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It is easy to blame the insurance companies. It is always big business making the big profit that is at fault. By the way, they are just now making some profits again on health insurance. No company exists to make a loss.
What I meant by every little thing is going to the doctor for sniffles. There ain't no cure for the common cold. Stay home and get some rest. Going to the ER for a slight fever or a sore knee is overkill. No where did I say you shouldn't see your doctor for regular checkups.
Small groups are more expensive because actuarily they cost insurance companies more. It is a statistical fact. It is not because they don't have the bargaining power. Most large companies self-insure with some stop-loss coverage. Large corporations are often involved in encouraging better health including providing gyms or paying for memberships at health clubs.
The Canadian government dictates what drugs are sold and at what price they are sold. What you don't hear about are the bus loads of people that come into the US from Canada to buy their prescriptions. Why? Because Canada either wouldn't let a drug company sell its drugs there or the price the government said they had to sell at wasn't acceptable. Talk about rationing healthcare. This is the way the whole Canadian government run healthcare system works. And they tax at a rate approaching 50% of income in some provinces.
Posts: 134 | Registered: Jul 2003
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When a drug company produced a new drug and it's released in Canada, the maximum price it can have in Canada is the maximum price for the current drugs treating the same diganosis on the market.
Canada spends 9% of it's Gross National Product on healthcare, the US, 14%.
Posts: 14745 | Registered: Dec 1999
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I just ran into some information from the government on how the health insurance premium dollar breaks down. Here it is:
$.43 goes to the Doctors and Health Professionals $.32 goes to the Hospitals $.13 goes for Prescriptions and Medical Supplies $.02 goes to Nursing and Home Health Care $.096 for Claims and Consumer Services $.004 for Insurance Income or Profit
Posts: 134 | Registered: Jul 2003
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quote:When a drug company produced a new drug and it's released in Canada, the maximum price it can have in Canada is the maximum price for the current drugs treating the same diganosis on the market.
Thus not paying for the expensive R&D costs involved producing new drugs. Don't take this as an endorsement of prescription drug companies. There are a lot of problems in the way they do business. I hope to see more government oversight and this is saying a lot coming from me. If an industry doesn't take care of business, then someone has to make sure they do. Sad to say but it happens.
Canada rations care. This is the reason people come to the US for some procedures because they are on long waiting lists in Canada or have been told no. There have been exoduses of healthcare professionals to the US because of the wage controls.
Actually, if your going to round up the US figure to 14%, you should round up the Canadian figure to 10% (your source of info. is probably the one guilty of "biased" rounding ). Of course, I don't want to quibble over such small matters. Actually, those numbers have been floating around for a couple of years. I'm trying to find some current numbers but I believe the US is close to 18% with Canada close to 15%. However, there is much more to this than a simple comparison of % of GNP.
Here is an interesting article about rising healthcare costs that I just ran into today. Though it is dated (1995) it is still relevant.
quote:Consequently, good medicine increases rather than reduces the proportion of people in our population who have illnesses requiring continued treatment.
An interesting observation. I highly recommend a read of the article.
There is too much involved in this for the answers to be so clear cut. This is why I don't see blame being owned by one party but by all. Even if all sides make positive changes, the plain truth may be that to live a quality, extended life is going to cost some bucks and there may be little to do about it.
quote:Even if all sides make positive changes, the plain truth may be that to live a quality, extended life is going to cost some bucks and there may be little to do about it.
I suspect you are right.
Interesting facts. What that government breakdown didn't show is what percent of the dollars collected by the insurance industry went into the profits of the companies. I'm not surprised that their payouts are aligned in the manner specified. But it doesn't address where the gouging is going on, IMHO.
Government is stepping in to cap malpractice premiums, but they are mostly doing it wrong, seems to me. They are stopping the citizens from suing for malpractice without demanding any concessions from the insurance industry. Big mistake, IMHO.
This is like their handling of the bankruptcy problem in the US. They didn't get any concessions from the credit card companies (a cap on rates at a reasonable level, for example), they just stopped ordinary citizens from declaring bankruptcy.
I'm not anti-industry, but when lobbyists have more access to our elected officials than the people do, we get some very screwed up legislation that mostly benefits the companies and not the people (unless they bought stock in the companies).
Posts: 22497 | Registered: Sep 2000
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bCurt I do think the number one thing that can be done to improve the health care system in the world is to emphasize one fact.
You And Only You Are Responsible For Your Own Health Care.
I don't mean that a person is responsible if they get sick, or break and arm, or have a disease. I mean that each person must take responsibility for their own care.
As the world became more modernized we have continually turned to doctors to tell us how to be healthy. We had Marcus Welby and those wonderful caring doctors on TV who would lead each ill person to health, usually against there will.
Life ain't like that.
When doctors failed we turned to hospitals.
We expected the Insurance companies to back up their promises to "be there for us."
They are there for themselves first.
You have to take care of your own health.
You have to over rule your doctors and your nurses, your insurance company and your diet books and decide for yourself what you must do to be healthy. You must find out the costs of your care. You must research the ills that ail you. You must research the medicines they are giving you.
If you are in the hospital, unable to make those decisions, then you should have a loved one, spouce, family, what ever, who can make those decisions.
or you are stuck relying on the kindness of strangers.
