This is the Government that You Want to Run Health-care?

[Architect]

And since I assume supporting evidence will not be forthcoming let me provide some:

48 patients wait longer than 6 months for their surgery in England!

I do wonder if such statistics are even possible to compile from the USA system of "no waiting lists". Indeed I just can't see how it would be possible to claim there are no waiting lists in the USA - after all theatres and staff and availability of resources still have to scheduled in USA hospitals. (Unless of course they are like that hotel with the infinite number of guest rooms! )

48 patients in a country (well, two, since Wales is included) of about 55million people. There you go.

Jerome might also want to note this bit:

Other figures released on Friday also showed that the NHS had met its target for a maximum 13-week outpatient wait by the end of last year

That's for non-urgent treatment, by the way.

Incidentally, I've checked and in Scotland at least it's typically much shorter:

http://www.waiting.scot.nhs.uk/

I did a quick check under general surgery in Ayrshire & Arran and was coming up with figures of 5-7 weeks.

 

[Architect]

This was exactly my point.
And, the quality of care is so high that most people don't even think of stepping outside the state-funded system (like Ming the Merciless and his lymphosarcoma, or indeed Gordon Brown and his younger son's cycstic fibrosis, or Sam Galbraith and his heart-lung transplant, all of these senior members of parliament including the current PM, using the NHS). One up again.

Although there was a right fankle when Dennis Healy (sp?) had his wife treated on the private back in the early 1990s. He's about the only one I can remember, though.

And since my mother did just that when she was caught with a wait for cataract surgery (caused by a ward closure in the NHS hospital due to an infection problem that was being investigated), and she was over 80 at the time, a clergyman's widow on just a state and a church pension, then perhaps that illustrates how affordable it can be. (And sonce she had both her bathroom and kitchen refitted the following year, again using savings, she clearly didn't scrape the bottom of the barrel either.)

It used to be about £2k an eye, I believe.

 

[Darat]

48 patients in a country (well, two, since Wales is included) of about 55million people. There you go.

Jerome might also want to note this bit:



That's for non-urgent treatment, by the way.

Incidentally, I've checked and in Scotland at least it's typically much shorter:

http://www.waiting.scot.nhs.uk/

I did a quick check under general surgery in Ayrshire & Arran and was coming up with figures of 5-7 weeks.

There are still quite significant variations from region to region throughout the country however the amount of information that is now available on line to the (paying!) public is phenomenal; you've linked to great site for the Scottish region, there are similar ones for the English, Welsh and NI regions as well.

For instance want to see how the different trusts are doing in the English region, just use this link

Does anyone know if there are any comparable sites for the USA so I can look up and see how long patients are waiting for outpatient appointments in say, south LA?

 

[jimbob]

No, America would not have produced the wealth it did over the last 60 years if it had taxed the citizens at the rate which would be needed to provide universal health-care.

We spend 6.3% of our (smaller) GDP, The US spends 6.6% of its (larger) GDP on governmental healthcare.

The US is spending more, so could afford to spend less.

 

[balrog666]

We spend 6.3% of our (smaller) GDP, The US spends 6.6% of its (larger) GDP on governmental healthcare.

The US is spending more, so could afford to spend less.

So, which parts are you going to cut out to improve it?


Another consideration in this comparison is the compactness of the UK and it's population - you could drive across the entire country in a day (depending on the roads, of course) while we are spread out over 1000 times the area per capita. You can apply enormous economies of scale because of that fact while we maintain over 60,000 hospitals spread over the whole of the USA and that's an equivalently enormous (and sunk) capital cost.

How many hospitals are in the NHS? How many doctors? I really would like to know, as I had some difficulty finding out online. Perhaps I am searching for the wrong phrase, common language and all that.

 

[jimbob]

Your numbers are based on the partly socialized system. This distorts the cost.

The details please.

Will a general hospital in a large prosperous city magically be built on land that is cheap? If not how will the capital cost of a general hospital be reduced?

Will a 5-hour surgery not require a surgeon, anaesthetist, and supporting nurses? Will surgery currently requiring 5-hours in theatre, suddenly need less time?

Will the surgeon and anaesthetist spend a greatrer proportion of their working time in theatre? (Actually my rough calculation, completely unrealistically assumed that they spent 100% of their time in theatre). If this time is to be maximised by the free-market, how?

Aside: Does anyone have any figures for what proportion of a general surgeon's work is actually in theatre?​

Will the general surgeon, and anaesthetist accept lower wages, when their skills are still in demand?

Will the capital cost of the theatre be reduced? If so, how? Will it be depreciated over a longer time?

Why would the cost of medical equipment be reduced?

