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

[volatile]

No, I don't, but then, I didn't present you with a model.

When you want to stop making stuff up, we can continue.

DR

Well, sorry if I took you saying "one's health is significantly influenced by one's own choices, and one's own interest in taking actions and responsiblity for one's health maintenance. How is that the state's responsiblity?" as advocating a reduction in state responsibility in healthcare provision due to the "significant" link between personal choice and health levels.

It sure sounded like a model to me.

For clarity's sake, would you like to clarify your preferred model of healthcare provision, and how it would fit into the general ideological principle that the state is not responsible for the health of it's citizens, as poor health is 'significantly' linked to poor choices?

 

[Billdave2]

Oh, and as an addendum to that, three words.

Basic. Human. Decency.

It is not morally justifiable to let the most needy members of society suffer for the selfish ideologies of the rich. It is not ethically sustainable to let pensioners and students writhe into bankruptcy, ill-health and even death whilst their neighbours and fellow citizens sit by and do nothing, when to act would be of negligible inconvenience.

Or can you make a case to the contrary, instead of just bleating about "rhetoric"?

See my post above on ways to improve things. There are no pensioners in the US who do not qualify for Medicare. Students for the most part can be carried under their parents insurance as long as they are in school and not over the age of 25. If you are a student past twenty five, you most likely qualify for assitance with university, which most have infirmaries that are covered under your tuition.

Who is bleating rhetoric? You are the one bemoaning the poor pensioners and students?

Once again, should we help others at a cost to ourselves when we could help them more at no cost? I would say that is Basic Moral Decency to help them more.

 

[Darth Rotor]

Why? Why? You sound like a whining child, Darth.

Since all you offered was platitudes and emotion, I thought I'd ask for something of substance.

You give me this.

You want to boil it down to basic moral principles? You're essentially asking me why it's better to help people at negligible cost to oneself instead of leaving them suffer.

No, I was asking why you presented the platitudes you offered.

What's with your wanting to put words into my mouth today? Tired of eating your own words? I am not sure that you are even speaking to what I have written, but seem rather to be jousting with a preformed bogeyman.

If you even need to ask that question, then there's nothing I can possibly say that will change your mind.

So you admit to your own inability to explain why you want what you want? OK.

If it is not self-evident to some degree that helping others when to do so does not inconvenience you and, in fact, possibly even makes you better off, should be a useful basic ethical precept, then I'm sorry, I can't help you.

Since you are crafting that position for me, how about you help yourself and then talk to yourself about it?

In this context, BillDave (and you) are arguing that the ideology of dogged individualism should triumph even when to work for the common good actually benefits everyone (including you). That's not only immoral, it's stupid.

Since I have not made that argument, how about you go argue with those who have?

The balance between what the person/citizen is responsible for, and accountable for, and what common baseline we collectively assign to and ask the state to fund through common "public" funds isn't as simple as the garbage you've posted, nor as simplistic as the "sucks to be poor" position you seem to argue against.

The public debate/discussion on what minimum level of care, mean and median levels of care are, and where the resources are to come for that care are damned well NOT left to the argument by platitude, which is what you have offered.

I"d ask you to, for the good of your fellow man, stay out of the policy making business, volatile. Your approach in this thread presents someone interested in expending assets you don't have in the name of humanity -- which is sorta like Bush funding his credit card financed war in Iraq in the name of spreading democracy, a first principle -- democracy -- that you and I would probably tend to agree on, but which when it comes to practical implementation, falls rather short in detail.

So thanks but no thanks for your interest in the American medical Gordian Knot. We may be able to discuss, in another thread, the genesis of how medical care became a corporate responsibility in America, and how with the change in corporate bodies, and rules, and how unions lost power, over the past few decades left a significant vacuum into which a great many people fall.

In this thread, you are just looking for a fight with a bogeyman who I am not. Please re-engage when the shadow boxing is finished.

