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Some healthcare cost figures to contemplate.(68 posts)

Some healthcare cost figures to contemplate.dr hoo
Jan 12, 2004 7:09 AM
This isn't my idea or analysis, and I have not checked the numbers. The following comes from a liberal blog, and it draws (I think) on a New York Times article. So feel free to dismiss it as liberal propaganda if you want. The NYT article link, no registration needed:

http://www.nytimes.com/2004/01/09/politics/09HEAL.html?ex=1388984400&en=57c33d5966f8c621&ei=5007&partner=USERLAND

From the blog Calpundit, with the first two paragraphs being quotes from the NYT article http://www.calpundit.com/archives/002989.html

"Health spending accounts for nearly 15 percent of the nation's economy, the largest share on record, the Bush administration said on Thursday.

....Public spending on health care accounts for 45 percent of all health spending in the United States, compared with a 72 percent average in O.E.C.D. countries. But health spending has outpaced economic growth in most of those countries, putting pressure on government budgets."

---start blog comment of NYT article---

The government already pays for 45% of healthcare costs in America, which means that public healthcare spending accounts for 45% of 15% of GDP, or 6.75%.

In other western countries healthcare costs are about 10% of GDP, which means that public spending accounts for about 72% of 10%, or 7.2%. That's barely more than we spend in percentage terms and less than we spend in actual dollars per person. And by most conventional measures they deliver care that's as good or better than ours. For everyone.

Now, our higher costs are partly due to the fact that we're richer than most other countries and choose to spend more of our income on healthcare. But that's not the whole story, and these figures suggest that if we had a rational public healthcare system in the United States we could fund it for barely more than we spend now.

Think about that: it wouldn't cost much more than it does now; if it were decently designed it would almost certainly do a better job of holding down costs than the ridiculous patchwork that we have now; corporations could largely get out of the healthcare business; everyone would be covered; and judging by the experience of European systems it would deliver care about as good as we get now. Hell, maybe better if my doctor is anything to go by.

And of course private care would still be available for anyone who wanted to pay extra to get it. So what's not to like?

Yeah, yeah, I know, it's socialism. But wouldn't it be nice if we could put the scary namecalling aside and instead just work together on building a real healthcare system to replace the creaky, dysfunctional, and out of control one we have now?

--- end blog comment---

I had this forwarded to me, and I thought you people might be interested.
Couple of issues...Dwayne Barry
Jan 12, 2004 7:22 AM
I watched a show on C-SPAN within the last year with Newt Gingerich (sp ?) and his people who I think are trying to tackle the whole Healthcare problem. He argued that the very foundation of the system is flawed. That is, you can't have a service provider (healthcare) and a consumer (the sickee) and then somebody in the middle doing the choosing of service provider, negociating what the service provider gets for a service and paying (Insurance companies and the government). He basically was arguing you can't have a three pary relationship and expect it to function properly that we need to get to a two-pary relationship (provider and consumer).

Having seen a little of how this all works via working some as a physical therapist the system is really screwed up.

FWIW, one of my anatomy professors (an MD) told us that 65% of the money you will spend for healthcare in your lifetime will be spent treating the disease that kills you!
Actually, the statistics are...................Len J
Jan 12, 2004 8:06 AM
that 65% of all healthcare money spent annually, are spent during the last 6 months of a persons life.

Same idea though.

Len
That's probably the right one,Dwayne Barry
Jan 12, 2004 8:14 AM
I heard the stat about a decade ago.
It's an interesting thought,TJeanloz
Jan 12, 2004 7:49 AM
I'm not sure the analysis is entirely correct in a few of its basic premises. The American attitude toward healthcare is significantly different than it is in other OECD states, and that causes some differences.

"And by most conventional measures they deliver care that's as good or better than ours." I don't know which "conventional measures" they're using, but I don't know of a single public healthcare system that delivers the same level of care that the US system does. This is partly an attitude thing - people in the United States expect more from their health care system, and they get it. I once had the misfortune of having [minor] surgery in Australia's public health system, for which the only anesthesia was a sponge to bite on. When I told my doctor in the U.S. this, he was shocked. Now, there was nothing wrong with the no-anesthesia approach (except that it hurt, a lot), but it wouldn't fly in the U.S. medical system. People in the U.S. are not willing to degrade care to the degree that most public health systems in the world do. The quality of the outcome is probably similar - but the "quality" of care is generally quite different. And don't get me started on the French medical "system".

