single-payer system ... singled out

[boooeee]

It just depends on what you consider a system "like those found in the UK." I think a universal system is absolutely necessary. I also think all the focus on single-payer and blaming the "evil" insurance companies for all of the problems is misplaced. A system similar to what the Netherlands uses, or even Germany, would work. Have the government "referee" the system at a national level, but not necessarily run it.

I'm in complete agreement with this. Make health insurance mandatory, provide premium assistance for those at the lower income levels, and prevent insurance companies from denying members for pre-existing conditions. It's a system that's been shown to work in other countries (no guarantee of success here, of course), and it wouldn't require a complete overhaul of our healthcare system. It also allows the majority of Americans to keep the coverage they already have. I'm probably a bit biased, since as an employee of one of those "evil" (non-profit) insurance companies, this means I would get to keep my job.

Another approach I've heard floated is to have the federal government tell each state that they have to implement universal healthcare, give the states a fairly free rein in determining exactly how to do that, provide some sort of baseline funding, and see what works. 50 laboratory experiments.

I find it odd that Oliver is so focused on single-payer healthcare in the US when his own country doesn't even have single-payer.

 

[Ziggurat]

then it's been shown that universal socialised healthcare systems sucha s those found in the UK do, in fact, produce better standards of healthcare based on key performance indicators such as infant mortality.

No, it really hasn't. The way infant mortality is defined and measured in the US is not the same as in other countries. Many cases labeled infant deaths in the US would be termed miscarriages elsewhere. So the statistics commonly cited are simply not comparable. Cuba does not have a lower real infant mortality than the US.

 

[Matthew Best]

So the statistics commonly cited are simply not comparable.

What statistics are comparable?

 

[volatile]

Oh, I wondered when it was going to be time for this thread again, where the usual suspects repeat the same falsehoods they did the last time, only to disappear after the same people have pointed out their errors, again.

Someone asked above how the USA could cover more people, for less. Perhaps they could start by stripping the enormous amount of bureaucracy that supports the system of means-testing in the first place?

The fact remains that every other country with a universal system can cover all their citizens more cheaply (per capita) than the USA can to cover only a tiny fraction. The experiment's been done. The USA system doesn't work, by any metric you care to pick. What's standing between Beerina, Balrog and acceptance of that bald fact?

 

[boooeee]

Someone asked above how the USA could cover more people, for less. Perhaps they could start by stripping the enormous amount of bureaucracy that supports the system of means-testing in the first place?

Fair enough. How much do you think means testing for Medicaid really makes up of our $6102 per capita healthcare costs? My guess is very, very little. Also, other countries, like Germany, apply means testing for premium assistance and it doesn't seem to be driving their costs through the roof.

 

[Professor Yaffle]

Fair enough. How much do you think means testing for Medicaid really makes up of our $6102 per capita healthcare costs? My guess is very, very little. Also, other countries, like Germany, apply means testing for premium assistance and it doesn't seem to be driving their costs through the roof.

Another post from the denialism blog linked to earlier (thanks Praktik) discusses the reasons for the increased costs of US healthcare:

http://scienceblogs.com/denialism/2009/05/what_is_the_cause_of_excess_co.php

 

[lomiller]

No, it really hasn't. The way infant mortality is defined and measured in the US is not the same as in other countries.

So go ahead and show us that by itself can account for the difference in mortality rates. In the absence of such evidence your statement is pointless trivia.

 

[volatile]

Fair enough. How much do you think means testing for Medicaid really makes up of our $6102 per capita healthcare costs? My guess is very, very little. Also, other countries, like Germany, apply means testing for premium assistance and it doesn't seem to be driving their costs through the roof.

Well... let's turn this upside down.

Why do you think every other developed country on Earth can provide universal healthcare more cheaply than the USA can provide care for a few? In light of that, I'd hazard that the answer to your question is "probably quite a lot".

 

[volatile]

Another post from the denialism blog linked to earlier (thanks Praktik) discusses the reasons for the increased costs of US healthcare:

http://scienceblogs.com/denialism/2009/05/what_is_the_cause_of_excess_co.php

Excellent link, and a must read - especially for those dogmatically opposed to UHC systems.

 

[Ziggurat]

What statistics are comparable?

I'm not sure anybody collects comparable statistics on infant mortality rates.

So go ahead and show us that by itself can account for the difference in mortality rates. In the absence of such evidence your statement is pointless trivia.

I don't need to. The burden isn't on me, because it's not my claim. The burden is on whoever is claiming that US infant mortality rates are higher than other developed countries to show that's true. But that hasn't actually happened.

