quote:In "Health Status, Health Care, and Inequality: Canada vs. the U.S.," (NBER Working Paper 13429) June O'Neill and Dave M. O'Neill take a closer look at the performance of the U.S. and Canadian health care systems. The authors examine whether the Canadian system delivers better health outcomes and distributes health resources more equitably than the U.S. system.
The authors begin by examining the evidence on health outcomes. They note that the infant mortality rate and life expectancy are affected by many factors other than the health care system. For example, low birthweight-a phenomenon known to be related to substance abuse and smoking-is more common in the U.S. For babies in the same birthweight range, infant mortality rates in the two countries are similar. In fact, if Canada had the same proportion of low birthweight babies as the U.S., the authors project that it would have a slightly higher infant mortality rate. Thus, the authors conclude that differences in infant mortality have more to do with differences in behavior than with the health care systems.
A similar argument may be made for life expectancy. The gap in life expectancy among young adults is mostly explained by the higher rate of mortality in the U.S. from accidents and homicides. At older ages much of the gap is due to a higher rate of heart disease-related mortality in the U.S. While this could be related to better treatment of heart disease in Canada, factors such as the U.S.'s higher obesity rate (33 percent of U.S. women are obese, vs. 19 percent in Canada) surely play a role.
quote:patented drug prices in Canada average between 35% and 45% lower than in the United States, though generic prices are higher.
Posted by CT (Member # 8342) on :
Wait ... have you read the paper you cited, or just quoted the summary?
Posted by Samprimary (Member # 8561) on :
Also, why is this just Canadian versus the US? It should be "Every Other Modernized Country In The World's Healthcare versus US Healthcare" since we are literally the last developed country that does not cover all of its citizens, and our healthcare is worse than all of them.
Anyway.
FACTS THAT MAY OR MAY NOT BE BIASED IN FAVOR OF THE REMOVAL OF THE ACTUARIAL MODEL OF HEALTH CARE
· The leading cause of personal bankruptcy in the United States is unpaid medical bills; the United States has more lost productivity and a lower average working age range than any of the other 'modernized' high-income nations such as the G8.
· Half of the uninsured people in America owe money to hospitals and a third are being pursued by collection agencies.
· Children without health insurance are less likely to receive medical attention considered reasonable and appropriate for serious injuries, for recurrent ear infections, or for asthma. Lung-cancer patients without insurance are less likely to receive surgery, chemotherapy, or radiation treatment. Heart-attack victims without health insurance are less likely to receive angioplasty. People with pneumonia who don’t have health insurance are less likely to receive X-rays or consultations.
· The death rate in any given year for someone without health insurance is twenty-five per cent higher than for someone with insurance. Part of this is correlative to the higher risks and lifestyles of poorer demographics and part of this is certifiably due to the consequence of moral hazard models in leaving chronic and/or life threatening conditions untreated.
· Americans spend $5,267 per capita on health care every year, almost two and half times the industrialized world’s median of $2,193; the extra spending comes to hundreds of billions of dollars a year. The extra spending does not provide us with anything approaching the effectiveness of non-actuarial models.
· We have fewer doctors per capita than most Western countries.
· We go to the doctor less than people in other Western countries.
· We get admitted to the hospital less frequently than people in other Western countries.
· We are less satisfied with our health care than our counterparts in other countries.
· American life expectancy is lower than the Western average.
· Childhood-immunization rates in the United States are lower than average.
· Infant-mortality rates are in the nineteenth percentile of industrialized nations, which means that we have higher infant mortality rates than some developing countries.
· Doctors here perform more high-end medical procedures, such as coronary angioplasties, than in other countries, but most of the wealthier Western countries have more CT scanners than the United States does, and Switzerland, Japan, Austria, and Finland all have more MRI machines per capita.
· The United States spends more than a thousand dollars per capita per year—or close to four hundred billion dollars—on health-care-related paperwork and administration. In contrast, a country like Canada spends only about three hundred dollars per capita.
· And, of course, every other country in the industrialized world insures all its citizens; despite those extra hundreds of billions of dollars we spend each year, we leave forty-five million people without any insurance.
Insight into why we stick stubbornly with the actuarial model:
quote:Health insurance here has always been private and selective, and every attempt to expand benefits has resulted in a paralyzing political battle over who would be added to insurance rolls and who ought to pay for those additions.
Policy is driven by more than politics, however. It is equally driven by ideas, and in the past few decades a particular idea has taken hold among prominent American economists which has also been a powerful impediment to the expansion of health insurance. The idea is known as “moral hazard.” Health economists in other Western nations do not share this obsession. Nor do most Americans. But moral hazard has profoundly shaped the way think tanks formulate policy and the way experts argue and the way health insurers structure their plans and the way legislation and regulations have been written. The health-care mess isn’t merely the unintentional result of political dysfunction, in other words. It is also the deliberate consequence of the way in which American policymakers have come to think about insurance. “Moral hazard” is the term economists use to describe the fact that insurance can change the behavior of the person being insured. If your office gives you and your co-workers all the free Pepsi you want—if your employer, in effect, offers universal Pepsi insurance—you’ll drink more Pepsi than you would have otherwise. If you have a no-deductible fire-insurance policy, you may be a little less diligent in clearing the brush away from your house. The savings-and-loan crisis of the nineteen-eighties was created, in large part, by the fact that the federal government insured savings deposits of up to a hundred thousand dollars, and so the newly deregulated S. & L.s made far riskier investments than they would have otherwise. Insurance can have the paradoxical effect of producing risky and wasteful behavior. Economists spend a great deal of time thinking about such moral hazard for good reason. Insurance is an attempt to make human life safer and more secure. But, if those efforts can backfire and produce riskier behavior, providing insurance becomes a much more complicated and problematic endeavor.
In 1968, the economist Mark Pauly argued that moral hazard played an enormous role in medicine, and, as John Nyman writes in his book “The Theory of the Demand for Health Insurance,” Pauly’s paper has become the “single most influential article in the health economics literature.” Nyman, an economist at the University of Minnesota, says that the fear of moral hazard lies behind the thicket of co-payments and deductibles and utilization reviews which characterizes the American health-insurance system. Fear of moral hazard, Nyman writes, also explains “the general lack of enthusiasm by U.S. health economists for the expansion of health insurance coverage (for example, national health insurance or expanded Medicare benefits) in the U.S.”
What Nyman is saying is that when your insurance company requires that you make a twenty-dollar co-payment for a visit to the doctor, or when your plan includes an annual five-hundred-dollar or thousand-dollar deductible, it’s not simply an attempt to get you to pick up a larger share of your health costs. It is an attempt to make your use of the health-care system more efficient. Making you responsible for a share of the costs, the argument runs, will reduce moral hazard: you’ll no longer grab one of those free Pepsis when you aren’t really thirsty. That’s also why Nyman says that the notion of moral hazard is behind the “lack of enthusiasm” for expansion of health insurance. If you think of insurance as producing wasteful consumption of medical services, then the fact that there are forty-five million Americans without health insurance is no longer an immediate cause for alarm. After all, it’s not as if the uninsured never go to the doctor. They spend, on average, $934 a year on medical care. A moral-hazard theorist would say that they go to the doctor when they really have to. Those of us with private insurance, by contrast, consume $2,347 worth of health care a year. If a lot of that extra $1,413 is waste, then maybe the uninsured person is the truly efficient consumer of health care.
The moral-hazard argument makes sense, however, only if we consume health care in the same way that we consume other consumer goods, and to economists like Nyman this assumption is plainly absurd. We go to the doctor grudgingly, only because we’re sick. “Moral hazard is overblown,” the Princeton economist Uwe Reinhardt says. “You always hear that the demand for health care is unlimited. This is just not true. People who are very well insured, who are very rich, do you see them check into the hospital because it’s free? Do people really like to go to the doctor? Do they check into the hospital instead of playing golf?”
For that matter, when you have to pay for your own health care, does your consumption really become more efficient? In the late nineteen-seventies, the rand Corporation did an extensive study on the question, randomly assigning families to health plans with co-payment levels at zero per cent, twenty-five per cent, fifty per cent, or ninety-five per cent, up to six thousand dollars. As you might expect, the more that people were asked to chip in for their health care the less care they used. The problem was that they cut back equally on both frivolous care and useful care. Poor people in the high-deductible group with hypertension, for instance, didn’t do nearly as good a job of controlling their blood pressure as those in other groups, resulting in a ten-per-cent increase in the likelihood of death. As a recent Commonwealth Fund study concluded, cost sharing is “a blunt instrument.” Of course it is: how should the average consumer be expected to know beforehand what care is frivolous and what care is useful? I just went to the dermatologist to get moles checked for skin cancer. If I had had to pay a hundred per cent, or even fifty per cent, of the cost of the visit, I might not have gone. Would that have been a wise decision? I have no idea. But if one of those moles really is cancerous, that simple, inexpensive visit could save the health-care system tens of thousands of dollars (not to mention saving me a great deal of heartbreak). The focus on moral hazard suggests that the changes we make in our behavior when we have insurance are nearly always wasteful. Yet, when it comes to health care, many of the things we do only because we have insurance—like getting our moles checked, or getting our teeth cleaned regularly, or getting a mammogram or engaging in other routine preventive care—are anything but wasteful and inefficient. In fact, they are behaviors that could end up saving the health-care system a good deal of money.
Sered and Fernandopulle tell the story of Steve, a factory worker from northern Idaho, with a “grotesque looking left hand—what looks like a bone sticks out the side.” When he was younger, he broke his hand. “The doctor wanted to operate on it,” he recalls. “And because I didn’t have insurance, well, I was like ‘I ain’t gonna have it operated on.’ The doctor said, ‘Well, I can wrap it for you with an Ace bandage.’ I said, ‘Ahh, let’s do that, then.’ ” Steve uses less health care than he would if he had insurance, but that’s not because he has defeated the scourge of moral hazard. It’s because instead of getting a broken bone fixed he put a bandage on it.
quote:Starr Sered and Fernandopulle interviewed a wide range of uninsured Americans with many levels of education, including graduate degrees. Many were employed at the time of their interviews and some had the opportunity to purchase insurance, but for amounts that would significantly reduce their take-home pay, making it unaffordable. Others could not work because of untreated or under-treated health care issues. Still others had been laid off after plant closings, but their chances of securing employment again if the economy improves are slim due to health conditions that have been exacerbated with lack of care. They also demonstrate that adhering to the work ethic guarantees neither health insurance nor steady work and income.
The final chapter of the book outlines suggestions that have been made for universal health coverage in America, but there is no easy solution. The authors argue that the current system for the poor is not economically sound. Without access to preventative care, problems worsen until there is no choice except to visit the emergency room or receive other exorbitantly priced treatment, which may be paid for by Medicaid or may never be paid. They contend that any feasible solution must sever the link between paid employment and insurance and must provide a minimal level of health care for all Americans, much as we provide a minimal level of education via the public schools. They argue that not only is this a humane way to treat citizens, but it is much more cost-effective than the current system.
quote:In a number of respects, this disparity between health insurance and health care comes from the fact that everyone gets sick, will age, and die. At some point in their life, every insured person will cost an insurance company money. Insurance companies can’t make much profit on human health care, unless they exclude or limit people from coverage and benefits. Otherwise, premiums aren’t profit centers, they are just pre-payments for health care we know we’ll need in the future.
To increase profits, insurance policies with benefit limits are commonplace, and no benefits are paid if those limits are exceeded, regardless of needs. You get a debilitating illness, such as cancer, and you receive a maximum payment from the insurance company that is a fraction of the total medical costs. It's as if you were a car and had reached your Blue Book value; you're declared totaled. From there, you pay the full cost of continued treatment, which can be hundreds of thousands of dollars. For people with health insurance, this is one of the main causes of bankruptcy: people have to use up their savings and sell their homes in order to pay uncovered medical costs.
Posted by jebus202 (Member # 2524) on :
/thread.
Posted by capaxinfiniti (Member # 12181) on :
How man people on this forum have actually experienced a healthcare system outside of the US and Canada? Anyone lauding the healthcare of another country sure as hell better have experienced it in a significant way or else their credibility is severely lacking.
Posted by EarlNMeyer-Flask (Member # 1546) on :
More ad hominem.
Posted by Rakeesh (Member # 2001) on :
Wait, what? While I think capax's point is wrong-direct personal experience isn't the only way to be knowledgeable about something-it's not a personal insult/attack on character, and thus not an ad hominem.
Posted by Orincoro (Member # 8854) on :
quote:Originally posted by capaxinfiniti: How man people on this forum have actually experienced a healthcare system outside of the US and Canada? Anyone lauding the healthcare of another country sure as hell better have experienced it in a significant way or else their credibility is severely lacking.
Really? So arguments based on statistical evidence and scientific and sociological studies lack in credibility compared to me, a non-professional, saying what i think about a foreign health care system because I live in a foreign country?
