quote:One-third of all Americans and two-thirds of low-income Americans are uninsured or underinsured at some point during the year. Family health insurance premiums have risen 87 percent since 2000 while median family incomes have increased by only 11 percent. One-third of families now report medical bill or medical debt problems. We spend 16 percent of our gross domestic product (GDP) on health care, yet we fall short of reaching achievable benchmark levels of quality care. ... The U.S. spends almost $2 trillion, or $6,700 per person on health care—more than twice what other major industrialized countries spend—and spending in the U.S. rose faster than in other countries in the last five years. Yet the U.S. is also alone among major industrialized nations in failing to provide universal health coverage. This undermines performance of the U.S. health system in multiple ways. Forty percent of U.S. adults report not getting needed care because of cost. And nearly one-fourth of sicker adults—those who rated their health as fair or poor or had a serious illness, surgery, or hospitalization in the past two years—wait six or more days to see a doctor, compared with one of seven or fewer in New Zealand, Germany, Australia, and the U.K. ... On key health outcome measures, U.S. performance is average or below average. On mortality from conditions that are preventable or treatable with timely, effective medical care, the U.S. ranked 15th among 19 countries. ... U.S. patients are more likely to report medical errors than residents of other countries. One-third of sicker adults in the U.S. reported such errors in 2005, compared with one-fourth in other countries. ... The fragmentation of the U.S. health insurance system also leads to much higher administrative costs. In 2005, the U.S. health system spent $143 billion on administrative expenses. In 2004, if the U.S. had been able to lower the share of spending devoted to insurance overhead to the same level found in the three countries with the lowest rates (France, Finland, and Japan), it would have saved $97 billion a year. ... [emphases added]
She draws on data from the WHO, from Commonwealth Fund international Surveys, and from the data on international comparisons out of the Harvard School of Public Health, among others.
Posts: 14017 | Registered: May 2000
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quote:Originally posted by Will B: ...don't cite UK, Canada ... they don't have a plan like the one that's being proposed. They don't have universal mandated health insurance; they have socialized medicine. Very different beasts.
This is incorrect.
Canada: physicians are private businesses paid by public funding -- and provinces have the option of opting out of the system, although all currently participate.
UK: most physicians are on contract with the government and paid by public funding. Of note, some physicians are private, and there is private insurance, although it is minimally used by the population.
Thus, although you might well call the UK's NHS "socialized medicine," Canada -- in contrast -- does have universal insurance but private physicians.
Posts: 14017 | Registered: May 2000
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So, I was curious, so I looked myself. This site links to the sites that list surgery wait times for each province. There are separate listings for different types of surgery, so I picked non-emergency hip replacements to check, figuring it would be a relatively low-priority surgery. Depending on province, between 1% - 6% of patients had to wait longer than 6 months. The longest wait times were in the small eastern provinces, which I believe are the poorest. Some of them had a category for up to 24 months, which would qualify for "years," but they only had 1% of patients in it. Which is a trade-off I think I'd accept vs 40% of US adults not getting needed care at all because of the cost, as cited in CT's above post.
Checking cataract surgery in a couple of the provinces showed similar wait times, a median of 13 weeks in Alberta, 22 in um, I think it was Manitoba. Anyway, I have no idea how long it takes to schedule non-emergency surgery here. *shrug* But "years and years" certainly doesn't seem to be representative of most people's experience in Canada.
Posts: 7954 | Registered: Mar 2004
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quote:I think the point I was trying to make (albeit hidden in a bunch of other stuff) is that it seems to me that there are options to fix the problems in our current health care system without resorting to mandatory universal coverage, which tends to limit patients ability to see a doctor. (At least, this is hat people in the UK and Canada have told me....in the UK they see something called a health visitor...a nurse with an extra year training.)
I’m in the UK and am registered with a typical GP practice. If I want to see a doctor I ring up to make an appointment (for the same day if necessary). There is no limit to access to doctors.
Health visitors also exist, but are not a replacement for doctors. I think new parents get a visit to check the baby is OK and to help with any problems. This doesn’t mean you don’t see a doctor if you are ill. People with chronic health problems will also get visits by health visitors in addition to (not instead of) seeing a doctor. For some things you can also see a nurse, but a doctor is always available.
There are problems with the NHS – mainly the funding can’t keep up with demand. However, if I get ill I know I will be treated regardless of whether I can afford it or not. Waiting times are likely to be longer for non urgent treatment than with private health care, but that is a price I’m willing to pay for universal coverage.
Every time I see someone on Hatrack ask a medical question with the caveat “I know I should go to a doctor, but I haven’t got insurance” I’m grateful for our system, for all its faults.
Dentists are more of a problem – there is a shortage and it took me about a year to get a NHS dentist (although there were practices accepting children straight away).
Posts: 169 | Registered: Aug 2005
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quote:Really? Where is your evidence for this? I am from Missouri (really) -- Show me!! I am open minded and willing to look at new ideas. But I have never seen any evidence to suggest that this is the case. I know for a fact that Canada taxes its population at up to 50% (depending upon the province). This doesn't seem cheaper to me.
Twinky decided to show the brunt of it. Really, that's most of it covered.
The good ol' U.S. of A has decided to stick with a very broken system that has watched its dysfunction exacerbate year-by-year. Even the largest private HMO's and PPO's casually admit that they have no contingency for future decades, and are merely trying to manage profitability in this decade as to be prepared to adapt to a new, expected change in the system which will avoid expected collapse. They are essentially saying "We're maintaining the black in these years and waiting for changes to come about so that the system that we rely upon does not crash and burn." What we have now is a makeshift system that runs the gamut between two extremes: the first side exists for the purpose of appeasing the desire of past legislators to have an actuarial 'free market' model. The second side is a concession by society to attempt to maintain the most tragic potential neglects of the actuarial model, e.g., poor children and the elderly. The end result is neither a free market nor a fully social model, and it's god-awful.
