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Tilting at Windmills

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May 2, 2006
By: Kevin Drum

YES, NATIONAL HEALTHCARE REALLY IS THE WAY TO GO....Advocates of universal healthcare frequently claim that European-style national healthcare systems, aside from being fairer, are just more efficient than ours. They provide decent healthcare at a lower cost than the jumbled, pseudo-free market system we have in the United States.

But is it true? Do even relatively mediocre, underfunded national healthcare systems like the one in Britain perform as well as American healthcare? A new study published in the Journal of the American Medical Association reaches a pretty unambiguous conclusion.

The researchers studied health outcomes in both countries and controlled for age by comparing only people aged 55-64. They controlled for race by studying only non-Hispanic whites. They controlled for obesity. They controlled for income. They controlled for education. They controlled for everything they could think of. Here's what they found:

"At every point in the social hierarchy there is more illness in the United States than in England and the differences are really dramatic," said study co-author Dr. Michael Marmot, an epidemiologist at University College London in England.

....The upper crust in both countries was healthier than middle-class and low-income people in the same country. But richer Americans' health status resembled the health of the low-income British.

The researchers are careful to say that their study doesn't prove that Britain's healthcare system is better than America's something that would be nearly impossible to demonstrate conclusively with a study like this in any case. But that's not the point. The point is that it's obviously not worse even though the British spend about half as much as we do per capita.

So here's the deal: under the British system, you don't have to worry about which doctors your HMO allows you to see. You don't have to worry about losing coverage if you get laid off. You don't have to worry about being unable to get a new job because you have a pre-existing condition. You don't have to worry about being bankrupted if you contract a serious chronic illness. And large corporations don't have to worry about going out of business because of spiraling healthcare obligations.

And the result of all this? Healthcare that's as good as ours and delivered for about half the cost. Under a national healthcare system, when you get sick, all you have to worry about is getting well. Explain to me again why we're afraid of this?

Kevin Drum 2:30 PM Permalink | Trackbacks | Comments (195)

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Comments

But but but...waiting lists! Canada! Socialism!

Posted by: Doug T on May 2, 2006 at 2:32 PM | PERMALINK

>>Explain to me again why we're afraid of this?

Because large medical companies would be less inclined to contribute money to political parties?

Posted by: PrivacyProponent on May 2, 2006 at 2:33 PM | PERMALINK

Did they normalize for religion? Maybe god just likes Anglicans more than Baptists and Catholics?

And think of all those poor insurance executives, having to find new ways to support their American Dreams.

Why do you hate the American Dream, Kevin?

Posted by: Mysticdog on May 2, 2006 at 2:36 PM | PERMALINK

Honstly, from the conservatives I know, family and friends, as soon as you start talking about it, they start shouting that they don't want their tax dollars paying for someone's sex change operation. Seriously. And if the poor people can't afford to pay for their children's health care, well, they should have thought of that before they had so many children.
And you wonder why I avoid political discussions with them....

Posted by: Timewalker on May 2, 2006 at 2:37 PM | PERMALINK

Bloody commies! Better dead than red I say!

Posted by: Wingnut on May 2, 2006 at 2:37 PM | PERMALINK

"Healthcare that's as good as ours and delivered for about half the cost. Under a national healthcare system, when you get sick, all you have to worry about is getting well. Explain to me again why we're afraid of this?"

Isn't it obvious?

The point is to keep healthy people in fear of getting sick, and to keep sick people from getting well unless they have the right connections. That's how America works, and if you don't like it, then there are many fine health care systems available to American emigrants to other countries.

Posted by: s9 on May 2, 2006 at 2:37 PM | PERMALINK

Mysticdog,

There was an article at MSNBC that compared patients who knew they were being prayed for to those who weren't prayed for. Turned out that knowing you're prayed for increases the likelihood of death. I don't they compared which flavor of xtianity God was being prayed for, though. Maybe you have a point.

Posted by: gq on May 2, 2006 at 2:39 PM | PERMALINK

People getting sick in the 55-64 range is the new Social Security Reform solution. Even better than dismantling it is just not having to pay any of it out to the people who paid in! Then we can build more bridges to nowhere and have more wars!

Everybody wins! Well, everyone who counts.

