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

[Eskarina]

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.

This is the definition of a free market:

A free market is a market in which prices of goods and services are arranged completely by the mutual consent of sellers and buyers. By definition, in a free market environment buyers and sellers do not coerce or mislead each other nor are they coerced by a third party.[1]

http://en.wikipedia.org/wiki/Free_market

 

[mumblethrax]

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.

No, I'm not. What I'm saying is that a single payer system is more efficient than a few insurance companies duplicating labor is more efficient than every hospital in the country duplicating labor.

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?

Because it isn't possible. The basic problem at hand here is that the objectives of profit maximization and optimal national health are at odds, and there's no way to fix that while retaining the market model.

No system runs as efficiently with choice as without, which is why HMOs became popular in the US.

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

Not at all true. Labor is expensive. But you haven't addressed the scarcity problem at all: how do you ration MRI time if not by charging more for it?

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.

Oh, no, I certainly do understand how volume works. The problem is that there's nothing compelling me, as a customer, to pay more when I could be paying less. Hospitals that work to identify risks and charge higher premiums (or refuse to take me on as a customer at all) will be able to charge their other customers less, and will therefore be more competitive. Why should I pay into a subscription model that doesn't account for the fact that I'm less likely to develop a serious illness?

This might sound familiar.

 

[fls]

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

That's a good choice.

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

These surgeries are considered separately anyway. A PTCA requires a whole difference set of equipment and specialists (plus the absolute necessity to have it available for emergency treatment) than a hip replacement, so there's no point to addressing them in the same manner.

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?

I am unfamiliar with the extent to which various countries cover dental services. However, that's a good illustration of why it is useful to look at the details rather than use ideologic labels. The problem was poor communication - there wasn't a convenient way to discover where services were readily available. This in analagous to local variations in surgical wait lists, where a centralized system of management can vastly improve efficiency. That is, the problem isn't a necessary feature of universal health care and is remedial within a universal system (I prefer to use the term universal rather than socialized, because 'socialized' implies a number of characteristics that are not shared by universal systems).

Linda

 

[fls]

but we also pay lower taxes.

Actually, you contribute more in taxes toward health care than any other country.

Linda

 

[The Painter]

Actually, you contribute more in taxes toward health care than any other country.

Linda

We're #1

 

[Ivor the Engineer]

<snip>

(I prefer to use the term universal rather than socialized, because 'socialized' implies a number of characteristics that are not shared by universal systems).

Linda

Could you clarify this.

 

[fls]

I prefer to use the term universal rather than socialized, because 'socialized' implies a number of characteristics that are not shared by universal systems.

Linda

For example, 'socialized' implies that it's under government control. The extent to which this applies varies considerably. There are countries like Germany and France with a mix of public and private health insurance, and single-payer insurance systems like Canada, where the healthcare providers operate independently of the government (with a few exceptions). And there are places like England where some providers, such as hospital doctors, are employees of the government.

And socialism implies a redistribution of wealth, whereas some healthcare systems allow for equal contributions from all (with the exception of the impoverished), in the payment of insurance premiums. Although, the components that are funded through general revenues may consist of progressive taxation.

The US does not differ in terms of progressive taxation or regulation of the insurance industry. So the US is just as socialist as some of the other universal systems, making the term not very useful for distinguishing the differences. Universal, as in 'meant to apply to all', seems to be a better way to distinguish them.

Linda

 

[balrog666]

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.

Incredibly well stated!


I applaud you!

 

[balrog666]

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.)

Does the profit motive make a difference or is it irrelevent?

 

[Mobyseven]

Most medical procedures like MRI's don't really cost anything to run, it is all in intial price and maintenance.

Well yeah, that may be (somewhat) true...but an MRI is significantly more expensive to purchase and maintain than (for example) an CT Scanner or pretty much most of the equipment you'll find in a hospital. Stands to reason it's going to cost more: That liquid helium dunt cool itself.

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

I imagine that Germany would very soon afterwards have to elect a new legislature, what with all the parliamentarians having been savegely murdered by the flying monkey demons emerging from the Reichstag to escape snow season in hell.

 

[Ivor the Engineer]

Does the profit motive make a difference or is it irrelevent?

How does universal provision of health care remove the profit motive?

How can inflation in the health care sector continue to be higher than inflation in the wider economy?

What would be the effect on the economy if inflation in health care did continue to be higher than in all other sectors?

If you understand the economics behind these questions you will understand why Beerina's (or should I say the Cato Institute's) argument is hand-waving, scare-mongering nonsense.

 

[fls]

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.

But that description doesn't fully apply to the US nor distinguish the US from other countries. And if it is a proposal for future directions, it seems to be an inadequate justification for presuming success. For example, drug development in the absence of regulation gave us a plethora of snake oil remedies and a few useful therapies. In the era of the regulation of therapeutic goods, we have had an explosion of useful therapies. And note that the unregulated counterpart - 'natural products' - gives us very little (if any) of use.