We spend about $5,200 per capita on health care in every year. This figure is over two and a half times the industrialized world's median of about $2,100. The amount of extra cash that we throw into our healthcare system amounts to hundreds of billions of dollars a year. So, what does this extravagant expense buy us? We have fewer doctors per capita than most western countries. We go to the doctor less often than our high-income neighbors. We get admitted to the hospital less frequently. We have worse patient satisfaction. We generally get our problems treated later rather than sooner. Our system is monstrously inefficient, hemorrhaging cash into miles of bureaucracy and care provider tape. We spend more than a thousand dollars per u.s. citizen on healthcare paperwork. You could compare that to Canada, which has a social healthcare system widely and rightfully criticized as being broken and overloaded and inefficient, and yet it only spends about three hundred dollars per canadian citizen on paperwork.
There's more, too. There are developing nations which have better infant mortality rates than our own nation. It's sad. And, lest we forget, all of the other similar high-income nations actually manage to ensure all of their citizens, where we pay into our system of incredible dysfunction, and still leave over forty five million people in our country without any coverage at all.
There's a book out called "Uninsured in America," and it's a damned scary book. It demonstrates through exposure that there is a cold, hard reality that we've put off for too long. There are a group of people in America who, according to Malcolm Gladwell, who I get most of this information from, increasingly look different from others, and suffer in ways that others do not.
Over half of personal bankruptcies are the result of unpaid medical bills. Half of the uninsured owe money to hospitals, and a third are being pursued by collection agencies. Children without health insurance are unlikely to receive proper attention for medical issues and serious injuries, recurrent ear infections, or asthma. The death rate in any given year for anyone without health insurance is about 25% higher than for someone with health insurance. Because the uninsured are sicker than the rest of us, they can’t get better jobs, and because they can’t get better jobs they can’t afford health insurance, and because they can’t afford health insurance they get even sicker.
There's some people who claim that the real problem with our healthcare system is that it isn't a 'real' free-market system, and claim that this would work better. It's not the case. The problems with our system represent all of the failings of a fully free-market system that we are not willing to tolerate as compassionate people, and for good reason. Free-market systems do not work unless you are willing to absolve the medical system from any responsibility to anyone. Remember the uproar about the hospital dumping incident? The hospital treats the man and then unloads him on skid row without a wheelchair. People were furious. With a fully free-market system, there would be no requirement nor incentive for competing medical systems to be required to treat the folks who get dumped at their doorstop every day, nor would there be any backup system or 'charity' which would have the billions and billions required to handle such issues. You would not be outraged by the hospital taking in that paraplegic and dumping him on Skid Row, as he would never be admitted to the hospital in the first place. We are absolutely not willing to set it up in our society so that insolvent folk have no right to care whatsoever and may be left to die on street corners and old folks homes or traffic accident sites, and the system doesn't work in a 'free market' sense unless we're willing to take that step, so anything in that direction should be billed as pure fantasy.
As it is, hospitals receive only about 40 to 45 cents back from every dollar of medical costs that they would otherwise charge patients. Yup, significantly less than half of that is absorbed or transmitted to others. People who are afraid of public healthcare because it means 'but i'll be paying for other people's medical costs!' should relax; they're already paying out the wazoo for everyone else's costs. Under the social system, about all that changes is that they'd cover less costs.
How much is free care? Standard practice is to fully write off all medical costs to people obviously incapable of paying, like the transients and other folk dropped off by the police every single day. Anyone who is uninsured has their costs usually sliced in half in the hopes of receiving a smaller recuperation rather than bankrupting the individual and risking recovery of no payment.
Plus, a free market system must run off of the model of profit motive, which is demonstrated as being absolutely terrible for managing priorities and channeling effective care. A perfect example: not too long ago, the city of New York set up a series of care centers which were designed around providing preventative care for folks with diabetes. The timing was perfect and the need was clear and distinct: with a looming diabetes crisis, it is imperative that the growing population of folks with diabetes go to training centers with dietitians and learn how to manage their disease to prevent the catastrophic end result of neglected diabetes.
The center had phenomenal success with their clientelle; anyone trained in their centers was extraordinarily less likely to have any medical issues and complications and early mortality associated with diabetes. Unfortunately, the vast majority of folks with diabetes were either uninsured, and/or not financially capable of supporting the costs of professional diabetes preventative care, usually due to issues like having diabetes permanently as a 'preexisting condition' after losing employment and benefits from a previous occupation, with few or no new affordable plans willing to cover the costs of managing their diabetes. Furthermore, most insurance companies wouldn't even cover it, seeing as it is, after all, a nonessential program.
So, they go out of business. All of them. They crashed and burned, actually. Major loss. Meanwhile, the companies that amputate the limbs of folks who never learned to manage their diabetes are just raking in the cash, since they deal with the emphatically 'non-optional' end result of neglected patients. And guess who foots the bill for every poor person who ends up with an amputation they can't afford? Yup.
The same issue is prevalent in all fields of american healthcare: we always end up paying more and getting less benefit because we're always managing the costly side effects of issues that were untreated because uninsured and poorly insured folk can't afford to get any sort of preventative care or screenings. HMO's have no motive whatsoever under the profit model to use preventative care to improve the later health of the people that they are covering: on average, people switch their HMO every six years. By providing preventative care, a HMO is only aiding their competitors. Unsurprisingly, preventative coverage ends up slim in nearly all plans. They try to compensate for issues with the current system by trying tricky things to stay profitable; likewise, so do the pharmacos, which attempt things like buying patents to rarely used medical consumables and jacking up their price a hundred fold.