Ok. Since I have this undeserved credibility: it's fantastic. Health Care outside of the US is the best thing EVAR. I need make no further substantive argument.
I had no idea it was this easy!
But in all seriousness, this is a completely ridiculous caveat. And if that's really the way you feel, honestly, I can't see why anyone should bother to discuss the topic with you at all. Where can it possibly lead?
Posted by Samprimary (Member # 8561) on :
quote:Originally posted by capaxinfiniti: How man people on this forum have actually experienced a healthcare system outside of the US and Canada? Anyone lauding the healthcare of another country sure as hell better have experienced it in a significant way or else their credibility is severely lacking.
That's an incredibly dismissable claim, even for you. According to this severely lacking system of who you qualify as having credibility in this matter, a postdoctoral epidemiological world health system researcher who has never needed medical care outside of this country has 'severely lacking credibility' versus some gorm who knows practically nothing about healthcare systems but had a hospital visit on a vacation in france.
Unless, of course, you are being more charitable than I expect and are noting that researching data on world health and health system issues counts as experiencing other countries' medical systems for the purposes of being credible in a debate about this.
Posted by Orincoro (Member # 8854) on :
It's funny, people *do* tend to lend more credit to a family member's tale of woe in a foreign country than to, you know, anything else.
My uncle just yesterday made the sweeping conclusion that social medicine is bad because his father had a bad experience in France when he was on vacation there.
The bad experience? He got sick, and had to go to the hospital. No, I'm not kidding. The story was that he got sick, and had to go to the hospital, and it was traumatic. Therefore French healthcare sucks. That's the quality of thinking for a lot of people.
When I pointed out to my uncle that his father is an old man who doesn't speak French, and anyway is not actually a participant in the French medical system- he got huffy about it.
Now just imagine, if you wish, what an old French man who spoke no English who got sick and had to go to a hospital in the states might have to say about it. And this is the kind of thing people base their opinions on.
When you get sick and have to go to the hospital, *everything* is *bad* because your *sick* and in the *hospital*. So the story when you get home is that *everything* in the hospital was *bad* and nobody was nice to you when you were *sick*.
But then, my uncle for some reason forms his impression of European cities not from talking to people who actually have lived in several of them, but from his brother who goes abroad on business trips. So Paris is full of *Black People*, London is full of *Arabs* and Prague is full of *Prostitutes,* because his brother spends a lot of time A) in airports in France, B) in Airports in England, and C) at expensive cocktail lounges at the Prague Hilton that nobody in their right mind would *ever* go to if they knew better. (hehe, actually I went there once, and there were a ton of escorts hanging around, so that much is true on the face of it). But it's like, seriously dude, your brother went to literally the most expensive bar in the entire country, and his conclusion was: "gee this country has a whole lot of whores walking around."
Posted by capaxinfiniti (Member # 12181) on :
Personal confirmation is now somehow a ridiculous caveat? How so? Substantive arguments can been made by both sides. If they're so substantive, they should be easily verified. Anyone saying Ford trucks are the best simply because they read Road & Track and saw one drive by would - and should - have their opinion more thoroughly scrutinized. Owning a truck - or at the very least, riding in one, at least once - would give an opinion more credibility.
What's funny is few people are saying healthcare in the US is without flaw, but that socialized medicine isn't a superior solution and that according to certain metrics - as well as personal values - it's certainly not the solution for a country like the United States.
For all the claims that Canada's healthcare is great, I know more than a few Canadians who are deeply dissatisfied with the Canadian healthcare system. But each country needs a personalized solution. We're not Denmark. We never will be like Denmark. So addressing the needs of the US population likely won't be accomplished the same way as Denmark has done.
There was an excellent thread back during the obamacare debate where a member here - fugu, I believe it was - outlined numerous options that could be immediately implemented to increase the standard of healthcare in this country, none of which really made the system substantially less privatized. My point is, there are courses of action that can be tailored for this country and we should save the "grass is geener elsewhere" rhetoric because when you start pointing across the Atlantic, you're no longer comparing apples to apples.
Posted by Orincoro (Member # 8854) on :
"would give an opinion more credibility"
does not compute with:
"or else their credibility is severely lacking."
That's your language. I'm responding to that. You don't get to change it afterwards and then get huffy with me for not agreeing with the spirit of the statement. Personal experience, as in, being a patient in a foreign medical system is a *ridiculous caveat* in this discussion. It just is. You wanna talk trees when we're talking forest, and you'll wanna talk forest when we talk trees. That never changes.
Posted by CT (Member # 8342) on :
quote:Originally posted by capaxinfiniti: .... but that socialized medicine isn't a superior solution ...
What do you mean by "socialized medicine?"
(Honest question. It is one I will ask until I get an answer, because I can't make sense of the rest of it without this.)
quote:Originally posted by CT: Wait ... have you read the paper you cited, or just quoted the summary?
EarlNMeyer-Flask, this is also both an honest question and one I will keep asking until I get an answer, because I have a series of issues with the paper (and source) you cited that won't make sense to ask if it is just something you found via Google and posted.
[ August 22, 2011, 11:45 AM: Message edited by: CT ]
Posted by capaxinfiniti (Member # 12181) on :
quote:Originally posted by Samprimary: According to this severely lacking system of who you qualify as having credibility in this matter, a postdoctoral epidemiological world health system researcher who has never needed medical care outside of this country has 'severely lacking credibility' versus some gorm who knows practically nothing about healthcare systems but had a hospital visit on a vacation in france.
Right. I've lived in France. I'm fluent in french so it's not like I was there on holiday. Direct me to this postdoctoral researcher. I'd like to take him to see someone dying of AIDS in Lyon and ask if he would enjoy such an experience. Or go to ask an elderly woman in Paris how long before she gets her hip replacement. You can spout some numbers about how long it takes to have an elective surgery done in France, but you're still only as credible as the sources you find.
Look, I'll throw you a bone and agree that for the exorbitant taxes they pay, the french have an OK system. But it's their system. France has 1/5 the population of the US, 1/15 the sq/km, and 1/7 the GDP. The fact that each situation has so many differing variables shouldn't be dismissed.
Posted by TomDavidson (Member # 124) on :
I'm pretty sure someone dying of AIDS wouldn't enjoy the experience regardless of where he's living.
Posted by CT (Member # 8342) on :
I'm pretty sure someone with a severe case of AIDS would be glad to be in the country with the lower mortality rate for AIDS, no?
Posted by capaxinfiniti (Member # 12181) on :
quote:Originally posted by CT:
quote:Originally posted by capaxinfiniti: .... but that socialized medicine isn't a superior solution ...
What do you mean by "socialized medicine?"
(Honest question. It is one I will ask until I gat an answer, because I can't make sense of the rest of it without this.)
A national healthcare system administered by the government. A single-payer, state-run monopsony. Basically, anything approaching drastic government oversight, regulation, taxation or subsidization of healthcare, such as is common in many countries of the western world.
Posted by CT (Member # 8342) on :
quote:Originally posted by capaxinfiniti: A national healthcare system administered by the government. A single-payer, state-run monopsony. Basically, anything approaching drastic government oversight, regulation, taxation or subsidization of healthcare, such as is common in many countries of the western world.
Thanks. These are varying definitions that together cover a very wide range of possible structures. I appreciate the answer -- it helps me understand your perspective a little more.
What do you expect the experience of a typical physician in the US vs. in Canada would be with respect to time spent on paperwork and restrictions on practicing medicine from outside forces? Just curious -- no need to cite sources.
Posted by Samprimary (Member # 8561) on :
quote:I'd like to take him to see someone dying of AIDS in Lyon and ask if he would enjoy such an experience.
Are they going to enjoy it less than someone who's dying of AIDS in Baltimore? Again, lest you be accused of personally being non-credible under your system, have you tried watching someone die of AIDS in both countries?
quote:You can spout some numbers about how long it takes to have an elective surgery done in France, but you're still only as credible as the sources you find.
And you haven't provided sources, and are relying only on personal anecdote. In fact, you seem strenuously to be attempting to demand that WE only be considered as reliable as our own personal anecdote. Do you realize why this comes off so poorly?
Posted by scholarette (Member # 11540) on :
I always wonder about those lists in other countries. I was diagnosed with endometriosis at 18. At 23, my doctor finally convinced my insurance that my condition was severe enough to justify surgery. I had pain and missed work at 18, but I needed to wait until I hit a higher pain level on a higher number of days per month. So, I waited 5 years for an outpatient, fairly simple surgery in the US. When people say US doesn't have waiting lists, how come I still had to wait 5 years? Also, my husband need an endoscopy. In order to go through the insurance approved facility, it took 4 months to get an appt. Now let's imagine I had no insurance, would I ever get a hip replacement in the US? So, would that wait list number in the US then be infinite?
Posted by capaxinfiniti (Member # 12181) on :
quote:Originally posted by CT: I'm pretty sure someone with a severe case of AIDS would be glad to be in the country with the lower mortality rate for AIDS, no?
Where are you getting your statistics?
The CDC "estimates that more than one million people are living with HIV in the United States."
Avert, the AIDS charity, estimates that approximately 150,000 people in France living with HIV/AIDS.
If you simply take the number of AIDS related deaths and scaled it according to population to find a mortality rate, important factors such as cost of treatment and ease of access (How may qualified treatment facilities in a given sq/mi area?) would be left out. These issues are both relevant and important when discussing healthcare costs. France may treat these individuals but it comes by way of a significant monetary burden - meaning taxation.
Posted by CT (Member # 8342) on :
Yes, there are many such issues, scholarette. There have been analyses of "waiting lists" in other countries which showed that a significant percentage of the persons on the list had already had the procedure (just not updated) or were placeholders. And the experience you had of unofficial -- but effective -- witing lists in the US isn't uncommon.
I think that is why the best indicators are looking at medical outcomes. If morbidity and mortality indicators are better, that matters more than how they get there. The primary goods of a healthcare system's delivery are to live longer, healthier lives.
Posted by capaxinfiniti (Member # 12181) on :
quote:Originally posted by CT:
quote:Originally posted by capaxinfiniti: A national healthcare system administered by the government. A single-payer, state-run monopsony. Basically, anything approaching drastic government oversight, regulation, taxation or subsidization of healthcare, such as is common in many countries of the western world.
Thanks. These are varying definitions that together cover a very wide range of possible structures. I appreciate the answer -- it helps me understand your perspective a little more.
What do you expect the experience of a typical physician in the US vs. in Canada would be with respect to time spent on paperwork and restrictions on practicing medicine from outside forces? Just curious -- no need to cite sources.
True, they do cover a spectrum of possible structures but I don't think they vary too widely. Can you think a more accurate, single definition of socialized medicine?
quote:Originally posted by scholarette: I always wonder about those lists in other countries. Now let's imagine I had no insurance, would I ever get a hip replacement in the US? So, would that wait list number in the US then be infinite?
Cost-shifting alone won't alleviate waiting lists. I don't believe any particular system can altogether end waiting lists. And I don't know how long the current hip-replacement waiting list is, nor the average cost. I'll have to look up those numbers.
Posted by CT (Member # 8342) on :
quote:Originally posted by capaxinfiniti: Where are you getting your statistics?
UNAIDS, the Joint United Nations Programme on HIV/AIDS, reports by countries.
quote:If you simply take the number of AIDS related deaths and scaled it according to population to find a mortality rate, important factors such as cost of treatment and ease of access (How may qualified treatment facilities in a given sq/mi area?) would be left out. These issues are both relevant and important when discussing healthcare costs. France may treat these individuals but it comes by way of a significant monetary burden - meaning taxation.
Are you saying that these other issues are to be factored into the mortality rate? [I am confused, alas, as I am too frequently. It is hard to follow thought lines in this area for me.]
I can see why you would want to include them in healthcare costs, but I do not understand why you are claiming that the percentage of general healthcare costs born by taxation is more important to someone dying of AIDS than how much longer her or she is likely to live would be.
That just seems like such a very strange thing to focus on in such extremity.
[ August 22, 2011, 01:29 AM: Message edited by: CT ]
Posted by CT (Member # 8342) on :
quote:Originally posted by capaxinfiniti: Can you think a more accurate, single definition of socialized medicine?
I confess I have yet to find a single, accurate definition of "socialized medicine." It seems to be one of those terms that gets waved about without being clearly defined, and I do not find it to be one of those creatures I enjoy having to tea at my own house.
Posted by Samprimary (Member # 8561) on :
quote:Originally posted by CT:
quote:Originally posted by capaxinfiniti: Can you think a more accurate, single definition of socialized medicine?
I confess I have yet to find a single, accurate definition of "socialized medicine."
