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Interesting article on CLark(36 posts)

Interesting article on CLarkClydeTri
Sep 17, 2003 4:46 AM
http://news.bbc.co.uk/2/hi/europe/671495.stm
Timely too. Here's one for you, note the 'polarizing the parties' issue128
Sep 17, 2003 5:19 AM
http://www.nytimes.com/2003/09/16/opinion/16BROO.html?n=Top%2fOpinion%2fEditorials%20and%20Op%2dEd%2fOp%2dEd%2fColumnists%2fDavid%20Brooks
The great Fox News/Republican strategist Dick MorrissOldEdScott
Sep 17, 2003 7:37 AM
said last night that Howard Dean was the only (serious)Democrat running who couldn't beat Bush. An interesting observation. He and his Republican friends must be worried about Dean.

I'm an 'intensity' Dumocrat, by the way. But I don't believe the country is so polarized left-right that there aren't many swing voters remaining in the middle to go after. I believe it's the MIDDLE that's jam packed with Americans, probably 80 percent of them.

We hear loud yapping from the nutty right and faint yipping from the nutty left (quieter than the right because of the right-wing media bias), but the fact is almost nobody in America agrees with the whackos. And the fact of the matter is, most Americans are liberals, when you pin 'em down on specific issues. Everyone's a conservative till real 'conservatism' rears its head. Then they do what Americans have always done, which is come down on the progressive side.

I say aim liberal 'intensity' at the center. That's where the liberals -- and the votes -- ARE.
Americans are liberals, until it comes time to pay for itTJeanloz
Sep 17, 2003 7:48 AM
When the bill arrives, everybody's a conservative. We all like liberal ideals, in theory, but when the bill arrives, we have serious buyers remorse.

Universal healthcare would be grand. But I don't want to pay for your poor decisions that lead to your poor health. At this point though, I'm having a hard time differentiating between liberal and conservative.
would universal heathcare really be more expensive?ColnagoFE
Sep 17, 2003 10:32 AM
seems that my insurance premiums keep going up and up. can the fed do any worse that these HMO clowns are doing now? maybe...but something to think about.
And poorer qualityTJeanloz
Sep 17, 2003 10:48 AM
I agree that something needs to be done about healthcare, but turning its management over to the government has hardly been a model for a successful system.

The U.S. has the best healthcare in the world. It's expensive, but it's the best. I have yet to see a nationalized system that could compete with ours.
the top vs. everyone.dr hoo
Sep 17, 2003 11:03 AM
The us health care is the best for THOSE THAT CAN AFFORD IT. Best health care for some is not the best health care *system*.

country, health spending per capita, life expectancy

USA, $2354, 76.3
Canada, $1683, 77.3
UK, $836, 76.0

all $ in us $. All numbers for 1989 (which i happened to have on my desk.)

The canadian and uk systems seem to be doing the trick for the POPULATION for far less money than the usa. If their care is so inferior, why are they living long, healthy lives?
the top vs. everyone.TJeanloz
Sep 17, 2003 11:19 AM
Canadians are living on average 1% longer. You're right that is a much longer, healthier average life. This also assumes that healthcare quality and length of life are directly correlated, without taking into account genetics, diet, obesity rates, etc.

You are right, and I don't contend that our healthcare is affordable for everybody. But I'm unconvinced that the Government could do a better job. I reiterate that I have yet to see a nationalized healthcare system provide the same quality of care that American hospitals are capable of.

My proposal, which would be shot down in a minute, would be to have a public system of basic-care hospitals that cover everybody, and a private system for those who want the best care. The problem is that everybody in the US wants the best care.
Nope, it won't be shot down becauseOldEdScott
Sep 17, 2003 11:25 AM
that's where we're headed. That's the compromise we'll eventually end up with. We liberals will accept it because we'll see it as a foot in the door. Conservatives will accept it because it protects the rich, who they love more than life itself. And as time goes on it will shake out toward the middle as it drifts slowly left, like all things in American do.
I don't know,TJeanloz
Sep 17, 2003 11:31 AM
There's a lot of controversy in Boston right now because some of our best hospitals (which are also among the best in the world) are beginning to offer "concierge" type services - a higher level of care for a ~$2,500 fee per year. People are really not happy about it.
It is and will be a hard pill to swallowOldEdScott
Sep 17, 2003 11:43 AM
and I don't doubt liberals will howl, but it's really the only available compromise. National health care WILL come to this country; but we the people are going to demand cutting edge health care too.

