In discussing health care, one often hears about how low America ranks on the WHO survey--37th in the world! This is true. But there are a couple of problems with it.
First of all, that survey is getting a little elderly; it hails from 2000. In the normal course of economics writing, that's pretty dated; my editors at The Economist would never have let me discuss health systems using a ranking that outdated. In general, an economics writer has to have a pretty darn good reason for using data more than a couple of years old.
Also, as John Stossel notes, many of the measures it uses, such as life expectancy, may be exogenous to the health system:
The WHO judged a country's quality of health on life expectancy. But that's a lousy measure of a health-care system. Many things that cause premature death have nothing do with medical care. We have far more fatal transportation accidents than other countries. That's not a health-care problem.Similarly, our homicide rate is 10 times higher than in the U.K., eight times higher than in France, and five times greater than in Canada.
When you adjust for these "fatal injury" rates, U.S. life expectancy is actually higher than in nearly every other industrialized nation.
Now a liberal might argue that crime and auto accidents could be resolved by other items on the progressive agenda. I disagree (for starters, from what I understand, America's higher homicide rate long predates the emergence of the European welfare states), but that's a legitimate argument in favour of a broader progressive platform. However, it undercuts the belief that single payer is going to magically improve things.
Other indicators seem almost cherry-picked to make America drop down on the rankings. Equality of distribution, for example, is heavily weighted; so heavily weighted that quality of basic care suffers in comparison. That's why places like Morocco, the Dominican Republic, and Costa Rica clean our clocks.
Now, personally, I don't really care about equality of distribution per se. I don't care if Bill Gates gets super-awesome treatment; what I want to know is, are people suffering and dying from lack of care?
Obviously, those things are linked, and it's not unreasonable that an egalitarian would put that on their list of criteria. But one would hope that the WHO rankings would reflect, to a first approximation, where you'd rather get sick. Does anyone really think that they'd rather be the average consumer of health care in Colombia, than in Columbus, Ohio?
But what about the worst off, you might say? What about them? The WHO table isn't even a good ranking of where I'd prefer to be poor. I'd far rather be an uninsured day laborer in San Francisco, than in the Dominican Republic. For that matter, I'd rather be uninsured anywhere in the United States than an average citizen in Costa Rica.
This is a problem for those touting our low ranking. I can't say I know what our ranking should be; a lot depends on value judgements that it would be hard to gather consensus for. But whatever our true ranking is, I'm pretty sure we're not behind a significant chunk of Latin America. You don't see a lot of uninsured illegal immigrants trying to get home for the awesome health coverage.
If you actually read that WHO report,it seems to be more a ranking of which country has the best socialized healthcare system rather than which country has the best healthcare period. Most of the categories have nothing to do with healthcare; they are more focused on fairness and distribution. In the one category which measures satisfaction with actual healthcare received(I think they call it "responsiveness") the US is #1. As Megan mentioned life expectancy is not a good indicator of healthcare effectiveness, it is influenced more by lifestyle choices than healthcare.
You know, I'd go into why your argument is offensively ironic, but it would be a greater gift if you just stopped embarrassing yourself.
I apologize for whoever posted the previous ridiculous comment. Thanks for citing some of the obvious holes in the WHO study, I appreciate knowing for sure that the study is completely misleading.
As a costarican, i have to say i'd rather be insured in my country wich (not too bad) may be bureucratic, but for the rest i am getting the health care a person just like me is ABSOLUTELLY lacking in your country. so to say.
So, I can tell you've got exactly zero experience with public health services in Costa Rica or the Dominican Republic. You simply have no idea what you're talking about.
Further, you speculating about where you rather be poor is one of those moments you might return to in the future and find particularly embarrassing, assuming you ever develop the kind of self awareness that keeps other people from making absolute fools of themselves in public.
But, ok, given that every objection you've expressed to the WHO study is true, would adjusting those move the U.S. to the top of the list? Near the top? Near enough to justify spending far more than anyone else for inferior care? Because, you know, that's the main point the WHO study is used to establish - not that just we receive inferior care, but that what we pay is completely unjustified given the poor level of care we receive.
A piece like this that doesn't even mention our place in the infant mortality rankings doesn't deserve much comment. Or is that also explained away by transportation accidents and homicide rates?
Megan is right. The WHO rankings are fatally flawed (and out of date)--and are essentially rigged to favor socialist systems. But the WHO recognized some of the American system's great strengths. To quote one astute observer:
The American system certainly has its failings, but a rational observer will concede that it is in some crucial respects the best in the world.
Oh - and John Stossel? Who will you be citing next - Bill O'Reilly? Stossel is a massive tool.
It seems worthwhile to address the oft-cited infant mortality statistics. Presumably the United States has a higher rate of infant mortality becuase some poor pregnant women are not getting adequate care (or are not taking adequte care of themselves). A targeted subsidy for these women would take care of the problem. There is no need to nationalize the whole health care industry.
Seriously, I'm drunk, and I don't want to be too hard on you. But John Stossel?
I'd far rather be an uninsured day laborer in San Francisco, than in the Dominican Republic. For that matter, I'd rather be uninsured anywhere in the United States than an average citizen in Costa Rica.
Please consider being an uninsured day laborer.
What do you say to experts when you have more than 50 million uninsured citizen? Do you expect them to put you on top of the list? Morocco, as modest a country as it is, has universal coverage. My experience with the health care system in the USA has been awfully bad. You make an appointment with your Dr. and you have to wait between 20 to 45 mins before you can hear your name. What's the point of making an appointment? I took my baby to a pediatrician and I was made to wait 45 minutes in a small room that they closed us in. After 30 minutes I opened the door and let my baby run with his diaper--as he was naked--to attract the attention of the staff; no one seems to care. Mind you I have a very good insurance policy. On another occasion, the administrative staff were discussing in front of me whether the shots the baby got were the right ones or not? And one thing that bothers me more than anything else is why the needle has to go straight into the skin when it can be injected obliquely like in the rest of Europe? Why is the blood taken from a vein on the right hand when it should be taken from a vein on the left hand, the left hand being closer to the heart? Etc Etc. No offense! We can't just assume we are the best, because hoards of immigrants from Latin America are lining up on the Southern border? Or that we have the best technology? No we don't anymore! We need to look ourselves in the mirror and think.
I disagree (for starters, from what I understand, America's higher homicide rate long predates the emergence of the European welfare states),
Ok, ok, ok. I come to you and your dear supporters in the spirit of compromise and a desire for detente. But can anyone please-- please-- describe for me precisely how this sentence does anything whatsoever to disprove the claim that came before it? Throw me a bone.
Also, who is claiming that single-payer is going to magically fix every problem in our health care system? That is a very flimsy straw man. Please, show me I'm wrong. Point me in the direction of a single rational figure from whatever political spectrum who thinks that switching to single-payer is going to magically solve all our problems. That is precisely the kind of freshmen-civics-class-essay snark and muddled thinking that has provoked hostility to you.
Most importantly, though... where is the evidence to defend the claim that it's better to be poor in America than in countries with universal health care? I'm looking high and low. I mean, you and your pet commenters seem to think that that notion is just self-evidently true. Well, sorry. I don't agree, and it's gonna take more than argument through assertion. How about that day laborer in San Francisco? If he's like many impoverished people with no coverage, he doesn't go to the emergency room (because that's where he'll go) with an ailment, until it either a)kills him or b)is so advanced that it costs many thousands of times more to treat him. That's your grand American system? Please, describe for me the mechanism through which you think the 47 million people in this country should go about obtaining health care. Please. Devote as many words as you want, but tell me what you think someone with no insurance and no money should do. Are your positions on health care really dependent on this utter trivializing of the difficulty involved for those with no coverage?
The American system certainly has its failings, but a rational observer will concede that it is in some crucial respects the best in the world.
It gets tiring to keep saying this. But just saying it doesn't make it so. There are plenty of rational observers who don't concede anything of the kind, and they--as rational agents are wont to do-- usually require evidence to support claims like this.
A piece like this that doesn't even mention our place in the infant mortality rankings doesn't deserve much comment. Or is that also explained away by transportation accidents and homicide rates?
The infant mortality is due to different measurement criteria.
In the US, pretty much any baby that comes out with a pulse is counted as a live birth. Doesn't even have to be breathing, doesn't matter if it weighs 2 lbs, it is a live birth.
Most other countries have much stricter criteria, eg the baby that lives less than 24 hours is counted as a stillbirth, likewise extremely premature babies and extremely small babies.
"I'd rather be uninsured anywhere in the United States than an average citizen in Costa Rica."
Wow, that's just ignorant. Clearly you know little of Costa Rica, so why make this?
Hmm, I read the comments and see all sorts piling on when it comes to a statement like, Costa Rica!!? You know nothing about costarica!
One person claims to be from there, and the others claim no special knowledge whatsoever. Of course you do have a couple that seem to claim to know everything about everything, as you look through the threads.
Being married to a person of Latin heritage (South American), has given me some very specific knowledge about a relatively small segment of their society, i.e., the middle and upper class. (I can hear the boos and hisses from the Bolsheviks)
In one case, one of the ultra rich of the world is a citizen of a European country, who has a house in that country and lives there, pretty much year round (England). He always comes to the USA to get his health care, even though he can stay in England (or go anywhere else in the world, for that matter), but chooses the USA because he realizes that we do have the best medical care system in the world. Having cancer tends to give you focus in life, too.
From Brazil, there are a number of middle class people who have all come to the USA (Johns Hopkins, Mayo Clinic, Scripps hospirals, etc.) for anything more than a wellness checkup. The slightest problem and they are on a plane to the US to get it fixed.
Tut-tut all you want, give Megan the bum's rush, whatever, but you folks that have a tendency to spit venom instead of rationally discussing issues, well, I'm beginning to get the idea you just don't like anyone who doesn't have an exact replica of your thoughts carved into their grey matter.
Sweetie, I just hope for your sake you never have to be uninsured, or even try to get individual insurance, or for that matter, come down with some condition your insurance company doesn't want to pay for.
And what the holy heck are you doing comparing the US with Colombia? Do you really think that the richest nation in the world should aspire only to be a bit better in health care than poor countries?
Would you rather be uninsured in the US or under the German healthcare plan?