"Socialized medicine is a term used to describe a system for providing medical and hospital care for all at a nominal cost by means of government regulation of health services and subsidies derived from taxation."
re: wikipedia, which notes that the primary use of the word is a united states-based politically motivated pejorative term. Elsewhere, healthcare systems are usually just called 'healthcare' or some derivative of that fact. It's not nominally referred to as 'socialized' or 'socialist' any more than post offices or firefighters are called things like "socialized fire response."
Posted by CT (Member # 8342) on :
Samprimary, I don't find that definition to be exactly what I am looking for, either, but I'm too tired to suss it out. Thank you for pulling it up, though.
---
quote:Originally posted by capaxinfiniti: ... but you're still only as credible as the sources you find.
Alas -- and this is a grave fault with the world -- the same is true for anecdotes.
And it's a lot harder to assess the reliability and relevance of another person's first-, second-, or third-hand anecdotes than it is to assess the same of formally collected and compiled data.
[ August 22, 2011, 01:29 AM: Message edited by: CT ]
Posted by Rakeesh (Member # 2001) on :
In my (limited) experience, 'socialized medicine' is much more a practice of imagination than it's ever been of real practices in the world. Everytime I've ever watched or listened to or read about actual examples of 'socialized medicine' in practice, the details end up being quite different than would be expected by American politics.
Posted by Strider (Member # 1807) on :
quote: It's not nominally referred to as 'socialized' or 'socialist' any more than post offices or firefighters are called things like "socialized fire response."
This will now become my standard way to refer to the fire department.
Posted by CT (Member # 8342) on :
Yeah. What [Rakeesh] said.
[But I agree with Strider, too. ]
The level of difference in control placed on individual physicians is so intensely striking. It is amazing how simple the practice of medicine is in Canada in comparison to the US.
Somewhere around 2003 or so, an AMA survey of its members found that >40% of work time for physicians is taken up by paperwork. There is the filing to justify the billing, then the reissuing of the billing, then the appeal for the billing that was declined, etc., etc. On the wall at the last place I worked in the US was a flowchart of what was required by the various HMOs for billing -- to bill for 7 minutes to this HMO, you needed (e.g.) 3 items on history of present illness, 1 element of social history, and 2 elements of the physical exam; to bill for 11 minutes, you needed 4 items of HPI, 1 of social history, blah blah blah. To bill for a procedure from List A, you needed 2 elements from the blah blah blah.
You know what you needed to do the same billing in British Columbia? Doublecheck that you have a referral form from the primary care physician sent within the last 6 months. After that, chart what you need to take care of the patient. That's it. The billing process is frighteningly simple by contrast.
More importantly, taking good care of the patient is frighteningly simple by contrast, and the salient decisions about what to recommend are in the hands of the physician.
Posted by MattP (Member # 10495) on :
quote:It's not nominally referred to as 'socialized' or 'socialist' any more than post offices or firefighters are called things like "socialized fire response."
Being in the middle of red-state Utah and having few opportunities for meaningful dialog of the merits of a political ideology something to the left of tea party, I tend to prefix every state-provided service with "socialized" as a minor rebellion.
I particularly enjoyed the socialized fireworks on the 4th of July this year.
Posted by rivka (Member # 4859) on :
quote:Originally posted by MattP: I particularly enjoyed the socialized fireworks on the 4th of July this year.
Posted by Orincoro (Member # 8854) on :
quote:Originally posted by MattP:
quote:It's not nominally referred to as 'socialized' or 'socialist' any more than post offices or firefighters are called things like "socialized fire response."
Being in the middle of red-state Utah and having few opportunities for meaningful dialog of the merits of a political ideology something to the left of tea party, I tend to prefix every state-provided service with "socialized" as a minor rebellion.
I particularly enjoyed the socialized fireworks on the 4th of July this year.
Aren't the socialized fireworks in the socialized parks overseen by the socialized fire reponse units, or are they handled by the socialized law enforcement? And who cleans up after the party? The socialized community sanitation agency? when I was a socialized teen counselor, they used to make the socialized parks and recreation crew pick up after the socialized movies in the park, and socialized concerts. Once I saw a couple having socialized sex behind a tree on socialized property. They were socializedly embarrassed when the socialized law enforcement arrived.
Posted by SenojRetep (Member # 8614) on :
A week or two ago, I was interested in mapping out how healthcare costs were growing in various industrialized economies. I created this graph, based off OECD data.
The graph shows what I see as three distinct phases in the growth of healthcare costs. The first, from 1961-1980 (or so; the dividing line could be as early as 1978, depending on what features you want to look at) spending on healthcare as a percent of GDP grew at about the same rate in the US as in other OECD countries. The US costs were roughly on par with (although a bit higher than) most other OECD countries.
During the second phase, which mostly covered the 1980s, the US continued to see steep growth in healthcare spending, while the other members of the OECD saw healthcare spending essentially flatline (again, as a percentage of GDP). From 1978-1990, US healthcare spending increased about 35%, while healthcare costs in other OECD countries increased by less than 5%.
Then, starting in 1990 (or so), the growth curve has been essentially identical between the US and other OECD countries, as shown in the third panel of the graph. The apparent correlation indicates to me that whatever has been driving cost growth in the US since 1990, it's relatively invariant to the precise system of healthcare delivery.
What I really want to have explained is what happened in the 80s? Why was cost growth in non-US OECD countries impeded? Why wasn't it similarly impeded in the US? And could we replicate whatever it was to "bend the curve" today? I haven't looked too hard, but I've looked some and I haven't found anything I think is very reasonable explanation.
None of this is intended as an answer to whether "socialized" medicine is better or worse than whatever you'd call the current US system. It's strictly a question of cost growth, which I recognize is only a single aspect by which to judge any healthcare system.
Posted by scholarette (Member # 11540) on :
The summary says well, if Canada had the same obesity rates or drug usage rates, they wouldn't look so much better. When my sister in Canada went to the dr, they told her she was overweight and gave her a voucher for meetings with a dietician, personal trainer and masseuse (she eats when stressed). When I go the dr, I get nothing like that. I do not know how they approach substance abuse during pregnancy or prenatal care in general, but if the weight thing is a trend, well, they probably treat those underlying issues better than we do in the US. The fact that we ignore things we could help prevent should be factored in.
Posted by Samprimary (Member # 8561) on :
quote:Originally posted by scholarette: When I go the dr, I get nothing like that.
quote:In the Treatment of Diabetes, Success Often Does Not Pay
With much optimism, Beth Israel Medical Center in Manhattan opened its new diabetes center in March 1999. Miss America, Nicole Johnson Baker, herself a diabetic, showed up for promotional pictures, wearing her insulin pump.
In one photo, she posed with a man dressed as a giant foot - a comical if dark reminder of the roughly 2,000 largely avoidable diabetes-related amputations in New York City each year. Doctors, alarmed by the cost and rapid growth of the disease, were getting serious.
At four hospitals across the city, they set up centers that featured a new model of treatment. They would be boot camps for diabetics, who struggle daily to reduce the sugar levels in their blood. The centers would teach them to check those levels, count calories and exercise with discipline, while undergoing prolonged monitoring by teams of specialists.
But seven years later, even as the number of New Yorkers with Type 2 diabetes has nearly doubled, three of the four centers, including Beth Israel's, have closed.
They did not shut down because they had failed their patients. They closed because they had failed to make money. They were victims of the byzantine world of American health care, in which the real profit is made not by controlling chronic diseases like diabetes but by treating their many complications.
Insurers, for example, will often refuse to pay $150 for a diabetic to see a podiatrist, who can help prevent foot ailments associated with the disease. Nearly all of them, though, cover amputations, which typically cost more than $30,000.
Patients have trouble securing a reimbursement for a $75 visit to the nutritionist who counsels them on controlling their diabetes. Insurers do not balk, however, at paying $315 for a single session of dialysis, which treats one of the disease's serious complications.
Not surprising, as the epidemic of Type 2 diabetes has grown, more than 100 dialysis centers have opened in the city.
"It's almost as though the system encourages people to get sick and then people get paid to treat them," said Dr. Matthew E. Fink, a former president of Beth Israel.
Exactly as it says: our system makes it so that with problems like diabetes, success does not pay. So we, as taxpayers, pay for the amputations instead later. And we pay more, for the system to work less.
Posted by CT (Member # 8342) on :
quote:Originally posted by Samprimary: [from quotation] Patients have trouble securing a reimbursement for a $75 visit to the nutritionist who counsels them on controlling their diabetes. Insurers do not balk, however, at paying $315 for a single session of dialysis, which treats one of the disease's serious complications. Not surprising, as the epidemic of Type 2 diabetes has grown, more than 100 dialysis centers have opened in the city.
Yes. This is why you cannot separate a population being healthier from the healthcare system -- sometimes you get better outcomes not just because you start with healthier people.
A well-designed system has the effect of keeping people healthier in general as well doing a good job of dealing with acute problems.
Posted by rivka (Member # 4859) on :
The exceptions to that are HMOs like Kaiser, which has its own nutritionists on staff, and runs diabetes clinics not too different from the centers in the article. Because they are self-contained systems, the perverse incentives don't apply in the same way.
Posted by Dan_Frank (Member # 8488) on :
quote:Originally posted by Orincoro:
quote:Originally posted by MattP:
quote:It's not nominally referred to as 'socialized' or 'socialist' any more than post offices or firefighters are called things like "socialized fire response."
Being in the middle of red-state Utah and having few opportunities for meaningful dialog of the merits of a political ideology something to the left of tea party, I tend to prefix every state-provided service with "socialized" as a minor rebellion.
I particularly enjoyed the socialized fireworks on the 4th of July this year.
Aren't the socialized fireworks in the socialized parks overseen by the socialized fire reponse units, or are they handled by the socialized law enforcement? And who cleans up after the party? The socialized community sanitation agency? when I was a socialized teen counselor, they used to make the socialized parks and recreation crew pick up after the socialized movies in the park, and socialized concerts. Once I saw a couple having socialized sex behind a tree on socialized property. They were socializedly embarrassed when the socialized law enforcement arrived.
Okay, I understand all of these except for "socialized sex." Was this sex part of some psychology experiment that received grant funding? A government-approved prostitute?
Seriously, man, how did the state provide this service? Inquiring minds want to know. And are also a little grossed out.
Posted by CT (Member # 8342) on :
quote:Originally posted by rivka: The exceptions to that are HMOs like Kaiser, which has its own nutritionists on staff, and runs diabetes clinics not too different from the centers in the article. Because they are self-contained systems, the perverse incentives don't apply in the same way.
I found Group Health Cooperative HMO to be much the same way.
Interestingly, this is a case where the larger a given corporation gets, in some ways, the better. With a lot of competition from small companies, the covering parties know that a given person isn't likely to stay with one insurance for the long haul. Jobs will change, policies will change based on who offers the best deal to the employer, etc.
However, if you are a large enough covering party, you know you are likely to be covering the same people not just for acute care this year, but also for the longterm effects of chronic issues. There is incentive to put in a small cost now to avert a larger one later.
Posted by Samprimary (Member # 8561) on :
The interesting thing about the healthcare debate is that it's a central glaring example of insufficiency in the notions people have about desiring a free-market solution.
There's some weird effects to that.
Normally, a system like this is to be judged based on a fairly simple cost to benefit analysis. How much money are we paying per capita into our system? Is it more or less than other countries? Are we more satisfied with our system for what we pay? Do we live longer? Are we healthier? Do we have less lost productivity through our system?
The people who are ideologically pressed to defend our system have to try very hard to ignore the cost to benefit ratio, because we're paying nearly two and a half times the median per person for a system that serves us less effectively than every other modern system. We're paying more, and getting less. We're paying a LOT more.
They have to try to sidestep that analysis completely and come up with increasingly arcane ways to prop up faith in our (mildly disintegrating) system. The most common caveats relied upon are to point repeatedly to waiting lists and to try to claim that even if the system works elsewhere there are significant differences between us and the body of every other modern nation on earth that makes it so that somehow adopting their system just 'won't work for us.'
This includes the whole size and population argument that we have already seen in this thread.
Yet we have already hashed that argument into the ground, quite conclusively, with the same parties. It doesn't matter; you will see it each and every time.
Posted by CT (Member # 8342) on :
Ayup.
Posted by Samprimary (Member # 8561) on :
quote:Originally posted by rivka: The exceptions to that are HMOs like Kaiser, which has its own nutritionists on staff, and runs diabetes clinics not too different from the centers in the article. Because they are self-contained systems, the perverse incentives don't apply in the same way.
Kaiser does a bang-up job managing to work like they work within their own self-contained system. And they can pull it off because, like with all of the rest of our systems, they can elect who can be let in to be part of that self-contained system, and that system is for people who can pay the subscription fee only. For the people who had trouble managing to front the small fees for nutritionists provided by the Beth Israel system, looking at Kaiser is like looking into a gated community.
Posted by SenojRetep (Member # 8614) on :
Samp (and CT and others), do you have any thoughts on the cost growth post I made above? Any idea why the structural differences between systems led to wildly different growth characteristics in the 80s, but very similar growth characteristics in the two decades before and the two decades since?