PS: fls has been making some very good points, though I'll point out that raising the minimum tends to bring with an attendant cost. Her point on the profit margins of HMO's versus the government programs has been well known for some time, and points to the layer of profit being another cost of care.
DR

 

[fls]

I agree that that we should, but is not the ideology that is wrong, it is the execution. The ideology that is wrong is that by lumping everybody together and letting the government take over so we "don't have to worry" about it is the problem. Right now the majority of insurance is tied to our jobs by the system. The system is set up to create these large blocks of consumers, instead of having individuals do it for themselves. The socialized system takes it further and puts us all in one block. What this means is less competion for our business (insurance). Less competition is always bad fro the consumer. If you have ever dealt with a insurnce company in the US and been frustrated, imagine how bad it would be if there were no options. Hillary Clintons plan made it illegally not to join the plan. That meant if you wanted private insurance you would have to pay for it on top of the government plan. I am not sure how the NHS does it in the UK, but assume it is similar.

By the way can anybody name me one thing the US government runs really well? Do you really want these guys running our health care system?

Another way to look at it is that private insurance companies merely add a layer of excess cost and bureaucracy, without contributing a morsel to health. There's no point to 'competition' among insurance companies unless you are talking about restricting services. How about getting rid of the idea of restricting services altogether?

Your rhetoric seems to be based on ideology. You expect your idea that the US government will run things poorly to go unchallenged, yet the research shows that government administered health-care systems, including those administered by the US government, are more efficient than those run by private health care companies.

http://content.nejm.org/cgi/content/full/349/8/768

"In 1999 U.S. private insurers retained $46.9 billion of the $401.2 billion they collected in premiums. Their average overhead (11.7 percent) exceeded that of Medicare (3.6 percent) and Medicaid (6.8 percent)."

Linda

 

[Billdave2]

Well, sorry if I took you saying "one's health is significantly influenced by one's own choices, and one's own interest in taking actions and responsiblity for one's health maintenance. How is that the state's responsiblity?" as advocating a reduction in state responsibility in healthcare provision due to the "significant" link between personal choice and health levels.

It sure sounded like a model to me.

For clarity's sake, would you like to clarify your preferred model of healthcare provision, and how it would fit into the general ideological principle that the state is not responsible for the health of it's citizens, as poor health is 'significantly' linked to poor choices?

It is more than just choices of unhealthy behaviors. Most of the people that are in these studies who go a period of time in the year are changing jobs and do not get short term policies. Others would qualify for assistance if they were to get sick. Many people don't get insurance as a choice. I used to work with a guy who would not pay $10 a week for insurance. He said he would rather spend it on beer. Of coarse, he was 21 and single and healthy. How many of the people with out health care do you think have cellphones? Or TV's (I will give you a hint almost every home in the US has at least one TV). Do you think they buy cigarettes? Never mind the health risks of smoking, cigs are like $4-5 dollars a pack, could they afford health insurance if they quit smoking?

 

[volatile]

Is it better to help someone at negligble cost to oneself, or to help that person more at no cost to yourself? That is the true issue here. Do you lower health care for most while only bringing it up a little for the rest, or do you seek a solution that brings everybody up to the top?

What? That barely makes syntactical sense, let alone logical sense!

How is your system helping people "more" than the socialised systems? Do you have a different definition of the wore "more" than the rest of us? In socialised systems, no-one goes without care they need. In insurance-based, "free-market" systems, this is manifestly not the case. You just have to compare the USA with Europe to see that this is the case. It's not even particularly hard to understand.

In what way does a socialised system lower the levels of healthcare for most? In what way do you propose we "help people more" at no cost at all? And, I note, you still haven't explained how your mystical free-market system will "bring everybody up to the top".

What are you talking about?

 

[fls]

Is it better to help someone at negligble cost to oneself, or to help that person more at no cost to yourself? That is the true issue here. Do you lower health care for most while only bringing it up a little for the rest, or do you seek a solution that brings everybody up to the top?

I seek a solution that brings everybody up to the top. Which one of your descriptions do you think applies to universal systems? How do you determine the "top" if you don't consider "health" the desired outcome (since you've rejected the study in the OP and the WHO outcomes)?

Linda

 

[Billdave2]

Another way to look at it is that private insurance companies merely add a layer of excess cost and bureaucracy, without contributing a morsel to health. There's no point to 'competition' among insurance companies unless you are talking about restricting services. How about getting rid of the idea of restricting services altogether?