I have already asked these questions, or simlar ones, and your answers seem to say that you accept my calculations but in later posts deny their validity, why:

Originally Posted by jimbob
Any specific examples?

The current problems in the American health-care system.

Quote:
In a deregulated market, will economies of scale suddenly vanish?

Nope.

Quote:
Will the capital cost and depreciation of medical equipmens suddenly reduse?

Nope.

Quote:
Will medical treatment and diagnosis suddenly not need highly qualified workers? Will highly qualified workers, in a field where there is demand for their services suddenly not command high wages?

Nope and nope.

Quote:
Will large hospitals not be needed, or will the capital cost of the hospital also not need to be covered? Will the land value of new hospitals vanish.

Nope and nope.

Quote:
Without regulation, how do you protect against cartels?

Why should I protect against cartels?

Where are the costs going to be reduced. With specific examples (other than the free market pixie).

ETA: Here are my detailed calculations, hidden for brevity,

Please tell me which parts are not estimating the lowest plausible cost:

But they wouldn't make any money in selling inherently expensive treatment at below cost.

According to this the median net worth of a renting household was $4k in 2004 (if I am reading the data correctly)

How could a household with a net worth of that actually pay any more than $4k for anything? Especially as they are likely to be poor credit risks, so borrowiong the money would be difficult.

Can we get the coronary healthcare cost below $4k?

5-hour bypass surgery: General surgeon with less than 1-year experience, $170k, Anaesthetist , less than 1-year experience, median salary $145k.

Both work 60 hour weeks for 50 weeks a year. This means that their combined equivalent hourly rate is $105/hour.

Now they are not performing surgery all of that time, so the actual money that the they are paid as an hourly rate whilst in theatre has to be higher.

As well as the two highly-skilled doctors, you need support staff, (in one photo, the team seemed to be four people), so that makes two other wages that need paying directly during the surgery.

You also need to pay for the use of the theatre, and expensive equipment, say $3million, depreciated over 5-years, when the equipment is in yse 52 weeks per year, gives a theatre cost of $11.5k/week. Now the theatre can't be in use all this time, there has to be preparation, so (generously) we could also assume a 60-hour week for the theatre, which gives $190/hour just for the theatre. Actually it will cost a lot more than this, but I am making a conservative point.

So far just taking the cost of the theatre depreciation and the salaries of the surgeon and anaesthetist, both at the bottom of their respective pay scales, and both working 60-hr weeks in theatre, we get to $295/hour, or $14745 for the five-hour surgery.

You could probably double this for more realistic utilisation rates.

You now need to add in the cost of the other two team members, and of the provision of facilities, and of the proportion of the hospital capital cost that is being depreciated (say over 30 years), and the cost of the bed and accomodation over (three days) stay inhospital.

It soon costs more than the $4k that these people have.


Rolfe works in a free-market system providing medical care to animals, so I will ask him this next question:

If someone's pet needs treatment that costs more than they can afford, do you (as the representative of the free market pixie) reduce the price of the treatment, or does the animal not get any treatment?

 

[jimbob]

Balrog, I have heard that the NHS is one of the three largest organisations in the world (the People's Liberation Army and thee Indian Railways aparently being the other two).

The NHS manages to effectively treat 60-million peiople, whilst medicaid costs significantly more and inadequately treats 37-million.

 

[Blue Mountain]

So, which parts are you going to cut out to improve it?


Another consideration in this comparison is the compactness of the UK and it's population - you could drive across the entire country in a day (depending on the roads, of course) while we are spread out over 1000 times the area per capita. You can apply enormous economies of scale because of that fact while we maintain over 60,000 hospitals spread over the whole of the USA and that's an equivalently enormous (and sunk) capital cost.

At the risk of derailing this thread in a similar manner to Jerome's "rape of its colonies" comment, how much is the USA spending on its war in Iraq (which, IMHO, has made the world a more dangerous place, not a safer one)?

I realise this comment could backfire: perhaps the war in Iraq is only a fraction of what the USA would spend if it decided to cover all its citizens with a single-payer health insurance plan.

 

[Alt+F4]

perhaps the war in Iraq is only a fraction of what the USA would spend if it decided to cover all its citizens with a single-payer health insurance plan.

Forget the war for a minute, just think what the U.S. could save on postage!

At a cost of nearly $42 million, the IRS wants you to know: Your check is almost in the mail. The Internal Revenue Service is spending the money on letters to alert taxpayers to expect rebate checks as part of the economic stimulus plan. The notices are going out this month to an estimated 130 million households who filed returns for the 2006 tax year, at a cost $41.8 million, IRS spokesman John Lipold confirmed.

$42 million could sure pay for a lot of eyeglasses, dental work and wellness check ups.