I feel like conversations of US healthcare, particularly conversations making transnational comparisons, tend to focus on absolute cost. But to my mind our funding challenge comes from unsustainable cost growth, and that seems to be a fairly universal problem.
Posted by CT (Member # 8342) on :
SenojRetep, I am interesting in reading your thoughts on the matter and glad you brought it up. I am in the midst of moving and have little free time (even fewer free brain cells!) and am just not up to giving it due consideration myself.
It takes work to sort through these issues. It's ever so much easier to read through someone else's sorting process. I will try to return to it another time, though.
[ August 22, 2011, 03:13 PM: Message edited by: CT ]
Posted by SenojRetep (Member # 8614) on :
CT,
I don't have clear thoughts on the matter. The fact that the costs for all OECD countries grew quickly in the 60s and 70s, and somewhat more slowly but at fairly uniform rates in the 90s and 00s, regardless of system, makes me think that what's driving cost growth isn't unique to any individual system.
I'm very interested in why non-US OECD countries suddenly went from rapid cost growth to essentially no cost growth in the late 70s, and also what caused their costs to begin growing again at rates very similar to those of the US in the early 90s. I haven't found anything in my few hours of internet research that I could point to as a reasonable causal factor, but I'm wondering if people with greater involvement in the issue would have some possible insights.
Posted by dabbler (Member # 6443) on :
Medications? I'd look into what part pharmaceuticals play in those countries like direct to consumer advertising, courting physicians, or strict medication cost cutting measures.
Posted by CT (Member # 8342) on :
I'd also look at the percentage expenditure of healthcare costs in the last six months of life and the shift in the effectiveness of ICU care (for the elderly, premature infants, and those with end-stage illness) in the last few decades.
Posted by Amanecer (Member # 4068) on :
quote:The exceptions to that are HMOs like Kaiser, which has its own nutritionists on staff, and runs diabetes clinics not too different from the centers in the article. Because they are self-contained systems, the perverse incentives don't apply in the same way.
Many large insurance companies are experimenting with wellness programs such as nutritionists. I'd venture to say most have or have had pilot programs testing these types of things. However, the incentive for wellness programs (from employer or insurance company) is decreased when people switch jobs and thus insurance companies regularly. If only 1/10 of the people you put on a wellness program 10 years ago are still on the plan today, it gets really hard to prove the effectiveness of the program and even harder to prove the cost-effectiveness of the program.
Posted by happymann (Member # 9559) on :
quote:Originally posted by Dan_Frank:
quote:Originally posted by Orincoro:
quote:Originally posted by MattP:
quote:It's not nominally referred to as 'socialized' or 'socialist' any more than post offices or firefighters are called things like "socialized fire response."
Being in the middle of red-state Utah and having few opportunities for meaningful dialog of the merits of a political ideology something to the left of tea party, I tend to prefix every state-provided service with "socialized" as a minor rebellion.
I particularly enjoyed the socialized fireworks on the 4th of July this year.
Aren't the socialized fireworks in the socialized parks overseen by the socialized fire reponse units, or are they handled by the socialized law enforcement? And who cleans up after the party? The socialized community sanitation agency? when I was a socialized teen counselor, they used to make the socialized parks and recreation crew pick up after the socialized movies in the park, and socialized concerts. Once I saw a couple having socialized sex behind a tree on socialized property. They were socializedly embarrassed when the socialized law enforcement arrived.
Okay, I understand all of these except for "socialized sex." Was this sex part of some psychology experiment that received grant funding? A government-approved prostitute?
Seriously, man, how did the state provide this service? Inquiring minds want to know. And are also a little grossed out.
I'm thinking you learn how to have socialized sex from those sex-ed films in socialized school, as opposed to learning about capitalist sex from hollywood films.
Posted by Blayne Bradley (Member # 8565) on :
quote:Originally posted by Dan_Frank:
quote:Originally posted by Orincoro:
quote:Originally posted by MattP:
quote:It's not nominally referred to as 'socialized' or 'socialist' any more than post offices or firefighters are called things like "socialized fire response."
Being in the middle of red-state Utah and having few opportunities for meaningful dialog of the merits of a political ideology something to the left of tea party, I tend to prefix every state-provided service with "socialized" as a minor rebellion.
I particularly enjoyed the socialized fireworks on the 4th of July this year.
Aren't the socialized fireworks in the socialized parks overseen by the socialized fire reponse units, or are they handled by the socialized law enforcement? And who cleans up after the party? The socialized community sanitation agency? when I was a socialized teen counselor, they used to make the socialized parks and recreation crew pick up after the socialized movies in the park, and socialized concerts. Once I saw a couple having socialized sex behind a tree on socialized property. They were socializedly embarrassed when the socialized law enforcement arrived.
Okay, I understand all of these except for "socialized sex." Was this sex part of some psychology experiment that received grant funding? A government-approved prostitute?
Seriously, man, how did the state provide this service? Inquiring minds want to know. And are also a little grossed out.
State run brothels.
Posted by rivka (Member # 4859) on :
quote:Originally posted by Samprimary: For the people who had trouble managing to front the small fees for nutritionists provided by the Beth Israel system, looking at Kaiser is like looking into a gated community.
Were you not talking about people with insurance? Because it sure sounded like you were.
quote:Originally posted by Amanecer: If only 1/10 of the people you put on a wellness program 10 years ago are still on the plan today, it gets really hard to prove the effectiveness of the program and even harder to prove the cost-effectiveness of the program.
And that's why Kaiser also works hard on maintaining customer loyalty. I have stuck with them through three employers. (And one of the changes, when I actually was still a client but had triggered the customer-leaving protocol, showed me how hard they work to keep customers.)
Posted by Dan_Frank (Member # 8488) on :
quote:Originally posted by happymann:
quote:Originally posted by Dan_Frank: Okay, I understand all of these except for "socialized sex." Was this sex part of some psychology experiment that received grant funding? A government-approved prostitute?
Seriously, man, how did the state provide this service? Inquiring minds want to know. And are also a little grossed out.
I'm thinking you learn how to have socialized sex from those sex-ed films in socialized school, as opposed to learning about capitalist sex from hollywood films.
So, socialized sex is restrained and clinical, while capitalist sex is glamorous and titillating? ... Yeah, sounds about right.
Posted by Teshi (Member # 5024) on :
Socialization for me means this, and it applies to things like education as well: Instead of having some people who have fantastic health care (or education, or opportunity) and some people who have no health care at all, everyone gets decent health care.
Comparing socialized health care to what you can get if you are lucky enough to pay never works because the speed and quality of service is always going to be better when you can pay.
However, comparing what healthcare is like for the majority of ordinary people when they have no insurance it's going to be a million times better and more easy to use because they actually have access to it.
When they first invented fire-fighters, you had to pay insurance to a company and then when someone called the fire engine they would put out the fire if you had insurance with them. If you didn't, that was it. Clearly, at some point in history, someone thought this was rather unfair. Rich people could continue to be rich because they could afford insurance. Poorer or middle class people just had their homes burn down. So someone invetned the fire-fighting service we have today in almost every civilised country because we actually think it's rather nice for everyone to have access to some level of fire-fighting service, even if they can't pay for it.
Why is this, in the USA, not applied to health care. Why do certain people feel that saving people from the loss of all their personal possessions is an acceptable price to pay, but the loss of their health or life is not? Is it because fire engines are cheaper and simpler?
In a world with healthcare, if you get sick, you go to the clinic, the doctor or a hospital, they swipe your card and you get semi-prompt service for absolutely free or with a reduced cost. You do this even when you're unemployed the same as if you have a good job (let's ignore the splendiferousy rich for now because almost nobody is splendiferousy rich and to use the splendiferously rich as an example for anything is misleading and silly.)
Not wanting socialised health care is an excercise in "I hope". It goes like this: "I hope that when I get sick I will be wealthy" and perhaps that's why America doesn't have it yet. Because every American believes that, when they get that debilitating illness or that injury, they will actually be wealthy by then and the chemotherapy will be affordable without a reduction in costs.
The UK has this problem with the school system, because it is very two tier the same way the American health system is. If you can pay, you get fantastic service. If you cannot, you either have to fight for a good school or you send your child to somewhere where they will not have a very good chance at success.
You might say, "Well, only those who fight for education and health care know its value and deserve it" but that's foolish in terms of the society you will produce. You don't want an unhealthy or poorly educated society. You want a healthy, well-educated one and you don't want to force people to re-mortgage their homes in order to save a member of their family.
Healthcare makes sense. It's better overall for the population. If you wish to have a two tier system, have a two-tier system so the splendiferously rich can get their kidney first (after all, they've worked for it!!!11one), but at least have that lower tier to catch those who will never make it to be splendiferously rich because that's most people.
Yeah. It's expensive. Get used to supporting your nation's poor and ill, because one day you might be.
Posted by Samprimary (Member # 8561) on :
quote:Originally posted by rivka:
quote:Originally posted by Samprimary: For the people who had trouble managing to front the small fees for nutritionists provided by the Beth Israel system, looking at Kaiser is like looking into a gated community.
Were you not talking about people with insurance? Because it sure sounded like you were.
I'm not dissing kaiser (i like them), I'm just noting the factors that allows them to work inside of our ... uniquely strained system.
Posted by rivka (Member # 4859) on :
I'm not defending Kaiser. I'm confused about your point.
Posted by imogen (Member # 5485) on :
quote:Originally posted by Teshi: Socialization for me means this, and it applies to things like education as well: Instead of having some people who have fantastic health care (or education, or opportunity) and some people who have no health care at all, everyone gets decent health care.
+1
The way the system works in Australia is I guess triaged in its way.
Firstly, everyone has access to free GP (primary doctor) care. However, these free GP clinics are popular, so if you want immediate access without waiting times,* or your own personal doctor who chooses not to bulk bill, you will pay something (usually about $40-70 an appointment).
Secondly, emergency and essential hospital care is free to all. No ifs, no buts. No matter what the operation. I had my son in a public hospital. The prenatal care (one midwife, continuos care) was free. The birth care (two midwifes, two hospital rooms, one emergency operating room, one obstetrician, one anesthesiologist, one registrar, several theater nurses) was free. The immediate post natal care (one hospital room, many nurses, one midwife (same from before the birth)) and subsequent post natal care (same midwife, home visits for 2 weeks) were also free.
Elective surgery - this can get more tricky. It is free, but waiting times are longer at public hospitals. So, my husband needs a knee operation. It's not crucial, he can live with it, but it pains him. It would be a lengthy wait under the public system, so we'll probably pay for it. However, it will only cost about $1500. I understand that's pretty cheap compared to most operations in the US.
*Usually anywhere from 1 - 3 hours for the walk in clinics, though sometimes more or less. Booking into a bulkbilling GP clinic will mean booking a week or so in advance, but they usually squeeze kids in if they can.
Posted by kmbboots (Member # 8576) on :
quote:Originally posted by imogen: Elective surgery - this can get more tricky. It is free, but waiting times are longer at public hospitals. So, my husband needs a knee operation. It's not crucial, he can live with it, but it pains him. It would be a lengthy wait under the public system, so we'll probably pay for it. However, it will only cost about $1500. I understand that's pretty cheap compared to most operations in the US.
Dad's pacemaker (a reasonably simple procedure as far as that goes) was $227,000. Just the surgery - not the emergency room care that got him into the hospital, not the tests to determine a diagnosis.
Posted by Teshi (Member # 5024) on :
Holy makeral.
Posted by Blayne Bradley (Member # 8565) on :
How would that *not* bankrupt you on just the interest?
Posted by kmbboots (Member # 8576) on :
No kidding. He had needed a pacemaker for quite some time but put it off. (Even with Medicare and his other insurance, the bills are significant.) In December, the lack of oxygen caused by the slow heart rate led to him falling down and breaking his right arm just below the shoulder. That was a whole separate surgery once the pacemaker got his heart rate to a point where they could do surgery. Plus rehab and temporary nursing home care.
And that was a fairly easy, not all that complicated, and quite "fixable" health situation.
[ August 24, 2011, 12:51 PM: Message edited by: kmbboots ]
Posted by scholarette (Member # 11540) on :
I've hear that India has some excellent heart surgeons who will fix stuff much cheaper than the US and with just as much success. Health-tourism is getting to be booming because of things like what kmboots mentioned. I think that when my daughter had a catheter, blood draw and some x-rays, the insurance paid more than $1500 (negotiated down from like 5k). We paid $350 I think.
Posted by Syphon the Sun (Member # 11873) on :
quote:The leading cause of personal bankruptcy in the United States is unpaid medical bills; the United States has more lost productivity and a lower average working age range than any of the other 'modernized' high-income nations such as the G8.
