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

[Ivor the Engineer]

But the cost of health care does directly impact the development of health care technologies.

Yes, but the cost of health care cannot continue to increase faster than the increase in peoples' ability to pay for it. Thus the rate of technological development is limited by the wider economy.

If there is no money in developing health care technologies then people/companies will switch to making new widgets.

There will always be money in developing useful health care technology.

Likewise a government monopoly on health care wields greater bargaining power at first, but eventually drives most of the providers out of business, which reduces the bargaining power.

You mean in exactly the same way as a free-market system does?

So which of the following do you think has more bargaining power with a large pharmaceutical company: a few hospitals clubbing together in the US, or the NHS?

 

[Billdave2]

Stossel is not an expert in this area and he simply gets it wrong. For example, I see you borrowed his line about whether people leave the US for healthcare, and that was already demonstrated to be incorrect. Even disease specific measures of outcome (in order to eliminate his claims about transportation accidents and homicides) don't show the US with a benefit (http://www.openmedicine.ca/article/viewFile/8/15). Money is paid by third-parties under universal systems, as well as the US. While the US pharmaceutical companies produce a lot of me-too drugs, useful new drugs are just as likely to come from elsewhere (http://books.google.com/books?id=PC...=print&ct=result&cd=2&cad=author-navigational).

Linda

So you think that this survey is accurate? That Chile has a better health care than the US, How about Dominca? Why don't people in the US go there for treatment? Did you look at the statistics behind the study? The Us rates #1 in responsiveness (one of the most critical catogories). This also shows Canada at 30, does that sound right? Almost half the top twenty are tiny countries like Andorra, Malta and San Marino. Is it really comparable to compare these small countries to big countries like the US and Canada?

I would also be interested to know where all these useful drugs that are being created my non-drug company and non-drug company research are coming from. Could you please provide some examples?

 

[UserGoogol]

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

Nonsense. The profit motive is important too, but new technologies are regularly pulled into existence largely by sheer momentum of knowledge. Look at mathematics. Specifically, number theory. Number theory was a useless pile of glorified recreational math for centuries, but people still did it, and now it's the foundation of cryptography and fundamental for so many important technologies. Reliably, math digs off into some profoundly obscure and pointless subject matter, and then it explodes as a use is suddenly found. Look at the Internet, which is surely the most important invention of all time. It was funded as a government research program, and the protocols that underly it were all freely released to the public. Or for that matter, so much of open software software. The free market being what it is people have been able to make some money off of it to help push it furhter, but so much of it was people writing good solid software because for the sake of knowledge and their own personal amusement.

(It should also be noted that in principle, the free market does not provide the highest possible profit incentive. If the government had some sort of reverse-welfare whereby everyone paid a head tax and in return the government subsidized every dollar of income with an extra quarter or whatever, the profit motive would be even higher.)

 

[Billdave2]

I asked before so I may have just missed your answer in this fast moving thread.

My mother had cancer of the larynx (stage 2) diagnosed about 18 months ago. Would my mother have received her surgery, her radiotherapy, her drugs, her hospitalization and at home care treatment and her reconstructive dental work if she was in the USA? (Note she has no health insurance.)

Yes. She might have had to file a ton of paperwork if she wasn't eligble for medicare yet (62 years old) and if she had a job still she would be expected to at least try and pay for some cost. Of coarse, if she had a job, she would probably have insurance and would have only had to met the deductable (on my plan $500 a year, and 10% of the next $10,000), so $1500. I don't think that is an unreasonable amount.

 

[fls]

An angioplasty is not considered an elective surgery in any case. It is being done to prevent another heart attack, to save the patients life. Even if it is two years later it is still treatment for the heart attack.

Under these circumstances, it is characterized as an elective procedure (the distinction is in the urgency, not in the condition it is being used to treat or prevent). It is referred to in the studies on wait times as an elective procedure. If the term offends you, suggest something else for the purposes of this conversation.

Linda

 

[Darat]

Yes. She might have had to file a ton of paperwork if she wasn't eligble for medicare yet (62 years old) and if she had a job still she would be expected to at least try and pay for some cost. Of coarse, if she had a job, she would probably have insurance and would have only had to met the deductable (on my plan $500 a year, and 10% of the next $10,000), so $1500. I don't think that is an unreasonable amount.

I think any amount is unreasonable however I'll let that slide.

If it is the case she'd get all that for treatment for free why does anyone bother with insurance in the USA? It doesn't seem to make financial sense to me!

 

[Billdave2]

Would you also claim that private enterprise could take over Medicare patients and run the system like an HMO providing care at a far lower cost?

