"France is healthcare leader, US comes dead last: study"

[fls]

At the risk of repeating myself, even 55-77 days is inexcusable wait for a procedure of this type.

If there isn't a mortality or event difference, why does it matter?

In the US this would be done as soon as the patient recovered enough from the heart attack to allow the surgery.

I had trouble finding a recent number.

This study shows 13 days. It is my impression that most elective PTCA's are done within a few weeks in the US, but I had trouble finding information to back that up. I don't think it's tracked in a systematic manner.

Of more interest to me is whether there is any difference in outcomes.

Yes at first they told her she couldn't have the meds because her symptoms were to mild. When they got worse she was told it's was because they were too bad and the meds wouldn't help. She apparantly didn't see the doctor on the one day her symptoms were just right.

If she and her family thought it was worth it, why didn't they simply pay for the medication themselves? It's not like US insurance companies don't do the same thing as the NHS when it comes to paying for drugs.

I am sorry for the confusion, I was refering to the WHO health studies not the ones in the OP. In their study satisfaction with cost is a major part of the rating. If this is taken out, the US moves to number one.

What WHO health studies are you talking about? This one?

http://www.who.int/whr/2000/en/whr00_en.pdf

What measure are you talking about that makes the US number one?

I have given you the source, I can even tell you the chapter (the one on medical myths), I don't see how giving you the page numbers will help you find it that much easier.

I have read the book and I have it in front of me now. There is no chapter titled "Medical Myths", but there is one titled "Our Health" but it contains stuff like "Being cold gives you a cold" and "Cracking your knuckles is bad for you". I have looked through the index under any likely heading, I have re-skimmed various chapters that look like they might be relevant, and I have looked through the end-notes looking for sources. I don't know what else to do if you won't at least give me the page number. It's not a trick question. I'm trying to sincerely address what you said.

Linda

 

[Billdave2]

I have already stated that I do not believe your anecdote - just repeating it won't change my mind.



So everyone in the USA just has to wait 2-5 days for their operation - that is quite an incredible claim - any evidence to support it?



So do I - thankfully that rarely happens in the UK.



Another anecdote I don't believe.

Would you like to hear the anecdote about my mother, an old age pensioner undergoing treatment for cancer of the larynx? All the surgery, radiotherapy, drugs, hospital and at home care and how she is currently undergoing dental work to replace all her teeth with tens of thousands of pounds worth of implants? See the problem with swapping anecdotes yet?

Your not believing it doesn't make it not so either. Whether you believe the 2 years that my friends father waited or not, Linda has shown that the average wait in 2005 was 55 days and 77 in 2004. That means that a person needing angioplasty is on a waiting list 2-3 months long. That is not anecdotal since that would include everybody in the UK who needed it. I am not saying that the US system is perfect, but to hear proponents of socialized medicene here in the states talk about it, socialzed medicine IS perfect. As I said my friend used to talk bad about the US system. Now he has come 180 degrees and says now he understands how having health care when you need it is worth the extra money. The idea that some people in the US go without health care if they need it is a myth. If you have a life threating medical problem you can not be denied care at a hospital. You may have to wait, and that is the complaint, that people without health insurance have to go to emergency rooms and wait, depending on how critical their need is. With socialized system they still have to wait, but now everybody has to wait.

 

[Billdave2]

In this model, you fail to account for accidents and emergencies, most mental illnesses, genetic diseases, genetic pre-dispositions, viral and bacterial infections and, I'd guess, the more-than-overwhelming majority of medical treatments.

People don't choose to get MS, or ME, or depression. They don't choose to get strep throat, staph infections, glandular fever or appendicitis. They don't choose to get congenital heart defects. In short, people's choices do not relate to their need for healthcare (or otherwise) in nearly all cases.

Assigning individual responsibility for all health care is a terrible, terrible idea (practically and ethically) for precisely these reasons. The metric of access which you decry is certainly the most sensible one in light of this, because it measures how available health care is in general.

For any of these emergency situations and accidents they would go to a hospital, where by law they could not refuse them care, regadless of their situation. If you have mental health problems and no insurance, you can go to the local Department of Mental Health, it is free. My wife is a casemanager for a genetics reasearch facility. She (along with a Clinical Geneticist) see patients regardless of their ability to pay. If thy have insurance or the government will pay they take what they can get (it is a non-profit agency), but no patient ever recieves a bill. There is no reason why anybody in the US can not get some form of health care if they really need. Yes you can find anecdotal stories, but you can everywhere (as Darat has accused me of doing with stories about my English friend).

