Socialised health care: Why is it scary?

[rustypouch]

As happens in the UK, albeit that there's no "opt out" for the public option (nor does there appear to be any demand for it).

Indeed.

I know of many people in the private system who want UHC, but I cannot think of anyone in a UHC system who wants things fully privatized.

I wonder why that is?

 

[Malcolm Kirkpatrick]

You do realise that you're arguing against a system (UHC) that's been shown to provide comparable (at least) results for a per capita cost less than the one you're advocating (For profit healthcare)?

Depends on what care is measured. Neither access to diagnostic machinery nor the quality of post-diagnosis treatment compare. Here.

Rationing : “Everything is Free but Nothing is Readily Available” (Frogue et al, 2001) Like other nations experiencing limitless demand, an ageing population and the costly advance of medical technology, Canada has faced pressure to control health expenditure. It has done so through explicit rationing.

Set up in 1989, the Canadian Co-ordinating Office for Health Technology Assessment is the Canadian predecessor to our NICE, charged with exactly the same brief and, it seems, carrying out its function in the same way. For example, in the case of new cancer treatment, the latest pharmaceuticals (such as visudyne for macular degeneration), and high-tech diagnostic tests, Canadian governments simply reduce their expenses by limiting the service. Such a method of rationing is only possible in a single-payer monopoly. Medicare also shares other defining characteristics of monopolies: limited information, little transparency and poor accountability.

Canada has faced increased pressure to reform hospital structures to accommodate the changing pattern of care from an institutional to a community-based model. Reforms have attempted to limit growth and manage the system more effectively. Provinces have proven their ability to manage cost control by the use of their monopsonistic power associated with the single payer structure (WHO, 1996). Hospitals are paid through the imposition of annual global budgets by provincial governments. The downside of this cost controlling efficiency is evident by the problem of waiting lists and dilapidated technology and equipment.

Here

The evidence on how the United States compares to other developed countries in terms of the quality of its preventive care is quite mixed. In a report that summarized survey research comparing quality of care in five countries, Davis et al. concluded that the United States had relatively high-quality preventive care. 85 percent of American women reported having had a Pap smear within the last two years and 84 percent of American women age 50 to 64 reported having received a mammogram within the last two years, the highest shares among the countries included in the survey.
Perhaps reflecting differences in data sources, the OECD15 found that the United States had above average average mammography rates (61 percent U.S. versus 55 percent OECD), although was far below the best performers (82-98 percent in four countries). However, the United States had the highest cervical cancer screening rate (83 percent) among 22 ountries reporting data to OECD. Among 30 OECD countries, the United States had above-average rates of flu vaccination for senior citizens (65 percent U.S. versus 55 percent OECD average and 80 percent in top-performing Australia). However, childhood vaccination rates were below the OECD average.16 The U.S. pertussis vaccination rate stood at 86 percent in 2005; only Austria and Canada reported lower rates. Even with a 92 ercent childhood measles vaccination, the United States came in below verage in a field where one-third of OECD countries have rates above 95percent.

Edited by LashL: 

Snipped for compliance with Rule 4.

 

[3point14]

Depends on what care is measured. Neither access to diagnostic machinery nor the quality of post-diagnosis treatment compare. Here.
Here

Ah, I see.

Well, I'm not going to have that argument with you. There are many, many threads that have covered that and (to my mind, at least) the outcomes seem to be broadly similar, with (again, to my mind) the slight advantage lying with the UHC side.

If you want to argue about outcomes, this is not the place. For the purposes of this argument, I will concede that results are broadly similar. If you can't make the same concession, then the debate is going to have to stop here.

 

[rustypouch]

Ah, I see.

Well, I'm not going to have that argument with you. There are many, many threads that have covered that and (to my mind, at least) the outcomes seem to be broadly similar, with (again, to my mind) the slight advantage lying with the UHC side.

If you want to argue about outcomes, this is not the place. For the purposes of this argument, I will concede that results are broadly similar. If you can't make the same concession, then the debate is going to have to stop here.