If you say you'd rather be uninsured in the US, either you're lying or you have no idea what it's like to be uninsured. Of course people are dying because they don't have insurance. It happens all the time. I know someone who needs a lung transplant and will probably die without it, and she is uninsured because she's "uninsurable", that is, she had the temerity to get sick, thus meaning no insurance company will touch her now.
I know a woman whose husband got laid off and then got cancer. The surgeon donated his time, but the hospital wouldn't donate-- allowed one operation, then started suing this fella and wouldn't allow him to be treated there. He died. His widow lost her house, all their savings, everything. She's 67 years old and can't retire-- no money.
Do not tell me, honey, that we're lucky. The only reason you can say that is because you are not battling a condition, like I am, which requires very expensive (standard) medication which my insurance company will not pay for because it's "out-patient". Of course, MOST medication, including most cancer chemo, is "out-patient". In most any other country, I wouldn't have to be beggaring myself to get a necessary medication.
You can go on having your silly, uninformed opinion... just as long as you stay healthy-- and your spouse, your parents, and your children. And you know what? I can just about predict that one of those people are going to get sick. Your parents, at least, probably have a great national health policy (called Medicare). I hope no one else you love gets sick. Because then you'd have to actually do some thinking about our health care policy instead of bloviating without any thought or information at all.
This is not some political talking point to most of us. It's real life. You are just very, very lucky that it is, at this point, still abstract to you. But if you think that anyone who knows anything really about this finds your ramblings insightful, well, you're wrong. I could go to the zoo and ask the zebras and get more insight. You have just shown how uninformed and naive you are. I can't believe a reputable magazine like The Atlantic would pay anyone so vapid. It's scary. Punditry has been reduced to the lowest denominator-- willfully ignorant people who go on and on about how much smarter they are than those who actually know.
Go away. Soon. Please.
Two Square,
If you are rich or have good insurance the US system is one of the best in the world. But that's not what Megan said when comparing with Costa Rica. She claimed that it was better to have no insurance in the US than be covered in Costa Rica. And that's just ignorant.
Excellent point, Two Square. The United States does provide excellent care for the wealthy. Unfortunately, that's not at issue here.
Megan's commenters give her a hard time when she spouts off about things with nothing in the way of actual knowledge - the public health services of Columbia, where she'd rather be poor. It's not so much a disagreement over substance as it is a reaction to a lack of substance combined with a surfeit of arrogance.
jenn-
What do you say to experts when you have more than 50 million uninsured citizen?
Umm... "Talk to me."?
I am one of the "uninsured citizens" that you speak of!
I have been voluntarily "uninsured" since 1992-- (I was 28 at the time- I will turn 43 in October). I still can't believe I didn't learn sooner...
I was quite happy being "uninsured" for the last 15 years (my only health expense before 2007 was for "lasik surgery"- yet, I had never, ever received "vision coverage" in any employer plan that I was ever eligible for...)
-- Unfortunately, I was in an auto accident last November 17-- I "rolled" my car three times off the freeway. I sustained a 'compounded' "monteggia fracture" (Bado type I) of my left (dominant) arm. (Dislocated elbow and wrist- serious damage to my ulnar nerve- not to mention the ulna was 'visible'-- at a literally 'sickening' angle in it's protrusion from my forearm...
I repeat... Uninsured!
Remember 1992? I simply took the $4k my previous employer was paying (in my name) for my health insurance at the time- and bought an "S&P 500 mutual fund"... and also in 1993... ditto 1994, etc.
Repeat... through 2007.
My total medical bills were almost $52K.
Paid in full--
Cash! (And, I'm still up almost $100K-- because I wasn't forced to subsidize some old crusty f*ck's health care at the same time-)
(...other than the $24,600 that I paid for 55 hrs in a hospital room!) (Saturday at 3AM -- Monday at 10 AM)
But, since I don't work no more... I'll happily let you tax some poor kid to pay my medical bills... from now on!
Gabriel,
She claimed that it was better to have no insurance in the US than be covered in Costa Rica. And that's just ignorant.
What she said was:
But what about the worst off, you might say? What about them? The WHO table isn't even a good ranking of where I'd prefer to be poor. I'd far rather be an uninsured day laborer in San Francisco, than in the Dominican Republic. For that matter, I'd rather be uninsured anywhere in the United States than an average citizen in Costa Rica.
It's about total quality of life, not medical coverage. Looks like Costa Rica has higher unemployment, more people below the poverty line and a significantly lower GDP per person than the US.
This comment deleted for calling single-payer systems socialist
"And what the holy heck are you doing comparing the US with Colombia?"
Perhaps if you had bothered to read the first three sentences of MC Ardle's post, we could have been spared your spittle-flecked dribble.
But here it is again, for your edification:
"In discussing health care, one often hears about how low America ranks on the WHO survey--37th in the world! This is true. But there are a couple of problems with it."
Furthermore, while John Stossel maybe a tool, he does have an enormously provocative mustache. And hating on him does not make this any less true:
"our homicide rate is 10 times higher than in the U.K., eight times higher than in France, and five times greater than in Canada."
which severely skews the healthcare ratings in other countries' favor.
Are you really sure, that you would like to be a uninsured day labourer - getting a cancer from say pesticide or sun exposure, rejected by a hospital because of lack of insurance - and then going away to die on the street or in a hovel. Be careful what you wish for!
As for Stossel's comments, any injury whether fatal or not, is a healthcare problem - indeed improper healthcare can quite easily turn an injury lethal. Only those injuries that are immediately fatal can rightly be considered exogenous to the health system.
[b]My question still remains unanswered, would you prefer to be priced or triaged out of treatment? [/b]
oh look, another attack on a weak argument for universal health care coverage.
are we ever going to get to your attacks against the good arguments? The threads over the last several days are full of really good and unrebutted arguments.
". My experience with the health care system in the USA has been awfully bad. You make an appointment with your Dr. and you have to wait between 20 to 45 mins before you can hear your name."
My experience with single-payer health care is that 20 to 45 mins counts as "almost no wait," while 1 to 2 hours is normal and anything up to 5 hours can happen. This is the kind of American complaint that people back home laugh about (like how rich and unaware you people are).
*
My country did pretty well on the WHO ratings last time they came out. One of the reasons is that we have a low education score (ratio of education to care is one of the important factors it seems). Given that our education system is much better than it used to be, we will be falling in the rankings next time as the older (uneducated) generations die out.
Actually, Stossel's arguments are more or less garbage.
I'm going to use one year's mortality rates to give a snap shot of the magnitude of the effect "exogenus" causes of death can have on life expectancy. Yes, I understand the difference between life expectancy and yearly mortality, but I'm just looking for a ball-park magnitude here.
In 1996 the preliminary crude death rate was 875.4 per 100,000 population.
Homicide accounts for 7.8 of those, suicide for 11.6, Accidents and adverse effects for 35.4.
Every other cause of death was health related - heart disease, lung diseases, etc.
So, the total non-health care related causes equals 54.6, or %6.2 of the total.
So, any differential effect that e.g. our ridiculously high homicide rates as compared to Brittan's have on the comparison of life expectancy (or, mortality, in this example) must be limited to some portion of that %6.2.
Given that that was only one criteria used to establish the WHO rankings, the effect on the total ranking has to be vanishingly small.
Those are CDC numbers. Here's the link: http://www.cdc.gov/mmwr/preview/mmwrhtml/00049527.htm
Can we just agree that Stossel is an intellectually dishonest tool?
Yes, the WHO study dates from 2000. And more recent studies have shown that...? Oh, McArdle hasn't looked at any more recent studies. Here are a few I could Google in the roughly 5 minutes I am willing to devote to rebutting this post, since I, unlike McArdle, don't get paid for this.
OECD Health Data 2007
How Does the United States Compare
Despite the relatively high level of health expenditure in the United States, there are fewer physicians per capita than in most other OECD countries. In 2005, the United States had 2.4 practising physicians per 1 000 population, below the OECD average of 3.0...The number of acute care hospital beds in the United States in 2005 was 2.7 per 1 000 population, also lower than the OECD average of 3.9 beds...
...In the United States, life expectancy at birth increased by 7.9 years between 1960 and 2004, which is less than the increase of over 14 years in Japan, or 8.9 years in Canada. In 2004/5, life expectancy in the United States stood at 77.8 years, almost one year below the OECD average of 78.6 years...Infant mortality rates in the United States have fallen greatly over the past few decades, but not as much as in most other OECD countries. It stood at 6.8 deaths per 1 000 live births in 2004, above the OECD average of 5.4....
Comparison study shows U.S. low in primary care physician visits June 13, 2007
The average American spends a total of about 30 minutes a year with a primary care physician...
Findings showed patient-physician time in the US is about half the average of New Zealand and one-third of Australia.
“The substantially shorter time per capita in the US ...impacts preventive care and management of chronic conditions in the US and could explain why the US does not achieve health outcomes that correspond to its higher level of investment in health care,” said study lead author Andrew Bindman, MD, of the University of California, San Francisco.
A systematic review of studies comparing health outcomes in Canada and the United States -- Guyatt et. al., 2007
"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. ...
Interpretation: Available studies suggest that health outcomes may be superior in patients cared for in Canada versus the United States, but differences are not consistent."
And so on, and so on. Can you find studies showing areas of superior care in the US? Yes; it seems the US does better at keeping cancer patients alive. But given that we are spending at least 1.6 times as much per patient as any other country in the world, it's not surprising we're at least better at something. What's dismal is that we're spending twice as much per patient as countries that are walloping us in terms of most of the indexes of care -- not to mention sucking it up royally in terms of preventive care.
That Aussie-NZ vs. US study reveals one of the keys here: Australians and Kiwis, because they have universal coverage, do indeed go to the doctor more often than Americans. But Australia and NZ spend LESS per capita on health care, not more. Maybe when insurance companies try to reduce the number of times patients see their doctors, that doesn't result in overall improved efficiency? Maybe they end up getting sicker?
From the John Stossel column:
When was the last time you heard of someone leaving this country to get medical care?
Last week. Flying into Bangkok for lasik eye surgery. Bumrungrad Hospital is also one of the world's best for sex change operations; lots of Americans there for that one, too. Similarly, there are hospitals in Singapore that rank number one in the world -- above every American hospital -- in certain procedures. Per capita income in Singapore is about 2/3 of the US; they have universal health coverage.