And just in case it's possible that still someone thinks I haven't ranted about just enough things wrong with our present system? Go talk to some doctors in rural support systems. They are in disaster mode. They talk openly about near crisis. A lot of medical-state relations involve coverage requirements that say that there's got to be hospitals to cover even the less populated regions and the poorer regions. These hospitals are required to exist and yet cannot -- cannot -- survive or profit. They are given de-facto subsidy and bailouts, that grow progressively larger year by year, to keep them operating. Even as the quality of their facilities and care declines.
Blah blah blah. There's a lot of text for you. I can kind of rant about this forever. I long for the day when my wealth of information about the dysfunction of this system is rendered obsolete. I expected rightfully that the system would be abandoned once the reality of its brokenness became too painful and costly to ignore at ideological convenience. We're about there. It's only a matter of time. This failed system will be left in the dust and the fact that we clung to it so long will be remembered only as a quixotic oddity in America's past.
Posts: 15421 | Registered: Aug 2005
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OMG. With twinky's numbers, covering all 300 million people in the US at Canada's rate per person will cost us $95 billion per year. If we continue to spend the same amount per person, it would be $1.8 trillion.
If I could find the amount of the federal budget, we could take that as a percentage. The next question that needs answering is how many existing services covered by Health and Human Services would be discontinued? We could pick up some significant savings there since HHS is the largest budget drain we have.
I'm curious to know how much this will end up costing us and what we will have to give up in return. I'm willing to give up a lot for the health of every American, but I'd still like to know what we're talking about before I say yes or no.
Posts: 2283 | Registered: Dec 2003
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So, now I'm looking for stats on surgery wait times in the US to compare to. Not as much information available. I was thinking there would probably be a big urban/rural divide as far as availability of services, but I haven't found much that address actual wait times yet. Here is a study that compares wait times for knee replacement surgery in Ontario to Indiana and western Pennsylvania. "The median waiting time for knee replacement after the operation had been planned was three weeks in the United States and eight weeks in Canada." So, 5 weeks longer. The wait time to have the specialist visit to plan the operation was also 2 weeks longer, total of 7 weeks difference. Still haven't found anything indicating wait times of years and years in Canada or the UK.
Posts: 7954 | Registered: Mar 2004
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Lines like this bother me "One-third of all Americans and two-thirds of low-income Americans are uninsured or underinsured at some point during the year." If I change jobs during the year, I would fall into the 1/3 of all American who are uninsured. I have no doubt since this is a statistic's arguement that we will never know how much is truly being spent by us, or any other country
Posts: 1918 | Registered: Mar 2005
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quote: What are the current concerns among patients?
A: The main concern is waiting times to get appointments with specialists and to have non-emergency operations.
Years of government underfunding has meant staff shortages, and the public is concerned at being treated by overworked and underpaid health workers. Many nurses are on short-term contracts to NHS hospitals, so patients are worried about falling standards. Patients also worry about communication problems with staff members who are recruited from countries where English is not the first language.
The underfunding has also resulted in the closure of many rural hospitals, regional restrictions on certain types of treatment for certain individuals (in one case, the NHS refused to pay for chemotherapy for a child with terminal cancer), and a notorious lack of hospital beds (only 4.5 per 1,000 population). Hospital buildings often suffer from poor maintenance, lack of repair work, and cleanliness problems.
Another concern is that the government plans to set up a two-tiered system of hospitals with higher and lower levels of funding, which would require that patients travel to larger centers for specialized treatment. Foundation hospitals would be tertiary-care centers, offering advanced diagnostic and treatment. Trust hospitals, or rural facilities, would offer basic services.
quote: After tourism and finance, healthcare is the most lucrative economic activity in the United Kingdom. The UK Government actively supports the growth of this industry by offering fiscal incentives and drafting investor-friendly policies that attract both domestic and foreign investors. The trade in pharmaceutical products has been profitable for the United Kingdom.
quote: The U.K. government encourages production of generic drugs in the country by offering incentives to pharmacists and doctors for prescribing them. The over the counter (OTC) drugs market has experienced significant, though erratic growth in the last couple of years. The government’s aim to reduce healthcare costs is expected to result in the movement of an increasing number of prescription drugs to OTC status, thus giving a boost to this sub segment. The country encourages clinical trials through various tax incentives and favorable investment policies. However, low cost countries, such as India and China pose threats to the U.K. clinical trial market. The U.K. government has promised to increase R&D funding from the current 1.9 percent to 2.5 percent of the gross domestic product (GDP) by 2010.
quote: Another concern is that the government plans to set up a two-tiered system of hospitals with higher and lower levels of funding, which would require that patients travel to larger centers for specialized treatment. Foundation hospitals would be tertiary-care centers, offering advanced diagnostic and treatment. Trust hospitals, or rural facilities, would offer basic services.
And you think that doesn't happen here? I live in Minneapolis, Minnesota, and have many relatives in South Dakota. I can think of at least three times when I was still living with my parents that we had relatives from South Dakota stay with us while they were in town to get medical treatment in "the city" that wasn't available where they lived. I'm pretty sure that they drove further than anyone in the UK would have to drive to get to a primary medical center.
Posts: 7954 | Registered: Mar 2004
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ElJay, please show me where I said that I think that doesn't happen here? I didn't say it or imply it although I am curious as to why you take immediate offense when someone points out issues with the UK's universal healthcare? No comments about the notorious lack of hospital beds? Part of this thread was on wait times in the UK and issues with the UK's system. I posted that to show that they too have many of the same issues we do. Your comments about how far your relatives had to travel in Minnesota and South Dakota and how far people in the UK have to drive is sort of misleading as the UK is only 94,251 sq mi and Minnesota by itself is 86,943 square miles. We are a much, much larger country so shouldn't we, in some cases, have to drive further to get to a primary medical center? Doesn't that just make logical sense?
Posts: 1918 | Registered: Mar 2005
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Another thing folks might want to consider is how those peoplel who have chronic conditions fare under the current state of health insurance and how universal health care would affect them as well.