 

[Phaedrus74]

<snip> With socialized system they still have to wait, but now everybody has to wait.

That is actually not entirely true, there are private hospitals over here...(the Netherlands) Also in Belgium where medical care is more socialized (fully?) than in the Netherlands (where all hospitals are semi-private) there are actually no (or close to no) waiting lists.

I guess it's more to do with how well things are organized (privately or publicly) than how they are financed...

 

[volatile]

The idea that some people in the US go without health care if they need it is a myth.

Absolutely 100% not true.

http://www.commondreams.org/headlines02/0522-05.htm
http://www.medscape.com/viewarticle/555051
http://www.cleveland.com/medical/index.ssf/2008/03/being_uninsured_can_be_a_death.html
http://www.consumeraffairs.com/news04/uninsured.html

http://www.medicinenet.com/script/main/art.asp?articlekey=89887

"Two-thirds of the young adults who went without health insurance for some time went without needed care because of cost, the report said."

Can you back up your assertion, because where I'm sitting, it sounds like you have the situation entirely backwards?

If you have a life threating medical problem you can not be denied care at a hospital. You may have to wait, and that is the complaint, that people without health insurance have to go to emergency rooms and wait, depending on how critical their need is. With socialized system they still have to wait, but now everybody has to wait.

Yeah, they cannot be denied treatment. But they do go bankrupt. And they do forego seeking treatment for the early onset of conditions, meaning that when they do seek treatment, it costs exponentially more to treat them. (eg: http://www.stvincent.org/about/press-releases/2006/cover_the_uninsured_week.htm)

Your system is broken. I used the word "tyranny" earlier and was accused of hyperbole, but I don't think it's excessive to say that the uninsured are, for the most part, under the tyranny of the market; under the tyranny of selfishness and individualism.

If you search the forum you'll find a previous thread when a number of posters lay out in considerable detail how the US already has a socialised system, but a monumentally crappy one. You guys pay more in taxes than those of us in the UK do, but you get much, much less for it. How you can continue to support this on pragmatic (let alone ideological) grounds is utterly beyond me.

 

[Billdave2]

If there isn't a mortality or event difference, why does it matter?



I had trouble finding a recent number.

This study shows 13 days. It is my impression that most elective PTCA's are done within a few weeks in the US, but I had trouble finding information to back that up. I don't think it's tracked in a systematic manner.

Of more interest to me is whether there is any difference in outcomes.



If she and her family thought it was worth it, why didn't they simply pay for the medication themselves? It's not like US insurance companies don't do the same thing as the NHS when it comes to paying for drugs.



What WHO health studies are you talking about? This one?

http://www.who.int/whr/2000/en/whr00_en.pdf

What measure are you talking about that makes the US number one?



I have read the book and I have it in front of me now. There is no chapter titled "Medical Myths", but there is one titled "Our Health" but it contains stuff like "Being cold gives you a cold" and "Cracking your knuckles is bad for you". I have looked through the index under any likely heading, I have re-skimmed various chapters that look like they might be relevant, and I have looked through the end-notes looking for sources. I don't know what else to do if you won't at least give me the page number. It's not a trick question. I'm trying to sincerely address what you said.

Linda

If it doesn't make a difference, why do it at all? There is at a minimum some reduction in the chance of a fatal heart attack, the longer a person waits to have the procedure done, the greater the risk of fatality. I would say that makes all the difference in the world if you are the one needing the operation.

As to why they didn't buy the meds, they were retired and could not afford them. Isn't that supposed to be the problem with the US system?

I am at work and my copy of the book is at home. I will look it up later. Doesn't it have an Index? I think it does but not sure.

 

[Darat]

Your not believing it doesn't make it not so either. Whether you believe the 2 years that my friends father waited or not, Linda has shown that the average wait in 2005 was 55 days and 77 in 2004. That means that a person needing angioplasty is on a waiting list 2-3 months long.

She quoted the median average.

That is not anecdotal since that would include everybody in the UK who needed it.

The figure she provided is indeed not anecdotal however yours was i.e. "2 years", have you any comparable figures for the USA by the way?