The end result will be a compromise along the lines of the Medicare drug benefit, which is really a dog but liberals accept as the price of getting SOMETHING into law. The old incrementalism strategy.

In the case of national health, though, the leftward drift to full and EQUAL coverage is going to be veeeeeeeeeeery slow. Basic major medical or catastrophic coverage may be all we get for a hundred years.
It is and will be a hard pill to swallowDuane Gran
Sep 17, 2003 12:00 PM
In the case of national health, though, the leftward drift to full and EQUAL coverage is going to be veeeeeeeeeeery slow. Basic major medical or catastrophic coverage may be all we get for a hundred years

If you could afford a nicer house or car, would you like to be forced to accept something less just in order to be equal? What is so great about equal coverage? In a sense the current system offers equal coverage for equal payment. Why is that bad?
ED, How come the real issue..........Len J
Sep 19, 2003 1:23 PM
around equal access to healthcare is never discussed? That is that healthcare is a limited resource, you can't afford to give every person every possible care. The tough choices, and IMO, the place where abdication of the decision leads to spiraling costs, is when is enough enough. I read somewhere that something like 60% of all health care dollars are expended in the last 60 days of a persons life. The most expensive care with the least return. I'm not suggesting that "We let them die", but I think that a more open discussion of options, and more rational choices are necessary if we are going to be able to afford basic care to all. Someone needs to make the tough choices, no one wants to.

Instead, the majority of discussions are about whether or not the Gov't should manage care. This strikes me as misdirection.

We do not have an inalienable right to any medical treatment that will extend our life, yet underlying most discussions of the rising costs is this assumption.

Len
please!dr hoo
Sep 17, 2003 12:26 PM
Yes 1% longer... FOR 30% LESS COST! Don't forget the other part of the equation. The key was not HEALTHIER but rather AS HEALTHY for less money.

What metric would you use for the quality of a health care system? I provide one: life expectancy. Crude, but it is measurable. Bad health care leads to earlier deaths.

Can you show me how the HEALTH of canadians or brits AS A GROUP suffers because of socialized medicine? What will you use? Infant mortality? Average "sick" days for workers? Hospitalization time?

Note, this is not asking for measures of SATISFACTION with health care, but objective measures of health of a population of a nation.

Face it, right now I have 1 fact. That's not much, but it is infinitely more than your zero facts.
This is interesting...TJeanloz
Sep 17, 2003 1:04 PM
It's an interesting question actually. Is health directly linked to health care? Or more telling, to health care expenditures? I'm not sure it is.

Taking me for example, I'm perfectly healthy (as far as I know), and yet, I haven't been to a doctor in several years. My health (good), and my health care expenditure ($0), don't seem to be related so there's one FACT for you to chew on.

I'm also not convinced that bad (or no) health care leads to earlier deaths. For example, would a heavy smoker with the best healthcare live longer than an otherwise healthy person with poor healthcare? I find it hard to believe that they would. I don't know what a good metric would be. But I'm pretty sure that those that deal with general "health" aren't very good indicators of the quality of the system.
you get into another important issue here...ColnagoFE
Sep 17, 2003 1:22 PM
that is preventative medicine (eastern approach) vs the usual western idea of fix it when it's broke. i think if more preventative care was available then the overall costs of healthcare might not be as bad though i have no stats to back that up. how does somewhere like japan/china compare to the US since they seem to put much more emphasis on preventative care?
I can make up an EXAMPLE to show anything.dr hoo
Sep 17, 2003 2:43 PM
There is a big difference between a single case and what happens in a population of millions. But of course you know that, right? College drop outs become billionaires, but would you want to generalize from that?

So let's take you for example, since you offer yourself up. You are healthy, great. Did you get your shots as a kid? Did you mom get prenatal care? Did you get a check up as a kid often? Did you get good information on your health and how to maintain it?

THAT kind of health care is directly related to health. How many children don't have that? How many adult health problems could have been avoided if they did? How much money would that save?

If you get an infection, do you go to the doctor? What if an uninsured person gets the same infection? Do they go pay out of pocket expenses, or do they wait until it gets so bad they go to the emergency room (and get the most expensive form of health care)?

I am certainly not claiming that money = health. In fact, the numbers I posted show that greater dollars does NOT lead to greater health... in terms of life expectancy at least.