When you adjust for these "fatal injury" rates, U.S. life expectancy is actually higher than in nearly every other industrialized nation.
Where does he get this figure? Who is he citing? What are the underlying stats? Looks like bull crap to me. As long as we're tossing out stats we seem to remember hearing somewhere, how about this one: if you take away the US's black population, then our lag behind other OECD countries in infant mortality disappears. Now, I wonder what that might indicate about how our health system works.
When I started reading this blog I hoped for something better. Megan seems like a nice person, and while I am far from being a libertarian I'm willing to look at intellectually honest arguments in support of her cause with an open mind. I'm not seeing them here. I see instead Megan's regurgitation of a ludicrous argument about our low life expectancy being due to our high rate of violent deaths, a grade school version of Robert Nozick's Anarchy, State, and Utopia, and a misleading and offensive comparison of our health system with those of poor countries that try hard but don't have the resources we do. If Megan argued that a low level of basic services is the price we have to pay to encourage entrepeneurial risk taking and technological innovation, I'd listen. But apparently that's too difficult for her intended target audience. Or maybe it's too difficult for her.
Fletch, the only reason your story isn't a tragic tale is because it didn't happen on November 17, 1993.
Having the good fortune to have a catastrophic event occur when you'd been saving up for it for 15 years isn't exactly a prescription for anyone. Anyone.
This thread is full of anecdotes and ad hominems and arguments from authority. There are a couple of posts with actual links to information. But a lot of the "rebuttals" are just attacks.
Infant mortality statistics around the world are not comparable. Every country has different criteria for counting live births versus infant mortalities. There is no real meaningful way to compare them. Using them in a ranking of health care systems is silly.
Accident and murder rates affect the ranking of health care systems by reducing life expectancies and by adding a burden to the health care system. Our system deals with a lot more trauma cases than those of other countries. This is not a good thing and our murder rate/violence rate is a problem, but it's not a failing of the health care system.
Our number of uninsured citizens includes a LOT of people who are young and healthy and who choose not to be insured. They may be foolish, but they are making a choice. In other countries, where taxes are high and insurance is mandatory, they don't have that choice. Again, this is not a failing of the health care system.
Even heart disease can be an issue of life style choices and not of the health care system. Americans are fat. Even our poor are fat. Fat people have more heart disease. So what percentage of deaths by heart attack are caused by Americans being fat versus failings in the health care system? I don't know.
EI
If they are rational they must be ill-informed. The United States has the highest cancer survival rate. Perhaps you think its just luck that we are beating single-payer Canada and Britain, but any rational observer will conclude that we have the best cancer treatment. Look here if you don't believe it: cancer survival rates
Megan
I do like you, but citing John Stossel's analysis of anything makes it very hard to take you seriously.
This thread is full of anecdotes... -- EI
Uh, dude:
Infant mortality statistics around the world are not comparable...Our system deals with a lot more trauma cases than those of other countries...Our number of uninsured citizens includes a LOT of people who are young and healthy and who choose not to be insured... -- EI
Physician heal thyself, as it were.
This is a summary of the findings of Dr. Verdecchia as published in Lancet Oncology. Does anyone here still deny that the United States has the best health care in the world in some important respects?
Isocrates, funny how you make this only about Britain and Canada when the two countries right on the United States' tail both have socialized health care.
The big question is what would happen if we devoted the U.S.'s current resources to a single-payer system that was funded at the same rate we currently fund private health insurance? We spend hundreds, if not thousands more than every other country on earth on health care per capita which, in any logical world, should result in better survival rates.
The real question is whether or not we're getting maximal benefit for spending $2 to 2.5K more per capita on healthcare per individual, and the answer is pretty flatly "no".
Does anyone here still deny that the United States has the best health care in the world in some important respects?
Cancer survival rates after diagnosis do appear to be higher in the US. I have read that this may be an artifact of earlier detection in the US, rather than more effective treatment; patients may not be living much longer, but they appear to survive longer with cancer because their cancers are caught early.
Anyway, it's interesting that the US has managed to achieve this excellence in cancer diagnosis and treatment with a health care system that is 45% government-funded. Obviously, many of the dollars that are paying for American cancer diagnosis and treatment are taxpayer-supplied Medicare dollars. This, of course, is what Ms. McArdle would like to eliminate: no more subsidies of the old and sick by the young and healthy! Could America's oncology establishment survive such a cutoff of funds? Who knows? But someone's confused pseudo-schmibertarian principles demand that no more extorted taxpayer dollars go to subsidizing the sick, because most of them are old; so, too bad.
You don't see a lot of uninsured illegal immigrants trying to get home for the awesome health coverage.
This is pure anecdote, but I know two immigrants (I'm pretty sure Gerard's legal -- he's married to a citizen, anyway; couldn't tell you about Adela) who went back to their Latin American countries of origin for medical treatment they couldn't afford here. Gerard went back to Uruguay with a badly broken leg that needed surgery and physical therapy, and Adela went back to the DR to get her diabeties under control. I don't know that the medical care they got is superior to what they would have gotten here if they could have afforded it, but it was medical care that they could afford.
Does anyone here still deny that the United States has the best health care in the world in some important respects?
Yes! And you know that they do, because you're here participating in this discussion, so you have probably been exposed to people who do indeed deny that many times. I don't know if it's a common trait for libertarians, but there is an incredible frequency around here, from both McArdle and her supporters, to simply assert a claim and act as though it is so self-evidently true that you can't counter-argue it. A single expert claims that the US is the best in some areas of medicine, and based on that individual quote-- which again, is bereft of evidence-- I'm supposed to abandon my objections? Come on.
And again, I keep reading stuff like this here:
Tut-tut all you want, give Megan the bum's rush, whatever, but you folks that have a tendency to spit venom instead of rationally discussing issues
The people who are disagreeing with Megan aren't having a rational discussion? That's funny, I find sound argument after sound argument from people disagreeing with her. Most of the arguments are certainly stronger than, say, this post. I'm still waiting for someone to show me a single piece of evidence in the last two paragraphs to defend her claim that it's better to be poor and uninsured in America than to be insured but living in Costa Rica or other poor countries. She's put that out there as a lynch pin argument and made absolutely no supporting claims from evidence. And then you guys turn around and attack her critics for not being rational. Over and over again she doesn't even meet the most basic criteria for defending an argument. She's got to get to the point where she realizes that the fact that something seems self-evident to her is not generally considered logically compelling.
What am I waiting for, really, from her or from any of you, is a description of what, exactly, the 47 million people in this country without insurance should do when they get sick. What is that day laborer in San Francisco supposed to do? If he's like many people, he doesn't get help at all, or he goes to the emergency room when he feels he absolutely has to. Emergency rooms, after all, can't turn away people who come to them, unlike other doctors. It's a disaster for our ERs, but again, these people don't have a choice. It's enormously expensive for all of us, it's inefficient, it takes doctors and resources away from the work they are supposed to be doing, and because they are treating conditions that are inappropriate for ER treatment, the quality of that care suffers.
As I said before, if someone wants to tell me what precisely they think someone without insurance in this country should do to obtain health care, I'm all ears. Preferably an option that doesn't leave them with financially debilitating debt.
brooksfoe,
The infant mortality issue, higher trauma rate, and statistics on voluntary uninsured citizens are not anecdotes. I have seen plenty of statistics and discussions of these in various places. I don't have the links right now, but they should be easy to find.
The anecdotes I'm referring to are all the stories about individual experiences. Those don't really prove anything.
Just out of curiosity, but do the per capita expenditure rates include voluntary procedures like plastic surgery and other unnecessary procedures? I keep reading that Americans are taking too many pain meds and/or mental health related meds. Are those included in the per capita expenditures?
The fact that we have people who have no insurance does not logically require a single-payer or socialized health care system to solve... there are many other ways to solve this problem.
Personally, having been watching our congress pretty closely for a while, now, I really don't want to give those corrupt idiots control of the health care industry.
EI
This post was a discussion of the WHO study that ranks US healthcare as 37th in the world. It did a few things
1. Showed how the WHO ranking works
2. Explained why it probably does not accurately reflect the performance of the US healthcare system.
One of the money quotes from the post was
Which explained why the US lower rank is related not to the quality of medical care but rather to how it is distributed.In other words a bad healthcare system that equally distributed bad healthcare would be ranked higher then a system that had good, excellent healthcare but gave some people excellent healthcare and the rest good healthcare.
This generates a comment thread with forty plus comments
Two (thanks brooksfoe and cs) provided data and useful additional information. There were a few other comments that provided insight or provided an interesting perspective on the issue. Unfortunately there were a lot of other comments like
are we ever going to get to your attacks against the good arguments? The threads over the last several days are full of really good and unrebutted arguments.The snark is entertaining but it tends to strengthen the arguments made in the original post.
If the only response you can offer to a post is snark and personal attacks that tends to show you can't come to the table with information to disprove the original post.
brooksfoe said
The bold emphasis is mine.Nationalized healthcare proponents argue that the US healthcare system would be improved by nationalizing it which would improve primary healthcare.
Yet according to brooksfoe the US system already does a better job on primary care because it catches cancer before the nationalized healthcare systems do.
Since early detection of cancer generally occurs in a primary care setting the superior ability of the US system to detect cancer calls in to question the article of faith that nationalized systems.
1. Have better primary care
2. Nationalizing the US system would improve primary care
TJIT - yes, we can all cherry-pick comments, too. It's fun!
By the way, this is simply fallacious:
"In other words a bad healthcare system that equally distributed bad healthcare would be ranked higher then a system that had good, excellent healthcare but gave some people excellent healthcare and the rest good healthcare."
The American system doesn't do this. It is a system that has anywhere from excellent healthcare to no healthcare, and is distributed accordingly.
Take this to the private market. Compustore is rated as better than Netmart in the community, despite the fact that Netmart sells the best, most reliable equipment on the market with great technical support. How could this possibly be? Well, the store's inconveniently located with bad hours, for one. You can only shop there if you have a club card, which costs $100, and the store's financing is 20% higher than Compustore's (and also the only method of payment they accept besides cash). They carry the best equipment, but it's iffy as to whether or not it's in stock, and the alternatives are often highly unsatisfactory.
