Topic: Canadian versus US healthcare or Is social medicine better?
Blayne Bradley
unregistered
posted
quote:Originally posted by Dan_Frank:
quote:Originally posted by Orincoro:
quote:Originally posted by MattP:
quote:It's not nominally referred to as 'socialized' or 'socialist' any more than post offices or firefighters are called things like "socialized fire response."
Being in the middle of red-state Utah and having few opportunities for meaningful dialog of the merits of a political ideology something to the left of tea party, I tend to prefix every state-provided service with "socialized" as a minor rebellion.
I particularly enjoyed the socialized fireworks on the 4th of July this year.
Aren't the socialized fireworks in the socialized parks overseen by the socialized fire reponse units, or are they handled by the socialized law enforcement? And who cleans up after the party? The socialized community sanitation agency? when I was a socialized teen counselor, they used to make the socialized parks and recreation crew pick up after the socialized movies in the park, and socialized concerts. Once I saw a couple having socialized sex behind a tree on socialized property. They were socializedly embarrassed when the socialized law enforcement arrived.
Okay, I understand all of these except for "socialized sex." Was this sex part of some psychology experiment that received grant funding? A government-approved prostitute?
Seriously, man, how did the state provide this service? Inquiring minds want to know. And are also a little grossed out.
quote:Originally posted by Samprimary: For the people who had trouble managing to front the small fees for nutritionists provided by the Beth Israel system, looking at Kaiser is like looking into a gated community.
Were you not talking about people with insurance? Because it sure sounded like you were.
quote:Originally posted by Amanecer: If only 1/10 of the people you put on a wellness program 10 years ago are still on the plan today, it gets really hard to prove the effectiveness of the program and even harder to prove the cost-effectiveness of the program.
And that's why Kaiser also works hard on maintaining customer loyalty. I have stuck with them through three employers. (And one of the changes, when I actually was still a client but had triggered the customer-leaving protocol, showed me how hard they work to keep customers.)
Posts: 32919 | Registered: Mar 2003
| IP: Logged |
quote:Originally posted by Dan_Frank: Okay, I understand all of these except for "socialized sex." Was this sex part of some psychology experiment that received grant funding? A government-approved prostitute?
Seriously, man, how did the state provide this service? Inquiring minds want to know. And are also a little grossed out.
I'm thinking you learn how to have socialized sex from those sex-ed films in socialized school, as opposed to learning about capitalist sex from hollywood films.
So, socialized sex is restrained and clinical, while capitalist sex is glamorous and titillating? ... Yeah, sounds about right.
Posts: 3580 | Registered: Aug 2005
| IP: Logged |
posted
Socialization for me means this, and it applies to things like education as well: Instead of having some people who have fantastic health care (or education, or opportunity) and some people who have no health care at all, everyone gets decent health care.
Comparing socialized health care to what you can get if you are lucky enough to pay never works because the speed and quality of service is always going to be better when you can pay.
However, comparing what healthcare is like for the majority of ordinary people when they have no insurance it's going to be a million times better and more easy to use because they actually have access to it.
When they first invented fire-fighters, you had to pay insurance to a company and then when someone called the fire engine they would put out the fire if you had insurance with them. If you didn't, that was it. Clearly, at some point in history, someone thought this was rather unfair. Rich people could continue to be rich because they could afford insurance. Poorer or middle class people just had their homes burn down. So someone invetned the fire-fighting service we have today in almost every civilised country because we actually think it's rather nice for everyone to have access to some level of fire-fighting service, even if they can't pay for it.
Why is this, in the USA, not applied to health care. Why do certain people feel that saving people from the loss of all their personal possessions is an acceptable price to pay, but the loss of their health or life is not? Is it because fire engines are cheaper and simpler?
In a world with healthcare, if you get sick, you go to the clinic, the doctor or a hospital, they swipe your card and you get semi-prompt service for absolutely free or with a reduced cost. You do this even when you're unemployed the same as if you have a good job (let's ignore the splendiferousy rich for now because almost nobody is splendiferousy rich and to use the splendiferously rich as an example for anything is misleading and silly.)
Not wanting socialised health care is an excercise in "I hope". It goes like this: "I hope that when I get sick I will be wealthy" and perhaps that's why America doesn't have it yet. Because every American believes that, when they get that debilitating illness or that injury, they will actually be wealthy by then and the chemotherapy will be affordable without a reduction in costs.
The UK has this problem with the school system, because it is very two tier the same way the American health system is. If you can pay, you get fantastic service. If you cannot, you either have to fight for a good school or you send your child to somewhere where they will not have a very good chance at success.
You might say, "Well, only those who fight for education and health care know its value and deserve it" but that's foolish in terms of the society you will produce. You don't want an unhealthy or poorly educated society. You want a healthy, well-educated one and you don't want to force people to re-mortgage their homes in order to save a member of their family.