The implentation of the proposal of universal health care has me curious as to how the matter of pre-existing conditions would be handled. Right now, if you have a chronic condition, if you want it covered by insurance, you can't ever let your insurance coverage lapse. So when you have a chronic condition, your worry when you face the moment of losing a job isn't just the money, but also the health insurance and how the hell, without a job, will you be able to pay the full premium until you find another job, because if you don't, you'll have to pay for all your doctor visits and medications out of pocket until your new insurance (if you even have it offered at your next job) will deem to cover your condition.
One of my maintenance medications costs over $400 a month at full price. There's still five more that I have to take to be a stable, productive member of society.
We ran into the issue at the end of last year, when nathan lost his job and I was out sick from work on short-term disability. The full premiums for our health insurance were just above $700 a month. However, the COBRA people took forever to finish out the paperwork and notify the insurance company (we'd paid them as soon as possible, meaning, as soon as we got the information from them) and they insisted on doing everything by mail, which added to the time it took to get things done. Two weeks went by, then another week when someone made a mistake on COBRA's end and mis-filed our policy type with the insurance company.
Meanwhile, because it had taken them so long, they wanted the next premium from us, yet all the while, we were paying out of pocket for my medications, so we were already strapped for cash, yet supposedly had health insurance but couldn't USE it. Thankfully, since we've been using the same pharmacy for a couple years, the pharmacist knows the both of us and floated us my medication until the insurance came through (so the filled the remainder of the prescription with just the copay at the end).
Then someone at the health insurance company (after many conversations with COBRA and the health insurance company) finally just said, "You know, common sense says that you can't switch from one plan to another on COBRA. By law, it has to stay the same. I'll just fix it now and then track down where it went wrong in the paperwork."
And this was working with full knowledge of the system, as the job I was on sick leave from is another health insurance company.
That is the type of situation I'd like to see disappear with the implementation of universal health care.
Posts: 14745 | Registered: Dec 1999
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My apologies if I misread your intent, DarkKnight, but when you just post quotes with no commentaries or opinions, it's hard to tell what your intent is. Most of the people who have been making comparisons on this thread have been doing so to point out that our system is better, whereas I think that that's a much harder judgment to make.
Likewise, I don't think I took offense at your post, I was just pointing out that the part of your quote that I had experience with was not terribly different between the US and the UK. If that was your point, then we're in agreement. As for not commenting on the lack of health care beds, well, it's not something I have experience with or knowledge of. I have no idea how many hospital beds are available per 1000 people in my area. Do you know for yours?
I don't think my comparison was misleading at all. The UK is much more densely populated than South Dakota is, and I don't think it makes sense to have expensive facilities and highly specialized doctors located where they won't be used. I would hope that everyone had basic emergency care within a reasonable distance, but if someone needs to travel six hours for specialized jaw surgery, (one of the things my relatives traveled for) I think that's just fine. My point was that travel for some healthcare needs has been a fact of life for people in large portions of this country for a long time, so it doesn't seem at all unreasonable to me that people in countries with socialized medicine should have to do the same.
Posts: 7954 | Registered: Mar 2004
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And it's worth noting that adequately funding a nationalized system would still cost less per capita than the US spends on a broken system.
The fact that other systems -- still with better outcomes than the US system, mind you -- could do even better with more adequate funding isn't a mark for the US. It's a mark for funding systems adequately.
And don't forget that underfunded (thus ultracheaper, not just cheaper) systems are outpreforming the US on the basis of measurable outcomes.
Posts: 14017 | Registered: May 2000
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Ok, I read this thread in bits and pieces over the weekend so please excuse me if Monday-morning-fog makes me address something that's already been addressed.
What *DO* they do if you can't afford coverage? If it's mandatory and you can't afford it even with the subsidies or the gov't decides you don't NEED subsidies and you still can't afford it.. What's the penalty? With mandatory auto insurance if you can't afford it, you just don't drive or get a fine if you DO drive without it. And in any event, that's to protect other people. You're not required to carry insurance for yourself, just the person you hit. You can't stop breathing just because you don't have mandatory health insurance.
Will everyone be charged the same rate or will it be based on your age, sex, health, etc? This is a really important question. Either answer leads to problems... If people are charged based on their health, then what about those of us with chronic conditions? Right now, we're part of the pool so we get averaged out with young people who never get sick.
Ok, so how about a flat rate for everyone? But now the government is involved instead of private industry. What if the government decides to start banning/taxing things that run up the rate on everyone. After all, is it fair I pay more because someone else smokes? What if we start putting big taxes on fat and sugar? What if they try to ban meat (which I think is coming down the road anyway, this will just give them more ammunition.) When the gov't starts paying for your health care you're giving them license to meddle even deeper into your life.
And what about controversial procedures? How are social conservatives going to feel about shelling out for a transexual's addadictomy (say it out-loud if you're alone) operation? Or is he just going to have to pay his mandatory insurance premium AND pay for his operation too? And what about Abortion? Are social conservatives going to allow mandatory government insurance to pay for that?
Posts: 7085 | Registered: Apr 2001
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btw, didn't we already have a thread on infant mortality rates and how it was a skewed statistic because we count underweight babies as babies that die and other countries count them as still births?
Posts: 7085 | Registered: Apr 2001
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quote:Originally posted by ClaudiaTherese: And don't forget that underfunded (thus ultracheaper, not just cheaper) systems are outpreforming the US on the basis of measurable outcomes.
I've been thinking about this assertion for a while now. I looked it up and you are right...the mortality rates in the U.S. are lower than that in many other countries, including those with universal health care. What I fail to see is the connection.
Here's the argument you seem to be making: We have two groups of people (those with and without UHC) and one variable (longevity). Obviously, since longevity is greater in countries with UHC, it is better to have UHC...?? There is no causal relationship there. We could as easily pick another variable...say percentage of people who are clinically obese, and link that the longevity. Granted, I would have an easier time buying that link but that is because countless other studies have proven that being obese adversely affects your health, not because of the observed number of fat people in the U.S.