Posted by: fishbane on May 2, 2006 at 2:39 PM | PERMALINK

But richer Americans' health status resembled the health of the low-income British.

Oh, great! Now I can't even lord that over the low-income British anymore...

Posted by: Stefan on May 2, 2006 at 2:40 PM | PERMALINK

But it can't be true, because the unregulated market for a service will always produce a better outcome than any other system. So the study must be flawed.

Posted by: Tom on May 2, 2006 at 2:40 PM | PERMALINK

Wait. Wait. Wait. You mean the more invisible hand isn't always best? I don't know what to believe now...

Posted by: gq on May 2, 2006 at 2:41 PM | PERMALINK

gq: Turned out that knowing you're prayed for increases the likelihood of death.

Careful with correlation and causation, there.

Posted by: fishbane on May 2, 2006 at 2:41 PM | PERMALINK

But Socialized Medicine is worse! I heard a coworker's brother's girlfriend's mechanic say that the heard on a talk radio show about a guy in Canada who got his arm chopped off on a farm and he had to carry it around for six months in a burlap sack because there was a huge waiting list to have it reattached.

True story.

Posted by: Doctor Gonzo on May 2, 2006 at 2:41 PM | PERMALINK

The fact remains that a huge majority of Americans associate single-payer/national health systems with shortages, lines, poor service, and incompetent doctors (the good ones presumably going to where the money is). Until that misconception changes, 'socialized medicine' will remain a scare word among enough people to win elections.

Posted by: nightshift66 on May 2, 2006 at 2:42 PM | PERMALINK

In reading the article to which Kevin links, one finds the following which seems to contradict the thesis of Kevin's post.


"However, Britain's universal health-care system shouldn't get credit for better health, Marmot and Blendon agreed.

Both said it might explain better health for low-income citizens, but can't account for better health of England's more affluent residents.

Marmot cautioned against looking for explanations in the two countries' health-care systems.


"It's not just how we treat people when they get ill, but why they get ill in the first place," Marmot said."

But, I suppose we don't want the facts to get in the way of a good story.

Regards,
Neil

Posted by: Neil S on May 2, 2006 at 2:42 PM | PERMALINK

To preempt the usual suspects, and save everybody time and effort, here are the standard conservative responses to any discussion of health care reform. Note that this this is a continuously refined list that I try to post every time Kevin mentions "health" and "care" in the same sentence; you should feel free to add more responses so that we can have a more comprehensive list for next time.

1. Single payer plans are socialistic and therefore ipso facto evil.
2. I know someone who knows someone who's related to someone from Canada who had to wait for tennis elbow surgery for months and months and came to the US and he had the surgery immediately and it saved his life.
3. Look what's happening in France right now; their health care is socialized and there are riots in the streets.
4. We have the best health care in the world and anyone who says otherwise is part of the blame-America-first liberal socialistic treasonous left.
5. Anybody who wants insurance coverage can get it, and the only reason some people don't it's because they don't want to.
6. People who get sick got sick because they weren't paying attention to their diets, etc. and they are therefore to blame for their problems; why should the taxpayer pay for lazy people who sit around eating hamburgers and watching TV and so get fat and sick?
7. Those who can't afford health care cannot do so because they are lazy and do not work hard enough to afford to pay for what they need in life and so they want me to pay for their expenses.
8. Those with children who cannot afford health care for their children shouldn't have had any children and to have done so was irresponsible; if we reward them with free health care they'll never become responsible.
9. Italians are disappearing because they don't reproduce enough, and they have socialized medicine, which obviously has not helped them to continue surviving as an ethnic group.
10. What we need is to promote preventive medicine so that nobody gets sick again.
11. All we need to do is make sure insurance companies do not have to pay any taxes whatsoever, which will undoubtedly lead to more competition, better care and lower prices.
12. Cuba has socialized medicine; you want to live in Cuba?
13. All statistics quoted by supporters of socialistic remedies to health care are false or faked, a priori; all anecdotes offered by opponents of health care are true and accurate, a priori.
14. With socialized medicine, research into new drugs and therapies will stop immediately, because it is the current healthy competition among our insurance companies that directly drives medical research.
15. Our problem is too much health care, and people tend to abuse the system by going to the doctor too often. With socialized care, we'll get even more abuse, while the market forces of free capitalism will discourage the slightly sick from tying up the system with complaints about sniffles.
16. The problem with health care is Medicaid and Medicare, which encourage the poor and the old to get sick more often.