And this means that the doctors have to let go of their control. They have to accept your desire for second opinions, and background checks, and being treated like any other businessman.
And this means that the insurance companies have to let go of their control. They have to allow us to take the medicines we believe are best for us, and get the procedures we believe we need, and not have nursing assistants and nurses make those decisions for us in some cubicle 500 miles away from the sickness.
And this means that the hospitals have to start answering patients questions, and not treating them as just a number in a bed, to be marched through the procedure like a car on an assembly line.
Posts: 11895 | Registered: Apr 2002
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Actually, the number was from 2003, and was 14.1%.
I rounded down.
Would you like the citation? I could even send you a copy of the article.
41 million Americans are without health insurance. This is more than the entire population of Canada in 2001 (30 million).
It is people who are uninsured and who have chronic illnesses (such as diabetes) are the ones who go without preventative care. Why? They simply can't afford it. So they end up in the emergency room, the healthcare available to all.
As for the Canadian system, it isn't exactly "socialized medicine". Instead, it is government funded and provicially run. Each province has its own plan and services are provided by private companies. Prescriptions are not covered by insurance. There was a recent commission in Canada to investigate satisfaction with the Canadian healthcare system. Overall, satisfaction was high and citizens in fact did not want change.
In the United States, managed care (the switch from PPOs to HMOs) has brought about major changes to the insurance/healthcare system.
1. A sharp decline in the type of insurance that allowed access to any hospital and any doctor that the consumer could choose, without penalty. (What, those EXISTED?! )
2. For those of us in managed care (HMOs) we get no coverage if we go to an out of network provider. We have "gatekeepers"--our primary care physicians--who refer us to specialists. These are specialists who contract with our insurance company for set prices already, locking out the high-cost providers.
3. Doctors' clinical decisions are under MORE external review--from the insurance companies. Doctors have to ask first for patients to be admitted to the hospitals, to have diagnostic tests, or to have procedures.
4. Insurance companies control the price of care, not the physicians or any other providers. (This is true in my field, mental health, as well). Meaning, providers can put a price tag on things, but insurance companies pay what they pay and we take what they give.
Posts: 14745 | Registered: Dec 1999
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I remember how cheesed Rush Limbaugh got when Jocelyn Elders (Clinton's first SurGen) said Cuba's PREVENTIVE Health care was better than ours. Now, you know that since I was listening to Rush I am either Right wing or like having high blood pressure. But she was right- when you can't afford medical intervention you'd better do your best to prevent getting sick in the first place.
My sister and I argue a lot about whether Type II diabetes is primarily lifestyle caused or genetic. I wonder what the rates are in Cuba vs. Carribeans living in the US.
Posts: 11017 | Registered: Apr 2003
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I did that as well, Dan. My current medical team was recommended to me by a good friend who has incredibly good access to records and recommendations and such.
They're both incredibly good at what they do and much more stubborn than I am.
They also have the ability to decide for me when I am unable to do so myself.
Posts: 14745 | Registered: Dec 1999
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Kat- it's stage II CLL; a form of lukemia. Not as bad as it sounds. If I'm good, I'll get an immune system for Christmas. ^_~
I consider myself pretty blessed in this whole thing - med. insurance, etc. It's darn good coverage at a darn good time. I got the job less than a month before I was diagnosed, but my benefits were effective from my hire date.
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The problem with the 41 million uninsured figure is it is not adjusted (thus includes) those who willfully choose not to be insured. That is, they feel they can pay for it out-of-pocket or they just have other priorities. Personal example of this is my sister-in-laws family with the same income as my family. We choose to budget for health insurance, they choose not to. It is not because they can't afford it, it is because they are not willing to pay for it. They would rather eat out more often and buy expensive items. What happened when my sil's husband's heart started quiting on him and required a pacemaker? They went to the hospital and got it done and will never pay more than a quarter of the bill because they can't. Who will pay for it? Those who take responsibility and buy health insurance and those who pay for their healthcare. Why? Because, as much as the hospital would like to eat all that expense everytime someone screws them, they can't, they must pass on the cost.
Canadians are pleased with their healthcare? Is that why Prime Minister Chretien established that commission to check out the system? They are going to infuse their "problemless" system with an additional $15 Billion through 2006. Maybe that will keep people happy? Well, at least they would be carrying around less in their wallets. I haven't heard much praise from Canadians about the healthcare system.
Median waiting times for surgery in Canada increased from 9.8 weeks in 1993 to 28.9 weeks in 2001. Read up on this problem with the Fraser Institute's Waiting Your Turn: Hospital Waiting Lists in Canada (the Fraser Institute is a Canadian organization).
That 14.1% figure (the source I had showed 13.8% and Canada at 8.7%) includes the American medical research program which expends more than the total healthcare expenditures of the provinces of Ontario and Quebec combined. Canada benefits from that research and has a system that encourages little research within its own borders. There are also demographic differences that should be taken into account. Canadians are younger on average, there are fewer obese and fewer smokers and etc.
At least here in West Texas, PPO plan enrollment still outnumbers HMOs and PPO plans have experience a resurgence. They do not exclude out-of-network coverage. Doctors do negotiate their rates (and they can do that collectively here in Texas) and if they don't like it, they don't sign up to be a part of the network. Doctors charge more here in the US than other countries (part of the reason for the high healthcare costs). I don't think they are hurting.
