single-payer system ... singled out

[Ziggurat]

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

It's interesting, and suggests that at least relative to Canada there is indeed a difference in rates. However, their conclusions about causes are not actually supported.

For example, they say, "In general, differences in gestational age distributions reflect aspects of maternal health, whereas differences in gestational age-specific mortality reflect differences in healthcare, both obstetric and neonatal." But they give no evidence for this latter conclusion. One would indeed expect that differences in healthcare could produce differences in gestational age-specific mortality, but they give no reason to think this is the only, or even primary, causative factor, and that issues like lifestyle and demographics would be irrelevant or unimportant.

They go on to say, "Thus, higher stillbirth rates at term can reflect lesser access to, or use or quality of, foetal monitoring and obstetric interventions, while higher post-neonatal mortality rates can be a consequence of adverse health behaviours (prone sleep position, unintentional injury.)"

Yes, those effects can reflect those causes. But they could also reflect other causes. For example, smoking (an adverse health behavior if there ever was one) might contribute to higher stillbirth rates, but is not an issue of foetal monitoring or obstetric intervention.

And note too that even the demographics of the mothers was markedly different. As I already mentioned, teenage pregnancies have higher infant mortality rates even within the same health care system. Mothers under 20 made up almost twice as large a fraction of the sample for the US compared to Canada (12.8% vs. 6.6%). But such differences were not controlled for, and so one cannot conclude from this paper how much such differences in demographics might have contributed to the differences in mortality rates.

 

[Beerina]

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".

Because they heave out technology that is already developed.

This argument isn't about the quality of current care (though that is also a concern.) The murderous, no, mass-murderous nature of socialized medicine is a future concern. It doesn't show up in front of the cameras, like a sob story and a howling politician promising to fix it does.

It shows up by failing to show up, so to speak. Medical tech is shared around the world. So if development is slowed, nobody notices what hasn't been developed yet. So it never enters into the discussion.


In any case, there's a scam going on with US politicians touting single-payer systems, which is to say, it's now illegal for you and a doctor to come to a private arrangement as free citizens in a free society. The meme claims this must be done to use that money to the system as a whole, but in fact its purpose is to prevent it from showing up the government's system as inferior.

There is no ethical reason to prevent people from not participating in this plan. It is simply a grotesque seizure of power.


I recall an observation by someone who was an expert on getting out of crashed planes. If someone ahead of you stops to get their bag from the overhead, push them out of they way. "For while they may own something risking their life over, I know damned sure they don't own anything worth risking my life over."

So, you all are so damned confident of the awesome-o-ness of this, you'll foolishly risk your lives over it (for reasons discussed above), I know damned sure you're not so confident as to justify risking my life over it.

So put down the guns, all of you who would outlaw them, and let people like me...and my doctor...be free. Hire them. Do not enslave them at the point of a gun.


It's interesting that you defend that position I just laid out in every other realm. But not here. But that's because it doesn't seem like a loss of freedom when you're the one behind the gun.

 

[Random]

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.

If your goal is overall quality of life for everyone (which it seems to be because of your bolding), you have to look at issues of access, not just level of care. Science can develop a magic pill that lets you live a hundred years completely free of disease or illness, but if you can’t afford it, what good is it to you?

Which is better? Everyone gets access to 1980 medicine, or half the population gets access to 2000 medicine and the rest get nothing? Which leads to better overall outcomes?

Sure you can argue that costs for cutting edge chemicals and procedures will come down eventually, but in a capitalist system the goal is to maximize profits, not optimize healthcare outcomes. If a company can make more money selling wonder drugs to a small handful of people at high prices than a large group of people at low prices, which will they chose?

 

[Ziggurat]

in a capitalist system the goal is to maximize profits, not optimize healthcare outcomes.

And in a government-run system the goal is to stay in office, not optimize healthcare outcomes.