I am not saying that the US system is perfect, but to hear proponents of socialized medicene here in the states talk about it, socialzed medicine IS perfect.

...snip...

I suspect this is strawman as I don't believe anyone of sound mind believes that any health system is "perfect".

...snip....

The idea that some people in the US go without health care if they need it is a myth. If you have a life threating medical problem you can not be denied care at a hospital. You may have to wait, and that is the complaint, that people without health insurance have to go to emergency rooms and wait, depending on how critical their need is. With socialized system they still have to wait, but now everybody has to wait.

Would my mother have received her surgery, her radiotherapy, her drugs, her hospitalization and at care treatment and her reconstructive dental work if she was in the USA? (Note she had no health insurance.)

 

[volatile]

There is no reason why anybody in the US can not get some form of health care if they really need. Yes you can find anecdotal stories, but you can everywhere (as Darat has accused me of doing with stories about my English friend).

"[FONT=Arial, Helvetica, sans-serif] Greg Story is a 50 year old uninsured freelance writer. After several days of severe cramps and constipation, he was rushed by ambulance to Valley Presbyterian Hospital. He was informed his bowels had ruptured, and after a life-threatening colostomy, he was admitted to the intensive care unit for four days, and then transferred to the cardiac unit for another nine days. He was billed over $78,000, and was told to make an initial $1,000 payment, and sign a contract to pay $500 a month to cover the costs of his care. He was urged to apply for Medi-Cal, but not informed of any other options, including charity care. He is still unable to work since he has limited mobility, and the medical emergency has depleted his savings, even as he has made all his monthly payments to the hospital. While he has his Medi-Cal application pending, he worked with Legal Services to ask the hospital for a charity care application. The hospital said that they didn't have one. No renegotiated payment plan was offered and yet the hospital sent the bill to a collection agency. He now faces the likelihood of bankruptcy, and depression from his medical and financial woes." (http://www.consumersunion.org/health/unisuredwc.htm)[/FONT]

Are you cool with bankrupting already poor people just so they can fix themselves up after a ruptured bowel? Is that your idea of a good system, ethically or pragmatically?

OK, so they're alive, but ruined. What a wonderful compromise.

 

[Billdave2]

Absolutely 100% not true.

http://www.commondreams.org/headlines02/0522-05.htm
http://www.medscape.com/viewarticle/555051
http://www.cleveland.com/medical/index.ssf/2008/03/being_uninsured_can_be_a_death.html
http://www.consumeraffairs.com/news04/uninsured.html

http://www.medicinenet.com/script/main/art.asp?articlekey=89887

"Two-thirds of the young adults who went without health insurance for some time went without needed care because of cost, the report said."

Can you back up your assertion, because where I'm sitting, it sounds like you have the situation entirely backwards?



Yeah, they cannot be denied treatment. But they do go bankrupt. And they do forego seeking treatment for the early onset of conditions, meaning that when they do seek treatment, it costs exponentially more to treat them. (eg: http://www.stvincent.org/about/press-releases/2006/cover_the_uninsured_week.htm)

Your system is broken. I used the word "tyranny" earlier and was accused of hyperbole, but I don't think it's excessive to say that the uninsured are, for the most part, under the tyranny of the market; under the tyranny of selfishness and individualism.

If you search the forum you'll find a previous thread when a number of posters lay out in considerable detail how the US already has a socialised system, but a monumentally crappy one. You guys pay more in taxes than those of us in the UK do, but you get much, much less for it. How you can continue to support this on pragmatic (let alone ideological) grounds is utterly beyond me.

I have bolded the relevant part. Most people in the US who are without some form of health care are in transition from one to another, like changing jobs and having to work 90 days before getting health insurance. Or in many cases, young healthy people with jobs that provide insurance chose not to buy it, because they think they don't need it. When I changed jobs last time, I ourchased a three month family plan for around $400. It didn't provide for doctor visits or drugs, but it tided us over til we got on the new plan. Lots of people don't even do this and just take a chance for three months. They all count it the statistics of people who spend some time with out insurance.

Once again, no one in this country is denied access to medical care if they need it, not even illegal immigrants. There is no "tyrany" in our health care system. If you can not afford insurance of some type, you qualify for government programs for the most part. If you do not have some form of coverage it is most likely your own fault.