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Dan, I think a better acronym is in order: TANSTAAFL
This isn't to imply that health care should be eliminated or anything. It's to imply that outstretched hands do not a competent healthcare system make, and that the only thing you get from that is opportunists and the like. In America, those opportunists are mostly in the insurance biz as far as healthcare (and business liability and even auto). The rest of the people are usually trying to handle the fickle interests of the insurance companies. It's pretty much the "shit rolls downhill" theory.
Posts: 289 | Registered: Apr 2002
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bCurt: These are the articles I've read in the past month. How about you stop telling me to go read your articles once you've gone and read these recent, peer reviewed, academic journal articles, okay?
Deber, R.B. (2003). Health care reform: Lessons from Canada. American Journal of Public Health, 93(1), 20-25.
Dracup, K., & Bryan-Brown, C.W. (2003). The United States health care crisis: Using our bold voices to effect change. American Journal of Critical Care, 12(4), 306-309.
Oberlander, J. (2002). The US healthcare system: On a road to nowhere? CMAJ: Canadian Medical Association Journal, 162(2), 163-169.
Schroeder, C. (2003). The tyranny of profit: Concentration of wealth, corporate globalization, and the failed US health care system. Advances in Nursing Science, 26(3), 173-184.
Shortt, S.E.D, & Shaw, R.A. (2003). Equity in Canadian health care: Does socioeconomic status affect waiting times for elective surgery? CAMJ: Canadian Medical Association Journal, 168(4), 413-418.
In 1999, health administration costs totaled at least $294.3 billion in the United States, or $1,059 per capita, as compared with $307 per capita in Canada.
After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada.
Between 1969 and 1999, the share of the U.S. health care labor force accounted for by administrative workers grew from 18.2 percent to 27.3 percent. In Canada, it grew from 16.0 percent in 1971 to 19.1 percent in 1996. (Both nations' figures exclude insurance-industry personnel.) source: http://content.nejm.org/cgi/content/short/349/8/768
quote:Is that why Prime Minister Chretien established that commission to check out the system?
No.
quote:They are going to infuse their "problemless" system with an additional $15 Billion through 2006.
Not "problemless," just "better."
See, e.g., all of the basic morbidity and mortality rates from the World Health Organization data, accessible via WHOSIS, the WHO Statistical Information System.
quote:Maybe that will keep people happy?
No, they already are. Possibly because they have excellent morbidity and mortality statistics for all major medical problems, unlike, say, the US.
quote:Well, at least they would be carrying around less in their wallets.
Well, at least they would be spending less per person to subsidize the healthcare of all their citizens than we do to subsidize only ~30% of all our citizens (through Medicare, Medicaid, Departments of Public Health, the Veteran's Administration, and State Labs). See mack's wonderful links above.
1. Yes, this is adjusted for population differences. It is cost per person. 2. No, this does not result in worse care. It results in better care, as per morbidity and mortality outcomes measures, gathered by the WHO.
quote:I haven't heard much praise from Canadians about the healthcare system.
Then you must not have looked. The gathered data is clear and widely replicated. The field of medicine must be held to high evidence-based standards, both in practice and in self-evaluation.
Anecdotes are useful for developing hypotheses, not for establishing them. The international study cited above found that:
quote:Yet results from The Commonwealth Fund 2001 International Health Policy Survey indicate that the majority of U.S. adults believe the system requires fundamental reforms or needs to be completely rebuilt. ... When asked their view of the country's health care system, nearly eight of 10 U.S. adults (79%) thought the health care system needed either fundamental reform (51%) or complete rebuilding (28%). Just 18 percent thought only minor changes were needed. ...
bCurt, I'd be happy to debate this with you. Of course, it would be important for both of us to cite our sources as we go. I've discussed this before on Hatrack, and I think it's time that I actually pull all this together in one place, anyway.
BTW, welcome to Hatrack! You've jumped in feet-first into one of our most interesting discussion topics. I hope you stay around and chat a bit. Hatrack has a way of getting under your skin -- it's hard to give up. They don't call it Hatcrack for nuthin.'
Posts: 14017 | Registered: May 2000
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My apologies, mackillian, I didn't mean any offense by suggesting an article or two. You rehash some of the same figures in your last post that you mentioned previously. As already mentioned, statistics will only take you so far because they don't give you the full picture. You fail to address the costs of medical research and R&D that are factored into the healthcare costs, for one. Demographic considerations are not taken into account, for another.
Claudia, to show Canadians are happy with their care you mention studies and statistics that do nothing to show that Canadians are happy with their care. Of course, you may be saying if you are alive you are happy ? You quote the The Commonwealth Fund 2001 International Health Policy Survey to show disatisfaction of US adults with the US healthcare system which does not automatically mean Canadians are satisfied with theirs.
I'm sorry, I don't see how Canadians can be happy with their healthcare when they have all the waits and delays (please see the Fraser Institute study for additional info.). Perhaps I am wrong but you show me nothing that says I am (on the happiness factor).
Canada does not score as well as the US in cancer mortality. As shown in these stats from the Cancer Advocacy Center, the Canadian province that has the lowest fatality rate is British Columbia and it scores worse than almost half of the US states. So, I suppose mortality rates are good for the healthy but if you have cancer...well, you might be in a little more trouble in Canada than the US. Maybe this is due to...