Comparing smokers to non-smokers is not the issue. Comparing smokers in a system of socialized medicine to those in a private insurance society WOULD be a valid way of measuring the effects of the systems.

I can't believe you would actually argue that lack of health care care does NOT lead to more premature deaths. Infections, stroke, influenza and pneumonia, and a whole list of things will kill you. Many of them easily treatable with BASIC health care.

Hey, I'm all for arguing points just for the fun of it, but that's just a bit too loopy for me.
O.K., since I'm bored enough to do this,TJeanloz
Sep 17, 2003 3:09 PM
Why don't we contrast ourselves with, say, Jordan. They have no public health system, are a relatively impoverished country, and spend an average of $162 per person per year on healthcare. Yet they have a longer life expectancy than the US.

I also think you are confusing public health with health care. Things like dietary education, and perhaps even immunizations, I would not say are really healthcare. I think the Government does have a role in providing education on how to be healthy, which is currently done in the school system, and an HMO isn't responsible for it.

Note also, if you are so hung up on data, that the US actually has higher rates of measles immunization than the UK.

And before you start holding me out as an example, count me among the millions of uninsured. If I get an infection? I don't know what I'd do. I'll cross that bridge when I get there.

The bottom line is that the data doesn't support the idea that people in nationalized healthcare countries are healthier than those who are not.
you should have taken more timedr hoo
Sep 18, 2003 4:57 AM
Jordan? NOW who is using countries with LOTS of confounding variables? Culture, genetics, political structure, and even data records in Jordan are all different. How many unrecorded infant deaths happen in Jordan? A higher percentage than Canada? Probably. Canada would be the closest culturally and in terms of technology with the USA.

USA probability of not reaching 60 = 12.8%
Canada probability of not reaching 60 = 9.5%

Which country has more early deaths?

Infant mortality:
USA 6.69%/1000 live births
Canada 4.95/1000 live births
Jordan 19.61/1000 live births

Which country has worse care for infants and expectant mothers?

Yeah, jordan looks like a GREAT place!

I am not confusing public health with health care at all. You are right that they are different, but they are linked in this discussion. The question is does a private or public health care system (includes public health) matter for health? I would say that of the countries I know about, those with socialized medicine put MORE emphasis on public health than in market driven economies. And THAT leads to a healthier population.

Your example of immunizations is a good one. Do you know why we have so many kids immunized? Because THAT IS SOCIALIZED. If a child goes to school, they must have their shots. If they are poor, the school directs them to where they can get the shots for FREE. Who pays? Government... meaning taxpayers.

But their mothers probably did not get proper pre-natal care. Any idea how much that costs the system?

BTW, I would like to see your source for immunizations. A nice chart of that would be handy for some of my classes.

As for your final claim, it is not supported. I am stating that ALL OTHER THINGS EQUAL, access to health care is the critical factor. Our current system is very expensive, the most expensive in the world, and millions don't have access to that system. But countries such as Canada pay less, and seem to have just as healthy or healthier a population, due to universal access. I would say that the differences in health are due not to the financing system, but rather due to ACCESS.

If you can show me data that Americans are, as a group, healthier than Canadians, then I will be convinced. If you can show me how less access to care is BETTER, I will be convinced.

You (and I) have BARELY touched the data on this in this post, so claims that the data supports things one way or another are very premature.

BTW, if you want to argue that a pure market system would be better than socialized medicine, I can see a good case for that. But only if you want to eliminate medicare, medicaid, and all forms of government subsidies.

So do you want to pull the plug on the elderly and children?
I would be the first to pull the plug on the elderly & childrenTJeanloz
Sep 18, 2003 5:20 AM
I thought your argument was that Canada's (and the U.K.'s) healthcare was every bit as good as the U.S.'s, and cheaper too. I agree that if everybody had access to U.S. quality care, on the whole, people would probably live longer (but not necessarily be healthier).

It would be interesting to see what would happen if the US went to a socialized system. Those who currently have no care would see their care improve (because it can't get any worse than none), but those who are covered, which, coincidently are the large majority, would see the quality of their care decline. One of my concerns is that under a socialized regime we would see a precipitous drop in quality of care. I was in Australia some time ago, and had a gangrenous infection (long story), and I came very close (within hours) of dying as a result of their medical system. Granted, this is just an EXAMPLE, but it's not the direction I want to see the healthcare system go.