Posts: 2392 | Registered: Sep 2005
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quote:Originally posted by Christine: Here's the argument you seem to be making: We have two groups of people (those with and without UHC) and one variable (longevity).
We have more than one variable. There's longevity, there's infant mortality, there are numerous other possible choices as well. I provided you with a link to a great deal of that data on the last page.
Added: Oh, also, researchers doing statistical analysis to look for causal relationships control for other variables that might obscure the effect.
Posts: 10886 | Registered: Feb 2000
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TP: I might note that you're asking questions as if an American universal health care system is something brand new. As if the US is trying to create a mission to the moon and has to solve all the problems on its own. But the fact is, many nations have gone ahead and dealt with these problems. It may be more useful to ask how they solved these problems and whether its applicable to the US.
For example, rather than asking " And what about Abortion? Are social conservatives going to allow mandatory government insurance to pay for that?" A more useful question is, "How was the abortion debate handled in Canada. How did social conservatives react in Alberta when abortion was legalised? How is our experience different?" and so forth.
Its just a bit strange in these threads when people ask questions as if they're "brand new information!"
Posts: 7593 | Registered: Sep 2006
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quote:Originally posted by ClaudiaTherese: And don't forget that underfunded (thus ultracheaper, not just cheaper) systems are outpreforming the US on the basis of measurable outcomes.
I've been thinking about this assertion for a while now. I looked it up and you are right...the mortality rates in the U.S. are lower than that in many other countries, including those with universal health care. What I fail to see is the connection.
Here's the argument you seem to be making: We have two groups of people (those with and without UHC) and one variable (longevity). Obviously, since longevity is greater in countries with UHC, it is better to have UHC...?? There is no causal relationship there. We could as easily pick another variable...say percentage of people who are clinically obese, and link that the longevity. Granted, I would have an easier time buying that link but that is because countless other studies have proven that being obese adversely affects your health, not because of the observed number of fat people in the U.S.
The thing that strikes me about it is the sheer number of countries, both with and without UHC, that have much higher life expectancies than the U.S. A few years ago I seem to recall that they were trying to link Japanese long life expectancies to the fish they eat.
Is it just possible that maybe there is something other than how our health system works that is affecting our lifespans? Like the number of greasy hamburgers McDonald's sells or the number of gym memberships that never get used?
All I do know for sure is that you can't make a causal assertion basd on the data you have.
Posts: 2392 | Registered: Sep 2005
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quote:Originally posted by Christine: All I do know for sure is that you can't make a causal assertion basd on the data you have.
I know you've double-posted, but I have to say that unless you have extensive background in statistics that you aren't telling us about, you're wrong.
Posts: 10886 | Registered: Feb 2000
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quote:And it's worth noting that adequately funding a nationalized system would still cost less per capita than the US spends on a broken system.
I'm still not convinced this is the case, focusing solely on "nationalized" and not commenting on the government subsidized aspect of it. As far as I know, there isn't any country on the comparison lists provided with better, nationalized health care and nearly as many people as we have - plus we are more spread out. I think regional (with several 1-state regions) systems make much better sense.
I have structure-of-government issues with nationalized health care. Our national government is far less responsive than our state government (partly due to the large number of people per representative we have). I much prefer political questions concerning allocation of resources be left to the states. If necessary, the federal government can do some fund-shifting to assist poorer states, but that should be the limit.
There's a growing tendency to subordinate structure-of-government concerns to outcome-based concerns (not saying anyone here is doing that, but on the national conversation it's certainly happening). I'd like to see such an important issue as health care be dealt with in a manner that addresses those structural aspects as well as the outcome-based aspects. If a structural change is needed, then there are ways to make those changes.
(If you didn't mean "national" per se, then disregard this. )
I tend to favor large-pool insurance solutions, with subsidized insurance payments for those with financial need.
Also, I haven't had time to go thorugh all the studies you posted yet, but I wanted to thank you for posting them.
Posts: 26071 | Registered: Oct 2003
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Apologies...I somehow managed to post have my thoughts before I was done and now we've even got intervening posts!
quote:We have more than one variable. There's longevity, there's infant mortality, there are numerous other possible choices as well. I provided you with a link to a great deal of that data on the last page.
Added: Oh, also, researchers doing statistical analysis to look for causal relationships control for other variables that might obscure the effect.
I saw your link. Thank you. I'm still questioning the data.
It's interesting that you bring up infant mortality. A few months ago I saw a study that was quite sure our higher infant mortality rates in this country were due to lack of breast feeding, not lack of health care. Technically, more than one thing can cause the same result but it's just something I thought I'd point out.
As for the statistical controls...I still don't trust statistics. Especially when you claim that the wealthiest Americans, with the best access to health care, still have worse outcomes than people in other countries. Now, why would that be? They aren't exactly going to be getting bad care, are they?
So let's assume that a healthy, active, rich white man in the U.S. is more likely to die young than the same person in the UK. They both have access to doctors and medicine, so what's the deal? It's not *access* to health care that seems to be the problem, but rather the quality of the health care itself.
Listen, I don't totally disagree with any of you who want the UHC. I really don't. I see problems with the U.S. current health system and I see a need for some real solutions. But I also believe this: You can't solve a problem unless you know what, EXACTLY, it is. Too often, I think we solve symptoms rather than problems. Perhaps fittingly, I feel the exact same way about my health. If I have an ache or a pain I am often told, "Take some tylenol." Well, my body is trying to tell me something and I want to know what it is, not just mask the pain with drugs. Just after I had my son, I went to three different doctors about excruciating back pain -- the first two told me to take some Tylenol and deal with it. The third told me that I had torn a muscle, that I should do these specific things to help it heal, and then gave me a drug to take the edge off the pain.