 

[Random]

In any case, there's a scam going on with US politicians touting single-payer systems, which is to say, it's now illegal for you and a doctor to come to a private arrangement as free citizens in a free society. The meme claims this must be done to use that money to the system as a whole, but in fact its purpose is to prevent it from showing up the government's system as inferior.

There is no ethical reason to prevent people from not participating in this plan. It is simply a grotesque seizure of power.[/i]

I am not aware of anyone advocating a complete abolition of private health care. Pretty much everyone touting government run care says you would be able to get extra private coverage if you wanted it. Indeed, most of the talk seems to be that if any sort of government run system comes around this time it will be opt-in, the so-called "public option". The private healthcare lobby is opposed to any sort of public scheme as they would never be able to compete with it in delivery of basic care.

The government-care only position has little to no support and is obviously stupid, so it serves only as a strawman.

 

[Architect]

And in a government-run system the goal is to stay in office, not optimize healthcare outcomes.

I think we're still waiting for you to come with some sort of "metric" to measure healthcare regimes by. Having had a wee look on Google myself just there, I suspect you're having some problems.

In the meantime, since you mention pharma innovations in support of private healthcare, perhaps you'd care to set out the figures for such research where supported by healthcare organisations (specifically the private medical system) as opposed to US central government grants? *




* Hint: You'll not like the answer to that.

 

[Architect]

I am not aware of anyone advocating a complete abolition of private health care. Pretty much everyone touting government run care says you would be able to get extra private coverage if you wanted it. Indeed, most of the talk seems to be that if any sort of government run system comes around this time it will be opt-in, the so-called "public option". The private healthcare lobby is opposed to any sort of public scheme as they would never be able to compete with it in delivery of basic care.

The government-care only position has little to no support and is obviously stupid, so it serves only as a strawman.

Indeed - you'll find that several of us here have pointed to the fact that our countries also have private systems, it's just that few folk use 'em for anything other than elective work as......wait for it....the NHS is quicker and just as good for anything urgent, serious, or otherwise essential.

For the avoidance of doubt, however, let me state that I would be opposed to any system which sought to remove that element of choice from the consumer. If some muggins is lucky, rich, or stupid enough to pay for surgery when they could get it free on the NHS, then hat off to them.*




* For my knee I cam under the "lucky" category. 2 weeks off an NHS waiting list, whoopeee doo. Nice private room, though.

 

[Ziggurat]

I think we're still waiting for you to come with some sort of "metric" to measure healthcare regimes by.

There are lots of metrics. And I'm not going to pretend that any one metric is definitive, because that's just not the case. And many measurements of a chosen metric are performed differently in different countries, so some comparisons are meaningless. Plus there's the problem (rarely mentioned let alone addressed) that many metrics simply don't measure only the health care system, but demographic and lifestyle effects too, which differ from country to country.

But here's one comparison of 5 English-speaking countries, including the US, which looked at 21 indicators:
http://content.healthaffairs.org/cgi/reprint/23/3/89
"None of the five countries consistently scores the best or worst on all of the indicators. In addition, each country has either the best or theworst score on at least one indicator. In other words, no country scores consistently the best or worst overall."
I'd further note that the US only came out worst in two of the 21 indicators, and was the best in two. By these metrics, we seem fairly middle of the pack.

In the meantime, since you mention pharam innovations

You must have me confused with someone else.

 

[Architect]

My apologies, it was Beerina that claimed the latter point:

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.

Beerina, this particular point on medical private sector funding of healthcare has arisen before and the point was made by others - and well supported, IIRC - that in fact your government, not the private health firms, support pharma research the most. Are you going to try and prove this to be wrong?

 

[Architect]

I'd further note that the US only came out worst in two of the 21 indicators, and was the best in two. By these metrics, we seem fairly middle of the pack.

However the Commonwealth Fund, authors of that article, note elsewhere:

The U.S. health system is the most expensive in the world, but comparative analyses consistently show the United States underperforms relative to other countries on most dimensions of performance.