Your rhetoric seems to be based on ideology. You expect your idea that the US government will run things poorly to go unchallenged, yet the research shows that government administered health-care systems, including those administered by the US government, are more efficient than those run by private health care companies.

http://content.nejm.org/cgi/content/full/349/8/768

"In 1999 U.S. private insurers retained $46.9 billion of the $401.2 billion they collected in premiums. Their average overhead (11.7 percent) exceeded that of Medicare (3.6 percent) and Medicaid (6.8 percent)."

Linda

Increased competition means that I have a greater number of options. Currently, because of the tax breaks my employer gets to offer an insurance plan, I have the choice between my company plan and much more expensive private plans. If I could get the money that my company spends on my insurance, plus there tax break, I could go out and shop for a private plan. It would cost more than I am paying now, but I would have extra money to buy it with. Because I now have options, I can look for the best deal. Since companies will want to encourage me to buy from them they will have to be competitive or someone else will get my business. Far from restricting service it would most likey increase it.

As to the governments ability to run a health care system, Have you ever dealt with Medicare/Medicaid? There is a reason lots of private doctors don't except it. It pays less and covers less than private insurance. I am sure that helps some with the overhead. If the government could run Medicare/Medicaid now, we wouldn't have as many probalams as we do. Like Volitle example above of the 67 year old who was bankrupt. He would have been covered under Medicare, so why is he bankrupt?

 

[Ivor the Engineer]

Billdave2,

IIRC, the NHS is one of, if not the most cost effective health care systems in the world.

Your idea an individual buying their own health insurance is probably the worst (i.e. most unfair and expensive) scheme possible as far as the supply of health care is concerned. Do you know what market failure is?

If left to free market forces, health care inevitably leads to market failure because consumers don't (and often can't) know enough about the health care they need/want to make informed choices about their purchases.

 

[Billdave2]

What? That barely makes syntactical sense, let alone logical sense!

How is your system helping people "more" than the socialised systems? Do you have a different definition of the wore "more" than the rest of us? In socialised systems, no-one goes without care they need. In insurance-based, "free-market" systems, this is manifestly not the case. You just have to compare the USA with Europe to see that this is the case. It's not even particularly hard to understand.

In what way does a socialised system lower the levels of healthcare for most? In what way do you propose we "help people more" at no cost at all? And, I note, you still haven't explained how your mystical free-market system will "bring everybody up to the top".

What are you talking about?

If you have two apples and I have 6 apples, are you better off if I give you two of my apples, or if I go and pick 4 more apples and give them to you? If we implement the things that I said in post #92 (which you apparantly didn't read) then we make so everybody in the US has top of the line health care instead of sacrificing the health care of opthers and still not improve the others health care to the level we could if we just fixed things.

Once again, supply and demand. If health care is socialized and the governemnet takes over demand will increase. Whether it is because more people have access, or people will think "hey its free I should go to the doctor for every little thing", or the fact that there would be less competition for health care professional which would make saleries stall, leading to fewer people going into the field it will increase. As demand increases, supply must decrease. This decrease will lead to lower quality health care, it is a certainty. This is pretty basic stuff. Try googling NHS and "doctor shortage" it is in excess of 400,000 hits.

 

[Billdave2]

Billdave2,

IIRC, the NHS is one of, if not the most cost effective health care systems in the world.

Your idea an individual buying their own health insurance is probably the worst (i.e. most unfair and expensive) idea possible as far as the supply of health care is concerned. Do you know what market failure is?

If left to free market forces, health care inevitably leads to market failure because consumers don't (and often can't) know enough about the health care they need/want to make informed choices about their purchases.

Can you provide eveidence that this is the case? It is simple supply and demand, market forces. The care in NHS hospitals might be more cost effective, but cost aside would you rather be in an NHS hospital of a US hospital? It is a no brainer. It is always better to find a way to reduce cost from a great t system than to start with a bad system and hope you can make it better without increasing cost.