If out health care system is failing us (and I will agree that it at least has issues) then let's find out how it's failing us.
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While health care in Canada is funded federally, it's operated at the provincial level. The federal government transfers funds to the provinces for health care, which the provinces then allocate.
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quote:For example, rather than asking " And what about Abortion? Are social conservatives going to allow mandatory government insurance to pay for that?" A more useful question is, "How was the abortion debate handled in Canada. How did social conservatives react in Alberta when abortion was legalised? How is our experience different?" and so forth.
Its just a bit strange in these threads when people ask questions as if they're "brand new information!"
Why shouldn't an opponent of a radical change to our current system pose perfectly legitimate questions about the effects of those changes? If, for example, Alberta's experience has something useful to tell us about government funding of a procedure a very large minority consider akin to murder, perhaps you could post a summary of that experience for us?
(BTW, the abortion issue is one of the prime reasons I want large, private insurance pools. If anything could spur me to a tax strike, this could.)
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quote:While health care in Canada is funded federally, it's operated at the provincial level. The federal government transfers funds to the provinces for health care, which the provinces then allocate.
I still have structural problems with that. If I were to propose a single tax reform, it would be flipping the state and federal tax burdens (after removing a few truly national expenditures such as defense). I want most of the tax money collected to be covered by a level of government closer to the people.
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quote:Originally posted by Christine: All I do know for sure is that you can't make a causal assertion basd on the data you have.
I know you've double-posted, but I have to say that unless you have extensive background in statistics that you aren't telling us about, you're wrong.
I have a year of graduate level statistics. I don't know if that's extensive or not, but there it is for you to tear up at your liesure.
Look, I can believe that the statisticians controlled for a lot, but it's nion impossible to control for everything. Even if somehow they manage to get it down to the different health systems, I can't even imagine how they would narrow it down to the public vs private health care. The world is too complex to isolate that variable. Like I said in my last post, I agree that our health system has problems and in that case, the data would say exactly what you've said it does. But that doesn't mean that the problem is in the insurance! It could be the hospitals or the doctors or a dozen other things...maybe it's more than one thing.
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Dagonee: you and I agree a lot on this issue. We should form a lobby .
I'm particularly interested in preserving the large amounts of health-care related research performed in the US by private companies, one of the notable areas our system does not seem to have underperformed.
Also, I see no reason to imitate other countries when I feel we can do it better by learning from their mistakes; many countries with significant government funding of health care or health insurance are currently feeling the problems caused by rising health care costs, and I think a well-structured system can be far more resilient to those problems.
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quote:Originally posted by Christine: I have a year of graduate level statistics. I don't know if that's extensive or not, but there it is for you to tear up at your liesure.
While not "extensive," it makes me willing to accept that your "I don't trust statistics" is based in reasonable skepticism than in an inherent distrust of all things scientific. That's about as much stats as I have, though I took graduate-level stats in my final year of undergrad since I didn't plan to pursue a graduate degree.
I know far too many people who simply disregard all statistics, particularly ones that say things they don't want to hear.
quote:Originally posted by Christine: Look, I can believe that the statisticians controlled for a lot, but it's nion impossible to control for everything. Even if somehow they manage to get it down to the different health systems, I can't even imagine how they would narrow it down to the public vs private health care. The world is too complex to isolate that variable. Like I said in my last post, I agree that our health system has problems and in that case, the data would say exactly what you've said it does. But that doesn't mean that the problem is in the insurance! It could be the hospitals or the doctors or a dozen other things...maybe it's more than one thing.
What I don't see is how the vast differences in cost can be accounted for by any of the other possibilities you're proposing. It's possible, as you say, that some of the differences in health outcomes might be caused by one or more other factors that researchers have thus far failed to control for, but that doesn't explain the cost difference. The only thing that can fully explain the cost difference is the structure of the system.
I'm not suggesting that you should turn your system into a mirror image of ours. What I'm saying is that given the vast difference in cost and the differences in various health metrics, it seems unreasonable at this point to claim that your system is anything other than broken. Given that, and given the high number of uninsured/underinsured Americans, exploring ways to insure everyone -- and thus ensure that everyone at least has access to care, regardless of quality as compared to other countries -- seems to me to be a natural first step. Whether this particular proposal is the best way to do that I don't know, but I find that often when I talk about anything containing words like "universal" or "socialized" or "single-payer" that connote government-run systems with Americans, there is an immediate negative knee-jerk reaction. Having said that, I think fugu's point is well taken: if you're going to make changes to your system, look at other systems and try to make sure you don't make some of the mistakes we did. Underfunding is an obvious example -- we have a doctor shortage at the moment because of government underfunding in the 1990s. If our funding levels had remained a bit higher, I think we'd be in a much better position (particularly given the difference in overhead that Samprimary pointed out above). We're in a decent position, but I think we could have had the best system in the world, and we don't. I'm an idealist in some ways, what can I say?
quote:Originally posted by Dagonee:
quote:While health care in Canada is funded federally, it's operated at the provincial level. The federal government transfers funds to the provinces for health care, which the provinces then allocate.
I still have structural problems with that. If I were to propose a single tax reform, it would be flipping the state and federal tax burdens (after removing a few truly national expenditures such as defense). I want most of the tax money collected to be covered by a level of government closer to the people.
I don't think that would work in Canada, because of equalization. However, I think we're too decentralized here as it is.
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Dagonee, my concern with having universal health care at a state level is will people in the lower population or poorer states get the same level of care as people in the more densely populated or richer states? I don't want to see states turn into haves and have nots based on health care, and people making decision on what state to live in like they do for school districts now. Minnesota is known in some circles as a Welfare state, and every now and then there are a lot of stories in the news about people moving here from surrounding states because out welfare benefits are better. I think the stories are usually alarmist, honestly, but I don't want to see the same sort of thing happening with health care.