Is this “fact” based upon the widely discredited Himmelstein study? Nobody has taken the Himmelstein study seriously since, well, pretty much since it came out. See, e.g., here. If not, I’d like to see the data, because all the data I’ve seen points to the fact that medical debt, if it contributes to bankruptcy at all, tends to represent a very small percentage of total unsecured debt. Indeed, even those citing medical debt as a “leading cause” of their bankruptcies have medical debt that represents only a very small percentage of total unsecured debt.
quote:Americans spend $5,267 per capita on health care every year, almost two and half times the industrialized world’s median of $2,193; the extra spending comes to hundreds of billions of dollars a year. The extra spending does not provide us with anything approaching the effectiveness of non-actuarial models.
A substantial portion of the U.S. health care costs are attributable to drug prices. Most Western nations have imposed price controls, which limit access to the newest drugs and eliminate incentives for innovation. Indeed, by imposing price-controls, these nations are cost-shifting to other nations (like the U.S.) that have adequate patent protection to spur innovation. We also utilize more health technology than our peers and provide much higher numbers of quality-of-living procedures (knee replacements, cataract surgery, etc.).
quote:American life expectancy is lower than the Western average.
Life expectancy is a terrible metric to measure quality of care, as lifestyles are incredibly important to longevity. You can have the best health coverage in the world, your life expectancy isn't going to be so great if you're smoking your tenth cigarette of the day while eating the fourth Big Mac of the hour. Our disease survival rates, however, which do measure quality of care, are quite good. Indeed, the U.S. has higher survival rates than the E.U. for thirteen cancers, while the E.U. has higher survival rates than the U.S. for only three (and of those three, there is only a 2% difference).
quote:Childhood-immunization rates in the United States are lower than average.
Our measles immunization rate is only slightly lower than the OECD average and is higher than the U.K.’s (and ties France’s).
quote:Doctors here perform more high-end medical procedures, such as coronary angioplasties, than in other countries, but most of the wealthier Western countries have more CT scanners than the United States does, and Switzerland, Japan, Austria, and Finland all have more MRI machines per capita.
quote:And, of course, every other country in the industrialized world insures all its citizens; despite those extra hundreds of billions of dollars we spend each year, we leave forty-five million people without any insurance.
One question: do you think the U.S. should insure all citizens, or all people? Because you’re using two different metrics, there. Around 20% of uninsured U.S. residents aren’t citizens. And, of course, another 25% are eligible for Medicaid and will be enrolled automatically by seeking medical care. Those remaining aren’t necessary poor, sick, or looking for insurance. 43% have incomes 250% of the poverty level, 86% report they are in good (or excellent) health, and only half will still be uninsured after six months. (That rate drops to 30% after a year, 16% after two, and 2.5% after three.)
Posted by rivka (Member # 4859) on :
Registered 3 years ago and posting for the first time now?
Interesting.
Posted by Rakeesh (Member # 2001) on :
That's a peculiar registration date and post count, Syphon. I wonder who you're an alt for? Obviously you're under no actual or even moral obligation to answer that question, it's just that there is sometimes a pattern `round here of that sort of style-alts posting in highly politicized issues. Made me wonder.
Posted by rivka (Member # 4859) on :
Of course, since you and I pointed it out, Rakeesh, we're the most likely suspects. Posted by Syphon the Sun (Member # 11873) on :
Pwebbers can verify that I'm not an alt of any Hatracker. By and large, Hatrack moves too fast (and after much lurking, I never really felt like I "fit in") for me to keep up with the board-as-a-whole, and I'm not a huge fan of watching only a few threads.
That said, health law and policy is sort of my expertise. So I thought I'd chime in.
Posted by Orincoro (Member # 8854) on :
Making a long and sweeping post dismissing the very basis of another viewpoint in very broad terms, as your first post in memory, is not good form. And that stands to reason. You don't have any credibility here, because nobody is familiar with you.
Posted by Samprimary (Member # 8561) on :
I don't care about 'forum cred' or lack of thereof at all, short of the now legitimate concern that this is another sock puppet. That post alone would have made for a better original post, as opposed to the google & run we got.
I'll pull my own quick response with the time I have at the pattern of the post which most intrigues me.
quote:Originally posted by Syphon the Sun: Our disease survival rates, however, which do measure quality of care, are quite good. Indeed, the U.S. has higher survival rates than the E.U. for thirteen cancers, while the E.U. has higher survival rates than the U.S. for only three (and of those three, there is only a 2% difference).
I have encountered this specific example (the Thirteen Cancers) multiple times, often specifically cherrypicked. This is a great way to say "Our survival rates for these specific cancer types is quite good" but this is not an argument for saying that our disease survival rates, as the chosen metric for showing off how well our system stacks up versus others, are good. Especially when we have two chronic problems:
1. In numberless categories, our disease survival rate is so significantly poorer and rife with so much inefficiency as to keep defenders of our own system stuck trying to point to these specific cancers, and ignore wide swaths of glaringly subpar performance elsewhere. To pick a pretty completely random example, our mortality rate for end-stage renal disease is 47% higher than Canada's. Yes, even after adjustment for patient and treatment variables between the two countries, and
2. The other systems don't have wide socioeconomic opportunity gaps associated with their health systems. International comparisons of cancer survival show that poor people here have significantly lower survival rates for most of those cancers, where Canada and elsewhere show no such association for any cancers.
~and~
quote:
quote:Childhood-immunization rates in the United States are lower than average.
Our measles immunization rate is only slightly lower than the OECD average and is higher than the U.K.’s (and ties France’s).
This also looks like a very selective, cherrypicking response. As in, it doesn't appear to actually address or disprove the preceding statement at all, but rather tries to stress a specific individual portion to make the comparison look much more favorable ...
Posted by SenojRetep (Member # 8614) on :
quote:Originally posted by Orincoro: Making a long and sweeping post dismissing the very basis of another viewpoint in very broad terms, as your first post in memory, is not good form. And that stands to reason. You don't have any credibility here, because nobody is familiar with you.
That seems like an overly harsh denunciation. I didn't think the post was mean-spirited or even that argumentative. I did think that, given the many factual assertions it would have been nice to have some links to further information.
I think the idea that the only way for someone to have credibility on Hatrack is to have a long posting profile is pretty facile. Certainly reputation is important, but my judgments of credibility are based on lots of factors including the tone and content of the posts, in addition to my personal history with the poster. Telling someone new that their post doesn't deserve a reasoned response because they are new strikes me as thoughtless and rude.
Posted by rivka (Member # 4859) on :
quote:Originally posted by SenojRetep: I think the idea that the only way for someone to have credibility on Hatrack is to have a long posting profile is pretty facile.
I agree.
quote:Originally posted by SenojRetep: Telling someone new that their post doesn't deserve a reasoned response because they are new strikes me as thoughtless and rude.
Agreed again, except for one thing -- with a join date of 2008, they're not exactly new. As Samp pointed out, the real issue is not whether they are new, but whether they are not.
Posted by capaxinfiniti (Member # 12181) on :
Syphon's familiarity on hatrack should have little bearing on the arguments he/she has made. A rebuttal to the points presented would be more appropriate than speculation about possible alts and other ad hominem drivel.
Posted by rivka (Member # 4859) on :
quote:Originally posted by capaxinfiniti: A rebuttal to the points presented
Samp already took care of that quite handily.
Posted by Syphon the Sun (Member # 11873) on :
quote:Originally posted by Samprimary: short of the now legitimate concern that this is another sock puppet.
I assume that I’m missing something, here, but why, exactly, is there a “legitimate concern that [I’m] another sock puppet?”
quote:Originally posted by Samprimary: I have encountered this specific example (the Thirteen Cancers) multiple times, often specifically cherrypicked. … In numberless categories, our disease survival rate is so significantly poorer and rife with so much inefficiency as to keep defenders of our own system stuck trying to point to these specific cancers, and ignore wide swaths of glaringly subpar performance elsewhere.
Could you explain why you feel the data is “cherry-picked?” It is my understanding that cancer survival rates are most often analyzed because that’s what data is actually collected consistently (through a large number of cancer registries) and can be most easily compared across borders. Disease survival rates for most other diseases aren’t collected in this manner, which makes cross-border comparisons much more difficult to perform. I’d be interested in seeing the data concerning other diseases and the data collection techniques.
quote:Originally posted by Samprimary: The other systems don't have wide socioeconomic opportunity gaps associated with their health systems. International comparisons of cancer survival show that poor people here have significantly lower survival rates for most of those cancers, where Canada and elsewhere show no such association for any cancers.
I’d be interested in seeing those studies, if you get the chance. (Particularly given the vast amount of research concluding that Medicaid patients – the “poor” – tend to have worse medical outcomes than even the uninsured. It would be nice to look at the interplay there.) At any rate, that’d be a discussion I’d be interested in having, precisely because it’s a meaningful discussion about quality of care, while a discussion about life expectancy is surely not. Which was the entire point of even bringing up survival rate metrics: at least it’s a step in the right direction of measuring quality of care, rather than lifestyle choices.
quote:Originally posted by Samprimary: This also looks like a very selective, cherrypicking response. As in, it doesn't appear to actually address or disprove the preceding statement at all, but rather tries to stress a specific individual portion to make the comparison look much more favorable ...
I don’t really think I was “cherry-picking” data. I used the first OECD data concerning vaccinations that was available in their statistics portal. After further investigation, it appears that our rates for pertussis vaccinations given to children under 2 is below OECD average, but our vaccination rates for hepatitis B are above average. Our rates are above-average for 2 of the 3 vaccines typically given to children under 2. Of course, our per capita incidence of measles, pertussis, and hepatitis B are all below OECD average, as well, so maybe vaccination rates aren’t terribly good metrics to begin with.
quote:Originally posted by SenojRetep: I did think that, given the many factual assertions it would have been nice to have some links to further information.
quote:Originally posted by rivka: Samp already took care of that quite handily.
He completely ignored the vast majority of the post. He failed to provide any sources for either his original assertions or any new ones. His only response concerned “cherry-picking” data. As it turns out, you have to cherry-pick data to get to the result he claimed in one of those instances (vaccination rates). For the other, cancer survival rates are the easiest to track across-borders, so I don’t really think it’s cherry-picking to use them (and, indeed, even if they were cherry-picked, they are still a better metric than his proposed life-expectancy metric, which doesn’t measure quality of care in any sense). Is that really what passes for “quite handily” providing a rebuttal?
ETA: Fixed some broken tags.
[ August 29, 2011, 02:34 PM: Message edited by: Syphon the Sun ]
Posted by Syphon the Sun (Member # 11873) on :
Also, thank you, SenojRetep and capaxinfiniti, for the somewhat warmer welcome.
Posted by Samprimary (Member # 8561) on :
quote:I assume that I’m missing something, here, but why, exactly, is there a “legitimate concern that [I’m] another sock puppet?”
It is a function and concern of the environment you have entered. Nothing you have done. Any random new poster (especially ones with long-dormant names that have tended to be alts in the past) has weathered scrutiny because of it. It's regrettable, but it's what's been stirred up here. Besides that, I'm in the camp of not caring about whether or not you have some sort of 'forum cred' or whatever.
quote:Could you explain why you feel the data is “cherry-picked?”
It should be evident through my previous post, but here's some more clarification. I have encountered this data multiple times precisely because it has a history of being used as a cherrypicked piece of data to use to try to support the American system. The strongest meta-analysis of comparisons between systems has usually been between the United States and Canada, which is pretty convenient given that Canada's system struggles a bit compared to other, better universal care systems. Of those meta-analyses, the strongest I can recall was from Open Medicine, and suggested that health outcomes were generally better in Canada. Every WHO ranking comparing the countries shows unanimous agreement with that declaration.
So what we're looking at is a comparison between two countries, where america seems to be a little bit worse in terms of overall health care outcomes and has people constantly stretching to try to claim that it is equal or maybe even a little bit better in these outcomes overall (which is extremely unlikely), yet inarguably pays remarkably more per capita into the system. Which is why I already addressed the issue of cost to benefit analysis and why one side in this debate so frequently hopes to leave it out of the discussion entirely.
quote:I’d be interested in seeing those studies, if you get the chance.
Sure, when I have time.
quote:He completely ignored the vast majority of the post.
I feel there is a significant difference between 1. 'ignoring a vast majority of your post' and 2. not actually ignoring anything, while opting for a quick response with the time only towards the pattern of the post which most intrigues me. And, in fact, noting clearly that I am doing as such prior to doing so. You're quick to determine and declare my actions and attentions for me!
quote:As it turns out, you have to cherry-pick data to get to the result he claimed in one of those instances (vaccination rates).
Interesting response. What result do you think I am claiming?
quote: (and, indeed, even if they were cherry-picked, they are still a better metric than his proposed life-expectancy metric, which doesn’t measure quality of care in any sense)
Also a intriguing response. What is my 'proposed life-expectancy metric?'
