Boy, I'd sure like to see some backup for that. If by "extraordinary" Megan means the most extreme 0.001% of procedures, then maybe she's right. Maybe. But nothing I've read about Western European healthcare systems makes me believe that there's any substantial difference between the way they treat severe illnesses and the way we do it. And no systematic difference in success rates for such treatment either. Nor should this come as a surprise, since most extreme medicine is practiced on older patients, who are covered by a public plan both here and in Europe.
If only Kevin had a subscription to The Atlantic--very reasonably priced at 19.95 a year--he would have found a hint in Virginia Postrel's article about Herceptin and early stage breast cancer, which we ran in March. That article is about New Zealand, but the controversy over Herceptin was not limited to the Southern Hemisphere; Britain had a famous case involving the expensive cancer drug, in which a woman successfully used a combination of legal and media pressure to force the NIH to provide her with the drug for her early-stage breast cancer (she has since died). Early stage HER2 positive breast cancer is hardly a 0.001% event--25% of breast cancers have the HER2 trait, and those tend to be the more aggressive kinds of cancer. The drug had already been offered for early stage cancers in the US for years, even though no one had definitive proof that it worked.
This may be why--contrary to what Mr. Drum has apparently read--cancer survival rates in Europe lag those in the US. (Although this is complicated: we catch cancer earlier, because we're screening-test-mad, and some cancers just hang out for decades without killing you). At the highest macro level, life expectancy, Europe generally outperforms us. But it's not clear how much of that is health care, and how much things like our murder rate, and our famously sedentary lifestyles. When you drill down into many diseases, we outperform them. And many argue that we outperform them on hard-to-measure "lifestyle" issues: how fast your torn ACL gets repaired, how quickly (or whether) you get a hip replacement, etc. Such quality of life issues are nearly impossible to measure, though this hasn't stopped many people from trying. But I don't really trust the figures they generate.
Europe gets a great deal out of all of this. We figure out what works, then they adopt it. But we get a great deal too--we get earlier access to controversial treatments, and our future generations get all the treatments we've discovered so far..
"Europe gets a great deal out of all of this. We figure out what works, then they adopt it. But we get a great deal too--we get earlier access to controversial treatments, and our future generations get all the treatments we've discovered so far.."
The "we" you use here refers, of course, to people like you and I and your other readers/commenters, who are in the upper income brackets of society and have insurance that will cover these expensive controversial treatments. You should take a poll of the 47 million uninsured Americans and ask them what kind of a great deal they're getting. And whether they'd want the great deal Europe gets instead, in which people have a much lower rate of going bankrupt or dying because of an inability to afford healthcare. Oh, and make sure you do it in person, so you can truly appreciate the intensity of their responses.
And whether they'd want the great deal Europe gets instead
They might also want your house, car, vacation, the schools your kids go to... They can also get all that, the same way like [presumably] we all did. It used to be a free country... and if it ceases to be, there's no longer any place to run to.
If you want the intensity of the responses from the other side of the isle, you can try that too. Just be prepared to handle it.
So you think owning a McMansion and two Ford Explorers--maybe even a Lincoln Navigator or two--defines quality of life? How about clean, architecturally beautiful, walkable cities with first-rate mass transit; a month's paid vacation for everyone; paid maternity leave; etc., etc. You evidently are partial to the cherished "freedoms" of American life, which include the freedom to suffer, die, and/or go bankrupt if you can't afford the premiums charged by the extortion racket known politely known as "the health-care insurance industry" in the United States.
The United States could do with a few dollops more of egalite and fraternite to complement its vaunted liberte.
clean, architecturally beautiful, walkable cities with first-rate mass transit
Yeah, like Paris? A freaking nightmare.
a month's paid vacation for everyone
Been there, done that. You can repair your 30-yr old flat in that month -- a little bit, 'cause materials might be a tad expensive.
You evidently are partial to the cherished "freedoms" of American life
Yes I am. I have immigrated to the USofA 15 years ago and never looked back.
The United States could do with a few dollops more of egalite and fraternite to complement its vaunted liberte
It can happily do without.
Well, Max, chacun a son gout, even if your gout is a bit . . . degoutant.
van mungo, you are truly right, the hallmark of civilization is walkable cities and first-rate mass transit.
The other day, a few of my troglodyte American cohorts and I took a break from driving our Ford Explorers around myMcMansion --- each bought with money earned from exploiting the proletariat --- and talked about what defined greatness in a society.
Each of us are American to our quick,that is we relish raping Mother Gaea with the internal combustion engine and have no interest in beautiful architecture, just ugly. But all agreed that through the annuals of history one thing remind consistent in all great civilizations --- their cities' walkabllity and a ton of top-notch mass transit. In comparison, freedom and innovation are mere imposers.
Excelsior, van mungo, for the bravery you have shown in advancing this theory. It reminds me of the words of another of our great thinkers --- Cliff Clavin. It was he, one Thursday night in the 1980s, who postulated that the common thread among great societies was comfortable footwear. As he reasoned, what else explains both the Greeks and Romans wearing sandals.
My only wish is that more people wake up to the potential glories of a civilization with walkable cities and and first-rate mass transit. Perhaps someday we'll have a leader strong enough to do away with silly liberties and bend the masses to his and your will, van mungo. The rest we can just throw into a mass grave, eh.
RMOccidental--
Heaping great piles of sophomoric sarcasm doesn't disguise your basic ignorance.
There is a vast literature among serious urban planners about the failed American suburban model--vast tracts of this suburban sprawl are likely to turn into unsustainable, abandoned slums in the next generation as the combined impacts of global warming and peak-oil price spikes torpedo the cheap-gasoline culture on which this McMansion creep depends--along with the whole infrastructure of strip malls that are accessible only by automobile.
Instead of polishing your eighth-grade snark style, you mind find your time better spent reading some of the literature of the New Urbanism to understand the scope of this impending crisis--already hastening upon us because of the real estate crash-and what can be done to address it. The excellent book The Architecture of Nowhere is an excellent place to start educating yourself.
Sometimes, it's just when you're straining hardest to sound smart that you end up sounding pathetically ignorant. In this self-embarrassment you have succeeded admirably.
Europe only gets their great deal because we get our great deal – we can't both have their deal because their deal requires an 'America' to actually create all the great new (expensive) things and let (global) rich people get first dibs. We can't all give everything equally to everyone. Someone, somewhere, needs to allow something like a market to exist. If anything, we (the humans) would be better off (overall) if everyone had a health care system like ours.
Oh, sure--America creates all the "great new (expensive) things" like impending global climate catastrophe, shopping malls, death-trap gas-guzzling SUVs, criminal wars of mass destruction in Iraq and Afghanistan, showering the planet with hundreds of billions of armaments each year to fuel tribal warfare, and, of course, Sarah Palin, Desperate Housewives, and homicidal video games.
Strike up the band!
Don't forget McDonalds, Disney, Wal-Mart, and JR Reynolds! Free Markets for all!
And removes the necessity for Europe to defend themselves.
Derek
Yeah, and America grows opium and exports it to various nations in order to ... wait, that's Afghanistan.
showering the planet with hundreds of billions of armaments each year to fuel tribal warfare,
Because people were naturally peaceful before guns were invented and nobody makes them except the United states. When China and Iran do this kind of thing, do you criticize them too>
And you didn't really address the previous argument; that the world really does do a tremendous amount of freeloading on American technological innovation and drug development.
As for global warming, you do realize that CO2 is historically a lagging, not a leading indicator of climate change, right? Apparently noone explained this to Mr. Gore before he made his famous powerpoint presentation. Which means either he's willing to deliberately misrepresent information or else he just doesn't understand what he's presenting.
Replying to van Mungo's two posts:
1. A month's paid vacation might become untenable for anyone in the currently developed world, once China / India and other formerly undeveloped countries get their act together. Whether you admit it or not, you will have to compete with give or take 1.5 billion new workers. Supply, meet demand.
On the same note, why not health tourism as a solution for the next 10 years or so (until medical costs in those countries escalate to our levels). If chinese factories could keep inflation in the states in control, no matter what Mr Greenspan did to the short rate, why not chinese doctors? (I dont see the AMA recommending that, of course; nor the NHS in Britain)
2. There is certainly a lot to decry in American life; just as there is in life in pretty much in every country. Similarly, there is much to savour. Optimist / Pessimist and all that.
3. The excesses you see in American life might be simply the lower tail of a distribution with larger sigma than in other developed countries. If you think the upper tail does not balance it out, ie, if you think there is a negative skew, I would like to know how you are valueing the two tails.
4. Dont you think Ms Palin is entertaining; now that she does not stand a chance to come to power in the immediate future? In any case, arguably she swung the issue for Obama by driving out those republicans who are fiscal conservatives, but social liberals.
5. Homicidal video games?
Actually, they get better care in some instances.
An orthopedic surgeon who grew up in Canada, worked in the US for a time and now is back practicing in Canada, said that when someone insured needed care, the insurance company would get the treatment in the local hospital with varying degrees of competence, experience, equipment, etc. Non insured were brought to his hospital where they received better care.
In Canada, unless the treatment is life threatening, you wait for a very long time. Right now, for me, who would be similar to an insured american, if I injure myself, trash my knee for example, non life threatening or 'elective' as they say, it is cheaper for me to pay for surgery than wait a couple of years without income until they get around to fixing it for free. I would be personally bankrupt if I couldn't work for two years waiting for treatment.
Derek
It's easy to toss around uninformed echoes of HMO scare propaganda. Why not have recourse to some facts?
http://canadaonline.about.com/od/healthcarewaittimes/Wait_Times_for_Health_Care_in_Canada.htm
http://www.denverpost.com/opinion/ci_12523427
http://www.ourfuture.org/blog-entry/mythbusting-canadian-health-care-part-i
http://www.ourfuture.org/blog-entry/mythbusting-canadian-healthcare-part-ii-debunking-free-marketeers
As for wait times--what are the wait times for the 46 million Americans with NO coverage whatsoever, or for the 70 million underinsured?
What are the wait times for the 18,000 who die EVERY YEAR because they can't afford to see a doctor? Their wait times are forever.
That's the price and market rationing of America's barbaric "pay-or-die" health-care system--the most severe and punishing rationing in the industrialized world.
Two things van Mungo,
The only thing the evidence you presents proves is you don't know the difference between anecdote and fact. Second, if you're statement that 18,000 die every year because they can't afford a doctor is correct then America is doing pretty good. That means more people go to the Sturgis bike rally than die do to medical neglect. Thanks for providing a salient point as to why America has such great health care.
"You should take a poll of the 47 million uninsured Americans and ask them what kind of a great deal they're getting"
Everyone knows the "47 million" figure is inflated by about 100%. Furthermore, not having insurance does not mean not having access to treatment, as there are a plethera of State and Federal programs which care for the greater share of the uninsured.
The people who get shafted are the working lower class, who do not make enough to be able to afford insurance, but make too much to qualify for aid programs. It is bad for them, I will grant you, but shoring up the system for them does not require revamping the entire system for everyone else, and saddling them with a government run, government-quality, one-size-fits-all, lowest-common-denominator, care-rationing system.
Everyone does not know this. Let's see your sources--serious academic sources, not right-wing propaganda mills like the Hoover Institution or Human Events.
Single-payer is not a government-run program. It would be publicly financed but privately administered, and would offer complete freedom of choice of physicians (as in Medicare and in Canada), unlike most HMO plans, which restrict choice to in-network physicians.
Here's where you can educate yourself on this matter so you won't further inflict your right-wing boilerplate on this thread:
http://www.pnhp.org/facts/singlepayer_faq.php
Clearly, you have no clue what you are talking about, so you try to stifle contrary opinions by erecting strawmen and referencing useless, boilerplate Left Wing propaganda as if it were dispositive because...? I can only surmise because it was written down somewhere, and it conformed with your prejudices.
Come back to me when you show yourself capable of speaking for yourself.
You peddle right-wing lies about what "everyone knows with no sources; you speak of a "government-run" health-care system even though I've documented the point about five times that the single payer proposals for the U.S. are privately administered. So who doesn't know what he's talking about, Mr. Walking Disinformation Machine?
The faq I provided was an opportunity for you to educate yourself on this topic. It's a full-time job in your case, and I have better uses for my time.
And, for your information, Physicians for a National Health Plan is one of the most distinguished medical advocacy groups in the country, whose leadership is composed largely of leading doctors from Harvard Medical School, with a membership of 16,000 physicians. All of the information they provide is thoroughly documented, unlike your spree of lies.
So you can either continue to spew your Fox News talking points like a demented parrot, or you can begin to educate yourself. Your choice.
We inform. You decide.
You should take a poll of the 47 million uninsured Americans and ask them what kind of a great deal they're getting.
I pay every penny of my own health care because I am one of those uninsured Americans. I have a regular doctor just like most people. I make appointments, then I pay with my debit card instead of with my insurance card. The doctor gets his pay right away instead of having to fill out an insurance form, send it in, and then wait for payment.
Insurance does not reduce the costs of health care - it increases the total costs. The insurance company (or government) pays the costs of health care, plus the costs of processing all of the paperwork, plus the costs of fraudulent claims. And the doctors' offices all have to hire someone to process insurance forms. Fifty years ago, doctors didn't have to pay someone to handle all the paperwork; now they do. And now, people get unnecessary tests because "the insurance will pay for it."
Am I a rich guy who can afford to pay for Cadillac health care? Hardly. I'm in the lower income tiers. I go without health insurance because it is much cheaper to buy the health care I need than it is to buy health insurance, which has state mandates for pregnancy, alcohol dependency, mental health, etc. all of which I don't want to buy.
And by paying my own way, nobody else can prevent me from getting a second (or even a third) opinion. And I can choose whatever doctor I want, and whatever treatment I want (e.g. an MRI) without having to get approval from anybody else.
I get better health care at a lower cost by doing without health insurance.
I'm sure you don't think that those the uninsured have no access to health care. The uninsured don't have access to the same degree as the insured but they surely benefit from the extra money spent in this country on health care.
Further why is it then when every anyone talks about the uninsured there's an implication that they're mired in poverty? Medicaid covers those people. The uninsured in this country are - generally speaking - people who are non-citizens, making too much money to be eligible for medicaid and can't afford private insurance,making too much money to be eligible for medicaid and don't want to pay for private insurance, and people who are eligible for some form of public health care but not taking advantage of it.
47 million
-10 million of those are not American citizens
-18 million have annual household income of more than $50,000
-12 million already eligible for Medicaid.
-----------
8 million uninsured
45% of those are uninsured four months or less
we get earlier access to controversial treatments
If, and only if, we can afford them. The 10.5% of men (and 8% of women) who are unemployed and have no health insurance because of that would be better off in a European system. The large number of men and women who get no health insurance from their employers would also be better off in a European system.
I think, based on my experience and that of my friends, that probably half the country would be better off under some sort of federalized health system. Half, that is, of the group that isn't already getting health care (directly or indirectly) from the Federal government. I wonder just how many people are in military health systems, VA, medicare, and other Federally subsidized (or fully funded) systems? A quarter of the country? More?
More specifically, they would be better off with a system where health insurance wasn't primarily provided by employers. That doesn't necessarily mean a government-run system.
bingo.
But I'm not sure I'd let the people who presently run the insurance business run it, either. The CEO's of the major insurance companies, pharma, nursing homes, etc. are all part of the problem. I don't expect they'll give up their honey pot of geriatric care easily; not with baby boomers getting ready to retire.
So who should?
The single-payer proposals being advanced for the United States--John Conyers's HR676 and Bernie Sanders's S703--do not involve a government-run system, either. They call for a publicly financed but privately administered system, along the lines of Medicare and the Canadian system, both of which afford complete freedom of choice of doctors (unlike the restricted in-network choices typical of HMOs). All the private hospitals and labs would remain private, and physicians would remain self-employed.
A quarter of US citizens are already the beneficiaries of federal health care? That's up from something lower, right? Has health care gotten better because of the large number of people covered by the federal government? What are we talking about again?
And if you're worried about having access to the most expensive controversial treatments, I'm sure there will be supplemental insurance plans out there for purchase if the baseline public OPTION or equivalent private insurance company plan is not enough to satisfy wealthy individuals. Ever heard of Medicare supplemental insurance?
But those supplemental insurance plans will be private like current health insurance, so expect to be F'd out of your benefits when you most need them by a privately-employed bureaucrat working to maximize profit.
I'm sure there will be supplemental insurance plans out there for purchase if the baseline public OPTION or equivalent private insurance company plan is not enough to satisfy wealthy individuals.
Don't be so sure. One of the "features" of HilaryCare was that you couldn't opt out - everyone was covered by it and it only.
Of the 47 million, we shouldn't count the 10-20 million or so illegal aliens and the 10-20 million or so who are eligible for insurance but choose not to take it. So out of 300 million people, about 3-7% can't get insurance. The rest choose not to or shouldn't get it. By all means, lets rip out the while system and try a new one to make sure that those 3-7% are covered instead of figuring out a way to cover them under the current system.
Also, let's make sure that we take the 80-90% who are happy with the current health care and give them inferior health care for good measure. Yay!
You forgot to mention all the lower income people who are covered by Medicaid.
I think that they're supposed to included in the "10-20 million or so who are eligible for insurance but choose not to take it" number Earnest Iconoclast cited. IIRC there are about 10 million people who are already eligible for Medicaid and/or SCHIPS but don't enroll unless and until they need to see a doctor. Unless Medicaid/SCHIPS denies payment for services for people who are eligible but unenrolled, they’re basically “insured” for all intents and purposes. If not then you can reduce the “uninsured” number by about a fourth by just making enrollment mandatory as a condition for receiving other benefits.
Other than the people who are eligible for insurance but don’t take it or people who shouldn’t be getting it, we’re largely talking about (a) people who work for smaller employers who don’t provide health insurance, (b) younger and (comparatively) healthier people who don’t buy it because it’s expensive and they get very little benefit, (c) people who could afford health insurance but chose to spend their money on other things (e.g. people with incomes above $50,000 or $75,000), and (d) a small number of people with health problems that make it overly-expensive to buy insurance but don’t qualify for Medicaid or SCHIPS.
For (a), I’d let smaller employers form Association Health Plans so that they can form larger risk pools to buy insurance at rates comparable to larger companies.
For (b) and (c), I’d let consumers and employers buy health insurance across State lines, let them buy an actual health insurance rather than prepaid health care policy, and get one with a higher deductible and a health savings account so that they’re protected against a catastrophic event but have affordable premiums.
As for (d), I’m pretty open about whether to enroll them in a publicly funded plan like Medicaid or subsidize their purchase of a catastrophic policy.
Ye Gods. How hard is that?
What you're suggesting makes all the sense in the world which guarantees that it'll never happen. The uninsured are just a whip to get people moving in a preferred direction not a problem to be solved.
The fact that we spend more on health care is not necessarily a reason to have the government step in and stop us from doing so. It may be that we just like to consume more health care.
Sure. but discretionary spending isn't forbidden in the rest of the world. In the vast majority (maybe all, but I'm not sure about this) of other countries there are people who either pay some procedures out of pocket or opt out of government coverage and get a more expensive private insurance that provides better coverage.
The way I see it, the aim of a public plan is not to provide the degree of coverage of a private plan. Health care would be rationed, in the sense that the less cost-effective diagnostic tests, procedures and drugs would not be available to the patients. The lower coverage, along with some other government advantages (greater bargaining power, lower administrative costs) would make the public plan cheaper. If the patient feels the need to perform some diagnostic test or procedure not covered by the public plan, they will have to pay for them.
The goal here is to provide the uninsured, underinsured, and people struggling to make their insurance payments access to affordable (albeit lower quality) care.
But consumers who both want greater coverage and can afford it are perfectly free to sign up to (or maintain) their current private insurers.
This is controversial in those other parts of the world! The reference to the Herceptin story is about a treatment that private citizens, willing to spend their own private money, could not purchase – by government fiat! Governments are rarely satisfied merely paying for something – by golly, they better make sure people are doing the right™ thing too.
There's a reason why the rich from these other-parts-of-the-world (excluding, of course, the parts that do not actually provide, or even allow, health insurance [or health care]) frequently travel to the US for treatment – in the absence of a market, these wonder treatments aren't even available.
Megan writes:
(Italics mine.)
Perhaps it wasn't available because it's efficacy was in question, and in countries with some sort of nationalized system, efficacy is an important part of the services paid for.
The quibble is about the system's inability to allow outside payment. Or perhaps with what that system had decreed legal and illegal. Another quibble could be the ability to have citizens in various nations participate in the clinical trails that advance any treatment. But other countries offer treatments that are outlawed in this country, also. And many American companies benefit from research that is done abroad and then imported to this country for development into a marketable product; typically offered first to Americans. (We are the guinea pigs, don't forget that pertinent fact.)
There's a reason why the rich from these other-parts-of-the-world (excluding, of course, the parts that do not actually provide, or even allow, health insurance [or health care]) frequently travel to the US for treatment
AFAIK, this is a myth. Apart from very specific prodedures, they don't travel to the US for treatment. Not in significant numbers, anyway. They travel to India and Singapore and Romenia, where there are very cheap state-of-the-art private clinics. And they aren't the only ones - medical tourism is increasingly popular in the U.S. too.
I'm going to read the Herceptin story. I would be very surprised if the government denied patients the possibility to buy the drug, since governments have every reason to like people that are willing to pay for supplementary treatment
"governments have every reason to like people that are willing to pay for supplementary treatment"
Why? If you're trying to convince people that you're giving them high quality care for free, how does it help if people hear that there's a treatment that you're not providing? An earlier post of yours seems to take it for granted that everyone in these countries accepts that only a low level of care is provided through government systems, but that doesn't seem like something that governments would be willing to admit.
Maybe the government-run system simply decided that it would get better PR by letting this woman die than by allowing her to pay for treatment herself.
I read the article. This assertion is simply false. The piece describes how people in New Zealand sold their houses to buy Herceptin. The author herself concludes that "If I lived in New Zealand, I wouldn’t be dead, just a lot poorer."
Ann,
See, the article is one link away! Why not read it before speculating on Big Bad Government letting people die?
Cases like Herceptin are tragic. The drug is expensive ($60,000 a year) and it's effectiveness was for some time controversial. And the New Zealand government eventually started subsidizing treatment, if only for 9 weeks.
But how does not having a public plan solve this kind of problems? I'll repeat what I said before - people will still be able to purchase private insurance that would presumably cover the cost of Herceptrin (although I'm sure you are aware that people get care denied by insurance companies too). Like it happens in several countries outside the U.S.
But for the people who can't afford private insurance, well, what do you think they prefer? To have a plan without access to Herceptin, or to not have access to any care at all?
Actually, with Herceptin, there was early and overwhelming evidence that it worked. Read HER2 by Robert Bazell and/or watch Living Proof to educate yourself.
To say there was no evidence that Herceptin was effective is a political statement and not a scientific one.
The concept of the postal code lottery in Postrel's article was not clearly explained. The UK NHS has regional boards with fixed budgets. Each regional board has to make decisions how to allocate that money. So, patients needing Herceptin in one region might get approved, whereas in another region, they would be denied. I think if the US had some such system, people would sue under equal protection.
My father died last summer and some English relatives came over for the funeral. One, my aunt, is a retired doctor and several of her children are doctors--one a research oncologist at Oxford, another a world-class epidemiologist who was awarded an OBE. One is a doctor who had breast cancer herself.
We were discussing my BrCa treatment; at that point, I had had my surgery and chemotherapy and radiation and most of my Herceptin treatments although I had a few months left to go.
They told me, "You are really lucky to get Herceptin."
I asked why. They explained about the regional NHS boards, just like I explained above. It is rare for any patient to get Herceptin approved.
I was quite alarmed. "If you're HER2 positive, you NEED Herceptin, otherwise your other treatment is futile. It's lifesaving."
I supposed that it would crack and scramble my nest egg, but if I had to, I could pay for my own Herceptin treatment under such a scheme.
They said no, you couldn't, the government won't let you. You would be kicked off NHS entirely if you tried to.
I could afford to pay for my own Herceptin, but I couldn't afford to pay for the retail tab on the entire course of treatment. So apparently, the only people in the UK who can get Herceptin are the very wealthy who are willing and able to write checks for their entire course of treatment.
After college I had tried to move to England, and the only reason why the Canadian Embassy didn't hire me was because I couldn't speak fluent French. The only reason for that is because, while my family spoke French at the dinner table, I was a little snot nosed rebel and took German to piss off my parents (WWII English, Dad fought in WWII). The decision at age 13 to take German SAVED MY LIFE.
My mother died 4 years after her diagnosis, after apparently successful treatment. This was in the US in 1988-1992. Herceptin was approved in 1996. She just missed out on the drug that would have saved her.
My BrCa was ER+/PR+ and HER2+, so I take tamoxifen and now aromatase inhibitors, and Herceptin through last November. These are saving my life. The science happened just shortly after Mum died. The only time I cried throughout my whole cancer experience was when I realized this timeline, and asked doc if she thought my Mum's cancer had the same characteristics as mine (she said yes, most likely), and realizing how unlucky Mum was to have barely missed out, while I am so lucky. People in the future will be even luckier than me. But it gave me such sorrow to think if it only happened a little later in Mum's life, she might still be with us and met her grandchildren.
Now the science exists, and Herceptin has recently been found to be effective in treating other HER2+ cancers beyond the breast and they're seeking FDA approval for those uses. I think gastric cancers are next IIRC.
So this drug exists, that can sharply reduce your risks of recurrence and mortality, it's scientifically proven.
The UK NHS NICE should not be allowed to consider cost factors when approving treatments. It should be solely on treatment effectiveness scientifically proven. Period. Bean counting should not poison the science.
Genentech offers patient assistance, if you're uninsured OR insured but need help with copays to get Herceptin.
http://www.genentechaccesssolutions.com/herceptin/patient/assistance/index.jsp
I have patient assistance with my aromatase inhibitor Femara even though I can afford the drug copay. They don't even means-test.
People give up too easy. They don't ask for help. Hospital social workers are a great place to start. I have great insurance but they were falling all over themselves trying to get programs to cover my treatment. I had to keep telling them to leave me alone and help someone else who needs it.
So link some sources. Saying "go read X to educate yourself" is deeply annoying, especially when X is an advocacy book.
It's not a political statement to say that there wasn't "early and overwhelming evidence that it worked". Herceptin had (stil has) a very high cost and the first trials showed limited survivability.
I would be more sympathetic to your whole story if you weren't using it to shame people who disagree into silence.
I'm a liberal, but I'm not that liberal. That sounds very nice. So if a treatment for a common illness turns out to cost 10 million dollars and increases your survival chances from 2% to 6% (therefore tripling your chances of survival), you should expect the state to pay for it? I'm sorry if I sound cold and calculating, but you'll eventually have to draw a line somewhere. At some point you'll have to consider the cost.
Please cite a creditable source for these statistics--and by creditable, I do not mean Human Events or the Hoover Institution; I mean a serious academic study. Thanks.
Seriously, guys, did you read the article?
The entire point of the article was that in New Zealand and Britain, the drug originally wasn't available for anyone. Why? Because it was too expensive. So, hey, if we can't afford it for anyone, let's force everyone to do without. Sounds good, right? No preferential treatment. No problem! Adam and Wiredog can fly over and tell people they can't have Herceptin, because that would be unfair. Good luck!
And then you can do it with the next drug to come down the pike, and the next one, and the one after that....
Or you could study the history of industry - you know, like when a treatment or product or service or ANYTHING new is very expensive at first, and is only available to the wealthy. Then people see if it works or not, and money is invested in manufacturing processes (see: Japan), and it gets cheaper and cheaper until, over time, everyone can get it. Aspirin, betamax vs. VHS, CD players, CAT scans, MRIs - look it up.
If you categorically state that everybody has to be able to get a treatment or nobody can, then you do shut the innovation factory down. Fact of life.
I never said what you just claimed I said. I said
You're right, you didn't say that. But the only way to put those people into a European system would be to either (a) put them in Europe; or (b) convince a European system to cover them. A European system in the US is kind of all-or-nothing, really. If you tried to exclude everyone but those "10.5% of men (and 8% of women)" [to name one among a number of other things required], you'd have to pay a lot more in those pesky administrative costs. And, of course, your European system won't cover anything 'wastefully' expensive.
'Poor' people would also be better off, short-term, if you gave them each $1 million, taken from random 'rich' people. But ... maybe there would be undesirable consequences (even if you promised to never do it again).
They would qualify for Medicaid in the US, which in my area, is a good system. People don't have trouble accessing doctors here.
"At the highest macro level, life expectancy, Europe generally outperforms us. But it's not clear how much of that is health care, and how much things like our murder rate, and our famously sedentary lifestyles."
There are other factors at work in the difference in life expectancies as well. For one, we are more ethnically diverse than Europe, and different ethnic groups tend to have different life expectancies, for cultural and perhaps biological reasons. For another, we drive a lot more than Europeans, and car accidents cause a lot of fatalities here.
Don't forget the western diet, like eating ramen noodles to get through college.
It's not healthy asian diet; it's western all the way.
Tangential, but I can't resist:
A friend of a friend had an inadequate stipend in grad school and subsisted on ramen noodles and Kraft macaroni & cheese -- without the butter and milk, just the orange processed cheese food powder. He was eventually hospitalized in serious condition, and had doctors coming from miles around to take a look at him. None of them had ever seen an actual case of scurvy.
About life expectancy, and at the risk of sounding like a broken record:
- Trauma-related deaths, like homicides and car accidents, are too small a cause of death to account for the observed differences in life expectancies.
- This is also the case with racial compositions. The famous difference in longevity difference between the 13% of African-Americans and other races is also too small to account for these differences.
- Differences in lifestyle is indeed a factor that can make a big difference in life expectancy. As Megan said, it's a hard thing to measure. Obesity is considered the second preventable cause of death in developed countries, and the U.S. has a higher percentage of obesity than any other country. On the other hand, smoking is the first preventable cause of death, and Europe have a larger number of smokers than the U.S.
It's true that life expectancy is influenced by a great deal of factors other than health care. So it's indeed naive to expect a perfect correlation between health care quality and life expectancy. It's also true that differences between developed countries aren't that large. The average U.S. citizen lives only 3 years less than the average of the 10 most long-lived countries.
But it's also true that
The U.S. is number 37 in the world. There's virtually no developed country with a shorter life span than ours. We're behind developing countries like Uruguay, Bosnia, Costa Rica, Jordan and Chile, as well as some so-called new developed countries, like Cyprus and South Korea.
This should give us pause. I accept the case that we have better in extremis services . It just isn't doing that much for us, especially considering what we pay for them.