A social medical system in the United States cannot work until Americans change their attitudes about health. And that will probably take a long time, if it ever happens. How else could we make healthcare cheaper in the current system? We could refuse to pay for the ridiculously expensive end-of-life procedures that go on every day. Recognizing that life is not priceless is the first step.
difficult to quantifyMJ
Jan 12, 2004 8:48 AM
on the basis of personal experiences yours or mine - on a direct comparison (pre and post-natal care) my family have received much better care under the NHS in the UK and in Switzerland than under private health care in the US - it was also much cheaper in the UK

I had plenty of contact with medical professionals across Europe when I was a tour guide for North American tourists - the tourists never had any complaints about their care - France, Germany, UK or otherwise

having said that the US cancer statistics are better than in most Euro countries

having said that the US spends twice the amount of it's GDP on health care than the UK and most other Euro countries

you can put a price on life AND everyone should be able to receive medical care when it's needed - IMO that doesn't mean emergencies only

if you're poor in the US without insurance you're statistically on par with third world countries on the medical front - that's wrong when Iraq is $84b and a manned mission to Mars is on the financial agenda - after all what benefits the most people

but it's a tired and incorrect argument to conclude that the only way to get great medical care is to pay for it the way you do in the US - most of the great medical care that is on offer is for people who require extraordinary measures which as you note are questionably administered in the first place and can be considered a waste of valuable resources which drive up the costs for everyone else in the private system
difficult to quantifyTJeanloz
Jan 12, 2004 9:34 AM
I don't think the healthcare system in the U.S. is a strong point. But I don't think any other [current] model has the answer for us.

But you have to figure that the existence of the U.S. model helps support everybody else's socialized systems. Most medical research [drugs in particular] is done in the United States, and then exported to other countries for lower prices. It is no secret that our drug costs are among the highest in the world. The question is, if drug companies lost the profit potential of the United States market, would they continue to develop drugs for the world market? Same goes for other medical research. Every socialized medical system in the world benefits from the advances paid for by the American patient. Not to say other countries don't contribute to the R&D - but they don't on the same scale.

I personally lean towards a Pentagon-style procurement system for medical advances, but I doubt it will happen any time soon. The bottom line is that I don't like the status quo because I think it's great to have people without access to healthcare, I like it because I think it's the best of many bad choices.
good point re R&DMJ
Jan 12, 2004 10:06 AM
everybody does benefit from US advances - but I think there's a false assumption that in order to achieve those superb results one must commit to the US model of medicine for profit - that dead Greek guy would have been appalled

- and - while the US R&D results are undoubtedly fantastic - they don't actually benefit the most people as most people will never require extraordinary measures - most people would benefit from a concentration on ordinary medical amd healthcare issues - access to doctors, basic drugs, checkups etc.

in the UK the private system runs in parallel with the public system - it seems that a similar model could be implemented in the US

I can't believe that the benefits of advances in extraordinary measures is preferable (or cheaper, or better) than a wider access to more basic care
Why?No_sprint
Jan 12, 2004 10:12 AM
Why worry about it?

Why in the world would anyone in the US want our system to be like that in the UK? That's a new one! I suppose everything has one supporter. You own that one by yourself!
Why don't you challenge me to a fight again? - nmMJ
Jan 12, 2004 10:20 AM
He's obsessed with you. nmBottomBracketShell
Jan 12, 2004 11:56 AM
actuallyMJ
Jan 13, 2004 1:14 AM
still waiting for just one substantive (look it up) comment from our latent friend
good point re R&DTJeanloz
Jan 12, 2004 10:18 AM
A couple of points: it isn't just R&D, it's ongoing payments. The fact that Americans are willing to pay $10,000 for a particular medication subsidizes the Canadian who pays $1,000 for it. Say we're at a point where the drug company needs $10,000 in sales to pay for the drug. If Americans organize, and say "we're only paying $1,000 for this, like they do in Canada" the drug company suddenly becomes less interested in developing the drugs.

