people running the organization, and the larger the organization, the worse this problem becomes.
Or as Jerry Pournelle put it in his iron law of buerocracy
Why should I believe this is a law? Could you give me a theoretical or empirical argument supporting its universal validity?
Theoretical argument: Those who spend time working on the actual goals of the organization, have less time to spend on the political and signaling games over who gets into positions of power.
Also, here are two examples from Pournelle's blog: 1 2. And one of my favorite examples comes form this TJ Rogers speech, (also seriously read the whole thing).
Thanks, I'll read through that speech when I have the time. The example you quote doesn't seem to be an instance of the law, though. The Office of the Surgeon General and the Dept. of Agriculture aren't run by the same people, so the fact that they support conflicting policies isn't really evidence that the people running them aren't working for the goals for their respective organizations. The organizations might just have conflicting goals. It's also unclear to me how the two examples on Pournelle's blog (especially the second) are good evidence for the law. Pournelle seems to be interpreting the law to mean something like "Bureaucracies do wasteful and counterproductive things", but that's not what the law says.
More broadly though, Pournelle's law seems to assume that working to further the goals of the organization and working for the organization itself are always incompatible. That's plausible in the example he gave, involving education, but I don't think it's generally true. Often a very effective way to further the goals of a bureaucratic organization is to bolster the political clout and prestige of the organization itself.
Depending on how far up the chain you go. Also FiftyTwo was trying to argue that the people providing health services will include future tax revenue in the set of things they seek to maximize.
True, assuming you ever actually get around to furthering your goals. Unfortunately, if you optimize your organization too much for obtaining political clout and prestige it will be hard to shift to accomplishing your goals.
Your statement was a description of the quality of government health care. Your argument provided possible reasons the government would have behind offering better care, but it didn't really back up your initial statement. If your introduction was, "The incentive for governments to provide quality health care is more reliable than the incentive for private systems," than the argument would fit. As it is your argument is just speculation on the motivations behind health care providers.
Also, I could be wrong, but I thought the government only helps pay for health care, and could only control its accesibility, not its actual quality. Wouldn't the state have to own the hospital to alter the actual care?
In fact, that's how the UK's NHS works. It's like the US's VHA, where the government actually provides health care. It's unlike the US's Medicare, which is "single-payer" because the government pays for everything, but the money goes to private hospitals and doctors who actually provide the health care.
See http://en.wikipedia.org/wiki/Single-payer_health_care and http://en.wikipedia.org/wiki/Socialized_medicine for more information. From the latter:
Thanks. In retrospect I should have defined my terms more clearly, illusion of transparency bites again.
In general private enterprise does a lot better than the government. From what I understand, there is massive overspending on healthcare in the US, most likely due to how insurance works. The obvious way to fix this is to just tax healthcare.
Your insurance is often payed by your work (I'm not sure how often, though), so you have no option to change insurance companies. If they let you choose your healthcare, you pick the most valuable. If they don't, they pick the cheapest. Neither results in the best deal. The only incentive is that you'll prefer a job with better healthcare, so your company will try to find a provider that can give better deals. It's kind of distant though. It's not like government healthcare has very direct incentives, but I suspect that the value of the two are similar, as opposed to the private sector being substantially better.
Does it? Thats a pretty broad statement, and even if it does in general that doesn't mean it does in particular cases. The obvious counterexamples are natural monopolies, e.g. water, roads and I would argue healthcare.
The main incentives are voter pressure for better healthcare and the cost of various infrastructure and treatments. As the public generally demands healthcare be at least as good as it has been before, if not better, there is an incentive to be efficient in allocating cost to healthcare.
That requires argument. Notice that the standard argument for water and roads doesn't apply to healthcare.
Raikoth/Yvain argues it better than I can
Which arguments do you mean? The obvious ones to me are economies of scale, limited resources and price control which seems to apply.
Could you clarify, are you arguing free market is always superior to state action, or that it sometimes is and sometimes isn't but healthcare isn't one of the latter cases?
The former is almost always true and the later is always true, so is your claim that all industries are natural monopolies?
I mean that healthcare is not a public good in the sense that it is both excludable and rivalrous.
The examples FiftyTwo provided -- clean water and roads -- aren't public goods either. In a sufficiently populated economy, they are rivalrous. They are usually classified as common goods, non-excludable and rivalrous.
Why are they regarded as non-excludable though? Both roads and clean water could be delivered as private goods. Toll roads demonstrate that roads can in fact be excludable. The Cochabamba water war would not have happened if clean water were non-excludable by its very nature. Non-excludability is not an intrinsic property of these goods. Providing these goods in a non-excludable manner is a social decision. We (or at least most of us) think it's important enough that people not be denied access to (certain) roads and clean water on the basis of their economic status that we are willing to tolerate some inefficiency in their provision.
So whether or not a good is a public good is not a great basis for deciding how that good should be provided, because whether or not a good is a public (or common) good is often a consequence of decisions about how it should be provided [1]. The way healthcare is provided in the US right now, it is both excludable and rivalrous. If we lived in a country with government-funded universal health care, healthcare would be non-excludable but still rivalrous, just like roads in the US.
Appealing to the excludability of health care in the status quo in order to distinguish it from roads and water isn't a great argument for treating health care differently. Of course, you may have independent reasons to think health care should be provided in an excludable manner while roads should be provided in a non-excludable manner. But the mere fact that these goods are actually provided in these ways is not an argument for the claim that they should be provided in these ways.
[1] There are certain public goods -- pure public goods -- which cannot possibly be provided in an excludable manner, at least not with currently available technology. Examples are streetlights and flood control. What I say here doesn't apply to those goods, of course. But roads and clean water are not pure public goods.
Yes, there's certainly something to be said for having water not be a government monopoly.
Well, interestingly, that's not all that far-fetched. Complicated features of production lead to non-convexity, which can break down proofs that the free market finds optimal solutions. To the extent that the real world is messy, there are lots of things out there that are qualitatively monoply-ish.
Note: That's Yvain's website.
One of the biggest facts on the ground here is that the US spends (more or less) 2X as much as any other rich western country, and is not statistically better on any quantitative metric for its extra expense. So one would presumably benefit immensely from understanding what the US is doing wrong compared to other rich western systems.
Is the difference that the US is not government controlled while others are? Arguing against that are these facts: 1) 50% of medical expenses in the US are made by the government (the number is 70% for Canada). 2) US health care insurance companies are highly regulated in the terms on which they can offer insurance, what they can require, what they can forbid and so on, 3) the US (even before obamacare) practically mandates health care through 3rd party paid insurance (through providing gigantic tax advantages for that form over any other form of health care paying.)
So the US's "private" system is pretty government influenced. And if you study countries with public health care, virtually all of them have a significant private component.
If the hypothesis was "the british health care system is at least twice as efficient at providing measurable benefits per pound spent than is the US system," I don't see how anybody rational could argue against that. And I would say you could put essentially any european country in place of britain and get the same result.
So have I argued for or against the original proposition? To decide this, I have to decide: "Is a health care system which provides more than twice the bang for the buck necessarily "superior" to one which doesn't?" Well ceteris paribus it must be, but of course ceteris is not paribus between ANY two countries' health care systems. But you know what? I'll let someone else try to sell you on how the non-health benefits of the US system over the British actually are more than justified by the factor of 2 higher expense of the US system, because I do not agree with that and this post is already too long.
As political gooey statements go: "Government controlled healthcare is generally superior to private systems. "