Socialised Healthcare

[fls]

I'm not sure where exactly you got the idea that the 'criteria were listed'. Bascially, all I could find about the initial screening of articles was "reviewers independently evaluated titles"... To me, that sounds a little vague.

The section starting with:

"Eligibility criteria
We included published and unpublished prospective or retrospective observational studies comparing health outcomes (mortality or morbidity) in Canada and the United States for patients of any age with the same diagnosis."

followed by seven paragraphs describing the process is the part I was referring to. Further details can be obtained from the corresponding author. I can go over them with you, if you're interested. It may need a new thread, but I'm always interested in explaining the process (this is my area of research, but I recognize that my fascination may not be shared by others ).

Correction... there were 2 people involved at each step. Given the political stance of the lead author of this study (and the nature of this particular peer reviewed publication) I do have to question who exactly was doing the initial screening.

I did say that wrong. There were multiple people involved in evaluating each study, as different pairs of reviewers were employed at each step for any particular study.

Why are you interested in who did the initial screening. The initial step is undertaken in order to exclude all the studies that have nothing to do with this particular research. Anything that could possibly be relevant is passed on for review - i.e. it's not the point at which any real judgments are being made.

I use MRIs because they are a good example of the problems associated with an all-user-pays system (at least here in Canada)... its infrastructure that COULD be improved by allowing free market participation, but is not because of government rules. That also includes CAT scans, PET scans, and any other diagonstic tools you can think of.

I understand. But the information you gave doesn't tell us whether or not diagnoses are delayed. Diagnostic tools aren't only used for initial diagnosis, and an average waiting time does not tell us what we really want to know, since we are interested in whether the wait corresponds to the urgency. For example, while my patient who needs a routine CT waits for 3 months, my patient that needs a CT done within a day or two gets it within a day or two.

We're skeptics... we should recognize that even if we set out with the best of intentions to remove any bias its just not possible. You can't have a double blind study with people who cannot effectively do any sort of random selection.

Random sampling is not an issue since the studies represent the entire population (all studies that looked at a particular issue) not a sample.

I'm not saying that all bias can be removed. A good researcher takes into consideration sources of bias and talks about the steps taken to reduce or eliminate those sources.

Just out of curiosity... did you actually read the results in any detail?

According to their study, they found 14 studies that showed Canada's health care system was better, vs. 5 in the U.S.. Yet if you look at the studies that showed Canada's system was better:
- 5 involved kidney disease. Basically, they were measuring the same thing 5 times. Even if the Canadian system IS better at handling Renal failure, including 5 different studies is a little misleading

But that would be poor research practice. I thought we were supposed to be opposed to that.

- Multiple Studies on cystic fybrosis are also included (2), as are multiple studies (3) covering breast and prostate cancer. (Ironically this conflicts with other studies they've done that how the U.S. system is better at handling certain cancers).

So now you want to arbitrarily include information that supports your particular bias?

- They've also included a study on AIDS survival rates... however, such results likely depend more on the affordability of drugs rather than the overall health care system, so personally I think that study should be discounted

Oh good. Even more cherry-picking after the fact.

- Something else I noticed... many of the pro-U.S. studies involved Arthritis, Cataracts, and Heart disease. These are (as far as I know) more common than AIDS and Cystic Fibrosis. So, why is a study of a disease which affects few people given as much weight as a study that affects a lot of people?
Once the 'duplicates' are removed (multiple studies supporting the Canadian system) the Canadian system doesn't exactly look as good.

Lets face it, your 'article' does not so much prove the superiority of the American system, but in the ability of researchers to research articles.

I agree that the article does not prove the superiority of the American system (or the Canadian for that matter). I agree with the researchers that a reasonable conclusion is that neither system can claim hegemony in terms of quality of care. However, you demonstrated that while the researchers stuck to the principles of good research practices, you would not have been interested in doing so, had it been your choice. I find that I cannot go along with that.

Linda

 

[IchabodPlain]

So What? They are not a substitute for insurance no matter what other benefits HSAs have. You couldn't even pay for a broken leg from your HSA. Who cares what eye glasses cost?

