Health care - administrative incompetence

[Emet]

I don't see many facts from the other side either. Plenty of name calling ("repugnant," "stupid") but no actual evidence that a free market system won't work. The fact is that the free market works just fine to distribute our food and shelter which we all agree are basic rights. They are both accessible for pretty much everyone in America. Healthcare, which is heavily regulated, is not. Things that make you go, "Hmmmmmmm..."

Except for the working poor and the homeless.

 

[Ducky]

Thank you, my mother was 37 when I was born. Her mother was 42 when she was born, in 1916. We are both very well, thank you very much.

Way to derail the discussion.

Rolfe.

My impression of that post was not as one of a derail, but one pointing out the hypocrisy of touting personal responsibility as a defense against the denial of universal coverage and health care compared to attitudes toward other conservative (mostly religious) socially accepted things.

 

[Tatyana]

Me too. WWJD? Where's the ethics?

If society really believes people's unexpected health bills should not be paid for by society pooling resources....then society should put its money where its mouth is and exert a lot more pressure on people causing preventable illnesses.

Example ~

A couple conceives a baby even though they know they're probably going to pass on a genetic illness or the mother is over 35 (more likely the child will have developmental disabilities)....

Why aren't the neighbors will picketing the house and throwing rotten eggs at them instead of throwing them a baby shower and praising them for being good parents/good Christians?

Or the couple lives in one of those evil socialist countries where the pre-natal care includes things like screening for beta-thalassaemia.

http://www.ncbi.nlm.nih.gov/pubmed/7820938
Clin Genet. 1994 Sep;46(3):238-43.
A 12-year preventive program for beta-thalassemia in Northern Sardinia.

.

Just an update on the science, it isn't just the age of the mother, but the age of the father as well.

There is also this thing called buccal translucency and a quadruple test that more or less gives parents the choice to have the child or not if there is a significantly high chance that they will have a child with trisomy 21 or numerous other 'developmental disabilities'.
http://www.nhs.uk/Conditions/Antenatal-screening/Pages/Introduction.aspx
100 % of women in the United Kingdom are offered this pre-natal screening (as well as being screened for rubella, HIV, syphilis, Hep B and C as well as a cross match for blood type).

The antenatal care in the UK is quite amazing and is one are of medicine that is FAR superior to that in the US.

 

[Rolfe]

My impression of that post was not as one of a derail, but one pointing out the hypocrisy of touting personal responsibility as a defense against the denial of universal coverage and health care compared to attitudes toward other conservative (mostly religious) socially accepted things.

Maybe so, but it was massively irrelevant.

The USA has socialised roads, and socialised schools and socialised public libraries, and socialised parks and a socialised army and goodness knows what else.

Why medicine is excluded, I simply have no freaking idea.

Rolfe.

 

[Architect]

I don't see many facts from the other side either. Plenty of name calling ("repugnant," "stupid") but no actual evidence that a free market system won't work. The fact is that the free market works just fine to distribute our food and shelter which we all agree are basic rights. They are both accessible for pretty much everyone in America. Healthcare, which is heavily regulated, is not. Things that make you go, "Hmmmmmmm..."

1. Strep throat discussion. Link provided to NHS data, ditto reference to Canadian and French documents. You were challenged to provide clinical data to provide clinical data to support your argument that antibiotic treatment was required. None provided.

2. JimBob has attempted to question you on the maths of the issue several times, see (for example) post 207. You've yet to provide a meaningful and comprehensive response.

3. Ducky as pushed you many times on the detail of your "catastrophy fund" (see, for example, post 236 et. seq.) but you've avoided a detailed response and done rater a lot of hand-waving.

4. In post 249 you are asked to clarify your views on transplant lists. No cogent reply that I can see.

5. In post 307 Agatha called your unsubstantiated claim on immigrant numbers as part of the problems and provided a source. You ducked the issue.

6. Post 314, Judy provides a source showing that your statement regarding those without insurance and money going without healthcare is wrong. You fail to respond, for example by providing a source for your original claim beyond personal incredulity.

7. You make play on the perceived inequalities in pay between sporting celebrities and medical staff. Agatha takes you to task on this including citing sources for funding (post 338 et. eq.) but you fail to provide a reponse.

8. A number of posters including Emet and UncaJimmy tried to discuss PII costs with you; they both quoted sources and provided links (#357, 359). You dismissed them from personal incredulity and provided little comparable background citations to support your position.