Healthcare makes sense. It's better overall for the population. If you wish to have a two tier system, have a two-tier system so the splendiferously rich can get their kidney first (after all, they've worked for it!!!11one), but at least have that lower tier to catch those who will never make it to be splendiferously rich because that's most people.
Yeah. It's expensive. Get used to supporting your nation's poor and ill, because one day you might be.
Posts: 8473 | Registered: Apr 2003
| IP: Logged |
quote:Originally posted by Samprimary: For the people who had trouble managing to front the small fees for nutritionists provided by the Beth Israel system, looking at Kaiser is like looking into a gated community.
Were you not talking about people with insurance? Because it sure sounded like you were.
I'm not dissing kaiser (i like them), I'm just noting the factors that allows them to work inside of our ... uniquely strained system.
Posts: 15421 | Registered: Aug 2005
| IP: Logged |
quote:Originally posted by Teshi: Socialization for me means this, and it applies to things like education as well: Instead of having some people who have fantastic health care (or education, or opportunity) and some people who have no health care at all, everyone gets decent health care.
+1
The way the system works in Australia is I guess triaged in its way.
Firstly, everyone has access to free GP (primary doctor) care. However, these free GP clinics are popular, so if you want immediate access without waiting times,* or your own personal doctor who chooses not to bulk bill, you will pay something (usually about $40-70 an appointment).
Secondly, emergency and essential hospital care is free to all. No ifs, no buts. No matter what the operation. I had my son in a public hospital. The prenatal care (one midwife, continuos care) was free. The birth care (two midwifes, two hospital rooms, one emergency operating room, one obstetrician, one anesthesiologist, one registrar, several theater nurses) was free. The immediate post natal care (one hospital room, many nurses, one midwife (same from before the birth)) and subsequent post natal care (same midwife, home visits for 2 weeks) were also free.
Elective surgery - this can get more tricky. It is free, but waiting times are longer at public hospitals. So, my husband needs a knee operation. It's not crucial, he can live with it, but it pains him. It would be a lengthy wait under the public system, so we'll probably pay for it. However, it will only cost about $1500. I understand that's pretty cheap compared to most operations in the US.
*Usually anywhere from 1 - 3 hours for the walk in clinics, though sometimes more or less. Booking into a bulkbilling GP clinic will mean booking a week or so in advance, but they usually squeeze kids in if they can.
Posts: 4393 | Registered: Aug 2003
| IP: Logged |
quote:Originally posted by imogen: Elective surgery - this can get more tricky. It is free, but waiting times are longer at public hospitals. So, my husband needs a knee operation. It's not crucial, he can live with it, but it pains him. It would be a lengthy wait under the public system, so we'll probably pay for it. However, it will only cost about $1500. I understand that's pretty cheap compared to most operations in the US.
Dad's pacemaker (a reasonably simple procedure as far as that goes) was $227,000. Just the surgery - not the emergency room care that got him into the hospital, not the tests to determine a diagnosis.
Posts: 11187 | Registered: Sep 2005
| IP: Logged |
posted
No kidding. He had needed a pacemaker for quite some time but put it off. (Even with Medicare and his other insurance, the bills are significant.) In December, the lack of oxygen caused by the slow heart rate led to him falling down and breaking his right arm just below the shoulder. That was a whole separate surgery once the pacemaker got his heart rate to a point where they could do surgery. Plus rehab and temporary nursing home care.
And that was a fairly easy, not all that complicated, and quite "fixable" health situation.
posted
I've hear that India has some excellent heart surgeons who will fix stuff much cheaper than the US and with just as much success. Health-tourism is getting to be booming because of things like what kmboots mentioned. I think that when my daughter had a catheter, blood draw and some x-rays, the insurance paid more than $1500 (negotiated down from like 5k). We paid $350 I think.
Posts: 2223 | Registered: Mar 2008
| IP: Logged |
quote:The leading cause of personal bankruptcy in the United States is unpaid medical bills; the United States has more lost productivity and a lower average working age range than any of the other 'modernized' high-income nations such as the G8.
Is this “fact” based upon the widely discredited Himmelstein study? Nobody has taken the Himmelstein study seriously since, well, pretty much since it came out. See, e.g., here. If not, I’d like to see the data, because all the data I’ve seen points to the fact that medical debt, if it contributes to bankruptcy at all, tends to represent a very small percentage of total unsecured debt. Indeed, even those citing medical debt as a “leading cause” of their bankruptcies have medical debt that represents only a very small percentage of total unsecured debt.
quote:Americans spend $5,267 per capita on health care every year, almost two and half times the industrialized world’s median of $2,193; the extra spending comes to hundreds of billions of dollars a year. The extra spending does not provide us with anything approaching the effectiveness of non-actuarial models.