Posted by: Aris on May 2, 2006 at 2:43 PM | PERMALINK

It is just a plot to recruit them into the one fabulous socialized health care system we do have in the US-- the United States Military. Screw the draft, let's just offer healthcare.

Posted by: Martin on May 2, 2006 at 2:44 PM | PERMALINK

WOW! That's Sir Michael Marmot. He's the guy that brought people's attention to social gradients in health (i.e. the really rich are healthier than the rich, who are healthier than the upper middle class, and so on down the ladder...).

Posted by: MadLad on May 2, 2006 at 2:44 PM | PERMALINK

More from the article (emphasis mine):

The United States spends about $5,200 per person on health care while England spends about half that in adjusted dollars.

"Everybody should be discussing it: Why isn't the richest country in the world the healthiest country in the world?" Marmot said.

"It's something of a mystery," said Richard Suzman of the U.S. National Institutes of Health, which helped fund the study.

The researchers looked for answers in the data, which came from government-sponsored health surveys. The research was supported by grants from government agencies in both countries. A U.S. researcher from the Rand Corp. was on the team.

Posted by: Stefan on May 2, 2006 at 2:49 PM | PERMALINK

But what would we tell the medical insurance companies???? Poor things - they would go out of business and throw thousands of people out of work. Plus what would happen to all the money they have invested in the markets?????

Single payer health care = complete chaos, don'tcha know that?

/snark

Posted by: morrigan on May 2, 2006 at 2:51 PM | PERMALINK

And here's an interesting point about how our increasingly frayed safety net and economic instability may be contributing to our ill health:

Marmot offered yet another explanation for the gap: Americans' financial insecurity. Improvements in household income have eluded all but the top fifth of Americans since the mid-1970s. Meanwhile, English citizens saw their incomes improve, he said.

Robert Blendon, a professor of health policy at the Harvard School of Public Health who was not involved in the study, said the stress of striving for the American dream may account for Americans' lousy health.

"The opportunity to go both up and down the socioeconomic scale in America may create stress," Blendon said. Americans don't have a reliable government safety net like the English enjoy, Blendon said.

Posted by: Stefan on May 2, 2006 at 2:51 PM | PERMALINK

Addendum (thanks to Timewalker)

17. I don't want my tax dollars paying for someone else's sex change operation.

Posted by: Aris on May 2, 2006 at 2:52 PM | PERMALINK

Actually, Neil, the thesis of Kevin's post was that the British are clearly not getting worse health care than the USA, despite paying half what we do per capita. I conclude the facts that they are healthier than us, and accepting the assertions as to costs as true, makes his prima facia case for him.

Posted by: nightshift66 on May 2, 2006 at 2:52 PM | PERMALINK

18. I don't want my tax dollars paying for some ho's abortion.

Posted by: nightshift66 on May 2, 2006 at 2:54 PM | PERMALINK

Aris: You forgot one. Lots of white folks are scared that a tax dollar will be spent to benefit a black person, and we can't have that.

Posted by: jimbo on May 2, 2006 at 2:56 PM | PERMALINK

How about people in the medical professions? How would they be impacted? That would be the only question I have not had answered on the topic. All the rest are clearly in favor of switching.

Posted by: bill on May 2, 2006 at 2:57 PM | PERMALINK

Honstly, from the conservatives I know, family and friends, as soon as you start talking about it, they start shouting that they don't want their tax dollars paying for someone's sex change operation. Seriously.

More or less, yes. If it's not someone's sex change operation, it's some poor black person they feel doesn't "deserve" to be treated by a national health care system.

If the country was predominantly white and much more homogeneous, some sort of national insurance plan would have been passed decades ago. However, there's an abiding fear by many voters that any national government service will in some way benefit those who those voters feel don't "deserve" any benefits they receive. The ultimate problem with promoting the "common good" is that for many people, the "common good" is "what benefits me and my tribe" and anything that will also benefit the other guy's tribe is something they don't want to pay for.

