single-payer system ... singled out

[martu]

No, we're not. In fact, that's precisely one of the criticisms of the current system: people at low risk often opt out of buying insurance, and so the remaining risk is not spread as widely. So you have this exactly backwards.

Do you think the US should force people into taking out insurance? If you have stated this already my apologies I must have missed it.

 

[lomiller]

ow, 80 people a year from a province of 12 million, that's really crashing the borders


The Canadian and US economies are so intertwined that people routinely cross the border in both directions for a wide variety of services, so all your example really points out is that people who need treatment in Canada get it one way or another.

There are studies that favor the US health care system, but more favor the Canadian system, as does the WHO and statistics like infant mortality and life span.

http://www.openmedicine.ca/article/view/8/1

We identified 38 studies comparing populations of patients in Canada and the United States. Studies addressed diverse problems, including cancer, coronary artery disease, chronic medical illnesses and surgical procedures. Of 10 studies that included extensive statistical adjustment and enrolled broad populations, 5 favoured Canada, 2 favoured the United States, and 3 showed equivalent or mixed results. Of 28 studies that failed one of these criteria, 9 favoured Canada, 3 favoured the United States, and 16 showed equivalent or mixed results.

 

[lomiller]

No, we're not. In fact, that's precisely one of the criticisms of the current system: people at low risk often opt out of buying insurance, and so the remaining risk is not spread as widely. So you have this exactly backwards.

People who opt out of paying insurance shift at least some of their risk to the people who do pay because they end up recieving expensve emergancy room care or go into bankrutcy, the costs of these are passed along to the people who buy insurance. it has nothing to do with spreading risk more widly and everything to do with optional insurance being vulnerable to self selection.

 

[Ziggurat]

There are studies that favor the US health care system, but more favor the Canadian system, as does the WHO and statistics like infant mortality and life span.

No. Neither infant mortality nor life expectancy are determined solely by health care systems. Demographics and lifestyle are important to both, and there are major demographic differences between Canada and the US in these regards. If you don't separate those effects out (and I have seen no sources that do), then you cannot conclude that these differences are attributable to differences in health care systems.

 

[Ziggurat]

People who opt out of paying insurance shift at least some of their risk to the people who do pay because they end up recieving expensve emergancy room care or go into bankrutcy,

Some of them do. Many of them don't end up needing medical care while they're uninsured, and a number of those who do get care can cover the costs of the care they get directly.

it has nothing to do with spreading risk more widly and everything to do with optional insurance being vulnerable to self selection.

No, it's related to both things.

 

[Eskarina]

Perhaps the system in the UK works because its been in place for 60 years. I really have no idea. But the argument that it works there so it should work here holds no water with me.

The fundaments of the current German healthcare system were layed 125 years ago by none other than Bismarck, someone who can hardly be accused of having been very sympathetic towards socialism.

http://en.wikipedia.org/wiki/Otto_von_Bismarck#Bismarck.27s_social_legislation

As Rolfe and others have pointed out, there are waiting lists for non essential treatments, but if there's anything seriously wrong then you're in straight away. One must always be careful with annecdotes but 3 Christmases ago I had an emergency admission for a suspected blood clot (it was "just" double pneumonia and pleurisy) and I was admitted 15 - yes 15 - minutes after I rang the doctor from the house. Within another 20 minutes they'd dragged the senior consultant away from his Xmas dinner and I was hooked up to more monitors than I ever want to see again. They kept me in an extra week for nothing more than monitoring, even once they'd worked out what it was (full body ultrasound scans, what fun).

Heh, sounds a lot like my first and hopefully only stay in a hospital, since I was born. Got admitted under suspicion of a very minor stroke, an MRT was done within half an hour, which confirmed the suspicion (diagnosis came within 20 minutes), immediate transport to a hospital with a stroke unit - alas, no fancy helicopter ride, under constant monitoring for 24 hours, an ultrasound scan of the carotid and the leg veins, an x-ray, a TEE (yuck), leeching enough blood of me to feed an army of vampires, 24 hour blood pressure monitoring, 24 hour ECG, EEG, medication, all in all almost 4 weeks of fully paid sick leave.

What did it cost me? A hundred Euros, 10 Euros per day in hospital, and 20 Euros for the two ambulance rides, plus the co-pay for the medication.

About two weeks later the hospital, where the MRT was done, sent me the bill. The MRT alone would have cost me around 4,000 Euros, if I had to pay for it. Which I didn't. Others did it for me at that particular moment in time. Just like I'm paying for them by going to work every day.

 

[Eskarina]

I think these programs are mostly an effort to secure votes.

And private health insurance exists, because it yields profits.