Median waiting time for radiation treatment for breast cancer in province of Ontario: 8 weeks
Median waiting time for angioplasty in the province of British Columbia: 12 weeks
Median waiting time for radiation treatment for prostate cancer in province of Quebec: 12 weeks
(Source: Fraser Institute) -----
Okay, now. Well...what fun. I never intended to get into a debate about Canadian versus US healthcare systems. I merely wanted to point out some issues with the US system. Yes, it is flawed. There is no denying that from me. However, I obviously do not have high praise for Canada's and predict they will have their own crisis as they try to keep their own costs and healthcare demands under control (the $15 billion is only the beginning). I don't believe a Canadian style healthcare system is the answer for the US.
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bCurt, the Commonwealth Survey compares five countries (United Kingdom, Australia, New Zealand, Canada, US). I didn't cite the stats for the other countries. You can read the full article for comparison percentages (or I can dig it out for you in the am). US has been at the bottom of the five countries for 1998, 2001, and 2003.
quote:I'm sorry, I don't see how Canadians can be happy with their healthcare when they have all the waits and delays (please see the Fraser Institute study for additional info.).
Nonetheless, they are. This is why evidence-based reasoning is important -- sometimes reality challenges our preconceptions.
(One good reason for liking their own system is that it is effective, even if there are waiting lists. Note, though, that those lists aren't straightforward to assess -- for example, some names on them are merely there as placeholders, and some have already been served but not removed from the list. Another big reason to like it is no paperwork, just one ID number -- no doctors having to spend hours arguing with insurers, not even any concept of "pre-existing conditions.")
I'm not sure where your article gets its numbers for cancer rate comparisons, but the WHO database indicates differently. (WHO is generally recognized as gold standard for international epidemiology comparisons.) E.g., the 2000 weighted ASR mortality for prostate cancer is 17.9 in US vs 17.07 in Canada, for non-Hodgkin's lymphoma is 7.06 in US vs 6.12 in Canada. These may or may not be significant differences.
Will answer more fully in the morning.
CT
PS: BTW, we don't have to debate this. It's one of my particular obsessions, and I have a vested interest in hashing it out with someone who will examine the data with me. However, you might not be in the mood, and you shouldn't assume that not replying means you agree. It just means that you aren't replying, for one of a variety of reasons, such as:
1. You find the discussion boring 2. You find something about the discussion offensive 3. You have better things to do with your time 4. You just aren't in the mood 5. You forgot you were engaged in the discussion (a decided major one for me -- I get confused with all the threads)
And so on. Which is cool -- we're more about getting to know one another here than about solving the world's problems. Sometimes debating is useful for that, sometimes not.
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You didn't provide a direct link to the article and the portion I found did not site Canadian satisfaction (or dissatisfaction). Perhaps you can provide a direct link or more info. so that I can locate it. Once you do so, perhaps I can then make a judgement based on facts.
The Cancer Advocacy Center Canada sites the North American Association of Central Cancer Registries as the source for the information. The existence of this organization and the efforts of the Fraser Institute are a couple of examples of Canadians concerned about the healthcare received in Canada.
quote:...doctors having to spend hours arguing with insurers, not even any concept of "pre-existing conditions."
Doctors spending hours arguing with insurers is an exaggeration and not the norm. Also, many pre-existing condition limitations worries have been curtailed by HIPAA which passed in 1996.
Posts: 134 | Registered: Jul 2003
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As much as it would be interesting to "hash" this out, I really don't have the time to do the topic justice. I have already expended more than I should . I'll have to look up other discussions on the topic that have already occurred.
A caution on statistics and surveys. They should always be taken in context. By that I mean we should look at the organizations putting them together and presenting them. Few organizations have no agenda. Figures can be bent in favor of a certain opinion by just using certain wording or leaving certain data out. I'm not saying that statistics and surveys should be ignored or are worthless but they should be taken in context. This applies to all sides of the issues.
Posts: 134 | Registered: Jul 2003
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I'm not good with creative names for forums. I guess mine could mean "be rude" but I hope I don't come across that way. You can call me Curt but I'm not normally curt.
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You know, the whole thing about the cost of prescription meds really ticks me off.
quote:The top nine prescription drug companies spent a total of $45.4 billion on marketing, advertising, and administration and only $19.1 billion on R & D last year. The highest paid drug company executive made almost $75 million, while the top five executives received more than $183 million in compensation. These figures exclude unexercised stock options, which in all cases totaled more than $45 million per CEO.
quote:You didn't provide a direct link to the article and the portion I found did not site Canadian satisfaction (or dissatisfaction). Perhaps you can provide a direct link or more info. so that I can locate it. Once you do so, perhaps I can then make a judgement based on facts.
I figured that identifying it as "an international comparison via the Harvard School of Public Health, comparing the US, New Zealand, Australia, United Kingdom, and Canada" would be a tipoff that there were comparisons made. Given that you were comfortable with simply stating "I just ran into some information from the government on how the health insurance premium dollar breaks down. Here it is:" without any reference at all, I also figured that giving you the name of the survey and one link would be, well, appreciated as a step up. However, I'll be happy to push on to track down the relevant details. They are interesting.
quote:The Cancer Advocacy Center Canada sites the North American Association of Central Cancer Registries as the source for the information. The existence of this organization and the efforts of the Fraser Institute are a couple of examples of Canadians concerned about the healthcare received in Canada.