I have no issue with wide access to more basic care. I think there should be, as a public health consideration, better access to basic care. The problem is in what "basic care" is. If you're on heart attack #2, angioplasty might seem like "basic care" to you. Two aspirin a day seems like about the limit of "basic care" to me.
you're still making the assumptionMJ
Jan 12, 2004 10:25 AM
that drug companies and medicine can only achieve results with a profit motive - and again most of the advances are for extraordinary measures and treatments which benefit a small percentage of folks

it works like that now because that's the system in place - medicine for profit - the point is there must be a better way - you can't keep saying that's the way it is - the question is how should it be?
Yeah, if medicine for profit is so good, why is it that...dr hoo
Jan 12, 2004 10:39 AM
... mortality rates at for profit hosptials are higher than at not-for profit hospitals?
You know any doctors who work for free?TJeanloz
Jan 12, 2004 10:41 AM
At least, doctors in the developed world?

Like it or not, drug discovery has costs. No company is going to lose money on drug development. My preference, as mentioned above, is a Pentagon-like structure where the Government [preferentially the UN, but that would never happen] provides a grant of X billion to develop a drug, and then once it's proven and marketable, its price is the actual cost of production, not production plus amortized R&D. My preference would then be that the US (or whatever country paid for the research) license the design to any other country for some fee (obviously more for countries in Europe, less for countries in Africa). In this way, you spread the costs of drug development more evenly across the population, in much the same way as you do national defense.

You might think that our current system is better, because those who benefit from the drug pay for its R&D, rather than having all of society pay for R&D, when only a small % use it. But this isn't the case because drug discovery is so risky, those who pay for drugs are also paying for the failed R&D costs of totally unrelated drugs for unrelated ailments. That really isn't fair.

Furthermore, the Government could focus its research dollars on drugs that really make people healthier. The world doesn't need another drug to keep men aroused for two weeks when we have real medical problems, or other drugs that cure diseases that were never diseases before - like whatever that purple pill does - but this is what pharma seems to be producing lately.
sex sellsColnagoFE
Jan 12, 2004 10:51 AM
Didn't you learn that by now? Drug companies are in it for profit and getting old men laid is gonna make them a mint. Makes the stockholders happy too and free endoresements by top political figures of the time. I'm sure if a company had the cure for cancer that would make big $ too, but easier to make $ by treating upset tummies (purple pill) and giving grampa wood.
medication pricing.dr hoo
Jan 12, 2004 11:03 AM
First, I find your plan interesting. I'll have to think about it. I don't know the current amount of government support for drug development, but it is significant when you lump in the grants from NIH and other government sources. For that investment, the government gets zero return, with pharmas getting all the benefits.

Your idea of how medications get priced is wrong. Pricing is not determined by RD for the company + cost of production + some % profit.

I am saying this as someone who has done research in drug adherence. I have been in rooms with pharma execs. If I wanted to sell my soul to the "man", I would go to work with a major pharma to make adherence higher on their drug trials, to increase the chances of FDA approval. Please excuse my appeal to authority here, but you will never find the info in the next paragraph documented.

Medication pricing is based on how much the market will bear. It is unrelated to costs of development of that drug, or the entire R&D budget of the company. If 30k a year maximizes profits, that will be the price, if it is 2k a year, that will be the price. It is the simple application of econ 101 principles.

Lives don't matter, only profit. If charging $2000 instead of $1000 for a year supply drops 20% of potential patients, they will charge $2000.

I am sure the "official" way of pricing product is different. But the profit calculations that made ford keep the exploding pinto are still being used today.
That doesn't surprise me,TJeanloz
Jan 12, 2004 11:11 AM
That's obviously how most people with a patented product manage their pricing. Which is, actually, really the same as costs + profit, except that profit isn't a defined number. The problem is really that Americans are not able to say: "no thanks, that's too expensive" when it comes to their or their loved ones' health. Life is treated as priceless, and as a result, extension of life becomes very expensive. If I were running a pharmacuetical company, I'd do the same thing. In fact, I'd have a fidiciary obligation to my shareholders to do that, and it would be illegal to price any other way. Investors get big rewards from drug companies because they take big risks. IMHO, the Government should take the risk away, by being a sole source of funding, and drop the reward down to some utility-like (i.e. risk-free) level.
you've argued yourself into a cornerMJ
Jan 13, 2004 1:20 AM
hanging everything on expensive R&D which benefit statisically few people - and saying that's the way it is - again the question is - should that be the way it is? should high end medical care be run for profit? and does a for profit medical approach deliver the best quality of care to the most people?