I'm all for government-sponsored public health initiatives - immunizations, education, basic needs. I would wholly support a government system that provided preventive medicine. But I'm not really convinced they would do a good job running the ER.

If you wanted to compare quality of system, you should be comparing the health of those in the US with access to healthcare vs. those elsewhere with healthcare.
I can argue it either way.dr hoo
Sep 18, 2003 7:53 AM
I think the case can be made that Canada is just as good as the usa in terms of its effectiveness for the entire population, and at lower cost. Still, the access argument is the easier one to make. That is because the 40 million americans without insurance bring our average down.

BTW, I don't think EVERYONE with insurance currently would see a decline in care. Many are now in HMOs, and they are basically facing a rationing situation. I would think that they would generally stay about where they are. It might mean slightly lower care for people in traditional fee-for-service plans (eg, blue cross). But then those that can afford blue cross/blue shield are far more likely to be able to afford private care in a socialized system, so not ALL of them will suffer a decline.

We have not even gotten into the economic impact. Lower health care costs. The ability for small businesses to have insured workers. Money savings from the elimination of those who currently burden the system in emergency rooms, since they can get care less expensively. The list goes on.

I've heard horror stories about Australia. I hear many horror stories about the US as well.

Quality of care is a good way to compare, but it ignores those that do not get care. Selection bias rears its head. You get no argument from me that those in the USA who have good insurance get the best care in the world, though other countries have very high quality care. When you are comparing countries where EVERYONE gets care, you have a population where the poorest are included. The USA data would then be biased, as lower class people are eliminated from the study.

But that is the problem with our system. Not the care once you are in, but that many never get in.
you work for free and you have NO health insurance?ColnagoFE
Sep 18, 2003 7:12 AM
You'd think that investment firm would at least be able to pop for health insurance for you. And if not you'd at least have a minimal plan to protect your assets in case you got a long term illness. Or are you saying you self-insure?
Yep...TJeanloz
Sep 18, 2003 7:31 AM
My working theory is that if something is so wrong with me that I can't afford to fix it, I'd prefer to let it kill me.

The really expensive treatments are basically for cancers, etc. If I have cancer, I ain't going to be one of those brave survivors.
I'd make sure you have a living will thenColnagoFE
Sep 18, 2003 8:03 AM
It sometimes isn't that easy to pull the plug in the US these days and some of those cancers and such can go on for a long time before they finally kill you.
Got it covered (nm)TJeanloz
Sep 18, 2003 8:27 AM
It's already kind of like that nowColnagoFE
Sep 17, 2003 12:55 PM
I mean you have your basic health insurance (assuming you have insurance) that will cover you to see your local doctors and any specialists as required. It won't (in most cases) allow you to pick the leading specialist at Johns Hopkins or the Mayo Clinic as an option, but if you have the cash you can choose to go there and pay whatever is not covered.
the top vs. everyone.Duane Gran
Sep 17, 2003 11:57 AM
The canadian and uk systems seem to be doing the trick for the POPULATION for far less money than the usa. If their care is so inferior, why are they living long, healthy lives?

If their system is so good, why do they come to the United States for medical care? From the first hand accounts I've heard, they don't want to be on a 2 year waiting list for routine procedures.

What is it about health care that makes it any different than any other service? If I can't pay for service on my car I don't consider it the duty of other people to pay for my car upkeep. This may seem cold, but I don't see why healthcare is so different. (fyi... I have lived with and without health care coverage)
the top vs. everyone.dr hoo
Sep 17, 2003 12:39 PM
"If their system is so good, why do they come to the United States for medical care? From the first hand accounts I've heard, they don't want to be on a 2 year waiting list for routine procedures. "

Do you know how many procedures are unnecessary? Do you have any idea how many unnecessary or incorrect procedures are done in the usa every year, and the price tag for them? Is waiting for something you don't NEED right away all that bad?

Face it, you break an arm in Canada, you have it set right away, no delay. Acute conditions and preventative care are there. Less crucial care takes more time. That is the trade off for the system.

Why do they come here? Same reason Saudis and South Africans do: to BUY the best care. But that is a small number of people, with most Canadians unable to use the resources to travel.

Whose health care system is better for workers at McDonalds? Or Wal-Mart? Or any of the jobs without health insurance in the USA?

What makes health care different from a car? Would you deny a 6 year old treatment because he could not pay for it? Why is it anyone's duty to pay for that? If the kid, or his family, can't pay... let him die.