...
A caution on statistics and surveys. They should always be taken in context. By that I mean we should look at the organizations putting them together and presenting them. Few organizations have no agenda.
Exactly. Which is why I cite the World Health Organization, rather than the "Cancer Advocacy Network."
quote:Doctors spending hours arguing with insurers is an exaggeration and not the norm.
And what source do you cite for this, bCurt? (My source would be my own experience as a physician, which is anecdotal, but also backed up by the details of the Is gatekeeping better than traditional care? A survey of physicians' attitudes 1997 JAMA article. Of note is that these physicians stated approximately 45% of office time spent in paperwork to justify insurance coverage concerns. Regardless, they weren't too concerned about gatekeeping -- but most had also not practiced under a standardized system, so the value of their comparison is questionable. The time spent, though, is likely not.
Note that the abstract above does not give figures, but that would require reading the actual article. I'm afraid I can't give you my JAMA password, but I will quote for anyone who's interested, after I catch up on sleep )
quote:Also, many pre-existing condition limitations worries have been curtailed by HIPAA which passed in 1996.
Of course, you are aware that HIPAA only applies to persons who have been without even a few day's break in their insurance coverage for the preceding year -- a problem for people who have not been able to keep up with premium payments on their own. The cost of COBRA really bites.
quote:As much as it would be interesting to "hash" this out, I really don't have the time to do the topic justice. I have already expended more than I should . I'll have to look up other discussions on the topic that have already occurred.
S'okay. Like I said, you mustn't feel awkward about that. Mack and Noemon and I can play around with the topic for awhile, along with anyone else who's interested. Feel free to look in or post if you want. No pressure -- it's a very dense topic that does require a lot of time to discuss with thorough rigor. Like I said, I have a vested interest, so I'd be doing it anyway.
*offers hand to shake (I'm not nearly as surly as I seem, just sleep-deprived. But you have my permission to call me Surly if you chose, as I've earned it. *warm smile)
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I provide links to sources that I can link to. The health insurance dollar breakdown is on printed material that is not readily available for others to get a hold of from sources I know of though I am sure they exist. I have not done a search to find an online source for this same info. though I imagine there is one.
I asked for a better link that showed Canadian satisfaction because what information you provided (sources or not) had nothing to do with that topic. All you provided was information on US dissatisfaction and statistics that supposedly show healthcare in Canada is better. I'm not looking for a comparison, I'm looking for satisfaction .
quote:Exactly. Which is why I cite the World Health Organization, rather than the "Cancer Advocacy Network
And yet you site a survey from The Commonwealth Fund. The Cancer Advocacy Center Canada is Canadian based and I don't see them being any less valid than WHO. You think WHO, part of the United Nations, is not biased or does not have an agenda?
I don't know why when Managed Care is brought up only HMOs are referred to. A California study I recently read (sorry no link) comparing California to the rest of the country showed HMOs to make up about 30% of health insurance coverage. Another form of managed care that doesn't use gatekeepers are PPOs and they make up about 40% of coverage according to the study. 25% of coverage is through POS plans that come between HMOs and PPOs - you do have a primary care physician who can refer you out of network. The remainder of coverage comes from traditional plans that do no use gatekeepers or networks.
Anyway, your linked information does not say doctors spend hours arguing with health insurance companies. In fact, they say gatekeeping does help control costs and is better than or comparable to traditional care arrangements. There is more administrative time spent, however.
My source - my interaction with physicians and people in general. Sorry, can't link that.
quote:...HIPAA only applies to persons who have been without even a few day's break in their insurance coverage for the preceding year...
You are allowed up to 63-day gaps in coverage.
Posts: 134 | Registered: Jul 2003
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quote:This is why evidence-based reasoning is important -- sometimes reality challenges our preconceptions
CT's a hero.
Q: Congrats on the coverage. You sound almost nonchalant, so I'll be insouciant and say, "Very cool about the Christmas present. Good to see you're gonna be okay." Posts: 26077 | Registered: Mar 2000
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quote:I provide links to sources that I can link to. The health insurance dollar breakdown is on printed material that is not readily available for others to get a hold of from sources I know of though I am sure they exist. I have not done a search to find an online source for this same info. though I imagine there is one.
Sweetheart, you don't have to provide links, just citations. That is, cite the source from which you got the information, be it online or hard copy, so that (at least in theory) people who wish to do so could track down more information and ask more questions.
"Though I am sure they exist" is reassuring in a sort of ghosts-on-Pluto way (i.e., it is certainly within the realm of possibility), but it isn't convincing.
quote:I asked for a better link that showed Canadian satisfaction because what information you provided (sources or not) had nothing to do with that topic. All you provided was information on US dissatisfaction and statistics that supposedly show healthcare in Canada is better. I'm not looking for a comparison, I'm looking for satisfaction.
*shrug It's in the report. I will find the data for you.
quote:Anyway, your linked information does not say doctors spend hours arguing with health insurance companies. In fact, they say gatekeeping does help control costs and is better than or comparable to traditional care arrangements.
As I said, the details are in the article.
quote:My source - my interaction with physicians and people in general. Sorry, can't link that.