9. Tatyna has provided significant detail and cited sources on the (massive) gaps in your healthcare system for example post 363. Post 392 is particularly compelling. You appear to have overlooked these for some reason.

10. You have complained that infant mortaility and life expectancy are not appropriate indicators of clinical outcomes but failed to provide any alternative measure which you consider acceptable. I note in passing that I posted links to papers which discussed the differences in recording different treatment success rates on each side of the pond. I suspect you didn't read it.


I see many facts, XJX, together with cited sources and plenty of links. I don't see them from you, however.

 

[Uncayimmy]

Except for the working poor and the homeless.

I all fairness, food is cheap, plentiful, and easily accessed in the USA. In the obesity thread I worked it out, and you can get adequate Calories and nutrition for about $3/day or less. I don't mean to sound callous, but that's an hour or two of begging at most. There won't be much variety nor will it be an ideal diet, but on a very basic level food itself is not really a problem.

The reason people "go hungry" is because of other expenses, which are typically fixed. Rent has to be paid in full. Transportation to/from work has to be paid in full. You need a certain amount of electricity and water no matter what. Food is different in that you can skip a meal or two, but you can't skip a day or two of rent. You can greatly vary the amount spent to get essentially the same Calories and nutrition, but you can't pay less for rent on a given day to cut back.

/derail

 

[Rolfe]

My point in illustrating this is that it doesn't matter if you do it your way or our way, there are still inequalities.

No, you have the inequalities, where some people get treatment and others don't. We don't have these inequalities, because everybody gets the treatment up to an extremely high ceiling.

In your system the height of the ceiling is massively variable, right down at floor level for many people. You still haven't come up with an example of someone who is not independently wealthy finding their ceiling is higher than the ceiling for all NHS patients.

You still have to explain why it's better to have your unequal ceiling, with many people being denied even basic care, than our very high ceiling which is equal for all.

In a free market, that drug could be much cheaper allowing more to afford it. But as long as government controls the decisions and not patients and doctors it never will.

So how come it's in Britain, where the NHS uses its massive bulk-buying power to negotiate discounts, that drug prices are forced lower, but in the USA prices for the same things are way higher?

You have given no mechanism at all whereby that drug, or any other, could be cheaper in your "free market". Nobody is going to sell a drug that costs thousands to produce for 55 cents. Nobody is going to invest millions in inventing a drug, when they know that they won't be able to sell enough of it to people who can afford it to recoup their costs.

There is no mechanism at all that will bring the price of something genuinely costly down to the price of a Big Mac. The way to get the seller to squeeze their margins as much as possible, is to wave a big fat carrot of a big fat bulk-buy order at them.

Rolfe.

 

[MatildaGage]

The fact is that the free market works just fine to distribute our food and shelter

Food and shelter are both regulated.

Food is regulated by USDA and FDA. Also we the taxpayers pay for many farms in the form of subsidies. The federal government regulates the agricultural market--have you heard of dumping milk or paying farmers not to produce?

Shelter is regulated by federal, state, and local governments in the form of HUD and agencies of that ilk. There are many laws about what landlords and tenants can and cannot do. Then there are regulations about mortgages, realtors, sales of homes, etc.

 

[Tatyana]

I all fairness, food is cheap, plentiful, and easily accessed in the USA. In the obesity thread I worked it out, and you can get adequate Calories and nutrition for about $3/day or less. I don't mean to sound callous, but that's an hour or two of begging at most. There won't be much variety nor will it be an ideal diet, but on a very basic level food itself is not really a problem.

The reason people "go hungry" is because of other expenses, which are typically fixed. Rent has to be paid in full. Transportation to/from work has to be paid in full. You need a certain amount of electricity and water no matter what. Food is different in that you can skip a meal or two, but you can't skip a day or two of rent. You can greatly vary the amount spent to get essentially the same Calories and nutrition, but you can't pay less for rent on a given day to cut back.

/derail

The issue with access to food is that the poor often don't have a car and the superstores providing the best, cheapest food require a car for access.

This isn't just an issue in the US, but there are areas in the UK as well, and referred to as 'food deserts'.

There may be corner shops, but very little else.

I would have to check on the accuracy of this, but Mayor Marion Barry claims that there is only one supermarket in the District of Columbia for 700, 000 people.

 

[MatildaGage]

Thank you, my mother was 37 when I was born. Her mother was 42 when she was born, in 1916. We are both very well, thank you very much.