A substantial portion of the U.S. health care costs are attributable to drug prices. Most Western nations have imposed price controls, which limit access to the newest drugs and eliminate incentives for innovation. Indeed, by imposing price-controls, these nations are cost-shifting to other nations (like the U.S.) that have adequate patent protection to spur innovation. We also utilize more health technology than our peers and provide much higher numbers of quality-of-living procedures (knee replacements, cataract surgery, etc.).
quote:American life expectancy is lower than the Western average.
Life expectancy is a terrible metric to measure quality of care, as lifestyles are incredibly important to longevity. You can have the best health coverage in the world, your life expectancy isn't going to be so great if you're smoking your tenth cigarette of the day while eating the fourth Big Mac of the hour. Our disease survival rates, however, which do measure quality of care, are quite good. Indeed, the U.S. has higher survival rates than the E.U. for thirteen cancers, while the E.U. has higher survival rates than the U.S. for only three (and of those three, there is only a 2% difference).
quote:Childhood-immunization rates in the United States are lower than average.
Our measles immunization rate is only slightly lower than the OECD average and is higher than the U.K.’s (and ties France’s).
quote:Doctors here perform more high-end medical procedures, such as coronary angioplasties, than in other countries, but most of the wealthier Western countries have more CT scanners than the United States does, and Switzerland, Japan, Austria, and Finland all have more MRI machines per capita.
quote:And, of course, every other country in the industrialized world insures all its citizens; despite those extra hundreds of billions of dollars we spend each year, we leave forty-five million people without any insurance.
One question: do you think the U.S. should insure all citizens, or all people? Because you’re using two different metrics, there. Around 20% of uninsured U.S. residents aren’t citizens. And, of course, another 25% are eligible for Medicaid and will be enrolled automatically by seeking medical care. Those remaining aren’t necessary poor, sick, or looking for insurance. 43% have incomes 250% of the poverty level, 86% report they are in good (or excellent) health, and only half will still be uninsured after six months. (That rate drops to 30% after a year, 16% after two, and 2.5% after three.)
Posts: 10 | Registered: Dec 2008
| IP: Logged |
posted
That's a peculiar registration date and post count, Syphon. I wonder who you're an alt for? Obviously you're under no actual or even moral obligation to answer that question, it's just that there is sometimes a pattern `round here of that sort of style-alts posting in highly politicized issues. Made me wonder.
Posts: 17164 | Registered: Jun 2001
| IP: Logged |
posted
Pwebbers can verify that I'm not an alt of any Hatracker. By and large, Hatrack moves too fast (and after much lurking, I never really felt like I "fit in") for me to keep up with the board-as-a-whole, and I'm not a huge fan of watching only a few threads.
That said, health law and policy is sort of my expertise. So I thought I'd chime in.
Posts: 10 | Registered: Dec 2008
| IP: Logged |
posted
Making a long and sweeping post dismissing the very basis of another viewpoint in very broad terms, as your first post in memory, is not good form. And that stands to reason. You don't have any credibility here, because nobody is familiar with you.
Posts: 9912 | Registered: Nov 2005
| IP: Logged |
posted
I don't care about 'forum cred' or lack of thereof at all, short of the now legitimate concern that this is another sock puppet. That post alone would have made for a better original post, as opposed to the google & run we got.
I'll pull my own quick response with the time I have at the pattern of the post which most intrigues me.
quote:Originally posted by Syphon the Sun: Our disease survival rates, however, which do measure quality of care, are quite good. Indeed, the U.S. has higher survival rates than the E.U. for thirteen cancers, while the E.U. has higher survival rates than the U.S. for only three (and of those three, there is only a 2% difference).
I have encountered this specific example (the Thirteen Cancers) multiple times, often specifically cherrypicked. This is a great way to say "Our survival rates for these specific cancer types is quite good" but this is not an argument for saying that our disease survival rates, as the chosen metric for showing off how well our system stacks up versus others, are good. Especially when we have two chronic problems:
1. In numberless categories, our disease survival rate is so significantly poorer and rife with so much inefficiency as to keep defenders of our own system stuck trying to point to these specific cancers, and ignore wide swaths of glaringly subpar performance elsewhere. To pick a pretty completely random example, our mortality rate for end-stage renal disease is 47% higher than Canada's. Yes, even after adjustment for patient and treatment variables between the two countries, and
2. The other systems don't have wide socioeconomic opportunity gaps associated with their health systems. International comparisons of cancer survival show that poor people here have significantly lower survival rates for most of those cancers, where Canada and elsewhere show no such association for any cancers.
~and~
quote:
quote:Childhood-immunization rates in the United States are lower than average.
Our measles immunization rate is only slightly lower than the OECD average and is higher than the U.K.’s (and ties France’s).