In fact we already do this. Medicare patients have the option of signing up for privately administered HMO care instead of the classic pay for service plan. The companies running these plans can reject any patent that applies and in practice only accept the healthiest patients. The cost to the taxpayer of providing care for these patients ends up being about 15% higher than for those in the traditional Medicare plan.

In other words, the Government run system delivers care at lower cost.

Where did I say that Medicare would be taken over by an HMO. I said that by providing tax breaks to individuals and tort reform we could overall the current system. I never said get rid of the government helping those who really need it. It would also help if people were allowed to purchase private insurance across state lines (this is illegal currently). The man in Volatiles example that could not afford the $850 a month policy in California, can not purchase the 133.34 a month policy I did in South Carolina. Why? because the government says he can't, another example of why the less government is involved the better.

 

[mumblethrax]

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?

Oh, yes, I want nothing more. Trust me, the depths of my laziness have yet to be plumbed.

But I do recognize that the system would likely fail if nobody checked up on it. So if things get a little wobbly, I will--reluctantly--do my part and vote for the politician/party I think will appoint the bureaucrats who will keep the health care infrastructure chugging along.

Some people call me a hero, but I'm just a man.

It is feasible that it could eventually become where you have absolutly no choices in the matter at all.

This is also true of any government service. There is little controversy about the need for a police force, where corruption and abuse directly impinge upon liberty. So here's what I propose as a solution: the people will--periodically--hold elections, in order to maintain control over their government.

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.

So build physician choice into the system, or allow for supplemental insurance policies. It'll still be cheaper. You're conflating a couple of different characteristics of health care systems--nothing about universal health care implies a lack of choice of physicians.

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.

'The people who need basic health care' is synonymous with 'the people', and they aren't all currently covered by government programs in the US. Those 'extra layers', meanwhile, are pure bureaucracy. Why not reduce overhead with a national plan?

Insurance companies, meanwhile, are the result of market forces: there is a demand for risk management.

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.

And charge you a hell of a lot more, because this is an administrative nightmare for doctor's offices and hospitals that burdens them with all of the work that insurance companies currently do, and requires that they do it less efficiently. I'm also not sure how it's supposed to work: let's say I subscribe to a local affiliate of doctors and hospitals for $200/month, and then I have a catastrophic accident that requires $500,000 worth of treatment. How do they make up the difference? The answer can't be 'volume': I'm just one guy. They raise the rate to $1,000/month, and I say "Hey, thanks for everything, but I've decided to go with another provider."

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.

Why wouldn't I have to worry about getting things approved? What if my affiliate decides that I don't need an MRI? Then what?

And MRI's do cost something to run: they're called technicians. Besides, MRI time is a scarce resource and needs to be rationed somehow, unless you want to buy more machines and hire more technicians, which jacks up the price of the plan, which means fewer people subscribe, which means you're making less money to pay for the machines you just bought. Basic market forces at work here, and you can't wish them away by doing the free market rain dance.

 

[Eskarina]

That is why I said that the only real barrier to entry is ability.

Ability to pass exams, you mean?

In Germany today, you get to choose your doctor. What if tomorrow your legislature decides that from now own you can't?

You can bet your sweet behind on me not voting for them at the next election. And write a letter to my member of parliament. And raise hell in general.

What if my private insurance company decides I can't choose doctors anymore? What if my private insurance company decides I'm no longer eligible for their insurance due to a pre-existing condition?

Background to this: I had a very minor stroke last year (at the age of 41), probably due to a small heart defect of which I was unaware. Would an American insurance company cover the costs, which amounted to a good 6,000 Euros and would have been a severe financial setback for me?

All in all, I paid 100 Euros, plus about 25 Euros for medication every three months.

What should I do in this case?

The only way they had to assess my risk was age, race, and do I smoke. So not a very stringent vetting process.

For a three months insurance policy, that's fair, I s'pose.

Can you afford not to die? Even if I had to go bankrupt, I would want the best care possible to avoid death.

In some cases, going bankrupt might be worse than dying. After my stroke, I signed a patient's testament, basically saying that if I ever become a vegetable - for whatever reason - turn off the machines, take everything from me that might be useful and thrów the rest on a compost heap.

 

[Billdave2]

Under these circumstances, it is characterized as an elective procedure (the distinction is in the urgency, not in the condition it is being used to treat or prevent). It is referred to in the studies on wait times as an elective procedure. If the term offends you, suggest something else for the purposes of this conversation.

Linda

How about necesarry procedures? To say that it is "elective surgery" makes it sound like it is not necessary, like plastic surgery.

Also if it is considered elective surgery by the NHS this article would seem to imply that waiting times are longer than a few months for elective surgery, and that the push to decrease those times is compromising quality.
http://news.bbc.co.uk/2/hi/health/3749801.stm

I will throw this article in for good measure
http://www.timesonline.co.uk/tol/news/politics/article3646522.ece
How does that socialized medicine sound now?