And no, costs are not justified by research. There was a productive discussion on this in another thread. Combined medical research in the U.S. is indeed a lot more than in Europe, in both the private and the public sector. So it's true that we are the main engine of the world's medical research. On the other hand, medical research is less than 1% of GDP, but health care costs us 16% of our GDP. The second country that spends more in health care is Switzerland, with 10% of GDP.
So I don't know how we can escape the conclusion that we spend a lot on health care, but get very little in the way of results. The fact that other countries depend on us for innovation is not a very good consolation prize.
You have to look at when the deaths occur, not the raw numbers. Something that kills 4 times as many 20 year olds will have a vastly outsized effect on life expectancy compared to something that kills 4 times as many 70 year olds. Trauma and accidents cost decades of life.
I know that. I'm deeply offended that you thought I would overlook the fact that early deaths have a disproportionate weight in LE. Is the regard you have for your commenters that low? :)
I've done the math before in another thread.
If you don't mind, I'm gonna go ahead and copy-paste the old post. One note: in my previous comment, I used the U.N. data, which is an average of the years between 2005 andb 2010. In the following analysis, I used CIA numbers, which are estimates from 2008. The U.S. ranks 30, not 38. I don't think the substance of my arguments in the previous comment is changed by this.
So, let's look at 2006 data for this:
Total deaths in the U.S. 2006 - 2,426,263
Deaths by assault - 18,573
Motor vehicle deaths - 47,000 (source)
Now, adding the by far 2 leading causes of death by physical trauma, we get ~65.6 thousand people per year. That's 2.66% of the total number of deaths in a year.
But the average age of death of these people is relatively low, right? Well, let's suppose that they age at the tender age of... zero years old. They are born, and they immediately get shot or drive a car into a tree at 80 miles an hour.
In that case, the U.S. life expectancy excluding these deaths gets a 2.13 year boost, from 78.06 to 80.19 years. This would place the U.S. as 11th in the world in longevity, between Canada and Italy (2008 estimates).
So, assuming that people in the U.S. die from physical trauma at birth and excluding these deaths from the population while not discounting deaths by physical trauma for other countries doesn't even put the U.S. in the top 10 in longevity.
Let's assume that the average age of death by physical trauma is instead the more plausible figure of 30 years old. I have no idea what the actual figure is, but 30 sounds ok. Shall we do some basic math?
0.934*x + .0266*30=78.06 x= 79.37
The U.S. now jumps from 30th to 18th, between Greece and Austria.
I'm still not excluding physical trauma from other countries, (that would take far more work that I'm willing to do, really). But we have seen that the U.S. gains 1.31 years in life expectancy by these exclusion, assuming these people die at 30 on average. Let's say that all other countries, if they do the same, increase their figures for 6 months. This is less than half the reduction I'm assuming for the U.S., which should comfortably allow for countries with less homicides and (especially) safer drivers. If we do this, the U.S. moves just 4 places in the ranking to 26th in the world, between Belgium and the U.K.
So much for the argument of reckless, dangerous Americans driving fast and shooting people. Yet we see this argument repeated many time in the media. The disinformation, of course, is bound to be amplified in blogs.
Conclusion - deaths by physical trauma are far from being a determinant factor in overall life expectancy.
Actually your math makes me wonder how useful the whole metric is. The change is small, but a change of a little over a year moves us up 12 places! To me, that seems like the ranking is just kind of pointless at the top levels, because everybody is so close. Now, if there was a 10-15 year gap I'd be more worried.
bombloader, I've certainly looked at the numbers from your perspective. That's kind of a philosophical discussion - what value should we attach to prolonging average longevity 1 to 3 years.
Two things: first, motor vehicle deaths and homicides are concentrated among very young people; and second, as bombloader says, a one year change moves us up, what, a dozen places? This does rather seem to matter. When you add in obesity/sedentary lifestyles, you're arguably most of the way there.
On the other hand, even white, insured Americans seem to be less healthy than their British counterparts--even white, *rich*, insured Americans. Why, I have no idea. But access to health care clearly isn't it.
Have you read my comment above? I have taken early cause of death under consideration.
Jesus. Read the freaking comment. You only move it one year (actually, 1.3 years) if you completely exclude trauma as a causes of death in the U.S. while maintaining in other countries. In any kind of realistic exclusion, the U.S. practically doesn't move in the ranking.
Yes, when you keep excluding death causes for the U.S. while keeping other countries with their traumas, and obesity related deaths, and smoking related deaths, and whatever reason makes people from other countries die, then the U.S. position goes up. Conversely, if you keep U.S. LE constant while you exclude smokers from other countries, than the U.S. gets further behind. Surely you realize how dishonest it is to engage in such an analysis.
I'm really skeptical of this statement. I bet differences get really attenuated between rich British kids and rich American kids. Where did you see this?
Nimed, I agree with a lot of what you say here. I do think the issue is that we spend too much on health care relative to what we get out of it, but I'm also worried that that isn't what's being addressed by Congress and the Administration right now. We need to study the differences in spending with little difference in outcome revealed by the Dartmouth study, and address our current system of pay per procedure in health care. I think if we combine changes there with detaching health care from employment, we can further reduce the number of uninsured by making it more affordable. At this point, it seems like the government is focused on calling for reform when they really mean expansion, and adding some preventative medicine and electronic records.
This is my concern too; reform need to change the stake holders a bit. And the current stake-holders in charge aren't budging willingly. We're talking the elderly, pharma, doctors, insurance companies. . .
Err you wouldn't expect the WHOLE R&D budget to be the difference... You get the R&D budget because you spend a lot more. The point of R&D is to make $$$, invest $1 and get $10 in profit (which probably means $20-100 in revenues). You have to spend a lot more to be an attractive market, especially compared to people who only buy a product after it has been fully proven and gone to essentially marginal cost.
To analogize, the US buys its cellphones at full price (say $700 for a new RIM without subsidy) and the EU pays $29 for the same phone 1-2 generations of phones later. If the $700 customer goes away, the $29 customer is screwed. You can't compare prices at all.
Where do innovations in surgical products and technique come from? The US, because you can make $$$ doing that. In the rest of the world, it's not quite as aggressive, though the $$$ available from selling into the US market has its attractions. You do get innovation without the $$ reward, it's just much much slower. Huge wars help - so many innovations came from WWII thanks to the social goal of helping hundreds of thousands of horrible trauma cases. But its much more expensive to constantly run a war at WWII level (in money and people) than it is to have current US healthcare spending.
In the US, orphan diseases get funding because people (or their insurers) WIlL pay huge $$$ for rare disease treatments. In the rest of the world, they just die and everyone looks sad. Governments would prefer that rare diseases didn't get cured as it would save them $$$ and are rather annoyed about their people finding out about expensive innovative US treatments. Breaks the healthcare budget which already threatens to eat government spending as is. You'll note that diseases which no one will pay to treat (i.e. mainly affect people in 3rd world) don't get dealt with outside of philanthropic efforts that throw money at them (hence creating a market).
But please tell us more about the Heroic Socialist project that will 100% guaranteed create new medicines through the power of slogans and socialist realist billboards.
It would be helpful if you would comment about things you were at least a bit informed about.
Some pretty crass mistakes in your comment:
- Your analogy is terrible. Innovation in cell phones is on par if not more advanced in Europe than in the U.S. Many times, the process you describe happens the other way around: a cell phone is introduced in the U.S. market months after it has been released in Europe. They have pretty big communication companies over there.
- The U.S. is far more socialistic when it comes to medical research than Europe. NIH alone accounts for 28% of total medical research, and government funding far exceeds any European country as a percentage of GDP. And yes, it's government funding that gets us all those nice Nobel prizes in Physiology and Medicine.
- Unfortunately, the tendency of innovation in medical research is to increase health costs. What's the point in having medical innovation if eventually almost no one will be able to pay for treatments? This is where we're heading. Medical expenses are growing at a much bigger rate than inflation, and the number of individuals and employees who can afford health insurance is diminishing.
- I don't have anything against the profit motive. But pharma research is incredibly wasteful, much more than most other industries, in producing innovation. I would post links to several previous discussions on the subject, but I just won't bother with someone who, in his very first comment, removes himself from a serious discussion by following the communist version of Godwin's law.
I did mention that it was an analogy. You acknowledge that it was an analogy. And then you complain that the EU has better cellphones. Do you have similar complaints about 2 cows analogies? Thanks for the heads-up on the validity of EU communications firms. I actually worked for 2 of them during the telecom/dotcom bubble, developing 3G routers for one of them. Which would be interesting, if I weren't making an analogy and was actually talking about the real cellphone market.
NIH develops targets, not drugs. But that has no bearing on our disagreement, because you were bewailing the difference between R&D spending and healthcare spending gap, as I said it didn't matter. Changing the numbers you're bewailing doesn't deal with my point. Nice try though.
Innovations increase health costs. Err yeah, and that's a GOOD thing. Computer innovations increased spending on them, and mobile phone innovations increase spending on them. What were global mobile phone revenues in 1970? They're higher now, this must be stopped!!! What was spent on MRIs in 1970? Much higher now, they must be stopped! How much would you pay for a cure for cancer? Does this mean it shouldn't be pursued? What's the point of innovation - living longer and healthier lives! If I didn't know your normal position on things I would swear that you were actually Leon Kass!
Pharma research is wasteful. Because it's much more research than in other industries. We can make much better predictions in physics than we can in molecular biology. So when Intel and IBM are working on new lithography techniques, they understand the general rules and are really just doing the D part of R&D. When you're making a new drug you don't understand the rules as well and are doing lots (far too much for your best interests) of R for your R&D dollar. Intel hasn't had similar screwups like the Parexel drug trial for TGN 1412 that killed and maimed 6 subjects in March 06. This also points out why you need a huge spending gap to encourage R&D - since the R&D is so likely to be a failure, you need a big reward (look at VC return targets vs stock fund targets).
So all of my mistakes aren't mistakes, they're the result of your ignorance or bad faith. Way to be a stereotype of internet commenting.
As to Godwinning - we're talking about government takeover and managing of industries. Exactly how is it inappropriate? You don't Godwin yourself when someone is arguing for lebensraum and the liquidation of parasitical populations.... It's not like we're discussing policy for a government that has taken over the car and financial industry and wants to redo health and energy...
Interesting that Europe has a market for cell phones (despite all the regulation). You can be guaranteed that if everyone in Europe had a stated sponsored cell phone plan that new cell phone innovation would grind to a halt.
I'm talking about no such thing. Nor is anybody else. You can increase the size of government research, and you can negotiate prices with pharmaceuticals. That's quite a straw man; I have yet to see a commenter that proposes government takeover of pharma.
By the way, your Godwinning was this sentence:
Oh, I see. You just don't know why people use analogies in the first place.
You see, usually the purpose of making an analogy between subject A and B is to make A more comprehensible by its similarity to B. So B should be a clear, easy to understand, uncontroversial case. Your analogy is not particularly helpful to understand A (you're just better stating A), so I assumed it would at least trying to make a general point about technology with a real case. My bad.
Which is, of course, not the point. The first personal computers and cell phones were prohibitively expensive. So almost nobody would spend anything on them. Since then, the industry has not only managed to make great progress, it has also brought prices down. Innovation in medicine is not like this. New, very sophisticated treatments cost a lot. Which would fine, if it wasn't for the fact that you don't pay (and can't really pay) for individual treatments. You pay for coverage, so expensive new treatments effectively elevate insurance premiums. You keep this up for a few more years, and pretty soon medical insurance becomes a luxury.
That's a statement on R&D efficiency. It's understood that efficiency in pharma R&D is very low. So each new drug costs a lot, because it's paying for the R&D of a lot of dead ends. But, obviously, the failures enter the R&D budget. So they are incorporated in R&D expenses, not profit margins.
By wasteful nobody means pharma spends a lot on dead-end research. What actually happens is that the percentage that is spent on all R&D, failures and successes, is very low. A lot more is spent on marketing, for instance. And the profit margin of pharma was for a long time the first in the world. Now it's second, behind oil companies.
So what exactly is the argument for the government not having a public plan that would negotiate prices?
Sure. Methinks you doth project too much.
This morning, on WINS news radio they had a story about your odds of dying before age 20. They were 1 in 250. That's pretty darn high. They cited the main causes as accident, violence, etc. (Before writing this I looked at their site and could not find the story). Right there you have a significant lowering a life spans. You will also find that auto accidents alone kill 40,000 Americans every year and injure far more - much higher than other developed countries - lowering lifespan and increasing medical spending.
Your references to various death causes related to genetics are disingenuous. While individual stats, like the difference between blacks and whites, etc might not mean that much singularly, when you add them up they do mean something.
Blacks suffer disproportionally from sickle cell amenia (1 in 400), kidney disease (MYH9 gene) and prostate cancer. The US has far more blacks than any other developed country. Jews of eastern European decent are far more prone to Tay-Sachs Disease, Canavan, Niemann-Pick, Gaucher, Familial Dysautonomia, Bloom Syndrome, Fanconi anemia, Cystic Fibrosis and Mucolipidosis - all genetic. The US has far more Jews than any developed country, far more than all of Europe combined.
I've only touched the surface with the above and nobody knows how intermarriage among different groups has spread, or not spread, genetic disorders. So yeah, ethnic propensity for certain diseases is a big deal, and when you add up the vast numbers of different ethnicities in the US you get a significant number.
I believe the US far outdistances other countries in the incidence of diabetes. As you state the US also leads in obesity, big time I would not be surprised if we also led in asthma. All of those can not only effect lifespan, but can also increase medical spending. Diabetics spend a lot over their lifetime as do severe asthmatics.
Sigh.
No. When you "add them up", meaning when you see the overall effect of genetic conditions on LE, you actually find they have a negligible effect on longevity statistics.
Sickle cell anemia and many of the conditions you mentioned are homozygotic. Their incidence decreases when there's more group intermarriage. Jews (and other groups, like royal families in Europe) suffer disproportionally from them because historically had very low intermarriage rates.
This is a good point. Still, you shouldn't just throw stuff around there without making any effort to measure their relative impact on longevity. Diabetes is becoming an increasingly serious problem in the U.S. On the other hand, people here smoke a lot less than in European countries.
I wonder if women in the US have to fight for this drug, too? I wouldn't be surprised to see my insurance deny it and suggest an alternative treatment.
But how on earth can you take a single drug and correlate it to the entire delivery of health care? I'd think if you wanted to do that (which I don't think you do), at least you'd pick a typical geriatric treatment used to extend life in those final months.
And what about the implications here that Americans and the rich function as the guinea pigs? And we pay for extra for that?
I like your notion of innovation, Megan. Think I'll see if my husband wants to downsize to Europe; the pay for jazz musicians is better, too.
I wouldn't be surprised to see my insurance deny it and suggest an alternative treatment.
And how much would you pay out-of-pocket for a lifesaving treatment? Vs. having to do without and die?
I already pay out-of-pocket for my health care; and I pay for insurance that hasn't paid a cent in 7 years. It's so that I won't loose my house should I need catastrophic care like this; and I fully expect to do battle with that company should such a think come to pass. (I also feel qualified to do that battle; many people with high-deductible insurance aren't.)
Then what was the point of the statement I quoted, pray tell me? If your insurance hasn't paid a cent in 7 years, I imagine it is a catastrophic plan? What will they ever have to say about the choice of medication?
They already deny things that I'll have to pay for; recently an MRI of my brain after my ability to speak became significantly impaired.
And I would have had to cover the entire bill out of pocket, about $4,000, and it would not count toward my deductible.
Let me ask you this: is it fair to make a woman who's struggling to speak defend her right to care under our contract? This kind of stuff is happening every day to people with plans like mine. I have it because I choose it. Most of my neighbors and friends have this kind of insurance because it's all they can afford, and they can't afford to meet the deductible. Or they don't have any insurance at all.
I don't think most of the posters here have any clue about the barriers to care people without either cadillac plans or medicaid/medicare face.
But Max, I'm not here to argue just for myself. I'm doing okay. I'm here for my neighbors and friends. They're farmers, mechanics, cooks, musicians, and knitters. And I'll stand up for them because they're too freakin' busy making ends meet to stand up for themselves right now.
$4K appears to be on the high end of the distribution but OK, it not going against the deductible makes yours a crappy policy. Why'd you buy it, anyway?
At any rate, I am not buying your argument. "Too busy to resolve issues between insurance & provider?" I'm sure I worked longer hours as a software engineer earlier in my career than any blue-collar guy with a regular job; I had a family; I was not entirely familiar with the language and the culture I have [then recently] adopted by immigrating here. Somehow it wasn't an issue to lose sleep over. Having had prior experience with universal, state-provided healthcare I remain utterly unconvinced.
You are absolutely right, zic. It's typical of her use of isolated incidents.
Plus, I love it when Megan waves at me from her big, fat Cadillac insurance policy...i.e.:
"we catch cancer earlier, because we're screening-test-mad, and some cancers just hang out for decades without killing you"...
Not catching things like cancer early because of a lack of primary/preventative care is a major problem with our system. In fact, a while ago, I was not given an MRI because it was too expensive, and when I ended up in the emergency room six months later, I had a huge complex tumor and had to have my ovary removed. I could have died, all because MRIs cost so much here.
Honestly, the standard of care we get in this country, even with an okay insurance policy, is just not that good. But I guess the Atlantic must be takin' care of people pretty well.
Oh, and I forgot to say, they billed my insurance 40,000 for 4 days in the hospital, and my insurance company made me pay 4,000 dollars of it. That is 1000 dollars a day for my hospital stay, even though I HAD INSURANCE!!!! (I am a grad student living on 1400 a month.)
Nobodies' assets are safe under our current system. It just costs whatever they think they can confiscate from you.
"Nobody's"...
Out of curiosity, why do you object to paying for what you consume? Or more precisely, why do you object to paying for 10% of what you consume? What makes you think you're entitled to free medical care?
Let me get this straight. They SAVED YOUR LIFE for 40 grand.
Meanwhile, as a grad student, how much are you forking out for tuition every year? What's more important, your life or stupid grad school?
Sorry to pile on, but as a matter of rhetorical strategy, you probably don't want to set yourself up as poster child with that story.
Not only did this system just spend $40K to save your life, but it only made you pay 1/10 of the cost. Whining that you shouldn't have had to cough up at all is not going to win you too many admirers. Telling people that you could have avoided the whole deal if you had just been willing to shell out for the cost of an MRI (about as much as a cross-country plane trip) -- but you didn't because you felt that "society" should be paying for that instead -- that's just going to loose you a few more.
But Evangeline, in other countries they wouldn't have done it either, because "watchful waiting" is much more likely to be the standard.
In reply to Megan and others below:
I do not expect to pay nothing...but why are we paying so much to get basically the same half-assed care that people get in other countries?
One myth you guys seem to be perpetuating is that US health care is so high quality and we (insured people) are getting all these extra screenings and deluxe care all the time, and it just isn't true. Insurance companies are implementing the same economies with MRIs and such that the governments do in other countries. Only for people with exceptional policies is it otherwise.
In fact, the only really deluxe health care in this country is for people on medicare, and that is because it is government-run, not health insurance company-run.
See response to Max above, I had a similar thing happen.
I did, with help from my husband, convince them to approve the MRI.
But I do have a survival strategy that I think all consumers of insurance at least know about. Whenever I have to deal with them, I'm prepared to tell them that I'll report them to my state's attorney general; and I have to be prepared to follow through. That means keeping good records; and notes of phone conversations.
I do agree with some of the other comment above that you should expect to pay some for your care; I don't know if what you were required to pay is reasonable or not; those terms should be spelled out in your contract with them, your policy.
And I think it's wrong that they can change your policy at, what seems to me, anyway, at their whim, by simply sending you another long, complicated document that's difficult to read.
How much of that 16% of GDP that we are paying for health care is discretionary? People go to the doctor sometimes when they don't necessarily need to. Or they get extra tests that they may not need. Or they have a fancy, deluxe surgery when a less fancy one might have done. Or they get an MRI instead of an x-ray.
The fact that we spend more on health care is not necessarily a reason to have the government step in and stop us from doing so. It may be that we just like to consume more health care.
And, most importantly, why does it always have to be "we"?
Sure. but discretionary spending isn't forbidden in the rest of the world. In the vast majority (maybe all, but I'm not sure about this) of other countries there are people who either pay some procedures out of pocket or opt out of government coverage and get a more expensive private insurance that provides better coverage.
The aim of a public plan shouldn't be to provide the degree of xoverage of a private plan. Health care would be rationed, in the sense that the less cost-effective diagnostic tests, procedures and drugs would not be available to the patients. The lower coverage, along with some other government advantages (greater bargaining power, lower administrative costs) would make the public plan cheaper. If the patient feels the need to perform some diagnostic test or procedure not covered by the public plan, they will have to pay for them.
The goal here is to provide the uninsured, underinsured, and people struggling to make their insurance payments access to affordable (albeit lower quality) care.
But consumers who both want greater coverage and can afford it are perfectly free to sign up to (or maintain) their current private insurers.
Here are some older numbers on REALLY discretionary spending:
2.8 Million: Number of Botox injections given in the U.S. in ’03.
6.9 million: People who had a minimally invasive cosmetic cosmetic procedure in ’03.
8.7 Million: People who had some cosmetic procedure in ’03.
$9.4 Billion: The amount of money spent on all cosmetic procedures in the U.S. during ’03.
That's just one year - 6 years ago.
The 10.5% of men (and 8% of women) who are unemployed and have no health insurance because of that would be better off in a European system.
I'm not so sure about that; they might have a heck of a hard time finding a new job in Europe, which has chronically high unemployment.
So I don't know how we can escape the conclusion that we spend a lot on health care, but get very little in the way of results.
I don't think we can escape that conclusion. But of course, health care and health outcomes are only weakly correlated once you get past the basics, like immunization and cheap antibiotics for pneumonia. Nexium doesn't exactly add years to your life, even if it wonderful things for the erosion in your esophagus. Rationing won't shorten our lives much. It will, however, be highly unpopular.
they may have a heck of a time finding a new job here, too. And you think they can afford COBRA after getting laid off?
Rob raises and interesting point. Just to get a baseline - how much would life expectancy fall if no medical care outside of antibiotics and vaccines were available? I'm willing to bet it would still be in the high 60's.
Just to get a baseline - how much would life expectancy fall if no medical care outside of antibiotics and vaccines were available?
Life expectancy at age 65 has gone from 11.9 years in 1900 to 17.7 years in 1997, while life expectancy raised from 49.2 to 76.5. My guess is the main driver in life expectancy has been due to antibiotics, vaccines and modern sewage preventing diseases that used to kill children. For those 65 and older antibiotics probably play a big role in diseases not killing the elderly as much with their compromised immune systems. One interesting point is that advances in child birth (and probably having fewer kids as well) have also contributed to women now living longer than men when they didn't used to. The link with data is here.
Life Expectancy
And many argue that we outperform them on hard-to-measure "lifestyle" issues:
I'm pretty sure I can name one major procedure that the "effectiveness" studies will suggest be dropped for many, if not most, patients. Cardiac Bypass. Studies of "cabbages" show that they usually don't extend life. They just make it possible for you to have a normal life - you can walk more than a few feet at a time, don't need oxygen, can go up stairs, etc. It makes perfect, bottom line sense to deny it to the elderly. They don't work, don't pay much in taxes - in short they don't need to be able to get around much. (Britain already does this for hip replacements, with a max age for the procedure.)
Wow, Drum really needs to get out more. Britain's NHS is quite explicit about doing this. It defines a QUALY (quality-adjusted year of life), writes guidelines about how many QUALYs a given treatment is likely to provide a given patient, and sets a limit each year on how much they will pay for a QUALY (currently it's about 30K pounds).
The upshot is that, if you are over a threshold age, you will be denied an expensive treatment, even if they are very likely to succeed, because even a cure will only buy you a few QUALYs and the effective cost per QUALY exceeds the limit.
Canada does this too, although they are not quite so cold-bloodedly analytic about it.
The quite intentional consequence is most definitely to deny expensive treatments to some classes of patients (and to deny very expensive treatments to everyone) in a way that no American insurance company could get away with writing into a policy. It's a very important component of the cost-containment strategy of those health systems.
It's a very important component of the cost-containment strategy of those health systems.
Except I have seen very few people advocate a NHS type system, since most of the universal plans do not work like that. The NHS is a different beast than the plans in France or Germany.
From you post, I must assume you're a fervent supporter of Medicare in it's current form.
Actually, Nimed, I like the basic NHS approach. I've proposed something like it in several debates. I call it the "80's medical plan." It offers tax-financed universal coverage for any procedure that was state-of-the-art in 1980. Antibiotics, casts, X-rays: approved. Statins, cancer treatments, MRIs: denied. The point is to offer the poor very low-cost coverage that was good engough to provide a decent life-expectancy in 1980, but absolutely refuse to cover expensive, state-of-the-art care for those who don't pay their own way. A nice side-effect of such a system is that people of any means would get on a private plan as quick as they could.
(The problem with my proposal is identified by Rob and is also one that plagues the NHS. Instead of working their butts off until they can pay their own pay, people just elect the politicians who promise the increase the scope of coverage.)
So my beef isn't with the cold-blooded rationing of medical care for those on the government plan, it's with people like Drum who claim that government medical care needn't involve any rationing and is simply a free lunch, win-win scenario for everyone.
Exactly. Ditto everything you just said.
Here's my beef with Drum, besides his superficial analysis.
How do you define extreme measures?
A mammogram is a completely ordinary, non extreme screening. But a mammogram for a 95 year old? Extreme. Does Medicare cover it? Yes.
If you have kidney failure from Type II diabetes, you can get weekly dialysis covered by Medicare, a costly, labor intensive procedure. And according to the NHS, it is an extreme treatment. Try gorging yourself on food to the point of kidney failure in the UK and then expect the taxpayers to pay for your dialysis. HA!
I keep harping on this on this blog and I feel like no one is really picking up on it. Sometimes the most obvious, staring you in the face realities are the hardest to get so excuse the all caps:
MEDICARE IS AN INSANE, UNSUSTAINABLE, OUT OF CONTROL MONEY PIT.
If the patient feels the need to perform some diagnostic test or procedure not covered by the public plan, they will have to pay for them.
This is the fallacy which underlies any notion of cost-cutting. If the consumer feels the need to perform some diagnostic test or procedure not covered by the public plan , the consumer will go on the Today show to talk about how AWFUL it is that the MEAN GOVERNMENT isn't paying for the test, which the lovable consumer can't possibly afford.
Look, we've been down this road before. HMOs were supposed to control costs by only paying for cost-effective treatment. And the functioned on the same principle: pay low prices for cheap care, out of pocket for anything they don't cover. What happened was that lefties got mad when the HMO said no to a picturesque patient, and either passed mandates or agitated for "patients' bills of rights" that let you sue your HMO for keeping costs down by rationing care. And people hated having care denied. Thus, the world-saving cost-cutting HMO has disappeared.
What you're proposing is that the government become an HMO. What makes you think that is politically feasible?
The US government is already like a huge HMO. In fact, it is the world's largest health insurer: Medicaid, Medicare, and the VA system combined. Its an insane HMO that everyone pays for but only a few reap the benefits.
Having just returned from an 18 month stint in New Zealand, and having a wife that worked in the Emergency Department of a public hospital there, I can confirm that, at least in NZ, they do far less "extreme" treatments there.
By "extreme," I mean that in the US, an elderly person who walks into an ER with chest pain will get the full range of available interventions. In New Zealand, the doctors will look at the patient's various morbidity factors (such as obesity, diabetes, etc.), and determine on the spot whether such interventions will be "worthwhile."
And those elderly US patients likely have the bill paid by Medicare for all this stuff. What happens in a few more years when Medicare dries up?
Will US doctors then be a little more judicious in utilization of resources? Will we Americans agree to pay more taxes to continue funding elderly health care? Will we say hell no to any tax increases and just continue to pile on to our national debt?
Good times ahead no doubt.
It's pretty hard as a physician to be judicious in utilization of resources when the threat of malpractice for not performing ever possible intervention looms over your every decision.
I agree. Too many Chiefs, not enough Indians, right?
Stewie,
I agree completely. But its not just in the future. Its already reached a crisis point in many parts of the country. Like, you know all those laid off auto workers in flyover territory you keep hearing about?
People in this country are DYING from lack of BASIC MEDICAL CARE. Literally DYING. It is no longer academic. It will be harder and harder to justify giving root canals to hospice patients when more and more Americans start dropping off because they can't afford their insulin.
Acrimon,
Americans start dropping off because they can't afford their insulin.
Get a grip dude. Typical insulin therapy costs $32 a week - you can buy a vial of generic insulin at wall-mart for $16.
No, with all due respect, you need to get a grip if you think $32 a week is affordable to the 5 million unemployed Americans and God knows how many uninsured wage slaves. Also, $32 a week? Please. Add in your metformin, neurontin, your glucotrol, office visits, and lab fees, and it starts to add up quick.
you need to get a grip if you think $32 a week is affordable to the 5 million unemployed Americans and God knows how many uninsured wage slaves
Begone. Translate those $32 a week into sixpacks and cigarette cartons and get a grip yourself. You must be living in Dickens's London.
"You must be living in Dickens's London."
No I live in Detroit.
What's the point in having medical innovation if eventually almost no one will be able to pay for treatments?
They won't be able to pay for the new treatments, they older treatments will be cheap. Are you not aware that eventually all drugs become generic and you can get them at wall-mart for $5?
Absolutely. Somehow the pure dreamworld thinking that government taking over will control costs. It doesn't. Canada is tightly controlled yet costs are out of control.
If there isn't a large market for expensive treatments, there will be a large market for inexpensive treatments. If hospitals and doctors can't sell 6-7 figure procedures, they will figure out ways of doing 4-5 figure procedures.
The US market in health care for decades has been 'do anything no matter the cost'. For some strange reason the system is expensive. If the market demand is 'the best for my dollar', the system will adapt to that, and in time be much better than anything the socialized systems can come up with.
We know what socialized systems do, and as someone upthread mentioned was particularly unpopular when tried in the US.
Government health care will take away the only thing that will make possible any rationalization of costs; the direct consumer connection to the costs. High costs are a political problem because every family either pays through increased insurance, or is forced to stay in a unoptimum job because of it. In the system in Canada, no one has a clue how much health care costs.
And in the US healthy people must pay to get treatment. In Canada healthy people drive the costs onto the sick with the perfectly normal desire to keep taxes low. The sick and dying don't vote.
Derek
I definitely agree that costs will continue to rise without consumer connection to costs. In fact, I think part of the reform that's needed is a stronger attachment, and as I have said above, I think this can only come from detaching employment from health care. I don't see that happening here, because the administration has already shown a tendency to pander to unions, and from what I understand unions are one of the biggest groups opposing that detachment.