This also looks like a very selective, cherrypicking response. As in, it doesn't appear to actually address or disprove the preceding statement at all, but rather tries to stress a specific individual portion to make the comparison look much more favorable ...
Posts: 15421 | Registered: Aug 2005
| IP: Logged |
quote:Originally posted by Orincoro: Making a long and sweeping post dismissing the very basis of another viewpoint in very broad terms, as your first post in memory, is not good form. And that stands to reason. You don't have any credibility here, because nobody is familiar with you.
That seems like an overly harsh denunciation. I didn't think the post was mean-spirited or even that argumentative. I did think that, given the many factual assertions it would have been nice to have some links to further information.
I think the idea that the only way for someone to have credibility on Hatrack is to have a long posting profile is pretty facile. Certainly reputation is important, but my judgments of credibility are based on lots of factors including the tone and content of the posts, in addition to my personal history with the poster. Telling someone new that their post doesn't deserve a reasoned response because they are new strikes me as thoughtless and rude.
Posts: 2926 | Registered: Sep 2005
| IP: Logged |
quote:Originally posted by SenojRetep: I think the idea that the only way for someone to have credibility on Hatrack is to have a long posting profile is pretty facile.
I agree.
quote:Originally posted by SenojRetep: Telling someone new that their post doesn't deserve a reasoned response because they are new strikes me as thoughtless and rude.
Agreed again, except for one thing -- with a join date of 2008, they're not exactly new. As Samp pointed out, the real issue is not whether they are new, but whether they are not.
Posts: 32919 | Registered: Mar 2003
| IP: Logged |
posted
Syphon's familiarity on hatrack should have little bearing on the arguments he/she has made. A rebuttal to the points presented would be more appropriate than speculation about possible alts and other ad hominem drivel.
Posts: 570 | Registered: Sep 2009
| IP: Logged |
quote:Originally posted by Samprimary: short of the now legitimate concern that this is another sock puppet.
I assume that I’m missing something, here, but why, exactly, is there a “legitimate concern that [I’m] another sock puppet?”
quote:Originally posted by Samprimary: I have encountered this specific example (the Thirteen Cancers) multiple times, often specifically cherrypicked. … In numberless categories, our disease survival rate is so significantly poorer and rife with so much inefficiency as to keep defenders of our own system stuck trying to point to these specific cancers, and ignore wide swaths of glaringly subpar performance elsewhere.
Could you explain why you feel the data is “cherry-picked?” It is my understanding that cancer survival rates are most often analyzed because that’s what data is actually collected consistently (through a large number of cancer registries) and can be most easily compared across borders. Disease survival rates for most other diseases aren’t collected in this manner, which makes cross-border comparisons much more difficult to perform. I’d be interested in seeing the data concerning other diseases and the data collection techniques.
quote:Originally posted by Samprimary: The other systems don't have wide socioeconomic opportunity gaps associated with their health systems. International comparisons of cancer survival show that poor people here have significantly lower survival rates for most of those cancers, where Canada and elsewhere show no such association for any cancers.
I’d be interested in seeing those studies, if you get the chance. (Particularly given the vast amount of research concluding that Medicaid patients – the “poor” – tend to have worse medical outcomes than even the uninsured. It would be nice to look at the interplay there.) At any rate, that’d be a discussion I’d be interested in having, precisely because it’s a meaningful discussion about quality of care, while a discussion about life expectancy is surely not. Which was the entire point of even bringing up survival rate metrics: at least it’s a step in the right direction of measuring quality of care, rather than lifestyle choices.
quote:Originally posted by Samprimary: This also looks like a very selective, cherrypicking response. As in, it doesn't appear to actually address or disprove the preceding statement at all, but rather tries to stress a specific individual portion to make the comparison look much more favorable ...
I don’t really think I was “cherry-picking” data. I used the first OECD data concerning vaccinations that was available in their statistics portal. After further investigation, it appears that our rates for pertussis vaccinations given to children under 2 is below OECD average, but our vaccination rates for hepatitis B are above average. Our rates are above-average for 2 of the 3 vaccines typically given to children under 2. Of course, our per capita incidence of measles, pertussis, and hepatitis B are all below OECD average, as well, so maybe vaccination rates aren’t terribly good metrics to begin with.
quote:Originally posted by SenojRetep: I did think that, given the many factual assertions it would have been nice to have some links to further information.
quote:Originally posted by rivka: Samp already took care of that quite handily.
He completely ignored the vast majority of the post. He failed to provide any sources for either his original assertions or any new ones. His only response concerned “cherry-picking” data. As it turns out, you have to cherry-pick data to get to the result he claimed in one of those instances (vaccination rates). For the other, cancer survival rates are the easiest to track across-borders, so I don’t really think it’s cherry-picking to use them (and, indeed, even if they were cherry-picked, they are still a better metric than his proposed life-expectancy metric, which doesn’t measure quality of care in any sense). Is that really what passes for “quite handily” providing a rebuttal?