 

[volatile]

Oh, and speaking of angioplasties that are apparently so easily and quickly accessible in the USA:

"Martin Cervantes, 67 years old, underwent triple bypass surgery at Sharp Chula Vista Hospital and a balloon angioplasty from Paradise Valley Hospital in May 2000. The hospital bills amounted to approximately $100,000, far greater than his insurance covered and much greater than his salary as a security officer. He was never told by the hospitals about the possibility of charity care or other financial options. After being referred to collection agencies, his attorney continues to negotiate with hospitals about whether he is eligible for charity care. It took eighteen months, after multiple requests, to even receive a charity care application from Paradise Valley, which was submitted and ultimately accepted. The attorney is still unable to get a copy of Sharp Chula Vista's charity care policy, since it was determined to be an "internal" document."

I can guarantee you that whilst we may have to wait a few weeks (and yes, probably too long), not one person in the UK will ever be asked to hand over a single penny for their treatment, let alone tens of thousands of pounds.

Do you honestly think a system where the rich can get treatment quickly whilst the poor and even the middle-classes are left destitute by routine medical costs is better than one where some non-urgent cases must wait a few weeks but everyone is treated (and, I hasten to add, the rich can still pay and get the treatment should they wish)?

Can you make a coherent case which supports such a system as the US currently has?

 

[Billdave2]

She quoted the median average.



The figure she provided is indeed not anecdotal however yours was i.e. "2 years", have you any comparable figures for the USA by the way?





I suspect this is strawman as I don't believe anyone of sound mind believes that any health system is "perfect".



Would my mother have received her surgery, her radiotherapy, her drugs, her hospitalization and at care treatment and her reconstructive dental work if she was in the USA? (Note she had no health insurance.)

Linda has provided some evidence that it is around 13 days in the US. That would include heart attack victims who have to recover before having the procedure. That is significantly different than the 55-77 days that you have proof of, even if you dismiss my friends story as anecdotal, which by the way I have as much proof as you do about your mothers story. (which by the way I am not trying to make light of, I am sincerly sorry she is having problems)

I will admit that using perfect was a strawman, but it is touted as being so much better than our current system, or even a revamped model of the current system that it might as well be. In many circles (especially Democartic circles) it is presented as such.

 

[volatile]

I have bolded the relevant part. Most people in the US who are without some form of health care are in transition from one to another, like changing jobs and having to work 90 days before getting health insurance. Or in many cases, young healthy people with jobs that provide insurance chose not to buy it, because they think they don't need it. When I changed jobs last time, I ourchased a three month family plan for around $400. It didn't provide for doctor visits or drugs, but it tided us over til we got on the new plan. Lots of people don't even do this and just take a chance for three months. They all count it the statistics of people who spend some time with out insurance.

Can people on minimum wage afford $400 a month? Would such a family qualify for government programs? In the link I posted earlier, there was a report of a student who had to give up the money she'd saved for college in return for "aid" - how compassionate.

It seems to me that the usual way of dealing with these people is to treat them at the last possible moment in the most basic possible way, and then to bankrupt them. So yes, they're not being "denied" healthcare on paper. So that's OK then, I guess?

Do you deny the higher mortality rates amongst the uninsured? How does your claim that "no-one is denied treatment" account for the vast differences between the insured and the uninsured?

Once again, no one in this country is denied access to medical care if they need it, not even illegal immigrants. There is no "tyrany" in our health care system. If you can not afford insurance of some type, you qualify for government programs for the most part. If you do not have some form of coverage it is most likely your own fault.

Well, given the post below which explains, to my horror, than even those with insurance end up bankrupt, your arguments hold little water. If someone who is insured still ends up in hock for tens of thousands of dollars, the system is broken. If your country has the worst levels of health in the developed world, and terrible infant and adult mortality rates to boot, then the system is broken.

As for fault - "David Smith, 57 years old, lives in Oakland and gets his income from maintaining a handful of rental properties, including a few in Sacramento. He is a healthy nonsmoker, yet he is uninsured, as health insurance would cost $850/month for him and his wife." How is it this guy's "fault" that he is in an income bracket too high for aid but still unable to afford insurance?