Anecdotal information is helpful in generating hypotheses about populations, but not in establishing them. There are more things in heaven and Earth, Horatio, than are dreamt of in your philosophy.
The practice of medicine must hold itself to high evidence-based standards. We used to think that calcium-channel blockers helped prevent heart attacks in hypertensive patients with congestive heart failure, since they are anti-hypertensive medications. When rigorously studied, we were surprised to find that these particular anti-hypertensives in this setting actually increased the rate of heart attacks.
Thus, what made sense from our (unexamined) experience and our theorizing turned out to be completely wrong. And dangerous.
We also used to think that treating E. coli bloody diarrhea with antibiotics would help survival rates. Makes sense, right? Treat a bacterial infection with antibiotics? But reality challenged our preconceptions -- treating with antibiotics increases the mortality rate via development of hemolytic-uremic syndrome.
"Because I think so" isn't good enough. "Because it seems like it should be right to me" isn't good enough. "Because I read it somewhere," or "because I talked to a few people about it, so their opinions must be representative of reality" just isn't good enough.
Medicine prides itself on being an evidence-based profession. No longer are we allowed, as physicians, to just get by with anecdotal data, or theoretical reasoning, or with the justification that this is how it's always been done. That is lazy, sloppy thinking, and it results in worse lives for the people it addresses. The profession holds itself to higher standards than that.
If you want to be accurate and convincing, especially in this topic, you should too.
quote:The problem with the 41 million uninsured figure is it is not adjusted (thus includes) those who willfully choose not to be insured. That is, they feel they can pay for it out-of-pocket or they just have other priorities. Personal example of this is my sister-in-laws family with the same income as my family. We choose to budget for health insurance, they choose not to. It is not because they can't afford it, it is because they are not willing to pay for it. They would rather eat out more often and buy expensive items.
I understand that this is representative of your experience and the people you know. I also understand that you did not attempt to specify the proportion of "gamblers" make up the uninsured percentage. The implication, though, is that this would be a substantial number. However, reality resists the preconception.
quote:The public's perception of the uninsured tends to encompass several unfortunate misconceptions. They are often characterized as either lazy individuals looking for a government hand-out or healthy individuals who freely choose not to purchase insurance. Many people also believe that the uninsured receive enough medical care through charitable physicians and institutions to remain in adequate health. Data tends to support none of these assumptions...
But who, exactly, are the uninsured? To begin with, 10 million of them are children. ...
In national polls, only 7% of people without insurance claim that they could afford a plan but are healthy enough that they do not want one. [emphases added]
The American Medical Student Association has compiled information about this and other pros and cons of a national healthcare plan at A Single Payer Health Care System for the United States: A Primer written by and for medical students. It is well-referenced. The studies referenced are, of course, appropriate to assess on their own merits,* but they do provide informational in a more than anecdotal way.
*that is, perhaps the polls are outdated, etc. But you can see how this information is more useful than anecdotes, which really cannot be assessed with regards to a population unless those anecdotes serve to generate a hypothesis which can be tested, and which can therefore can be critiqued and resisted.
[AnnaJo, thanks for the concern. Yes, I need some Cheetos. ]
quote:In national polls, only 7% of people without insurance claim that they could afford a plan but are healthy enough that they do not want one.
Of course that is what they say. That is what my sister-in-law says but her claim is not true.
I sorry you don't count personal experience has having any value and being anectodal. To call my comments as unreliable or untrustworthy is not very kind. I'm not putting a scholarly work together. I'm not in the field of medicine. I'm a consumer and a concerned citizen. Take my anectodal information as you wish. I'll take personal experience over statistics and surveys anyday.
quote:
quote: I asked for a better link that showed Canadian satisfaction because what information you provided (sources or not) had nothing to do with that topic. All you provided was information on US dissatisfaction and statistics that supposedly show healthcare in Canada is better. I'm not looking for a comparison, I'm looking for satisfaction.
*shrug It's in the report. I will find the data for you.
quote: Anyway, your linked information does not say doctors spend hours arguing with health insurance companies. In fact, they say gatekeeping does help control costs and is better than or comparable to traditional care arrangements.
As I said, the details are in the article.
I read the article and searched the link and came up with none of the information you mentioned.
*shrug
You take more time calling my information anectodal than providing useful information (not to say you haven't provided any useful information).
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bCurt, I've been markedly snarky to you. It was unfair and crabby, and you deserved more respect than that. I'm very sorry for my misbehavior, and I will happily delete any or all of the posts above, should you wish.
(Sometimes it is ruder to delete inappropriate comments and pretend like it never happened, so I'll leave the choice of that up to you.)
By "article" I meant the original study, not the secondary source -- and that was unclear. I did not find a direct link to the original study, and I linked to the secondary source, which only focused on part of the article. Regardless, I will track down the details by hard copy.
Let me clarify:
quote:Of course that is what they say. That is what my sister-in-law says but her claim is not true.
I'm sure it is true for her, but what is true for her may not be generalizable to others. That's a different matter, and it has little if anything to do with the truth value of her statement.
quote:I sorry you don't count personal experience has having any value and being anectodal. To call my comments as unreliable or untrustworthy is not very kind.
It's not that personal experience has no value -- it has value in the context of a person, but it may or may not be generalizable to others.