Exactly. The outcomes are very close, it depends on what the issue is as to who has a slight advantage.

But Americans pay almost twice as much as Canadians for health care. Plus we don't have to deal with all the paperwork, or have to worry about bankruptcy if we get sick or in an accident. Oh, and the system up here covers everyone.

 

[L.Y.S.]

Exactly. The outcomes are very close, it depends on what the issue is as to who has a slight advantage.

But Americans pay almost twice as much as Canadians for health care. Plus we don't have to deal with all the paperwork, or have to worry about bankruptcy if we get sick or in an accident. Oh, and the system up here covers everyone.

The best system I've seen by far is the one they have in Taiwan. Not that we'd ever get it like that over here, but they have a great system.

 

[Darth Rotor]

OPen Ended Entitlement that Will Only Grow.

That is what makes it scary, under the present state of organization/disorganization of the system writ large.

 

[L.Y.S.]

OPen Ended Entitlement that Will Only Grow.

That is what makes it scary, under the present state of organization/disorganization of the system writ large.

Has this proved true for Europe, Australia, or Japan? Or is this a statement about the fragile moral character of Americans?

 

[ponderingturtle]

OPen Ended Entitlement that Will Only Grow.

That is what makes it scary, under the present state of organization/disorganization of the system writ large.

So when will we start fighting the gray menace? We need to do declare war on the baby boomers.

 

[Corsair 115]

OPen Ended Entitlement that Will Only Grow.

So, kind of like the Department of Defense then?

 

[Malcolm Kirkpatrick]

So, kind of like the Department of Defense then?

Not according to this. See chart #32 (the third or fourth one down. 32 is the OMB number). According to this table, Defense accounted for about 50% of total Federal outlays in 1960 (about 9 % of GDP) and 20% of Federal outlays in 2010 (4.8% of GDP). According to this table, transfer payments to individuals (Social Security, Medicare, etc.) went from $566 billiion in 1990 to $2,076 billion in 2009. Medical payments went from $188 billion to $892 billion. It looks like these last figures (transfer payments) are unadjusted dollars.

 

[Sawbones79]

I believe the fear is that many people equate UHC and their local underfunded Urban Free Clinic... Long waits, crowds, overworked staff, etc.

While Medicare has it's issues, it would be a pretty good start. People are already able to pay for additions, which leaves free market in the mix.

UHC doesn't need to be achieved in one fell swoop. Right now, with the current employment issues, it would make sense to put anyone receiving Unemployment into the Medicare system. That alone would probably take a big chunk out of the number of uninsured folks.

So many good posts to ponder, but this caught my eye, 'cause there is a point here. The hospitals I've worked in DO have an eastern bloc feeling about them, with old buildings, ER waiting rooms freely mixing loud addicts with crying kids and confused senior citizens and, of course, waiting.
I can totally understand why anyone with the ability to pay for private care would wish to do so, and also why private health consumers would fear to be thrown down amongst the unwashed masses, to put it bluntly.

 

[Malcolm Kirkpatrick]

Exactly. The outcomes are very close, it depends on what the issue is as to who has a slight advantage.

Dunno 'bout "slight". I would like to see actual numbers which compare post-diagnosis survival rates, for different conditions, from different countries, before I will believe "slight".

 

[This is The End]

NICE is funded by but independent of the government and mostly made up of medically qualified peopleand people who have run health boards etc. IE not politicians.

I don't like to post off topic but I can't help but be tickled from this discussion of the NICE in the UK.

One of my favorite books is C.S. Lewis's That Hideous Strength

The story involves the allegedly scientific institute, the N.I.C.E., which is a front for sinister supernatural forces.

Written in the UK in the 40s, and set in the UK. I wonder how long the real NICE has been known by those initials .

 

[3point14]

Dunno 'bout "slight". I would like to see actual numbers which compare post-diagnosis survival rates, for different conditions, from different countries, before I will believe "slight".

Are you prepared to concede, for the purposes of this discussion, that results are broadly similar?