In other words, it's possible that you'll get a great deal when you go there. However, for a significant number of consumers, it's also possible that you'll get a bad deal or no deal or all, based largely on the luck of the draw.
But yes, let's get back to the You Don't Take My Silliness Seriously Hour, with special guests the I Have Links And Stuff Band.
Yet according to brooksfoe the US system already does a better job on primary care because it catches cancer before the nationalized healthcare systems do.
I believe brooksfoe's point is that early detection of cancer doesn't constitute doing a better job unless it makes superior treatment of that cancer possible. Prostate cancer's an example of this -- slowgrowing prostate cancer in an older man is likely to have no effect on his health in the time before he dies of something else. Additional detection of such cancers is going to make our stats look better, but won't actually extend anyone's life by a day.
I don't know that this is the full explanation for our superior cancer survival rates after detection, but it's certainly a confounding factor.
TJIJ: here's the thing, vis a vis the equality of distribution issue.
Equality of distribution, for example, is heavily weighted; so heavily weighted that quality of basic care suffers in comparison. That's why places like Morocco, the Dominican Republic, and Costa Rica clean our clocks.
You could argue that, actually, India has health care just as good as any rich country in the world; it's just that it's only available in Bombay and Delhi, at like three hospitals. Sure, only fifty thousand people can access it, in a country of 1.4 billion, but that's a matter of distribution, not quality.
This, obviously, would be an absurd thing to argue. But it's a limit case explaining why equality of distribution has to be a major factor in any measure of how good a country's health system is. And when you look at the distribution by wealth of health results in the US, you find that when you get into the lower income ranges, we stop looking like a first-world country. If you just took the top 30% of US wage-earners, we might look like a Scandinavian country. But if you take the bottom 30%, we start to look as bad as a lot of third-world countries. You could say, well, we Americans are willing to accept a lot of social inequality; that's a political choice. But you have to accept that at some point, "how good our health system is" is not about how good the best care at the best hospital is; it's about how good care is for the average guy. (And even if care is pretty good for that "average (or modal) guy", you have to think seriously about whether you might have a problem of a vanishing middle -- there may only be like 20 modal guys, and care could be great for the 150 million above him, and really awful for the 150 million below him. But the point is that distribution matters.)
Second: let's stipulate that US health care really isn't worse than Costa Rican. (A note, here: I have been treated numerous times by Cuban doctors, in West Africa, and it was a perfectly fine experience. I'm less inclined than McArdle to dismiss the quality of Latin American health care, for this reason. In the vast majority of cases, what you really need isn't a lot of fancy equipment; it's an experienced doc with basic meds, and the most important thing is just that the doc is there, and you can see him.) But this really isn't the point of the argument. The argument is really about whether US health care is better than French, German, Dutch, Japanese, British, Canadian, Swedish, and Italian health care (and Taiwanese, Swiss -- etc.). We spend almost double what virtually every other advanced economy spends on health care, per capita. And on so many indices, our health system performs worse than theirs do. To try and redirect attention to the US vs. Costa Rica, when the real question is the US vs. France, is just gamesmanship. And it's extremely provocative, because of the desperate seriousness of the issue.
Freddie said
If one followed the links provided in the original post one would find this statement To summarize the 45 million includes1. People who could afford health insurance but choose not to carry it
2. People who are eligible for public finance of their healthcare
3. People who are not citizens of the US
In other words the figure of 45 million people without health does not accurately reflect the number of people who can't afford healthcare.
In fact it grossly inflates the number of people who can't afford healthcare.
Besides the fact that it's written by renowned fabulist John Stossel, the linked article in the original post has one major problem, repeated here ad nauseum.
It presumes that we are to judge the ability of a healthcare system to deliver effective healthcare only by the quality of the care delivered, ignoring the care that's not delivered.
Applying this same standard, for instance, to policework: well, when police *do* investigate a crime in Citytown, they solve it faster than any other municipality in the state.
It's just that they don't investigate crimes in a particular area of town. But really, should that be held against them? Certainly not.
LOL- Thanks, Starscream. No personal attacks, per se, and some relative humor, an approach that sees the point in no vitreous humour.
May I gently point out that the part you quoted form TJIT says nothing about the American system. Quote it in context, with the compleate reference to the American system. Not a biggee, but makes it a bit more encompassing and could add a little more to your argument.
Still, TJIT's point was really refuted. The weighting was for 'distributed healthcare,' which is a definite strongpoint of socialized (single payer) medicine. It can mean the rich and poor, alike, get a dry wrap for that compound leg, making it rank high on the list in that category.(Aside: WHO describes their data coming from 'official' healthcare sources, which leaves out the sources for the rich and powerful in these single-payer countries, as in, "Do you really expect Fidel to receive the same healthcare opportunity as the sugar-cane harvester?" of course not, but it isn't in the WHO statistics, either)
What do the 50 million uninsured do when they need healthcare?
1) Most of them rarely need healthcare. They chose to be uninsured because they are young and healthy.
2) You may not be aware of this, but it is actually possible to pull out a credit card, checkbook, or cash and pay for it yourself. For routine medical care, this saves about an hour of paperwork - the costs of which ultimately comes out of your paycheck if you have employer-provided medical insurance. The only problem is if your doctor inflates his bills for the uninsured to make up for patients that stiff him, while letting insurance companies negotiate away that extra margin... But there are also doctors that will quietly give a large discount when you pay in full at the time of the visit.
3) If you are poor and uninsured, you qualify for Medicaid. It's not great, but it beats the worst of the British socialized medicine.
4) The people that genuinely have a problem are the ones that are neither poor nor rich, and are in the minority of under 65's that happen to need expensive treatment. AFAIK, they still get treated - but then the bill collectors will make them poor. It's a risk that group 1 thinks is worth taking.
As for me, for the last couple of years I have had employer-provided major medical insurance that only pays for a few things until we run up $5,000 in bills in one year, and a HSA that now has about that much in it, and is growing. So for procedures not covered by insurance, I just pull out the debit card and pay with tax-free dollars from the HSA. I may have a problem next year, because the plant here is closing, and I'm out of a job in February, but that HSA will provide a bit of a buffer as far as health care goes.
In the twenty years since I left the Air Force, between my wife and I there's been just one time our annual medical bills exceeded a few hundred dollars, when ny wife needed gall bladder surgery. Although we had "full coverage" type insurance back then, it still cost us $5,000 out of pocket, with the insurance paying about $10,000 more. If we'd had the HSA all along and had been putting the difference between what my employer paid for full coverage and the current major medical plan into it, I expect it would be over $50,000 by now and be earning enough interest to pay our routine bills and still be growing by itself.
...and John Stossel. Before he started coming out as someone who shined the light on the cockroaches in the cracks, I remember him as being one of the 'up and coming' bright journalists. My memory can be misleading of course, but incredibly birght comments like:
"Besides the fact that it's written by renowned fabulist John Stossel,..."
as well as (awa)
"Actually, Stossel's arguments are more or less garbage."
awa
"I do like you, but citing John Stossel's analysis of anything makes it very hard to take you seriously."
...don't sway me in the least.
Mr. Krueger seems to think all who say a kind word about Megan must be a libertarian. With that kind of misguided faith, you might as well end your comment with the tombstone (in a tongue-in-cheek kinda way).
One of the problems with a 'fact' or assertion from an opponent, is that is is more often than not distorted in the extreme, or if it works well enough, just a little - as long as it ends up supporting whatever it is your point is all about. I don't want to go back to some of the previous commenters and embarass them, but those who read this thread completely will see it clearly, at least until that predisposition filter starts ActingUp.
Megan writes:
"Now, personally, I don't really care about equality of distribution per se."
And that's that, folks. Why bother trying to argue against that? Does anyone really think that any argument proffered in the comments is going to make her think otherwise? That statement is her major premise and, lo and behold, consistent with her conclusions. If there were 300 million uninsured Americans, she would feel the same way, and she would still insist on the superiority of American healtcare, even though it wasn't being distrubuted at all among the population. So let's all just move on and find another writer to annoy with our comments.
Farewell,
Brady
If we'd had the HSA all along and had been putting the difference between what my employer paid for full coverage and the current major medical plan into it, I expect it would be over $50,000 by now and be earning enough interest to pay our routine bills and still be growing by itself.
Hey, that's impressive. Fifty grand. Guess how much money I have available to pay my emergency medical costs? As much as I need. Know how much it costs the employer? About eight thousand a year for family coverage for me, my wife and two kids. Guess what the deductible is? Zero dollars and zero cents.
Guess why? It's through my wife's job, she's Dutch, and it comes through the Netherlands, where insurance costs are half or less what they are in the US because of the superior way the health care market is organized. In fact, it even covers emergency care in the US when we travel there -- no copay.
Megan asks: Now, personally, I don't really care about equality of distribution per se. I don't care if Bill Gates gets super-awesome treatment; what I want to know is, are people suffering and dying from lack of care?
Yes Megan, at least 18,000 people die each year from lack of acess to health care. That works out to more than 50 a day. Does this bother your conscience any?
Here are some sites on the subject:
http://www.usatoday.com/news/health/healthcare/2002-05-22-insurance-deaths.htm
http://www.bmj.com/cgi/content/full/326/7404/1418-f
http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=10719
http://www.medicalnewstoday.com/articles/67342.php
http://www.aidsnews.org/2004/01/IOM.html
http://www.forward.com/articles/7233/
http://www.slate.com/id/2161736/
I do not see how Megan's take on health care can be considered Libertarian. Here is mine, and I have self described as a Libertarian for a long time.
On health care, a Libertarian would first ask: what is my rational self interest in this situation. Clearly it is to protect myself from disease and illness so I can live as long and as healthy as possible. Then I would look into how health works. Along the way I learn something that Megan seems never to have heard of: the germ theory of disease. Dr. Pasteur discovered that tiny microbes pass from person to person and attack their new host.
So, rationally I want to avoid catching a germ because it would make my life less pleasurable. There seem to be two solutions to this situation. One is to live like Howard Hughs, isolated from the world. But I can't do that, I have to work in the world.
Which tells me right up front that the health of others has a direct bearing on me. I need to be concerned that they will not pass something on to me. As we learned in the AIDS epidemic, what protects people and saves their lives is Universal Practices rigourously enforced. Always wear a condom. Have clean safe water available to everyone. Especially heated water so they can bath. Wash your hands every time you use the toilet.