Why do you insist that life expectancy for a country does not measure quality of care in any sense? (note the power word, here)
Posted by SenojRetep (Member # 8614) on :
StS-
Looking at the data on pharmaceutical spending, it shows the US spends roughly the same amount on pharmaceuticals (as a % of GDP) as other OECD countries (1.9% for US; 1.8% for Canada, France, others; 1.6% OECD average). But the US total spending, as a percentage of GDP, is much higher than the OECD average. So the idea that pharmaceutical spending alone explains the disparity, or even a significant portion of the disparity, doesn't seem very valid to me.
Do you have other ideas of what is causing the significant disparity in spending?
<edit>Looking at some of the other charts from the OECD ilibrary, I think the prevalence of tests is a more likely culprit. Per capita, individuals in the US spend more than twice the OECD average on MRI scans and CT scans. And the difference between the US and the next highest consumers of such tests is fairly significant.
Doing a rough calculation* of $2000/MRI scan (assumed uniform across countries; if MRIs cost more or less in other countries, it won't be reflected in this rough analysis), the US spend $50B on MRI scans in 2007. Had we only consumed MRI scans at the OECD avg, it would only have been $22B, a difference of about 0.2% of GDP. So the difference in cost due to MRI scans alone is roughly equivalent to the difference in pharmaceutical spending.
Doing the same rough analysis on CT scans, using $3000/scan we get spending of $120B, whereas if we consumed at the OECD average we would have spent only $60B, a difference of about 0.6% of GDP, or more than twice the difference in pharmaceutical spending.
*Obviously all calculations are only as good as the calculator and the input assumptions. I make no guarantees that my assumptions or my calculations are accurate. </edit>
[ August 29, 2011, 03:34 PM: Message edited by: SenojRetep ]
Posted by Samprimary (Member # 8561) on :
Also, cause someone's going to have to say it eventually:
quote:Originally posted by capaxinfiniti: A rebuttal to the points presented would be more appropriate than speculation about possible alts and other ad hominem drivel.
Can we get some sort of agreement from you, for your sake as much as anyone else's, that you try not to use 'ad hominem' until you've really boned up on how not to use the term incorrectly?
Posted by Syphon the Sun (Member # 11873) on :
quote:Originally posted by Samprimary: You're quick to determine and declare my actions and attentions for me!
I think you missed the point. I wasn't trying to determine or declare your actions or intentions. I was pointing out how silly it was to say that several points have been skillfully rebutted by a response that addresses only one small portion. Perhaps I should have said "did not address," rather than "ignored," but I thought the meaning would come across and certainly didn't intend to imply that you would not be back to discuss the rest.
quote:Originally posted by Samprimary: Interesting response. What result do you think I am claiming?
I think you're claiming that "[c]hildhood-immunization rates in the United States are lower than average." For one of the immunizations: yes. For the others: no.
quote:Originally posted by Samprimary: What is my 'proposed life-expectancy metric?'
In your list of "facts" of why our healthcare is worse, you noted that "American life expectancy is lower than the Western average." That's what I mean when I say you're using a life-expectancy metric to analyze quality of care.
quote:Originally posted by Samprimary: Why do you insist that life expectancy for a country does not measure quality of care in any sense? (note the power word, here)
It measures quality of care in the same sense that it measures car ownership, smoking habits, obesity-related illness, alcohol consumption, crime rates, etc. That's precisely why it's such a useless metric and why it's rarely used as a measuring stick by anyone doing real research: it simply has too many non-quality variables to be useful. You can't control for all the factors to do any real measurements with it.
Posted by Syphon the Sun (Member # 11873) on :
quote:Originally posted by SenojRetep: Looking at the data on pharmaceutical spending, it shows the US spends roughly the same amount on pharmaceuticals (as a % of GDP) as other OECD countries (1.9% for US; 1.8% for Canada, France, others; 1.6% OECD average).
Well, I was actually responding to per-capita spending comparisons. Our per-capita pharmaceutical spending is significantly higher. But, no, higher pharmaceutical prices certainly don't tell the whole story, and I do apologize if I implied otherwise.
quote:Originally posted by SenojRetep: So the idea that pharmaceutical spending alone explains the disparity, or even a significant portion of the disparity, doesn't seem very valid to me.
I noted some of the other high cost-drivers: increased use of medical technology (we have more of it, we have the newest models, and we use it more often), and our use of quality-of-life procedures. There are several factors, of course, and in many cases, we're getting some kind of benefit from the higher costs (whether those benefits outweigh the costs is a different discussion, of course). Our physicians, specialists, and nurses are among the highest paid. We have below-average physicians per-capita, which obviously increases cost. Our consumption of pharmaceuticals is near the top, while our consumption of new pharmaceuticals is far-and-away leading the pack. We also spend 4 times the average OECD spending on public health programs. We invest more in medical facilities. And, of course, the big kicker: we pay less out-of-pocket (as a percentage of total health care spending) than pretty much any other OECD nation.
Posted by scholarette (Member # 11540) on :
quote:Originally posted by Syphon the Sun: And, of course, the big kicker: we pay less out-of-pocket (as a percentage of total health care spending) than pretty much any other OECD nation.
Link please.
Posted by capaxinfiniti (Member # 12181) on :
quote:Originally posted by Samprimary: Also, cause someone's going to have to say it eventually:
quote:Originally posted by capaxinfiniti: A rebuttal to the points presented would be more appropriate than speculation about possible alts and other ad hominem drivel.
Can we get some sort of agreement from you, for your sake as much as anyone else's, that you try not to use 'ad hominem' until you've really boned up on how not to use the term incorrectly?
No.
Show my incorrect usage. And since you obliviously think this is a recurring error, show previous posts where I've incorrectly used the term.
Posted by kmbboots (Member # 8576) on :
Does that include what we pay for insurance?
Posted by Mucus (Member # 9735) on :
Nope, it doesn't include taxes or amounts paid for insurance. (The rather contrived nature of this number should make you suspicious and thus ... http://www.oecd.org/dataoecd/52/32/38976612.pdf Voila )
Posted by Syphon the Sun (Member # 11873) on :
quote:Originally posted by kmbboots: Does that include what we pay for insurance?
No. What you pay for insurance doesn't count as an out-of-pocket expense in the context of healthcare financing, particularly within the framework of a third-party-payer problem.
(Note that I wasn't attempting to claim that we pay less individually for health care. Just that our low out-of-pocket share for services (rather than our overall costs of what we pay for health insurance + deductible + copays) contributes to the third-party-payer problem of inflating prices.)
Posted by SenojRetep (Member # 8614) on :
The idea behind the metric of out-of-pocket expenses, I would guess, is the hypothesis that in a non-socialized system costs are better kept low if the price of services is transparent to the consumer. That transparency should be maximized if more of the cost is out-of-pocket. So prices in a market-driven system should theoretically be lower if the ratio of out-of-pocket spending to total spending is high.
I'd be interested in testing that hypothesis. So, for instance, using the data in the link Mucus provided, does high out-of-pocket percentage correlate with lower overall healthcare prices? It doesn't jump out as immediately obvious to me that it does.
<edit>I guess that's the "third party payer" problem Syphon mentions in the above post. Syphon, do you have a useful link on the effect of the third party payer problem on healthcare spending? It seems like an intuitive conjecture to me, but the lack of clear correlation between low costs and high out-of-pocket expense percentage strikes me as evidence against the hypothesis.</edit>
Posted by Samprimary (Member # 8561) on :
quote:Originally posted by capaxinfiniti: No.
Well, that's a shame.
quote:Show my incorrect usage. And since you obliviously think this is a recurring error, show previous posts where I've incorrectly used the term.
1. your incorrect usage: it's on this page. It's not really hard to find. 2. Silly, where do I say it's a recurring error? I'm worried precisely because you've started using the term, and (already notoriously bad) arguers expanding their repertoire to start slinging out formal fallacy names with scattergun applicability is exactly the sort of thing I'd like to nip in the bud, if you don't mind.
Posted by Samprimary (Member # 8561) on :
quote:Originally posted by Syphon the Sun: It measures quality of care in the same sense that it measures car ownership, smoking habits, obesity-related illness, alcohol consumption, crime rates, etc. That's precisely why it's such a useless metric and why it's rarely used as a measuring stick by anyone doing real research: it simply has too many non-quality variables to be useful. You can't control for all the factors to do any real measurements with it.
You can't control for all the factors in pretty much any metric we could possibly be using here, though. What I'm asking is why you are insisting that life expectancy cannot measure quality of care in ANY sense. This, as opposed to saying that it's a very poor metric to use due to x, y, z.
Posted by Stone_Wolf_ (Member # 8299) on :
Forgive me for not reading all the thread, I just wanted to pipe in and complain about something:
[sour grapes]My wife is the Medical Assistant for the head a specialist (I won't mention which) in the county in his (and his partner [omitted]ologists) private practice. My wife makes very little per hour while preforming the vast majority of the work, while the doctors make millions (seriously) while doing very little of the work. Yes, not only did he get all the schooling to be an MD, but then more to be a specialist, and then became the premier [omitted]ologist in the area, but his practice would grind to a messy halt without my wife and he pays her a pittance for her daily hard work while he just bought his second new car this year. [/sour grapes]
Posted by Syphon the Sun (Member # 11873) on :
quote:Originally posted by Samprimary: What I'm asking is why you are insisting that life expectancy cannot measure quality of care in ANY sense. This, as opposed to saying that it's a very poor metric to use due to x, y, z.
While I enjoy the fact that you'd rather play a game of semantics than actually discuss the topic, I'm not sure what you're trying to accomplish, other than distract from the actual issues involved.
The value of using life expectancy as a metric for quality of care is so very close to zero that I don't think it's that outlandish to, for simplicity's sake, call it zero, particularly given the context in which it is called such. Indeed, you might note that I originally just called it a "terrible metric."
The fact that quality of care has an effect on life expectancy doesn't mean that you can reasonably use it to measure quality of care any more than you can reasonably use it to measure violent crime simply because violent crime has an effect on life expectancy.
Of course, if you'd like to defend your use of life expectancy as a metric, I'd be open to discussing that. If not, it's really not worth my time to continue playing your trivial game.
Posted by Syphon the Sun (Member # 11873) on :
quote:Originally posted by SenojRetep: I guess that's the "third party payer" problem Syphon mentions in the above post. Syphon, do you have a useful link on the effect of the third party payer problem on healthcare spending?
I'm actually on my way to a conference, and will be out of town for the next few/several days, but as soon as I'm back home to my desktop and research cache, I'd be happy to.
If I get a few free moments with internet access, I'll try to find some alternate links so you folks don't have to wait.
(And I apologize in advance for the fact that my responses are going to be at least somewhat delayed until I get home.)
Posted by rivka (Member # 4859) on :
SW, sadly, that problem is not limited to the medical field. People who appreciate good support staff -- and put their money to back up that appreciation -- are few and far between. Posted by Orincoro (Member # 8854) on :
quote:Originally posted by Stone_Wolf_: Forgive me for not reading all the thread, I just wanted to pipe in and complain about something:
[sour grapes]My wife is the Medical Assistant for the head a specialist (I won't mention which) in the county in his (and his partner [omitted]ologists) private practice. My wife makes very little per hour while preforming the vast majority of the work, while the doctors make millions (seriously) while doing very little of the work. Yes, not only did he get all the schooling to be an MD, but then more to be a specialist, and then became the premier [omitted]ologist in the area, but his practice would grind to a messy halt without my wife and he pays her a pittance for her daily hard work while he just bought his second new car this year. [/sour grapes]
I have been smarter and more generally competent than every boss I've ever had, save one or two. But the value of my time was measured by the availability of replacements, and their ability to do the work I was being payed to do, at the same rate of pay. You're a capitalist, you know how that works.
The only thing these experiences have taught me is that I typically find employment below my actual potential, but for various reasons, personal, circumstantial and economic, I have still worked these jobs. Ive worked for a few too many companies who were addicted to freelance work- underpaying for and undervaluing their primary product. That's actually something I've been working to change recently. It sounds like your wife could also find greater satisfaction in another job.
Posted by Samprimary (Member # 8561) on :
quote:Originally posted by Syphon the Sun: While I enjoy the fact that you'd rather play a game of semantics than actually discuss the topic, I'm not sure what you're trying to accomplish, other than distract from the actual issues involved.
A game of semantics, versus a game of questioning an individual prioritization of data analysis? You can think it to be whatever you want. I'm trying to figure out what importance you want life expectancy to have when discussing healthcare system. You apparently want it completely disregarded, so that draws forth some inevitable new questions.
- what, to you, is the potential value of analyzing adjusted life expectancy by removing infant mortality, accidents, assault from overall mortality stats, and comparing life expectancy for various groups (diabetics, etc) between countries?