Pentagon/UN backed medical programmes is a good idea - but it's less likely than free access to health care for everyone in the US - a few choice changes to legislation would take care of the problem - it would be probably end up cheaper due to the high costs of treating no insurance folk on an emergency basis when preventative and on-going medical care is cheaper to fund

I also keep hearing the me, me, me arguments - it's not difficult to establish that everyone is better off if everyone has access to health care AND as everyone seems to have already agreed - I'll shed no tear for large corporate medical and pharma businesses reduction in profits

nobody's asking doctors to work for free
How so?TJeanloz
Jan 13, 2004 6:45 AM
There's a fundamental question here that you and I are probably on opposite sides of: is good health a right?

I'm inclined to say that it's not. I'm also inclined to say that the for-profit model has its benefits. It's clear that a socialized system has its drawbacks.

You'll shed no tear for large corporate medical and pharma business profit reductions? What about when they decide it isn't worth it anymore, and they start closing hospitals? They stop developing drugs? Any crying then? No, the Government should force them to operate at a loss, of course.

I've said many times that I'm not opposed to a system of "basic" care for all people in the world, as a matter of public health. But my idea of basic (from which I would exclude critical care) is probably quite different than somebody else's.
So what would you consider "basic" care?dr hoo
Jan 13, 2004 8:48 AM
I'm curious.

I know years ago Oregon went to a model where they ranked treatments based on effectiveness and cost, then they drew a line every year based on the budget. Treatments above the line were paid for, below the line were excluded. Low cost (preventative) stuff was high on the list. Do you make a decision based on cost? Prevention vs. treatment? Chronic vs. acute?
You know any doctors who work for free?Duane Gran
Jan 13, 2004 5:40 AM
You might think that our current system is better, because those who benefit from the drug pay for its R&D, rather than having all of society pay for R&D, when only a small % use it. But this isn't the case because drug discovery is so risky, those who pay for drugs are also paying for the failed R&D costs of totally unrelated drugs for unrelated ailments. That really isn't fair.

I'm struggling to understand how the Pentagon-like structure is any more fair, because the tax payers foot the bill for R&D in that scenario. Drug research is expensive and somebody has to pay. Why not the people who need need and pay for drugs?
Because everybody needs and pays for drugsTJeanloz
Jan 13, 2004 6:36 AM
I'm struggling to think of somebody who hasn't benefitted from drug discovery. Even I have, and I haven't been to a doctor in years. The way the system is currently structured, somebody with, say prostate cancer, is funding the both the successful development of the cancer drug, and the failed research of, say, a parkinson's drug. That doesn't seem fair. Those who use drugs after the patents have expired (and are thus paying really only the production costs), aren't funding the research that went into developing those drugs. In a government-funded system, all drug users (everybody) would be equally sharing the risk of development of new drugs. That seems more fair to me than forcing people who happen to have an illness whose treatment is still patent protected pay for the failed research into other drugs.
Because everybody needs and pays for drugsDuane Gran
Jan 14, 2004 8:24 AM
That seems more fair to me than forcing people who happen to have an illness whose treatment is still patent protected pay for the failed research into other drugs.

Good points. I can see your point of view, but I'm concerned about the administration of such a public works program. The current private system has an effective way of motivating companies to perform well. If the drug doesn't work well, they don't make money. I fear that drug companies would shift their business model from producing effective drugs to winning grant proposals. In short, I would rather have drug companies satisfy the marketplace than to satisfy beaurocrats.

Maybe another way of putting is that I am more comfortable with the present corruption (making the sick pay for R&D) than with the potential corruption of public funding for R&D. Having done technology consulting around DC with the beltway bandits has made me a tad jaded about bidding for public works.
Good profit is 3%, pharms have averaged 20% over last 20/y128
Jan 13, 2004 7:31 AM
I should know better than to make unresearched assertions here, let's just call it opposite day.