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

Given that new technologies are developed and used by health care providers in other countries, and that Americans would likely continue to demand useful products, I presume that the profits you are referring to are those from excessive and unnecessary use. So this is money that we are directing toward technology producers from which we are not deriving any health benefit. The question is, does directing money in this manner (excess profits to end-producers of technology) effectively increase the development of new and useful medical technologies or are there more efficient ways to direct the money in order to increase development. Since the pipeline to the development of new and useful technologies does not usually start with the end-producers, but rather with academic research, independent inventors, government research institutions, etc., I would argue that directing money to those areas would be much more likely to stimulate the production of new technology than allowing end-producers to enjoy excess profits. You may not agree, but I hope that you can see that these things cannot be assumed.

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

I was talking about whether the US could pull ahead in terms of health outcomes. This is only possible if the US would be expected to pull ahead in terms of access to useful medical technologies - highly questionable. And it is only possible if useful medical technologies can influence health outcomes to a larger degree than dealing with issues of access can (ETA: this is relevant because this is the trade-off under discussion) - they don't.

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.)

This only helps if you are able to buy something that makes a material difference to your health. What sort of a difference does having ten ACE-Inhibitors to choose from instead of nine? None.

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.

The choice is between cheap useful care and expensive useless care. What you haven't established is whether the money directed toward useless care trickles down into the increased development of useful care.

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?

I having trouble picturing your scenario in a way that makes sense. You could help by providing an example of useful technology (this can include drugs) that was developed between 1998 and 2008 that would have been unavailable had we not paid for unnecessary care. What technological differences are available now that were unavailable in 1998, what material difference do they make to life and the quality of that life, and how was their development stimulated/funded?

Linda

 

[The Painter]

Why do you feel the USA health care system has to be like yours? You've got yours, we've got ours. We do a lot of things different than you. Next thing you know, you'll be making us eat Haggis, yuk!

Look at the Internet, which is surely the most important invention of all time

This made me laugh, I don't even think it's in my top 10.

 

[fls]

Why do you feel the USA health care system has to be like yours? You've got yours, we've got ours. We do a lot of things different than you. Next thing you know, you'll be making us eat Haggis, yuk!

Is that the equivalent of the "why don't you leave her alone, she's not hurting you" defense of Sylvia Browne?

We need a name for that.

Linda

 

[Darat]

Shortsightedness.

 

[Mobyseven]

Shortsightedness.

Hypocracy. It's all well and good to criticise other countries, but when the USA is under the microscope it's all, "Stop trying to force your system on us - we have ours and it doesn't need to be the same as yours."

 

[volatile]

Hypocracy. It's all well and good to criticise other countries, but when the USA is under the microscope it's all, "Stop trying to force your system on us - we have ours and it doesn't need to be the same as yours."

This quote necessarily ends:

"...even though ours costs more, and functions less efficiently. Ideology trumps reality!"

 

[The Painter]

This quote necessarily ends:

"...even though ours costs more, and functions less efficiently. Ideology trumps reality!"

I dispute both of those, but lets say I didn't. Now explain this "Ideology trumps reality" with the Queen.

 

[boooeee]

Thanks for your trouble.

So, the German healthcare system isn't working? That's odd, I have a different impression, and I've been living here for almost all of my life.

It certainly isn't perfect. It's annoying and bureaucratic at times, and, contrary to popular opinion, it isn't free, but at least I don't have to worry much about what gets covered and what not.

Oddly enough, I have the same impression of the US Healthcare system, having lived in the US all of my life. Which is the whole problem with making decisions based on anecdotes and personal experience.

I think the US Healthcare system works for the majority of Americans. Does that mean we shouldn't try to improve it for the substantial section of the population that it doesn't work for? Of course not. I'm just a little leery of wholesale changes (e.g. government run single payer). There's plenty of room for incremental improvements: expanding Medicaid, expanding Medicare, coverage mandates, etc.

 

[Architect]

Why do you feel the USA health care system has to be like yours? You've got yours, we've got ours. We do a lot of things different than you.

One of the things that often surprises me is the unwillingness of the US to look at regimes, legislation, and the like in other comparable countries; here, such studies are commonplace in helping determine policy issues and the like. Ironically, the US is one of the countries we look at the most.

The fact is that other countries do have directly comparable standards of universal healthcare which, in key indicators such as life expectancy and infant mortaility, show consistently better results overall than the US system......and costs less in taxes. Moreover every resident of the UK is guaranteed treatment regardless of the cost of treatment and whether they have paid taxes. I can't see how this is a bad thing. The vulnerable are protected by a full safety net. And in the Scottish and Welsh systems, dental healthcare is also guaranteed free (you may have to travel a little until new staff come on-stream) and so are prescriptions. And nursing care for the elderly. And eyesight tests.

Next thing you know, you'll be making us eat Haggis, yuk!

I have tasted American fast food, and I'm quite happy with haggis (in small doses) thank you very much.