I'll say it again - in what way is your system, which penalises the poorest and most needy people - better than ours? We do not have to pay a single penny for 99% of all medical care. Doctor visits; emergency room; airlifts; ambulances; operations; palliative care; neo-natal care; almost everything entirely free at the point of use, for less tax dollars in percentage terms than you pay in the US for Medicaid, and with much better results in terms of population health and life-expectancy. Do you have a different definition of the word "better" than I do?

 

[Billdave2]

Oh, and speaking of angioplasties that are apparently so easily and quickly accessible in the USA:

"Martin Cervantes, 67 years old, underwent triple bypass surgery at Sharp Chula Vista Hospital and a balloon angioplasty from Paradise Valley Hospital in May 2000. The hospital bills amounted to approximately $100,000, far greater than his insurance covered and much greater than his salary as a security officer. He was never told by the hospitals about the possibility of charity care or other financial options. After being referred to collection agencies, his attorney continues to negotiate with hospitals about whether he is eligible for charity care. It took eighteen months, after multiple requests, to even receive a charity care application from Paradise Valley, which was submitted and ultimately accepted. The attorney is still unable to get a copy of Sharp Chula Vista's charity care policy, since it was determined to be an "internal" document."

I can guarantee you that whilst we may have to wait a few weeks (and yes, probably too long), not one person in the UK will ever be asked to hand over a single penny for their treatment, let alone tens of thousands of pounds.

Do you honestly think a system where the rich can get treatment quickly whilst the poor and even the middle-classes are left destitute by routine medical costs is better than one where some non-urgent cases must wait a few weeks but everyone is treated (and, I hasten to add, the rich can still pay and get the treatment should they wish)?

Can you make a coherent case which supports such a system as the US currently has?

I fail to see where Mr. Cervantes had no options. He may not have known about them, but they existed. He was 67 and should have at least had Medicare. How does this disprove my point?

 

[Billdave2]

Can people on minimum wage afford $400 a month? Would such a family qualify for government programs? In the link I posted earlier, there was a report of a student who had to give up the money she'd saved for college in return for "aid" - how compassionate.

It seems to me that the usual way of dealing with these people is to treat them at the last possible moment in the most basic possible way, and then to bankrupt them. So yes, they're not being "denied" healthcare on paper. So that's OK then, I guess?



Well, given the post below which explains, to my horror, than even those with insurance end up bankrupt, your arguments hold little water. If someone who is insured still ends up in hock for tens of thousands of dollars, the system is broken. If your country has the worst levels of health in the developed world, and terrible infant and adult mortality rates to boot, then the system is broken.

It was a three month plan for $400, that equals $133.34 per month. That included my child, who most certainly would have qualified even if I didn't since I was employed, just waiting out my three months. People who are unemployed would qualify. So people are not being denied health care either on paper or in actuality. Is it fair that the student you mentioned (which by the way is anecdotal evidence) had to use her school money to pay some medical bills, no. But I must have missed the part where the government is supposed to make life fair.

 

[volatile]

I fail to see where Mr. Cervantes had no options. He may not have known about them, but they existed. He was 67 and should have at least had Medicare. How does this disprove my point?

Because he shouldn't need other options? Because he shouldn't need to go looking for care, begging to charities or wading through complicated financial programs at the same time as recovering from major surgery? Because he was insured and still couldn't get his expenses covered? Because the guy is 67 and bankrupt?

If you really can't see how that most definitely is not a satisfactory state of affairs, I worry for you.

 

[Billdave2]

Can people on minimum wage afford $400 a month? Would such a family qualify for government programs? In the link I posted earlier, there was a report of a student who had to give up the money she'd saved for college in return for "aid" - how compassionate.

It seems to me that the usual way of dealing with these people is to treat them at the last possible moment in the most basic possible way, and then to bankrupt them. So yes, they're not being "denied" healthcare on paper. So that's OK then, I guess?

Do you deny the higher mortality rates amongst the uninsured? How does your claim that "no-one is denied treatment" account for the vast differences between the insured and the uninsured?

Well, given the post below which explains, to my horror, than even those with insurance end up bankrupt, your arguments hold little water. If someone who is insured still ends up in hock for tens of thousands of dollars, the system is broken. If your country has the worst levels of health in the developed world, and terrible infant and adult mortality rates to boot, then the system is broken.