Way to derail the discussion.

Rolfe.

Huh? I think you've entirely misconstrued my remark. Refer to the comment I was replying to and agreeing with.

 

[Rolfe]

Well, yes. I simply didn't know how to construe your post. If we are in agreement, then we need say no more about it.

Rolfe.

 

[kellyb]

Maybe so, but it was massively irrelevant.

The USA has socialised roads, and socialised schools and socialised public libraries, and socialised parks and a socialised army and goodness knows what else.

Why medicine is excluded, I simply have no freaking idea.

Rolfe.

I think it's because Any Rand's religion of "government is always the problem, never the solution" didn't go mainstream until after we'd socialised our schools, highways, etc.

While you guys were building the NHS, we were going through the second Red Scare, too.

 

[Rolfe]

I keep thinking the USA could be a lot more creative with the QALY.

Here, NICE decides how much a QALY is worth, and patients don't get much of a say in it. I sometimes imagine the USA could create a universal healthcare system in which a QALY was priced very much less than in the NHS, and anyone who wanted to spend more could then do so either out of pocket or through insurance.

Or the insurance companies could compete by marketing their products as providing up to a certain sum per QALY for the patient's treatment. You want the Rolls-Royce deal, sign up with X for up to $1M per QALY! It'll cost you though! Or Y might provide similar cover but for a lower premium. Or for a much lower premium, you could be covered up to $5,000 per QALY.

Maybe the government might mandate that everyone should have cover up to a certain sum per QALY, and subsidise that if necessary. Then people could choose to pay for better coverage if they wanted to.

Think of the possibilities! We could be saying, huh, here we are, everybody covered up to (what is it, about £20,000) per QALY, no choice at all compared to these Americans.

Look at what an opportunity is being missed!

Rolfe.

 

[Uncayimmy]

I would have to check on the accuracy of this, but Mayor Marion Barry claims that there is only one supermarket in the District of Columbia for 700, 000 people.

Generally speaking, if Marion Barry said it, it's probably wrong. It's wrong in this case. That doesn't negate your point, though.

 

[FattyCatty]

The strawmanned version of them are. How can you say this when we don't even have a free market right now? What's the test for this theory? Government regulation is the best way to enrich the few people who are in a position to take advantage. Guess who is a big beneficiary of the government run system? Nazir Mohammed who paid for Nikki Blunden's care. He's rich off the government system.

Why do you say Nazir Mohammed got rich off the government system? He runs a family pharmacy. Where's your evidence for that statement?

Here's what your "free market" produced:

For the top brass at the big health plans, there also was a wide range in pay changes between 2007 and 2008. Three executives — Jay Gellert, president and CEO of Health Net; Angela Braly, president and CEO of WellPoint; and Aetna Chair and CEO Ronald Williams — saw boosts in total compensation. Williams’ went up by 5%, from $23 million to $24.3 million; Braly’s by 8%, from $9 million to $9.8 million; and Gellert’s by 20%, from $3.6 million to $4.4 million.
On the other end of the spectrum, the pay package for UnitedHealth Group President and CEO Stephen Hemsley dropped 75%, from $13.1 million in 2007 to $3.2 million in 2008.

How do we provide health care to other countries again?

http://www.usaid.gov/fani/ch03/

The changing profile of disease is affecting the economies of developing countries. Moreover, in many newly democratic countries, people are demanding better health care. U.S. medical and health care organizations have the expertise and experience to help solve many of their problems. All these points suggest that U.S. efforts to improve health care overseas must continue to evolve to benefit both the public and private sectors and the citizens of all the countries involved.

From the CRS Report for Congress, Foreign Aid: An Introductory Overview of U.S. Programs and Policy, updated April 15, 2004:

Global Health. One of the most striking changes in the distribution of economic aid resources in recent years has been the sharp growth in funding for Global Health, especially in the area of HIV/AIDS programs. The budget for Global Health has nearly doubled since FY2001, while HIV/AIDS resources have increased almost five-fold⁷. In FY2004, the Bush Administration launched a five-year, $15 billion Global AIDS Initiative, with the goals of 7 million new infections, treating 2 million HIV-infected individuals, and caring for 10 million infected people and AIDS orphans.