Furthermore, as that link points out, there are many factors which influence infant mortality rates besides the health care system, so even to the extent that any difference might persist after accounting for different definitions, there's no reason to attribute it to our health care system. Teen pregnancy rates and smoking, for example, are strongly correlated (and probably in a causative manner) with infant mortality, but there's no reason to think that any change in our health care system will have any effect on those factors. And then you've got things like higher infant mortality rates in cases of multiple births, which are much more common with fertility treatments. You might be able to drop infant mortality rates a bit by cutting back on fertility treatments, but that's not an outcome the American public actually wants.

 

[lomiller]

I don't need to. The burden isn't on me, because it's not my claim.

You claimed that the difference between infant mortality rates in the US vs the rest of the industrialized world is due to the way the US collects those statistics. You must either support or retract that claim.

 

[Professor Yaffle]

How about this study, comparing foetal and infant mortality between the US and Canada?

Background Infant mortality rates are higher in the United States than in Canada. We explored this difference by comparing gestational age distributions and gestational age-specific mortality rates in the two countries.

Methods Stillbirth and infant mortality rates were compared for singleton births at 22 weeks and newborns weighing 500 g in the United States and Canada (1996–2000). Since menstrual-based gestational age appears to misclassify gestational duration and overestimate both preterm and postterm birth rates, and because a clinical estimate of gestation is the only available measure of gestational age in Canada, all comparisons were based on the clinical estimate. Data for California were excluded because they lacked a clinical estimate. Gestational age-specific comparisons were based on the foetuses-at-risk approach.

Results The overall stillbirth rate in the United States (37.9 per 10 000 births) was similar to that in Canada (38.2 per 10 000 births), while the overall infant mortality rate was 23% (95% CI 19–26%) higher (50.8 vs 41.4 per 10 000 births, respectively). The gestational age distribution was left-shifted in the United States relative to Canada; consequently, preterm birth rates were 8.0 and 6.0%, respectively. Stillbirth and early neonatal mortality rates in the United States were lower at term gestation only. However, gestational age-specific late neonatal, post-neonatal and infant mortality rates were higher in the United States at virtually every gestation. The overall stillbirth rates (per 10 000 foetuses at risk) among Blacks and Whites in the United States, and in Canada were 59.6, 35.0 and 38.3, respectively, whereas the corresponding infant mortality rates were 85.6, 49.7 and 42.2, respectively.

Conclusions Differences in gestational age distributions and in gestational age-specific stillbirth and infant mortality in the United States and Canada underscore substantial differences in healthcare services, population health status and health policy between the two neighbouring countries.

http://ije.oxfordjournals.org/cgi/content/abstract/38/2/480

 

[Professor Yaffle]

Canada and some Nordic countries use the same system as the US for recording infant mortality:

Some of the international variation in infant and neonatal mortality rates may be due to variations among countries in registering practices of premature infants (whether they are reported as live births or fetal deaths). In several countries, such as in the United States, Canada and the Nordic countries, very premature babies with relatively low odds of survival are registered as live births, which increases mortality rates compared with other countries that do not register them as live births.

http://creativedestruction.wordpress.com/2006/05/22/regarding-the-uss-high-infant-mortality-rate/

That link also gives a graph with combined infant mortality and stillbirth rates, showing that the US is still worse than other comparable nations.

 

[Rolfe]

Another post from the denialism blog linked to earlier (thanks Praktik) discusses the reasons for the increased costs of US healthcare:

http://scienceblogs.com/denialism/2009/05/what_is_the_cause_of_excess_co.php

Now this is fascinating, in relation to the oft-repeated assertion that stopping the practice of throwing unlimited amounts of money at drug companies would cause "untold numbers of deaths" due to inhibiting research.

Most drug company R&D is on the creation of sibling, or "me too" drugs that mimic existing mechanisms and enjoy equal patent protection to novel classes of drugs. Novel drug mechanisms are usually a product of the public R&D through institutions like the NIH. As long as our patent system rewards the creation of "me too" drugs, that is what we're going to get and what drug companies will invest in. If we restructure the patent system to again encourage innovation, by shortening the patent protection of sibling drugs, or calling them what they usually are, generic equivalents, then we would not only have cheaper drugs but more novel drugs. See the work of Marcia Angell for more on this topic. When she examined the idea that drug company research produces new treatments what she instead found was the overwhelming majority (85%) of novel drugs resulted from government-funded research.