 

[Billdave2]

Yes, but the cost of health care cannot continue to increase faster than the increase in peoples' ability to pay for it. Thus the rate of technological development is limited by the wider economy.



There will always be money in developing useful health care technology.



You mean in exactly the same way as a free-market system does?

So which of the following do you think has more bargaining power with a large pharmaceutical company: a few hospitals clubbing together in the US, or the NHS?

Not if there is no money in health care period.


It is a free market system, that why it is better, they work while socialized and communistic systems do not.

Who has more bargaining power the US government, or the only Pharmaceutical company left standing?

 

[Earthborn]

the push to decrease those times is compromising quality.

If you read carefully you would have noticed it said ... compromising quality by sending patients to private clinics...

 

[Ivor the Engineer]

How would the cost of being a doctor, or getting into med school be effected by a changes to the health care system. It is the same barrier that every doctor faces around the world no matter what.

The particular health care system does not affect it at all.

It is more of a problem for a free-market health care system because doctors can ristrict the supply of doctors to increase their profit.

In a nationalised system such as the NHS, doctors (eventually) receive a very good salary (as well as God-like status).

So on the assumption that some doctors would be greedy, we should destroy our health care system? That is good. Why do you assume that all these doctors would risk losing there medical licsenses that were so hard to get to do that? If they are prescribing unecessary procedures that is what will happen eventually.

Well if a doctor treating a patient with heart disease also recommended they have a nose job, then it would be fairly obvious they were on the make. But what about recommending MRI scans or other tests which aren't strictly necessary? What if the doctor has a profit share in the MRI scanner / testing facility? Is she guilty or just making extra sure of her diagnosis?

In the end it boils down to conflict of interest. A doctor under a free market system has to tear themselves in half. Removing the profit motive removes the conflict of interest.

Once again, in the US if you NEED health care, you will recieve it. If you go into the emergency room of any hospital and you need care they must give it too you, regardless of wether you have insurance or not. That means that 0.0% of the populationb cannot get health care if they need it.

Yes, when you're at death's door in the US an ER doctor will treat you. That must be good to know. Unfortunately, delaying treatment typically results in a poorer outcome and much more expensive treatment, which someone has to pay for.

The story clearly says that there is a shortage of doctors. Here is another story about how the UK is making up for the shortage by getting doctors from third world countries leaving them with a severe shortage.
http://econ.worldbank.org/WBSITE/EX...K:210083~piPK:152538~theSitePK:544849,00.html
What was it Volatile said about sacrificing poor peoples health care for your own greedy benefit? I believe he said it was abhorant.

Yes, it is abhorant, which is why there is a ban on doing it (at last).

However, it's rather ironic you are denigrating the UK government for incentivising doctors from other countries to behave in the way a free-market health care system would.

 

[Billdave2]

Oh, yes, I want nothing more. Trust me, the depths of my laziness have yet to be plumbed.

But I do recognize that the system would likely fail if nobody checked up on it. So if things get a little wobbly, I will--reluctantly--do my part and vote for the politician/party I think will appoint the bureaucrats who will keep the health care infrastructure chugging along.

Some people call me a hero, but I'm just a man.


This is also true of any government service. There is little controversy about the need for a police force, where corruption and abuse directly impinge upon liberty. So here's what I propose as a solution: the people will--periodically--hold elections, in order to maintain control over their government.


So build physician choice into the system, or allow for supplemental insurance policies. It'll still be cheaper. You're conflating a couple of different characteristics of health care systems--nothing about universal health care implies a lack of choice of physicians.


'The people who need basic health care' is synonymous with 'the people', and they aren't all currently covered by government programs in the US. Those 'extra layers', meanwhile, are pure bureaucracy. Why not reduce overhead with a national plan?

Insurance companies, meanwhile, are the result of market forces: there is a demand for risk management.


And charge you a hell of a lot more, because this is an administrative nightmare for doctor's offices and hospitals that burdens them with all of the work that insurance companies currently do, and requires that they do it less efficiently. I'm also not sure how it's supposed to work: let's say I subscribe to a local affiliate of doctors and hospitals for $200/month, and then I have a catastrophic accident that requires $500,000 worth of treatment. How do they make up the difference? The answer can't be 'volume': I'm just one guy. They raise the rate to $1,000/month, and I say "Hey, thanks for everything, but I've decided to go with another provider."


Why wouldn't I have to worry about getting things approved? What if my affiliate decides that I don't need an MRI? Then what?