A society where the people who handle your food don't have access to health care endangers those who do. A kitchen guy who is not feeling well should see a doctor. Under our system he will go to work, handle food and pass along hepatitis. Or typhoid. Megan sees these instances as 'anecdotes'. I see them as specific evidence of why everyone should have access to health care.
Not to provide beneficence to others, but to protect our very own selves. Universal health care is in my rational self interest.
Interestingly enough, one cancer (Kaposi's Sarcoma) is now shown to be clearly caused by a virus. Other cancers are showing a viral involvement. Which more or less shows that ascribing disease to 'lifestyle' or 'choices' is not particularly helpful.
falkoyn types: "No personal attacks, per se, and some relative humor, an approach that sees the point in no vitreous humour."
I think falkoyn meant "vitriolic humour" here, but who knows with this guy? falkoyn is the Norm Crosby of posters here.
The real question is whether or not we're getting maximal benefit for spending $2 to 2.5K more per capita on healthcare per individual, and the answer is pretty flatly "no".
Yes, but on the other hand, American physicians get to live in really nice suburbs. And healthcare-related personal bankruptcies are clearly being overtaken by dodgy mortgage-related personal bankruptcies.
Brady, full context of Megan's outrage-inducing quote:
Now, personally, I don't really care about equality of distribution per se. I don't care if Bill Gates gets super-awesome treatment; what I want to know is, are people suffering and dying from lack of care?
Greater inequality is only necessarily worse in a zero-sum world, where gains for the wealthy must correspond to losses for the non-wealthy. But our world doesn't work like that. Say an advanced gene therapy is developed that costs a million dollars. Even though the majority who can't afford it are no worse off than previously, a rating based on "inequality" would claim that they are.
As for the massive tool known as John Stossel and why using him as a source is rather absurd, here's a link with some other links. Make up your own minds, but I wouldn't use this clown as a source for anything.
http://www.fair.org/index.php?page=19&media_outlet_id=19
Anyway, it's interesting that the US has managed to achieve this excellence in cancer diagnosis and treatment with a health care system that is 45% government-funded.
Actually, this 45% looks to my eyes understated. Cancer cases tend to cluster pretty heavily among the elderly, so US cancer survival rates are surely at least partially a byproduct of America's own evil socialist healthcare plan, Medicare. In other words, American socialism is some of the best anywhere in the world.
Screw the WHO comparison and ranking... independent of the high homicide rates and fatal car accidents - the average health of an US middle class citizen is deteriorating?
I.e. it does not matter if China is catching up with the US economy or not - what matters if you are John Doe (and not a country) is if per capita real income (PPP) is increasing or not for the individual?
Most observers of the most recent US data claim that we in the West will for the first time in decades decrease our (US) life-expectancy compared to US data (and not international). The same holds true for Europe? And it is clearly NOT the case that Elvis could not afford proper health care - it is question of priorities in life and world view?
On a global level - we all face our challenges. For the first time in history there are more overweight and obese people than hungry ones. For the first time - the economic costs of eating too much are higher than the economic costs of undernourishment and disease.
Besides - who on earth would dare to improve health care for the poor.. if those poor belong to the richest 5% on the planet. Worse - why should anyone in the US try to help the "poor" if the "poor" themselves prove every day that they would not help improve conditions for anyBODY if they were in power - I am referring to how we all treat animals (99% do not see daylight, cannot move around, sleep in their own shit, are routinely raped and removed from their families, etc.)
no - I say we should all continue with our numbing pleasures and forget health care, the environment and animals. We have more important things to do - fight wars, trying to end them, the iPhone, bugging our phones, God and who knows what...?
If it were up to me (London School of Economics BSc, MSc) - I would simply scrap all subsidies on saturated fats (ca $20 billion per year for factory farms in the US). In the EU it is merely getting rid of CAP... I HOPE that the US will not continue along her historic reasoning: as long as Europe does not quit heroin - neither will we...
ALL nutritionists in the US and EU claim that we consume at least 3 times TOO MUCH saturated fats and cholesterol (meat and milk - insulin and lactose are worse than white sugar for cancer and diabetes?)
Not only would this be the BEST free-market measure one can take in order to improve health care - but also the environment.
PLEASE - do not invest $1,5 billion in clean energy of into health care.. get rid of the $20 billion market distorting subsidies on cholesterol!! Preventable heart disease has been on the rise since the advent of factory farms and our addiction to the red and white. Preventable heart diseases causes more deaths than all 5 following causes (cancer & accidents) combined.
If were to find a cure for ALL cancers today - we could increase our life-expectancy by 3 years. If we decrease saturated fats consumption to say 10% of all calories - the American Heart Association estimated that we could gain 7 years or the equivalent in economic productivity?
And don't forget that the major driver behind our exploding health care costs is also the worst environmental polluter we know of...
In both cases - extreme government/human intervention (as always when it comes to the economy and ecology) is the major problem. IF we find arguments to continue with our market distortions - we should AT LEAST subsidize prevention? we should at least subsidize "healthy" things and not "drugs"? What about pouring $20 billion a year into organic fruits and vegetables?
I guess our budget does not have room for that? Bugging our phones to protect us from terrorists and pouring tax money into factory farms has left us with nothing left for making us healthier, happier and saving the resources of our children?
What does Clint Eastwood eat? Anybody?
Nationalized healthcare proponents argue that the US healthcare system would be improved by nationalizing it which would improve primary healthcare. Yet according to brooksfoe the US system already does a better job on primary care because it catches cancer before the nationalized healthcare systems do.
No, as has been pointed out, the heavy concentration of cancers among older people very likely means that America's good results in this area flow directly from its effective, lavishly-funded government healthcare program, Medicare.
It would be interesting to see how the cancer survival rate for Americans under 60 stacks up against the under 60 citizens of other rich world nations. My guess is the heavy presence of non-insured in the under 60 US population would yield results a lot less satisfactory for the United States.
Say an advanced gene therapy is developed that costs a million dollars. Even though the majority who can't afford it are no worse off than previously, a rating based on "inequality" would claim that they are. - Brian
Brian, a lot hinges on how often such "non-zero-sum" cases arise, versus how often things actually turn out to be rather zero-sum indeed.
For example: are Congolese villagers worse off because of the invention of Viagra? No, of course not, one might argue; at ten bucks a pill they can't afford it, but they're no worse off than previously. But Congolese villagers would prefer that pharmaceutical companies spend their time and money working on affordable anti-malaria drugs, not erectile dysfunction drugs for rich Westerners. Researchers and labs who might have been spending the past 10 years working to fight malaria were instead working on getting old guys hard. So, yes, they are worse off because of the invention of Viagra.
brooksfoe writes: "Researchers and labs who might have been spending the past 10 years working to fight malaria were instead working on getting old guys hard."
Now that's funny. Get rid of Ambinder and give brooksfoe a space here.
cs notes that non-health care related deaths in the year he quotes as 54.6/1000. Unfortunately, although cs states that the difference between mortality and lifespan is understood, the argument put forth that the greater number of deaths on the U.S. from said causes is NOT a real factor in lifespan statistics is incorrect.
In the second half of the 21st century the two greates factors behind the lifespan gains in the U.S. were Armistice Day, ending the carnage of WWII, and the institution of vaccines against childhood illnesses such as smallpox and polio. It is not the mortality in a given year that affects lifespan, it is the age at death. NOT losing hundreds of thousands of young men to wartime deaths and NOT losing hundreds of thousands of children to childhood illnesses means also NOT losing those years of lifespan. So whereas 54.6 may represent only 6.2% of deaths in a given year, it is the loss of years to be lived by the relatively youthful victims of those deaths that affects lifespan statistics. If the average age at death of this group is 25 this statsistic would have a dramatic effect on aggregate lifespan.
I am not a statistician, but I wonder if controlling for non-healthcare related deaths wouldn't bring the U.S. lifespan that extra year that is so distressing to the WHO, etc.
Do you post these articles as flame-bait deliberately to drive up site traffic, or are you just an exceptionally callous person? In a time when almost everyone recognizes serious faults in US health care, why are you wasting time on statistical quibbling? For God's sake, the number of uninsured children in the US is a disgrace, and the use of emergency rooms to provide last resort medical care is an obviously mostrous inefficiency.
Is it too much to ask for a connection to be established between your heart and your brain?
To gain more information on the "why" of rising costs in healthcare, please read the Health Economics text by (now I can't remember his name, but the publisher is Southwest) who is a professor at Baylor. In it he uses the anacronym SALT which is Socioculture, Aging, Legal, and Technology to explain why healthcare in the US is so expensive. In Socioculture, he mentions that crime, teen pregnancies, drug abuse, HIV, etc. are much worse in America. Of course the "Aging" population and the "Legal" problems are self-explanatory, though I personally think he is wrong about "Legal" as a force driving costs up, instead it keeps doctors on their toes. The last, "Technology" means that the US spends more on CT, MRI, etc. than anyone, which is true. Don
"What I want to know is, are people suffering and dying from lack of care?"
Um, yes?
The information about suffering and dying is admittedly anectodal -- but of course it is there. Would you like to hear my stories? About a little girl in my son's first grade class whose stomach cancer was not diagnosed because her employed but uninsured mom was embarassed to return to the doctor because she owed him money? About another child's randfather who chose not to undergo cancer treatment because of the expense to his family? About the married couple, schoolteachers, who can't afford to have children because they don't have health care?
Those are people I know, and I am just another over-educated fortunate person like you. I am sure there are a million stories.
What now, MM? What do you do now that you know that people are suffering and dying?
Remember 1992? I simply took the $4k my previous employer was paying (in my name) for my health insurance at the time- and bought an "S&P 500 mutual fund"... and also in 1993... ditto 1994, etc. Repeat... through 2007. My total medical bills were almost $52K. Paid in full-- Cash! (And, I'm still up almost $100K...)
As others have pointed out, if the auto accident had occurred in 1994, you would have been deeply in the hole -- and if you were lucky enough to arrange a long-term payment plan, using your employer's $4K contribution, but with interest now working against you, you might or might not have gotten out of the hole by now.
I would only add that as a matter of public policy, I want outcomes that are invariant under the timing of the accident, or the timing of the cancer, etc.