- likewise, what about analyzing life expectancy among our population 65 and older, which even the AEI (no friend of nationalized anything, mind you) believes is a valuable piece of data to incorporate into the study of the efficacy of our system versus others? Because, well, we do get some useful numbers out of that, honestly.
quote:Even if we look at life expectancy for sub-populations relatively less affected by the reasons people use to try and discredit the metric as a quality measure, we still look pretty bad.
There's countries out there with worse health habits and more dangerous lifestyles overall, countries with higher obesity rates than us. What with us unambiguously paying more of our overall productivity into ours than theirs, we should be seeing better results for that if we want to claim a superior system or (as is often the case) the 'framework for a superior system' if we could just get rid of a few hiccups here and there, such as allowing better coverage competition across state lines, or whichever vanishing-point market correction ideal is in vogue. We should be seeing better outcomes in the end-point, end-user categories, senior citizens living longer, 'less waste than a government bureaucratic nightmare,' any of these things. We should probably have also been improving vis a vis other countries what with the significant downturn in murders and other violent crimes across the decades. We have none of that!
Which is why, of course, I end up returning to cost to benefit ratio. Which is interesting to note (and begin using as a chorus piece) in light of the, as mucus said, notably intriguing presented number figure for .. I guess, Pay Less Out Of Pocket As A Percentage Of Total Health Care Spending.
Hmm.
Posted by capaxinfiniti (Member # 12181) on :
quote:Originally posted by Samprimary: 1. your incorrect usage: it's on this page. It's not really hard to find. 2. Silly, where do I say it's a recurring error? I'm worried precisely because you've started using the term, and (already notoriously bad) arguers expanding their repertoire to start slinging out formal fallacy names with scattergun applicability is exactly the sort of thing I'd like to nip in the bud, if you don't mind.
I said 'no' because your accusation is incorrect.
There have been previous discussions where I've identified ad hominem fallacies and I assumed you were only now commenting on those instances. You're clearly unaware of those 'recurring' uses.
Either you've suffered a moment of intellectual retardation or you really are ignorant as to the nature of this particular logical fallacy. Again, instead of showing the error, as I requested, you've reiterated what you said in the previous post. Hopefully you can see how condescending that behavior is and 'nip it in the bud.'
And all this is getting old. Your needlessly antagonistic comments are the real 'shame' in these discussions.
Posted by MattP (Member # 10495) on :
quote:Your needlessly antagonistic comments
quote:...ad hominem drivel
Posted by Rakeesh (Member # 2001) on :
I'd settle for knowing where the ad hominem attack in this thread was that you initially referred to, capax. I still generally disagree with you, but lately you've appeared-to me at least, for what that's worth-an honest participant in discussions.
Complaining about ad hominem attacks from others to a third party while slinging them yourself is, well, pretty weird and smacks of dishonest discussion.
Posted by Dan_Frank (Member # 8488) on :
I'm a little late to the sock-puppet game, but I just wanted to say that I joined Hatrack many years ago and posted very, very rarely for the first several years. There are a lot more lurkers here than you might expect.
Posted by Samprimary (Member # 8561) on :
I like how this:
quote:Originally posted by capaxinfiniti: Either you've suffered a moment of intellectual retardation or you really are ignorant as to the nature of this particular logical fallacy.
is literally, with no sense of irony, posted right alongside this:
quote:Originally posted by capaxinfiniti: Your needlessly antagonistic comments are the real 'shame' in these discussions.
Please, continue trying to show me what your version of high ground looks like.
Posted by Orincoro (Member # 8854) on :
I am above name-calling, you poopy-face!
Posted by Stone_Wolf_ (Member # 8299) on :
rivka: Thanks...yea, a good boss is hard to come by.
Orincoro: Thank you for the thoughtful answer. I don't actually classify myself as capitalist...more of a middle of the road, I like freedom although it can get messy kinda guy. Kinda like, I'd rather the government set the rules of the game and then not play it.
My wife has been talking about a change...I encourage it, but accept that while I'm not voiceless in this category, it is her career and she who has to live with the daily consequences of these choices.
Posted by rivka (Member # 4859) on :
quote:Originally posted by Dan_Frank: There are a lot more lurkers here than you might expect.
Lurkers are one thing. Someone with 0 posts who pops out to post long posts on a hot-button topic . . . that doesn't meet the usual definition of a lurker, nor the usual pattern. StS may indeed be a lurker (or more likely, someone who created an account, wandered away, and now came back), but I stand by the assertion that it's potentially suspicious behavior.
It's no Chinese menu, though.
Posted by Orincoro (Member # 8854) on :
quote:Originally posted by Stone_Wolf_: My wife has been talking about a change...I encourage it, but accept that while I'm not voiceless in this category, it is her career and she who has to live with the daily consequences of these choices.
Yeah. For my part, having been in that kind of situation, I can only say it helps to have other encourage you to move forward. If she really is the key to making that office work smoothly, and she isn't satisfied with her pay, then she can find another position with more responsibility and better pay.
As a friend of mine told me a few years ago: Every year, double your rates, and fire your worst client. It's an exaggeration, but at the time I was making about US $18 an hour (consider, not in the US) and hated some of my clients. Now I make more than twice that with some clients, and I don't work with the ones I used to hate. And I know people who still make what they did 3 years ago in the same field. They've had the same job since 3 years ago, and I haven't.
Posted by Dan_Frank (Member # 8488) on :
quote:Originally posted by rivka:
quote:Originally posted by Dan_Frank: There are a lot more lurkers here than you might expect.
Lurkers are one thing. Someone with 0 posts who pops out to post long posts on a hot-button topic . . . that doesn't meet the usual definition of a lurker, nor the usual pattern. StS may indeed be a lurker (or more likely, someone who created an account, wandered away, and now came back), but I stand by the assertion that it's potentially suspicious behavior.
It's no Chinese menu, though.
I may have been mistaken, but when I first saw StS's posts I saw two in this thread but the post count read 3. I checked post history and just saw those two posts in here. So, they must have made a single post back when they made the account.
I guess my first posts were in controversial topics too. Maybe that's why it doesn't seem odd to me.
Posted by jebus202 (Member # 2524) on :
quote:Originally posted by rivka:
quote:Originally posted by Dan_Frank: There are a lot more lurkers here than you might expect.
Lurkers are one thing. Someone with 0 posts who pops out to post long posts on a hot-button topic . . . that doesn't meet the usual definition of a lurker, nor the usual pattern. StS may indeed be a lurker (or more likely, someone who created an account, wandered away, and now came back), but I stand by the assertion that it's potentially suspicious behavior.
It's no Chinese menu, though.
Syphon the Sun is a pwebber.
Posted by Mucus (Member # 9735) on :
What is a pwebber? Google isn't coming up with anything useful for me.
quote:Originally posted by rivka: It's no Chinese menu, though.
?
Posted by dkw (Member # 3264) on :
Philotic web. It's another forum about OSC books.
Posted by rivka (Member # 4859) on :
quote:Originally posted by Dan_Frank: when I first saw StS's posts I saw two in this thread but the post count read 3.
When I read his first post, the count was 1. The fact that it's off by one now implies that he deleted a post.
And many Hatrackers' first posts are on controversial topics. Not generally after 3 years of nothing, though.
Posted by capaxinfiniti (Member # 12181) on :
quote:Originally posted by Rakeesh: I'd settle for knowing where the ad hominem attack in this thread was that you initially referred to, capax. I still generally disagree with you, but lately you've appeared-to me at least, for what that's worth-an honest participant in discussions.
quote:Argumentum ad Hominem (abusive and circumstantial): the fallacy of attacking the character or circumstances of an individual who is advancing a statement or an argument instead of trying to disprove the truth of the statement or the soundness of the argument.
To put it in simpler terms, presenting "character flaws or actions that are irrelevant to the opponent's argument." (wikipedia)
Speculation of a negative slant regarding the person, their motivations, and/or circumsatance, in no way advances the discussion. Syphon's identity - when he registered; if he's an alt - is irrelevant to the credibility of the arguments he presented. Saying things like "I wonder who you're an alt for?" or "You don't have any credibility here, because nobody is familiar with you" or claiming that "the real issue is not whether they are new, but whether they are not" all serve to undermine the credibility of the person presenting the argument, not the argument's logic or accuracy. The ad hominem attack doesn't have to be intentional or effective in order to qualify as such.
A simple test: Does anyone's registration date have any bearing on the facts and arguments of the healthcare discussion? No.
Posted by MattP (Member # 10495) on :
Except this isn't a formal debate. A lot of meta-conversation is the norm. A person who appears under unusual circumstances is worthy of discussion, regardless of the merit of their arguments. Orincoro pointed out that a new user is not going to have credibility in the community, which is true. No one said the arguments were invalid because of that fact and some explicitly noted that it was irrelevant. In fact there had been some substative response prior to your comments about ad hom. Your snarky comment was a bit late.
[ August 31, 2011, 03:39 PM: Message edited by: MattP ]
Posted by Rakeesh (Member # 2001) on :
Capax,
Yes, I know what an ad hominem fallacy is. That wasn't my question.
When you made your initial claim, the closest thing I could find to such a thing was Orincoro stating he (Syphon) had no credibility in the community. Rivka and I were (I think I can speak for her in this, but she'll correct me if I'm wrong) pointing out that it was odd and a bit worrisome that Syphon's history was what it was. I thought to myself, "OK, there's another hot-button political issue poster who is likely an alt for someone else around here." Rivka specifically rejected the idea that for Syphon to have credibility, s/he'd need long history here.
It doesn't even appear that Syphon took the questions as nearly as insulting as you did on his behalf.
I don't really think someone stating, "You don't have credibility within the community as a poster," qualifies as an attack like you described as 'other ad hominem drivel'. It appears as though your outrage was largely because Syphon was criticizing a set of policies you also disagree with...which, when we're speaking of poster histories, is a bit up your alley.
I wouldn't have added that last bit in the post, btw, if you hadn't decided to lecture about personal attacks while...y'know, flinging some explicit personal attacks yourself. More than a little silly and hypocritical.
Posted by Samprimary (Member # 8561) on :
Also to note (what led me to critically comment in the first place) is that capax said "speculation about possible alts and other ad hominem drivel"
Why the 'and' is important is that it makes sure that we know he's saying that speculation about possible alts is 'ad hominem drivel'
and, well, orincoro was not speculating specifically (and appropriately, IMO, unless we like to play the 'fool me 15 times' game) on potential altiness. You and rivka were. And to have fingered those two posts as ad hominem drivel is a perfect example of starting to sling around a formal declaration of fallacy loosely and stupidly, so.
But here, let me make the alt conspiracy witchhunt derail more fun, just for kicks.
quote:Originally posted by capaxinfiniti: There have been previous discussions where I've identified ad hominem fallacies and I assumed you were only now commenting on those instances. You're clearly unaware of those 'recurring' uses.
Like I said, you've just now started using the term ad hominem. I'm 'unaware' of recurring use of the term, because there is no recurring use of the term. Perhaps you accidentally thought that you had used it before on this account, but you're getting your alts mixed up? (dramatic music! rabbit hole! inception! m. night shyamalan!)
Posted by Orincoro (Member # 8854) on :
There's one thing you should know about me. I specialize in a very specific type of security... Forum security.
You're talkin' about alts?
Bwaaaaa!
Posted by Samprimary (Member # 8561) on :
And then i look up sources, but leave the links on the computer where i was searching ebsco, and i don't have ebsco here
urrrrrrrrrrrrrrrrrrrrrr
Posted by Samprimary (Member # 8561) on :
quote:Kyle Willis, a 24-year-old man from Ohio, died on Wednesday from a tooth infection, Cincinati's WLWT reported.
According to the station, Willis' wisdom tooth began hurting two weeks ago, and dentists said it needed to be removed.
Willis, however, was a single father without health insurance, and couldn't afford the procedure.
After developing severe headaches and facial swelling, he went to the emergency room.
Although doctors recommended antibiotics and pain medication, Willis could only afford one.
Patti Collins, Willis's aunt, told WLWT what happened next.
"'The (doctors) gave him antibiotic and pain medication. But he couldn't afford to pay for the antibiotic, so he chose the pain meds, which was not what he needed,' Collins said. Doctors told Willis' family that while the pain had stopped, the infection kept spreading -- eventually attacking his brain and causing it to swell."
Willis leaves behind a 6-year-old daughter, and family members are hoping to create a fund for her future college education.
Dr. Irvin Silverstein, a dentist at the University of California told ABC news that Willis' story isn't uncommon.
"People don't realize that dental disease can cause serious illness.The problems are not just cosmetic. Many people die from dental disease. When people are unemployed or don't have insurance, where do they go? What do they do? Silverstein said. People end up dying, and these are the most treatable, preventable diseases in the world."
Four years ago, 12-year-old Demonte Drived died after his mother, Alyce, couldn't find a dentist who took Medicaid and bacteria from a tooth abscess spread to his brain.