But heck, let's assume that really we were all within spitting distance of each other. You're still paying more than double what we pay in the UK. I mean, that's not exactly good value for money now, is it?

 

[lomiller]

I'd further note that the US only came out worst in two of the 21 indicators, and was the best in two. By these metrics, we seem fairly middle of the pack.

If the care in the US is middle of the pack, but it costs twice as much doesn’t that indicate there is a problem?

 

[Architect]

If the care in the US is middle of the pack, but it costs twice as much doesn’t that indicate there is a problem?

Not if you're the healthcare provider, sitting in your new Merc.

 

[Ziggurat]

If the care in the US is middle of the pack, but it costs twice as much doesn’t that indicate there is a problem?

Did I ever deny that we had problems with our health care system? No, I don't recall that I did. That's not actually the argument. The argument is whether the US should try to solve those problems by adopting some form of government-run health care. I don't think we should. That does not preclude any changes to our current system, nor does that position deny the existence of problems with our current system.

 

[Architect]

But what changes do you propose then?

 

[Rolfe]

Quoted in post 114, specifically aimed at Beerina.

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.

Then in post 119, just below,

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.

Skip posts you don't like, much?

And by the way, I seem to remember mentioning these guys before.

The world's largest medical research charity funding research into human and animal health.

Just a part of the contribution. So how about some evidence for that "doesn't produce as much as they would" part.

We've been over this before. Much information has been produced about how medical innovation occurs (as opposed to "sibling drugs"), and how this continues where universal healthcare is availabe to the populations. You have invariably deserted these threads without replying to these posts. Do we have to go and dredge them up again? So that you can just desert this thread too, only to reappear with the same tired, baseless assertions next time the subject comes up?

Rolfe.

 

[Ziggurat]

But what changes do you propose then?

Decouple insurance from employment. Allow out-of-state insurance companies to provide you coverage. Encourage low-cost high-deductible plans with truly flexible health savings accounts (current rules are cumbersome). Develop electronic records systems. Do a bit of tort reform. Lots of things can be done without going to a government-run system, and this is not a comprehensive list.

 

[Rolfe]

So you still want people to contribute to the common pot in proportion to their perceived risk of having to draw on that fund, rather than in proportion to their ability to pay?

Rolfe.

 

[Architect]

Decouple insurance from employment. Allow out-of-state insurance companies to provide you coverage. Encourage low-cost high-deductible plans with truly flexible health savings accounts (current rules are cumbersome). Develop electronic records systems. Do a bit of tort reform. Lots of things can be done without going to a government-run system, and this is not a comprehensive list.

Do you have examples of healthcare systems where any of these have been tried, and what were the results? And are you able to estimate the savings so arising?

 

[Ziggurat]

So you still want people to contribute to the common pot in proportion to their perceived risk of having to draw on that fund, rather than in proportion to their ability to pay?

You have conflated two different problems: the information problem and the equality problem. The former is a serious problem. The latter? Not as much as is commonly suggested.

And no, I don't want people to pay in proportion to their ability to pay. I want what people pay to have some connection to what they get in terms of service and coverage (and that includes paying for good coverage even if you end up not using it). This does not preclude the possibility of assistance to the poor (which already exists in the US system), but I am very much against the whole "from each according to his abilities, to each according to his needs" philosophy.

 

[Rolfe]

No, I have not conflated two different problems. I have introduced the other side of the same problem.

You have not answered my question. You have rejected the concept of people paying in in proportion to their abiity to pay. You have mentioned paying according to the level of benefit you would like to receive. Sounds good, but what does it mean? If you have very limited means, you decide you don't want to be covered for cancer treatment, or a heart bypass? Then what happens if you need such treatment? Assisting the "poor" is all very well, but first that gets you into a lot of expensive means testing, and the clear temptation to fraud. And second, it leaves those just above that poverty line in a very bad position if they happen to need something expensive.

How are you going to determine what each citizen contributes, in a system designed so that everyone will receive the healthcare they need, when they need it?

Rolfe.