I would only add that as a matter of public policy, I want outcomes that are invariant under the timing of the accident, or the timing of the cancer, etc.
Michael Cain: I wouldn't be so hard on him. It seems to me that playing Russian roulette with the possibility of financial ruin is a perfectly reasonable basis upon which to form public policy.
cs,
I wonder if you really do understand the difference between life expectancy and total mortality. What is the average age of death for those dying of non-medical causes vs medical causes? I would guess that the non-medical causes have a significantly younger age of death, and thus, a higher affect on life expectancy than the 6.2% number from total mortality. I think this is going to be true since most murder victims are young males, and a disproportionate number of auto accident victims and suicides are young people. Someone dying of a heart attack at age 60 has a much smaller impact on life expectancy than an 18 year old murder victim.
It is a pity that Stossel doesn't provide support for his argument, and he may be wrong, but no one here has actually demonstrated that he is wrong about his claim on life expectancy.
And to most of the rest of the commentators,
Read carefully before you write comments. Some of you have attacked things you thought McArdle wrote. In particular, a large number of you completely misinterpreted her comment about Costa Rica, a misinterpretation that is hard for me ascribe to anything other than dishonesty or not reading carefully enough. I hope it was the latter for most of you.
Say what you will about Megan McArdle, but at least she isn't John Stossel.
Brady said
If brady had bothered to read the paragraph he lifted that single sentence from he would have noticed that Megan also wrote
Which seems to be the important thing to be concerned about.-
If everybody had equally distributed but poor quality care That is a worse situation then the poor having acceptable quality of healthcare and Bill Gates having his own wing in a hospital.
"But Congolese villagers would prefer that pharmaceutical companies spend their time and money working on affordable anti-malaria drugs, not erectile dysfunction drugs for rich Westerners."
I agree with your general argument, but I figured this point was worth making...
However, given the low ratio of drugs that make a profit to those that don't, then drug companies need to ensure they have a profit-generating drug so they can fund the research and production of an affordable Malaria vaccine, which will likely sell at a loss. Of course the US government could fund such things, but under the current situation when something like 3 in 10 drugs make a profit, the drug companies have to get the money from R&D from things that rich Westerners buy, like Viagra, so they can sell things poor Third World citizens can buy, like malaria vaccines. Again, assuming the government doesn't fund it. If it did, finding money wouldn't be a problem.
"Our number of uninsured citizens includes a LOT of people who are young and healthy and who choose not to be insured. They may be foolish, but they are making a choice. In other countries, where taxes are high and insurance is mandatory, they don't have that choice."
I don't know why on earth this is trotted out as some kind of "proof" that healthy people feel comfortable living everyday in a healthcare lottery. They are betting against the odds of getting seriously injured or ill because they cannot afford to do otherwise, the investment for healthcare against the investment for their future is too great.
But of course, it is a gamble that many lose and that is where the injustice comes in; that in America, one must purchase their health and quality of life. It is only luck that keeps some young people out of the emergency room and a lifetime of debt prior to building their lives.
Larry: "falkoyn types: "No personal attacks, per se, and some relative humor, an approach that sees the point in no vitreous humour."
Well, I was wondering about the vitreous humour myself. I had thought possibly he meant, like vitreous china, it is humour in which one can look through and see the light.
"If you are poor and uninsured, you qualify for Medicaid. It's not great, but it beats the worst of the British socialized medicine."
Bullshit, another anecdote trotted out by the privileged that simply bares their naivete.
Medicaid is a poor excuse for nationalized healthcare, tightly controlled by the wealthy and forced to compete in a for-profit system, most persons under Medicaid (NOT to be confused with Medicare) often must go without appropriate care or services or suffer inferior care.
Also the hurdles to qualification and the endless bureacracy involved in such, not to mention the eligibility standards which exclude most working people, relegate its distribution to a very small number of people. Although blaming the poor is quite fashionable and doesn't require a lot of thought, it isn't the truth.
I find it quite amusing that conservatives will hold up the "but there's Medicaid!" card when there is talk of the suffering of the uninsured, when in fact, conservatives have led the hue and cry for years that Medicaid is an evil supporting the Evil Poor that must be defunded immediately. Please, get it straight will you people?
Those who do find themselves looking to Medicaid often were once part of the middle class and enjoyed the benefits therein until illness or tragedy struck. Then, faced with denial for service from their insurers or lack of funds for premiums, they turn to the only system left and then only after they have fulfilled their requirement to prove themselves adequately deserving by divesting of every shred of financial holdings or assets they have, or even potential future earnings (a good job) -- if they have any left anyway.
A large contingent of this country's culture functions on the notion that they will never incur tragedy or suffer grave illness, or have a loved one or a relative suffer same.
Like the fave example of the uninsured younguns, they are willing to gamble their entire lives and think that as long as they fix the numbers their way, they are all set, such thinking is not only morally bankrupt, it is just plain stupid.
"So whereas 54.6 may represent only 6.2% of deaths in a given year, it is the loss of years to be lived by the relatively youthful victims of those deaths that affects lifespan statistics. If the average age at death of this group is 25 this statistic would have a dramatic effect on aggregate lifespan."
ok. so, remember when I said i was looking to ballpark the magnitude effect that "exogenus" causes can have on life expectancy and thus on the WHO ranking? I really actually did mean ballpark.
Maybe I was wrong - could a small but non-negligible difference in homicide rates, accidents, and suicides (which combined account for less than %6 of US yearly mortality) account for a %10 difference (78 years (pop 301 mil) US vs. 78.7 years (pop 60 mil) UK) in aggregate life span? If so, cool.
And would that difference in aggregate life span result in the US moving up in the WHO rankings 37 places? 10? 3? 1?
Because I think that was Stossel's point - that somehow the WHO study ranking was unfair by virtue of not adjusting for exogenous causes. which, ok its at least arguable, but really, how unfair are we talking? I'm saying not a whole lot, really.
In fact, I'm saying that the whole minor nitpicky issue is raised just to try to discredit the whole of a study whose conclusions Stossel disagrees with for ideological reasons. And that this minor objection by Stossel is used by people like Megan who don't bother to do the math themselves to convince other people who also don't bother to do the math themselves that the entirety of a study they've never looked at and never will is BS. It's ridiculous - I mean, look at the third comment in this thread: "Thanks for citing some of the obvious holes in the WHO study, I appreciate knowing for sure that the study is completely misleading." Seriously, it's like watching the exact opposite of thought happen.
Anyway, this whole notion of accident, homicide and suicide fatalities being somehow entirely "exogenus" to the health care system is questionable - some portion of those events never end up interacting with the health care system, but I'd guess that that portion is pretty small. That's what we have emergency rooms and trauma centers for, right? It'd be interesting to look up some comparative measure of trauma care by nationality. Then, instead of saying accident fatalities just don't count, you could ballpark the number of accident fatalities that really aren't attributable to the health care system, as opposed to just asserting that they're all magically "exogenous."
Sophie Brown says: 'The information about suffering and dying is admittedly anectodal -- but of course it is there. '
There is scientific information on the dying. Hospitals report a catagory called something like 'preventable death' to the Centers for Disease Control. In it are people who die of easily preventable conditions, such as appendicitis, tooth ache, bed sores, tonsilitis, syphillis, ear infections and so on are noted as having died of something that could have been cured with earlier treatment.
I once worked at a Cancer Registry. Every autopsy report had this information in it. Additionally it was sometimes on the death certificate. And then if you need more confirmation, get a medical specialist to go through a stack of death certificates. S/he can quickly pick out the obvious preventable deaths.
Generally, medical facilities play this down, shuffling only the most obvious cases into the pd area. There are over 18,000 of these deaths reported each year. That is over 50 people a day who die from preventable causes. In almost every case, lack of or inadaquate insurance is the culprit. Remember, Generally they die in grater pain because they held out until the last minute to seek help. Which is when it was too late.
A simple Google search turned up numerous links to this information. Including a major story in USA Today. Earlier I tried to post the information and the links. The response was that this would need reviewing before it would be posted. No idea what that is about.
Yancey,rather than guessing about the modal age of suicides, why not look it up? This should be readily knowable. My understanding is that many suicides are prompted by lack of medical, particularly psychiatric care. You could even do this for accident victims.
Thank you Sophie for posting these anecdotes. They flesh out the human pain and suffering brought about by lack of insurance. Which I for one feel is a more important moral issue than the one in the lead to this thread.
Yancey,
Here is the NIMH statement on suicide. The highest incidence group is men over 85. This would tend to lift life expectancy. The NIMH urges that this information go out:
Suicide is a major, preventable public health problem. In 2004, it was the eleventh leading cause of death in the U.S., accounting for 32,439 deaths.1 The overall rate was 10.9 suicide deaths per 100,000 people.1 An estimated eight to 25 attempted suicides occur per every suicide death.2
Suicidal behavior is complex. Some risk factors vary with age, gender, or ethnic group and may occur in combination or change over time.
If you are in a crisis and need help right away:
Call this toll-free number, available 24 hours a day, every day: 1-800-273-TALK (8255). You will reach the National Suicide Prevention Lifeline, a service available to anyone. You may call for yourself or for someone you care about. All calls are confidential.
What are the risk factors for suicide?
Research shows that risk factors for suicide include:
depression and other mental disorders, or a substance-abuse disorder (often in combination with other mental disorders). More than 90 percent of people who die by suicide have these risk factors.2
stressful life events, in combination with other risk factors, such as depression. However, suicide and suicidal behavior are not normal responses to stress; many people have these risk factors, but are not suicidal.
prior suicide attempt
family history of mental disorder or substance abuse
family history of suicide
family violence, including physical or sexual abuse
firearms in the home,3 the method used in more than half of suicides
incarceration
exposure to the suicidal behavior of others, such as family members, peers, or media figures.2
Research also shows that the risk for suicide is associated with changes in brain chemicals called neurotransmitters, including serotonin. Decreased levels of serotonin have been found in people with depression, impulsive disorders, and a history of suicide attempts, and in the brains of suicide victims. 4
Are women or men at higher risk?
Suicide was the eighth leading cause of death for males and the sixteenth leading cause of death for females in 2004.1
Almost four times as many males as females die by suicide.1
Firearms, suffocation, and poison are by far the most common methods of suicide, overall. However, men and women differ in the method used, as shown below.1
Suicide by: Males (%) Females (%)
Firearms 57 32
Suffocation 23 20
Poisoning 13 38
Is suicide common among children and young people?