 

[Rolfe]

In my "ideal system" nobody would be coerced through force to give handouts to others. I don't have a problem with handouts per say, just the use of force to extract them. In my "ideal system" people would would be responsible for themselves. If they couldn't because of back luck, poor planning, or what have you, charities funded through voluntary donations could pick up the slack. Now, I can't say (and neither can you) whether or not charities would be enough- but we are talking about ideal here. Perhaps if people didn't feel that it was the state's job to play nanny, people would feel compelled to voluntarily help their fellow man. My system is more ethical than your''s because nobody is compelled through force give out handouts.

We hear this quite often from Americans, it's as if it's some sort of brainwashing. No, I'd be absolutely perfectly ecstatically happy to give large donations to charity to fund the healthcare of the poor. I just don't like it that I don't have the choice not to. Not that I would choose not to if I had the choice, no, of course not....

OK, fine, we believe you. Maybe. You really, really would give at least as much as you pay in tax, if the tax were not deducted? Really.

What about the people on fairly low incomes, who get by but with only a little spare every month. Do you think that they would contribute voluntarily at the rate they are being taxed at? Or might they just say, I'm quite poor, let the rich people give the money?

What about the humungously rich? Some may be like Bill Gates and set up well-funded charitable trusts. Others, though, may just drop the odd few bucks in a collecting can and reckon they've done their duty. And others may decide that it's their money and they're going to keep it, end of.

And then consider that with charity, there is a choice in what to donate to. Maybe Bill Gates thinks that malaria and AIDS in Africa are more deserving of help than people who need hip replacements in the USA - and maybe he's right, but that won't help you if you need a hip replacement. Someone else may decide they want to give their money to the opera house, or the art gallery. Or perhaps - and this one really does make a difference - the charities with the cuddliest profiles get a lot of money while the Cinderella charities get little. Fine if you're a blind person needing a guide dog (that's always a popular one), too bad if you have schizophrenia. Catholic charities will refuse to give money to any medical system that provides contraception, or any hospital that performs abortions.

It's been tried. Even when medical resources were relatively cheap, before a lot of the things that cost big bucks were even invented, charities couldn't keep up with the need. And there was the perennial problem of the cuddly charities doing relatively well and the less cuddly ones struggling. And a significant proportion of the moderately well off didn't donate nearly as much as they "should". That, as was pointed out above, is why most of the universal health services were established.

That's what I mean by freeloading. Having a good income and reasonable wealth, and just keeping it all for yourself rather than contributing to society. Leaving it up to people with consciences to pay double - you hope, if you think about it at all. That's what taxation is designed to prevent.

Yes, everyone would be ever so virtuous and clearly on the path to heaven if they gave and gave and gave again for everything from the fire brigade to the public library to the Chinese embassy, without any element of compulsion. But human nature is human nature. People won't do it.

It's completely ridiculous to say, oh, all donations should be voluntary, and if enough money isn't rasied then the needly can just crawl away and die, because I really don't like the idea that I don't have a choice not to pay.

Why do so many Americans take this attitude? It's completely beyond me.

Rolfe.

 

[lomiller]

Demographics and lifestyle are important to both, and there are major demographic differences between Canada and the US in these regards.

care to back up your claim that there are demographic differences large enough to account for the differences in lifespan?

 

[Rolfe]

I was just thinking about the position of those who decide to pay for private treatment in Britain. You can buy insurance (cheaper than in the USA), or you can just decide to pay-as-you-go.

I'm told that in the USA, the insurance companies routinely negotiate the prices they pay right down to cut-throat levels. At the same time, hospitals will charge an inflated list price to the self-payer. And one way or another, the hospitals have to cover their costs for treating the emergency cases that show up on their doorstep with no insurance and no assets.

Is this equitable? The insured suffer higher premiums in order to cover the hospitals' costs for providing the mandatory emergency service. But even there, the price is shaved. Individuals who self-pay don't have any bargaining power, and end up paying a very inflated price to compensate for hospital outgoings for treatment given to others.

In Britain, a private hospital doesn't have to treat anyone who can't pay. If I decide I want to have my cataract operated on a bit sooner by paying for it I know I'll be charged a fair price, not an inflated one to cover the hospital's losses in another area.

If I'm wrong about how this works in the USA, then I apologise, but many people have said on the forum that that's how it works.

Rolfe.

 

[Rolfe]

I don't have a problem with handouts per say, just the use of force to extract them.

Just thinking about this some more. "The use of force." What sort of language is that? You're getting as bad as Beerina, saying that in Britain we are "held at gunpoint" because we have a universal healthcare system we can all benefit from!