I am sure the U.S. does more in extremis than Europe and the rest of the developed world. Healthcare decisions are far more centralized outside of the U.S., and there is general agreement about who gets what type of treatment. Greatest good for the greatest number given a fixed amount to spend on healthcare. (Okay, not fixed, healthcare costs continue to rise everywhere, but that's as much demographic-driven as it is procedure-cost driven.)
The calculation is simple: treat one person for $1,000,000, or have $1,000,000 to treat a lot more people, e.g. In the U.S. with decent insurance you'll probably be treated, because we're willing to spend more for everyone in terms of premiums and out-of-pocket costs. Outside the U.S. you stand a good chance of not being treated, especially if you have low survival probabilities, except as Megan mentions if the cost is a lot lower given that treatment has been largely paid for by innovations perfected in the U.S.
If that sounds great (and for those of us with insurance, it sure is!), consider that a higher proportion people are not treated in the U.S. for conditions that require relatively less costly procedures than they are in countries with soclialized medical care, given that people without insurance in the U.S. either can't afford or don't want to pay for it.
Politically the only solution that sells is a plan that somehow provides all of the extreme procedures that we're used to getting in the U.S. and all of the broad-based access people get in other developed countries, but as Megan has pointed out before we won't. Or if we do, it'll be far more expensive than what we have now.
LeeM you have cut to the marrow of the issue here.
Lets say you have $50,000 of taxpayer money to spend on health care.
You may:
A.) Spend it on a 6 week ICU stay for an elderly demented 92 year old with pneumonia, with the possibility of extending his or her life (in the nursing home) perhaps another 6 months to a year.
- OR -
B.) Spend it on treating 10 unemployed, uninsured young people with asthma for an entire year, or more.
A is America.
B is Europe.
I lied. A 6 week ICU stay probably runs closer to $70,000.
That is more than double what the average American makes in a year.
Multiply that by every other senior on Medicare and you will see what the very heart of the problem is with medical care in this country. Its staring you in the face.
Anecdotal Costs info:
My 79 Aunt just completed a 2 month stay in hospitals and nursing homes. She has Medicare and Kaiser.
First bill for 4 weeks at Reston Hospital, including 10 days in CCU $130,000.
This bill includes no specialist time or procedures.
No bill yet for :
7 days in Nursing home
5 days again in Reston Hospital
10 days in Nursing home
10 days in Fair Oaks hospital
I am guessing total costs for her episode will come to $00k. She doesn’t pay a cent due to her Kaiser plan. She worked 20 years and chose to have full medical coverage rather than a pension when she retired. Smart cookie.
After several months at home she was recovering great. She fell and dislocated her shoulder…guess what. It didn’t reset properly due to ligament and tendon damage requiring surgery to repair properly. Consultation with her Kaiser doctors and the determination was made to move forward with physical therapy only, no surgery.
2nd story:
A woman I work with mentioned that her 90 year old father fell and broke his hip. He was sent to the hospital and it was replaced. He got a life threatening infection while in the nursing home causing his heart to fail. They inserted a pacemaker. The infection damaged his colon to the point where it had to be removed. He is still in the hospital with poor prognosis for recovery.
Medicare. I would be shocked if his bills came in under$550k for this episode. With a low probability for recovery. It is likely that prior to this episode his total lifetime healthcare costs didn’t total this amount.
What is wrong here?
Hmmmm:
While anecdotal, I think it does highlight some of the problem with out system. In Europe, the government would have decided the 90 year old wouldn't get the hip surgery, which in my opinion would have been the right choice, even without the ensuing complications. Currently in the US, the family makes that decision because they are so far removed from paying for it, whether in private insurance or medicaid.
Concurrently, doctors in this scenario have to make the choice between what about 95 percent of them know, that hip surgery in a 90 year old has almost no chance of doing anything approaching substantial, and the money they get for doing the hip surgery. Most don't have or take the time to look past the fact that insurance will pay for it and the family wants it to how it continues the cost increasing cycle of the current system.
Two things can be done (in my mind) to remedy this sort of situation. First, make the family/patient somehow financially culpable for this. If insurance is detached from employment, insurance companies will have more freedom to adjust premiums, etc based on usage. So the obese person that eats McDonalds 4 times a week pays more than the health nut that runs 5 miles a day. The family pressing for a hip replacement for the 90 year old great grandfather realizes this will come out of their inheritance, whatever. Caveat: the oft cited practice of insurance companies rejecting claims out of hand would have to be regulated, but I think that can be pretty easily taken care of between free market pressures and regulatory penalties, etc.
Second, the physician payment scheme needs to be studied and readjusted. The pay for service practice provides the wrong motivations for physicians and hospitals, whether they be conscious or not (and often, especially in the case of doctors, I think it's more subtle, but I might just be naive). Also, we're quickly getting past the point where one physician can manage anything other than the simple patient that never gets anything more than a cold or breaks an arm. Doctors in hospitals or networks with required peer review panels and salaries seem to pose the best answer I've heard of, and are somewhat detailed in this interview:
http://voices.washingtonpost.com/ezra-klein/2009/06/an_interview_with_atul_gawande.html#more
@HMMMM . . .
"Medicare. I would be shocked if his bills came in under$550k for this episode. With a low probability for recovery. It is likely that prior to this episode his total lifetime healthcare costs didn’t total this amount."
What is shocking is that most people probably assume these are isolated incidents. They are not. Spend some time working in a nursing home and you will see these stories repeated day after day.
"What is wrong here?"
I have a pretty good idea of what's wrong, but I will get accused of being conspiratorial. What is wrong here has a lot to do with the AARP.
> and there is general agreement about who gets what type of treatment.
No there isn't. The only agreement is that it must be free. From there no one cares until one gets sick and has to wait. The benefit for society comes from the fact that very few people are in that situation, a perfectly ignorable demographic when it comes to voting.
Interestingly, there was a case in Quebec a few years ago where a person made the argument that the limits of care, and the fact that it is illegal to make one's own arrangements here denied a person their right to security of person.
If there is wholesale denial of care in the US, would there be a constitutional challenge to such a scheme?
Derek
Yes, I should've clarified that there are standardized protocals to determine who gets what type of treatment, based on cost of treatment and likelihood of survivability and effectiveness, not that those who are denied or have to wait for treatment are likely to be in agreement when they want/need it!
Let me be blunt: I want NOTHING to do with conventional medical care save for diagnostic measures; I haven't used pharmaceuticals in over a decade and have NO intention of starting now.....consequently, I will not be part of any health insurance mandate - PERIOD, and I have informed the President of as much as well as several key senators. I won't stand in the way of anyone else that chooses to comply, but never will I abandon the homeopathy that saved my life when conventional modalities failed or be penalized for refusing to support a system that I believe is inherently biased toward allopathic medicine which is highly suspect. I was DONE with typical health insurance coverage long ago and every day I am reminded all over again of just why; more and more Americans are turning to alternative treatments to prevent major diseases but throughout this incredibly uninformed debate there has been not ONE mention of this fact.
Living in Massachusetts, I have taken an available religious exemption and will only support a single-payer system that reimburses me, at least in part, for the health care I - I - choose - NOT you, the brain-dead products of teaching hospitals and universities or anyone else; I completely reject the rampant ignorance that has characterized this debate - the mandate in MA was passed without an OUNCE of public advice and ostensibly violated the state constitution - not only that, not one legislator read the finished bill. Not ONE.
There is no more sacred human right than the ability to make informed decisions about one's health care without philosophical restrictions or truly noxious judgements, and too many of the mouths influencing any outcome (Kennedy, Wyden, Baucus, O'Connell, Grassley et al) have failed to recognize as much. If these zealots really DO care about my health, relieve the unrelenting stress caused by values that don't see fit to create enough jobs without ridiculous, costly demands that only benefit a few interested parties or, at the very least, get out of my way and my life!
There's a perversity among free-market fundamentalists like McArdle that always amazes me: the proclivity--rivaled only among Lubavitchers, Hare Krishnas, and Southern Baptists--for blindly reiterating cherished dogmas no matter how starkly they are contradicted by plain facts.
I was reminded of anti-empirical bent recently when N. Gregory Mankiw, a professor of economics at Harvard and former adviser to President George W. Bush, gallumphed into print in The New York Times to declare, "A competitive system of private insurers, lightly regulated to ensure that the market works well, would offer Americans the best health care at the best prices." (http://www.nytimes.com/2009/06/28/business/economy/28view.html) This is dogma gone delusional--this is precisely the overpriced, dysfunctional, unraveling system WE ALREADY HAVE: DOUBLE the average per capita costs of any other industrialized country and the leading cause of personal bankruptcy, even for people with these lousy private insurance plans. Yet these facts do not deter Professor Maniw from declaring, in effect, that the sun revolves around the earth. As the old saying goes, why let the facts spoil a good story?
The same sovereign immunity to basic realities applies to Ms. McArdle's post above. Her boilerplate right-wing nitpicks about cancer-survival rates ignore the very comparable rates in Canada (see http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20080716/cancer_statistics_080716?hub=MSNHome) or the wide disparities in survival rates in the U.S. based on income and class (see the previous and http://jnci.oxfordjournals.org/cgi/content/abstract/99/18/1384 and). The basic reality she is so desperate to flee from is this: the rest of the countries of the industrialized world all have variations of nonprofit, single-payer health-care systems, and they all have HALF the average per capita costs of the United States and BETTER health outcomes: better life expectancy and lower infant-mortality rates.
If McArdle wishes to believe that those superior outcomes bespeak some variable other than the quality of the health-care system, that's her privilege. But the 2000 WHO report on global health systems pretty much puts paid to that diversionary feint of the right-wing apologists for America's HMO-bred chaos. WHO rated the U.S. health-care system 37th in the world, only two notches ahead of Cuba, behind Costa Rica, and dead last in the industrialized world. This report, assembled by some of the leading public-health scholars in the world, attribute life expectancy and infant-mortality rates to the quality of the health-care system, not to other variables of McArdle's arbitrary imagining.
That's a half-century of empirical evidence that predominantly nonprofit health-care systems produce far better results at far less cost than the chaotic for-profit shambles here in the United States, which fails to cover 1/6 of the population AT ALL, much less with quality care.
But, as I said--why let some simple facts spoil a good story? Ms. McArdle, like Prof. Mankiw, is determined to believe that Americans live in the best of all possible health-care worlds. Far be it from me to disturb their dogmatic slumbers with a few bracing splashes of empirical reality.
The data comes from 1990-1999.
The waiting lists in Canada have increases substantially since then. In the early 90's the training of doctors and nurses was cut creating serious delays in treatment later in the decade and early 00's.
So these statistics have very little relation to the reality today.
Sorry.
Derek
Oh, a few years ago the provinces and federal government got together and made a 5 year plan (seriously) to focus on decreasing waiting times for cancer, heart disease, hip replacements and some other things I don't remember. They set targets for waiting.
You see, the system was so effective that they had to convene a crisis meeting to fix it.
What happened is that if you were sick but didn't have heart, cancer or whatever was on the list, the waiting period went up as those departments were starved of funds and personnel.
Derek
Sorry--but most of those statistics come from the late 1990s, and those rankings are still give an excellent snapshot of the comparative global realities of health care. See, for example, the following scholarly study (from 2008), which finds, "France, Japan and Australia rated best and the United States worst in new rankings focusing on preventable deaths due to treatable conditions in 19 leading industrialized nations." (http://www.reuters.com/article/latestCrisis/idUSN07651650)
The waiting times in Canada are for ELECTIVE procedures only--urgent cases are always seen immediately. You're just recycling the obligatory HMO/right-wing talking points about Canadian health care, which are easily debunked. See the following, among many other sources:
http://www.usatoday.com/news/health/healthcare/2002-05-22-insurance-deaths.htm
Now--about those 18,000-plus Americans who DIE each year in the U.S.: their waiting time is FOREVER. That's the price and market rationing of America's barbaric "pay or die" system. I guess that kind of death-dealing rationing, found nowhere else in the civilized world, is just to your taste?
I think all you need to do to evaluate your WHO study that ranks the US Healthcare system as only "2 notches above Cuba and Costa Rica" is to ask yourself this question....
Would you rather get care here? Or there?
It is impossible for me to take that 'study seriously'. NO person in their sane mind would suggest that care offered in Cuba is better than in the US (and there is no difference between 37th and 39th in this kind of study).
Might there be a bias in the way the study was formulated that favor government run programs? There's obviously NEVER a leftward bent in academic institutions afterall....
If you're one of the 47 million Americans with no health-care coverage, or if you're one of the 18,000 annually destined to die in this country because you can't afford to see a doctor, you would rather be treated in Cuba or Costa Rica.
One of the criteria in the study was ACCESS to health care, and the United States ranked dead last among industrialized nations overall because of its wretched unevenness on that critical criterion. What good are all those MRI machines and fancy meds if they are unavailable to you?
Your obliviousness to this point reeks of the complacency of middle-class insularity and indifference to the plight of all those not of your social class.
What if the average lifespan comparisons between the U.S. and other countries are utterly bogus? Some years back, I read (perhaps in the Public Interest) that they are skewed by different definitions of infant mortality. As I recall the article, other countries don't even bother to try to save the lives of tiny premature infants, and list them as stillborn even if they breathe and cry for some time before they die. The U.S. tries to save any infant born alive, and does in fact save many of them, though many of the very premature ones cannot be saved. Those who don't make it are counted as dying very very young in the U.S., and not counted at all in other countries. This would inevitably affect average lifespans, since a single baby dying an hour or two old would be equal to (e.g.) several 55+ lung cancer deaths.
So much for my memories. I was going to see if I could find some reference to the paper I read on the web, but Random Jottings recently posted on this very subject. Here is what he quotes from an IBD editorial:
". . . Infant mortality rates are often cited as a reason socialized medicine and a single-payer system is supposed to be better than what we have here. But according to Dr. Linda Halderman, a policy adviser in the California State Senate, these comparisons are bogus.
"As she points out, in the U.S., low birth-weight babies are still babies. In Canada, Germany and Austria, a premature baby weighing less than 500 grams is not considered a living child and is not counted in such statistics. They're considered 'unsalvageable' and therefore never alive. Norway boasts one of the lowest infant mortality rates in the world -- until you factor in weight at birth, and then its rate is no better than in the U.S.
"In other countries babies that survive less than 24 hours are also excluded and are classified as 'stillborn.' In the U.S. any infant that shows any sign of life for any length of time is considered a live birth.
"A child born in Hong Kong or Japan that lives less than a day is reported as a 'miscarriage' and not counted. In Switzerland and other parts of Europe, a baby is not counted as a baby if it is less than 30 centimeters in length. . . ."
I don't know if the supposed difference in infant mortality rates produces all or most or just some of the difference in average lifespans, but it is certainly at least "some", and the U.S. should therefore certainly be higher than #37 in the world.
One more thing: I think it's safe to assume that medical statistics from Cuba (for instance) are simply made up to look good, and have no relation to reality.
Here are the 44 countries that rank ahead of the U.S. in infant-mortality rates, according to the CIA World Factbook (deaths per 1,000 births)--now what's your excuse for all the NON-European countries that better the U.S. in this crucial yardstick of health-care quality?
180 United States
6.26
2009 est.
181 Cuba
5.82
2009 est.
182 European Union
5.72
2009 est.
183 Italy
5.51
2009 est.
184 Isle of Man
5.37
2009 est.
185 Taiwan
5.35
2009 est.
186 San Marino
5.34
2009 est.
187 Greece
5.16
2009 est.
188 Ireland
5.05
2009 est.
189 Canada
5.04
2009 est.
190 Wallis and Futuna
5.02
2009 est.
191 Monaco
5.00
2009 est.
192 New Zealand
4.92
2009 est.
193 United Kingdom
4.85
2009 est.
194 Gibraltar
4.83
2009 est.
195 Portugal
4.78
2009 est.
196 Australia
4.75
2009 est.
197 Jersey
4.73
2009 est.
198 Netherlands
4.73
2009 est.
199 Luxembourg
4.56
2009 est.
200 Guernsey
4.47
2009 est.
201 Belgium
4.44
2009 est.
202 Austria
4.42
2009 est.
203 Denmark
4.34
2009 est.
204 Korea, South
4.26
2009 est.
205 Liechtenstein
4.25
2009 est.
206 Slovenia
4.25
2009 est.
207 Israel
4.22
2009 est.
208 Spain
4.21
2009 est.
209 Switzerland
4.18
2009 est.
210 Germany
3.99
2009 est.
211 Czech Republic
3.79
2009 est.
212 Andorra
3.76
2009 est.
213 Malta
3.75
2009 est.
214 Norway
3.58
2009 est.
215 Anguilla
3.52
2009 est.
216 Finland
3.47
2009 est.
217 France
3.33
2009 est.
218 Iceland
3.23
2009 est.
219 Macau
3.22
2009 est.
220 Hong Kong
2.92
2009 est.
221 Japan
2.79
2009 est.
222 Sweden
2.75
2009 est.
223 Bermuda
2.46
2009 est.
224 Singapore
2.31
2009 est.
What kind of moron cuts and pastes a long list of numbers easily available at the link that's already been provided? And what kind of moron writes something like "what's your excuse for all the NON-European countries . . .?" when Hong Kong and Japan have already been specifically mentioned in the comment to which he pretends to reply?
What kind of MORON never cites sources and so needs a good, solid listing of FACTS to counter his vaguely recalled propaganda from neocon rags?
That moron would be YOU!
You provide us this list (thanks...) but you refuse to address the real issues brought up in the post that linked to it. There are serious issues with the methodology of this "study" that make it difficult to draw valid conclusions from. If the denominator is different it's comparing apples to oranges.
I can tell you that if I had a kid that was born prematurely, I'd much rather have that child taken care of in a NICU in the US than anywhere else in the world. Ditto that for prenatal care. Rather have the care here in the US than abroad.
I'm not sure where you can have your immunity to facts treated. In your case, that appears to be a congenital and untreatable condition.
No matter how frantically you try to finagle and upend the clear and irrefutable data, the rest of the industrialized world provides health-care that is at LEAST on a par with that of the United States (by most creditable authorities, better) and HALF the average per capita cost.
Ya' know, some collective social services in advanced societies work better in the public sector: police and fire protection and health care.
Just curious: how would you feel if the fireman showed up at your blazing house and demanded a copay and an insurance card before he turned on the hose? If you lacked either, would he be justified in letting your house turn to ashes? Do you consider human lives inherently less valuable than houses?
The absolute numbers of deaths of premature babies is too small to have much of an impact on life expectancies. Per the CDC, only about 28,000 infants a year die, and something less than 10,000 are directly attributable to prematurity. (See Table 8 in the link -- there's an entry specifically for prematurity, but many of those other top 10 causes, like necrotizing enterocolitis, are often complications of prematurity.)
Also, when we start talking about prematurity and birth complications, infant mortality is usually the wrong statistic to use. Infant mortality includes all deaths up to one year of age, which includes things like SIDS and child abuse and accidents and other illnesses. Those are important in other contexts, but not helpful in rating maternity care. Neonatal mortality, which is deaths up to 30 days of life, or perinatal mortality, which is neonatal mortality plus stillbirths/miscarriages after 20 weeks gestation, is more relevant for those purposes. Perinatal mortality teases out all those differences in definitions of life, and it's also useful to know how many babies die during pregnancy and birth.
US perinatal mortality is 7/1000, on par with France and Austria and Japan, and superior to that of the Netherlands and Great Britain. It's much better than several of the countries van mungo lists below, like Luxembourg (10/1000). The infant mortality statistics show that we have problems with older babies, but we're good at dealing with pregnancy and childbirth.
The point is that all the industrialized countries are pretty much on a par in all the key indices of quality of health care. The key differences are the following: in the United States, there are huge disparities in access--and hence quality of care--based on income, class, and race of a kind not found in the other industrialized countries; and those other countries guarantee high-quality care to their entire population at HALF the average per capita cost of the United States.
It's safe to assume that the public-health scholars of the World Health Organization who assembled their landmark report took all these variables into account and that their work constitutes a far more reliable interpretation of the available data than the neocon spinmeisters of The Public Interest or a Republican health advisor to the California State Senate.
Frankly, this is one point on which I'd rather trust the judgment of the CIA than the statistical gymnastics of right-wing propagandists:
https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html
Even Cuba does better than the U.S. on this score--sez the CIA, which surely has no interest in puffing the stats on Cuban health care.
Why do so many far-right ideologues twist themselves into such contorted pretzels of sophistry to deny the obvious? Do you think that if Europe had appreciably worse infant-mortality rates than the U.S., some enterprising journalist or scholar would have sniffed this out by now? Why the endless spasms of distortion and denial?
Here's my hunch: some people just can't stand the thought that the Latino or African American across the tracks will have essentially the same access to the same doctor as they do. This doesn't bother them in regard to other forms of societal collective self-protection--say, fire or police departments--but they just can't surmount this class prejudice on medical care.
Here's my advice: get over it. The rest of the civilized world did a half century ago, and it's still thriving.
Sorry, this just strikes me as a weird hunch:
"Here's my hunch: some people just can't stand the thought that the Latino or African American across the tracks will have essentially the same access to the same doctor as they do."
Dude, seriously, do you think concept has crossed the average American gray matter for even a second?
It's more than a hunch--I've heard this very thing repeatedly in off-the-record conversations.
People like their BMW health plans. They don't want to be thrown into the same risk pool--much less the same waiting room--as the little people. Of course, this is not the kind of thing these people will avow publicly, but you can bet on it.
You know perfectly well there's some truth to this. But I'm sure you're in the same denial about this as you are about the superior cost-effectiveness and medical superiority of Canadian and European health care.
OK sorry for the snark. I see what you are getting at.
I do think, however, that it is totally unconstitutional to force people onto a public health plan. If you like your Cadillac plan, keep it. I hope to get one myself someday.
But I think you and I are in the same boat.
PS: I don't think Euro-care is more cost effective. I just think it is more fair.
have you ever used canadian or european health care?
i thought not.
jamie t
I have used American care, with its exorbitant premiums, deductibles, copays, and coverage exclusions--the kind of extortionate, cost-bloating, and dysfunctional BS that goes on nowhere else in the industrialized world.
This is the only "civilized" country in which 18,000 people die EVERY YEAR because they cannot afford to see a doctor. No other industrialized country tolerates this kind of barbarity. You find this perfectly acceptable?
That's between you and your shriveled conscience.
Acromion--
You don't believe that European/Canadian health care is more cost-effective?
Prepare to have your belief dispelled by the facts:
http://www.kff.org/insurance/snapshot/chcm010307oth.cfm
So 'van mungo' thinks statistics from the brutal Castro dictatorship can be trusted, but statistics from The Public Interest or a Republican health advisor to the California State Senate cannot be trusted. I think that tells us all we need to know about van mungo's judgment.
The article to which I linked gave specific examples of different definitions of infant mortality in different countries. If van mungo thinks IBD is printing lies, he should be able to make himself a name in the blogosphere by demonstrating it, or at least offering some specific evidence. "It's safe to assume" is evidence of nothing except his willingness to believe what he wants to believe.
As for his stupid hunch, there are not a lot of Hispanics in my town, but the African Americans on my block and the next street over already have the same doctors I do. We all go the county medical center.
I'm glad to hear that some of your best "patient" friends come from the little people. This makes you sound like a self-parodying suburbanite right out of The Graduate.
I think that the exhaustive ten-year global study of the World Health Organization is to be trusted above the neocon blather of The Public Interest. These scholars--among the leading public-health experts in the world--just didn't credulously swallow data served up by various governments; they spent years visiting and gaining first-hand observations of the health systems in all these countries.
Have you even bothered to read the report? Or do you read only sources that massage your preconceptions?
Just to repeat: the nonprofit single-payer variants in the rest of the industrialized world achieve superior results at HALF the per capita cost, and with guaranteed coverage for all. Now even if you want to quibble and claim that their results are only just as good as ours, or marginally not as good, it is indisputable that they accomplish comparable results with twice the efficiency.
Another ding in the armor of free-market-fundamentalist dogma.
1. Infant mortality isn't counted the same in all countries. The US counts any infant born live and dying as an infant mortality. Many European countries consider it a stillbirth. This alters statistics. This is one more reason why 'infant mortality' is not the most reliable statistic.
2. Do you think that if Europe had appreciably worse infant-mortality rates than the U.S., some enterprising journalist or scholar would have sniffed this out by now?
Oh, I'm sure if they find anything you don't like that you'll dismiss them it as coming from a 'far right ideologue.'
3. Here's my hunch: some people just can't stand the thought that the Latino or African American across the tracks will have essentially the same access to the same doctor as they do.
Speaking for myself; There are a lot of problems with government run health care. But just to address the social aspect;
I eat very healthy, I exercise, am financially responsible, don't use drugs and don't sleep around. I don't want to have to pay for people, regardless of skin color, who have trashed their bodies. And this seems, by my reckoning, to be most people. Thanks. It seems to me, based on the link between lifestyle and health issues, that lifestyle issues have a far more profound effect on health than quality of medical care for most people. And I would benefit more from having $200,000 in my pocket when I hit 25 years old than $200,000 worth of "free" medical care when I hit 75. At the least, I'd like the opportunity to make that choice. Thanks.
I don't want to have to pay for people, regardless of skin color, who have trashed their bodies.
Except that you do now. Inflated cost at doctor's since they still cover a lot of the uninsured for free, and possibly higher health insurance premiums since you're in their risk pool, unless you pay for individual insurance. You pay taxes to support the elderly in their health care. I'm not sure what you're getting at here.
And I would benefit more from having $200,000 in my pocket when I hit 25 years old than $200,000 worth of "free" medical care when I hit 75.
It's far easier when you are under 25 to think that insurance is just a waste, until you come to an age where you will need it. This isn't an if you will need it, but a when. Are you going to forgo a hip replacement or cardiac bypass surgery? Or would you whine and cry about how you made a bad decision 50 years ago and demand care?
The taxes you would pay for a publicly financed health-care system would be far lower than the annual premiums you would pay--complete with steep copays and deductibles--for a lousy HMO plan.
It's safe to assume that the public-health scholars of the World Health Organization who assembled their landmark report took all these variables into account...
The esteemed lords and ladies of the WHO also concluded that the US is #1 in "responsiveness"--that is, actually providing care to the sick--and IIRC, #3 for "distribution"--that is, fairness in who gets care. What knocks the US down to #37 is "unfairness" in the distribution of payments and similar things which have nothing to do with health care qua health care.
All the purple prose and laudatory adjectives you can muster--and you have demonstrated quite the capacity to muster them--can't change the fact that your source doesn't support your contentions.
Here's my hunch: some people just can't stand the thought that the Latino or African American across the tracks will have essentially the same access to the same doctor as they do.
Your hunch is that people who disagree with you are bigots. Lovely.
My hunch is that YOU are a bigot, because you are oblivious to this reality: the "unfairness" has to do with ACCESS. The WHO report found that ACCESS to first-rate health care is the spottiest in the U.S. among all industrialized countries, and on some Indian reservations no better than the average conditions in sub-Saharan Africa.
Now--for the people who have inadequate or no access to health care: what do you suppose the quality of their care is? Some 18,000 people DIE each year in this country because they cannot afford to see a doctor--see http://www.usatoday.com/news/health/healthcare/2002-05-22-insurance-deaths.htm. And you think distribution and access have nothing to do with the QUALITY of health care? You think that people who suffer and die from lack of access are receiving high-quality care? Are you making some kind of sick joke?
Evidently those 18,000 deaths every year--the equivalent of three 9/11s--simply bounce off your arrogant, Teflon, yuppoid, and very thick skin.
18,000 people DIE each year in this country because they cannot afford to see a doctor
18,000 French seniors died because they didn't have access to air conditioning - what's your point?
http://en.wikipedia.org/wiki/2003_European_heat_wave
My point is that 18,000 people die in this country EVERY YEAR because they can't afford to see a doctor--no precipitating natural disaster needed. THAT'S EVERY YEAR. That's 180,000 people just in the past ten years--because of the brutal price and marketing rationing of America's "pay or die" system.
That's a man-made disaster, and one that is remediable by human will and compassion--no divine intervention necessary.
That's my point--now what was yours?
"Evidently those 18,000 deaths every year--the equivalent of three 9/11s--simply bounce off your arrogant, Teflon, yuppoid, and very thick skin."
This May I treated an uninsured mother who had gone without a routine pap smear for years. She wasn't feeling well so she came into our clinic. Turned out she had late stage cervical cancer. She couldn't even afford hospice, so we referred her to a free hospice run by nuns so she could die.
Yes I know it sounds maudlin but its an anecdote at least as instructive as the lady without Herceptin story. Van Mungo is on point. Thanks for taking this out of policy wonk land and into reality.
Dear Mungo,
With your winning personality and soft persuasion, I'm sure we will get a govt-run single-payer health care very soon. People will definitely pay attention after hearing endearing compliments such as bigot.
Sincerely,
rsbsail
Ya' know, I don't care whether you find me endearing or not.
I don't find your neoliberal rationalizations for America's health-care chaos and brutality very endearing either.
By the way--you might wish you educate yourself a bit on the key issues. The single-payer plan under consideration in the House (HR676) and Senate (S703) do not call for "government-run" health care. Here you betray a common penchant for parroting the distortive buzzwords of the corporate MSM; these bills call for publicly financed, PRIVATELY administered health care, along the lines of U.S. Medicare or the Canadian system.
Here's a source that might help you get a clue or two that you might not pick up from reading The New York Times, Washpo, The Atlantic Monthly, and other shapers of the neoliberal narrative through which you seem to refract your view of "reality":
http://www.pnhp.org/facts/singlepayer_faq.php
Hey, Mange,
Who said I was a neoliberal? I'm a conservative, and definitely do not want the govt running my health care.
rsbail--
There is no appreciable difference between the free-market religiosity of the typical conservative and the typical neoliberal. Milton Friedman is demigod to both William Kristol and Larry Summers.
And I see that you still insist on recycling the canard about "government-run" health care.
Here's where you can enlighten yourself about the details:
http://www.pnhp.org/facts/singlepayer_faq.php
Nimed,
. I would be very surprised if the government denied patients the possibility to buy the drug, since governments have every reason to like people that are willing to pay for supplementary treatment
Well then consider youself surprised. If you pay for your own drugs the NHS will refuse to treat you.
And I quote:
The NHS apparently works roughly like American public schools. You don't have to use them, but to go private you need to pay from the ground up.
Also, both frequently suck.
Well, that situation just sucks.
However:
1- Eckley was not actually forbidden by government fiat to buy the drug, which is what Kenny Evitt was falsely claiming about the Herceptin article.
2- The NHS blows, and I don't know why we keep choosing as a standard of comparison one of the worst health care systems in the developed world.
3- I don't see any reason why a UHC system would need to have a rule in which, if you buy out of pocket stuff, you lose the right to further care. I know for sure that rule doesn't exist in Portugal and France, and I sincerely doubt it exists outside the U.K.