Posted by: Constantine on May 2, 2006 at 2:58 PM | PERMALINK

Although I agree with Kevin Drum's that the UK's system is free of the worries by individuals and pressures on companies that the US system has, this does not fully explain the difference in health outcomes. I have no numbers for this. It is more a gut feeling. And Mr. Colbert has explained to us how important that is.
Put it this way: why should wealthy Americans have the health outcomes of poor Britons? They can afford to pay for better insurance, can have a secretary or someone handle all the bill-paying, and if push comes to shove, any out-of-pocket expense is proportionally less significant than for middle-class people. So why are rich Americans as sick as poor Britons?
All I can think of is that our system must be actually warping the medical care itself in some way.

Posted by: Kevin on May 2, 2006 at 2:59 PM | PERMALINK

I dunno, if they controlled for obesity their sample size must have been pretty small...

Posted by: S Ra on May 2, 2006 at 3:05 PM | PERMALINK

[Stephen Colbert]You're missing the point, American health care is not more expensive.
It's just that the dollar is overvalued by 80%. Adjust for that, and everything is find and dandy.[/Stephen Colbert]

Posted by: Matthew Saroff on May 2, 2006 at 3:07 PM | PERMALINK

Apologies to invoking the great one, I am not worthy.

Posted by: Matthew Saroff on May 2, 2006 at 3:08 PM | PERMALINK

I think this study backs up my point that we are stuck with our insurance corporation enriching system beause of the selfishness of the upper middle classes. The upper middle classes do not want to wait for their elective medical procedures in order for more seriously ill folks to obtain healthcare first, even if it means having a healthcare system that does not provide services to them as well as that healthcare boogey man - Britain's socialized medicine.

Posted by: Hostile on May 2, 2006 at 3:09 PM | PERMALINK

Here's what I want explained to me:
Health care resources are limited. There needs to be some way to ration them. If we nationalize the healthcare system how is it decided who gets what?

Posted by: Garble on May 2, 2006 at 3:11 PM | PERMALINK

If the country was predominantly white and much more homogeneous, some sort of national insurance plan would have been passed decades ago

Maybe. The UK is about 92% white at the moment, as compared to ~75% white in the US. But when the British NHS was founded in the late 1940s, the nation was "homogeneous" only by color. It contains four countries (and therefore four semi-independent NHSs), several languages, and ancient class distinctions that parallel racial distinctions in America (and gave rise to the same kinds of objections that we see in the US: I don't want my taxes paying for services for "them," "they" are improvident, marry on the dole, drink too much, &c.)

The major difference I'd suggest is that Britain had (much more in the 40s than now) a deep, committed, tireless working-class political movement, of the kind that has not existed in the US for many, many years, if ever.

Posted by: Tim Morris on May 2, 2006 at 3:14 PM | PERMALINK

"More or less, yes. If it's not someone's sex change operation, it's some poor black person they feel doesn't "deserve" to be treated by a national health care system.

If the country was predominantly white and much more homogeneous, some sort of national insurance plan would have been passed decades ago. However, there's an abiding fear by many voters that any national government service will in some way benefit those who those voters feel don't "deserve" any benefits they receive. The ultimate problem with promoting the "common good" is that for many people, the "common good" is "what benefits me and my tribe" and anything that will also benefit the other guy's tribe is something they don't want to pay for.

Posted by: Constantine on May 2, 2006 at 2:58 PM | PERMALINK
"

I just wanted to post this again so everybody could read it again. Because it's very important.

Where this tribalism came from, in my mind is actually from American religion, which has always, to some degree more or less encouraged tribalism, which makes it acceptable.

Posted by: Karmakin on May 2, 2006 at 3:15 PM | PERMALINK

you should feel free to add more responses so that we can have a more comprehensive list for next time.

This is pretty much standard to any right-wing objection to anything:

"Liberals are for it? Then I'm against it."

Everything else is just rationalization. If something in some way shape or form seems to be touched by "The Left", it is automatically something to oppose. No thinking required.

Posted by: BB on May 2, 2006 at 3:17 PM | PERMALINK

No one seems to have considered the obvious alternative: it's not single-payer, it's that American doctors are the least competent in the developed world. Sounds right to me. So, paraphrasing Dick (the Butcher) in Shakespeare's Henry VI, Part 2, "The first thing we do, let's kill all the doctors."