Funding for two other health sectors are rising, but far more modestly than HIV/AIDS programs. Child Survival and Maternal Health projects aim to reduce infant mortality by, among other interventions, decreasing the incidence of acute respiratory infections, diarrheal disease, measles, and other illnesses that occur in the first 28 days of life and combating malnutrition, and to improve the quality of child delivery facilities and raise nutritional levels of mothers. Funding for these activities has grown by 27% in the past four years. Congress has placed special attention on other infectious disease activities -- mainly those addressing malaria and tuberculosis -- increasing spending by 43% since FY2001.

You don't know me enough to make that judgement. You only know a set of arguments on the internet and not what I practice in real life.

As I said earlier, "your posts sound" uncaring and egocentric. I based that on your posts. You know, you post X, I say your post sounds Y (not you are Y). I don't have to know you, only the "set of arguments on the Internet" to say something about your posts.

Offer the best possible life? I don't remember reading that in the Constitution. Maybe the best possible life is liberty to make their own decisions as to what's best for them.

General welfare. Pursuit of happiness. See previous post.

Food, shelter, protection from harm and healthcare are all rights? One of things is not like the other . . .

See previous post.

People who don't agree with you are stupid. Got it.

They aren't stupid because they don't agree with me. They are stupid, and on some issues they don't agree with me.

What is basic food? What is basic healthcare? No one has defined these things, except for "Prime Rib" is not basic food, but "Liver Transplants" (but not life-extending breast cancer drugs ) are basic healthcare. Be more definitive about what these things are, then we can argue it.

Talk to a nutritionist for their guidelines. Basic food will be what's required to keep a person alive and healthy. For basic health care, check out the systems "across the pond."

Please stop posting reasonable things I agree with. You're screwing with my zen thing, man.

I agree. It's mind boggling to find I agree with an UncleYimmy post.

I don't see many facts from the other side either. Plenty of name calling ("repugnant," "stupid") but no actual evidence that a free market system won't work. The fact is that the free market works just fine to distribute our food and shelter which we all agree are basic rights. They are both accessible for pretty much everyone in America. Healthcare, which is heavily regulated, is not. Things that make you go, "Hmmmmmmm..."

Bushwaw. Hunger in the U.S. is increasing. Didn't you look at the links about hunger here?

And from the Executive Summary of The 2009 Annual Homeless Assessment Report to Congress by the U.S. Department of Housing and Urban Development Office of Community Planning and Development:

On a single night in January 2009, there were an estimated 643,067 sheltered and unsheltered homeless people nationwide.
<snip>
Nearly 1.56 million people used an emergency shelter or a transitional housing program during the 12-month period (October 1, 2008 through September 30, 2009). Two thirds were homeless as individuals, and one-third were homeless as members of families.

So how is your famous "free market" successfully feeding and housing all American citizens?

 

[xjx388]

1. Strep throat discussion. Link provided to NHS data, ditto reference to Canadian and French documents. You were challenged to provide clinical data to provide clinical data to support your argument that antibiotic treatment was required. None provided.

Herehttp://www.aafp.org/afp/2004/0315/p1465.html are the Evidence Based Guidelines we use here. If rapid strep is positive we give penicillin unless they are allergic in which case we give erythromycin. Every positive case unless they are chronic. Then we consider other measures. UK and France, no antibiotics. Wonder why socialized medicine would be so different?

2. JimBob has attempted to question you on the maths of the issue several times, see (for example) post 207. You've yet to provide a meaningful and comprehensive response.

His numbers are 1. Made up and 2. Based on delivery in the current system.

3. Ducky as pushed you many times on the detail of your "catastrophy fund" (see, for example, post 236 et. seq.) but you've avoided a detailed response and done rater a lot of hand-waving.

To respond directly to that post, I need him to clarify some numbers. He says $1.2 million. 1. Is this what the bills amounted to? 2. How much of that did the insurance pay? 3. How much was written off? And 4. How much do you personally owe? There is a lot of padding in medical bills because of the system we currently have. 1.2mil may actually be $500000 of which he would be responsible for $100000 or so. Big difference. It's hard to debate with ink the 1.2mil number.

4. In post 249 you are asked to clarify your views on transplant lists. No cogent reply that I can see.

I was asking if transplants are part of the basic health care everyone has a right to. You guys said yes. Be more clear about what you want to know and I'll do my best to answer.

5. In post 307 Agatha called your unsubstantiated claim on immigrant numbers as part of the problems and provided a source. You ducked the issue.

I never made a claim about immigrants. That was someone else.