4- Private insurance companies deny care too! Surely you are aware of similar horror stories in the U.S.
5- Eckley chose the second option. So perhaps he went broke to pay for his cancer treatment, which is pretty outrageous. But the same thing would happen to him here. Don't forget we are by far the country with the most bankruptcies caused by medical care.
I am not aware of any situation where private insurance companies in the USA "deny care". They will say, "your policy doesn't cover this", but it is only the insurance claim that is denied, not the ability of the person to choose to have the care (and pay for it) or not.
But the same thing would happen to him here.
It could have happened here. However, for the vast majority of people in this country with insurance (either public or private) it would never happen. In the UK it is guaranteed to happen.
Must we do this again? Your expressed sentiment would have been a lot more credible if you had something like this about Megan's snarkiness over the last several days or about any of a number of posters making similarly inane comments.
You didn't. So this comment is nothing more than an expression of phatic tribalism . . . something we could do with a lot less of, imho. Note that your comment would have been a lot more appropriate if you hadn't deleted his 'some', as in "Your hunch is that some people who disagree with you are bigots." Offhand, I'd say this was a near-certainty.
Note also that inserting the qualifier some without any further elaboration makes such expressions meaningless for all intents and purposes. If you want to object to something substantive, object to that. I certainly do when Megan does so - it's nothing but a lazy cop-out, and dishonest to boot.
Your expressed sentiment would have been a lot more credible if you had something like this about Megan's snarkiness over the last several days or about any of a number of posters making similarly inane comments.
You find me a comment from someone on the "conservative" side saying that the "liberal" side is motivated by racism, and I'll condemn it.
Also, if van mungo is willing to give a name, I'm willing to reconsider the "some" part. Because it would surprise me if anyone either here or meaningfully involved in the public debate was in any way motivated by racism. Maybe there are some morons somewhere worried about it, but it had never occurred to me until now.
As for the other stuff going on, I think the "communist" comments are dumb, but they have at least one toe in reality. The "socialist" comments have rather more than a toe there. And you'll note that I didn't bother to go after any of van mungo's snark about "freedom" and capitalism far above, either. None of that is worth bothering with.
Accusations of racism occupy a whole different plane of contemptiblity.
If you want to object to something substantive, object to that.
I did. Look again.
It's more than a hunch--I've heard this very thing repeatedly in off-the-record conversations.
People have said to you, "I don't want black people to get to go to the doctor"?
People like their BMW health plans. They don't want to be thrown into the same risk pool--much less the same waiting room--as the little people.
On what basis to you infer racism from that? Just because people don't want to give up their luxury health plans for something crappier doesn't mean they're racist or opposed to health care for the masses.
If the government was trying to force me out of my house and into Chicago's projects, I'd be pretty pissed off. But that's not because I hate black people, it's because it sucks to live in the projects.
I have heard many people say--and have seen them write on blogs--that they don't want to pay for the medical care of the disadvantaged--although they were not quite so decorous in their terminology.
The nonprofit, single-payer health plans in Canada and Europe are not "crappy." The World Health Organization considers them far superior to the dysfunctional US system in both cost efficiency (half the per capita cost on average) and results (better life expectancy and lower infant-mortality rates). Moreover, in most of those countries people can purchase supplementary "boutique" coverage if they want private hospitals rooms or a private nurse for instantaneous handling of their bed pans. And most of those private insurers in Europe are nonprofit, so they don't engage in the inflationary price gouging of the HMOs in the US.
My feeling, from reading your post, is that I'd much rather live in the projects, among the people there, than inside your callous skull.
I have heard many people say--and have seen them write on blogs--that they don't want to pay for the medical care of the disadvantaged--although they were not quite so decorous in their terminology.
Give me a link and I'll apologize (tomorrow, I'm going to bed).
And I'll stipulate to being an evil, evil person if that makes you feel better
I've seen this thing all over huffpost and even sometimes among the far-right trolls in the commondreams comment sections.
You really can't bring yourself to believe that someone would make such a statement?
Welcome to Neverland. My name is Peter. Nobody here ever grows up.
I don't think you're an evil person--stupendously naive and more than a little callous, maybe, but let's hope that you're a work in progress and not a finished product.
My hunch is that YOU are a bigot
So SoV, I believe my point is now made: disagreement = bigotry. Also, arrogant, yuppoid, and Teflon.
I didn't just gratutiously fling the term "bigot" at you: I gave good reasons for suspecting that you are one--namely that you are indifferent to the suffering of "little" people who have to suffer and die because they cannot afford to see a doctor; you made it clear that this atrocity doesn't figure in to your estimate of the quality of U.S. health care--a pretty brutal admission on your part.
In case you missed the explanation the first time, I'll reprint it here:
My hunch is that YOU are a bigot, because you are oblivious to this reality: the "unfairness" has to do with ACCESS. The WHO report found that ACCESS to first-rate health care is the spottiest in the U.S. among all industrialized countries, and on some Indian reservations no better than the average conditions in sub-Saharan Africa.
Now--for the people who have inadequate or no access to health care: what do you suppose the quality of their care is? Some 18,000 people DIE each year in this country because they cannot afford to see a doctor--see http://www.usatoday.com/news/health/healthcare/2002-05-22-insurance-deaths.htm. And you think distribution and access have nothing to do with the QUALITY of health care? You think that people who suffer and die from lack of access are receiving high-quality care? Are you making some kind of sick joke?
Evidently those 18,000 deaths every year--the equivalent of three 9/11s--simply bounce off your arrogant, Teflon, yuppoid, and very thick skin.
If you want to convince us that 18,000 people die in the U.S. every year because we don't care, you need to provide a link that actually leads somewhere, so we can judge the plausibility of your source. You've given this link twice now, but it just goes to a page that says "The requested document was not found".
Here's another link to the report, along with a summary from USA Today:
http://www.iom.edu/?id=19175
05/22/2002 - Updated 04:54 AM ET
18,000 deaths blamed on lack of insurance
By Steve Sternberg, USA TODAY
WASHINGTON — More than 18,000 adults in the USA die each year because they are uninsured and can't get proper health care, researchers report in a landmark study released Tuesday.
The 193-page report, "Care Without Coverage: Too Little, Too Late," examines the plight of 30 million — one in seven — working-age Americans whose employers don't provide insurance and who don't qualify for government medical care.
About 10 million children lack insurance; elderly Americans are covered by Medicare.
It is the second in a planned series of six reports by the Institute of Medicine (IOM) examining the impact of the nation's fragmented health system. The IOM is a non-profit organization of experts that advises Congress on health issues.
Overall, the researchers say, 18,314 people die in the USA each year because they lack preventive services, a timely diagnosis or appropriate care.
The estimated death toll includes about 1,400 people with high blood pressure, 400 to 600 with breast cancer and 1,500 diagnosed with HIV.
"Our purpose is simply to deliver the facts, and the facts are unequivocal," says Reed Tuckson, an author of the report and vice president for consumer health at UnitedHealth Group in Minnetonka, Minn.
Among the study's findings is a comparison of the uninsured with the insured:
* Uninsured people with colon or breast cancer face a 50% higher risk of death.
* Uninsured trauma victims are less likely to be admitted to the hospital, receive the full range of needed services, and are 37% more likely to die of their injuries.
* About 25% of adult diabetics without insurance for a year or more went without a checkup for two years. That boosts their risk of death, blindness and amputations resulting from poor circulation.
Being uninsured also magnifies the risk of death and disability for chronically sick and mentally ill patients, poor people and minorities, who disproportionately lack access to medical care, the landmark study states.
"The report documents the immense consequence of having 40 million uninsured people out there," says Ray Werntz, a consumer health expert with the Employee Benefit Research Institute. "We need to elevate the problem in the national conscience."
Calculating the cost in human suffering, he says, "is one way to get there."
van,
My point is that 18,000 people die in this country EVERY YEAR because they can't afford to see a doctor--no precipitating natural disaster needed.
Our population is 5x higher - all the socialized medicine in France barely compensated for their lack on air conditioning.
This is irrelevant. The 18,000 deaths in France were due to an act of God--a freakish heat wave--combined with the Europeans' well-known aversion to air conditioning. This has nothing to do with the overall quality of their health-care system. If an asteroid hit New York tomorrow, killing 2 million people, would that tell us that Columbia-Presbyterian is a lousy hospital?
By contrast, the 18,000 death EVERY YEAR in this country are due to people's inability to afford health care--a human-made disaster that occurs EVERY YEAR because of a manifest shortcoming in the health care system.
You really fail to apprehend this difference? Just where did you do your training in formal logic--at the Jean Arp Institute of Philosophy?
It was not a "freakish heat wave". Not like temperatures jumped to saharan 130's, with eggs getting cooked before they even came out of chickens. It was high 80's and low 90's. Shorts and T-shirt weather. It's not even hot by southern standards...
Irrelevant? How? Their system of healthcare and government and standard of living go hand in hand. It's a heck of alot hotter here in Phoenix today and we don't have thousands dying from heat. It ABSOLUTELY is a man-made problem, not an act of God.
Well known aversion to air conditioning? Are you serious? How about they are so poor that they couldn't afford it. God knows that that is what you'd say if it happened in Mississippi.
This is just ridiculous.
All those people had access to first-rate medical treatment.
They died from a unique and temporary circumstance.
In the meantime, the 18,000 people who die in this country EVERY YEAR because they can't afford to see a doctor are of no concern to you.
That's what's known, in any country, as arrant hypocrisy.
By the way, the exhaustive study of global health systems by the World Health Organization ranked the French system first in the world.
Do you have ANY clue about what goes on outside the southwest of the United States?
Oh, well, I guess that's okay then.
Sorry you're dead folks, but hey - at least you don't live in France!
How is someone getting MS not "an act of God"? Seriously, "did you do your training in formal logic--at the Jean Arp Institute of Philosophy?
Come ON, jmo3, how much evidence has to be amassed for you and most of the conventional idiots to recognize that MS - most if not all autoimmune disease states - are primarily as a result of environmental considerations, with pre-genetic dispositions being only a secondary one? These things do NOT occur in a vacuum no matter how much the establishment tries to brainwash the masses otherwise, and I can personally cite evidence to that effect which is EXTREMELY disturbing - autoimmune responses are NOT an 'act of God' - and yes, vaccines are most certainly an exacerbating factor despite an avalanche of industry propaganda from Offit and Oh! You are one arrogant suss, BTW.....
Please van mungo, before we go any further... explain to me why suffering heat stroke in France due to a lack of air conditioning is an "act of God" but suffering from MS isn't "an act of God."
Please, I'm eager to hear your explanation.
The deaths in France were due to (a) a freakish natural disaster combined with (b) a well known national aversion to air conditioning. The problem was NOT lack of access to timely medical care. GOT IT?
The 18,000 who who succumb to ALL MANNER OF DISEASES AND AILMENTS in this country EVERY YEAR--not just on one occasion--perish BECAUSE THEY CANNOT AFFORD TO SEE A DOCTOR. THE OLD PEOPLE IN FRANCE DIED IN SPITE OF THEIR ACCESS TO GOOD MEDICAL CARE. THE 18,000 IN THIS COUNTRY EVERY YEAR DIE BECAUSE OF LACK OF ACCESS TO MEDICAL CARE.
Now let's review this--slowly, this time, so you can understand: In France, causes of death: (a) natural disaster, (b) distaste for air conditioning, but NOT (c) lack of access to medical care.
In the United States, 18,000 deaths PER YEAR because of (c), lack of access to medical care because they CAN'T AFFORD IT.
(c) NEVER happens anywhere else in the industrialized world. ONLY in the United States.
Clear enough now?
The statement that "The problem [in the French heat-wave] was NOT lack of access to timely medical care" seems to be false. Here are some bits of the Wikipedia article already linked by jmo3, since van mungo was apparently too lazy to follow it:
"As a consequence of the usually relatively mild summers, most people do not know how to react to very high temperatures (for instance, with respect to rehydration), and even most single-family homes and residential facilities built in the last 50 years are not equipped with air conditioning. Furthermore, while there are contingency plans for a variety of catastrophes and natural events, high heat had never been considered a major hazard and so such plans for heat waves did not exist at the time."
Were there public-service announcements on TV to tell people to rehydrate? Did they encourage people to go to air-conditioned public buildings, as is done in the U.S.? Not so far as we are told.
More from Wikipedia:
"The heat wave occurred in August, a month in which many people, including government ministers and physicians, are on holiday. . . . .
"That shortcomings of the nation's health system could allow such a death toll is a matter of controversy in France. The administration of President Jacques Chirac and Prime Minister Jean-Pierre Raffarin laid the blame on families who had left their elderly behind without caring for them, the 35-hour workweek, which affected the amount of time doctors could work and family practitioners vacationing in August. Many companies traditionally closed in August, so people had no choice about when to vacation. Family doctors were still in the habit of vacationing at the same time. It is not clear that more physicians would have helped as the main limitation was not the health system but locating old people needing assistance.
"The opposition, as well as many of the editorials of the local press, have blamed the administration. Many blamed Health Minister Jean-François Mattei for failing to return from his vacation when the heat wave became serious, and his aides for blocking emergency measures in public hospitals (such as the recalling of physicians)."
Weevil--
Do you bother reading your own posts?
"It is not clear that more physicians would have helped as the main limitation was not the health system but locating old people needing assistance."
This is all a lot of diversionary nonsense. The fact remains that 18,000 people die in this country EVERY YEAR because they can't afford to see a doctor--no freakish climatic events needed, just ordinary SOP--mass death from systemic barbarity and indifference.
And reactionary Babbits like Weevil smugly pick their teeth in indifference to this nonstop barbarity here in the home of the free.
Of course I read my own comments. I even make sure to include both sides of disputed points so trolls can demonstrate their dishonesty by seizing on a single statement on one side and ignoring the much stronger evidence on the other. Congratulations on falling into my pitfall trap, troll. Now go back and reread my comment and note that the "It is not clear" statement is a lame excuse for not doing more, and that obviously many died in France because of lack of competent medical care: there was no government declaration of emergency, a shortage of available doctors since most were at the beach, no government request for them to return early from vacation, and a maximum 35-hour workweek for those available.
By the way, shouldn't you be less obnoxious? Your gratuitous offensiveness to just about everyone else here doesn't fit your statement that "The United States could do with a few dollops more of egalite and fraternite to complement its vaunted liberte." Certainly your fraternité needs work.
"It is not clear that more physicians would have helped as the main limitation was not the health system but locating old people needing assistance.""
What kind of moron just repeats the one piece of evidence that (very shakily) supports his side of the argument, while ignoring the four pieces of evidence that show how shaky it is? The 'van mungo' kind, of course, who just can't bring himself to argue like an honest human being.
van mungo,
You keep forgetting that 18,000 in France is equivalent to 90,000 in America as our population is 5x higher.
Third grade compare-and-contrast exercise:
18,000 die ONE TIME in France because of ONE-TIME natural disaster, IN SPITE of good access to medical treatment.
18,000 die EVERY YEAR in U.S. BECAUSE OF lack of access to ANY medical treatment.
Compare and contrast. Use a separate sheet of paper if necessary.
The deaths in France were due to (a) a freakish natural disaster combined with (b) a well known national aversion to air conditioning. mThe problem was NOT lack of access to timely medical care. GOT IT?
The 18,000 who who succumb to ALL MANNER OF DISEASES AND AILMENTS in this country EVERY YEAR--not just on one occasion--perish BECAUSE THEY CANNOT AFFORD TO SEE A DOCTOR. THE OLD PEOPLE IN FRANCE DIED IN SPITE OF THEIR ACCESS TO GOOD MEDICAL CARE. THE 18,000 IN THIS COUNTRY EVERY YEAR DIE BECAUSE OF LACK OF ACCESS TO MEDICAL CARE.
Now let's review this--slowly, this time, so you can understand: In France, causes of death: (a) natural disaster, (b) distaste for air conditioning, but NOT (c) lack of access to medical care.
In the United States, 18,000 deaths PER YEAR because of (c), lack of access to medical care because they CAN'T AFFORD IT.
(c) NEVER happens anywhere else in the industrialized world. ONLY in the United States.
Clear enough now?
So Katrina was a "freakish natural disaster" as well?
This is really idiotic.
18,000 people die in this country EVERY YEAR because they can't afford to see a doctor, and you're nattering on about Katrina?
"Corporate serf" just about sums up the mental prison you inhabit.
Please get your irony shot re my nick.
You were the one going on about "freakish natural disaster" when the favorite socialist nation of the moment is the one affected. Katrina would be the rough equivalent in the US. Let me hear your opinion re that.
Plus, as many have already pointed out to you, what happened in France was the equivalent of 90000 US citizens dying in one "freakish natural disaster".
May be your larger point is that a bureacratic government dominated medical system can't really handle events that are outside, say one and half sigma, of the mean?
My larger point is that you seem incoherent and have no idea what you're talking about.
You think a one-time heat wave in France, with its attendant deaths, contravenes decades of accumulated and painstakingly gathered evidence that the French health-care system provides better care than the U.S. at half the per capita cost?
Is that what you're really saying? Or do you have any idea what you're saying?
You really can't bring yourself to believe that someone would make such a statement?
I believe that many people have said "I don't want to pay for care for the disadvantaged."
I do not believe that anyone has said "I don't want to let black people see doctors."
Only the latter statement is bigoted/racist. The former is not.
I didn't just gratutiously fling the term "bigot" at you: I gave good reasons for suspecting that you are one--namely that you are indifferent to the suffering of "little" people who have to suffer and die because they cannot afford to see a doctor
That might make me a jerk, but it doesn't make me a bigot. A bigot is a very particular kind of jerk. A subset, if you will, of the broad class of jerks.
Re: 18,000 deaths, I'd like to know what that number really means. We have Medicaid, we have charity care, we have ERs. I struggle to understand what it means to not be able to "see a doctor." Do we mean people who can't afford and office visit plus $4 generic antibiotics (why can't they find a free clinic)? Or people who can't afford weekly dialysis (which is rather more than "seeing a doctor")? Why didn't Acrimon's no-pap-smear lady go to Planned Parenthood?
The proper solution depends on what the problem is, you see.
See my post below, which I think links to the 18,000 deaths story. You can read it for yourself and realize the relative stupidity behind people quoting it in big bold letters.
For comparison, in 2008:
34,234 people died from Septicemia (arguably one of the easiest to prevent causes of death)
43,354 died from motor vehicle accidents (we could definitely save 18,000 lives in there!)
And here's a good one: 13,322 people died from falls.
So basically, you are 74% as likely to die from a fall this year as you are from lack of health insurance. Add in drowning (3,842) and basically you are even.
My point is this: 18,000 is a terrible number. But if you are truly looking to reduce the number of unnecessary deaths on a yearly basis, there are far easier and cheaper ways to go about it. 18,000 is a very LOW number by most standards (about .8% of all deaths).
P.s. It's always good to look at things in a greater perspective, and I hope what I wrote helps.
P.p.s. Just to confuse Van Mungo: about 2.5 million people die in Africa each year from malaria. It is estimated that a one year spending of about $2-4 billion would essentially wipe malaria off the continent (as was done almost everywhere else in the world prior to recent resurgence). So for far less money, we could save at least a million african lives each year.
Yet you are raging on about 18,000 americans? How racist are you?
I believe the topic of this thread is the U.S. health-care system. I, of course, would be happy to see the United States spend even one-tenth of its current hypertrophic war/death budget on combatting global disease--along with creating a rational, civilized health-care system to rival those of the rest of the industralized world.
Tell me--is dredging up specious analogies you avocation, or is that your profession?
This is really unbelievable. You're quoting statistics that cite the random circumstances of disease and accident. No amount of human intervention can shield all humans from the contigencies of disease and accidents.
For the 18,000 people who die because they cannot afford to see a doctor, the immediate cause of their demise is ENTIRELY AVOIDABLE HUMAN INDIFFERENCE. If this country could muster the necessary collective conscience and will, those people COULD BE TREATED AND THEIR DEATHS AVOIDED. There is a clear difference between a humanly created and thus humanly remediable disaster, such as war or injustice, and random, unavoidable strokes of fate such as disease and accidents.
But even victims of disease and accidents have a far better chance of survival if they have access to medical care. Excluding people from such access--as this country does for 47 million people in this barbaric "pay-or-die" system--clinches their doom at the hands of fate.
Only a cynical propagandist--or a complete idiot--would carelessly obliterate these obvious and critical distinctions.
Two things for van mungo:
1. Cite the 18,000 deaths. I assume you are referring to the institute of medicine study (here's one link: http://www.usatoday.com/news/health/healthcare/2002-05-22-insurance-deaths.htm)
If you take a close look at that study, you will see the serious flaws in just blithely claiming "18,000 people die due to lack of healthcare!" (which is just an incredibly ignorant statement anyway, as far more than that die due to lack of healthcare in the U.S. and every other country).
2. You throw the terms bigot, racist, and other words around frequently and without any apparent analysis as to what those words mean. Let me use a personal anecdote:
I work in a company with a good healthcare plan provided to employees. One of my co-workers is morbidly obese and very publicly moaned about how the recent changes to the healthcare plan will impact her dramatically because she expects to be in the hospital several times this year (each day in the hospital will now cost $150 in a deductible, up to $750 max), is on numerous mail-order drugs which also went up in price, and visits various doctors about once every other week.
This woman has followed a lifestyle that has led her to being extremely unhealthy while she is relatively young, and requires constant medical attention to NOT die before the age of 60.
Now - I'd prefer not to have to subsidize her lifestyle choices with my health insurance premiums. I'd prefer she pay far more out of pocket for her choices.....I'm more of a mindset that we all make choices, and we should pay for them.
Does this make me cold-hearted? Bigot? Racist? Neocon? Any other derogatory claim you can come up with?
Or does it make me someone who wants everyone to have basic major medical care but doesn't want the entire society burdened with the chronic care of individuals who have made very bad choices for a very long time, or individuals who choose to pursue a lifestyle that leads them into much more medical care?
Those are personal choices, and I'm happy for people to have those choices as long as they pay for them. But that's just me.
Joe
Tree Joe, do actually KNOW she's morbidly obese because of lifestyle, or is there a possibility she's obese because of a thyroid condition?
I did metabolic research at Hopkins and I observe her lifestyle on a pretty much daily basis. Do you need more details?
FYI, hypothyroidism is a very, very minor cause of obesity. If you understand basic metabolism, you probably understand that someone suffering from a hypoactive thyroid (and subsequent obesity) can barely move.
Ok, here's another anecdote since I know alot more details: My father is 59 years old. He is seriously obese (though not morbid, I think his BMI is around 38 right now).
He has very serious sleep apnea, which he refuses to accept is massively affected by his obesity. He has had 3 unsuccessful surgeries. He uses a C-PAP machine (B-PAP didn't work for him), he takes multiple stimulants to stay awake during the day and drugs to help him sleep at night. Drugs for high cholesterol and hypertension.
He complains about spending ~$5000 out of pocket for himself each year, so I'm guessing his cost on the system is between $75,000-150,000 a year (he works for the government and has good insurance). I feel that he would reduce that expenditure down to maybe $10-15k a year by working on his obesity substantially. Hypertension and Hyperlipidemia would probably be dealt with, and Sleep Apnea would be greatly reduced (in all likelihood) with subsequently less medications.
But instead, we all pay so that he can maintain an easy lifestyle and die younger than he otherwise would.
Maybe you'll understand that my anecdotes aren't just about co-workers?
Joe
no, I actually assumed you were correct; but a lot of people make snap judgments about obese people without ever considering the potential for a medical basis for the condition. (My sister is fighting this battle right now.)
And I agree with you; many folks' lifestyle choices cost others, burden the system. But the pause to consider, 'Is my snap-judgment potentially wrong?' bears reinforcing before we start off a new round of the blame game.
There will always be someone/something putting a heavy burden on any such system, and I'm not trying to rush judgement. I think my question is specifically aimed towards those who produce the heaviest burden from lifestyle choices without having a subsequently heavier payment.
Similar to how smoker's pay more for life insurance. Should those who smoke/are obese pay substantially more into the system?
Most obese people get checked for thyroid conditions, which at any rate do not cause morbid obesity. A thyroid in that bad shape would have caused a number of other issues that would have called it to their physician's attention: weird hair growth, a voice dropping an octave or so, strange periods, etc. Thyroid patients can become very chubby, but they do not gain 300 pounds. All that mass has to come from somewhere.
FYI Megan (you probably know this) Morbid obesity is a BMI of greater than 40....a 5'7" male of ~260 pounds is morbidly obese. A 5'5" female of 240 pounds is right at the borderline. You definitely don't need to even be 300 pounds total.
Regarding thyroid, to your point, a truly hypoactive thyroid will also result in a lethargy that is pretty much unable to be overcome. As I just said elsewhere, it takes 70% of an average person's entire metabolic needs just to live and breath. When a hypoactive thyroid actually starts to impinge on that 70%, it's actively slowing the body's functions down.
Megan, there's also a difference between the medical term "morbid obesity" and the social stigma of obesity. My sister, at 5'2" was treated as a an overweight freak a lot quicker than someone at 6'2" facing the same medical condition might.
A good friend, beginning in her mid-40's, began putting on weight, went through early menopause, and suffered a number of auto-immune disorders. Her thyroid function tested normal. Because she worked in a teaching hospital and was able to do the research, she found a doctor who was studying thyroid-caused auto-immune disorders, and now is one of his patients participating in clinical trails he runs. Despite the normal tests, he put began treating her thyroid, and she began her menses again, many of her auto-immune problems decreased substantially, and she lost significant amounts of weight. It does make me wonder how many people who battle weight constantly have a similar underlying problem that goes undetected by our current diagnostics.
More sophistry from old Joe.
In every insurance risk pool, you are subsidizing other people, and they are subsidizing you, depending on which of you ends up getting sick and needing to tap the pool of resources created by the HMO's premiums.
But having 1,300 risk pools is just grossly inefficient and irrational. You end up paying more for less care than you would if the entire country were in a single risk pool.
As Sen. Tom Harkin put it, "I used to sell insurance. The basic rule is the larger the pool the less expensive the health care. Today we have 1,300 separate pools - separate health care plans - and that is why health care is so expensive; 700 pools would be more efficient and less expensive and one pool would be the least expensive. That's why single payer is the answer."
But if you want to pay more for less--well, as P. T. Barnum once said, "There's a sucker born every minute."
It's not racist to prefer to help Americans over foreigners. Foreigners are black, white, brown, yellow, etc... Americans are black, white, brown, yellow, etc... It may be nationalist or something else and some people may believe it's wrong but it's not racist.
The problem with obesity in this country (the US) is that our food supply is full of delicious foods that contain lots and lots of calories and are very cheap and most people do not have jobs that require much physical exertion. Since the urge to eat is a very basic and powerful urge, it can be very difficult for some people to lose weight (or stay thin). Metabolisms vary and some people can eat all they want and stay thin while others can struggle and be hungry all the time and still gain weight. In addition, there are other problems that can lead to obesity, like thyroid problems and depression.
EI - Is it then tribalist to prefer to help Americans over foreigners? Nationalist, yes.
But why is it not morally wrong to spend 100x the amount saving 100x less people from dying each year?
On obesity - Both of my parents are obese, and I was overweight and still have some psychological problems (I hate taking my shirt off at the beach despite lifting weights/exercising 3-4 days a week for the past 9 years and eating right). I understand alot of the psychology and physiological effects behind it (my own loss of weight probably led me into metabolic research earlier in my career).
The problem is slightly more complex, in my view. A person can add 50 pounds of fat onto their system by eating an extra 500 calories a day for 1 year. And the metabolic effect of that additional fat is about 50-100 extra calories per day needed to sustain the weight.
But all it takes to lose it is a bit of willpower and discipline, some walking, and eliminating some foods or regulating your diet.
Joe
P.s. Depression as a cause of obesity is just another lack of willpower, not a cause in and of itself. Also, people with hypoactive thyroids tend to have alot of problems functioning normally. And it's very easy to regulate the thyroid with a bit of synthroid or even just dietary additions in some cases.
It takes X calories for the body to breathe, beat, and just lie still. Typically X = 70% of all calories needed by the body. Another 10% comes from the digestion of food. The last 20% is physical activity. I bring this up because it's not all that hard to put your body is a caloric deficit as long as you can wake up and get out of bed.
Joe:
As far as whether it is morally right or wrong to spend 100x the amount saving 100x less people from dying, it depends on who is doing the spending. If it's my neighbor Jim, who has worked his whole life and has money saved and premiums paid on an excellent health care plan, then it's not any more morally wrong than it is for Jim to live in his huge beautiful Garden District house and eat at Commander's Palace (New Orleans resident) every Sunday brunch while there are homeless with hardly any food or shelter in the Central Business District.
If it's the government doing it, then it is morally wrong. And that's why I think we need to reform Medicare/aid; I don't think the resources are properly allocated, let alone properly administered or administrated. This is difficult politically, obviously, because the senior citizens of the country are terrified about politicians touching their programs, and vote.
Not to mention the medical industries who benefit from that nearly unlimited spending on seniors.
zic:
I would agree that with the system as it is now, most medical industries (I'm going to assume hospitals?) perform multiple expensive procedures because they're often being underpaid by medicaid. But I'm pretty sure hospitals and doctors, for the most part, would rather deal without medicare and medicaid altogether. Again, I think it's a bad system that rewards too much for procedures, so if the hospital feels the only way it can break even is by encouraging more procedures, that's what happens. The hospital is partially to blame for this, but so is the system that's almost requiring them to perform unnecessary procedures to break even.
Nola Dawg--
What you're "pretty sure" of is contrary to fact.
According to a survey in The Annals of Internal Medicine, 59 percent of American physicians favor a single-payer system. See http://www.reuters.com/article/latestCrisis/idUSN31432035
First, your survey has nothing to do with what I claimed. I said I was pretty sure most physicians prefer not to work with medicare and medicaid. I am pretty sure because that's the attitude I have encountered while working with physicians, as well as what I recall reading. Either way, your survey does not address this issue, but rather whether they would prefer working under a single payer system.
Further, next time don't substitute a news review for a primary source, refer to the actual source so I don't have to waste my time searching for it. Interestingly enough, I did manage to find it:
http://www.annals.org/cgi/content/full/139/10/795?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=survey+single-payer&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT
It had the following to say:
Our survey found that 49% of physicians supported legislation to establish national health insurance ("strongly support," 18%; "generally support," 31%) and 40% opposed it ("strongly oppose," 21%; "generally oppose," 19%)
Please also refrain from standing on moral high ground, berating people for using non-credible sources, and then mis-cite your own data.
And while we're on the subject, this article is so vague as to be laughable. Only 49% saying they support some type of national health care covers a huge variety of scenarios, including several in this comments section about a catastrophe insurance.