Posted by: marcel on May 2, 2006 at 3:17 PM | PERMALINK

Here's what I want explained to me:
Health care resources are limited. There needs to be some way to ration them. If we nationalize the healthcare system how is it decided who gets what?

Here's what I want explained to me: police and fire department resources are limited. There needs to be some way to ration them. If we let the government run the police and fire departments how is it decided who gets what?

Posted by: Stefan on May 2, 2006 at 3:20 PM | PERMALINK

Well we Americans are less healthy than the Brits because we're fat, because we eat like pigs, not to mention that the pharma industry fosters a culture of illness.

Why are we afraid of adopting universal health care? Follow the money.

Posted by: Del Capslock on May 2, 2006 at 3:24 PM | PERMALINK

Turned out that knowing you're prayed for increases the likelihood of death.

Quick, someone tell Cheney I pray for his health every day. Every day! Because he's the only thing standing between this administration and string of total fuckups.

Oh, wait...

Posted by: craigie on May 2, 2006 at 3:29 PM | PERMALINK

"Explain to me again why we're afraid of this?"

Because it's socialism.

Posted by: JRI on May 2, 2006 at 3:30 PM | PERMALINK

Kevin: "Put it this way: why should wealthy Americans have the health outcomes of poor Britons? ... All I can think of is that our system must be actually warping the medical care itself in some way."

It's self evident. Go to the doctor. You'll be stuck in a room, where a nurse will do 95% of the work. In the last 5 minutes, the doctor will pop his head in the door, ask a few questions, prescribe something, and leave. The next time you visit, he won't remember you.

The pressure to see as many clients as possible in as short a time as possible in order to maximize profit is warping the amount of time that the doctor spends with each patient. Health care in the US can be hasty and slipshod.


Posted by: AFriend on May 2, 2006 at 3:30 PM | PERMALINK

Here's what I want explained to me:
Health care resources are limited. There needs to be some way to ration them. If we nationalize the healthcare system how is it decided who gets what?

The basis for this is the belief that if medical care were free, everyone would spend all day at the doctor.

Maybe I don't get out much, but I don't know anyone who would say "let's see, should I play golf today, or should I go to the doctor, just in case. Hmm, decisions, decisions..."

Posted by: craigie on May 2, 2006 at 3:32 PM | PERMALINK

Del: "Americans are less healthy than the Brits because we're fat"

They controlled for weight. In other words, they intentionally picked Americans who weighed the same as the Brits they picked. Yet, the Americans were sicker.

Posted by: AFriend on May 2, 2006 at 3:33 PM | PERMALINK

101. nationalized health care will attract all sorts of immigrants, legal and illegal, who would want to benefit from the system at our expense.

Posted by: gregor on May 2, 2006 at 3:34 PM | PERMALINK

Americans are less healthy than Brits because of the Brits hate us for our Freedom Fries.

Posted by: lib on May 2, 2006 at 3:35 PM | PERMALINK

Explain to me again why we're afraid of this?

Maybe because a lot fewer people will be making six- and seven-figure incomes if they can't skim off the profits (insurers & administrators) or maintain godlike social & economic status (doctors- maybe not all, but enough)? And what about all of those poor paper-pushers we all know so well from our doctors' offices?

Seriously though, if we cut the dead weight and inflation from our healthcare system and treated it like an actual public good instead of a high-end consumable, a lot of not-terribly-useful, but still influential, people would make a lot less money. Can't have that.

Posted by: latts on May 2, 2006 at 3:37 PM | PERMALINK

Wrong comparison.

You have to compare two diferent industries. For example, if country A regulates and nationalizes health care; and country B regulates and nationalizes the shoelace industry, who has better shoelaces, and why?

There are a lot of things more valuable than good health, and liberals who suddenly think choosing worse health is not allowed have to explain why I am therefore allowed to wear tennis shoes without shoelaces.

Posted by: Matt on May 2, 2006 at 3:38 PM | PERMALINK

Take a gander at yesterday's WSJ. The CEO of HealthUnited has 1.6 billion in unexercised stock options. $1.6 billion of the money we spend on "healthcare" is aimed at this one guy's pocket.
Republicans control the federal government and the public discourse. Ergo, this is considered good, and alternatives are considered to be bad.