Fine with me. If you want to make society a radical anarcho-capitalist thing, I'm with you all the way. I'll do fine in that system, just like our current one.

However, we already have socialized medicine for many (elderly, poor, government workers). The logic of a single payer plan is less cost. Data shows less cost with similar levels of health. Considering that the cost of health care premiums in the USA went up 13.9% last year, and have gone up faster than inflation for 20 years, something needs to be done to make health care available to people at a price that they can afford.
the top vs. everyone.Duane Gran
Sep 17, 2003 3:32 PM
Would you deny a 6 year old treatment because he could not pay for it? Why is it anyone's duty to pay for that? If the kid, or his family, can't pay... let him die. Fine with me. If you want to make society a radical anarcho-capitalist thing, I'm with you all the way. I'll do fine in that system, just like our current one.

The current system is fair, but then I view health care as a service, not a fundamental right. Neither the capitalist or socialist approach is anarchy, they just differ about whether health care is a service or a right. Personally I think it degrades the profession of medicine to in effect make a doctor beholden to anyone who has a need for medical care. I don't see anything wrong with a doctor operating his or her service like a business.

However, we already have socialized medicine for many (elderly, poor, government workers). The logic of a single payer plan is less cost. Data shows less cost with similar levels of health. Considering that the cost of health care premiums in the USA went up 13.9% last year, and have gone up faster than inflation for 20 years, something needs to be done to make health care available to people at a price that they can afford.

Just because we have started down the slippery slope doesn't mean we have to fall face first into error. I'll grant that partial socialism is less effective than socializing the whole medical system, but I would contend that we shouldn't have socialized medical care in the first place.

This is all academic though... OldEd hit the nail on the head. We will have socialized medical care, it will just take time to happen. I hope it will be better than I suspect. At least I hope there will be a country I can travel to for medical care.
I bring up the 6 year old because...dr hoo
Sep 18, 2003 5:03 AM
... it can't be their fault they don't have health care. I am all for responsibility for one's own actions. I also believe that people should be given a chance to succeed in society. For example, I am FOR public education, because that makes for a better society.

Now, if you wanted to socialize medicine for anyone under 18, then thow them out to get what they can pay for, I'll go with that. At least that would stop all the high bills for end of life care that the elderly are racking up. Can't they just go out on an iceflow or something?
Funnily enough...Charlie Amerique
Sep 17, 2003 3:34 PM
... I recently had some elective surgery done up here (in Canada.. Quebec to be precise) and what do you know? The waiting room was filled with people from... the United States!! Why? Because the clinic I was in has THE BEST REPUTATION for this surgery in the world.. oui, le monde!

As for the rest of Canada's health care system, I see a whole hell of a lot of ignorance in this discussion. The health care system here is already a two (or I should say multi-) fold system:
Basic health care for everyone. You get it when you can be scheduled for it.
Enhanced health care: Subsidized by your employer or paid for out of pocket. Deleivers additional elective or non-critical care (chiropractor, acupuncture, nutritionalist, etc.).
Private care: Paid for out of your pocket: Just like in the States.. you pay a private health care provider for care.

The big difference I see here: Cradle to grave care... and I really mean that. Hospitals for people who cannot be cared for by anyone because they need 24 hour a day service, Half-way homes for those who need some support. The nicest veteran's hospital I've ever seen.
Perfect? Hell no! Better than my old HMO? Not really. Better than Aetna? Oh HELL YES!!

The belief than the U.S. will be able to handle another entitlement program is at best a dream... but this would be a good one.
agree...you get what you pay for...but it is very expensive (nm)ColnagoFE
Sep 17, 2003 12:51 PM
It's more like 50%-60% in the middle around here...PdxMark
Sep 17, 2003 9:17 AM
with 20%-25% firmly planted at each end of the spectrum. You can see that 20-25% number in lots of our statewide elections... particularly ballot measures. Even the wackiest right- or left-wing idea gets about 20-25%.
He needs a running mate named Lewis...nmmohair_chair
Sep 17, 2003 7:56 AM
Jamal? nm128
Sep 17, 2003 8:05 AM
Or Bob Barr. WhichOldEdScott
Sep 17, 2003 8:08 AM
isn't as weird as it sounds, now that he's taking a firebrand liberal position on Bush-Ashcroft's New Alien and Sedition Acts.