Now listen very carefully, you inept crank.
You provide ZERO sources for your crackpot burbling.
I provided an unimpeachable source.
Now poor little baby had to go find the primary source reported on, and HE WENT TO THE WRONG SOURCE.
The article I linked quotes a survey reported on in the April 2008 issue of Annals of Internal Medicine. You found and quoted a survey from 2003.
Could you be any dumber?
Do you lack the gene that triggers public embarrassment in normal people?
I have experience with the Danish system, although it is purely personal rather than statistical. I would not want to be seriously ill here. One relative died from very treatable lymphoma at age 62. Once he was diagnosed, he received agressive treatment comparable to that in the US. But because he had to wait literally months to get an appointment for his initial complaint, a bad back, his disease, once diagnosed, had progressed too far for him to survive. Other family members with cancer did not receive aggressive treatment because they were deemed terminal. Rationing is a fact of life here. The concept of getting a scan or MRI within days or even hours is simply alien to most Danes, who, btw, are increasingly purchasing extra insurance for private treatment.
With healthcare you have three things: 1) fast, immediate access with no waits 2) quality, high tech / most advanced care 3) cheap.
You can probably at best have two of the three. That's it. Take your pick. In the US, we opt out of #3. In many of the socialized systems, they opt out of #1 and in many ways (documented above) #2.
I don't understand why we as Americans are rushing headlong into a system that so many want to move away from (whether in Canada, Denmark, England). And to move towards the government led system we will NECESSARILY be opting out of the same things the other socialized medicine countries do to get it cheap.
It is as sure as night follows day....
This sounds like a typical HMO-inspired scare story. In all the countries of Europe, serious, urgent cases are seen immediately.
It is just as possible that a bad back could be misdiagnosed in the United States and left untreated.
This anecdotal evidence is worthless. According to the World Health Organization, which spent a decade studying world health systems, the Danish system ranks 34th in the world, three notches ahead of the United States. You will forgive me for according more credibility to this painstaking study than to your undocumented personal anecdote.
Treejoe,
Totally off topic but I find this topic fascinating. My BF has 2.7% body fat. How is he able to do that you may ask. Well, he never gets hungry. He'll get a headache, he'll get irritable, but he just never feels hungry. I of course, am always hungry and keeping my weight under control is a constant battle.
My question then - do you agree that the amount of willpower required to maintain a set body fat varies widely between people. For someone like my BF, it doesn't take any willpower at all, for you and me it takes a considerable amount of willpower. For your unfortunate coworker perhaps all the willpower in the world isn't enough to counteract her malfunctioning appetite control center.
My weight lifting partner and good friend in college had a body fat around 6% (Your boyfriend's being 2.7% is highly doubtful, as he'd be close to death, but that's most likely due to inaccurate measuring equipment being widely available).
My friend was the type of guy who had a 8-pack of abs no matter what he did. I'd pack on fat if I looked at food (speaking of which, I'm going to go get my peanut butter and jelly sandwich).
There's alot of discussions and theories why some people tend to pack-on fat more easily. Genetic influences? More fat cells and insulin in the bloodstream? I don't know.
I agree that the amount of willpower required to maintain a set body fat varies widely between people. But my friend, who swore no matter how much he ate he never would gain weight, actually gained substantial fat once I put him on a 5,000 calorie a day diet. And muscle mass, for that matter.
He was simply a guy who didn't eat alot as a kid and was extremely active his whole life. Versus me, who ate fatty foods and was barely active. I had alot of fat cells in my body and not much muscle. He was the opposite.
I raise this anecdote because it's an example that the body doesn't waste calories, and it can't maintain function indefinitely when it's caloric intake is reduced. The problem is making the body store calories as you want them or use caloric stores as you want the body.
And that seems to differ for everyone too.
Joe
Joe,
Its true. There is a largely genetic component to it. Number of fat cells and fat distribution are fixed. The number, type, and distribution of muscle cells is also genetically determined. People have varied responses to exercise as well. Some will undergo muscle hypertrophy (getting ripped) by just looking at a dumbell. Contrary to popular belief, muscle hyperplasia (growing brand new muscle cells) is rare and occurs under extraordinary stress to the muscle fibers, or under the influence of excessive growth hormone.
Well, I'm not TreeJoe, but I think it's interesting too so I'll have a crack. Also, I don't think it's off topic at all, because the fundamental issue here inevitably redounds to whether government health schemes should pay for treatments related to smoking, obesity, and even some lifestyle-related traumas and infectious diseases.
The problem with making these judgments is it's like watching someone move a box that you're not allowed to touch: there's no way to standardize the experience. So when you see the mover struggling with it, you have no way to tell if the box is really heavy or if he's really weak.
In practice, we address this problem by assembling other clues about both the person and the box. How big is the box? How fit does the mover look? Have we seen him move other things that we can standardize? &c. This works pretty well, but it's very far from perfect.
TreeJoe doesn't, and never can, really know if his morbidly obese coworker is weak or if she's burdended in this regard. The good news is he doesn't have to make a judgment in this matter so long as he's not being asked to pay for the consequences of her condition. As soon as he is being asked to pay, he will inevitably make such judgments --- and want them acted on.
He's sort of there now, with his resentment about sharing a risk pool with her. But universal-coverage proposals exacerbate the problem considerably, because they're purpose-built to expand the pool to include a population who suffer disproportionately from many "lifestyle" ailments and whose other "clues" are largely unflattering.
Really, an awful lot of people simply do hardly anything physical - including simple walking.
Many get up in the morning, get in their car, drive to work, and sit at a desk all day. Then they get back in the car, drive home, eat dinner and plop themselves down in front of the TV.
I live in a suburban neighborhood of fairly small houses and lots. Teh area is not a wealthy one. It's mixed blue and white collar. The average lot size is about 5000 sq. ft. I'd say that less then 30% of the people cut their own lawn. It takes me all of an hour and a half to cut mine every 2 weeks (including trimming and clean up). When it snows in the winter, many don't shovel the sidewalk in front of their house. They only shovel the driveway and the path from the front door to the driveway. I'm not talking blizzards - more like 2 to 4 inches of snow.
I have a dog. I walk him maybe 3 to 5 miles a day. Some of my neighbors also walk their dogs, but the vast majority don't. The dog gets to go into their backyard. That's it. If they walked their dog regularly, they'd burn a lot of calories.
I can walk to the convenience store, or deli in 5 minutes. I run into neighbors driving up to those stores. I never run into any walking to them. I walk to the supermarket, 15 minutes at most, when I don't need a big order. I only know one other neighbor that ever does that. When I drop the car off for an oil change or such at the local service station, the guys there are always surprised that I don't want a lift home. It's a 15 minute walk. Most of their customers take them up on the offer - as well as a pick up when the car's ready.
It's really amazing how little physical activity, people actually do. I'm not talking running six miles a day or going to the gym. I'm talking simple stuff that's not overly taxing. Yet, they simply refuse to do it.
You should change your own oil. Of course, you'd need to do it a nice 15 minute walk from home, but stil :)
I'm far lazier than you and maintain a good balance in my life. Walking is a superb way of staying in relatively good shape throughout life, as is yard work.
My in-laws own a heavily wooded 1.25 acre lot, and I swear it's kept them in great shape as they crack 60.
I am 60. I'm 6'1" with a 33 inch waist and 44 inch chest and weigh 180. All I do is walk a lot and do all the work, including construction, on my house and property. I DO NOt live on a diet of salads - anything but.
People always comment that I don't seem to gain weight yet they refuse to do simple, easy things, like I mentioned above that would burn calories.
18,000 die EVERY YEAR in U.S. BECAUSE OF lack of access to ANY medical treatment.
Well, the link finally working again, we can see that the claim in the article is that 18,000 people die every year because of lack of medical insurance.
NOT "lack of access to ANY medical treatment," as you said. And it isn't clear form the article what the causal mechanism is. Did people die because they needed lifesaving interventions which were denied to them based on lack of ability to pay? Did they die because they didn't feel like spending money out of pocket on preventive or diagnostic care that would have been covered? Or because, despite spending every penny they had, they couldn't afford an MRI or biopsy? Who knows?
Again, defining the problem is a necessary precursor to crafting the solution, and the fact that you have grossly distorted a source that you yourself provided doesn't inspire confidence.
I have accurately reported the source.
Here it is:
http://www.iom.edu/?id=19175
Read it for yourself.
You seem to spend entire contriving apologetics for the plainly irrational and barbaric deficiencies of America's health-care chaos.
Can't you think of a more productive use for your time?
Of course, if we just banned cars we'd save 40,000 lives per year and countless severe injuries.
According to the CDC, about 75,000 people die of "alcohol attributed deaths" each year.
If we locked up every bad guy for life, or just executed them, we'd have a big drop in the 16,000 murders every year.
If people didn't use illegal drugs, we'd save about 14,000 lives per year.
So right there we have 145,000 deaths each year. Is your precious universal coverage prevent those?
People get sick. That's part of the human condition for ALL humans--not just those who drink or drink and drive or use illegal drugs.
ALL people who get sick should have access to medical care. NO ONE should die ONLY because he/she cannot afford to see a doctor.
You can spew your irrelevant analogies and bizarre sophistry all day long.
No one can guarantee human safety in the face of all the contingencies of life.
But we CAN guarantee that no one will die ONLY because he/she cannot afford medical treatment. EVERY OTHER industrialized country makes good on that guarantee. It's a little something called "civilization"--mustering human will and compassion to combat the suffering and injustice that is within the reach of human intervention, even if everything is not.
Sometimes in this blog I feel like I'm talking to five-year-olds--that's how lame some of these counterarguments are.
It's a tribute to the strength of the case for Medicare for all that it requires such mangling of logic and basic ethical decency to attempt to counter it.
I couldn't read the articles in the link above other than (sparse) summary because I'm not going to buy them. But I wonder what these people are dying from. Are they dying because they received screening too late? If that's the case, it's their own fault. A yearly general practitioners visit is not too expensive for those not covered by government health care.
I've seen these sort of argument devolve before, and there always seems to be a slight disconnect. One party will argue about how many people die, and the overall statistics, while the other party will say how they'd prefer treatment in this country over any other. Both tend to be true, because the statistics cited by party A refer to the whole population, some of which does not have equal access to health care compared to the other. The question in my mind becomes is there a way the US can maintain a standard of care which most of us seem to believe is higher than most other countries while also granting access to that portion of the population that doesn't have it.
I think there is, and I personally don't think this country would be best served by a single payer system (van mungo has pointed out, correctly, that not all the proposed single payer systems are government run. I think the problem isn't so much whether they are government run, although that's part of the problem, but more that a single payer system allows for no competition, which I think is a huge problem, especially in the US).
Those that have read my previous comments in this post and others can probably tune out now.
My basic ideas for where the system should go are:
Reform (not expand, actually reform) the compensation structure for health care workers, eliminating the pay per procedure practice that, for even the most altruistic physicians, can play a subtle and subconscious role in decision making. Detach insurance from employment, allowing free market principles (the same ones that pretty much got the US to where it is today, for better or worse) to take more effect and giving the consumer a stronger link to what he or she spends. Hopefully, and obviously there would need to be a fair amount of regulation, especially at the onset, these two measures would at the very least attenuate the rising cost of health care.
If we can accomplish that, then 1 of 2 things can happen. This might reduce health care costs enough to allow those that aren't covered by the government but do actually want health care to purchase it. If not, it might at least keep medicare/aid from running out of money, and save the country as a whole enough money to consider raising the requirements on medicare/aid to include those that still can't afford it.
One of my biggest concerns is that we will pass universal health care without any serious reform (medical records and preventative medicine do not count), which would result in either much higher government rationing or an even larger financial hole than the one in which the country already finds itself.
I think that it's important to not lump all European countries together. Each country has its own implementation of health insurance. I am most familiar with Belgium's since that is where I grew up (I now live in the US).
Regarding the cost of health insurance, people have to realize that health insurance in a place like Belgium is mandatory. As an employee, a certain amount is deducted from your paycheck to pay for it. Your employer pays a portion as well. If you have your own business, you must pay for all of it (and you don't get paid maternity leave). See http://www.justlanded.com/english/Belgium/Belgium-Guide/Health/Health-Insurance for a good discussion about this.
Having grown up there (but having left at 19 before having to really deal with this myself), I have experienced the system. I think it worked relatively well for me. I got all the shots I needed, we could see our family doctor on weekends, etc. My dental care, however, was subpar. I'm not sure whether this was due to a bad dentist or whether the whole system was just bad. It took me a very long time to get used to the American system. I still don't understand the need for talking to at least 1 nurse every time I see the doctor. Seems to me like that is just not necessary (I never saw a nurse growing up). And then repeat the same story to her and the doctor, at a minimum.
Another thing to take into consideration is that medical school in Belgium is extremely cheap. Back when I lived there (I moved to the US in 1996), college tuition was about $1000/year. Med school lasted 7 years (you start out in med school; you don't get a degree along the way, then go to med school). Belgium has too many doctors as a result and is trying to limit the number of students who can study medicine. I would guess that this would lower the cost of medical care. Additionally, I doubt that doctors in Belgium have to buy as much liability insurance as doctors in America.
I do think that it is amazing that THE ONE would go to the AMA meeting and say that tort reform was off the table.
And it DOES influence the type and cost of care given in the US. For sure....
I have accurately reported the source.
The only sources you have cited claims that people die because they lack insurance. Your claim, repeated over and over, is that people die because either they "can't afford to see a doctor" (ludicrous in light of free clinics, relatively cheap walk-in clinics, and ERs) or because the "don't have access to care" (makes more sense but is very vague as to what "access" means). To put it in words of a single syllable that a 5-year-old can understand: these are not the same thing.
Start saying "18,000 people die because they lack insurance" and you'll be on firmer ground. But even then you need to explain why they need insurance rather than charity care or paying out of pocket, and why they can't get Medicaid, Medicare, or even private insurance, which programs cover the vast majority of the country.
People who can't afford insurance premiums also cannot afford to pay retail prices to physicians and hospitals.
Speaking of five-year-olds, even most of them can understand this--that these 18,000 die because they cannot afford to see a doctor.
Do you really think there are "free clinics" around every street corner in this country? Do you ever get out of the house, much less do any reading?
There are tens of millions of people who don't qualify for Medicare but who still cannot afford (a) the exorbitant premiums and deductibles that make up the lousy policies offered by the HMO extortion racket and (b) retail physician and hospital prices (and, by the way, people are BILLED for ER treatments--you really are quite the ignoramus in this field; it seems as though there is an inverse ration to the quantity of your verbiage and the quantity of facts at your disposal).
Read the study. I've posted links to it above. Educate yourself to spare yourself further public embarrassment.
People who can't afford insurance premiums also cannot afford to pay retail prices to physicians and hospitals.
That rather depends on what those retail prices are for. An office visit with antibiotics? Affordable for anyone who doesn't qualify for Medicaid. Pap smear? Free at Planned Parenthood. Emergency surgery to remove a bullet in the abdominal cavity? Not particularly affordable for anyone other than the very rich.
Insurance premiums are, of necessity, more expensive than what the average insured consumes, which means that there is considerable financial wiggle room beneath the premiums for people of modest means to "see a doctor."
(It's certainly true that people get billed for ER treatments--but equally true that large numbers of them never pay, or pay only a fraction of the bill.)
Speaking of five-year-olds, even most of them can understand this--that these 18,000 die because they cannot afford to see a doctor.
You can keep asserting that over and over and over, but your own source doesn't say that. "Seeing a doctor," as in an office visit to a GP, just isn't that expensive. Most people can afford to do it a couple of times a year. Hell, most people spend more on restaurants in a year than they would to "see a doctor."
And incidentally, I'm still waiting for evidence of racism as a significant motivator behind opposition to UHC.
BTW, are you clear on the difference between Medicare and Medicaid? Because you seem to be conflating them in several of your posts.
I defy you to cite a single instance where I have conflated Medicare and Medicaid. You're just as dishonest and clueless about this as you are about every other point of fact and logic in this discussion.
You are simply oblivious to the financial realities of a typical working family. Are you some kind of trust-fund twit?
If you think that a family that cannot afford insurance premiums can afford most retail doctor and drug bills, you're on another planet. If these people could afford to pay doctors' bills for themselves and their children, they could afford insurance premiums. A retail doctor's fee in most metropolitan areas is in the neighborhood of $200 for a PCP and $400 for a specialist. Most of the people in this country live check to check, and those are BIG expenses for them--big enough to make them think twice about seeing a doctor.
When was the last time you had any contact with working families? When you paid the valet parking attendant at your favorite sushi restaurant?
Those 18,000 people who die every year--you think they just decided to give up the ghost and say "the hell with it"? Think about it--why do you think they end up dead because they didn't see a doctor? Don't trust doctors? Fear of waiting rooms? Don't like to appear naked in front of strangers? Try this one--IN MOST CASES, THEY HAVE DECIDED THAT THEY JUST CAN'T AFFORD TO GO.
The report states in part: "Uninsured people are often charged substantially more than their insured counterparts, whose insurance companies can negotiate discounts. The cost to an adult patient of hospital admission in 1999 for treatment of simple pneumonia ranged from $100 to $3,434 under fee-for-service plans, but was $9,812 for a person with no insurance.
• More than half of all current and recently uninsured working-age adults reported difficulties paying medical bills, compared with less than a quarter of insured adults. Of those with severe bill problems, two-thirds reported borrowing from family or friends, and a quarter needed a loan or mortgage on their home."
Your posts betray a fundamental dishonesty--the kind of petty, specious spinning so common among right-wingers desperate to cling to their sense of entitlement even as their dysfunctional mechanisms of greed go into fatal meltdown.
Racism? You're beyond racism. You have ascended to heights of bigotry that render the adjective "racist" an empty signifier.
You have contempt for whole swaths of suffering humanity, whom you quite evidently objectify as an "other" unworthy of your concern or compassion.
Even "misanthrope" is too mild a term to capture your cynical indifference, your android-like ethical void where a conscience should be.
You cop to being a jerk--I'll cosign to that, to the tenth power.
I defy you to cite a single instance where I have conflated Medicare and Medicaid.
Well, you said, for instance: "There are tens of millions of people who don't qualify for Medicare but who still cannot afford..." But of course there are more millions of people who don't qualify for Medicare (because they aren't old enough) but who can afford insurance. It makes little sense to bring up a program for old people in this context, but it would certainly make sense to say that there are millions of people who don't qualify for Medicaid (because their incomes are too high) but who can't afford individual insurance. You also mentioned the "strength of the case for Medicare," which seems strange given that nobody has really argued that we should dismantle Medicare root-and-branch (although some argue for rationing to control costs).
Think about it--why do you think they end up dead because they didn't see a doctor? Don't trust doctors? Fear of waiting rooms? Don't like to appear naked in front of strangers? Try this one--IN MOST CASES, THEY HAVE DECIDED THAT THEY JUST CAN'T AFFORD TO GO.
Once again, you have not established that they're dead because they "didn't see a doctor." The report says they're dead because they lacked insurance. Maybe they're dead because they need $200k in chemo, and they can't afford it without insurance. I'm sure you'll agree that dying because you can't afford a monstrously expensive treatment and dying because you can't afford a GP visit are different problems calling for different solutions.
The two facts you cite from the report do nothing to clarify the issue. A hospital admission is not merely "seeing a doctor," as you have persisted in saying; it's a very expensive treatment and only required for fairly serious illnesses. As for the second, I can't say I'm surprised that people with no insurance have more trouble paying their bills than people with it. Really: duh. Nothing to do with death, really.
Plus, now you've added a new "fact": the people who die have "decided they just can't afford to go" to the doctor. Can you offer evidence instead of speculation?
Look, it's certainly possible that you're right, and thousands of people ineligible for Medicaid and living infeasibly far from any charity clinics or doctors willing to offer a humanitarian discount die because they can't scrape together $200 and don't want to take the credit-score hit that comes from an unpaid ER bill. But I find it hard to believe, which is why I'm pushing you for real evidence instead of misquotation and unfounded speculation.
That was a typo--hasty typing. I meant "Medicare."
You can't possibly be serious about this--after all, we're talking about people who DIE because they can't afford insurance coverage. That means that they have serious, life-threatening conditions and STILL to not seek or obtain adequate medical attention. Your points above are trivial--you have to first see a doctor to qualify for the 200k chemo treatment, much less for a $300 vial of antibiotics. You have to see a doctor to qualify for a hospital admission. "Seeing a doctor" is shorthand for "not being able to afford medical treatment"--because the doctor visit and the medical remedies--surgical, pharmacological, whatover--that ensue from it are part of a contuum of treatment. So fine--if you want to refine my formulation to state that these people die "because they cannot afford the necessary medical treatment," that's fine. Do you deny the truth of this? And do you think that this is an ethically acceptable situation?
Your argument is all over the place--first you doubt whether finances are the real deterrent, and then you quibble over whether it's seeing a doctor or whether it's the whole array of treatments they can't afford. So which of these pegs are you going to hang your argument on now? Do you acknowledge that these uninsured end up dead because they cannot afford medical treatment in general--if that formulation is more to your satisfaction--or do you still harbor doubts about their motivation?
If the latter, think for a minute--if these people with life-threatening conditions are not suicidal, what do YOU think is deterring them from either seeing a doctor, entering a hospital, or taking the needed drugs?
Let's see now--let's all think REALLY HARD and see what we come up with. I'm guessing it's the fear of being naked in front of a stranger--but I'd like to hear what you come up with.
Woops--compounded my initial typo: I meant "don't qualify for Medicaid."
I said, "the case for Medicare FOR ALL," which is another way--more accessible to a larger audience--of formulating single payer. Medicare as currently constituted in not for all, but only for seniors.
I'm sure I've forgotten more about the differences between Medicaid and Medicare than you'll ever know.
Sorry I miss the "for all."
Racism? You're beyond racism. You have ascended to heights of bigotry that render the adjective "racist" an empty signifier.
Well, I'll certainly agree that "racist" is an empty signifier in this discussion.
Yes--as applied to you, inadequate to capture the cravenness of the dishonesty and indifference with which you approach a human health emergency of massive proportions in this country.
Oh, SoV, if you're still around, I wonder if you could offer me your opinion on whether this accurately describes the positions I have taken in this thread:
You have contempt for whole swaths of suffering humanity, whom you quite evidently objectify as an "other" unworthy of your concern or compassion.
About time someone told you what we all think about you. The sentence pretty much captures the essence of your monstrous character. And don't you be leaving any parts out, such as the "android-like ethical void where a conscience should be".
Let's just tell it like it is: you basically have the blood of 18,000 people in your hands. I hope you're proud of yourself.
Rob, I just logged on, and your apologetics leave me cold. You were nasty, snide, and worse, failed to consistently apply standards. No, you don't get to arbitrarily decide what categories are so conveniently egregiously offensive - and which just happens to be the offense of someone on the opposite side of the fence.
As far as I'm concerned, all that sermonizing about being a good guy, turning the other cheek, not being offensive or provocative or aggressive even when provoked - all of that was just an act.
I'm ashamed to say I actually thought you might have been sincere, even if the benefits conveniently went to your tribe at the time. Well, I won't make that mistake again. Later, Lucy.
SoV: you seriously think I haven't turned the other cheek to van mungo, who has said some pretty nasty things directly to me, unprovoked by anything but disagreement?
So fine--if you want to refine my formulation to state that these people die "because they cannot afford the necessary medical treatment," that's fine. Do you deny the truth of this? And do you think that this is an ethically acceptable situation?
I'm sure that there exists some population of people who die because they cannot afford care that would save their lives. Whether or not it is 18,000 or not, I can't say.
As for whether I think this "ethically acceptable," the answer is broadly yes. I do not think that all people are inherently entitled to everything that might be necessary to life merely by virtue of being born. That was precisely the point of the comparisons above that others made re: malaria in Africa. Lines must be drawn somehow because resources are not infinite. Somebody, somewhere, is guaranteed to die so that somebody else can live. The question is not whether this happens, but to whom and based on what reasons.
To the extent that the current system is "pay or die," that is an irrational and foolish rule, and it would be better to adopt the somewhat more cold-blooded NHS-style analysis, diverting hip replacements for 90-year-olds to antibiotics for 25-year-olds. But the thing is this: most people--that is the vast, vast majority of Americans--can pay (through their insurer, of course). So the question is less "Should these 18,000 people die?" (we'd all prefer that they not) and more "How many people with a dramatic change in systems kill?"
It may be that the answer is "fewer, and people who deserve it more, anyway." But a new system will surely kill some people, and it will also divert money that could be used for other life-sustaining activity, such as bridge repair or bomb-sniffing dogs.
Now, I know that foreign systems are cheaper. They achieve much of this savings through rationing care. So the question is: how much care do you think the AARP will let you ration to get the costs down?
Whether or not the number is 18,000 is a good question. I haven't read the 224-page report, and don't intend to, but I'm quite sure 'van mungo' hasn't read it either. The USA Today story implies that it uses statistical correlations to calculate the 18,000. Of course, we all know that correlation is not causation, and any calculated number will inevitably be very soft.
An example may help explain what I mean. Suppose it is true that "Uninsured trauma victims . . . are 37% more likely to die of their injuries". Is that because they are uninsured and therefore treated less competently, or are there independent differences between the insured and uninsured that would make the latter more likely to die even if they were insured? If we think of the professions most likely to turn up in emergency rooms with (e.g.) gunshot wounds, I think it's safe to say that the policemen are just about all insured, the taxi drivers and convenience store clerks a mixture of insured and uninsured, and the (full-time) hookers and drug dealers just about all uninsured. Of course, the hookers and drug dealers are also much more likely to be drunk or stoned when they are shot, which will tend to increase their mortality rate. The policemen are much more likely to be wearing protective armor and to be in good all-around physical condition (other than the bullet wounds), which will tend to decrease their mortality rate. You cannot just compare the death rates of the insured and the uninsured as if they are otherwise comparable groups. They are not. Did the study attempt to adjust for differences in the composition of these groups? I don't know: I haven't read it, but neither has 'van mungo'. I doubt that it would even be possible to adjust for the differences.
You're trying to hard. Do you see any good reason why the uninsured would have any fundamental characteristic that would make them more prone to death independent of treatment? Maybe it's in their uninsured genes.
There is a limit to apologetics.
You write, "I do not think that all people are inherently entitled to everything that might be necessary to life merely by virtue of being born."
You're so ethically callused that there's almost no point is continuing this discussion--it's like trying to convey the feeling-tone of a symphony to a deaf person.
Let's take your points in order. Cold-blooded NHS analysis? You can't be quite serious. First of all, this is just another urban myth of right-wing propagandists. No one has ever demonstrated--from creditable sources--that anyone needing urgent care in any European country ever faces any kind of delay or stinting of treatment (further documentation below). That's why WHO rates all those countries' health-care systems so far ahead of ours--NO ONE is denied timely and effective treatment for ANY reason, least of all financial straits.
Your ignorance is as boundless as your ethical callousness. You state that the European/Canadian systems "achieve much of this savings through rationing care." This is completely false. They achieve savings through creating a single risk pool, as opposed to the irrational chaos of the 1,300 HMO risk pools of this country. By pooling resources in this manner, they achieve bargaining power over costs that are unavailable to a gazillion splintered payers. I guess you were out at your favorite sushi restaurant the day that lesson was covered in economics 101.
As for rationing, this is another of your sick jokes. You are blind to the fact that the United States already has rationing--the most severe in the industrialized world.
In this country, 50 million people--1/6 of the population--have no health insurance whatsoever. Some 70 million are underinsured. About 20,000 of those people die EACH YEAR because they cannot afford to see a doctor--that's three 9/11s annually because of the barbaric price and market rationing of America's brutal "pay-or-die" system.
Contrary to the right-wing disinformation that you peddle, there are no age limits to hip replacement in single-payer systems. In fact, here's a survey of hip replacements in people over 80 in the UK: http://www.jbjs.org.uk/cgi/reprint/72-B/3/450.pdf. There are reasonable wait times for elective surgeries in Canada and Europe, but urgent, life-threatening conditions always receive immediate treatment.
The nonprofit, single-payer systems in place in those countries achieve high-quality, universal coverage at HALF the per capita cost of the United States because of low administrative overhead (typically 3 to 5 percent compared to 30 percent in the United States, with its bloated, redundant billing bureaucracies, shareholder profit distribution, exorbitant CEO compensation (averaging $14 million per year) and premium price gouging--some $400 billion per year in waste that contributes not one whit to anyone's health care. All those countries have better life-expectancy rates and lower infant-mortality rates--the key yardsticks of health-care quality.
That's why the World Health Organization ranks the U.S. health-care system 37th in the world, dead last among industrialized nations. France is first, Great Britain ninth--both nonprofit systems.
So, Mr. Free Market Fundamentalist--the U.S. has much more severe and brutal rationing than any of those countries, but you don't recognize it because it's the vicious rationing of the market, which is exactly to your callous sensibility. As for those 20,000 dead each year because they can't afford health care? That's not rationing to you--that's what . . . triage? Overhead? Tough luck?
Finally--all industrialized nations have reached at least this point of civilization: they prize the lives and dignity of their citizens enough to guarantee at least minimal physical protections: public police and fire departments. Canada and Europe have extended that principle of collective, social physical protection to medical treatment as well.
So I pose the following scenario to you: Imagine a world in the fire departments of major cities had been taken over by private insurance companies. How would you feel if the fireman showed up at your blazing house and demanded a copay and an insurance card before he turned on the hose? If you lacked either, or the card and funds were inaccessible because of the fire, would he be justified in letting your house burn to ashes?
Most civilized people would answer no, which is why fire departments are public services in modern societies. So here's the question for you to ponder: Do you consider human lives inherently less valuable than houses?
I agree with pretty much everything you say, and you provided an abundance of sources.
Do you think you can make your points with a less inflamed rhetoric? Like, for instance, not insulting and demonizing every person who disagrees with you? And perhaps go easy on the CAPS? We get it, you're outraged. It is outraging. But your style isn't helping you.
Some people invite and warrant a more decorous mode of discourse.
Some people invite and warrant the same kind of discourse they dish out. I would take your sermonizing more seriously if you dished it out more equitably--there a abundant examples of snark initiators in this thread who somehow eluded your unsparing judgment--most notably McArdle herself, with her dependably and insufferably pose of snarky omniscience.
Ya' wanna cafeteria monitor? Stop with the selective enforcement and get REALLY serious--slather strictures all over the joint.
By the way, all caps are a substitute to italics, which are unavailable to me. OK, parson?
So many typos in that last one--made a hash of things, but you get the point, Nimed: you're coming off as a sanctimonious jerk. But you've made your point--snide sarcasm is more to your taste than serious discourse. Duly noted.
Gee--hope I didn't give offense!