ETA: Fixed some broken tags.
[ August 29, 2011, 02:34 PM: Message edited by: Syphon the Sun ]
Posts: 10 | Registered: Dec 2008
| IP: Logged |
quote:I assume that I’m missing something, here, but why, exactly, is there a “legitimate concern that [I’m] another sock puppet?”
It is a function and concern of the environment you have entered. Nothing you have done. Any random new poster (especially ones with long-dormant names that have tended to be alts in the past) has weathered scrutiny because of it. It's regrettable, but it's what's been stirred up here. Besides that, I'm in the camp of not caring about whether or not you have some sort of 'forum cred' or whatever.
quote:Could you explain why you feel the data is “cherry-picked?”
It should be evident through my previous post, but here's some more clarification. I have encountered this data multiple times precisely because it has a history of being used as a cherrypicked piece of data to use to try to support the American system. The strongest meta-analysis of comparisons between systems has usually been between the United States and Canada, which is pretty convenient given that Canada's system struggles a bit compared to other, better universal care systems. Of those meta-analyses, the strongest I can recall was from Open Medicine, and suggested that health outcomes were generally better in Canada. Every WHO ranking comparing the countries shows unanimous agreement with that declaration.
So what we're looking at is a comparison between two countries, where america seems to be a little bit worse in terms of overall health care outcomes and has people constantly stretching to try to claim that it is equal or maybe even a little bit better in these outcomes overall (which is extremely unlikely), yet inarguably pays remarkably more per capita into the system. Which is why I already addressed the issue of cost to benefit analysis and why one side in this debate so frequently hopes to leave it out of the discussion entirely.
quote:I’d be interested in seeing those studies, if you get the chance.
Sure, when I have time.
quote:He completely ignored the vast majority of the post.
I feel there is a significant difference between 1. 'ignoring a vast majority of your post' and 2. not actually ignoring anything, while opting for a quick response with the time only towards the pattern of the post which most intrigues me. And, in fact, noting clearly that I am doing as such prior to doing so. You're quick to determine and declare my actions and attentions for me!
quote:As it turns out, you have to cherry-pick data to get to the result he claimed in one of those instances (vaccination rates).
Interesting response. What result do you think I am claiming?
quote: (and, indeed, even if they were cherry-picked, they are still a better metric than his proposed life-expectancy metric, which doesn’t measure quality of care in any sense)
Also a intriguing response. What is my 'proposed life-expectancy metric?'
Why do you insist that life expectancy for a country does not measure quality of care in any sense? (note the power word, here)
Posts: 15421 | Registered: Aug 2005
| IP: Logged |
Looking at the data on pharmaceutical spending, it shows the US spends roughly the same amount on pharmaceuticals (as a % of GDP) as other OECD countries (1.9% for US; 1.8% for Canada, France, others; 1.6% OECD average). But the US total spending, as a percentage of GDP, is much higher than the OECD average. So the idea that pharmaceutical spending alone explains the disparity, or even a significant portion of the disparity, doesn't seem very valid to me.
Do you have other ideas of what is causing the significant disparity in spending?
<edit>Looking at some of the other charts from the OECD ilibrary, I think the prevalence of tests is a more likely culprit. Per capita, individuals in the US spend more than twice the OECD average on MRI scans and CT scans. And the difference between the US and the next highest consumers of such tests is fairly significant.
Doing a rough calculation* of $2000/MRI scan (assumed uniform across countries; if MRIs cost more or less in other countries, it won't be reflected in this rough analysis), the US spend $50B on MRI scans in 2007. Had we only consumed MRI scans at the OECD avg, it would only have been $22B, a difference of about 0.2% of GDP. So the difference in cost due to MRI scans alone is roughly equivalent to the difference in pharmaceutical spending.
Doing the same rough analysis on CT scans, using $3000/scan we get spending of $120B, whereas if we consumed at the OECD average we would have spent only $60B, a difference of about 0.6% of GDP, or more than twice the difference in pharmaceutical spending.
*Obviously all calculations are only as good as the calculator and the input assumptions. I make no guarantees that my assumptions or my calculations are accurate. </edit>
posted
Also, cause someone's going to have to say it eventually:
quote:Originally posted by capaxinfiniti: A rebuttal to the points presented would be more appropriate than speculation about possible alts and other ad hominem drivel.
Can we get some sort of agreement from you, for your sake as much as anyone else's, that you try not to use 'ad hominem' until you've really boned up on how not to use the term incorrectly?
Posts: 15421 | Registered: Aug 2005
| IP: Logged |
quote:Originally posted by Samprimary: You're quick to determine and declare my actions and attentions for me!