In 2004, suicide was the third leading cause of death in each of the following age groups.1 Of every 100,000 young people in each age group, the following number died by suicide:1
Children ages 10 to 14 — 1.3 per 100,000
Adolescents ages 15 to 19 — 8.2 per 100,000
Young adults ages 20 to 24 — 12.5 per 100,000
As in the general population, young people were much more likely to use firearms, suffocation, and poisoning than other methods of suicide, overall. However, while adolescents and young adults were more likely to use firearms than suffocation, children were dramatically more likely to use suffocation.1
There were also gender differences in suicide among young people, as follows:
Almost four times as many males as females ages 15 to 19 died by suicide.1
More than six times as many males as females ages 20 to 24 died by suicide.1
Are older adults at risk?
Older Americans are disproportionately likely to die by suicide.
Of every 100,000 people ages 65 and older, 14.3 died by suicide in 2004. This figure is higher than the national average of 10.9 suicides per 100,000 people in the general population. 1
Non-Hispanic white men age 85 or older had an even higher rate, with 17.8 suicide deaths per 100,000.1
Are Some Ethnic Groups or Races at Higher Risk?
Of every 100,000 people in each of the following ethnic/racial groups below, the following number died by suicide in 2004.1
Highest rates:
Non-Hispanic Whites — 12.9 per 100,000
American Indian and Alaska Natives — 12.4 per 100,000
Lowest rates:
Non-Hispanic Blacks — 5.3 per 100,000
Asian and Pacific Islanders — 5.8 per 100,000
Hispanics — 5.9 per 100,000
What are some risk factors for nonfatal suicide attempts?
As noted, an estimated eight to 25 nonfatal suicide attempts occur per every suicide death. Men and the elderly are more likely to have fatal attempts than are women and youth.2
Risk factors for nonfatal suicide attempts by adults include depression and other mental disorders, alcohol abuse, cocaine use, and separation or divorce.5,6
Risk factors for attempted suicide by youth include depression, alcohol or other drug-use disorder, physical or sexual abuse, and disruptive behavior.6,7
Most suicide attempts are expressions of extreme distress, not harmless bids for attention. A person who appears suicidal should not be left alone and needs immediate mental-health treatment.
What can be done to prevent suicide?
Research helps determine which factors can be modified to help prevent suicide and which interventions are appropriate for specific groups of people. Before being put into practice, prevention programs should be tested through research to determine their safety and effectiveness.8 For example, because research has shown that mental and substance-abuse disorders are major risk factors for suicide, many programs also focus on treating these disorders.
Studies showed that a type of psychotherapy called cognitive therapy reduced the rate of repeated suicide attempts by 50 percent during a year of follow-up. A previous suicide attempt is among the strongest predictors of subsequent suicide, and cognitive therapy helps suicide attempters consider alternative actions when thoughts of self-harm arise.9
Specific kinds of psychotherapy may be helpful for specific groups of people. For example, a recent study showed that a treatment called dialectical behavior therapy reduced suicide attempts by half, compared with other kinds of therapy, in people with borderline personality disorder (a serious disorder of emotion regulation).10
The medication clozapine is approved by the Food and Drug Administration for suicide prevention in people with schizophrenia.11 Other promising medications and psychosocial treatments for suicidal people are being tested.
Since research shows that older adults and women who die by suicide are likely to have seen a primary care provider in the year before death, improving primary-care providers' ability to recognize and treat risk factors may help prevent suicide among these groups.12 Improving outreach to men at risk is a major challenge in need of investigation.
From Medscape, an online journal for medical professionals:
Secular Trends
The adolescent and young adult age group (aged 15–24 years) showed a continuously increasing trend in rates until 1994, at which point rates began declining steadily to levels not seen since the early 1970s. It is too soon to tell if the slight increase from 1999 to 2000 represents a statistical fluctuation, a stabilization of rates, or a reversal in the declining trend, although data for 2001 show the suicide rate for this age group declined again (to 9.9 per 100000),[44] and final data for 2002 show that it remained at 9.9 per 100000.[45] Rates among the oldest group (those aged 65 years and older), fluctuated somewhat during the 1970s, reached a low point in 1981, increased rather sharply until 1987, declined steadily through 2001, and then increased in 2002. Rates among the 45-to-64-year age group declined rather sharply during the late 1970s and more gradually thereafter, but rates increased each year from 1999 through 2002. Rates among the 25-to-44-year age group, by contrast, showed a slight bump during the late 1970s, somewhat stable rates through the 1980s and early 1990s, and a slight decrease after 1995 to fairly stable rates for 1999 to 2002.
In the oldest and youngest groups from 1990 to 2002, Poisson regression models, with standard errors adjusted to account for overdispersion, showed that the trend for decreasing rates was statistically significant for both age groups (P
Uh... Ok.
I don't doubt that the highest incidence group for suicide is older men (this makes a certain morbid sense to me), but the numbers of such total suicides is quite small for the simple reason that there are few men over age 85. The numbers you cite suggest that the rate of suicides of young adults is higher than the overall rate of such deaths. The factor I was getting at is that the average age of death for suicide victims is certainly going to be significantly below the average age of death for all who die.
When I have time later, I will attempt to put some numbers to Stossel's claim. It is easy for me to find numbers for the United States, but for other countries, it is not so trivial to do.
cs,
If I use the numbers you gave for the US and the UK, the difference in life expectancy between the two is less than 1%. Using the numbers from the WHO, the difference between the US and Japan, the country with the first rank, is just over 5%. I doubt that the US would be ranked #1 with such adjustments, but that is not what Stossel claimed.
"our homicide rate is 10 times higher than in the U.K., eight times higher than in France, and five times greater than in Canada."
Don't know where these data come from but they are flat wrong. The homicide rate per year per 100,000 inhabitants was:
U.S. = 5.6 (2002)
U.K. = 2.03 (2002)
FRA = 1.64 (2003)
CAN = 1.67 (2002)
As you can see, it's not 10, 8, or 5 times higher, it's more or less 2 to 3 times higher (source)
Homicide in 2002 accounted for 0,7% of all deaths.
Unintentional injuries (or "accidents" as in motor vehicle accidents, falls, drowning, fires, poisoning, etc.) in 2002 accounted for 4.4% of all deaths (source).
Comparing transportation deaths between countries is more difficult: the US spends far more time ‘on the road’ than other countries do. People in other countries therefore would have more change dying from other accidents: falls, drowning, electrocution, etc.
Such differences in numbers (for instance 4.4% unintentional injuries in the US as compared to lets say 2.2% in the rest of the world, highly unlikely but just for the sake of argument) are far too small to dramatically change life expectancy. It would change a month at most, even if all these unintentional injuries were suffered by infants.
Another point. Some claim other countries report stillbirths etc. differently. The WHO - or any other health research institute - doesn't use the numbers that are reported by the countries uncritically, it computes it so that the numbers can be compared. Read the WHO-reports. The WHO also gets a lot more data, esp. from the Western countries. And those countries have standardized their methods for recording those data, according to guidelines from the WHO.
Ok. Let's put this Stossel thing to bed, ok?
I just looked at Stossel's article again to see what exactly he does claim. He lists exactly three reasons the US was incorrectly ranked poorly in the WHO study: inaccurate life expectancy, poor diet and exercise, and factoring in equality of distribution.
I've talked about life expectancy already and I'm not going to again. It's a red herring: so what if life expectancy numbers can be adjusted by some small but non-trivial amount? Would that small adjustment actually serve to significantly undermine the broader claims of the study? No.
Second - sure, diet and exercise do affect health. But it's silly to pretend that these affects occur separate from the health care system. It's not just that the diseases caused by diet and exercise problems are ameliorated by better health care; health care includes altering diet and exercise. It's not like you only have the option of treating diabetes: there is also the option of going to the doctor before you have diabetes, getting a physical, and avoiding getting diabetes in the first place. That's called preventative care, or public health, but we hardly practice it in this country because private insurance companies have decided not to fund it.
Third, this is Stossel's "conclusion" as to why equality of distribution unfairly penalizes the US: "By that criterion, a country with high-quality care overall but "unequal distribution" would rank below a country with lower quality care but equal distribution."
How, exactly, can a country be held to have "high-quality care overall" without having that care equally distributed? What does the "overall" in that sentence refer to except distribution? Am I really supposed to conclude that the US has a good health care system because it provides great care for the wealthy?
From these objections Stossel concludes: "saying that the U.S. finished behind those other countries is misleading," and "it strains credulity to hear that the U.S. ranks far from the top."
Well, no, actually, it's not surprising at all. A lot of studies conclude much the same thing - are they all wrong in equally insignificant ways? The US may be, say, 30th instead of 37th, but that's a minor correction.
But let's stop pretending that Stossel actually cares about health care. If he did, he'd have looked at the broader claims of a number of studies. He'd have looked at some serious cost/benefit analysis. He'd have examined alternative solutions to the problems he found. But, instead, he decided to rhetorically discredit the entirety of one particular study by picking ineffectively at minor details and not showing any of his work. That isn't serious or honest, it's garbage.
And Megan caught Stossel's propaganda and passed it on - notice that she didn't bother to look at any other studies either. She's written thousands of words here about health care just this week and she's not bothered to actually do any ECONOMICS - are we supposed to conclude from that that she cares deeply about health care? Or, rather, that she cares, but not enough to do any actual work? Or can we just conclude that Megan doesn't care at all about what she posts and move on to someone who does?
As far as I can tell (quick google search), infant mortality counts against life expectancy at birth. This would have a significant effect. Given how infant mortality is counted, the US penalizes itself by counting more births as "live births" than many other countries.
Many of the young people who choose not to have insurance CAN afford it. Somewhere in this thread, someone posted the household incomes of these people. They are not poor. They may choose to play Russian roulette with their health, but they are making an informed decision. There's an unstated assumption by some in this thread that they shouldn't be ALLOWED to make this choice.
brooksfoe, what is your tax rate? Mine is about 14% and I make pretty good money and don't use any financial shenanigans to avoid taxes.