Italics are unavailable to you? The rest of us don't have any trouble with them, we can handle bold, too, and even bold italics for tasteful emphasis. I think you just like to SHOUT (oop, sorry!), as you like to misrepresent what others write in slanderous ways and reject any evidence that disagrees with your position, even if that means pretending that the New York Times and Washington Post are too right-wing to be trusted, that the Public Interest makes stuff up, and that the Cuban régime does not make stuff up.
Well, you're being pretty indiscriminate.
You must be joking! Next time, before you speak please browse through my comments in the thread. Also, feel free to also look in other the comment sections of previous health care related posts.
My "sermonizing" is pretty damn "equitable". It's just not hyperbolic and unnecessarily insulting (well, most of the times).
OK, Nimed--you're proud of being a sermonizing jerk and derailing this discussion with a purely ad hominem tangent.
Where were you when Weevil called me an "idiot," to name but one of many instances of uncivil discourse in this thread that outstrip any of my venial sins?
Stick to the subject. If you want to sermonize, stick to health care. No one is really interested in your personality assessments.
Weevil--
You are SO PROUD that you have mastered HTML codes. I don't bother with them. So I use all caps instead of ital or boldface. Wow--you've scored a MAJOR POINT with that one.
I'm touched by your sensitivity on the issue of slander. I note that this solicitude did not prevent you from calling me an "idiot" in an earlier post.
Here's your problem: you are devoid of relevant facts and logic, but you have a great big bellyful of bile.
It's pretty laughable to see you scolding anyone else for rejecting or deriding legitimate sources--considering the fact that you haven't cited a single one! Just something you "vaguely recall" reading in the neocon Public Interest some time ago . . . sure that's a rock-solid citation, Chief!
When it comes to "rejecting evidence that disagrees with your position," you are the undisputed champ: the World Health Organization global health study, the Institute of Medicine study showing that 18,000 Americans die each year for lack of medical insurance, the documentation on waiting times in Canada and UK--all commie propaganda, right, chief?
As frauds go, you're a very entertaining one--so dependably risible? I suggest you go relax with a Havana cigar. As William Buckley once said, you'd be destroying the property of a communist country.
Just curious: did Terry Southern base the character of General Jack D. Ripper on you? (Purity of Essence!)
Alright, please proceed with the attention grabbing attitude. Just don't think it's not transparent you don't actually care that much about the uninsured you keep mentioning. Otherwise you wouldn't be antagonizing every single person who engages you in the thread.
That's funny. I just searched for "idiot" on this comment thread and found three previous instances, none by me, and two by (who else?) 'van mungo', who called TreeJoe "a cynical propagandist--or a complete idiot" and something Corporate Serf wrote "idiotic". Can 'van mungo' get anything right?
I did call him a "moron" but only after he did something blatantly moronic: he cut and pasted a huge list of numbers already easily available at a link and utterly irrelevant to the point at issue.
The fact is that comparing health care from country to country is not easy, there are numerous studies that contradict each other, and all of them have been done by people with some sort of axe to grind. I have offered rational arguments explaining why his preferred studies are dubious, and he has been unwilling to even try to refute my arguments. He's just a common troll, who seems more interested in finding excuses to insult people at a distance than in actual argument.
OK, Weevil--I did you the favor of misquoting your "moron" as "idiot." Of course your "moron" is thoroughly justified, but someone else's "idiot" is not--because you're an . . . don't tempt me, General Ripper!
It's the same old story with you--you have yet to cite a creditable, serious source of your own, but you continue to cast facile aspersions on the research of some of the most distinguished public-health experts in the world because it happens to contradict your troglodyte, reactionary preconceptions about the world.
Duly noted, General Jack. Purity of Essence!
Care to explain what "Purity of Essence" has to do with anything whatsoever that I have written here, moron? Feel free to use HTML in your reply, if you're not too lazy.
And try to understand that when you are systematically rude to everyone else here, including your allies, and then complain that others are rude back to you, you reveal yourself as a pathetic intellectual bully, demanding respect that you are unwilling to give.
Finally, next time you cut and paste a list of "44 countries that rank ahead of the U.S. in infant-mortality rates", you might want to read the list to see if they are all actually countries. Macau, Hong Kong, Anguilla, Gibraltar, Guernsey, Jersey, and the Isle of Man are not independent countries, even if the CIA includes them separately on a list of countries.
Weevil--
Glad to see your scrutinized the CIA list so closely. It does my heart good to see you rubbing your nose in the facts that overturn your ill-informed notion that the US of A has the best damn health-care system in this whole solar system, and if you don't like it, well, then, you can just move to one of them socialist European countries where they play commie sports like soccer and drink wine and . . . read books .. . . and actually care whether poor people drop dead or not!
Purity of Essence, General Ripper! POE/OPE/EOP.
If you're going to use an ad hominem, it helps if it's actually aimed at your target: otherwise it's an ad neminem, aimed at nobody. I've been blogging for nearly eight years, so it's easy enough to find out what I think about American sports vs soccer (indifferent), wine (in favor), and reading (very much in favor). Here is a picture of the southeast corner of my living room: the rest of the apartment is similarly furnished. My SUV is a '97 Accord acquired in 2007, my McMansion is one apartment of six in a subdivided 1858 mansion on Main Street in a small town, . . . I could go on, but my point should be clear by now even to such a moron as 'van mungo': everything he says about me is a bald-faced lie. What he says about healthcare in America is not much more honest.
Nimed--
Why don't you start a blog entitled, "Nimed's Rules of Internet Decorum." There you can bore everyone with your dull-witted sanctimonies 24/7--if anyone bothers to show up, that is.
As for who cares about the "uninsured," I am quite confident that I have advanced a series of trenchant arguments and unimpeachable sources that are well beyond your reach.
Here's what I think. You're jealous. And peevish. And small-minded. A buzzing gnat of irrelevance and sanctimony.
Now do you want to keep this up, or do you have something useful to say about health care?
Actually, I hate to disappoint you, but most of your sources have circulated in previous comment threads around here. The WHO report, for instance, has already been discussed to death. So has infant mortality. So has perinatal mortality, which is actually a more comparable indicator than infant mortality among OCDE countries.
I could go on and on: success of cancer treatment and other diseases per country, size of the private insurance sector in other countries, various numbers concerning private and public sources of medical research, differences in health care systems in European countries, Australia, Japan, Taiwan, etc.
So, shocking as it may sound to you, a big part of the stuff you linked is pretty old news.
But that really doesn't matter, because it's quite clear you are trying very hard to avoid any sort of meaningful discussion. The 18,000 deaths of the uninsured are just an excuse. At some point in your life you became convinced you're witty. So, no matter what other people say, you're going to keep up with the role of happy little troll until every single person stops paying attention.
Which is fine, I suppose, if that's how you get your kicks. Cada cabeça sua sentença.
Dear Jesus--
Will you EVER shut up and get back on topic?
You've now formed a united front with the clutch of right-wing nematodes. You and they belong together.
Now go lecture your cat or dog or something.
Chill out, little troll. You're running out of gas.
And by all means, let's get back on topic. What are you for, exactly? Single payer? Public plan? With all the noise and posturing, that wasn't very clear.
Hey, dunderhead--I've only made it clear about forty times now that I favor a nonprofit single-payer system, and have referred people about as many times to the PNHP FAQ on just this subject.
Pay attention, Parson.
Two points here, Rob, you were insulting first, and in fact, that's where I made my initial comment:
So don't even try to pretend that you that you're just some poor bruised innocent randomly accosted by this guy(and yeah, he does come across as a jerk.)
The second point is, even if he's said some nasty things to you, and even if he did it entirely unprovoked, and he did it first . . . so what? That's exactly the same circumstances I found myself in and was complaining about. As I recall, your admonishment then was so what? And that you heartily prescribed a good dose of not replying in kind.
Let me be clear on this: yes, I agree that he comes across as a jerk, even if I concur with some of his opinions. But I'm not talking about him. I'm talking about you. Believe it or not, you were one of the few reasons I keep looking in on this blog from time to time :-( I had thought that even if we disagreed politically, at least we still liked guns and cars, and could be fairly civil to each other, and I'll give you the 'compliment' of saying you don't come across as an uneducated yahoo.
Oh, well.
I love you, too, Lucy.
Too bad you have nothing interesting or informed to say about health care.
We will all keep tuned for more hearts and flowers from you.
Maybe you can audition for a spot on "The View"?
Coupla points: take your little love/hate fliration with Rob private. Or get a room. It's gotten a bit thick and embarrassing.
I'm such a "jerk" that I have trenchantly answered nearly all the objections to single payer while you have sat on your hands waiting for an opportunity to enact your little soap opera with Rob. Remember, we're discussing dysfunctional health care, not dysfunctional Internet relationships. Tell it to Maury or Richard Bey!
Nimed wrote, "I'm a liberal, but I'm not that liberal."
Now THERE'S a hoot. No wonder this poor shlep shudders when someone shows some real conviction about something.
Mort Sahl has your sniveling, vaccilating political type perfectly pegged. Here's the only difference between you and the right-wingers with whom you feel so comfortable and with whom you have predictably jumped into bed:
"Liberals feel unworthy of their possessions. Conservatives feel they deserve everything they've stolen."
So much pointless noise... Are you actually for something in health care?
Dear Parson Nematod . . . er Nimed:
Someone once proffered me some unsolicited but cherished advice that I have solemnly lived by ever since. Allow me to quote it to you now:
"Do you think you can make your points with a less inflamed rhetoric?"
--Parson Nematode, July 10, 2009
Are you referring to "pointless noise"? Aren't we sensitive for someone who accuses others of having a "contempt for whole swaths of suffering humanity, whom you quite evidently objectify as an 'other' unworthy of your concern or compassion".
No--that point about contempt for huge swaths of humanity was a political point.
Your nattering about posting styles is the equivalent of a yenta in hair curlers on a party line.
And that you heartily prescribed a good dose of not replying in kind.
SoV, I earnestly believe I have not replied in kind, or at any rate that my mild sarcasm ("Lovely") rather pales in comparison to calling people racist for no reason (and, so far, without evidence). I also (quite earnestly) think that tossing out accusations of racism merits a response in the way that making snide remarks about McMansions (as van mungo did above) or communism (as many others have) does not.
I admit I'm a little touchy about the racism thing, having been yelled at for the "racist" belief that AA in law school admissions is a bad idea.
And thanks for saying I'm not a yahoo. Of all the people who have ever called me a noisome excrescence, you're my favorite. And to be perfectly earnest, I hope you'll stick around. I frequently disagree with both your points and your tone, but (when you want to) you do add a level of rigor which is frequently lacking otherwise, and which I frankly cannot add, my statistics being limted to "Statistical methods in C." I wished you'd have commented on the IID issue in a different thread.
By pooling resources in this manner, they achieve bargaining power over costs that are unavailable to a gazillion splintered payers. I guess you were out at your favorite sushi restaurant the day that lesson was covered in economics 101.
As it turns out, you couldn't get decent sushi where I took econ 101, which means that I did learn that monopolies and monopsonies cannot change economic costs. It still takes years of life to become a doctor, years of research to make a drug, and a given amount of plastic and titanium to make a new hip. What a monopsony can do is extract economic rents by divorcing price from costs. That is normally regarded as a bad thing, which is why the Antitrust Division exists at DoJ.
But you're right. We can force doctor pay and pharma profits down through single payer. But the costs will not change, they'll just be borne by different parties and in different ways.
Some people invite and warrant the same kind of discourse they dish out.
I would be gratified if you could point out where I have been half so rude to you as you have been to me.
the U.S. has much more severe and brutal rationing than any of those countries, but you don't recognize it because it's the vicious rationing of the market, which is exactly to your callous sensibility.
I have pointed out on numerous occasions around these parts that rationing occurs in the US. Often people have disagreed with me. Yell at them, not me.
Do you see any good reason why the uninsured would have any fundamental characteristic that would make them more prone to death independent of treatment? Maybe it's in their uninsured genes.
Maybe they're poorer on average, and prone to obesity and smoking. Maybe they're stupider on average, and prone to dangerous choices (drugs, appearing on "COPS," refusing to see a doctor, refusing to buy health insurance even when it's affordable or take advantage of Medicaid or charity care). Maybe they're sicker on average, and their uninsurance and death are both symptoms of that third cause, rather than causally related.
But hey, let's stipulate that some previously healthy people die because they can't get insurance. There must be some people who fit that description. Same question: will changing the system mean more or fewer people die, and how do we know?
So nonprofit single payer doesn't lower costs? Prepare to have your belief dispelled by the facts:
http://www.kff.org/insurance/snapshot/chcm010307oth.cfm
As Paul Krugman, what other countries call health-care costs, the HMOs and Big Pharma call revenue. By depriving the poor CEOs of maybe one of their four Lexuses and one of their three summer homes, by squeezing their wasteful profiteering and redundant billing bureaucracies out of the system, we can save a LOT of money--about $400 billion per year.
Hey, you cherry-picking scoundrel, I noticed that you entirely dodged the following, so I repeat it below:
Finally--all industrialized nations have reached at least this point of civilization: they prize the lives and dignity of their citizens enough to guarantee at least minimal physical protections: public police and fire departments. Canada and Europe have extended that principle of collective, social physical protection to medical treatment as well.
So I pose the following scenario to you: Imagine a world in the fire departments of major cities had been taken over by private insurance companies. How would you feel if the fireman showed up at your blazing house and demanded a copay and an insurance card before he turned on the hose? If you lacked either, or the card and funds were inaccessible because of the fire, would he be justified in letting your house burn to ashes?
Most civilized people would answer no, which is why fire departments are public services in modern societies. So here's the question for you to ponder: Do you consider human lives inherently less valuable than houses?
Fires count as emergencies. Emergency rooms must treat people, regardless of insurance. Are you expanding the scope of what fire departments would do in this analogy past just putting out the fire, to say checking their homes yearly for fire hazards (which would be, in this metaphor, the relatively cheap yearly GP visit)?
Also, please see above re: your critique on my comment about doctors preferring a single-payer health system. That's the only Annal of Internal Medicine survey I could find when browsing their cite, so if that isn't the right study, perhaps you could find the right one for me?
Medicare cannot control costs in the system as a whole. Thanks to Bush's Big Pharma-sponsored Medicare Part D farce, Medicare has no power to negotiate drug costs. Hint: The U.S. is the only industrialized country that places no control on drug costs. And don't start giving me the song and dance about research. Big Pharma firms spend more than half their profits on advertising, promotion, and legalized political bribery.
For the costs that it can control, Medicare has an overhead of about 3 percent, compared to the roughly 30 percent overhead of the private system.
As for your demonstration program: how about Canada and Europe for the past fifty years?
C'mon--is this really the best you can do?
I posted the wrong reply to you above--it was intended as part of a response to someone else's post.
Here's my reply to you:
You completely miss the analogy. Once the house has burned down, the house is dead. The fire department, therefore, is a kind of preventive social insurance against the loss of the house or the loss of life as a result of the fire--which is far different from private fire insurance, which covers the rebuilding of the house. Medical insurance is likewise designed to prevent the destruction of the human being by illness--there is no "rebuilding" of the human being once it is dead. So here's the question: why do you draw a sharp line of demarcation between (a) the socially pooled and prepaid protection of the physical well-being of a citizen from fire (fire department) or from theft or violence (police department) and (b) the protection of the physical well-being of the citizen from disease and illness? As I've pointed out, European societies have long ago understood that (a) and (b) fall under the same umbrella of collective social responsibility--only here in the Friedmanite Wild West is 1/6 of the population left the cruel whims of fate on (b). Civilization--it's a great concept, and we ought to try it at long last in the realm of health care.
Here's the article--unfortunately, you have to pay for access:
http://www.annals.org/cgi/content/full/148/7/566
Here's the author's free summary of the report:
http://cthealth.server101.com/majority_of_physicians_support_single_payer.htm
All those things, if they are true, increase their propensity for certain illnesses, but I fail to see how, given that you already have a particular illness, you are less likely to survive. OTOH, the uninsured are typically younger, and youth is a big factor in increasing survivability.
I don't have sources for this, but it seems very likely that survivability of the uninsured may be primarily affected by at what stage in their illnesses they seek medical care. The uninsured have strong incentives to avoid superfluous medical expenses, and not go to a doctor until they are suffering a lot from a condition. And survivability is greatly affected by how early you initiate treatment of many conditions.
If you lacked either, or the card and funds were inaccessible because of the fire, would he be justified in letting your house burn to ashes?
No. Which is why no ER may, by law, turn away somebody who shows up.
But should the fire department be forced to pay to rebuild my house if it burns before they arrive? Is it their fault I didn't bother to get adequate fire insurance?
We really need to understand why those 18,000 people (allegedly) die to understand what the real cause of their death is, and thus the way to prevent it.
By depriving the poor CEOs of maybe one of their four Lexuses and one of their three summer homes, by squeezing their wasteful profiteering and redundant billing bureaucracies out of the system, we can save a LOT of money--about $400 billion per year.
No doubt there is waste. But as others have suggested--and I concur--if the government system is so capable of lowering costs, let it be done in a demonstration program first. It is well-known that Medicare is a massive and growing drain on the Federal budget. Show me that Medicare can control its costs, and I'll believe you when you say the government can cut costs across the board. In the mean time, growing costs for my health care are not your problem because you aren't paying for them, so you shouldn't be worried about them.
I posted a reply, but it disappeared--here we go again.
You completely miss the analogy. Once the house has burned down, the house is dead. The fire department, therefore, is a kind of preventive social insurance against the loss of the house--which is far different from private fire insurance, which covers the rebuilding of the house. Medical insurance is likewise designed to prevent the destruction of the human being by illness--there is no "rebuilding" of the human being once it is dead. So here's the question: why do you draw a sharp line of demarcation between (a) the socially pooled and prepaid protection of the physical well-being of a citizen from fire (fire department) or from theft or violence (police department) and (b) the protection of the physical well-being of the citizen from disease and illness? As I've pointed out, European societies have long ago understood that (a) and (b) fall under the same umbrella of collective social responsibility--only here in the Friedmanite Wild West is 1/6 of the population left the cruel whims of fate on (b). Civilization--it's a great concept, and we ought to try it at long last in the realm of health care.
As for Medicare: it cannot control costs in the system as a whole. Thanks to Bush's Big Pharma-sponsored Medicare Part D farce, Medicare has no power to negotiate drug costs. Hint: The U.S. is the only industrialized country that places no control on drug costs. And don't start giving me the song and dance about research. Big Pharma firms spend more than half their profits on advertising, promotion, and legalized political bribery.
For the costs that it can control, Medicare has an overhead of about 3 percent, compared to the roughly 30 percent overhead of the private system.
As for your demonstration program: how about Canada and Europe for the past fifty years?
Ya' know even the pope finally grudgingly acknowledged that the earth revolves around the sun, even though it took a couple of centuries. I hope it doesn't take you that long to conjure with a few simple empirical realities about global health care--why the rest of the industrialized world has systems that the populations, whatever their quibbles, are proud of and would not want to see privatized, and why this greed-driven U.S. extortion racket is falling apart and bleeding the economy white.
Wow, that wasn't a bad comment at all, and the amount of snark that you decry in Megan was actually kept to a minimum.
I couldn't agree more with this passage. But there's the problem - most of the countries in Western Europe and Canada do have a superior, more just model of health care (my opinion, Rob might disagree), but they don't produce medical research.
This is a 2004 article from the NY Review of books. I'm reposting the highlights:
"...research and development (R&D) is a relatively small part of the budgets of the big drug companies—dwarfed by their vast expenditures on marketing and administration, and smaller even than profits. In fact, year after year, for over two decades, this industry has been far and away the most profitable in the United States. (In 2003, for the first time, the industry lost its first-place position, coming in third, behind "mining, crude oil production," and "commercial banks.") The prices drug companies charge have little relationship to the costs of making the drugs and could be cut dramatically without coming anywhere close to threatening R&D."
"Drug industry expenditures for research and development, while large, were consistently far less than profits. For the top ten companies, they amounted to only 11 percent of sales in 1990, rising slightly to 14 percent in 2000. The biggest single item in the budget is neither R&D nor even profits but something usually called "marketing and administration"—a name that varies slightly from company to company. In 1990, a staggering 36 percent of sales revenues went into this category, and that proportion remained about the same for over a decade.[13] Note that this is two and a half times the expenditures for R&D."
Not a pretty picture.
http://www.medpagetoday.com/PublicHealthPolicy/HealthPolicy/1767
Although medical expenses in the U.S. are the highest in the world, amounting to 16% of GDP, actual total medical research was $94.3 billion in 2003, less than 1% of 2003 GDP. Pharma invests 57% of this amount, mostly in drug development and clinical trials. Basic research is largely funded by the NIH and it's 28% of total research expenses.
Here's another article, stating that research is 5.6% of total health expenditures
None of this is news - Pharma is pretty wasteful, invests a lot in superfluous bullshit, and generates obscene profit margins.
*But*
While the $94.3 billion spent by the United States in 2003 is not a big percentage of GDP, the EU, in the same year, spent $3.7 billion. - 25 times less.
Conclusion: the U.S. has a pretty wasteful way of doing drug development, but it's not a myth that it is by far the main world engine of drug development. If investment in research goes down, the libertarian talking point that future lives will be lost is not some made up bullshit.
If drug prices are to be heavily negotiated - something that's necessary to bring costs down to comparable EU levels - profit margins will go down; and medical research will go down with it.
Maybe the government could take the place of big pharma in doing drug development. But the question is: why is this not already happening in the rest of the world? The EU is far more generous than the U.S. in foreign aid and a bunch of other stuff. But it doesn't do proper medical research.
So, van mungo, I would like (no kidding, I really would) to hear your thoughts on this.
Boy you just can't resist stirring the pot with your snarky observations about this one's excess or lack of snark.
Just stuff all that in a hat.
You seem too obsessed with this personal crap.
Maybe I'll feel like responding tomorrow--maybe not.
You started all this personal jazz and just can't let it go, so I'm inclined to let you go.
You also conveniently ignored this one, you cherry-picking dodger:
"So nonprofit single payer doesn't lower costs? Prepare to have your belief dispelled by the facts:
http://www.kff.org/insurance/snapshot/chcm010307oth.cfm "
Good. So am I. Any thoughts on how do you plan to get that passed in Congress?
Also, one of the single-payer big advantages (besides the large pool you have already mentioned) would be the possibility to negotiate drug prices. This is critical to reduce a part of health care costs to an acceptable level.
But when you negotiate prices, you reduce the profit margin of pharma. Not a big concern, you would say. They are the 2nd industry with the biggest profit margins. Except for the fact that 57% of medical research in the U.S. comes from private industry. A reduction in profit would most likely translate into a reduction in research.
By the way, research is something that Europe has not gotten right. We do a lot more research in the U.S. than what's done in the sum of all other developed nations. And about 5 to 10 times more than the EU.
So what are your thought on keeping medical research going?
Briefly--because it's late--I support only single payer. All the concretly specified versions of the public options amount to consumer fraud, designed-to-fail farces that will discredit the idea of publicly funded health care. The main objective of all the plans I've seen so far seems to be to keep the HMOs in business, not to really offer a serious alternative to the tens of millions who desperately need one.
As for research, Big Pharma spends the vast majority of its profits on advertising, marketing, and political bribery. There is no reason to believe that thinning their bloated profit margins need affect research one whit, especially since most of the significant spade work on pharmaceutical research comes out of the NIH anyway.
As for getting single payer through Congress--one way to do that is not to become caught up in the "public option" diversionary feint.
I probably won't catch you today. I've developed this in greater detail above. But, if you cut profits from bloated pharma, they may cut marketing, or they may cut research, and you basically have no control over their decisions unless you basically nationalize the industry.
Sorry, that is not good enough. If people "focus" on single payer, how is that going to change Congressmen and Senators' votes? The public plan that you vilify so much is now hanging by a thread, and may very well not pass in the Senate. So I don't know what sort of magic would make single payer a political possibility again. You may say something like "Well, with that attitude of yours we are surely never going to get it." Ok, but how are we going to get it with any other attitude?
OK--what is your concept of the public plan? Which of the plethora of the proposals out there now corresponds to your concept of the public option? Would it be publicly funded or self-sustaining? Would it charge premiums and deductibles?
The NYT poll that every one cites to the effect that 72 percent of the populace supports a public option is also a bit of a fraud. The poll asks people if they would support a "Medicare-like" public option. But all of the REAL public options afloat in Congress--as opposed to the amorphous fantasies inside the heads of progressives (who have no idea what they mean by this term, much less by a "robust public option")--are radically UNlike Medicare--they cannot accept public funding (after an initial infusion of cash), they would have to charge premiums and impose deductibles, they would end up with the costliest (oldest, sickest) cohort (while the HMOs aggressively cherry-pick the youngest, healthiest, and most profitable), so the whole thing is a Rube Goldberg contraption with no real mechanism for (a) controlling costs or (b) expanding coverage, the two main desiderata of health-care reform! (Here is the precise wording of the poll question: "Would you favor or oppose the government's offering everyone a government-administered health-insurance plan LIKE MEDICARE that would compete with private health insurance plans?" [emphasis added; http://www.nytimes.com/imagepages/2009/06/21/health/policy/21poll_graphic_ready.html])
These public option plans are being pushed by Democrats who are deeply indentured to the health-care sector to the tune of hundreds of millions of dollars over the last few campaign cycles. These plans reek of K street deception and chicanery--quite obviously their main objective is to retain the HMOs stranglehold on the system, not to achieve serious cost control or even substantially increased--much less universal coveage.
This is just fiddling while the whole health-care system and economy are burning. See the following:
http://www.commondreams.org/print/43440
http://www.pnhp.org/facts/singlepayer_faq.php#public-option
Single payer is a winnable fight if people don't let themselves be gulled by the K-street knavery of the mainstream Democrats who care more about maintaining their perks in office than serving the public interest.
I fail to see how, given that you already have a particular illness, you are less likely to survive.
True, for the most part. Differences in treatment are the most likely explanation when you control for particular illnesses.
Re: research. That's one of those economic costs I was mentioning. If research drops due to "bargaining power," then some of the cost will be borne by future generations of dying people.
van mungo,
Are you insured? You should see a doctor immediately. You're seriously brain-damaged, and it has shut down your area of self-awareness.
Dude, your comments have been a giant parade of "personal jazz".
Now that was a removal from context worthy of Fox News. But it was totally worth it, because how else would you get to make your idiotic remark about ideological purity?
A clever pun if I ever saw one.
And that wins the "I'm so great. I'm kidding. But not really." award.
And so on.
And then there's all the other trolling and abuse directed at other people while you were jerking off in logorrhoea mode. The invectives directed at SoV were particularly despicable. I suggest you read them again to realize how much of a sad sod you are. One wonders exactly what kind of abject satisfaction you took from it. Rob was remarkably thick-skinned when targeted by your "political points" and is now basically one of the two people who are still taking you seriously.
I kind of put up with it to see where the talk about health care was going. Now, you seemed to be under the impression that all the facts you spewed were news. They are not. Most people around here have been exposed to them again and again. Some basically choose to ignore them and continue parroting the same old "I just discovered a news article demonstrating how horrible health care Canada/Europe/Japan really is" crap. You've met some of them. You are not going to change their mind. We've heard it all before about big pharma, life expectancy and perinatal mortality, cost as a percentage of GDP, obesity in the U.S. and smoking in Europe, HMOs, etc.
As far as I'm concerned, there are basically 2 difficult problems in the implementation of a new system of UHC:
- a new model of drug development - If you make drugs affordable by negotiating prices, which is absolutely indispensable to reduce costs, Pharma is most likely not going to take a cut in profits and marketing while maintaining research intact. They are going to do what is most profitable, which can very well be slowing R&D to a crawl. So there needs to be a new model of research, or the world runs a serious risk of seeing drug development slow dramatically. And you can't just vaguely say "let the government do it". Other countries with far greater tolerance towards government spending practically don't do drug development, so this is not trivial.
- the political path to get to UHC. Data showing that European/Canadian/Japanese/Australian health care systems are superior has existed for a long time. Public support for UHC has existed for the last 50 years. Public support for single payer has existed for at least the last 15 years. But in spite of this, it has never been implemented (which tells us something about the sorry state of our democracy). I just don't see a political path to this. Donating to MoveOn.org and writing to you Senator are manifestly insufficient.
So this is basically what interests me. I sincerely doubt you have too much insight into these 2 problems, since no one managed to give a satisfactory answer to them yet. So I kind of don't give a s**t about some fragile and delusional egomaniac that is so affected by a passing snark that just can't resisting whining and making a tragicomic threat of "letting it go". Kindly f**k off.
By the way, if anyone has any ideas about either of these things, it would be great to hear them.
Nimed, Schizophrenic, Versions 1 and 2:
Parson Nimed 1:
"Do you think you can make your points with a less inflamed rhetoric? Like, for instance, not insulting and demonizing every person who disagrees with you?"
"Your style isn't helping you."
Mad Dog Nimed 2:
"So I kind of don't give a s**t about some fragile and delusional egomaniac that is so affected by a passing snark that just can't resisting whining and making a tragicomic threat of "letting it go". Kindly f**k off."
"jerking off in logorrhoea mode."
"you're seriously brain damaged"
Nimed receives this thread's Norman Bates Award for Most Radically Split Personality; but wait--there's MORE! He also receives the Fox News Golden Hypocrite Trophy for most laughably two-faced sputtering, bordering on dementia.
Now let's all hope Nimed wipes the foam from his mouth, takes a nice shot of Valium or Demerol, and gets the help he needs--hopefully on an HMO plan with a small deductible.
Nimed, I'd like to add to your list:
An explanation of how to control prices without controlling costs. You and van mungo agree that Medicare cannot change system-wide costs because it is only part of the system. My point is that system-wide costs are inherently uncontrollable because "costs" are the economic opportunities foregone in order to have medical care delivered. The only way to reduce "costs" is to reduce consumption.
To the extent that Medicare needs a monopsony to control costs, it won't be controlling costs at all, it will be controlling prices, and thereby shifting the costs away from consumers of medical care and on to providers.
We can save money in the healthcare budget by slashing doctor salaries. We can compensate them by subsidizing their educations so they don't need high salaries to pay off their loans. But we will not have cut costs, because it will still take the same number of earning years to become a doctor, and other careers will be foreclosed to the doctor. And what's more, we will have moved some of the price of medical care onto the education budget, which does nothing meaningful but perhaps looks good.
In the end, cutting costs requires cutting consumption. So that's why I want to see Medicare lead the way. We spend (waste?) a tremendous amount on end-of-life care. Prove to me you can ration that well to save money and I'll believe in the promise of universal care.