As for fault - "David Smith, 57 years old, lives in Oakland and gets his income from maintaining a handful of rental properties, including a few in Sacramento. He is a healthy nonsmoker, yet he is uninsured, as health insurance would cost $850/month for him and his wife." How is it this guy's "fault" that he is in an income bracket too high for aid but still unable to afford insurance?

I'll say it again - in what way is your system, which penalises the poorest and most needy people - better than ours? We do not have to pay a single penny for 99% of all medical care. Doctor visits; emergency room; airlifts; ambulances; operations; palliative care; neo-natal care; almost everything entirely free at the point of use, for less tax dollars in percentage terms than you pay in the US for Medicaid, and with much better results in terms of population health and life-expectancy. Do you have a different definition of the word "better" than I do?

Since Mr. Smith is healthy he has no need for health care above physicals and such. If he develops some condition he would then qualify for disability and would be covered. Has he shopped around for insurance? What kind of policy is the one that costs $850 a month, does it pay for everything or is it a catastrophic policy?

Once again, the US system has problems. As you pointed out the government is already involved, and there parts are the worst. Why would we want to turn ALL of it over to the group who has shown themselves the most incompetant?

 

[Shalamar]

The main issue is that no system is perfect. The US system suffers from serious issues, and abuses. Many people seem to under-insure themselves to avoid paying more, and hope they don't get sick. But even those that don't can still become financially ruined due to a catastrophic illness.

In socialized systems, there may be longer wait times. But again, it seems to be a money issue. Medical care is expensive, whether we pay for it, or the government does. If a person gets sick in the US, they stay home, and hope it doesn't get worse. Usually, it doesn't. They don't want to pay. In Canada, the system may well be abused, with people going to the emergency room because they have the sniffles.


So whats the solution? What is the best system?

 

[volatile]

But I must have missed the part where the government is supposed to make life fair.

Well, there's the rub, eh? Essentially, your world view boils down to something like "As long as the rich are OK (and as long as I'm rich), then screw everyone else. 'cause life isn't fair".

Well, you know what? I think it's the duty of human beings, as social creatures, to strive for fairness. To not let people die or suffer when to help them is of minimal inconvenience to the whole. To work together to smooth out the pockets of unfairness where they can reasonably be eliminated. To live with bold ethical convictions and a keen sense of the needs and desires of my fellow man. to be a decent human being who actually feels bothered when students, old people, immigrants and manual labourers are left even more destitute after life-saving surgery than they were before.

If you want to live in a world where it's dog eat dog, every man for himself and well, life's not fair so why bother with compassion, then fine. I don't, and nor do most mature, sensible, grown-up adults.

 

[Billdave2]

Because he shouldn't need other options? Because he shouldn't need to go looking for care, begging to charities or wading through complicated financial programs at the same time as recovering from major surgery? Because he was insured and still couldn't get his expenses covered? Because the guy is 67 and bankrupt?

If you really can't see how that most definitely is not a satisfactory state of affairs, I worry for you.

So it would be better if he had been told that because he is too old, he has to go on a waiting list and dies before he gets the surgery? Yeah that would be much better!

My point is that it is a myth that that are people "tryanized" by the US health care system because they don't have options. I pointed out how your example had options, then you say he shouldn't have to look for options. What should people have to do and not have to do? I think if I was facing death or bankruptcy the least I could do is look to see if I had options.

 

[volatile]

So it would be better if he had been told that because he is too old, he has to go on a waiting list and dies before he gets the surgery? Yeah that would be much better!

Evidence that this would have happened in a socialised system? Your paranoia has no relation to reality.

My point is that it is a myth that that are people "tryanized" by the US health care system because they don't have options. I pointed out how your example had options, then you say he shouldn't have to look for options. What should people have to do and not have to do? I think if I was facing death or bankruptcy the least I could do is look to see if I had options.

So it's the critically-ill, hospitalised insured old-age-pensioner's fault that he's bankrupted by an immoral, absurd, unfair system? Really?

This system, which has no doubt cost him thousands of dollars in insurance and still left him bankrupt, is better than one in which he is treated according to his need, free at the point of use? How? You keep saying so, by shifting blame and sticking dogmatically to the ideology of individualism, but you haven't actually made a case.

Here's mine - the socialised system is better because, despite its faults, old guys never end up bankrupt at the same time as recovering from invasive surgery. Seems quite simple to me. What's your case?