I spend ~$1,000/ month for health insurance. At $12,000/year I have so far paid more than I have used. (I think, because I did have one major surgery and I'm not sure what that would have run.) That doesn't mean I want to insure myself. I also have malpractice, auto, and house insurance and I have one claim on the house insurance when my pipes froze and flooded a room. That doesn't mean I want to insure myself for those potential costs. HSAs have nothing to do with medical insurance needs.

That is not what I said. Do you know how HSA's work? You must purchase catastrophic hc in conjunction with the HSA. The HSA money is used (for the 3rd time) for small expenses. You are not supposed to use it to pay for emergencies (although in theory you can). It would pay for eye exams, glasses, generic prescriptions, doctor visits, physicals, etc. Regular hc expenses are not that expensive (my doctor visit is $35, eye exam $60, etc), but if you were to be diagnosed with prostate cancer, you would use the healthcare you purchased in conjunction with activating your HSA account.

 

[Ivor the Engineer]

To the proponents of a free-market health care system:

Imagine there are two ill people, let's say with a genetic condition (i.e. no fault of their own), which if left untreated will lead to a significant impairment of their quality of life and likely shorten it. One has comprehensive health insurance and can get treated, while the other has only basic cover and the cost of treatment is more than they could ever possibly afford. Thus the rich persons lives and the poor person suffers and dies early.

Your argument appears to be that this is a desirable or at least acceptable outcome in a so-called civilised society.

Medical treatment is unlike any other service or product you buy; it is often a need not a want. The free-market works well providing people with what they want, but poorly providing them with what they need.

 

[Molinaro]

A quick, dumb question for those who live in countries with universal healthcare:

If someone has injuries which are clearly caused by another person (for example, I punch someone and break his jaw), do the taxpayers have to pick up the tab, or is the person at fault made to cover the costs?

What if I break my wrist in addition to his jaw? Is my own injury covered?

In my experience (personal and via friends/family), you don't pay for anything ever in Canada, so long as the procedures themselves are covered. The circumstances leading to you needing a particular procedure are irrelevant.

The only things I've ever heard of not being covered are:

- cosmetic surgery

And that's about it.

Some incidental costs are not always covered. For example you can get a plaster cast for free, but they will ask you to pay a surcharge out of pocket if you want fiber glass instead. Although, I find this depends on the hospital. Some will simply so ok you can have it anyway if you tell them you can't afford it. Same thing with crutches, that sometimes they ask you to pay $15 for, and sometimes they just give them to you and ask that you return them (if you only need them for a few days).
An ambulance ride is also billable, although I never had to pay the 1 time I was in one.
Getting a private room is something you either need private insurance to cover or have to pay out of pocket for.

 

[Kestrel]

To the proponents of a free-market health care system:

Imagine there are two ill people, let's say with a genetic condition (i.e. no fault of their own), which if left untreated will lead to a significant impairment of their quality of life and likely shorten it. One has comprehensive health insurance and can get treated, while the other has only basic cover and the cost of treatment is more than they could ever possibly afford. Thus the rich persons lives and the poor person suffers and dies early.

Your argument appears to be that this is a desirable or at least acceptable outcome in a so-called civilised society.

Medical treatment is unlike any other service or product you buy; it is often a need not a want. The free-market works well providing people with what they want, but poorly providing them with what they need.

In the USA, hospitals are required to provide emergency health care regardless of ability to pay. But treatments such as chemotherapy are not considered emergency care. If you don't have insurance and can't pay yourself, treatment is not provided.

Having health insurance doesn't always protect you. A 2001 study found that half of all American bankruptcy filings were due to medical causes. The scary part is that 75 percent of them had insurance at the onset of the illness that eventually caused them to go bankrupt.

 

[JEROME DA GNOME]

If people could just pay health care costs out of their savings accounts we wouldn't be having this discussion.

People could if taxes were not so high and lawyers like John Edwards did not get rich on payments from doctors for causing genetic disease during childbirth.


How would a doctor cause a potentially genetic disease during childbirth?