Rob Lyman:
Many of the points you have made have already been addressed. Part of the problem is that you do not address all the points addressed to you--rather only the ones for which you think you have an answer--so discussing with you is like trying to grip mercury. So I'm going to number the points this time in the hope that you will address all of them:
1.You keep doubting that a single-payer system can effectively reduce costs while providing high-quality care. But there is abundant empirical evidence that it can do both, based on a half century of real-world application in Canada and Europe. Here's the authoritative evidence on costs:
http://www.kff.org/insurance/snapshot/chcm010307oth.cfm
2. Now here's the authoritative evidence that those less-costly nonprofit single-payers--half as costly as the U.S. system per capita--also provide high-quality guaranteed health care to the entire population--care that is ranked higher than that of the United States:
http://www.who.int/whr/2000/en/whr00_annex_en.pdf
3. Now--on the reason for costs and methods for controlling them. You seem to treat the concept of cost as though it were pure Platonic Form, floating in the economic ether, unperturbed by messy tellurian realities. In the U.S. health-care system, two such gritty real-world components of cost are (a) the redundant, elaborate billing bureaucracies in hospitals, labs, and doctors' offices needed to keep track of the myriad byzantine, ever-shifting rules, exceptions, disputes, and evasions of dozens of HMO contractors and (b) profiteering, both in the form of shareholder profit distribution and exorbitant CEO compensation, which averaged $14 milliion per year in 2008. As Paul Krugman has noted, what other countries call health-care costs, the HMOs call revenue.
Under a single-payer system, these nonproductive costs(as in contributing nothing to anyone's actual health care) would be eliminated at a stroke, saving hundreds of billions of dollars a year.
That's how Canada and Europe are able to provide high-quality, universal care at half the per capita cost of the United States --no tangle of expensive billing bureaucracies, and no profit-draining from the system revenue flow. That's also why those systems and U.S. Medicare have overhead rates in the neighborhood of 3 percent to 5 percent compared to the U.S. system's 30 percent.
4. Here's another point from an earlier post that you pointedly ignored, so I'll repost it here:
Why do you draw a sharp line of demarcation between (a) the socially pooled and prepaid protection of the physical well-being of a citizen from fire (fire department) or from theft or violence (police department) and (b) the protection of the physical well-being of the citizen from disease and illness? As I've pointed out, European societies have long ago understood that (a) and (b) fall under the same umbrella of collective social responsibility--only here in the Friedmanite Wild West is 1/6 of the population left the cruel whims of fate on (b). Civilization--it's a great concept, and we ought to try it at long last in the realm of health care.
I see little evidence that pharmaceutical companies are doing the necessary research right now. Nor do I see a logically implied link between 'research' of the sort that's needed and 'profits'. Finally, and central to the discussion but immediately important, I do not see any discussion of the relative levels of research in the public vs private sectors. If it turns out that 90% of the research is already done in the public sector, it would seem to me that the research argument lacks force.
1) I do not doubt that care is cheaper to society in other countries. What I doubt is that their success can be replicated here, given the realities of US politics. One source of low-hanging cost-cutting fruit would be end of life care. Care to tell me how you'll get the AARP on board?
2) Medicare requires a byzantine coding/billing bureaucracy. However, I agree that eliminating insurance companies will reduce billing overhead for hospitals somewhat. But see below.
3) Medicare's admin costs are low in part because it doesn't do all the things that insurance companies do, such as collect premiums (the IRS does it and doesn't bill them for it.) And it's also low in part because they tolerate high levels of fraud. If we are serious about keeping spending down, we'll need to spend more on admin to cut fraud. This is why I want some proof that Medicare can cut costs before I believe that the Medicare model can be applied across the board.
4) The fire thing just doesn't work the way you want it to. The fire department will save you from an acute emergency, but it will not repair damage to your house. Similarly, an ER will stabilize you regardless of ability to pay, but it won't give you long-term care. The fire department will not conduct an annual fire-safety inspection or kill the carpenter ants that are going to make your roof collapse on you. Those things are more akin to what you want single-payer to cover, but in the housing world, they are covered by homeowners and in some cases their insurance companies.
So to answer your question, I don't draw a sharp line between health care and fire protection. The line is drawn between long-term care for yourself and acute emergencies.
Speaking of grasping at mercury, you haven't explained how "bargaining power" lowers costs as opposed to shifting them onto different parties, or explained what restaurant you were at on the day they discussed monopolistic rents in econ 101.
I do not see any discussion of the relative levels of research in the public vs private sectors.
Nimed claimed above that 57% of US research is private. I have no idea if he's right or if that research is the sort that you wish were done.
1. Here you shift from an argument based on economic principles to one based on political feasibility. Naughty, naughty. I take this as your implicit confession that we don't really need a "pilot program"--that a half century of success in the rest of the industrialized world is enough of a pilot program for you.
2. Medicare requires exactly ONE billing bureaucracy, not 1,300 times three or four (hospitals, doctors, labs, etc.). Same for other single-payer systems. In American hospitals, the billing departments occupy an entire floor, sometimes two. In Canadian hospitals, it's usually one little office. This is part of the reason that HMOs have ten times the overhead of Medicare and Canada/Europe.
3. Please cite your sources about high levels of fraud--this sounds like right-wing viral disinformation to me. There's plenty of fraud in the private insurance sector, too, ya' know, so this argument is a nonstarter. It's easier to monitor fraud in a single-payer system than in the splintered chaos of 1,300 risk pools.
4. You're way off base on the police/fire/medical comparison. First of all, emergency rooms do BILL people--to the skies--for their services. Then they dun those people to the point of driving them into bankrupcty if necessary. When's the last time a police or fire department did this? Get the difference?
And police and fire departments aren't just about "emergencies." They're about affording continuing physical protection to the citizenry through the public pooling and sharing of resources. And any illness--walking pneumonia, gastritis, early-stage skin or prostate cancer--can become a full-scale health emergency if left untreated because of financial constraints, just as a minor kitchen fire can destroy a whole block of buildings if left untreated by the fire department, or a nuisance hoodlum can become a major safety threat if not collared early on. There is no qualitative conceptual difference between the idea of physical protection of the citizenry as embodied in police and fire departments and doctors and hospitals. It's just that Canada and Europe are civilized enough to have recognized this, and the United States is not . . . yet.
I further assume that you are conceding the point on costs--the extent to which costs in U.S. health care are bloated by profiteering and billing bureaucracies.
Thank you for your time.
For the information of all those who are SO CONCERNED about how the poor Big Pharma firms will EVER find the money to do research if their porcine profit margins are squeezed a bit by taming their extortionate pricing:
51 Percent of revenues Go to Marketing and Profits
13 percent go to R & D.
These companies are monstrosities designed mainly to generate ever larger piles of cash, not primarily for creating drugs to serve sick people--the latter is incidental to their true purpose.
I don't deny that other countries achieve comparable or better levels of health at lower expenditures. What I doubt is whether they deliver comparable levels of health care. The former is what counts in the statistics, but the latter is what people will demand. So: show me that you can cut Medicare costs without cutting health outcomes. I believe it is possible from a medical and economic perspective, but probably not from a political perspective. Prove me wrong.
I agree that there is waste in the US system which don't appear elsewhere. I doubt that it amounts to 50% of the price, and I doubt you can truly eliminate all of it; some of it will simply be moved off-books (such as subsidized education for doctors appearing under the education budget where it currently appears under the health care budget). Keep in mind that the health care system in other countries sits inside of a broader social and economic context (cheap higher education, social standing which may replace money for doctors to some extent, walkable cities which act to limit obesity, relatively homogeneous populations). That's why I want to see Medicare lead the way in cutting costs: prove it can be done here.
As for Pharma, how do you intend to force cuts in marketing rather than in R&D?
One minor point: I believe there is a case for subsidizing education for doctors. Many people, especially if they come from low-income families, may very well be intimidated by the pile of debt they have to accumulate to get a medical degree. This wouldn't be surprising - people are risk averse in most other situations.
So our current system is probably in part responsible for us having relatively few, ridiculously well-paid doctors.
I'm not necessarily opposed to subsidizing medical education, I'm opposed to calling it "health care savings" because it appears on a different part of the budget.
Slight correction:
While the costs associated with medical school are daunting, I sincerely doubt it is responsible for having fewer doctors. The number of doctors is controlled by the number of licensed residency positions. Also, despite the financial hardships, medicine does everything but guarantee work for everyone that completes the schooling/training. According to the American Association of Medical College, through which you must submit Medical School applications, there were about 42,000 applicants for medical school in the 2007-2008 application period for close to 18,000 spots.
http://aamc.org/data/facts/charts1982to2007.pdf
SoV,
I shared your annoyance at how it was just assumed by 90% of the commenters in past threads that Pharma was so precious and essential to medical research. But a while ago somebody posted a link of 2003 data on this.
Of a total of $93.7 billion devoted to medical, 57% is spent by pharma and biotech, 28% by the NIH. More on the link between and research and profits below.
Rob,
In a single-payer system, there will be a component of cost shifting, but insurance pooling is a real reduction in cost. Not to get into semantics, but I object to your characterization that billing overhead is only reduced "somewhat". Avoidance of database duplication and reduction in administrative staff will provide a real and substantial cost reduction. Furthermore, some incentives to commit fraud, such as using another person's Medicare card, would simply disappear under a single payer system. Other types of fraud would likely subsist, but again, this is not a big problem in other countries.
In addition to bargaining, which you correctly identify as a cost shift, there will have to be, yes, rationing. Advocates of single payer and other public plans are squeamish about this, because of the dystopian imagery the word inevitably invokes in the U.S.
Some incredibly expensive treatments with very low, often still undemonstrated, increases in survivability rates cannot all be covered by the government. But this rationing has a very small effect in denial of treatment (that already exists in our system anyway) and overall effectiveness of care. And on overall . Cases like Herceptin are extremely rare, but somehow get blown out of proportion by our press. This is anecdotal, but I've lived 15 years in Portugal, not exactly the wealthiest country in the EU, and there was no palpable concern with care denial, and I've only heard of waiting lists in elective surgery.
That said, the effect of rationing in countries with a public plan is not zero. So there is a complementary private insurance market in many countries with UHC (for sure in Portugal, France and Germany, probably for most others).
But the point is, quality basic care is provided to everybody, it is cost efficient, and it has good results. I don't know how it can be seriously denied that single player is vastly preferable to what we have now.
That is, if we exclude medical research. Which is a pretty big if.
van mungo,
Well, duh. But paper clip and cutlery industries are also "designed mainly to generate ever larger piles of cash", and I'll bet they are not in business out of an overwhelming concern to improve our filing systems and dinning experiences. Yet, these industries work well, so we are not particularly bothered by their greedy motives.
One may feel it's morally repugnant to have a profit motive in selling life-saving drugs, but as long as Pharma is a private industry, it's unrealistic to expect them to act otherwise.
I believe concern for Pharma itself is pretty much non-existent. And it's true that, if their profit margins was severely cut, they would still have lots of money for research. Which doesn't mean they would spend it on research. That's the problem.
Again, we know those numbers. They are posted in one of my comments upthread. In 2000, 14% of revenue went to R&D, 36% to "marketing and administration", 17% to profit.
But let's think of the bargaining process. When the government bargains the prices of drugs (or medical equipment, or whatever) this is, as Rob said, a transference of existing costs to Pharma. We can all live very well with that.
But the government has no say on how Pharma will spend their diminished revenues. Since their primary concern is generating those piles of cash, they may very well decide they are better served by maintaining their current expense profile.
Here's the problem: Pharma spends 57% of total medical research in the U.S., disproportionally allocated to drug development. More importantly, from 1989 to 2002, the U.S. invested in biomedical research an average of more than 5 times the EU source (see table in page 162). Furthermore, European Pharma releases drugs first in the U.S. markets, where presumably (because we don't negotiate prices) it gets most of their revenues.
So a likely outcome of heavily bargaining prices of drugs with Pharma is reducing drug development dramatically.
The Americans get stuck with large bills for their meds, while all the rest of the world negotiates them. But the whole world benefits from drug development. Slowing down the release of new drugs has worldwide consequences.
Medical research, either public or private, is the single thing other countries didn't get right in their health care models. That's why we need a new model of drug development, which will be necessarily a step in the dark. Everything else in single payer is pretty easy, in the sense that it has clear advantages over our current system. Of course, finding a political path to it is another matter.
Screwed up the source.
Well, duh yourself.
Comparing drug companies to paper-clip companies? I don't think so.
Why do you think the former are so much more heavily regulated (right down to the prices, in Canada and Europe) than the latter?
If it's in the national interest to require drug companies to devote X amount of their revenues to R&D--or to appropriate the necessary amounts to make sure the government does it if the private firms don't--then that's just what will have to happen.
And if those reforms--along with a nonprofit, single-payer health system to complement them--can't be extracted from this massively bribed Congress, then the country is doomed to Third World status anyway. The only hope is to press ahead with European-style public regulation and reform of the entire health-related sector.
Given the hundreds of billions of graft bulging in the pockets of the main players in both major parties, this will take a massive popular uprising on the order of the anti-Vietnam war or civil-rights movements. Right now, something is simmering, but it will take a while before it comes to a full boil--perhaps it will take the passage and then failure of this public-option farce--doomed (indeed, designed) to fail--to spark the needed mass mutiny.
If nothing is done, health expenditures, according to a recent study (don't have the source now), will drain off about a third of GDP in about thirty years--and that seems conservative to me. I don't imagine that even an MSM-drugged public will fail to understand that the entire country is in danger of falling into peonage to the banks, HMOS, and drug companies.
Even if you insist that such a popular movement is impossible or unlikely, we have no choice. The country will swirl down the toilet if these health-care extortion rackets are not reined in. So we must make it happen, or go down trying.
Yes, I'm aware of these figures. I may even have participated on that thread. But this is most assuredly not what I am talking about. I am talking about a) basic research, and b) research which is useful from a medical standpoint. In other words, spending $20 billion on the next new and improved viagra simply doesn't count.
Period. Anyone talking about the 'free market' directing research has at this point jumped the shark. It's already a given that the glorious free market has failed to deliver yet again.
This is primarily funded by the NIH. But there's lots of basic research with a very low likelihood of ever translating into something useful from a life-saving standpoint. I'm basically working in such a project right now, which is partly funded by the NIH.
Life saving it may not be, but I'm not going to diss those future viagras. It's an attitude that just reeks of hubris.
SoV--
If you have any good sources on the percentages of public and private research that go into medically important or live-saving drugs as opposed to lifestyle drugs like Viagra, please post them.
Thanks,
Van
Actually, I fully support further study of Viagra. Do you know the history of Viagra? Drug companies weren't sitting around thinking let's make men more sexually active. It started as an antihypertensive drug. They were targeting phosphodiesterase, which when inhibited can cause smooth muscle relaxation. Viagra just happened to inhibit a phosphodiesterase inhibitor (type 5) that was specific to erectile tissue.
http://en.wikipedia.org/wiki/Sildenafil
I'm not saying drug companies don't do their best to maximize their profit, I'm just saying that researching lifestyle drugs can lead to important discoveries, just as medical research can lead to lifestyle changing drugs.
I've lived 15 years in Portugal, not exactly the wealthiest country in the EU, and there was no palpable concern with care denial, and I've only heard of waiting lists in elective surgery.
This is why I want to see it done in Medicare first. I've never been to Portugal, but the US is a very litigious society with a sometimes adolescent level of personal entitlement. We had someone here complaining about paying 10% co-insurance (totaling $4,000, or the price of a well-used Honda Civic) on a lifesaving hospital stay. There was a minor fuss during the Anthrax scare about Cipro costing $5/pill (two pills a day for 5 days = $50). The "standard of care" most doctors hew to is "everything that might make a slight difference."
Fundamentally, Americans believe we should never have to worry about or pay for our health care. We cheefully pay for food, water, shelter, and transportation--willingly go into deep debt to buy cars--but ask someone to pay $50 to not die, and they freak out about eeeeeeeeeeevil profiteering pharma.
I'd like it shown that our culture, legal, political, and health care culture, can actually deny and ration care, before I put myself on the hook for all this. So start with Medicare.
Sheesh, Rob--you're incorrigible. It's already been pointed out to you ad nauseam that there's a fifty-year track record of superiority for variants of nonprofit single-payer in the rest of the industrialized world, yet you still want your "proof." This reminds me of the scene in an obscure Brazilian horror movie I was watching last night. The tormented main monster character demands proof that there is a God, so a massive lighting bolt strikes a tree and hurls it atop the hapless villain/monster; lying there pinned and bloody, he defiantly shouts, "I'm still not convinced!"
Speaking of monsters, here's one of your periodic roars of atavistic cruelty that well entitle you to your self-characterizations as "jerk" and "evil" (remember, I'm quoting you about you now): "Fundamentally, Americans believe we should never have to worry about or pay for our health care. We cheefully pay for food, water, shelter, and transportation--willingly go into deep debt to buy cars--but ask someone to pay $50 to not die, and they freak out about eeeeeeeeeeevil profiteering pharma."
Here again you evince your tropisms toward a callousness bordering on viciousness. We're not talking about $50 copays here--we're talking about accumulations of tens of thousands of dollars in medical expenses--62 percent of the personal bankruptcies in this country are due to such medical catastrophes, and most of those people HAVE private insurance.
Just as your old-time Friedmanite religion doesn't work well for fire/police departments, so it's a bust in health care as well. McArdle makes this same facile Reaganite assumption--that free-market-fundamentalism is a magic nostrum for the world's economic ills--as though we didn't already know that it just doesn't work in many socially necessary applications, and as though it hadn't been exposed in the last year as a catastrophe in most others as well.
Consider the following: If the price of one used car is too high, you can go down the street to the next lot and find a cheaper one. Or, if you live in a large city, you can decide not to buy a car and use mass transit. If Windex is too expensive, you can switch to the store brand or put off washing your windows. If you have colon cancer and have a huge, unaffordable deductible on your lousy HMO policy, you cannot just switch to another cheaper plan; nor can you decide to forego treatment, because the penalty is not just the inconvenience of a public-transit commute or a dirty window: the penalty is suffering and death. Chipper, frivolous economic fantasists like you and McArdle don't seem inclined to conjure with such existential realities--nor any other realities, for that matter.
It's already been pointed out to you ad nauseam that there's a fifty-year track record of superiority for variants of nonprofit single-payer in the rest of the industrialized world, yet you still want your "proof."
Why yes, yes I do. You want to cut costs? Then you'll need to consume less, because as I've pointed out ad nauseam, health care is expensive because it consumes lots of economic resources that could also be applied elsewhere. You can cry about admin costs all you want, but those costs are buying something worth more than their price, or they wouldn't be spent. And they don't add up to half our expenses no matter how you measure it.
Even today, we have dramatic regional differences in health care costs, with minimal differences in results, because health care is only weakly correlated with outcomes past a certain point. The driving force in expense is consumption, so to push expenses down, you simply must ration.
I don't believe Americans will accept government rationing, and therefore I believe costs will not be controlled by US government health care. Why don't I believe it? Because when real HMOs existed, they sought to cut costs by the very mechanisms now proposed that government will accomplish: rationing and denying "experimental" treatments. What was the result? Ted Kennedy introduced the "patients' bill of rights" to give people the right to sue their insurance companies for denying care; state mandates proliferated, requiring that certain things be covered in all health plans; numerous editorials were written about how it was absurd to cover Viagra but not birth control.
Americans will not take no for an answer.
But hey, prove me wrong. Medicare covers 1) the most expensive patients, and 2) the ones with the least to gain from wildly expensive treatments, because they have many fewer years of life left. It's a whole f'n forest of low-hanging fruit. If you can't cut those costs, then you can't cut costs, period. If you can, then hey, maybe it will work in other areas as well.
As for my atavistic cruelty, I stand by it. We pay tens of thousands of dollars for cars. No reason we shouldn't pay tens of thousands of dollars--and be glad we technology even gives us the option--for our very lives. Would you rather be broke, or dead?
We agree on this much: the public option is a doomed-to-fail joke.
As I tried to point out to you--to no avail--spending money on a fancy car or other consumer items is optional. Spending money on saving one's life is not--hence medical expenses are by far the most common cause of personal/family bankruptcy in this country. You just don't get the distinction between optional consumer spending and nonoptional go-bankrupt-or-die health spending. Must be hardening of the intellectual arteries from overconsumption of free-market-fundamentalist junk food.
Your self-contradictions abound. Medicare has one-tenth the overhead of the HMOs EVEN THOUGH is is saddled with the oldest/sickest cohort. If we had a single national risk pool--like the rest of the industrialized world--just imagine THOSE savings.
Sometimes I think you're just having fun with us--as in this quip: "You can cry about admin costs all you want, but those costs are buying something worth more than their price, or they wouldn't be spent." Thanks for the laugh, Rob. Ya' mean like the "services" provided by other upstanding corporate citizens like AIG and Goldman Sachs, which provide the service of torpedoing the global economy? Are you quite serious? The HMOs in general are COMPLETELY SUPERFLUOUS middlemen; they suck resources out of the system with their greed and administrative waste but contribute NOTHING to medical care. They just gum up the works with their skimming and inefficiency. The only people who benefit from HMOs are the stockholders and upper executives. The rest of us are the victims of this extortion racket, which preys on human illness and suffering to pad the lifestyles of the rich and infamous. That's a good one, Robbie--I bet you got a milion of 'em!
As for Ted Kennedy and the patient's bill of rights, the issue there is that HMOs fatten their bottom line not by providing care but by DENYING it--often denying necessary care. For all the bleating of the right about not wanting medical decisions made by "government bureaucrats"--a typical canard--we now have medical decisions made by CPAs! That's just great! In Medicare, as in Canada and in HR676, only doctors decide what care is given--the only constraints are in the timing, based on seriousness of the condition, and the doctors make THOSE decisions as well.
Your repeated contention that we will have to "consume less" under single payer is nonsense. We just squeeze $400 billion in administrative and profiteering waste from the system, and there's still plenty to cover everyone, with no waits for urgent conditions and reasonable waits for elective procedures, as in the rest of what's known as civilization.
All this right-wing angst about rationing is abject hypocrisy--even you know that the United States already has the most severe and brutal medical rationing among industrialized countries; righties just can't bring themselves to call it that because it's price and market rationing. For the nearly 50 million without coverage and the families of the nearly 20,000 of those who die each year, rationing by any other means is just as repugnant. To you willfully blind reactionaries, only the modest, nonbarbaric, death-free rationing for elective procedures in Canada and Europe leaves a bitter taste, while the death-dealing rationing for EVERYTHING, including the gravest illnesses, in the United States is just dandy. Takes all kinds!
Whassamatter, Rob--you're afraid you and your fellow trust funders won't be able to get your hemorrhoid removed within two days? Are you really so self-absorbed as to prefer alacrity for your hemorrhoids to survival for those 20,000, to no bankruptcy for millions more, to not seeing the country bled white by the extortionate HMO racket? If so, then you're really thinking with your tuchis. And you surely qualify for an emergency transplant to replace the stone lodged in your chest now.
You can keep all your snark, all your glib distortion and evasion, all your snide contempt for "the little people." If you think they have it tough (not that you care), if there's a life after this one--or a law of karma--just wait until you see what's in store for you and your ilk.
It is simply not true that "medical expenses are by far the most common cause of personal/family bankruptcy in this country". How do I know that? I recently read a whole series of thoughtful posts with hundreds of comments hashing out the question thoroughly on some site or other. Now what site was it . . . ? Oh yeah, it was this one. Megan McArdle and her commenters covered the question very thoroughly just last month. There's a search field at the top of the page, and it's easy enough to find the posts, though there are a lot of them (122 if you search on 'medical bankruptcy'.
Long-time readers of this site also know that the huge percentage of Big Pharma's budget spent on 'marketing' includes giving away free drugs to doctors who give them to their indigent patients. Maybe it's a good thing that Big Pharma spends so much on 'marketing'. See the January 2008 archives for some interesting posts on pharmaceutical marketing budgets, or just search on 'pharmaceutical marketing' (30 posts).
It's more than a little disgusting to see 'van mungo' accuse others of "glib distortion and evasion", given his own efforts to do exactly that.
By the way, I've never had a trust fund, none of my right-wing friends have them, and the few people I've ever met who do have them are all raging lefties. I've never once had my car valet parked either, though a friend who is currently unemployed and uninsured has (something to do with living in Miami). It appears that 'van mungo' lives in some sort of fantasy world where his enemies are all required to conform to his own twisted stereotypes. I don't wear spats or a monocle, either.
I don't wear spats or a monocle, either.
Really? I've always taken my fashion cues from Mr. Peanut. What's your problem?
General Ripper's big fat compendium of lies and propaganda:
"It is simply not true that "medical expenses are by far the most common cause of personal/family bankruptcy in this country"
Empirical reality:
"Medical problems caused 62% of all personal bankruptcies filed in the U.S. in 2007, according to a study by Harvard researchers. And in a finding that surprised even the researchers, 78% of those filers had medical insurance at the start of their illness, including 60.3% who had private coverage, not Medicare or Medicaid."
http://www.businessweek.com/bwdaily/dnflash/content/jun2009/db2009064_666715.htm
General Ripper LIKES to see people suffer, die, and go bankrupt and the hands of the health-care extortion racket. It just KILLS him to see all those healthy, happy people in Canada and Europe, with their superior life expectancy, never having to worry about their health care if they lose a job. General Ripper just BRIDLES at the thought of an efficient, compassionate, humane civilization. For General Ripper, it's every man for himself! Feed me, Mandrake, I think the commies are moving in! Purity of Essence!
As I knew he would be, 'van mungo' was too lazy to actually read any of those posts, and just repeats the false assertion. Here are a couple of comments on just one thread to start with:
J Mann (June 5, 2009, 10:31am):
"My favorite factoid is that Warren and her co-authors classify people who declared bankruptcy because of alcoholism or gambling addiction as 'medical bankruptcies.' That may be an interesting finding, but it doesn't necessarily show the need for a single-payer health care system."
The Ninja Zombie (June 5, 2009 12:01pm):
"Not to mention $1001 or more in medical expenses.
"So if you spend $50,000 on hookers and $1001 on syphilis treatment, then go bankrupt, you just had a medical bankruptcy."
The study seems tendentious and highly misleading.
By the way, I just realized why 'van mungo' is so eager to compare me to General Ripper. I pointed out that totalitarian countries like Cuba cannot be trusted to provide honest medical statistics, and 'van mungo' can't admit that that is true, so he twists it into a supposed paranoia about a communist takeover. Just another stupid lie on his part. I had't even made a point about communism: I assume that non-communist totalitarian countries like Iran, Zimbabwe, Libya, and Saddam's Iraq make up their medical statistics to look good, with no relation to reality.
OK, General Ripper--a clutch of anonymous right-wing Internet nuts are FAR more reliable than the trained team of Harvard scholars who conducted the study. They're just part of the liberal/commie/homo conspiracy to steal from the super-rich so that ordinary working people can actually survive.
We all know that kindred troglodyte loons are the only responsible social scientists in this damn country where liberals elect black presidents and want homos to get married.
The only people whose considered analyses are MORE reliable than Joe X in a comment thread are Glenn Beck and Sarah Palin.
(Also, see Nimed's detailed comments below.)
Purity of essence!
As I tried to point out to you--to no avail--spending money on a fancy car or other consumer items is optional.
Right. So someone facing a medical emergency can choose to forgo consumer spending to pay for their medical care.
My point is that the American public is whiny and entitled on the question of medical care. We don't put medical care in the same mental basket as we put food or cars, which are not provided by others. We don't think we should have to forgo consumer spending to get medical care. Otherwise, the vast majority of us could easily afford a high-deductible health policy and self-insure on the large deductible. But we think health care should simply be free.
Sometimes I think you're just having fun with us--as in this quip: "You can cry about admin costs all you want, but those costs are buying something worth more than their price, or they wouldn't be spent." Thanks for the laugh, Rob. Ya' mean like the "services" provided by other upstanding corporate citizens like AIG and Goldman Sachs, which provide the service of torpedoing the global economy? Are you quite serious?
You yourself have said repeatedly that health insurance companies are rapacious and care about nothing but the bottom line. So...why are they spending 30% on admin instead of 5%? Why don't they cut that down to say, 10%, and reap vast profits unheard of in any other industry?
Because they need to spend that 30% on things that make them money, like billing and yes, disputes with people they have denied care. Some it, like marketing, would not be present in the government system you propose, and some of it would be moved off-books, as Medicare moves billing to the IRS, and fraud investigation and litigation to the Justice Department.
That is to say, I am not as optimistic as you are about administrative savings.
And I don't see any reason why the age of Medicare patients has anything to do with their admin costs: please explain.
Furthermore, I am not arguing that rationing is bad. I have already said that price rationing is irrational. I am arguing that government rationing will not be accepted by the populace. You seem to take the position that rationing will be unnecessary; I think its unavoidable.
And you never did reply to Nimed on research.
For emphasis:
The reason that I'm so eager to see Medicare used as a demonstration program for cost cutting is that is widely acknowledged that Medicare is a gigantic sucking hole threatening to consume the Federal budget. This despite its miraculously low admin costs. So something must be done to control Medicare's costs no matter what we do for everyone else.
Giving it responsibility for the rest of the country isn't that something.
Spending money on a car is not always optional. I can't get to work without one. There are no buses in my county, the only cab company is very expensive, and my commute is triangular (3.5 miles to one school, 13 miles to another school, then 10 miles home), so I can't car-pool. If my car dies, I will have to replace it immediately. If Congress passes a law paying people to junk their old cars when they buy new ones, that will kill the used-car market, and I will be forced to buy a new one, whether I can afford it or not. A dead-car emergency is very much like a medical emergency, except that you can't buy insurance for it. Only someone very callous or very ignorant could write something like this: "If the price of one used car is too high, you can go down the street to the next lot and find a cheaper one." Not if Congress passes the junker law, you can't.
A car is a commodity--it is replaceable.
A human life is not a commodity--it is irreplaceable.
Your level of ethical consciousness is so low one would need a submarine to find it.
It doesn't matter whether you are subjectively optimistic about administrative savings.
The point is that we have all the "pilot projects" and proof of superiority we need in a half-century of empirical reality in the rest of the industrialized world. Your private doubts are an interesting anecdote in personal pathology--inability to cope with reality--but have no serious bearing on a debate about health care.
Spending money on a car is not always optional. I can't get to work without one.
True. But most people--including many uninsured people--spend much more on a car than they need to, so a goodly fraction of that spending is optional. All of us self-insure against car death. What, then is so horrible about doing some degree self-insurance against medical expenses?
Medical costs are so over-the-top in this country that most of the medically induced bankruptcies sink people WITH these lousy HMO policies you so laboriously hawk here like the late Billy Mays--with about the same degree of subtlety and authority.
Even many insured people can't afford to get sick because of the steep deductibles that are lurking in the bait-and-switch scams doled out by the HMOs.