Good point re R&D. Here is the counter argument as I understand it

I'm citing foggy memory of the 60 Minutes piece awhile back where the points were made:

-The pharms spend an inordinate amount on advertising the 'purple pill' etc, it all doesn't go back into R&D.
-The pharms have been making 20% profit for the 20 years where most goods average three.
-The drugs are not as great as advertised as evidenced by the success of generics when the patents run on the brand names. It's not like these drugs can't be made chaeper and more available.

Sure we may need to change our culture re healthcare (TJs ponit) but we also need to change our culture of profit at all costs esp re necessities. It's already managed, gov subsidised care. Call it what it is and make it more efficient.
inputs versus outcomesdr hoo
Jan 12, 2004 10:23 AM
"I don't know which "conventional measures" they're using, but I don't know of a single public healthcare system that delivers the same level of care that the US system does. "

What about life expectancy? That is a common measure of health of a population. Plenty of public/private systems do fine on this measure compared with the US system.

Level of service is an input to measure health. Health of a population is an outcome.
I agreeTJeanloz
Jan 12, 2004 10:44 AM
I agree that life expectancy is a fine statistic.

The question is really whether Americans would accept a lower standard of care, even with no detriment to quality of outcome. I think the European systems are just as good at keeping people alive - but they don't do it with the creature comforts of the American system (surgery when you want it, vs. when you need it, etc.). And would Americans be willing to give up these comforts?
by "Americans" you mean those with the ability to payColnagoFE
Jan 12, 2004 10:55 AM
God help the poor faceless rabble that can't afford decent insurance. I would be willing to accept a lower standard of care if it meant that others who can't currently afford insurance would get the same basic level of care that I get. I assume our capitalist system would still allow for private practive for those who want "premium" services or care and could afford it.
Hmm. I'm not sure,TJeanloz
Jan 12, 2004 11:04 AM
No, I don't think this has so much to do with "haves" and "have nots" as it has to do with American attitudes. When it comes to critical care - I think you're right, anybody would prefer something rather than nothing. But imagine the lawsuit in the United States if a hospital performed surgery without anesthesia - even [or maybe especially] if the procedure were free.

I think all Americans have basic expectations of the healthcare system, whether they can pay for it or not. I think somebody who couldn't pay for a costly procedure would feel like he was being unfairly discriminated against.

From another perspective, I serve meals at a homeless shelter, and there's a significant group that complains about the quality of the (admittedly basic) food. You would think that would be pretty far down the list of concerns...
homeless shelters serve too much spaghetti.dr hoo
Jan 12, 2004 11:13 AM
The patrons here really like it when my students serve dinner. They make ham. Cheap, and "real".

There is an interesting book on the homeless you might like to look at. Snow and Anderson are the authors, and they spend some time on the community table/ soup kitchen dynamic. It might give you some insight into those you see on the other side of the line.

Out of print, but you can find used versions floating around.

http://www.amazon.com/exec/obidos/tg/detail/-/0520078470/qid=1073934028/sr=1-1/ref=sr_1_1/002-7312076-8651245?v=glance&s=books
You may be right about the attitudesColnagoFE
Jan 12, 2004 11:30 AM
I think the sticking point would be mostly for experimental treatments and riskier procedures. If I get cancer I would be willing to spend what I need to (within my means) to insure I get the best care possible. That may involve untested or new procedures and treatments that are not mainstream yet. Someone without the means to pay extra would get basic care which may not be as comprehensive or effective as my treatment, but what can you do? Gotta draw the line somewhere. As you said, Doctors and drug companies need to be paid too. As it is now, a indigent person would still get basic treatment but effectively the cost of treatment would be put back onto those of us who have the ability to pay through increased premiums, taxes and such so would it really be any more expensive to just guarantee some basic level of health care in the first place?
Measured in principles, it would be very expensive.czardonic
Jan 12, 2004 1:36 PM
"Entitling" the indigent to care removes the satisfying sense of moral superiority and outrage when we dein to pay for it with OUR money.

Plus, once you socialize medicine, who know which domino will fall next?
Measured in principles, it would be very expensive.TJeanloz
Jan 12, 2004 1:47 PM
"Entitling" everybody to care removes the satisfying sense of earning enough to take care of yourself.