And MRI's do cost something to run: they're called technicians. Besides, MRI time is a scarce resource and needs to be rationed somehow, unless you want to buy more machines and hire more technicians, which jacks up the price of the plan, which means fewer people subscribe, which means you're making less money to pay for the machines you just bought. Basic market forces at work here, and you can't wish them away by doing the free market rain dance.

In one place you want to get rid of overhead by having the government do it, then in another you say hospitals/doctors can't because they need the insurance companies to do that. You are contridicting yourself.

Instead of worring about how to build choice into a system that will not run as efficiently with choice as without, why not fix the system that does run better that way instead, which aslo provides better care?

The cost of the technician is negligble (they are there whther the machine is running or not)

In your example about the having the the health problem, I don't think you understand how volume works. It works because you aren't the only person paying the $200 a month. If they have 5,000 people paying $200 a month they are making getting a million dollars a month. that might lose money the month you cost $500,000 dollars but other months wouldn't be as bad. The market would sort itself out.

 

[Billdave2]

If you read carefully you would have noticed it said ... compromising quality by sending patients to private clinics...

And why is that? Because they have to go to inferior private clinics. If the health plan was free market, all clinics would be available. This does not prove your point, rather it is another point to prove mine.

 

[fls]

So you think that this survey is accurate? That Chile has a better health care than the US, How about Dominca? Why don't people in the US go there for treatment? Did you look at the statistics behind the study? The Us rates #1 in responsiveness (one of the most critical catogories). This also shows Canada at 30, does that sound right? Almost half the top twenty are tiny countries like Andorra, Malta and San Marino. Is it really comparable to compare these small countries to big countries like the US and Canada?

No, I think it is more reasonable to compare the US to the G8 countries or to those 18 countries from the study in the OP.

I would also be interested to know where all these useful drugs that are being created my non-drug company and non-drug company research are coming from. Could you please provide some examples?

AZT was developed at the National Cancer Institute.
Taxol was developed at the National Cancer Institute.
Gleevec and Zometa from Novartis (Swiss).

Linda

 

[Kestrel]

Where did I say that Medicare would be taken over by an HMO. I said that by providing tax breaks to individuals and tort reform we could overall the current system. I never said get rid of the government helping those who really need it. It would also help if people were allowed to purchase private insurance across state lines (this is illegal currently). The man in Volatiles example that could not afford the $850 a month policy in California, can not purchase the 133.34 a month policy I did in South Carolina. Why? because the government says he can't, another example of why the less government is involved the better.

Actually you claimed that government is always inefficient and I proved that it's just not true.

 

[Billdave2]

Ability to pass exams, you mean?



You can bet your sweet behind on me not voting for them at the next election. And write a letter to my member of parliament. And raise hell in general.

What if my private insurance company decides I can't choose doctors anymore? What if my private insurance company decides I'm no longer eligible for their insurance due to a pre-existing condition?

Background to this: I had a very minor stroke last year (at the age of 41), probably due to a small heart defect of which I was unaware. Would an American insurance company cover the costs, which amounted to a good 6,000 Euros and would have been a severe financial setback for me?

All in all, I paid 100 Euros, plus about 25 Euros for medication every three months.

What should I do in this case?



For a three months insurance policy, that's fair, I s'pose.



In some cases, going bankrupt might be worse than dying. After my stroke, I signed a patient's testament, basically saying that if I ever become a vegetable - for whatever reason - turn off the machines, take everything from me that might be useful and thrów the rest on a compost heap.

Yes, their skill and ability is the only limit in any system.

If they have already changed the system, isn't to late at the next election? I mean it might get changed back, but it might not.

If your private insurance company tries this, find another (easier than finding another government).

If you were in the states you would most likely have had insurance through your company. As I said in response to Darat's question it would probably be about $1500 dollars, more than you paid, but we also pay lower taxes. the medication would range from $8 -50 a month depending on what it is and your specific plan. You can have money taken out of your check pre-tax and get reimbursed for this, which results in a slight tax break. All in all probably cheaper here in the long run because of the tax savings you get all the time, not just a savings when you get sick.

We having living will's also, and if you are dead, do you really care that it cost you a lot of money?

 

[Billdave2]

I think any amount is unreasonable however I'll let that slide.

If it is the case she'd get all that for treatment for free why does anyone bother with insurance in the USA? It doesn't seem to make financial sense to me!

Yes it is more than nothing, but our taxes are a lot cheaper, so I think we come out ahead in the long run.

As I said if she was working and could afford to pay, she would have to (that is why we have insurance). If she was retired/or made very little money she would qualify for assistance.

 

[Earthborn]

Because they have to go to inferior private clinics.

If the free market was so great, why are the private clinics (your claim) inferior? Why do so few patients choose to go to them instead of government hospitals, and if they do only if their treatment is subsidised by the government?