If we were to eliminate drug company R&D, the outcome would be less of these drugs that allow them to finagle their way past patent laws by making sibling drugs. If we eliminated direct to consumer advertising, their marketing budgets (far larger than their R&D) could instead go to research on drugs. If we reform the patent system so they no longer enjoy equal protection for non-novel substances, then maybe they'll spend all of their R&D on new treatments for diseases rather than the shortcut to wealth that sibling drugs represent.

Those posters who support the USA continuing to pour large amounts of money into "Big Pharma" as an altruistic effort to subsidise global pharmaceutical R&D, take note.

Rolfe.

 

[Matthew Best]

I'm not sure anybody collects comparable statistics on infant mortality rates.

OK. If that's true (there seems to be some doubt) what statistics on health care outcomes do you think are comparable?

 

[Architect]

Let me just make clearhow much more you chaps in the US spend on healthcare compared to the rest of us:

http://www.oecd.org/document/16/0,2340,en_2649_34631_2085200_1_1_1_1,00.html

Now, some reading:

[FONT=Arial, Helvetica]A Comparison of the USA Health Care Effort with other OECD Countries[/FONT]

[FONT=ARIAL, HELVETICA]EDUARD GRACIA [/FONT]
[FONT=ARIAL, HELVETICA]University of Barcelona[/FONT]

[FONT=ARIAL, HELVETICA]JOAN GIL [/FONT]
[FONT=ARIAL, HELVETICA]University of Barcelona - Department of Economic Theory [/FONT]

[FONT=ARIAL, HELVETICA]Hacienda Publica Espanola, Vol. 161, No. 2, 2002, Instituto de Estudios Fiscales, [/FONT]

[FONT=ARIAL, HELVETICA]Abstract: [/FONT]
[FONT=ARIAL, HELVETICA]We use a sample of OECD countries in order to better understand why the US health care expenditure as a percentage of its Gross Domestic Product ("health care effort") is so far above any other. To this end we employ a descriptive cross-country methodology based partially on econometric estimations, synthetic indicators and the Lerner's formula of market power, that allows us to dismiss as explanatory variables all those factors that were not differential across the sample. We advance the exploratory hypothesis that the availability of a universal public health coverage would increase the price elasticity of demand and thus would reduce the control of prices by the suppliers. [/FONT]
​

 

[Architect]

You know, perhaps it would just be easier if everyone just re-read this thread:

http://www.internationalskeptics.com/forums/showthread.php?t=106255

 

[martu]

OK. If that's true (there seems to be some doubt) what statistics on health care outcomes do you think are comparable?

Any that show the US is doing better than the rest of us I expect. Maybe number of machines that go 'ping'?

 

[Beerina]

Oh, I wondered when it was going to be time for this thread again, where the usual suspects repeat the same falsehoods they did the last time, only to disappear after the same people have pointed out their errors, again.

Ironically, I thought the same thing, with the tired old observations that "everybody in those countries absolutely adores it, as if that had anything to do whatsoever with whether it "works" or not, a fact that everybody around here agrees on in every other realm but politics.

Someone asked above how the USA could cover more people, for less. Perhaps they could start by stripping the enormous amount of bureaucracy that supports the system of means-testing in the first place?

I wonder how much is government paperwork, or quasi-government paperwork for lawyers...

The fact remains that every other country with a universal system can cover all their citizens more cheaply (per capita) than the USA can to cover only a tiny fraction. The experiment's been done. The USA system doesn't work, by any metric you care to pick. What's standing between Beerina, Balrog and acceptance of that bald fact?

I wonder what you mean by "doesn't work", especially with the odd qualifier of "by any metric you care to pick."

Here's a metric: Nationalization of health care will lead to slower development of medical technolog, leading to more deaths and protracted suffering, due to cures and treatments coming later and later than they otherwise would have in an "evil, greedy" system like the US's.

Europe already doesn't produce as much as they would, should they have been like the US. Hence the entire world suffers for it given people, oddly, share medical technology.


You should all be ashamed of yourselves.

 

[Ziggurat]

You claimed that the difference between infant mortality rates in the US vs the rest of the industrialized world is due to the way the US collects those statistics. You must either support or retract that claim.

No, that is not what I claimed. I claimed that the results are not comparable, and so we do not know if the US has higher infant mortality rates. I gave a link detailing those differences, so I have supported what I actually claimed. Furthermore, as I already mentioned, there is no way to attribute any differences that may exist to our health care system, since so many non-healthcare issues can affect those rates.