I'm not opposed to expanding medicaid to cover those at particular income levels (the indigent).
And what is the point of health care without . . .czardonic
Jan 12, 2004 1:51 PM
. . .that satisfaction of earning the money to pay for it yourself?
I don't know,TJeanloz
Jan 12, 2004 1:54 PM
I'm confused.
First assumption is wrongmoneyman
Jan 12, 2004 9:14 AM
"The government already pays for 45% of healthcare costs in America"

The government does not pay a nickel in healthcare. That money comes from taxpayers. It was OUR money, hence taxpayers in the US pay ALL healthcare costs.

$$
I thought that was Doug's linetorquer
Jan 12, 2004 1:41 PM
"That money comes from taxpayers. It was OUR money, hence taxpayers in the US pay ALL healthcare costs." That sounds familiar.

That money comes from the USG printing office. Therefore, before it was OUR money, it was the government's money.

Sound silly? No more so than your original formulation.
Its OUR printing office. (nm)czardonic
Jan 12, 2004 1:42 PM
re: Some healthcare cost figures to contemplate.Duane Gran
Jan 12, 2004 9:18 AM
In other western countries healthcare costs are about 10% of GDP, which means that public spending accounts for about 72% of 10%, or 7.2%. That's barely more than we spend in percentage terms and less than we spend in actual dollars per person. And by most conventional measures they deliver care that's as good or better than ours. For everyone.

Not to say that other countries don't have good health care, but I've read enough about people coming to America to avoid excessive waiting lists in socialist countries. For the United States to go down that road effectively means that we think we can do socialism better than Europe. Aside from my personal dislike of socialism, I think it won't work here.

People in America simply aren't brought up with a sense of community that reaches far enough. We can institute the program, but we can't change the fundamental attitudes of Americans. Give a free lunch and most American's will go to the table for seconds, not thinking for a moment if there is enough for others.
Comparing Health Care Systems: Just the facts, Ma'm.Dale Brigham
Jan 12, 2004 10:25 AM
While it's fun for us all to chime in with our anecdotal evidence, there are folks who compare the performance of health care systems, as evaluated by life expectancy, responsiveness, fairness in distribution and payment, and other factors, in countries around the globe. I think the results of these analyses are illuminating to our discussion.

(These data came from the U.S. Centers for Disease Control, the U.S. Central Intelligence Agency World Factbook, and the World Health Organization. I will gladly provide links to specific data sets upon request.)

The "rawest" measure of health system performance is life expectancy, and the U.S. ranks 48th out of 225 counties in that measure (Andorra is 1st; much-reviled France is 16th). Adjusted for years of disabling disease, the health-adjusted life expectancy for the U.S. ranks 24th out of 191 WHO member countries (Japan is 1st; those cheese-eating cowardly French are 16th).

Health system performance can be evaluated as a composite index made up of statistical factors related to population health, availability of services, responsiveness to needs, level of health disparity among populations, and fairness of financial contribution. In two related, but somewhat different, composite indices, the U.S. ranks 15th and 37th out of 191 countries. (Japan is 1st in one index; those Gallic surrender monkeys, the French, are 1st in the other index.)

When health care system financial efficiency is evaluated (in essence, health outcomes divided by monetary input), the U.S. ranks 72nd out of 191 countries. (Oman is 1st; those beret-wearing, Saddam-apologizing, francophoning Frenchies are 4th.)

I think the U.S. has a bit of room for improvement in our health care system.

Dale
Good post. Especially the French bashing language.dr hoo
Jan 12, 2004 10:43 AM
I do like their food and wine though.
Fear of a French Planet: Just poking fun at Francophobes. nmDale Brigham
Jan 12, 2004 10:51 AM
Watch some french new wave cinema.dr hoo
Jan 12, 2004 11:05 AM
Then get back to me.

dr. (would like to cycle through RURAL france) hoo
jump cuts give me motion sicknessColnagoFE
Jan 12, 2004 12:06 PM
ever see the remake of Godard's Breathless starring Richard Gere? pretty awful. the orginal was decent though (A Bout de Souffle?)
That's okay. I wouldn't call what you guys eat cheese anyhow.Spunout
Jan 12, 2004 11:32 AM
Yuck.
Where did the author get this notion?Live Steam
Jan 12, 2004 10:27 AM
...by most conventional measures they deliver care that's as good or better than ours.

I seem to recall a long list of Canadians seeking medical attention here in the US. There socialized medicine does not work that well, it appears. Everyone knows the US has the best healthcare money can buy.