EI
Somewhere in this thread, someone posted the household incomes of these people. They are not poor. They may choose to play Russian roulette with their health, but they are making an informed decision.
I wonder about this figure, though. How many of them are still dependents, or living with roommates? I didn't have health insurance for two years, and my household income was nearly $55,000. However, over $36,000 of that was my roommate. What areas are they living in? $50,000 in California is not $50,000 in Iowa.
To draw your conclusion from those figures is beyond presumptuous.
See, this is what I was talking about when I said you can't really seperate the efficiency arguments from the moral ones.
Part of the argument in favor of universal health care *is* paternalistic.
"Given how infant mortality is counted, the US penalizes itself by counting more births as "live births" than many other countries."
In the comments section of the JaneGalt blog I posted the results of studies of the relation between infant mortality and income level in places that have universal medical coverage and places that don't. This kind of study bypasses the question of how live births are counted. The first study I cited compared infant mortality in Manhattan, Paris, London, and Tokyo. It found a strong inverse relation between infant mortality and income level in Manhattan, but not in the other cities. People like Earnest Iconoclast objected. They said that low income women in Manhattan had much more unhealthy life styles than their more affluent sisters, but that there was little difference between the life style of low and high income women in Paris, London, and Tokyo. I then cited a study of infant mortality in the US armed forces, the one segment of American society that has universal medical coverage. In contrast to Manhattan, there was virtually no relation between infant mortality and service rank. As I recall, the study covered both women in the armed forces and the spouses/partners of men in the armed forces. I was then informed that the women in the study resembled women in Paris, London, and Tokyo in that they had healthy life styles at all income levels, unlike Manhattan. I then cited a study showing that smoking is much more prevalent among low service rank women on US military bases than higher rank women on the same bases. I was then informed that other bad life style choices have a much greater effect on infant mortality than smoking. Needless to say, the comments objecting to the articles I cited were unsupported by any data.
At this point, I gave up.
EI, what exactly are you getting at by asking my tax rate? I live outside the US, so my first $80,000 is tax exempt. (Which, in my case, is more than I earn.) However, I'm self-employed, so I pay self-employment taxes on my income after business expenses and deductions. What is the relevance supposed to be?
Thanks, Dalea
I am familiar with some preventable death data, the kind generated as result of hospital screw-ups. Which brings up some more important anectdotes.
As an attorney who has had experience prosecuting and defending med mal cases and has also represented insurers for physicians and hospitals, I can tell you that the quality of care has fallen because of hospital efforts to cut labor costs. The number of patients under the care of each nurse has risen, and many hospitals now resort to less trained staff to monitor patients. Seems to me that there is pretty clear evidence that we are being hurt by the efforts to address the bottom line -- something which is not an issue (or at least not the same type of issue) with state-provided care.
At this point, I gave up. -- Stan
Unfortunately, Stan, because your opponents are funded by the health insurance industry, they never fucking give up. They keep slinging the stupid, year after year after year.
Gosh, the American ego really is fragile. Every issue has to be discussed in relation to every other nation in the world in order for it to have meaning. And then everyone gets caught up in how differing standards mean that comparisons are impossible.
It really is odd. In the rest of the modern world, most people view health care as a response to particular problems and socialised health care as a way to address what can be a disastrous financial crisis for too many people. Hardly anyone thinks of it as a mechanism by which the nation can become bestest country in the world!
Why don't you forget the rest of the world and look at the good/harm associated with the present system of health care delivery and fix things to solve some of the problems?
Frank, it's not a matter of discussing things in relation to the rest of the world in order for it to have meaning. It's a question of how to do better. The world outside Great Britain started industrializing in the early 19th century because Great Britain showed it was possible. The British government sent officials to Germany in 1909 to learn how to set up a retirement system. Germany learned how to run a dictatorship in the 30's from Russia. The list is endless. The reason people look abroad to learn about health care systems is that they don't want to reinvent the wheel. Every scientist in the world reads foreign journals and books to improve their own work. Why should public policy be any different?
Quoting Stossel? Are you nuts?
"Similarly, our homicide rate is 10 times higher than in the U.K., eight times higher than in France, and five times greater than in Canada.
When you adjust for these "fatal injury" rates, U.S. life expectancy is actually higher than in nearly every other industrialized nation.
This is one of his favorite tactics - baldface lying.
About 20,000 Americans per year are murdered, and another 50,000 or so are killed in car accidents. That's less than 2% of our deaths. Multiply that 2% by less than 50 years of life cut short, and you get less than a 1 year change in our life expectancy. Even without considering murders and accidents in other countries, it isn't a big relative change. And as long as we are considering our high homicide rate compared to other industrialized nations, how about considering our low suicide rate compared to others.
If you care at all about your rep, don't quote Stossel. He lies frequently and intentionally.
Why don't you forget the rest of the world and look at the good/harm associated with the present system of health care delivery and fix things to solve some of the problems?
Posted by Frank | August 27, 2007 12:06 PM
Because there are people in this country who insist that we have the best health care in the world so those of us who WANT to "look at the good/harm associated with the present system of health care delivery and fix things to solve some of the problems" should just STFU.
That's why.
brooksfoe, I guess I should have asked what the tax rate in the Netherlands is. But I can see that the Netherlands have both high income taxes and high VAT compared to the US.
I tried to find something on exactly how Dutch health insurance/health care is funded but didn't have time. I did note that health care costs seem to be rising rapidly in the Netherlands.
Anyway... I don't think that our system is perfect nor do I like the fact that poor people do not get good treatment. I would like to have a safety net in place so that the poor receive better care. I do not, however, want to see a socialized system or universal, government controlled system. Even if it works in other countries, I have no faith in our own Federal government to run such a system effectively.
EI
EI, check out this URL on the health system used in Singapore:
www.watsonwyatt.com/europe/pubs/healthcare/render2.asp?ID=13850
It achieves universal coverage in a free enterprise way, it gets good results, it's inexpensive, and it's popular. It's similar to what Arnold Schwarznegger is proposing in California and to the system under development in Massachusetts. Bismark enacted a system like this in Germany in the 19th century to head off something more socialistic. I think universal coverage is coming in the US because big manufacturers here are cutting their medical benefits and people need a safety net. I don't understand why conservatives find it so difficult to adapt.
Wow, Megan----so let's incorporate murders to make the mortality picture look prettier?!
And as to the "outdatedness" of the 2000 report, please be advised that our current rating is even worse----we've since sunk to no. 42.
No, a single payer isn't going to "magically improve things," dear. There is nothing "magic" about it: it simply makes far better economic sense for the government to administer the health care of a third of a billion people, than to treat it as a retail commodity, like new shoes. The idea that health care would be submitted to the vagaries of the free market is, to me, preposterous. After all, if I think a pair of sandals is too pricey I can always wait for a clearance sale. But can I hold out for a sale on appendectomies if mine bursts?
This obvious bit of wisdom has been recognized by EVERY CIVILIZED COUNTRY ON THE PLANET. Except us. When will we come out of the Dark Ages?
I am a physician, and I have lived and traveled extensively in Costa Rica. I can assure you that it is much better to be an average person in Costa Rica than a poor person in the USA---and even the poor people (which is the minority there as well as in the USA) have better access to health care in Costa Rica.
I have also lived in Canada...and it is better to be a poor person in Canada than working class in the USA...and that is clearly because of the social safety net that they enjoy in Canada. The USA could do better than Canada, after all it is much richer. So why doesn't it? People criticize the Canadian system, but it works well enough to put the US system to shame. I know this from direct observation, as a physician within the health care system.
Most Americans would rather live in America than anywhere else...but there are 4 million Costa Ricans who would rather live there than anywhere else (just go there and ask a few, not to mention all the Americans and Europeans who have immigrated there). Furthermore, there is a growing medical tourist industry for Americans who travel to Costa Rica specifically to get high quality medical care that is affordable.
Your argument just isn't valid, but does reflect common misperceptions that Americans have who have never really gotten to know what life is like in another country.
hmmmm... I live in Costa Rica. I don't have super-awesome experience with the health care system, but I will note that, first of all, it's not "universal," it's single payer. you don't get health insurance as a birth right, you have to pay for it from the Caja Costarricense de Seguro Social.
second of all, it's definitely got problems. For example, they have a national emergency right now because the state hospitals can't seem to keep anesthesiologists around. that's kind of bad for you if you need surgery.
third of all, the "medical tourists" who come here generally come for cosmetic dentistry and plastic surgery, not cancer treatment. and no one comes to visit the state hospitals.
fourth of all, the state hospitals occasionally catch fire and kill a few dozen people, and the state bureaucracy seems too paralyzed to do anything about it.
fifth of all, I seriously doubt any American would feel perfectly comfortable in a state hospital here, although to be fair, I would imagine that inner-city American hospitals aren't much prettier.
All that said, if you trot out the cost-benefit analysis, I would say health care here is still a much, much, much better value for your buck, even with all the inefficiencies and whatnot.
The real question remains: why do Americans pay so much to get so little? and that's why our system is in need of fixing.
"Wow, Megan----so let's incorporate murders to make the mortality picture look prettier?!"
Um, no. Her point was that murders are ALREADY incorporated into the healthcare figures, dragging the U.S.'s rating down.
God, I F***ing HATE SOPHISTRY. Who are these people who can't be bothered with keeping their arguments honest? At least Rush & Hannity are getting paid for dishonest blather.
Just to respond briefly to pjk above, Health Care actually is more than a birth right in Costa Rica. It is a universal right, extended even to illegal Nicaraguans. The caja de seguro social is obligatory payment that wage earners contribute, just like social security in the USA, but unlike the USA the national health plan, by law, can not exclude anybody, even if they aren't working.
My poor neighbor in the country side wasn't complaining about the lack of comforts and air conditioning when the surgeons saved his childs hand that was injured in a slammed door, nor did my mother when her life was saved in the public hospital. They wouldn't trade their system for an American style system where they would have been denied care.
Maybe Americans won't come here for cancer treatment, but when a tourist has a serious accident he sure is glad when he can get excellent quality critical care and pay only a few thousand for it (instead of a few hundred thousand).
To Twosquare:
Instead of referring to an unnamed European that you know who comes to the U.S. to get health care I will give you a real name that all will know.
Rich de Voss ( of Amway fame) went to Europe a few years ago to get some kind of heart surgery.
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