 

[JEROME DA GNOME]

To the proponents of a free-market health care system:

Imagine there are two ill people, let's say with a genetic condition (i.e. no fault of their own), which if left untreated will lead to a significant impairment of their quality of life and likely shorten it. One has comprehensive health insurance and can get treated, while the other has only basic cover and the cost of treatment is more than they could ever possibly afford. Thus the rich persons lives and the poor person suffers and dies early.

Not the rich person, the person who choose to fund their health-care to a larger extent.

Should the government also provide everyone with life insurance?

Imagine two people who are injured in a car accident. Prior to the accident one choose to buy health insurance (the poor one) and the other choose to buy porn, cheeseburgers, and sports cars (the rich one).

Why should taxes taken from the poor man that acted with responsibility be used to fund the lifestyle of the rich irresponsible person?

 

[Molinaro]

I expect the government to provide roads, sewage treatment, police depts, fire depts, and health care regardless of a person's ability to pay.

I see no difference and that is a difference among many people on either side of the issue. Everything else discussed is irrelevant because I lump it into the above essential services no matter what the economics.
It just so hapens that the economics are reasonable and it's a good thing to do.

 

[JEROME DA GNOME]

I expect the government to provide roads, sewage treatment, police depts, fire depts, and health care regardless of a person's ability to pay.

I see no difference and that is a difference among many people on either side of the issue. Everything else discussed is irrelevant because I lump it into the above essential services no matter what the economics.
It just so hapens that the economics are reasonable and it's a good thing to do.

Roads, and sewage are payed for by specific taxes tied to usage.

Police, and fire depts. are payed for by individual communities per the agreement of that community.

I think you are unaware of different types of tax and levels of government to make these comparisons.


Should the tax for health-care be tied to usage?

Should the tax for health-care be tied to individual community agreements?

 

[Abe_the_Man]

Here is a prime example of a situation where universal healthcare is definitely prefered.

http://www.wltx.com/news/story.aspx?storyid=57496

Doctors diagnosed the 7 year old with heart failure. Arielle would need a transplant in order to live. It wasn't long though before a match was found. On May 5, 1997, she recieved a new heart.

But now 12 years later she faces yet another crisis. "I always knew that maybe this day would come, the question about insurance," says Brown.

Last week she got the news that because Arielle is 19, she no longer meets Medicaid's guidelines. "I'm not scared for my life, I'm scared for hers but in retrospect her life is my life," says Brown.

Without prescription coverage, Brown doesn't know how she'll pay for Arielle's $3200 a month anti-rejection heart medication. A cocktail of 14 prescriptions she must take for the rest of her life. "She get's sick and she'll die," says Brown.

She says she's recieved nothing but rejection from insurance companies. "She doesn't qualify for this insurance but why don't you try another insurance," says Brown.

From what I understand about anti-rejection drugs (my Girldfriend is an RN) you need to take them forever. Under a universal system these drugs would be provided for free for as long as they are needed. So now this girl has no coverage and she is unable to get more coverage. What kind of insurance company would grant her coverage when they know she will require $38,000 a year in medication (plus other expenses I'm sure).

Let's think about that. $38,000 is more than most peple make in a year. Where is she supposed to come up with the money? I guess it's good she is in a free market system. Now she can "choose" to pay for the expenses out of pocket. I'm sure glad she is able to choose $38,000 in out of pocket expenses every year. I'm also glad she is able to choose which Insurance companies she can go to for a rejection as she is uninsurable and a guaranteed loss for them. I'm sure glad she and her familly aren't being forced to cough up only a small amount in taxes to guarantee 100% coverage for her meds and medical procedures for life.

I'm not saying a universal system is perfect but in a universal system things like this don't happen. I can speak from personal experience as I have related already, I have a familly member with cancer who has incurred $80,000 in expenses in 6 months. She did not have private insurance and would have been considered uninsurable (what company would grant insurance to a person in need of a brain surgeon and ongoing radiation/chemo treatments for the forseable future?). I'm just saying this familly member of mine would likely be dead without our universal system. Either that or her and myself and everyone else in the familly who could afford to help (which is not many, we all have many university/college/car/mortgage/credit card/having kids debts) would be in dire financial straights.