Aside from the fact that pretty much any western nation that one can cite as being comparative in terms of lifestyle and standard of living, the US has a much larger population, with greater numbers dependant upon public assistance for everyday sustenance. There is already a tremendous burden on the system. There is also a diverse population, unlike many of the western European nations that one would use to compare to the US. We have unique problems and a much greater influx of immigrants each year. The system is stressed already. You want to compare the US with Denmark, Switzerland, Germany and GB? I don't think it can be done.
Nope. Can't be compared. We couldn't possibly do better. . .czardonic
Jan 12, 2004 11:42 AM
. . .than those other smaller, less diverse countries.

Wait, we are better. . .We couldn't possible do worse.

Wait. . . .
Not what I said, but that doesn't matter ...Live Steam
Jan 12, 2004 12:11 PM
does it?

I believe it is difficult to compare the US to other countries because of the disparity between the fundamental variables. But they don't really matter if one chooses to ignore them. For instance the French are allowed to be nationalistic, but Americans that do so are considered jackboot neocons! Ha!
Do you know what nationalism is I wonder?BottomBracketShell
Jan 12, 2004 12:14 PM
The neocons may be jackboots but they're the opposite of nationalists.
Hardbottom is back...No_sprint
Jan 12, 2004 12:20 PM
Look like someone missed their dose of haldol today.

Never before 10:30/ll:00 of course.

MPD must be a tough one to kick.
You're obsessed with me. nmBottomBracketShell
Jan 12, 2004 12:24 PM
Imitation is the deepest form of flattery. nmNo_sprint
Jan 12, 2004 12:54 PM
And so is No_sprint's <i>raison d’etre </i>. (nm)czardonic
Jan 12, 2004 12:25 PM
He's obsessed with you too.BottomBracketShell
Jan 12, 2004 12:33 PM
He's a jumble of obsessions.
I never said they were the same ....Live Steam
Jan 12, 2004 12:24 PM
however, unless you have some liberal interpretation of it, the following works for me :O)

The belief that nations will benefit from acting independently rather than collectively, emphasizing national rather than international goals.

1: love of country and willingness to sacrifice for it [syn: patriotism] 2: the conviction that the culture and interests of your nation are superior to those of any other nation
Doubt that "nationalistic fervor" was taken into account...Dale Brigham
Jan 12, 2004 12:28 PM
...in the life expectancy, health-adjusted life expectancy, health system achievement and performance, and comparative efficiency ratings. The published articles containing these ratings list the variables that went into their composite indices. I'd be happy to provide you links to the works I cited if you wish to challenge the authors' methods and findings.

I'm sure there is plenty of disagreement in this area of scholarship among experts as to the best way to evaluate health care systems. I'd welcome seeing citations of studies that come to different conclusions.

Dale
Doubt that it was. The point is ...Live Steam
Jan 12, 2004 12:44 PM
it is very difficult to compare apples and apples when you don't have that. Heck it's difficult to compare the Italians to the French to the Germans, in any respect. But, to try and compare our situation to there's is even more impossible. That is on every level too -economic, healthcare, cultural, etc ..... Number crunchers will try, but I doubt it represents the true essence of what one is really looking for.

As for nationalism, I just used that as an example for the differences in how something as understandable and innate as it is viewed and perceived by discerning eyes. It would make a neat study though :O)
No useful comparison possible, don't even bother.czardonic
Jan 12, 2004 12:55 PM
Too dificult. Never get to the real "essence" of the problem.

I'll leave it to the scholars to discuss the understandability and innateness of nationalism.
Nationalists of Note: Ho Chi Minh, DeGaulle,BottomBracketShell
Jan 12, 2004 1:18 PM
Jefferson, Lenin. At least 3 of those are very understandable and innate, Paul Wolfowitz isn't on the list.
I get your point, Steam 'ol buddy, but...Dale Brigham
Jan 12, 2004 1:37 PM
...I do think there must be at least some validity and lessons to be learned in comparing health care systems of different nations. I'm sure the scholars who do these analyses would agree with many of the points you made. These are complex systems impacted by many factors, some of which defy quantification. I'd bet the authors of the pubs I cited know plenty of deficiencies in their own evaluation models. Still, they are trying to get a handle on this mess.