I think you missed the point. I wasn't trying to determine or declare your actions or intentions. I was pointing out how silly it was to say that several points have been skillfully rebutted by a response that addresses only one small portion. Perhaps I should have said "did not address," rather than "ignored," but I thought the meaning would come across and certainly didn't intend to imply that you would not be back to discuss the rest.
quote:Originally posted by Samprimary: Interesting response. What result do you think I am claiming?
I think you're claiming that "[c]hildhood-immunization rates in the United States are lower than average." For one of the immunizations: yes. For the others: no.
quote:Originally posted by Samprimary: What is my 'proposed life-expectancy metric?'
In your list of "facts" of why our healthcare is worse, you noted that "American life expectancy is lower than the Western average." That's what I mean when I say you're using a life-expectancy metric to analyze quality of care.
quote:Originally posted by Samprimary: Why do you insist that life expectancy for a country does not measure quality of care in any sense? (note the power word, here)
It measures quality of care in the same sense that it measures car ownership, smoking habits, obesity-related illness, alcohol consumption, crime rates, etc. That's precisely why it's such a useless metric and why it's rarely used as a measuring stick by anyone doing real research: it simply has too many non-quality variables to be useful. You can't control for all the factors to do any real measurements with it.
Posts: 10 | Registered: Dec 2008
| IP: Logged |
quote:Originally posted by SenojRetep: Looking at the data on pharmaceutical spending, it shows the US spends roughly the same amount on pharmaceuticals (as a % of GDP) as other OECD countries (1.9% for US; 1.8% for Canada, France, others; 1.6% OECD average).
Well, I was actually responding to per-capita spending comparisons. Our per-capita pharmaceutical spending is significantly higher. But, no, higher pharmaceutical prices certainly don't tell the whole story, and I do apologize if I implied otherwise.
quote:Originally posted by SenojRetep: So the idea that pharmaceutical spending alone explains the disparity, or even a significant portion of the disparity, doesn't seem very valid to me.
I noted some of the other high cost-drivers: increased use of medical technology (we have more of it, we have the newest models, and we use it more often), and our use of quality-of-life procedures. There are several factors, of course, and in many cases, we're getting some kind of benefit from the higher costs (whether those benefits outweigh the costs is a different discussion, of course). Our physicians, specialists, and nurses are among the highest paid. We have below-average physicians per-capita, which obviously increases cost. Our consumption of pharmaceuticals is near the top, while our consumption of new pharmaceuticals is far-and-away leading the pack. We also spend 4 times the average OECD spending on public health programs. We invest more in medical facilities. And, of course, the big kicker: we pay less out-of-pocket (as a percentage of total health care spending) than pretty much any other OECD nation.
Posts: 10 | Registered: Dec 2008
| IP: Logged |
quote:Originally posted by Syphon the Sun: And, of course, the big kicker: we pay less out-of-pocket (as a percentage of total health care spending) than pretty much any other OECD nation.
quote:Originally posted by Samprimary: Also, cause someone's going to have to say it eventually:
quote:Originally posted by capaxinfiniti: A rebuttal to the points presented would be more appropriate than speculation about possible alts and other ad hominem drivel.
Can we get some sort of agreement from you, for your sake as much as anyone else's, that you try not to use 'ad hominem' until you've really boned up on how not to use the term incorrectly?
No.
Show my incorrect usage. And since you obliviously think this is a recurring error, show previous posts where I've incorrectly used the term.
Posts: 570 | Registered: Sep 2009
| IP: Logged |
posted
Nope, it doesn't include taxes or amounts paid for insurance. (The rather contrived nature of this number should make you suspicious and thus ... http://www.oecd.org/dataoecd/52/32/38976612.pdf Voila )
Posts: 7593 | Registered: Sep 2006
| IP: Logged |
quote:Originally posted by kmbboots: Does that include what we pay for insurance?
No. What you pay for insurance doesn't count as an out-of-pocket expense in the context of healthcare financing, particularly within the framework of a third-party-payer problem.
(Note that I wasn't attempting to claim that we pay less individually for health care. Just that our low out-of-pocket share for services (rather than our overall costs of what we pay for health insurance + deductible + copays) contributes to the third-party-payer problem of inflating prices.)
Posts: 10 | Registered: Dec 2008
| IP: Logged |
posted
The idea behind the metric of out-of-pocket expenses, I would guess, is the hypothesis that in a non-socialized system costs are better kept low if the price of services is transparent to the consumer. That transparency should be maximized if more of the cost is out-of-pocket. So prices in a market-driven system should theoretically be lower if the ratio of out-of-pocket spending to total spending is high.
I'd be interested in testing that hypothesis. So, for instance, using the data in the link Mucus provided, does high out-of-pocket percentage correlate with lower overall healthcare prices? It doesn't jump out as immediately obvious to me that it does.