Posted by: Max on May 2, 2006 at 3:41 PM | PERMALINK

Waits for breast cancer treatment are getting worse as the NHS battles to meet a key target to speed up access to care, new figures revealed yesterday.

In the period from July to September last year, only 81 per cent of patients urgently referred for treatment for breast cancer were treated within the Executive target of two months - down from 86 per cent in the previous quarter.

In some cases, patients were still waiting more than 200 days for treatment, with the longest wait being 291 days. Waits for all other cancers were either improving or staying the same.

...

In Shetland only 33 per cent of patients with breast cancer were treated within two months of urgent referral. In the Grampian and Highland areas 50 per cent were seen within two months.

http://news.scotsman.com/topics.cfm?tid=57&id=348832006

Yeah. That sounds really great.

Posted by: DelBoy on May 2, 2006 at 3:44 PM | PERMALINK

Only Kevin and his unfathomable logic:

"The researchers are careful to say that their study doesn't prove that Britain's healthcare system is better than America's something that would be nearly impossible to demonstrate conclusively with a study like this in any case. But that's not the point. The point is that it's obviously not worse even though the British spend about half as much as we do per capita."

The study doen's prove that the sly is bluer today, only that it is not less blue?

Posted by: Matt on May 2, 2006 at 3:46 PM | PERMALINK

Yeah. That sounds really great.

You're assuming that it would be better in the US. But that very much depends on who needs the treatment, and how much money they've got.

Posted by: craigie on May 2, 2006 at 3:46 PM | PERMALINK

敬啟者,您好:請問一下雨 傘的用途是什麼?是否是用 來遮風避雨的庇謢所,但帶 著庇謢所的面具把遮風避雨 的雨傘打斷呢?還是打在寄 養童身上呢? 2000年五月 小女她說:『在她小時後阿 媽用雨傘打她,一直打一直 打,打到雨傘斷掉』,『在 一老人會』(場所)。 [Family Violence Prevention];[家暴];[家暴中心];[taipei7.tripod.com]

Posted by: 88 on May 2, 2006 at 3:48 PM | PERMALINK

敬啟者,您好:請問一下雨 傘的用途是什麼?是否是用 來遮風避雨的庇謢所,但帶 著庇謢所的面具把遮風避雨 的雨傘打斷呢?還是打在寄 養童身上呢? 2000年五月 小女她說:『在她小時後阿 媽用雨傘打她,一直打一直 打,打到雨傘斷掉』,『在 一老人會』(場所)。 [Family Violence Prevention];[家暴];[家暴中心];[taipei7.tripod.com]

Posted by: 88 on May 2, 2006 at 3:50 PM | PERMALINK

Several observations. First, I think marcel nails it in suggesting that Britons have better health than us because their doctors are better. Perhaps not at golf, investing, retiring early or cranking out charges, but in treating patients. The reason is also obvious. We have a system where the number of physicians is controlled so there is not too much competition. As a result there is very intense competition to get into medical school with the result that the winners are those who are most competitive, not the best healers. Further those same competitive types want to win the game by accumulating as much money as possible as quickly as possible. And many of them have to do this because unless they are wealthy to begin with, they will come out of medical school with horrendous debt. Do not get me wrong. There are many fine doctors in this country who work long hours for little pay or knowledge that their patients can not or will not pay. My point is simply that the way the selection process is set up does not place a premium on recruiting good physicians, but merely on selecting highly competitive people. A recent headline indicated that some study showed that the wrong medical protocols were followed 57% of the time with the V.A.--ie government doctors- doing somewhat better.
With respect to the question about rationing, you can still require a co-pay with the result that you would discourage overutilization by poor people and the idea of waiting times for elective medical care serves the same purpose.
For those upper middle class folk who do not think they should have to wait for anything or want to be sure that they are getting the "best" (richest) doctors, you can see a "private" physician in Britain as long as you are willing to pay for it and I imagine the same system would arise here.
One of the issues which does arise under the British system which also appears here, but to a lesser degree, is "closed practices" where physicians no longer accept new patients. Whether the single payor system contributes to this phenomena, I do not know.
Finally, while a single payor system would undoubtedly throw millions out of work in the insurance industry, it would also result in millions of hours of time being spent productively rather than fighting with those soon to be unemployed insurance employees.