 

[JEROME DA GNOME]

Here is a prime example of a situation where universal healthcare is definitely prefered.

http://www.wltx.com/news/story.aspx?storyid=57496

You are using an example of government insurance gone wrong to champion government insurance?



Why was the child on Medicaid in the first place?

Did her parents not buy insurance prior to the birth of their daughter?

Were her parents expecting their neighbors to pay for the health-care of their child?

This story looks like parental neglect, not a problem with private health-care.

 

[Fitter]

Why was the child on Medicaid in the first place?

Did her parents not buy insurance prior to the birth of their daughter?

Were her parents expecting their neighbors to pay for the health-care of their child?

This story looks like parental neglect, not a problem with private health-care.

Obviously it's parental neglect. The parents probably wasted the money that could have been spent on health insurance on something frivolous like food and shelter.

 

[JEROME DA GNOME]

Obviously it's parental neglect. The parents probably wasted the money that could have been spent on health insurance on something frivolous like food and shelter.

Family health insurance was about $150-$250 a month depending on the coverage and deductibles in 1997.

Do you find it responsible not to cut out a few movies nights and eating out so as to be able to pay for insurance for your child?

$5 dollars a day saved and they could have afforded to care for their child instead of having their neighbors pay for their responsibility.

 

[Fitter]

Family health insurance was about $150-$250 a month depending on the coverage and deductibles in 1997.

Do you find it responsible not to cut out a few movies nights and eating out so as to be able to pay for insurance for your child?

$5 dollars a day saved and they could have afforded to care for their child instead of having their neighbors pay for their responsibility.

Why are you assuming they spent money on movie nights and dining out? They may well have but nothing in the article gives that impression.

 

[JEROME DA GNOME]

Why are you assuming they spent money on movie nights and dining out? They may well have but nothing in the article gives that impression.

The article states that they have been getting free health-care for at least a decade payed for by their neighbors.


They must be spending their money on something.

 

[Earthborn]

Do you find it responsible not to cut out a few movies nights and eating out so as to be able to pay for insurance for your child?

$5 dollars a day saved and they could have afforded to care for their child instead of having their neighbors pay for their responsibility.

Thank you for your excellent argument for making it mandatory to pay into the healthcare system.

 

[Fitter]

They must be spending their money on something.

Like food and shelter?

 

[YoPopa]

Like food and shelter?

Why do you assume that all their money is spent on food & shelter? It is a rare family that has money only for food & shelter.

But since these are necessities (more so than roads, sewer and fire protection) why are you not arguing that food & shelter should also be covered by the government?

 

[JEROME DA GNOME]

Here is a note from the mother:

Hey everyone,
This is Selina the mom of Arielle and would like to thank you for your comments good and not so good ones. Just to shed some light on some things and maybe it will help others see this in a different light. First of all i did not just sit around for 11yrs waiting on medicaid or any welfare check....i have worked all of my daughters life and having good jobs in between her medical crisis but during those times things did get hard and and cars did get repoed...eviction notices came to me but not once did i break or start a cycle of a welfare career. I have a good family who made sure they had a helping hand in helping me...they are very supportive. I have even worked and at times questioned myself as a parent and if i was doing the right thing by her being in an ICU bed and going to work but I did....I do have insurance but the premium would be and are high to where i still can't afford it(ex:$400-$500)a month, and i have checked with other insurance companies and the answer is still the same(NO)or (SORRY)so for those of you who think i just sit on my butt and wait for the 1st or the 15th of the month to roll around your very wrong....i work hard for my daughter and try to give her a good and long life to live and by no means am I looking for a hand out or any freebies i just want something that i can afford for her.Thanks

http://www.topix.net/forum/source/wltx/THFJVOA8H8COGI4M9/p2




She is stating that she does have coverage but just does not want to pay for it.


ETA: By her own admission her neighbors have been paying for health insurance for the past 11 years. Maybe its time she payed for her own.

 

[Fitter]

to where i still can't afford it(ex:$400-$500)a month

"Can't afford" and "chooses not to" are two different things where I come from.