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TP: I know the US has more social conservatives, which is why I specifically highlighted Alberta which I believe would have a comparable number.
Dagonee: Of course I never said that the original question could *not* be asked. I just said that it would not be particularly *useful*. A question posed in the original manner (Imagine a system like this!), tends to lead the answerer to answer in hypotheticals ("Ok, I imagined it, but I imagined it like this!), which get rebutted with hypotheticals ("But your imagination is wrong like this!"), until the whole conversation is filled with too many hypotheticals to be particularly useful to anyone. A question asked in the new manner, may be able to find someone with that experience (in this case, an Albertan) who can give, not hypothetical conjecture, but a concrete example of what happened.
I don't happen to be Albertan. But that doesn't invalidate the approach. For example, if I was considering the consequences of a nationalised dental system, I would first consider systems around the globe and then try to extrapolate their experience to Canada. I think this would be much more useful and evidence-based than guessing how Canada would react from scratch with no evidence but my imagination.
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quote:Dagonee: you and I agree a lot on this issue. We should form a lobby
I'm all for it.
quote:Dagonee, my concern with having universal health care at a state level is will people in the lower population or poorer states get the same level of care as people in the more densely populated or richer states? I don't want to see states turn into haves and have nots based on health care, and people making decision on what state to live in like they do for school districts now.
"If necessary, the federal government can do some fund-shifting to assist poorer states, but that should be the limit."
quote:I don't want to see states turn into haves and have nots based on health care, and people making decision on what state to live in like they do for school districts now. Minnesota is known in some circles as a Welfare state, and every now and then there are a lot of stories in the news about people moving here from surrounding states because out welfare benefits are better. I think the stories are usually alarmist, honestly, but I don't want to see the same sort of thing happening with health care.
I think it's right, to a certain extent, to allow states to decide the level of subsidized health care they provide. We have representative government that is supposed to be largely state-based. The allocation of shared resources is one of the primary functions of government. I want that primary function accountable to the people both providing and receiving those resources to as great an extent as possible.
If one state decides that the level of health care needed is lower than another state decides, it shouldn't be up to the rest of the states acting in concert to take that choice out of its hands.
I think it's pretty clear that, at least at the margins, there's a lot of play in deciding hot resources should be allocated. That play has been used on this thread already to support state-sponsored systems. If one state wants to decide that an 8-week delay is acceptable for knee replacement and another 16, I don't want the federal government to override those decisions.
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quote:Dagonee: Of course I never said that the original question could *not* be asked. I just said that it would not be particularly *useful*. A question posed in the original manner (Imagine a system like this!), tends to lead the answerer to answer in hypotheticals ("Ok, I imagined it, but I imagined it like this!), which get rebutted with hypotheticals ("But your imagination is wrong like this!"), until the whole conversation is filled with too many hypotheticals to be particularly useful to anyone. A question asked in the new manner, may be able to find someone with that experience (in this case, an Albertan) who can give, not hypothetical conjecture, but a concrete example of what happened.
An answer given in the original manner ("You should have asked X instead of Y") has a tendency to inspire responses concerning that suggestion and isn't particularly useful to anyone.
An answer given in a new manner such as "When the Albertans faced this issue, they did X," even when the original question didn't ask for examples, would actually provide relevant information rather than simply scolding someone for bringing up a relevant issue.
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I suspect that a well-run system with multiple very large groups, where some of those groups were for entire states, would see comparable levels of health care available for cheaper in the least-dense states. Why? Because I suspect the health risks in those states are decidedly less. Having those costs be different is then a good thing; besides being a more efficient allocation, it incentivizes people to move towards places with lower health risks.
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"I don't know, not my area of expertise. But maybe you should find a textbook on calculus and find out instead of working out from first principles what formula to use for integrals."
"What? You should have just given me the answer! How dare you ask me to do research instead of giving me a simple answer!"
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"I don't know, not my area of expertise. But maybe you should find a textbook on calculus and find out instead of working out from first principles what formula to use for integrals."
"What? You should have just given me the answer! How dare you ask me to do research instead of giving me a simple answer!"
Your analogy is so wildly inappropriate I hardly know where to begin. That would have been fine had you not attempted to put it into my mouth. That turned it into a dishonest rhetorical trick.
I'm not sure if the dishonesty is intentional or not at this point. If you truly can't see the difference between a homework problem given to a student attempting to learn how to do something and a potential issue raised by someone skeptical of a plan that others are proposing and advocating, then your dishonesty is inadvertent. I'll let you inform us whether this is the case. Or, you could simply correct your mistake. Your choice.
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quote:Originally posted by Dagonee: I think it's right, to a certain extent, to allow states to decide the level of subsidized health care they provide. We have representative government that is supposed to be largely state-based. The allocation of shared resources is one of the primary functions of government. I want that primary function accountable to the people both providing and receiving those resources to as great an extent as possible.
I agree with you in theory, but I have a lower level of trust that representatives actually make decisions based on what the electorate wants. Then again, there's no saying a national system would do that any better, so I guess I don't have a horse in this race.
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Dagonee: I'm not going to answer that on the basis that you're really just asking a question akin to "Are you still beating your wife?" There is in fact a simple third choice aside from my analogy being false and me being intentionally dishonest. That you simply misunderstand the analogy.
I could in fact turn this around and be similarly facetious, "Are you so obtuse that you cannot understand this analogy or are you feigning indignation to score cheap points?"
Instead, I will assume good faith and that you simply missed the parallel in the analogy.
A student working on a math question often asks "what is the answer to this?" It is often easy to answer "47.1 m^2" or whatever the answer may be. Instead, the proper way is to lead the student to find out the answer for themselves. This is summed up in the popular saying, "Give a man a fish; you have fed him for today. Teach a man to fish..."