That said, I humbly offer my own take on these analyses:

1) We have pretty darn good health care in the U.S. Not the world's best, but not far off. There's not a ton of difference between the top 10 countries and the U.S.'s standing in most of the life expectancy and health system rating indices. Japan, the Western European countries, and the U.S. are all at or near the top.

2) We lag behind in addressing disparity in access to health care in the U.S. (it's a CDC top priority for Healthy People 2010, by the way), but we have tremendous infrastructure and technology that partially offsets that deficiency. In other words, we need to do better in making our great health care available to everyone.

3) We pay too much for what we get, compared to other countries. We are way down (72nd) in ranking of comparative efficiency (i.e., health outcomes divided by money input). We have to do better here. This issue will become a defining part of American political life for the remainder of my years. We can barely afford the health system as we have it today in the U.S.; it will be impossible to afford it in the future with our older, fatter populace.

Give the kitties a hug for me, Steam!

Dale
Hey Dale they're almost too ...Live Steam
Jan 12, 2004 2:50 PM
big to put my arms around :O)

Yes there is room for improvement in every aspect of not only our healthcare system, but in all aspects of our society. And yes there are unquantifiable variables such as race and culture. Japan being a good example. We certainly need to look at these studies to determine rate of success, but I doubt using any one model would work here much less in any other country that it wasn't originated in.

I am of the opinion that middle of the road income earners have it the worst. If one is considered to be in the poverty level, they have access to some of the best medicine money can buy - well at least in larger metro areas they do. I doubt that would be the case in rural areas. But that is also why we find large concentrations of low income population in our cities. They are closer to services such as mass transit and social infrastructure.

There is a lot of waste and in part it's because of our incongruity. Our society has yet to consider itself homogeneous. We are not Americans in America. We are everything but. That was my reason for referencing nationalism. We could never reach the Japanese potential. They have a different ethic about everything. Waste is disgraceful to them. We, as Americans collectively never even consider waste as a source of the problem. Yes we look at it superficially, but when the nitty gritty work of cutting it out comes around, it's conveniently forgotten. We overlook it and try to figure out how we can spend our way out of it. Good money after bad. It's a selfish concept.

My training is in Architecture. I look at everything from the perspective of how something was put together and what could make it better. Our society doesn't consider that when it comes to design and construction. Just knock it down and start over is the way it's done. The designs represent that too. They are very superficial and have no concept of longevity. It's here for the moment, but next week it may be a McDonalds. Some day we may change our way of thinking, but I fear it's not any time soon.
Yes! In Japan, "waste is disgraceful".czardonic
Jan 12, 2004 3:16 PM
And back in America, poor people flock to the cities so that they can take the bus!

So few people realize these basic facts.
I get your point, Steam 'ol buddy, but...Duane Gran
Jan 13, 2004 5:54 AM
2) We lag behind in addressing disparity in access to health care in the U.S. (it's a CDC top priority for Healthy People 2010, by the way), but we have tremendous infrastructure and technology that partially offsets that deficiency. In other words, we need to do better in making our great health care available to everyone.

Why? Seriously. I'm not a heartless bastard or anything like that, but why should health care be extended to everyone? Substitute "health care" for "automobiles" or "computers" and most people would easily recognize the absurdity of the statement. Why should the hospital (and by extension the Doctor) be an indentured servant to anyone who walks through the door?
Human decency? Community spirit?czardonic
Jan 13, 2004 10:29 AM
Is access to health care comparable to owning an automobile or a computer?
Human decency? Community spirit?Duane Gran
Jan 16, 2004 10:48 AM
No, they are obviously different, but why is one person's health condition an automatic lien on the doctor and society at large? What is so unfair or unreasonable about expecting payment for services from the person who receives the service?
Sounds like the soft bigotry of low expectations to me.czardonic
Jan 12, 2004 12:32 PM
Read Dale Brigham's post. Then stand in front of a mirror and deliver your best explanation of why none of the comparisons can be valid -- even those that account for the disparities you allude to.

I think you will find the excercise useful.
That was a great line in his speech.BottomBracketShell
Jan 12, 2004 12:50 PM
Too bad we all took it wrong. We didn't realize he meant to replace it with the hard bigotry of no expectations.