Here's a good mental/spiritual exercise for you: Meditate an hour each day on Kant's fundamental dictum of ethical philosophy: Treat every human being not merely as a means but as an end in himself. That means, for example, not treating human lives as commodities to be bought, sold, insured, not insured, etc., on the same plane of discourse as cars.
Discuss within yourself for a couple of days and report back.
I don't understand the purpose of this comment, save perhaps to support my supposition. I would also suggest that you need to cast your net a bit wider when it comes to what you consider to be 'basic research'. Ferreting out the structure of DNA and how it transmits information was at one point considered 'basic research'. How much time, manpower, effort and money was spent for the purpose by private firms? Not a whole lot, comparatively speaking.
In other words, you can call some of what the pharmaceutical industry does 'research' only in the same sense that some of what Toyota or Ford does is 'research'.
Oh, I don't disparage the use of viagra, or the search for better analogs; I just don't think you can point to the expenditures of vast sums of money to find them as proof of the superiority of the American plan. Let me put it this way: suppose one country spends perhaps $3 billion to find viagra substitutes; another a comparatively modest $500 million on the cloning of epithelial cells, say, for skin grafts to be used in the treatment of burn victims. I would imagine that few people would tout the simple 6:1 ratio of expenditures as evidence that the health care system in the first instance was superior to the one in the second instance.
As for 'reeking of hubris', frankly, I could care less whether that's true or not. I feel quite comfortable in adjudging money allocated to burn research to be more providently spent than money lavished on the search for a new and improved Viagra. If that impels certain people to tar me as elitist or arrogant, so be it. I probably think I'm better than they are already ;-)
Not relevant for the research discussion, but I can't let it pass.
Dr. Weevil said
Actually, medical expenses really are "by far the most common cause of personal/family bankruptcy in this country". They are responsible for more bankruptcies than all other causes of bankruptcy put together. The latest figure, from 2007, is 62%.
I'm astonished you propose this particular example as a badge of honor for this blog. It was actually one of Megan's lowest points. She wrote a post in which she accused Elizabeth Warren, one of the co-authors of the article in which the 62% figure appears, of intellectual dishonesty.
"Warren and her co-authors have obscured important and obvious facts that call the integrity of the work into serious question."
"(...)the two doctors who co-authored this study are prominent spokespeople for Physicians for a National Health Program, and thus have an obvious agenda, one that Elizabeth Warren has not been shy about sharing."
"There is, of course, a large amount of terrible advocacy masquerading of social science out there" (clearly implying that Warren's study was one such case)
So, what was the cause for making what constitutes to an academic an extremely grave accusation, one that, if it happens to stick, it pretty much destroys your credibility?
Warren et. al. neglect to mention is that bankruptcies fell between 2001 and 2007. In fact, they were cut in half. Going by the numbers Warren et. al. provide, medical bankruptcies actually fell by almost 220,000 between 2001 and 2007, a fact that they not only fail to mention, but deliberately obscure. (bold in the original)
She added, with a lot of chutzpah:
"I invite any of my readers to scan the paper for any hint that medical bankruptcies had fallen significantly over 6 years.
And that's just what some of her readers did. Turns out Megan hadn't read, or just choose to ignore, a whole section of the article titled "Changes in the Law" (page 5). It revealed an interesting fact - Congress enacted in 2004 a bankruptcy bill, the Bankruptcy Abuse Prevention and Consumer Protection Act (BAPCPA),
"which instituted an income screen and procedural barriers that made filing more difficult and expensive."
The paper adds:
"The number of filings spiked in mid-2005 in anticipation of the new law, then plummeted. Since then, filings have increased each quarter.".
and
BAPCPA’s effects appear nonselective. Current filers differ from past ones mainly in having struggled longer with their debts. New restrictions fall equally on medical and nonmedical bankruptcies, with no preferences for medical debts or sick debtors."
Megan's accusations were completely false. Not only it the article acknowledged the decrease in absolute bankruptcies, it reveals its cause - the decrease in bankruptcies is fake, a result of not economic activity, but of changing the rules of bankruptcy filing, making them significanlty more stringent.
Political sympathies aside, we found that Megan used her public medium to shamefully accuse Warren of intellectual dishonesty, based on assertions that are easily verified to be false just by reading the very source she linked. She also never mentioned the BAPCPA bill in her first post, a fact that had to be rubbed in her face by the readers she invited to "scan the paper for any hint that medical bankruptcies had fallen significantly over 6 years". So draw your own conclusions about the character of someone who engages in this sort of despicable behavior.
In the comment section of a posterior post, I commented on the article methodology, which I found and still find perfectly adequate. Megan responded to my comments with speculation on why the BAPCPA bill could disproportionally affect non-medical bankruptcies. She concludes her response with:
"This is all speculative; we really don't know. But it's not crazy on its face."
So we go from characterizing an article as a piece of propaganda that deliberately omits crucial facts to advance a political agenda to, you know, engaging on speculation on why there might be some problems with the study. The spirit now is "Come on, these objections, albeit not supported by any data, are at least not crazy on its face". She never apologized Warran and the other authors.
By the way, in the middle of all this, the 62% figure was never questioned.
I'd like to think you weren't able to keep a straight face while you were writing this. Of that 36% spent by Pharma in marketing and administration, do you seriously believe that more than the equivalent of rounding error goes into the P.R. operation of giving away free drugs?
Looks like I'm making a habit of screwing at least on link per post.
Correction:
Megan responded to my comments with speculation on why the BAPCPA bill could disproportionally affect non-medical bankruptcies.
Christ! Screwing at least ONE link per post.
Wow, people.
Who woulda thunk a thread in McMegan's Apologetic Disinformation could be this entertaining.
I feel I must reward the best tirades with an honour board:
Rob Lyman
Really? I've always taken my fashion cues from Mr. Peanut. What's your problem?
Nimed
And that wins the "I'm so great. I'm kidding. But not really." award.
I'm not going to diss those future viagras. It's an attitude that just reeks of hubris.
van mungo
Whassamatter, Rob--you're afraid you and your fellow trust funders won't be able to get your hemorrhoid removed within two days?
General Ripper just BRIDLES at the thought of an efficient, compassionate, humane civilization. For General Ripper, it's every man for himself! Feed me, Mandrake, I think the commies are moving in! Purity of Essence!
*Clap Clap Clap*
And now for the most amazingly hilarious, absolutely undisputed, the-other-poor-bastards-never-had-a-chance winner of the thread:
Dr. Weevil
"Maybe it's a good thing that Big Pharma spends so much on 'marketing'." (notice the use of both italic and blod html tags aproved and recommended by the winner)
*Thunderous applause*
Here's a good mental/spiritual exercise for you:...
Perhaps instead of offering lectures in moral philosophy, you could clarify some things for me.
1) Private medical insurance has higher admin costs than Medicare. Now, clearly the rapacious capitalists running these companies think they are getting some kind of return on that admin investment: it's increasing their revenues or decreasing their costs somehow. So the question is, what are they buying with that money that Medicare doesn't need to buy (or is able to buy much cheaper)? A related question is, how much would it affect their profits, and in which direction, if theyreduced their overhead?
2) Germany has a number of private, separate health insurance companies that do things like run TV ads trying to convince you to switch to them. (I am told that other countries also follow this model, but I've only dealt with Germany's) How is it possible for Germany to have much lower health care costs, given the redundant billing departments, excessive admin costs, marketing expenses, etc?
3) We know that health care spending per capita varies wildly within the United States itself, while health outcomes are far less variable. Why is this? Can the lessons of the low-cost regions be applied to the high-cost regions somehow? How will the new government run system be sure that it emulates the low-cost regions rather than the high-cost ones?
By the way, in the middle of all this, the 62% figure was never questioned.
It was questioned numerous times, most memorably by somebody who pointed out that if you spent $50,000 on hookers and blow, and $2000 on syphilis treatment, Warren et al. put you down as a "medical bankruptcy."
But in any case, I'm not sure the number actually matters much as a point in favor of government health care. Bankruptcy is a method to avoid paying your debts. I'd rather have the bankruptcy system bailing out people who got sick (which they probably couldn't help) and let people who merely spent too much on shoes and dinners at Nobu toil in debt slavery.
You are either poorly informed or intentionally purveying misinformation--or both.
1. The private insurers in Germany are nonprofit and heavily regulated, as are the supplemental private insurers in France--hence none of the cost-bloating profiteering--hiking premiums and deductibles, pell mell coverage exceptions and denials, etc., etc.
2. Those sprawling and wasteful administrative bureaucracies are the equivalent of the mob's collection soldiers--without them they couldn't squeeze the loot from their extortion racket. Do you really need this explained to you? In the typical large U.S. hospital, the billing department occupies multiple floors; in Canada, one room.
3. Your insistence on viewing the economics of health care and the economics of cars and widgets as part of the same continuum shows that the disagreement here extends beyond metrics of efficiency--your view of this issue is refracted through an ethically warped paradigm that is politely known as free-market-fundamentalism--taken to an such a bizarre extreme in your case that it blinds you to the unique dysfunctions of a for-profit health-care system, its radical dysfunctions, and the reasons that it has been abandoned by every other civilized nation on earth. If anyone ever needed a lecture on moral philosophy--several semesters' worth--it's you.
You have not meaningfully answered any of my questions, all of which would seem to be of interest to someone considering the proper structure of a health care system. At best, you've offered vague generalizations (German insurers are regulated) and weird unexplained analogies (insurance bureaucracies are like mob footsoldiers: huh?).
Is it because you don't know the answers?
Your thinking is incoherent on this. OF COURSE the HMOs are forced to spend X amount on billing bureaucracies to collect the far greater Y amount in revenues in profits.
You seem to think you have been struck by a bolt of some kind of insight here, but you seem to have been struck dumb--making a trivial, almost nonsensical points in a tone as though you had discovered a cure for cancer.
German for profit-insurers, as I note below, cover only 10-15 percent of the market and are tightly regulated to prohibit prior-condition exclusions, inflated premiums and deductibles, the whole bag of tricks of the U.S. HMOs that dominate the market here in the Wild West U.S.
I have thoroughly answered all your questions, to the extent that they are answerable. You might consider posing more intelligent questions--that might help.
Rob,
Let me clarify that - is was never questioned by someone with a serious argument. The example you provide is one evident case of trying too hard. Whoever made that argument, if it wasn't desperately trying to find reasons to push the statistic in one direction, should immediately have seen that the same argument also works in the opposite direction: medical bills can push you to the brink of bankruptcy, and a posterior small expense is then responsible for your "non-medical bankruptcy".
van mungo,
I haven't replied yet to your suggestions about maintaining current medical research volume after bargaining because I'm still thinking about it, and have a Tuesday deadline. But it's coming. You offered 2 alternatives - imposing some sort of research quota to Pharma, or to compensate loss in research with governmental funding. I'm leaning to the second. But I'll elaborate in that later, so stick around.
Meanwhile, you now mentioned several times the subject of Congressional legalized bribery and political corruption. If you haven't seen it already, I can't recommend this video enough (not just to van mungo, but to everybody):
http://fora.tv/2008/08/13/Lawrence_Lessig_Wants_to_Change_Congress
It runs for 1 hour, but I assure you it's worth the time. I really think this has a chance of turning into something.
The same argument only "works in the opposite direction" if anyone had argued that only bankruptcies where 100% of the debts were medical could be counted as medical bankruptcies. Absolutely no one has suggested that. Obviously if half or three-quarters of the debts are medical it can be counted as a medical bankruptcy, and maybe even if it's only a third of them, though it's hard to say where the line should be drawn. Where the line was drawn was ridiculous and tendentious. Counting any bankruptcy where more than $1,000 of debts was medical as a medical bankruptcy grossly inflates the percentage of bankruptcies counted as medical, and seems to be designed to do so for propagandistic reasons, among other things to provide people like 'van mungo' with prepackaged talking points.
From the article:
Although we needed to use the threshold of $1000 in out-of-pocket medical bills for consistency in the time trend analyses, we adopted a more conservative threshold—$5000 or 10% of household income—for all other analyses. Adopting these more conservative criteria reduced the estimate of the proportion of bankruptcies due to illness or medical bills by 7 percentage points.
So the low threshold was chosen for comparability with 2001 data and doesn't "grossly inflate" the results. Comparability was crucial, because one of the main purposes of the article was to access a trend from 2001.
Furthermore, notice that both the $1000 and $5000 figures refer to out-of-pocket expenses, and more than 75% of filers were insured. And a $5000 dollar threshold is just that - a threshold. That didn't stop commenters in the thread of treating this value as an average of medical expenses. In reality, the average out-of-pocket value of medical expense was $17,943. The median monthly household income of medical bankruptcy filers was $2586. The mean family size was 2.79 members. These numbers draw a picture. What does it look like to you?
In addition, you seem to forget that these are just the explicit additional pecuniary expenses as a result of your condition. A common consequence of many illnesses is that you stop working and may very well lose your source of income, either immediately or after some time, and you become unable to continue paying for your treatment.
Many commenters at the time tried very hard to depict the bankruptcy filers as dishonest and/or irresponsible losers who had it coming. So you get enormities like the hooker example, which I find fairly outrageous and a telltale of a certain kind of mentality. But, most of all, unsupported by the article figures.
Of course, I reject the notion that you deserve to be bankrupt unless you have conducted your money-related affairs in an exemplary manner and have a pristine financial situation prior to your condition. Health problems are unpredictable, and most people go through tight budgets at some point in their lives.
Obviously not access, but assess.
Forgot to respond to this:
In the specific case of the threshold, the criteria is "reporting uncovered medical bills greater than $1000 [or $5000] in the past 2 years". So if you have had a past illness that stripped you from you savings and other assets, but that you managed to pay in its entirety, stopping short of forcing you to mortgage you home (another criteria), and some time later, you file for bankruptcy for other reasons, you are not classified as a medical related bankruptcy. Even though the financial drain from your recent medical expenses obviously contributed to the filing.
And here are General Ripper's prepackaged--and 100-percent undocumented!--talking point:
1. Human lives and cars and widgets are interchangeable market commodities.
2. Any thoroughly documented academic study that upends General Ripper's barbaric worldview is a cockeyed commie conspiracy--just see the ravings of a group of anonymous Internet commenters--also undocumented!--to prove it!
3. Purity of essence.
Have I missed any?
Thanks for the link. Will check it out. The long-term solution is complete public funding of public elections, but by the time that passes--if it ever will--the HMOs and drug companies will have bled the country white. We have to put the screws to these knaves now--meaning in the next couple of years--to make the consequences of defying an aroused electorate will be equal to or worse than the consequences of dissing their corporate paymasters. For that to happen, we have to build a strong, independent movement for Medicare for all; as I said, it's just in the simmering stage now, but we must continue to turn up the heat. The public option being floated is a farce--and is potentially a step backward, because it is likely to be such a disaster that it will discredit rather than advance the idea of publicly financed health care.
medical bills can push you to the brink of bankruptcy, and a posterior small expense is then responsible for your "non-medical bankruptcy".
There is very high probability that would be counted by Warren et al. as "medical," too, if either 1) some of the medical bills were still around when you filed, or 2) you reported to her in a phone interview that you had huge medical bills last year that depleted your cash savings to the point that something else tipped you over the edge.
Plus, she counted lost wages due to illness as causing "medical" bankruptcies, too, which makes no sense for single-payer advocates unless our single-payer health plan is going to include a short-term disability insurance program, too. (Which was also pointed out in that thread)
The paper had a strong bias towards a finding that a given bankruptcy filing was "medical." Which is fine, I guess. I don't know what the "right" distribution of bankruptcies by cause is.
At minimum a $1000, for comparability. See my reply to Weevil. They also used a superior minimum of $5000, that excluded only 7% of filings. So these hypothetical guys still had to have a lot of debt around. So much debt, if fact, that it's probably not a bad idea to classify their bankruptcy as medical related.
They made the telephone calls after examining respondents' bankruptcy court records and received the answers to the questionnaire. They checked for consistency in these 3 sources of information. Come on, don't just throw stuff out there.
Yes. In this cases we are forced to speculate on, out of those cases, how many would file for bankruptcy if they didn't have to pay an average of $17,943 in out-of-pocket medical bills. Hint - their median income was $2586. So out-of-pocket is 7 months of income.
Now, now. You're using one of Megan's favorite tricks here (or perhaps one of your own, you lawyer you). The strong bias is what we are actually discussing, and I think that, if you are honest, you'll recognize that there's a very weak case for it. So don't treat it as a foregone conclusion to which you add a conciliatory remark.
I don't want to duplicate my response to Weevil. But have a look at the average numbers of income, out-of-pocket payments, low percentage of insured, family size, etc. Then tell me how does the average Joe that filed a medical bankruptcy look like to you.
The strong bias in this thing is nonsense. In order to stick to her initial theory of advocacy, Megan had to switch her reasons again and again. I remind you that her initial argument was that Warren et al. were obviously biased because they didn't even mention the decline in bankruptcies. It turned out they had a whole section of the paper devoted to this. Megan reported the lower absolute numbers without even mentioning BAPCPA in her first post. Then she switched to "problems in composition". And finally she started posting long technical reader's comments that supported her position at a vertiginous velocity. Of course, those last posts made methodological points that she never even dreamed of at the time she wrote the first 2 posts. And that nobody had the time and/or patience to examine.
What I believe happened was that Megan was precipitate and sloppy in her first post - not the first time it happens, and daily blogging carries these risks. She backed herself into a corner, just like she did in her recent post of a Krugman quote (the one that supposedly recommended a housing bubble). And then she dodged the best she could until the storm passed.
Correction--the 1,200 funds that handle about 90 percent of German medical insurance--the standard mandatory plan--are nonprofit.
There are about 50 for-profit companies that offer supplemental insurance, but they cover only about 10-15 percent of the total system.
So the point holds--the German system is predominantly nonprofit, which is that main reason it achieves radically better cost efficiency than the U.S. system.
Most of the supplemental private insurers in France are nonprofit.
Correction--the 1,200 funds that handle about 90 percent of German medical insurance--the standard mandatory plan--are nonprofit.
OK, so why do 1,200 German insurers not suck up massive admin costs like the 1,300 American insurers? It costs very little to deny a claim or hike next years' premiums to get higher profits.
Furthermore, many American insurance companies (Kaiser, Blue Cross) are nonprofit.
Because the 1,200 that make up 90 percent of the German market are NONPROFIT.
Because the vast majority of the 1,300 American HMOs are FOR-PROFIT extortion rings.
You can't really fail to understand such elementary distinctions.
No one is that dumb.
You are either poorly informed or intentionally purveying misinformation--or both.
In addition to actually answering my questions, would you mind identifying something I said which was factually false?
Here's what's false:
"Germany has a number of private, separate health insurance companies that do things like run TV ads trying to convince you to switch to them. (I am told that other countries also follow this model, but I've only dealt with Germany's) How is it possible for Germany to have much lower health care costs, given the redundant billing departments, excessive admin costs, marketing expenses, etc?"
You intentionally make it sound like these private, for-profit companies dominate the market, as in the United States, when they offer only 10-15 percent of the market and are tightly regulated to prohibit the kind of cost bloating and undercoverage by which U.S. HMOs line their pockets from illness and suffering in this country.
You'd have to pretty dumb/economically illiterate and/or ill-informed and/or intentionally misleading not to have any idea why a country whose system is about 90 percent nonprofit has "much lower health care costs." What do you need to figure this out--an abacus?
van: in other words, I didn't say anything incorrect, you merely imputed "for profit" where I wrote "private." But I chose "private" because I didn't know the tax status of German health insurance companies, I just knew they were non-government and operate in a somewhat competitive marketplace.
Because the 1,200 that make up 90 percent of the German market are NONPROFIT.
"Nonprofit" is a tax status. A nonprofit company can pay its CEO an exorbitant salary and waste tremendous amounts of money on pointless bureaucracy. A for-profit company can be streamlined and highly efficient. Your claim that "billing bureaucracies" are responsible makes no sense. Nonprofit companies need billing bureaucracies to collect premiums,too; what's so different (as between profit and nonprofit) about sending a bill to a customer?
So again, explain to me 1) What private (for- and non-profit) health insurers are buying with their admin costs that Medicare doesn't need to buy, 2) Why Germany's private (nonprofit) health companies work so well despite having a tremendous number of different, competing plans, which you allege causes waste, and 3) why health care spending varies so widely within the United States itself, and what lessons we might take from those variations.
Nimed: let's just agree to disagree on the bankruptcy thing, it's not productive to discuss it (though if it makes you feel better, I agree that our gracious hostess was unfair to Warren and should have issued a correction). But if you don't mind, could you take a crack at the questions van mungo is dodging?
Rob--
You don't know enough about this topic to comment intelligently.
The 1,200 German nonprofit funds are part of the standardized government plan that covers nearly everyone; they are coordinated to achieve de facto single-payer leverage over costs; they are tightly regulated to prevent the abuses of the American system; they are part of a single revenue-payer stream so that there is no need to maintain separate bureaucracies to keep track of 1,300 different policies on reimbursement, fees, coverage exceptions, etc., etc., each of which is different for each of those 1,300 companies.
I am not dodging any of your questions.
Trying to discuss with you is like trying to have a dialogue with a computer programmed to answer every question with a limited number of formulas/quotations from a single free-market economics bible.
Moreover, you're slithery.
First you question technical feasibility. Then you are given the citations on cost-effectiveness of nonprofit systems around the world. Vanquished on that point, you switch to political feasibility. And so on. And so on. A new petty specious maneuver a day, to keep the truth at bay.
You are challenged to examine the presuppositions that underlie the philosophical anthropology that underlies you economic religion; you demur. Such reflection seems alien to you. You have your religion, and you're sticking to it.
You sit in your corner muttering your catechisms while reality passes you by.
I have more important matters to deal with.
Have a nice day. Maybe Nimed will enjoy beating his head against your brick wall. I've had it. You and General Ripper should get together and start an Ayn Rand reading society.
I am not dodging any of your questions.
You have not even tried to explain what private health plans buy with their admin costs that Medicare does not buy (other than kneecaping thugs, which does not strike me as plausible). Nor have you even tried to explain why costs vary so much between regions within the US. Nor indeed have you explained why nonprofits should inherently have lower admin costs than for-profits, beyond the obvious lack of profits (which only accounts for a fraction of the alleged difference). So that's pretty much 3 for 3 of non-responses.
First you question technical feasibility. Then you are given the citations on cost-effectiveness of nonprofit systems around the world. Vanquished on that point, you switch to political feasibility.
I do not question--have never questioned, and have discussed in numerous threads on this very blog before you arrived--that equal or better health outcomes are possible with less expense. That is because equal or better health outcomes are possible with less care. A conservative, lifestyle-based approach is often as good as (for instance) immediate surgery or immediate drugs, sometimes better, and always cheaper. And of course lots of end-of-life care is both extremely expensive and pointless. Technically speaking, what you advocate is possible, as I have acknowledged numerous times. And in fact, I believe that this is what underlies the regional differences in health care expenses seen within the US itself.
So the question is really political, not medical: can you convince Americans to take "no" (or, alternatively, "no surgery for now, you need more exercise") for an answer? HMOs tried and failed, and got politicians on their backs for having tried at all.
Why will the government succeed?
I have already explained this--what HMOs buy with their administrative costs are their profits--they could not squeeze the profits without the myriad billing bureaucracies and staffs of bean counters hired expressly to squeeze and deny coverage. Not sure how many repetitions of this rather obvious point are needed to permeate your dogma-encrusted skull.
You keep recycling canards, like a windup doll: that a single-payer system means reducing the amount of care. This falsehood does not get any truer with your endless rote repetitions.
Every serious, reputable comparative study of global health systems finds that the other industrialized countries offer, overall, superior care, more equitably and widely distributed by far, than the U.S. system.
Your auto-immunity to empirical reality persists. I'm beginning to think it's incurable by any health-care system on this or any other world.
I have already explained this--what HMOs buy with their administrative costs are their profits--they could not squeeze the profits without the myriad billing bureaucracies and staffs of bean counters hired expressly to squeeze and deny coverage.
OK, no disagreement here. But, here's the heart of my question, which you haven't yet really explained: the large, nefarious, care-denying staff cuts more in care expenses than it costs in wages and paperclips, right? That's what it means to say HMOs are "buying profits" with admin expenses. If the bureaucrats didn't save more money than they cost, they wouldn't be contributing to profitability, and the company could just lay them all off and reap still bigger profits from doing so.
What that means is that eliminating the wasteful care-denying billing department will raise health care costs, because all the administrative savings will be consumed and surpassed by increase spending on care. It will also raise the amount of care delivered, which may very well be a good thing. But by your own logic (extra admin --> profits) it will not reduce expenditures. Quite the opposite.
The myriad billing bureaucracies and Simon Legree bean counters do not reduce aggregate costs for the system. They might reduce costs for each individual HMO, but the bloated revenue stream remains intact. It is the profiteering bloat--shareholder profit distribution--and the attendant bloated billing bureaucracies needed to sustain that profit/revenue flow--that so dysfunctionally fatten the aggregate cost of the system. All they do is transfer dollars from the patients and/or hospitals and/or doctors to the bank accounts of the investors and CEOs--but no aggregate reduction in cost.
The only way to achieve that is to eliminate these wasteful, superfluous, skimming extortion rackets known as HMOs. They contribute nothing to anyone's medical care--they just stand in the middle of a revenue flow--bloated to meet their profiteering needs--and skim liberally off the top.
Please recall the shrewd Krugman remark--what other countries call health-care costs, the HMOs call revenue. SEE THE POINT, AT LONG LAST?
Once this far-flung and byzantine skimming operation is eliminated, you can have a better, more efficient distribution of health care with available resources while eliminating $400 billion in waste every year--money that goes to no other purpose than feeding the maws of this ever-fattening monster of greed, which now swallows 16 percent of GDP and is projected to gobble up a full third in another generation if someone doesn't slay it soon.
357 (+1) comments in four days, and still going strong;
You people have the Energizer Bunny beat all hollow.
Have you accomplished anything, except running up
the popularity meter on MM's website ?
My own intuitive conclusion is that you are all
standing at different points on the same slippery
slope, all headed downhill to the bottom, where
you will be greeted by a large number of hungry
useless eaters, angrily demanding their fair
share, for free.
"Old age was not a usual cause of death in that generation."
RAH, talking about us.
Thanks for this strenuous effort at stating . . . nothing in particular. You could easily have accomplished the same with less effort--such as not having posted at all.
It is the profiteering bloat--shareholder profit distribution--and the attendant bloated billing bureaucracies needed to sustain that profit/revenue flow--that so dysfunctionally fatten the aggregate cost of the system.
Am I to understand, then, that Kaiser Permanente and Blue Cross/Blue Shield (nonprofits both) deliver excellent European-style health care at low cost with minimal skimming? If so, how on Earth can any for-profit insurer stay in business against that kind of competition?
I know you think I'm a moron, but you're doing a very poor job explaining why nonprofit health insurers in the US haven't crowded the for-profit ones out of the business, if in fact being a nonprofit gives a huge administrative cost advantage with absolutely no downside. And if being nonprofit doesn't give that huge of a cost advantage, how is the government system going to achieve savings without slashing doctor salaries or rationing?
It is for this reason that I think the "public option" will fail: it faces the same problems that Kaiser faces with the need to make expenses match revenue, and there's no reason to think the government will be dramatically more brilliant at it than private nonprofit health insurers.
And then there's this: "They might reduce costs for each individual HMO, but the bloated revenue stream remains intact." What I don't understand about this statement is that if the admin people are reducing costs, that means an even more bloated revenue stream would be necessary if the admin people weren't there. Right?
And I still want to know (because I don't actually know) why we see huge regional variations in health care expenditure right here in the US. I strongly suspect it has to do with the medical culture. For instance, if someone comes into the doctor complaining of back pain, the doctor could prescribe some Vicodin and refer the person for surgery, or could recommend that the patient change his diet and exercise to lose the extra 100lbs he's carrying, plus add in some Yoga and sit-ups to strengthen the muscles supporting the spine. The former course is vastly more expensive, and from what I've read, not especially effective. The latter course--if the patient agrees--not only helps clear up the back pain for 1/10 the cost, it also reduces the chances of diabetes and heart disease, saving even more costs down the road.
But which course the doctor and patient choose have little or nothing to do with the insurance company's profits or Medicare's coding system, absent either explicit rationing (no back surgery for fat people) or cost discipline (Patient can't afford surgery but can afford walking shoes). Can the government change the medical culture to prefer the cheap, conservative approach over the expensive one? I think the opposite is a serious risk: cut reimbursements, and more unnecessary procedures will occur as doctors struggle to make more money. That's why my wife had an overnight hospital stay before her wisdom teeth were pulled in Germany. They billed the insurer more than $1000 to give her a place to sleep, and they did nothing for roughly 24 hours while she took up space and told us it was "against medical advice" for her to leave.
Two companies do not make up the whole system--they function with a system that is predominantly profit-driven, unlike any system anywhere else in the industrialized world. You keep expecting minority slivers of the health system--this or that single company, Medicare--to control costs that are soaring because of profiteering in the system as a whole. The nonprofits simply pass on the soaring costs that are endemic to the for-profit system as a whole.
You seem to have a congenital inability to distinguish between micro and macro analysis of this problem.
Your little personal anecdote is worthless compared to the exhaustive, painstaking studies that show all the other industrialized countries offering superior overall health-care delivery at half the per capita cost of the United States. There are countless stories of Americans who face really serious health problems in Europe who are treated promptly and effectively and never see a bill.
You bring nothing to this debate except a head full of blinding economic dogmas. You start from this religious proposition: free markets and profits are good, so there must be some other reason why the health care system is crumbling.
Until and unless your brain undergoes a serious paradigm shift--some kind of incursion of logic and fact into your closed religious-fundamentalist universe of perception--you will remain trapped in your little labyrinth of confusion.
Or, to put it another way, you're like a rat stuck on a wheel--the wheel is your Friedmanite religious indoctrination. Until you step off that wheel, you will be running in place on this issue indefinitely.
Kafka once said that the purpose of his work was to put an axe to the frozen sea within us. You need to do the same for some of your petrified intellectual constructs.
This, mercifully, will be my last attempt to communicate with you. I won't be checking this thread after this.
One more thing (as Nixon famously said about 100 times in his 1962 retirement speech)--if you want to play the overseas health-care anecdote game, I can easily swamp you on that one. Here a just a few choice examples:
http://www.huffingtonpost.com/2009/07/13/international-health-care_n_230961.html
The nonprofits simply pass on the soaring costs that are endemic to the for-profit system as a whole.
The principal costs they "pass on" are the doctors' bills they pay. What is it about the existence of for-profit health insurers that causes doctors to send larger bills to nonprofit health insurers than they would otherwise?