<edit>I guess that's the "third party payer" problem Syphon mentions in the above post. Syphon, do you have a useful link on the effect of the third party payer problem on healthcare spending? It seems like an intuitive conjecture to me, but the lack of clear correlation between low costs and high out-of-pocket expense percentage strikes me as evidence against the hypothesis.</edit>
Posts: 2926 | Registered: Sep 2005
| IP: Logged |
quote:Show my incorrect usage. And since you obliviously think this is a recurring error, show previous posts where I've incorrectly used the term.
1. your incorrect usage: it's on this page. It's not really hard to find. 2. Silly, where do I say it's a recurring error? I'm worried precisely because you've started using the term, and (already notoriously bad) arguers expanding their repertoire to start slinging out formal fallacy names with scattergun applicability is exactly the sort of thing I'd like to nip in the bud, if you don't mind.
Posts: 15421 | Registered: Aug 2005
| IP: Logged |
quote:Originally posted by Syphon the Sun: It measures quality of care in the same sense that it measures car ownership, smoking habits, obesity-related illness, alcohol consumption, crime rates, etc. That's precisely why it's such a useless metric and why it's rarely used as a measuring stick by anyone doing real research: it simply has too many non-quality variables to be useful. You can't control for all the factors to do any real measurements with it.
You can't control for all the factors in pretty much any metric we could possibly be using here, though. What I'm asking is why you are insisting that life expectancy cannot measure quality of care in ANY sense. This, as opposed to saying that it's a very poor metric to use due to x, y, z.
Posts: 15421 | Registered: Aug 2005
| IP: Logged |
posted
Forgive me for not reading all the thread, I just wanted to pipe in and complain about something:
[sour grapes]My wife is the Medical Assistant for the head a specialist (I won't mention which) in the county in his (and his partner [omitted]ologists) private practice. My wife makes very little per hour while preforming the vast majority of the work, while the doctors make millions (seriously) while doing very little of the work. Yes, not only did he get all the schooling to be an MD, but then more to be a specialist, and then became the premier [omitted]ologist in the area, but his practice would grind to a messy halt without my wife and he pays her a pittance for her daily hard work while he just bought his second new car this year. [/sour grapes]
Posts: 6683 | Registered: Jun 2005
| IP: Logged |
quote:Originally posted by Samprimary: What I'm asking is why you are insisting that life expectancy cannot measure quality of care in ANY sense. This, as opposed to saying that it's a very poor metric to use due to x, y, z.
While I enjoy the fact that you'd rather play a game of semantics than actually discuss the topic, I'm not sure what you're trying to accomplish, other than distract from the actual issues involved.
The value of using life expectancy as a metric for quality of care is so very close to zero that I don't think it's that outlandish to, for simplicity's sake, call it zero, particularly given the context in which it is called such. Indeed, you might note that I originally just called it a "terrible metric."
The fact that quality of care has an effect on life expectancy doesn't mean that you can reasonably use it to measure quality of care any more than you can reasonably use it to measure violent crime simply because violent crime has an effect on life expectancy.
Of course, if you'd like to defend your use of life expectancy as a metric, I'd be open to discussing that. If not, it's really not worth my time to continue playing your trivial game.
Posts: 10 | Registered: Dec 2008
| IP: Logged |
quote:Originally posted by SenojRetep: I guess that's the "third party payer" problem Syphon mentions in the above post. Syphon, do you have a useful link on the effect of the third party payer problem on healthcare spending?
I'm actually on my way to a conference, and will be out of town for the next few/several days, but as soon as I'm back home to my desktop and research cache, I'd be happy to.
If I get a few free moments with internet access, I'll try to find some alternate links so you folks don't have to wait.
(And I apologize in advance for the fact that my responses are going to be at least somewhat delayed until I get home.)
Posts: 10 | Registered: Dec 2008
| IP: Logged |
posted
SW, sadly, that problem is not limited to the medical field. People who appreciate good support staff -- and put their money to back up that appreciation -- are few and far between. Posts: 32919 | Registered: Mar 2003
| IP: Logged |
quote:Originally posted by Stone_Wolf_: Forgive me for not reading all the thread, I just wanted to pipe in and complain about something:
[sour grapes]My wife is the Medical Assistant for the head a specialist (I won't mention which) in the county in his (and his partner [omitted]ologists) private practice. My wife makes very little per hour while preforming the vast majority of the work, while the doctors make millions (seriously) while doing very little of the work. Yes, not only did he get all the schooling to be an MD, but then more to be a specialist, and then became the premier [omitted]ologist in the area, but his practice would grind to a messy halt without my wife and he pays her a pittance for her daily hard work while he just bought his second new car this year. [/sour grapes]
I have been smarter and more generally competent than every boss I've ever had, save one or two. But the value of my time was measured by the availability of replacements, and their ability to do the work I was being payed to do, at the same rate of pay. You're a capitalist, you know how that works.