 

[Beerina]

Putting aside the fact that other countries and their scientists, physicians and entrepreneurs are invested in advancing health, just like the US, the US can't pull ahead in health and reduced mortality. Health status is closely tied to socio-economic status. And the US distributes health care on the basis of ability to pay, rather than need. This means that excess health care is given to people who don't need it. And this is doubly so for new technologies, which tend to be expensive. So the new technologies will be used where they can do the least good, making it difficult, if not impossible, for the US to catch up on the basis of differences in technology. In addition, new technologies (of the type pursued by entrepreneurs) make a difference in lifespan that can be measured in days, if not hours, while the differences made by reducing the influence of socioeconomic status are measured in years. Even if we bought in to your claim that technologic advances falter under universal systems (a claim for which you've provided no supporting evidence), technological advances provide too little incremental benefit and are too maldistributed under the US system to allow it to inch its way into the lead.

Linda

I'm confused. You've just said exactly the opposite of what hundreds of massive economic "experiments" demonstrated last century with all level of command-and-control of economies. The less, the better, as long as rule of law is preserved, i.e securing people and their property from thugs, be they criminals or bribe-demanding politicians.. There have been no set of experiments as massive and unquestionable as this, ever. There's your "proof". Name one area that's had such massive and long-term experimentation.

Relativity? Quantum mechanics? Not even close.

In any case, new technologies are pulled into existence largely by the profit motive. Reduce that and you reduce new technologies.

It's that simple. That's why the US would pull ahead, not lag behind.


And worse, we should be proud of rising overall costs. That means there's more to buy, not that individual things are more expensive. Last time I checked, we want more things to buy in the medical realm.


Old people have drug cost problems because there's so many new drugs to use. Take away the profits, and you will have fewer new drugs in the future. (See: Far and away most massive set of experiments ever performed above.)


The choice populist politicians offer (which, like many goofball things, sounds good to the masses, and thus becomes an infuriatingly entrenched, evolved ethical meme that's actually deadly harmful) is between "cheap, top notch medical care" and "expensive, top notch medical care".

But that's a murderously (word carefully chosen) fraudulent claim. The choice isn't between cheap great care and expensive great care. The choice they offer is between expensive great care and cheap, lagging, ever more inferior care as the years go by.


A 10% slowdown in tech, a disturbingly small underestimate of the probable effect, would, after 100 years, offer you, for example, 1990 level care in the year 2000.

Which would you rather have today? Free 1998 level tech, or expensive 2008 level tech? Anyone wanna guess which "system" would be saving more lives and quality of life?

And a 20% or 30% reduction would make it far worse. Anyone think they're a friend of humanity offering free 1978 level medical care in the year 2008?

Anyone? Anyone? Bueller? Bueller? Anyone?



People don't like to be told their beliefs, in which they are certain they are correct, kind, and caring, are in fact, more murderous than Hitler and Stalin combined.

Deal with it. "Universal Health Care" is to politics what Nessie, UFOs, psychics, and conspiracy theories are -- something for people to believe in. By the way, I've described the massive, overwhelming proof for the freedom+profit vs. productivity link.

But in every other realm, we demand that those who make fantastic claims demonstrate them. And how utterly fantastic are claims that a government takeover of medicine and profits will improve things!

Proof? Don't you want proof before you do this? Also, where's the freedom of people who don't want to join? We don't strip away religious freedom because some populist can lead the population on a cruscade about religion.

 

[fls]

I would say that someone who just had a near fatal heartattack and was told that he needed the angioplasty to help prevent another, is not quite "just impatient".

Exactly. You need to know his risk for a second heart attack over what time period and whether angioplasty will alter this risk above that provided by medical therapy. If the mortality benefit from angioplasty shows up after 6 months or a year or 5 years, then that tells you how quickly it needs to be done. The benefits from urgent and emergent angioplasties show up in the short term, such as 30 day mortality, so they are performed within a few days or hours.

His wait was not due to lack of urgency, but because of his age. So we should tell old people they aren't worth saving if they can't wait?

How could it have been urgent if he was able to wait two years?

Linda

 

[mumblethrax]

I don't understand how private insurance is supposed to make sense, even from a strictly self-interested point of view. My employer pays a hell of a lot for a health care plan that I don't use to a greater degree than I would a national plan. I assume that the treatment I receive (if not the health outcome) is better than the health services in much of Western Europe. But so what? Many of these measures--wait times is the classic--are red herrings: health outcomes are what I actually care about. I'd prefer to have a relatively cheap national plan (cheaper than any of the plans on offer from my employer, if other state-run plans are any indication) and have my employer pay me the difference, and that option is not currently on the table. I'm wicked tough, I can wait a few days if I save dollar bills.