So, you have no problem giving the same amount of money voluntarily to medical charities, no strings attached, as you are currently paying in tax to fund social health provision. Maybe you'd give more? Great!

So what's your problem about the tax system? You're not out of pocket at all. You'd be giving the money anyway, right?

So why do you have a problem with a system designed to make sure everybody else pulls their weight too (as I said, no freeloading), so that you don't have to pay double to make up for their lack of charity?

Rolfe.

 

[Ziggurat]

care to back up your claim that there are demographic differences large enough to account for the differences in lifespan?

You're the one who made the claim that healthcare system differences created life expectancy differences, you should back it up. The burden of proof is on you, not me, because you made the claim. That there are life expectancy differences is not enough to do so.

 

[lomiller]

There is never need to explicitly refute every possible alternative explanation to a phenomenon. Rather, you show one that satisfactorily explains it and if someone wants to hypothesize an alternative it’s up to them to show that alternative is viable.


How many times have you seen discussions with tinfoil hat theorists go something like this

Science based theory is presented
Tinfoil hat crow goes “well you haven’t proven alterative X isn’t responsible”
Proof is presented X isn’t responsible
Tinfoil hat crow goes “well you haven’t proven alterative Y isn’t responsible”
Proof is presented Y isn’t responsible
Tinfoil hat crow goes “well you haven’t proven alterative Z isn’t responsible”

Unless you are dealing with a mathematics the problem is that the number of possible alternatives is infinite so the discussion can go forever with the tinfoil hat crowd saying “you haven’t proved it” . Appeals to some alternative theory therefore should require some evidence they are viable before they are considered. (I'm not suggesting you are engaging in woo, simply showing that your underlying logic has similar elements"


In this particular case I think we can agree that medical care plays a significant role in lifespan, if it doesn’t why are we discussing it at all? It isn’t nearly so clear that US and Canadian demographics differ significantly, if fact the two countries are very similar in most respects. Occams razor therefore suggests that the medical systems are the prime candidate for explaining the different lifespans, but I’m certainly open to alternative explanations if they can be demonstrated as viable.

 

[ddt]

If that's really the problem, then why not fix that first?

It's on you to fix that, not on me. Write your Congress(wo)man!

Demonstrate that it will make a difference. And if that's not possible because Congress is too beholden to the drug companies, well, why on earth would that change by going to government-run health care for everyone? That would exacerbate the problem, because drug companies would have even more reason to lobby Congress, since Congress's decisions would have even more impact on their bottom line.

This is not a reason to adopt UHC. It is, rather, a reason to insist upon fixing Medicare before trying to tackle UHC.

Why is Medicare the yardstick, and not the Veteran Administration? Sure, fix what's wrong with Medicare, but the US Govt. runs several health programs and Medicare is only one of them.

Recent data shows that Medicare costs about $6500 per person covered, most of them old or disabled. It is fully controlled and regulated by the US government.

And it is only partial coverage, albeit a significant portion of same. Large co-pays and deductions are charged, requiring additional (regulated) insurance plans.

If we extend it to cover all US citizens and foreign nationals here illegally, it would cost on the order of $2.4 trillion dollars, which is about the same that we are currently spending, including both taxpayer, insurance, and private dollars.

Reread the quotes I gave from wiki. The expected spending on drugs was $2,250 per person. That's one third of the Medicare expenditures. The Veteran Administration pays 58% less on drugs. So by just negotiating on that, you can shave off on sixth of the Medicare costs. Just one letter to Glaxo, one to Novartis, etc., saves you $400 billion.

Moreover, you forget that Medicare has lots of elderly people who, on average, cost more than the average Joe.

So, to reduce costs we would still have to ration care and close currently productive hospitals, as well as fire productive doctors, nurses, technicians, etc all of which would reduce currently provided medical services, reduce efficiency, and increase misery.

You haven't given any argument for that.

And it still wouldn't be "free" for anyone involved, even assuming every competent doctor, PA, nurse, et al. in the US would be willing to put in the same hours for less pay. (And higher taxes).

Again, I see no arguments why they'd have to work harder and get less paid. I don't hear the NHS doctors complain about their income.

In effect, the US government is able to provide cost-effective and high-quality healthcare. See this article on the Veterans Administration:

But when it comes to health care, it's a government bureaucracy that's setting the standard for maintaining best practices while reducing costs, and it's the private sector that's lagging in quality. That unexpected reality needs examining if we're to have any hope of understanding what's wrong with America's health-care system and how to fix it. It turns out that precisely because the VHA is a big, government-run system that has nearly a lifetime relationship with its patients, it has incentives for investing in quality and keeping its patients well--incentives that are lacking in for-profit medicine.