The only thing these experiences have taught me is that I typically find employment below my actual potential, but for various reasons, personal, circumstantial and economic, I have still worked these jobs. Ive worked for a few too many companies who were addicted to freelance work- underpaying for and undervaluing their primary product. That's actually something I've been working to change recently. It sounds like your wife could also find greater satisfaction in another job.
Posts: 9912 | Registered: Nov 2005
| IP: Logged |
quote:Originally posted by Syphon the Sun: While I enjoy the fact that you'd rather play a game of semantics than actually discuss the topic, I'm not sure what you're trying to accomplish, other than distract from the actual issues involved.
A game of semantics, versus a game of questioning an individual prioritization of data analysis? You can think it to be whatever you want. I'm trying to figure out what importance you want life expectancy to have when discussing healthcare system. You apparently want it completely disregarded, so that draws forth some inevitable new questions.
- what, to you, is the potential value of analyzing adjusted life expectancy by removing infant mortality, accidents, assault from overall mortality stats, and comparing life expectancy for various groups (diabetics, etc) between countries?
- likewise, what about analyzing life expectancy among our population 65 and older, which even the AEI (no friend of nationalized anything, mind you) believes is a valuable piece of data to incorporate into the study of the efficacy of our system versus others? Because, well, we do get some useful numbers out of that, honestly.
quote:Even if we look at life expectancy for sub-populations relatively less affected by the reasons people use to try and discredit the metric as a quality measure, we still look pretty bad.
There's countries out there with worse health habits and more dangerous lifestyles overall, countries with higher obesity rates than us. What with us unambiguously paying more of our overall productivity into ours than theirs, we should be seeing better results for that if we want to claim a superior system or (as is often the case) the 'framework for a superior system' if we could just get rid of a few hiccups here and there, such as allowing better coverage competition across state lines, or whichever vanishing-point market correction ideal is in vogue. We should be seeing better outcomes in the end-point, end-user categories, senior citizens living longer, 'less waste than a government bureaucratic nightmare,' any of these things. We should probably have also been improving vis a vis other countries what with the significant downturn in murders and other violent crimes across the decades. We have none of that!
Which is why, of course, I end up returning to cost to benefit ratio. Which is interesting to note (and begin using as a chorus piece) in light of the, as mucus said, notably intriguing presented number figure for .. I guess, Pay Less Out Of Pocket As A Percentage Of Total Health Care Spending.
quote:Originally posted by Samprimary: 1. your incorrect usage: it's on this page. It's not really hard to find. 2. Silly, where do I say it's a recurring error? I'm worried precisely because you've started using the term, and (already notoriously bad) arguers expanding their repertoire to start slinging out formal fallacy names with scattergun applicability is exactly the sort of thing I'd like to nip in the bud, if you don't mind.
I said 'no' because your accusation is incorrect.
There have been previous discussions where I've identified ad hominem fallacies and I assumed you were only now commenting on those instances. You're clearly unaware of those 'recurring' uses.
Either you've suffered a moment of intellectual retardation or you really are ignorant as to the nature of this particular logical fallacy. Again, instead of showing the error, as I requested, you've reiterated what you said in the previous post. Hopefully you can see how condescending that behavior is and 'nip it in the bud.'
And all this is getting old. Your needlessly antagonistic comments are the real 'shame' in these discussions.
Posts: 570 | Registered: Sep 2009
| IP: Logged |
posted
I'd settle for knowing where the ad hominem attack in this thread was that you initially referred to, capax. I still generally disagree with you, but lately you've appeared-to me at least, for what that's worth-an honest participant in discussions.
Complaining about ad hominem attacks from others to a third party while slinging them yourself is, well, pretty weird and smacks of dishonest discussion.
Posts: 17164 | Registered: Jun 2001
| IP: Logged |
posted
I'm a little late to the sock-puppet game, but I just wanted to say that I joined Hatrack many years ago and posted very, very rarely for the first several years. There are a lot more lurkers here than you might expect.
Posts: 3580 | Registered: Aug 2005
| IP: Logged |
quote:Originally posted by capaxinfiniti: Either you've suffered a moment of intellectual retardation or you really are ignorant as to the nature of this particular logical fallacy.
is literally, with no sense of irony, posted right alongside this:
quote:Originally posted by capaxinfiniti: Your needlessly antagonistic comments are the real 'shame' in these discussions.
Please, continue trying to show me what your version of high ground looks like.
Posts: 15421 | Registered: Aug 2005
| IP: Logged |
Printer-friendly view of this topic
![[Wink]](wink.gif)
I'm confused about your point.
![[Frown]](frown.gif)