As I say, the discussion you now want to have is one about comparative results, and I don't think that's this discussion.

I can understand you wanting to shift the basis of the discussion as your initial gambit was financial and based entirely on theory that seems to be contrary to the way things have been actually demonstrated to work, but it's a bit disingenuous, don't you think?

 

[Darat]

OPen Ended Entitlement that Will Only Grow.

That is what makes it scary, under the present state of organization/disorganization of the system writ large.

In the UK we could almost double the cost per head of our NHSs and still only reach the current level of the USA per head cost. (And of course the USA per head cost is an under estimation since there are millions in the USA with no non-emergency healthcare treatment.)

 

[Darat]

So many good posts to ponder, but this caught my eye, 'cause there is a point here. The hospitals I've worked in DO have an eastern bloc feeling about them, with old buildings, ER waiting rooms freely mixing loud addicts with crying kids and confused senior citizens and, of course, waiting.
I can totally understand why anyone with the ability to pay for private care would wish to do so, and also why private health consumers would fear to be thrown down amongst the unwashed masses, to put it bluntly.

I would have thought from what has been said by the USA folks in many of these threads that their A&E departments are much worse for the " ER waiting rooms freely mixing loud addicts with crying kids and confused senior citizens and, of course, waiting." given that A&E treatment is the only guaranteed treatment when needed for many USA folk.

Also what you describe otherwise is pretty much what it was like in the NHS in 1997, thankfully the next three governments started to again properly resource the NHS and it is pretty much a thing of the past. Whether it will remain so - the indicators are not positive.

 

[Malcolm Kirkpatrick]

Are you prepared to concede, for the purposes of this discussion, that results are broadly similar?

No. I don't know. I expect that performance varies widely, depending on the feature under consideration.

As I say, the discussion you now want to have is one about comparative results, and I don't think that's this discussion.

A comparative cost/benefit calculation must include benefits as well as costs.

I can understand you wanting to shift the basis of the discussion as your initial gambit was financial and based entirely on theory that seems to be contrary to the way things have been actually demonstrated to work...

I don't see much "demonstration" in this thread. Neutral readers may assess the accuracy of "your initial gambit was financial and based entirely on theory that seems to be contrary to the way things have been actually demonstrated to work". Here's my original post to this thread:...

Here.

...,but it's a bit disingenuous, don't you think?

I think that "disingenuous" is the gone-to-college way to call someone "liar",

 

[3point14]

No.

Then you want to have a discussion I don't.

 

[Darth Rotor]

So, kind of like the Department of Defense then?

False.

The difference politically is non trivial.

You can declare less risk, hand wave away risk, take more risk, or reason away risk, which is what defense spending is, a policy risk mitigation tool, and do as we did in the late 80's and the 90's: cut the defense estab about 40%.

You CAN'T do that at litically with healthcare. I say again, to be sure you understand, that if the costs get too high, you can't do as you could with defense spending, and just claim "we find less risk so we will cut 40%."

So, when you tell me you you will fund the program, and then make the political case to allocate the resources there, you will have a viable program.

That hasn't been done, and part of that reason is that it is politically difficult to do so. Hard work.

So, health care was delegated to private sector/industry for about two generations via activism and hard nosed work by unions. (From end of WW II to roughly now, except industry started drying up in the 80's.)

It was done on an actuarial basis.

So far, no plan that is fundable with open ended care options has been presented.

When one is, I'll be interested to see it.

For Darat: change costs money. Nobody on this side of the pond is happy with the cost of care and drugs.

That doesn't make your idea of hand waving in a system not built from the ground up as your is remotely practical.

Cost containment and care are Two Different elements of the problem.

I am done here, you all feel free to keep playing.

 

[Corsair 115]

False.

My post was not intended as a factual statement. (I thought that obvious as indicated by the use of a smiley but perhaps it wasn't.)

It was more a satirical poke at the fact that spending on social programs raise the ire of some conservatives ideologues, but defense spending hardly ever seems to get questioned. Cut welfare, cut social security, but cut defense? Unacceptable!