"Anecdote" is not a dirty word. It isn't an insult. It's just a category. Items of that category are appropriate to answer certain questions, but not so appropiate for other questions.
Anecdotes are personally meaningful, they are very useful for generating ideas about how things might be for other people at large, and they often give the impetus to look further into a possible problem. They answer the question of how things are in a given situation (say, for a given person) very well.
Anecdotes do not, however, answer the question of how things are across a population. They are just not useful for that purpose (kind of like how a Phillips-head screwdriver is not the right tool for hammering in a nail -- it's just not designed for it.) That doesn't mean your personal anecdotes aren't meaningful to you, or are somehow "less." It just means that without further information, you can't properly base a judgement of an entire system on them. They do, though, often give a good idea of where to look further to find interesting things about a population.
Again, I'm sorry. My tone was definitely uncalled for in most of my prior postings to you. I will behave better in the future.
Thanks for calling me on it, and for being so straightforward. It was well done.
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And that, boys and girls, is one of the many reasons we love CT. She apologizes with style and grace, while still maintaining her position. *applauds*
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Katharina: I work at a children's research hospital named for the patron saint of desparate (or hopeless) causes. ^_~ It's kind of hard to get worked up about what's up with me.
This whole discussion has been pretting interesting, though. I'm not as informed as I should be; until recently, I've always just been on my parents coverage. Looks like I've got a lot of reading to do.
quote: I'll take personal experience over statistics and surveys anyday.
My personal experience is that men are vile, violent beasts that should be castrated, tortured slowly and only be kept around for manual labor. Shall we argue the merits of applying that experience to the general population?
asQmh, that wouldn't be St. Jude's, by any chance, would it? My son just did a Math-a-thon for them. Posts: 9871 | Registered: Aug 2001
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quote:I'll take personal experience over statistics and surveys anyday
**TomD mode This is one of the scariest statements ever uttered within the context of public policy, ever. /TomD mode
That's just plain ludicrous. Not in a "you are lying" perspective, but in a "I will use my limited experience with maybe 300 people to prescribe a system for 300 million" perspective.
After all, if I were to use MY anecdotal experience, I'd say that we ought to ENFORCE everyone to go to the doctor once every year... After all, it was due to my grandparents' general fear/distrust of doctors that caused at least 2 of them to ignore signs of cancer until it was too late to do anything about it. Who knows, I think it probably would have cajoled one of my grandmothers to change her extremely sedentary and smoking lifestyle. Maybe if that were the case, I'd have one or two grandparents still around to meet my wonderful girlfriend... Instead, I don't have a single direct relative over the age of 53 (specifically, my parents). And I bet those routine checkups would have been cheaper than the treatments my grandparents went through. Or perhaps I would reccomend that we are researching the wrong cancers; only one of my grandparents died of lung cancer, and another of breast; however, one of them, and a great-aunt, died of intestinal cancer. And the 2 intestinal cancer victims died soon after diagnosis, so obviously there was a lack of treatment options, compared to the lung cancer, who contracted it before the other cancer showed up, and then subsequently outlived all the other grandparents, by 2-3 years even.
Of course, if I were to insist that the US implement this, I'd bet that it would be a grossly inefficient system, that would help some, hurt others, and certainly would not help our society as a whole.
-Bok
EDIT: I would like to add that bCurt DOES raise the issue that statistics don't always illuminate special/extreme cases... But by virtue of those cases being special and/or extreme, they aren't useful when crafting a public policy, since they are likely uncommon, short of someone compiling evidence of widespread lying about motves to not have healthcare, say.
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First, my apologies to you. I took your use of the term anecdote wrong and more negatively than I should have. Second, thanks for your apology though I wasn't expecting or needing one . Third, I absolutely do not want or expect you to delete any posts.
My sister-in-law example is just one of many. I have spoken to several (in other forums) and personally who have the same line of thinking. A lot of the time it is a matter of priorities as to what one can afford. I wouldn't mention it if hadn't run into that problem on more than one occasion.
Those eligible for public programs but not enrolled. Over 14 million uninsured Americans, most of them low-income, fall in this segment.
Low-income people who do not qualify for public programs. About 9 million uninsured Americans fall in this segment.
Moderate- to high-income Americans. About 18 million uninsured people fall in this segment, with 11.4 million having incomes over 300% of poverty or $54,300 for a family of four.
I'm currently in the Low-income category. I choose to afford coverage. I am sure I am not the only one who could afford it in the same category if they chose to. Of the 41 million, a majority can get coverage but just haven't.
quote: I'll take personal experience over statistics and surveys anyday
Okay, so that is overstated . I won't restate my issues with statistics and surveys. They don't tell the full tale. Most do not take them in context. What do you think surveys do? They take a segment of the population, survey them, and apply the results to the whole population.
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If you think that is all that scientific surveys do, you don't know the science of statistics very well. Why there may be some biasing in the sample (or more likely, in the design of the questions), that fact is taken into account... There's a reason you get those "Margin of Errors" disclaimers.
Scientifically designed surveys take a sufficiently sized, and random, sampling of a population so that certain conclusions may be drawn on the population as a whole (with a certain fudge factor admitted).
It is certainly NOT the same as yours or mine smaller, more biased population samples in our informal surveys.
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I'll add that EVERY SINGLE member of the board, save one, of bCurt's source is a CEO of an insurance agency... In particular they are all CEO's of regional Blue Cross / Blue Shield companies.