Linky: http://www.cnn.com/2008/US/03/08/tax.letter.ap/index.html

 

[Blue Mountain]

Forget the war for a minute, just think what the U.S. could save on postage!
$42 million could sure pay for a lot of eyeglasses, dental work and wellness check ups: http://www.cnn.com/2008/US/03/08/tax.letter.ap/index.html

In all fairness, they're spending 32 CENTS per household on the mailing. 32 cents might buy a week's worth of dental floss for a household.

One of the interesting things in these debates is people tend to forget that the US has a very large population. Were I to give just one penny to every person in the United States, I'd burn through more than $3,000,000 just in pennies (let alone the costs of managing such a program! )

By the same token, though, the US also has an gigantic GDP. And that's what we non USians see when we notice they fail to provide health insurance to a population the size of Canada's.

 

[jimbob]

Sorry, just a snide remark about the differences in culture with regards to caring for oneself.

Caring for the vulnerable, I think you mean.

Collectively, as citizens, we enforce our access to universal healthcare, together with most other citixens of most other OECD countries.

We enforce a bertter deal than you, because of our collective wills. THis *is* looking after ourselves, as well as the vulnerable.

 

[Alt+F4]

In all fairness, they're spending 32 CENTS per household on the mailing. 32 cents might buy a week's worth of dental floss for a household.

One of the interesting things in these debates is people tend to forget that the US has a very large population. Were I to give just one penny to every person in the United States, I'd burn through more than $3,000,000 just in pennies (let alone the costs of managing such a program! )

What you are saying is true, but not everyone in the United States is in need of medical treatment at the same time.

My step-daughter works full time, but has no coverage. Recently she needed a very expensive eye medication. We asked the doctor (a family friend) to write the prescription in my name as I have excellent coverage and only pay $5 per script.

 

[Architect]

Another consideration in this comparison is the compactness of the UK and it's population - you could drive across the entire country in a day (depending on the roads, of course) while we are spread out over 1000 times the area per capita. You can apply enormous economies of scale because of that fact while we maintain over 60,000 hospitals spread over the whole of the USA and that's an equivalently enormous (and sunk) capital cost.

Aha, but average densities mask the dispersed and remote populations in the North of England, Scotland, and Wales. It would also lead you into some sort of statistical nightmare trying to compare different standards of primary healthcare and issues about local levels of support.

 

[Architect]

My step-daughter works full time, but has no coverage. Recently she needed a very expensive eye medication. We asked the doctor (a family friend) to write the prescription in my name as I have excellent coverage and only pay $5 per script.

That would, of course, be fraud.

 

[Alt+F4]

That would, of course, be fraud.

Tells you a lot about healthcare in the U.S., right?

 

[balrog666]

Balrog, I have heard that the NHS is one of the three largest organisations in the world (the People's Liberation Army and thee Indian Railways aparently being the other two).

The NHS manages to effectively treat 60-million peiople, whilst medicaid costs significantly more and inadequately treats 37-million.

Which is why we don't want MedicAid expanded to cover another 270 million.

 

[Architect]

Would you like us to run it for you?

 

[Blue Mountain]

My step-daughter works full time, but has no coverage. Recently she needed a very expensive eye medication. We asked the doctor (a family friend) to write the prescription in my name as I have excellent coverage and only pay $5 per script.

May I ask why she has no coverage? Ideas that come to mind are:

1. Her job does not have health benefits, and due to a medical condition she is unable to get them herself (or the premiums would be astronomical)
2. Her job does not have health benefits, but she does not wish to pay for insurance herself
3. Her job has health benefits, but she does not want to pay her portion of the premiums

If it's #2 or #3, is she unwilling to pay the premiums because she cannot afford to, or is unwilling to do so? ("I'm healthy right now, so why should I be giving $300 a month to some insurance company?")

 

[zooterkin]

Which is why we don't want MedicAid expanded to cover another 270 million.

Who's proposing 'expanding MedicAid'? We're pointing at the fact that it is possible to provide better health cover for the whole population than you currently pay to cover a fraction of it. How you get there from where you are is a different matter.

 

[Rolfe]

Which is why we don't want MedicAid expanded to cover another 270 million.

Would you like us to run it for you?

Now there's an idea.

G'Kar, why this fixation with expanding Medicaid? We point out that we get an excellent universal service for proportionately less than you pay for what you yourself declare is a poor service that only covers 10% of your population.

Normal people might imagine that, in that case, a country like the USA, so full of get-up-and-go and can-do and all that, a country that likes to portray itself as the pinnacle of civilisation, could surely utilise the funds it's spending at the moment more wisely.

But all you can do is assume that your country is incapable of doing any better.

That's a shame.

Rolfe.