In TP's case, I could have answered the question outright by making something up without evidence. But in fact, I do not know the answer, I merely know where to find the answer, in the Albertan experience. In fact, TP asked the proper question, "Are you you sure this is relevant?" in the same sense that a math student would say "This math textbook does not have the exact question I'm trying to solve, are you sure this is relevant?" A much less constructive approach would be feeling indignant that one has the audacity to suggest a different approach at asking a question.
In the end, a student would be much better served by asking "How do I find out how to solve this question?" rather than "What is the answer?" Similarly, TP would be better served by asking "What was the X experience, and how could it be extrapolated to us?" or even "Did anyone else have X experience, how can we learn from it?" rather than simply "What about X? I think it might be a problem."
In the end, I was not pushing an agenda. In fact, I suspect that Alberta may not be a good argument to convince social conservatives to accept UHI, but instead would be a cautionary tale. But I do not know for sure.
TP may very well find that the research might lead them to ask "In Alberta, X happened with UHI, with this evidence, would not the problems be magnified by the unique characteristics of the US?"
But in the end, this would be much more interesting, assuming they do not follow your puzzling indignation and avoid the research out of spite.
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I'm interested in why we can't phase in a system over time, starting by targeting some more neutral targets. I'm a big proponent of instituting automatic coverage of preventative and emergency care for minors. I see it as a parallel principle to public education. I also think there'd be much more support for this step, and I think it provides our society a pretty good bang for the buck.
I am also sympathetic to not automatically assuming funding will come from the national level.
quote:Originally posted by Bokonon: I'm a big proponent of instituting automatic coverage of preventative and emergency care for minors. I see it as a parallel principle to public education. I also think there'd be much more support for this step, and I think it provides our society a pretty good bang for the buck.
SCHIP is supposed to provide this for children not otherwise covered.
---
Edited to add: SCHIP is the State Children's Health Insurance Program, which was established in 1997 as Title XXI of the Social Security Act. The US Federal Govenment provides matching funds to State governments to provide and administer healthcare coverage to uninsured and underserved children in each state.
Whether I've understood the analogy or not, your putting it into my mouth is cheap. (And, for the record, I did understand. Your explanation added nothing to it that wasn't obviously there.) It's not what I said; it is in fact very different than what I said.
quote:the proper way is to lead the student to find out the answer for themselves.
How utterly patronizing of you. You haven't led Pixiest anywhere, and she certainly doesn't need you to do so.
The proper way to help a student trying to learn how to do a math problem is to lead the student to find the answer for themselves. Pixiest isn't your student, or anyone else's here.
Pixiest was not looking for someone to teach her how to do a problem. Pixiest was pointing out a possible problem and giving those advocating the solution a chance to address that problem.
She's not better served by going and doing the research to support someone else's position.
quote:But in the end, this would be much more interesting, assuming they do not follow your puzzling indignation and avoid the research out of spite.
It would, in fact, be much more interesting if you were to summarize the Alberta experience and make a point based on it, rather than continually hinting that others should care enough about your point to do your research for you.
posted
twinky -- about the cost differences between our system and others -- I do find it interesting that health care costs so much more here than it does in other places. My concern on this topic is to ask where, exactly, is all the money going and how, exactly, does UHC fix this? If, for example, all the money is going to insurance companies profits and wasteful spending, then there is a point to be made. On the other hand, I understand that drug companies charge Americans far more for prescriptions than any other country. Many Americans have resorted to buying Canadian drugs for this reason (illegally). Will drug companies charge less if we have UHC?
I don't know what else is affecting those numbers...but I think it is a worthwhile question to ask.
A while back, Pixiest brought up a point that I think is also worth exploring. How do we get charged for this system? Is it based on age, health, or income?
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quote:Originally posted by Christine: My concern on this topic is to ask where, exactly, is all the money going and how, exactly, does UHC fix this? If, for example, all the money is going to insurance companies profits and wasteful spending, then there is a point to be made.
From above, to explain a good part of this:
quote:The fragmentation of the U.S. health insurance system also leads to much higher administrative costs. In 2005, the U.S. health system spent $143 billion on administrative expenses. In 2004, if the U.S. had been able to lower the share of spending devoted to insurance overhead to the same level found in the three countries with the lowest rates (France, Finland, and Japan), it would have saved $97 billion a year.
That's a savings of about 2/3, or in other words, dropping down to 1/3 the current cost.
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That's 1/3 of the cost for administration, right?
According to the figures you posted on the previous page and google searches for 2004 GDP and population, we spent 1.7-1.9 trillion in 2004 on health care.
So this would be a 5% overall savings, which is far more than I would have guessed. Not bad.
Do you know where the rest is coming from? (And if I'm being too presumptuous asking so many questions, let me know. I find this terribly fascinating but never have the energy to really research it.)
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This thread has made me realize that I'm a scary patriot. When I saw Mucus asking why didn't we just see how Canada had dealt with UHC issues, my first thought was, "Why do I give a crap about Canada? I don't want to do it their way."
I wonder how many other Americans suffer from this knee-jerk reaction to America needing to be best. That will be important to framing the debate as it goes forward. We can't just ignore how everyone else did it because some of us want us to do it on our own. But we have to be careful how we present infoon other countries if it's going to turn people off. What a strange dilemma I never expected to suffer from.
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You know, no one ever answered Pix's question about controversial procedures (beyond this Canada vs. US abortion thing). And beyond that, what about simply unconventional procedures or methods of therapy? Who decides what off-label uses of what drugs are acceptable?
And, as Dag said, if you really think we should consider how it worked in other countries, why not say something about it instead of expecting us to automatically jump to it? Honestly, there are enough large differences that it's probably not as directly applicable as you think. It's like gun control. It's great to say that the US should just do what Country X should do when it comes to gun control, except that Country X did it's gun control thing years ago. We're not frozen in time here.
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