There seems to be this rigid aversion to having people take money from us for the benefit of others, but that's effectively what happens anyway. I really don't have any choice about whether I contribute to the health care of my co-workers--I can opt out of my part of the contribution, but it's a pittance compared to the true cost. The major difference between the health care systems in the US and Europe is that we pool costs at the level of employment, rather than nationally.

And this perennial decision-making (evaluating plans every time I switch employers, annually reviewing plans even if I stay with the same employer, deciding whether to take advantage of COBRA between jobs, etc.) doesn't comport to my individual interests, anyway. What I would like is to optimize my health, lower the cost to me, and never have to think about it again (beyond giving the odd 'performance evaluation' to the specialized professionals maintaining the system). I think a lot of self-styled individualists in the US underappreciate the degree to which we offload these burdens onto the state for the purpose of maximizing individual liberty.

 

[Billdave2]

Exactly. You need to know his risk for a second heart attack over what time period and whether angioplasty will alter this risk above that provided by medical therapy. If the mortality benefit from angioplasty shows up after 6 months or a year or 5 years, then that tells you how quickly it needs to be done. The benefits from urgent and emergent angioplasties show up in the short term, such as 30 day mortality, so they are performed within a few days or hours.



How could it have been urgent if he was able to wait two years?

Linda

An angioplasty is just as necessary the day after a heart as at any time following. The risk is the same. There is nothing in your body that says, "hey we just had a heart attack, we can't have one for 30 days". Actually even if the risk is not greater, the longer your heart has to work against a blockage, the more damage that is doone to the, That is why it is so urgent toi get it ASAP. It might not kill you in the time between, but it could take years off your life.

 

[fls]

Increased competition means that I have a greater number of options. Currently, because of the tax breaks my employer gets to offer an insurance plan, I have the choice between my company plan and much more expensive private plans. If I could get the money that my company spends on my insurance, plus there tax break, I could go out and shop for a private plan. It would cost more than I am paying now, but I would have extra money to buy it with. Because I now have options, I can look for the best deal. Since companies will want to encourage me to buy from them they will have to be competitive or someone else will get my business. Far from restricting service it would most likey increase it.

Why on earth would I be interested in purchasing various insurance plans instead of purchasing health care?

As to the governments ability to run a health care system, Have you ever dealt with Medicare/Medicaid? There is a reason lots of private doctors don't except it. It pays less and covers less than private insurance. I am sure that helps some with the overhead. If the government could run Medicare/Medicaid now, we wouldn't have as many probalams as we do. Like Volitle example above of the 67 year old who was bankrupt. He would have been covered under Medicare, so why is he bankrupt?

You are talking about two different things - the efficiency with which the system is run and the extent of the coverage. Even if the system is expanded, the lower proportion used for administration still leads to increased efficiency.

Linda

 

[Kestrel]

As to the governments ability to run a health care system, Have you ever dealt with Medicare/Medicaid? There is a reason lots of private doctors don't except it. It pays less and covers less than private insurance. I am sure that helps some with the overhead.

It's time someone explained to you the concept of overhead.

Overhead is the money that doesn't go to paying for medical services. It's what is sucked up by the army of clerks working for insurance companies. It's the money spent entering forms, talking on the phone with doctors and explaining why they can't treat their patient. It's the money spent on advertising and lobbying Congress to keep the system exactly the way it is. And it's the money used to pay high salaries to insurance company executives.

Insurance company paperwork also creates high overhead in the medical profession. Next time you visit a doctor, try counting the number of people in that office that are shuffling paper. Preparing the complicated forms demanded by the insurance companies. Or trying to contact insurers for permission to treat a patient.

Compare that to the system in Canada, where most physicians have one assistant that greats patients, does the filing, sets up appointments and sends the bills to the single insurance provider. The money is spent on providing medical services, not creative paperwork.