 

[Ziggurat]

There is never need to explicitly refute every possible alternative explanation to a phenomenon.

The glaringly obvious and quite likely alternatives (because demographics and lifestyle are known to affect both longevity and infant mortality) do need to be accounted for if you want to attribute different outcomes to a specific cause. For example, infant mortality rates are higher for teenage mothers. Prof. Yaffle linked to this study earlier in the thread:
http://ije.oxfordjournals.org/cgi/content/abstract/38/2/480
It compares US and Canadian infant mortality rates. The proportion of the sample of births coming from under 20 mothers was about twice as high in the US as in Canada. But the effect of this demographic difference was not separated, and the data needed to do that was not given within the paper.

How many times have you seen discussions with tinfoil hat theorists go something like this

Science based theory is presented
Tinfoil hat crow goes “well you haven’t proven alterative X isn’t responsible”

Oh please. Is this the best you can do to cover up the fact that you haven't actually presented any evidence of a causative connection?

Unless you are dealing with a mathematics the problem is that the number of possible alternatives is infinite so the discussion can go forever with the tinfoil hat crowd saying “you haven’t proved it”.

Except that we know for certain that other factors besides health care systems affect these things. This isn't speculation about factors which might or might not make any difference: it's about the fact that we KNOW these factors have an effect, and they haven't been separated out.

In this particular case I think we can agree that medical care plays a significant role in lifespan, if it doesn’t why are we discussing it at all? It isn’t nearly so clear that US and Canadian demographics differ significantly

Uh, no. A number of demographic differences are rather obvious. There are a lot more blacks and hispanics in the US, for example. A lot more recent immigrants too. I believe teenage pregnancy rates are higher as well. And lifestyle too (smoking, drinking, diet, exercise) should not be assumed to be uniform. Yes, these differences are not huge, but then, the differences in life expectancy aren't huge either.

 

[Ziggurat]

Why is Medicare the yardstick, and not the Veteran Administration?

Because Medicare is larger, but the VA isn't exactly impressively run either.

Reread the quotes I gave from wiki. The expected spending on drugs was $2,250 per person. That's one third of the Medicare expenditures. The Veteran Administration pays 58% less on drugs. So by just negotiating on that, you can shave off on sixth of the Medicare costs. Just one letter to Glaxo, one to Novartis, etc., saves you $400 billion.

If it's so easy, then there's no reason government shouldn't do that first. So I'll wait for them to actually, you know, do it before I lend my support to any expansion of the system.

Moreover, you forget that Medicare has lots of elderly people who, on average, cost more than the average Joe.

And there are many more average Joes than people over 65. Plus with the baby boomer retirement starting soon, the number of elderly is going to increase quite a bit, so if the government can't handle servicing them well, the problem will only get worse. And lastly, of course, Medicare doesn't even cover all their expenses for most beneficiaries.

In effect, the US government is able to provide cost-effective and high-quality healthcare. See this article on the Veterans Administration:

The premise of the article is that things used to be bad, but they were turned around and now care is excellent and the problems of the past have been fixed. Small problem: it's a little out of date.

 

[SezMe]

If it's so easy, then there's no reason government shouldn't do that first. So I'll wait for them to actually, you know, do it before I lend my support to any expansion of the system.

You know why Medicare can't negotiate the price of medicines. You must unless you live under a rock. The pharmaceutical industry spends gobs of money in Washington to see that such a practice is prohibited. They spend hundreds of millions of dollars to safeguard their billion dollar profits and grotesque executive pay.

 

[Rolfe]

Yes, but Balrog thinks that's a good thing because no medical research would be done otherwise. And America is subsidising the rest of the world by throwing all this money at Big Pharma.

Ignoring the fact that the money is mostly going on bribing the politicians to keep it that way, and developing "me too" drugs to extend patents and so keep raking in the profits. While government and charity-funded research does the really cutting-edge work.

Rolfe.

 

[Ziggurat]

You know why Medicare can't negotiate the price of medicines. You must unless you live under a rock. The pharmaceutical industry spends gobs of money in Washington to see that such a practice is prohibited. They spend hundreds of millions of dollars to safeguard their billion dollar profits and grotesque executive pay.

In which case, as I've already stated, we should expect that the problem will persist in any expanded government system. With even more reason to lobby Congress, why would drug companies become less influential? This is rather an argument for private insurance, where the insurers (unlike Congress) have a profit motive to lower drug costs.

 

[Ziggurat]

It's on you to fix that, not on me.

And it is likewise on me to decide what healthcare system I want to live under, not you. But you aren't shy about voicing your opinion anyways.