A Kaiser Family Foundation report found that between 2007 and 2008, the number of uninsured adults rose by 1.5 million.
ABC news added that in April the same foundation also found that 33% of people skipped dental care because they could not afford it.
~americaaaaa~
Posted by Samprimary (Member # 8561) on :
Also, here's that (extremely tardy) sourcing, which seems to have been conveniently packaged for me.
Seems the renal disease issue our system has has jumped out to far more than just me, so I guess it's not just a random plucked-from-the-aether stat. It's worth some notoriety.
Oh yeah, remember fish antibiotics, cocaine, and american dental care?
Posted by Lyrhawn (Member # 7039) on :
I finally have dental coverage again after not having it for about eight years. That reminds me, I need to schedule a checkup...my first in several years.
Posted by Samprimary (Member # 8561) on :
quote:Originally posted by Parkour: Oh yeah, remember fish antibiotics, cocaine, and american dental care?
to share with the class, have some real stories about the uninsured managing dental care in the US.
quote:one of my partially erupteds erupts a little bit more, tearing through the gum and generally just causing my face swelling and misery. After a week of hourly orajel applications, I decided to cut out the pharmaceutical manufacturing middleman and buy cocaine off the street to put on my ragged gums. Which worked amazingly well, truth be told, but STILL...
quote: in regards to the antibiotics on Amazon...it says it is for fish use, not for human consumption, but I take it from the tone that humans actually CAN take it and it works and you won't die?
quote:I don't have allergies to this kind of stuff, but to me this is a big ****ing deal, as me and my wife don't have any kind of medical insurance at the moment and we might find ourselves in need of something like this in the future...I mean, Clindamycin for $40, Amoxicillin for $11, holy ...
quote:it is still a goddamn embarrassment that people in this country even know how to convert doses of fish antibiotics to human size doses.
I've done it with my cat's meds before. His meds are much cheaper, as are his doctor visits.
quote:Jesus guys, fix your goddam system.
How why ugh my mind can't comprehend how a supposedly civilized country can be so underdeveloped when it comes to helping its own citizens. I just ...
Posted by Orincoro (Member # 8854) on :
Where are those quotes from? They're hilarious.
Posted by Samprimary (Member # 8561) on :
SA's GBS thread on the article about Kyle Willis.
Which has allowed some more of those dirty furrigners to have their own chance to be shocked and appalled at discovering the ins and outs of America's Wonderful Not Dirty Socialism System Which Totally Works.
quote: Seriously? This thread has made me realise that I actually have no idea how your healthcare system works. I knew you had to pay for it but Jesus. I've had a tooth removed and paid fifty quid for the whole thing (and I still think that's a bit steep). How can healthcare providers be charging a price that bears absolutely no relation to the actual cost of pulling a tooth?
Sorry again America
quote:We're just mind-blown by how bad health-care in the richest country in the world is. When you see an entire population digging themselves into a hole, you can't help but scream at them to stop, even if it has no effect.
quote:It's stories like this which always go some way to making me question my long-term plan to move to the USA from Europe, mainly to help my career. I just don't know how I could live somewhere where I'd have to give serious thought whenever planning something to whether I could afford it if something went wrong. I did a whole load of hiking last year which ended up with an injury: doing something which kept me fit, healthy and fulfilled could have ended up bankrupting my family if we'd lived in the States.
quote:It's funny. We reject UHC, yet we've taken our privatized model and unevenly patched it over with unofficial socialized medicine to soften the brutality. The result is a bewildering patchwork where you can get things for free if you know the system well or if you've got a good provider.
quote:I'm so sorry that people in the US get properly financially screwed over because of health problems. My Dad is currently undergoing rehab after a major brain aneurysm and has been in hospital since March. I cannot even begin to imagine how much worse the situation would be if my Mum was having to worry about money right now on top of everything else. Our evil socialist government is actually giving my Mum extra money at the moment because she's with Dad in hospital a lot and can't work as much.
Sorry US. Hope the situation gets better... Some time? Is there actually any chance of you guys getting anything like UHC any time soon?
One thing I've known for a while: the brits and their stereotypically bad teeth can mock us gleefully now. We have worse teeth than them on account of the dysfunction in our dental coverage. Not even joking.
Posted by Orincoro (Member # 8854) on :
Yeah, but Samp, see, if we had UHC, then we might have to WAIT FOR THINGS!
We might not live in constant fear of being bankrupted by a sudden illness that isn't covered by our healthcare provider or that they will refuse to cover us or that we will lose our jobs and the only possible way of getting health care we can afford because we're 61 and our spouse is suffering from dementia and diabetes and we have chronic arthritis, and although we've saved diligently for our entire lives for our retirement, that won't matter if we suddenly find ourselves laid-off by a company wanting to save an extra billion dollars for a rainy day and there are no options for paying for your own health insurance that are anywhere near affordable, and there is no way to pay for the things we need medically because the prices are all hyperinflated for cash customers because we don't come packaged as part of an HMO that dials down those costs, so you find yourself at the end of a 40 year career in which you worked and saved, and it could all be gone in a year, but WE WOULD HAVE TO WAIT FOR THINGS!
Posted by Bella Bee (Member # 7027) on :
Well, British dentistry is still not totally fantastic - limited by the fact that there just aren't enough dentists willing to work for the NHS. They make a lot more money going private.
But if you can get hold of an NHS dentist, you get everything 'for free', even orthodontistry if your teeth are badly misaligned. Plus, the private dentists pass their patients into the NHS system for more serious problems, so you still don't need to have dental insurance.
When I had my wisdom teeth taken out (it wasn't exactly an emergency), I had to wait about a month between first consultation and the operation, spoke to a specialist about what they were going to do, had the teeth taken out in one of the best hospitals in the country under general anaesthetic, was given all the right medicines to take home, and it didn't cost me anything - which was lucky because I was a poor student at the time.
Posted by The Rabbit (Member # 671) on :
One more reason why Cancer statistics are a bad way to compare the US health care system to those in other countries. Cancer is an old peoples disease. Most of the people who get cancer in the US (53.25%)are over 65 and are therefore covered by "socialized" medicine (i.e. Medicare).
83% of cancer patients are over 50 at the time of diagnosis and 93% are over 40. Only 5.6% of all cancer patients are between the ages of 20 and 40 at the time of diagnosis. This is the age group that is most likely to be uninsured in the US system.
This is important for several reasons. The key one being that cancer survival rates are less likely to be sensitive to the weaknesses in US health care than other diseases. The next being that it raises serious concerns future of cancer diagnosis and treatment in the US since we are likely to see a big increase in the number of uninsured over 50 people due to changes in the economy and attitudes toward entitlements programs.
Posted by Samprimary (Member # 8561) on :
quote:Originally posted by Bella Bee: Well, British dentistry is still not totally fantastic - limited by the fact that there just aren't enough dentists willing to work for the NHS.
Yeah, I watch the work that the NHS goes through to try to keep a ready enough supply of treatment available to the british public, but 'not totally fantastic' is a matter of leagues over our own 'totally dismal' — to wit, the article I quoted earlier from mg:
quote:Tooth decay begins, typically, when debris becomes trapped between the teeth and along the ridges and in the grooves of the molars. The food rots. It becomes colonized with bacteria. The bacteria feeds off sugars in the mouth and forms an acid that begins to eat away at the enamel of the teeth. Slowly, the bacteria works its way through to the dentin, the inner structure, and from there the cavity begins to blossom three-dimensionally, spreading inward and sideways. When the decay reaches the pulp tissue, the blood vessels, and the nerves that serve the tooth, the pain starts—an insistent throbbing. The tooth turns brown. It begins to lose its hard structure, to the point where a dentist can reach into a cavity with a hand instrument and scoop out the decay. At the base of the tooth, the bacteria mineralizes into tartar, which begins to irritate the gums. They become puffy and bright red and start to recede, leaving more and more of the tooth’s root exposed. When the infection works its way down to the bone, the structure holding the tooth in begins to collapse altogether.
Several years ago, two Harvard researchers, Susan Starr Sered and Rushika Fernandopulle, set out to interview people without health-care coverage for a book they were writing, “Uninsured in America.” They talked to as many kinds of people as they could find, collecting stories of untreated depression and struggling single mothers and chronically injured laborers—and the most common complaint they heard was about teeth. Gina, a hairdresser in Idaho, whose husband worked as a freight manager at a chain store, had “a peculiar mannerism of keeping her mouth closed even when speaking.” It turned out that she hadn’t been able to afford dental care for three years, and one of her front teeth was rotting. Daniel, a construction worker, pulled out his bad teeth with pliers. Then, there was Loretta, who worked nights at a university research center in Mississippi, and was missing most of her teeth. “They’ll break off after a while, and then you just grab a hold of them, and they work their way out,” she explained to Sered and Fernandopulle. “It hurts so bad, because the tooth aches. Then it’s a relief just to get it out of there. The hole closes up itself anyway. So it’s so much better.”
People without health insurance have bad teeth because, if you’re paying for everything out of your own pocket, going to the dentist for a checkup seems like a luxury. It isn’t, of course. The loss of teeth makes eating fresh fruits and vegetables difficult, and a diet heavy in soft, processed foods exacerbates more serious health problems, like diabetes. The pain of tooth decay leads many people to use alcohol as a salve. And those struggling to get ahead in the job market quickly find that the unsightliness of bad teeth, and the self-consciousness that results, can become a major barrier. If your teeth are bad, you’re not going to get a job as a receptionist, say, or a cashier. You’re going to be put in the back somewhere, far from the public eye. What Loretta, Gina, and Daniel understand, the two authors tell us, is that bad teeth have come to be seen as a marker of “poor parenting, low educational achievement and slow or faulty intellectual development.” They are an outward marker of caste. “Almost every time we asked interviewees what their first priority would be if the president established universal health coverage tomorrow,” Sered and Fernandopulle write, “the immediate answer was ‘my teeth.’ ”
The U. S. health-care system, according to “Uninsured in America,” has created a group of people who increasingly look different from others and suffer in ways that others do not. The leading cause of personal bankruptcy in the United States is unpaid medical bills. Half of the uninsured owe money to hospitals, and a third are being pursued by collection agencies. Children without health insurance are less likely to receive medical attention for serious injuries, for recurrent ear infections, or for asthma. Lung-cancer patients without insurance are less likely to receive surgery, chemotherapy, or radiation treatment. Heart-attack victims without health insurance are less likely to receive angioplasty. People with pneumonia who don’t have health insurance are less likely to receive X rays or consultations. The death rate in any given year for someone without health insurance is twenty-five per cent higher than for someone with insur-ance. Because the uninsured are sicker than the rest of us, they can’t get better jobs, and because they can’t get better jobs they can’t afford health insurance, and because they can’t afford health insurance they get even sicker. John, the manager of a bar in Idaho, tells Sered and Fernandopulle that as a result of various workplace injuries over the years he takes eight ibuprofen, waits two hours, then takes eight more—and tries to cadge as much prescription pain medication as he can from friends. “There are times when I should’ve gone to the doctor, but I couldn’t afford to go because I don’t have insurance,” he says. “Like when my back messed up, I should’ve gone. If I had insurance, I would’ve went, because I know I could get treatment, but when you can’t afford it you don’t go. Because the harder the hole you get into in terms of bills, then you’ll never get out. So you just say, ‘I can deal with the pain.’ ”
Posted by Teshi (Member # 5024) on :
This is reminding me I need to find a dentist for a checkup. I'm in the UK, which is actually better than being in Canada because, as discussed above, dentistry is covered in the UK under the NHS, whereas it's not covered in Canada.
Posted by Mucus (Member # 9735) on :
Going to stash this here. It's a pretty neat way of graphing the effectiveness of countries that spend more or less on healthcare in terms of how it affects life expectancy.
quote:Originally posted by Mucus: Going to stash this here. It's a pretty neat way of graphing the effectiveness of countries that spend more or less on healthcare in terms of how it affects life expectancy.
It's already been established - here and elsewhere - that life expectancy isn't an effective way of judging the quality of healthcare in the country. There are other metrics which better address that question. Simply looking at life expectancy ignores a great deal of other very relevant variables.
Posted by Mucus (Member # 9735) on :
I disagree of course.
Handy that this is the precise thread where people were hashing out metrics like "Pay Less Out Of Pocket As A Percentage Of Total Health Care Spending" versus cost/benefit Posted by Samprimary (Member # 8561) on :
Yes; you can say 'life expectancy isn't a useful metric!' — okay, great, we've got all these other ones which demonstrate exactly the kind of direly pathetic results our health system provides, so.
Posted by Orincoro (Member # 8854) on :
I stand by my unwillingness to wait for things that are freely available as a reason to maintain a system in which a large percentage of people have no access to care at all, and in which others pay enormous premiums and sacrifice their social mobility in favor of employer provided slavery... Er, healthcare.
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I'm confused about your point.
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