 

[Billdave2]

I don't understand how private insurance is supposed to make sense, even from a strictly self-interested point of view. My employer pays a hell of a lot for a health care plan that I don't use to a greater degree than I would a national plan. I assume that the treatment I receive (if not the health outcome) is better than the health services in much of Western Europe. But so what? Many of these measures--wait times is the classic--are red herrings: health outcomes are what I actually care about. I'd prefer to have a relatively cheap national plan (cheaper than any of the plans on offer from my employer, if other state-run plans are any indication) and have my employer pay me the difference, and that option is not currently on the table. I'm wicked tough, I can wait a few days if I save dollar bills.

There seems to be this rigid aversion to having people take money from us for the benefit of others, but that's effectively what happens anyway. I really don't have any choice about whether I contribute to the health care of my co-workers--I can opt out of my part of the contribution, but it's a pittance compared to the true cost. The major difference between the health care systems in the US and Europe is that we pool costs at the level of employment, rather than nationally.

And this perennial decision-making (evaluating plans every time I switch employers, annually reviewing plans even if I stay with the same employer, deciding whether to take advantage of COBRA between jobs, etc.) doesn't comport to my individual interests, anyway. What I would like is to optimize my health, lower the cost to me, and never have to think about it again (beyond giving the odd 'performance evaluation' to the specialized professionals maintaining the system). I think a lot of self-styled individualists in the US underappreciate the degree to which we offload these burdens onto the state for the purpose of maximizing individual liberty.

But do you want to give up all control? You mention the odd performance evaluation of the professionals, how much choice or power would you have if the government had 100% control? It is feasible that it could eventually become where you have absolutly no choices in the matter at all. Frankly, if I don't like my doctor, I want to be able to change. If my insurance provider doesn't cover something, I want to be able to look for another one. If my insurance plan is mine to control, I have options, I can make changes. The government would still be providing basic health care to people who need (we will still be paying taxes), it is just that the rest of the process has the extra layer of our employers inbetween. If there was more market freedom, you could even possibly see the elimination of the insurance companies. I see Hospitals and doctors providing a service that is paid for the same way we pay the insurance companies now. You just pay the hospital/doctor every month and they provide your health care. If you don't get good service switch to another, but you would have choices. You wouldn't have toi worry about getting things approved since the doctor/hospital/insurance company is the same. Most medical procedures like MRI's don't really cost anything to run, it is all in intial price and maintenance.

 

[Ivor the Engineer]

Can you provide eveidence that this is the case? It is simple supply and demand, market forces.

Yes, it is. For a market to work efficiently and not fail, certain conditions have to be met. These include easy entry to the market for suppliers and enough information for consumers to make informed choices. Health care satisfies neither of these.

To become a supplier requires extensive training and is heavily regulated, limiting the number of suppliers. The vast majority of consumers do not (or cannot) know enough to make informed choices about treatment. They rely on suppliers to tell them what treatment they need/want. For example, how is a consumer with a heart problem to decide between the various treatment options? How is a individual consumer to decide how much health insurance they need to buy?

Insurance is taken out to mitigate against risk. Private companies are not going to be interested in providing individual insurance to people who have a high risk of needing expensive treatment. So many of these people would end up going either bankrupt, suffering or dying because they are bad risks as far as a private company is concerned.

There's much more on all of the above here:

http://www.ohe.org/page/knowledge/schools.cfm

The care in NHS hospitals might be more cost effective, but cost aside would you rather be in an NHS hospital of a US hospital? It is a no brainer.

Why is it a no-brainer? Do you believe US health care system does everything better than the NHS?

It is always better to find a way to reduce cost from a great t system than to start with a bad system and hope you can make it better without increasing cost.

The US health care system is not 'great' by the majority of measures.

 

[Billdave2]

Why on earth would I be interested in purchasing various insurance plans instead of purchasing health care?



You are talking about two different things - the efficiency with which the system is run and the extent of the coverage. Even if the system is expanded, the lower proportion used for administration still leads to increased efficiency.

Linda

You want options of plans to save money. Just like when you get a cell phone, if you never text you don't want to pay for unlimited texting. A single male could get a plan that was cheaper, but did not cover OB/GYN care. It would allow for tailoring a plan to fit your needs and only paying for what you need. The market will force inefficient companies to get leaner or die. That is the way the free open market works.