While not actually negating their info, it makes me somewhat skeptical of their goals, and I would like to see if another group had replicated those facts.
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Yes, there is a lot of effort put into some surveys to word the questions right to avoid bias and to choose a good cross-section of the population. There are also those who do a very poor job of question wording and selecting those who participate. Problem is, when survey results are presented to the public they often do not know a bad survey from a good. To tell one does have to know the exact questions asked and the number of and how those surveyed were chosen.
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But not the Advisory Board, both boards must approve what comes out of the NICHM. The NICHM has even worked with The Commonwealth Fund. The figures in the study were from Census Bureau information.
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Yes, but bCurt, you were contesting CT's info, which was (and correct me if I am wrong CT) all from peer-reviewed scientific journals. The peer-review process is not trivial, and therefore using the argument that "surveys can be ill-designed" is fairly weak, unless you can show actual issues with the methodology, or provide some sort of weakness in the peer-review process itself.
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I read through the source study you provided, bCurt, and I apologize. It seems fairly balanced to me, but it doesn't appear to support the conclusions you use it to support.
It tends to find that the reason there are plenty of "high income" households in the uninsured bracket is due to increasing retirees (thus losing company benefits) and also job transitions (voluntary and involuntary) in the young worker class (who, incidentally have increasingly acquired the high-income jobs, no doubt due to the tech boom), and the subsequent termination of company benefits as well. In both of these cases they people affected aren't able to gain corporate subsidies/group discounts, and thus have to shoulder a much higher cost, while being on much lower/fixed incomes. It isn't so much that they don't want to get the coverage, it's that they are currently in a more precarious financial position (despite the [seemingly lagging] high-income indicators) and being implicitly penalizied for that situation.
As for the low-income, but eligible, grouping, they tend to attribute that as due to ignorance of available benefits, indignance/shame at receiving public aid and becoming a "bloodsucker on society", or due to overly complex paperwork. Once again, not due to feeling like they don't need it, though no doubt there are some who feel that way.
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CT wasn't citing peer-reviewed statistics and surveys except for a 1997 JAMA article. She sites The Commonwealth Fund and WHO. The big statistic mentioned but not by CT is the cost percentage of GNP comparing Canada to the US. When one first looks at those figures they don't know, because it is not mentioned or not clearly mentioned, that the figures include all healthcare expenditures which means R&D and medical research are included - something the US is more heavily involved in than Canada and that even Canada as well as the rest of the world benefits from.
Retirees have Medicare available unless their younger than 67 or 65. So they do have coverage available. I don't see where the study says a sizeable portion of the medium-high income without coverage do not have it available and can't afford it.
quote:
Labor market, business and economic trends. Self-employment, part-time, contract and so-called “contingent” work became more common throughout the 1990s. In 2001, 7.3% of all workers (9.8 million) were self-employed, up from 6% (7.1 million) in 1990. About 23 million people (17%) in the nation’s full-year work force of 134 million worked part-time in 2001. Health coverage is less likely in both situations; about one in four (23.6%) self-employed people are uninsured, for example. Likewise, 22% of part-time workers were uninsured. Many part-time workers are members of households that also have another working member. These workers, however, may not have insurance even though their household income may exceed poor or near-poor levels.
Costs and premiums. More middle and upper income Americans are uninsured because of escalating health care costs. During the past two years health care spending increased by $204.8 billion, or 16.8%, totaling over $1.4 trillion in 2001. Health care costs went up largely because of increasing spending on hospitals and prescription drugs. These increases have driven the rise in health insurance premiums. In 1998, the average cost of employer-sponsored health insurance was $3,817 per employee. That rose to $5,646 in 2002.
The retiree factor. Retiree coverage has steadily declined since the early 1990s. Two-thirds (66%) of U.S. companies offered retiree health benefits in 1988. That declined to 34% of companies in 2002.13 About 18% of early retirees were uninsured compared to 12% of those aged 55 and above who remain employed. Low-income 50 to 64 year olds (household income below $25,000) were most at risk of having no health insurance – about 30% lacked it in both 1989 and 1999. But the proportion of middle and higher income 50 to 64 year-olds with no coverage rose between 1989 and 1999, from 12% to 14% of middle income ($25,000 to $75,000) and from 4% to 6% of those earning $75,000 or more.
[edit attempt: to eliminate odd line breaks to no avail]
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). Of course, I don't want to quibble over such small matters. Actually, those numbers have been floating around for a couple of years. I'm trying to find some current numbers but I believe the US is close to 18% with Canada close to 15%. However, there is much more to this than a simple comparison of % of GNP.![[Wink]](wink.gif)
![[Big Grin]](biggrin.gif)
? You quote the The Commonwealth Fund 2001 International Health Policy Survey to show disatisfaction of US adults with the US healthcare system which does not automatically mean Canadians are satisfied with theirs.![[Eek!]](eek.gif)
but I hope I don't come across that way. You can call me Curt but I'm not normally curt. ![[Frown]](frown.gif)
I will behave better in the future.![[Razz]](tongue.gif)
. I won't restate my issues with statistics and surveys. They don't tell the full tale. Most do not take them in context. What do you think surveys do? They take a segment of the population, survey them, and apply the results to the whole population.