6. Post 314, Judy provides a source showing that your statement regarding those without insurance and money going without healthcare is wrong. You fail to respond, for example by providing a source for your original claim beyond personal incredulity.

Again, someone else.

7. You make play on the perceived inequalities in pay between sporting celebrities and medical staff. Agatha takes you to task on this including citing sources for funding (post 338 et. eq.) but you fail to provide a reponse.

I don't see sources for funding cited. Not sure what you are getting at there. You are the ones who say health care is a basic right. If you truly believe that, how can your society justify expenditures on footballers, etc when so many people are denied treatments based on cost-effectiveness?

8. A number of posters including Emet and UncaJimmy tried to discuss PII costs with you; they both quoted sources and provided links (#357, 359). You dismissed them from personal incredulity and provided little comparable background citations to support your position.

There is no contention that reform in Texas resulted in reduced Malpractice Insurance rates. In a free market, lower costs = lower price. We don't have a free market, so those prices haven't come down. It's simple economics.

9. Tatyna has provided significant detail and cited sources on the (massive) gaps in your healthcare system for example post 363. Post 392 is particularly compelling. You appear to have overlooked these for some reason.

The paper concludes that there appear to be important inequities in access to some types of health care in the UK...

This report demonstrates that there are big inequalities between rich and poor in the UK.

I conclude there are bigger gaps in healthcare in the UK than you may be aware of.

10. You have complained that infant mortaility and life expectancy are not appropriate indicators of clinical outcomes but failed to provide any alternative measure which you consider acceptable. I note in passing that I posted links to papers which discussed the differences in recording different treatment success rates on each side of the pond. I suspect you didn't read it.

I'll concede the point that life expectancy and infant mortality are at least quick an dirty measurements of outcomes.

I see many facts, XJX, together with cited sources and plenty of links. I don't see them from you, however.

And there are mine with sources disputing yours.

 

[xjx388]

Why do you say Nazir Mohammed got rich off the government system? He runs a family pharmacy. Where's your evidence for that statement?

Where do you think his pharmacy gets the bulk of it's income from?

Here's what your "free market" produced:

It's not OK for corporate CEOs to make a ton of money? How do you figure that, but at the same time have no problem with Tom Brady making $8mil?

http://www.usaid.gov/fani/ch03/

From the CRS Report for Congress, Foreign Aid: An Introductory Overview of U.S. Programs and Policy, updated April 15, 2004:

Expertise and advice <> health care. We aren't sending doctors over there to care for patients for free. That's what charities are for.

As I said earlier, "your posts sound" uncaring and egocentric. I based that on your posts. You know, you post X, I say your post sounds Y (not you are Y). I don't have to know you, only the "set of arguments on the Internet" to say something about your posts.

OK.

General welfare. Pursuit of happiness. See previous post.

General welfare of the United States. Pursuit of happiness not happiness.

They aren't stupid because they don't agree with me. They are stupid, and on some issues they don't agree with me.

Clever.

Talk to a nutritionist for their guidelines. Basic food will be what's required to keep a person alive and healthy. For basic health care, check out the systems "across the pond."

So basic healthcare = liver transplants but not breast cancer drugs that extend life?

Bushwaw. Hunger in the U.S. is increasing. Didn't you look at the links about hunger here?

And from the Executive Summary of The 2009 Annual Homeless Assessment Report to Congress by the U.S. Department of Housing and Urban Development Office of Community Planning and Development:
So how is your famous "free market" successfully feeding and housing all American citizens?

Oh, sorry. It's successfully feeding and housing 99.8% of all American citizens. Pretty damn good.

 

[Uncayimmy]

Why are you okay with $30B/year of tax dollars being spent on medical research but would rather let your family die than accept tax dollars to pay the providers using the knowledge and equipment gained from those tax dollars?

xjx388: This is the third time I've asked the above.

 

[kellyb]

This report demonstrates that there are big inequalities between rich and poor in the UK

That's life expectancy inequality, not "access to healthcare" inequality, isn't it?

While that's (social determinants of health and gini coefficient factors) an interesting discussion in and of itself, it doesn't mean the NHS is giving unequal care to the UK's poor compared to the rich.

ETA:

The paper concludes that there appear to be important inequities in access to some types of health care in the UK...

Link isn't working...

 

[kellyb]

xjx388: This is the third time I've asked the above.

And whatever happened to the discussion about tax dollars partially funding medical schools?