Posted by: terry on May 2, 2006 at 3:50 PM | PERMALINK

Did they control for diet? It's my intention that Americans diets are much worse than the rest of the world. Obesity indicates that you aren't eating right. But being thin doesn't indicate that you are eating right. I was 5'10" 160 pounds when the doctor told me I had high chloresterol.

Did our health care system make me have high chlorestorel? I would say no. My suspicion is it was all the fries and chick-fil-a chicken sandwiches.

Are you guys proposing that everyone should have to take a health course in high school to educate them on healthy lifestyle choices, esp. dietary? No, you're proposing a complete overhaul of 1/5th of the US economy.

Posted by: Chad on May 2, 2006 at 3:56 PM | PERMALINK

First - "culture of illness?" yeah, that's why the death rate in the US went down by 4% last year, primarily driven by drug therapy. Because we foster a culture of illness.


Second - our crappy, wasteful, disorganized, unbalanced system is the only one that is consistently and robustly producing medical innovations. Not just NMEs (drugs), but all of the equipment and software and other stuff that goes along with medical practice.

Your gut may tell you that NHC will not decrease the rate of medical innovation. I say that 90+ years of communist and socialist experimentation has demonstrated that there are only two countries that have been highly innovative over the last century - the US and Japan. Dampening profits dampens innovation. I will admit to being dogmatic about that, because I have yet to see any compelling evidence to the contrary.

You may point out individual inventions created in socialist economies. And I will simply say that I didn't say all inventions occur in the US and Japan, just most.

You may say 'the rate of medical innovation isn't that high right now.' And I will say "As compared to what?" - what magical socialist wand is going to force people to find new ways to creatively come up with drugs? Because so far it doesn't exist. Wishing will not make it so.

You may say "We don't need all that innovation, really." And I will say "Tell that to my mother, who died of Multiple Sclerosis just a few years before they came out with some of the excellent new treatments."

The US medical innovation engine is incredibly messy, wasteful and unpleasant to look at. But if you want to replace it, you had best have compelling reasons why the replacement will be no worse on the innovation side. Because I think that innovation is more important than cost.


Posted by: jb on May 2, 2006 at 3:57 PM | PERMALINK

If they account for obesity, the difference in health may come down to the fact they simply walk more than we do. Also a much higher proportion of people continue playing active sports (soccer, rugby) for a considerable time after leaving school.

I've said it before, so I'll say it again, health care is not market driven. It doesn't respond that way; it's not set up that way.

Garble: rationing. In this country there is a shortage of livers for transplant. We put people on a list and also require that they be alcohol free (if that's an asociated problem) for six months, then they wait for a suitable liver to turn up when it's their turn. In this country we raise deductibles, co-pays and minimum caps to marginalize the poorer members of our society.

In the UK, GPs manage their practices and refer as needed. If the treatment is non-urgent then, yes, there are waiting lists and the debate in society at large (yes, it comes up as a political issue) is what's acceptable. The present labor government has just gone through the usual cycle of expanding expenditure and is now reining it in. But it's still cheaper! For the richer, private insurance is also available or they can pay outright to jump most lines. Life critical (like livers, hearts, etc.) not included as far as I know.

Posted by: notthere on May 2, 2006 at 3:59 PM | PERMALINK

Kevin ponders: Explain to me again why we're afraid of this?

A medical care system that is not designed to enrich the rich has no place in America.

The sole and entire purpose of the American way of life is to enrich and empower the rich and powerful.


Posted by: SecularAnimist on May 2, 2006 at 3:59 PM | PERMALINK

If its just that we pay doctors more, then why not propose increasing the number of medical students versus a complete overhaul. It seems to me a lot of this boils down to you guys having a position of wanting single payer, but my interest and the American people's interest is in having better health at lower costs. My interests can be meet by means other than single payer.

Posted by: Chad on May 2, 2006 at 3:59 PM | PERMALINK

Finally, while a single payor system would undoubtedly throw millions out of work in the insurance industry, it would also result in millions of hours of time being spent productively rather than fighting with those soon to be unemployed insurance employees.
Posted by: terry

I would suggest that THIS, as opposed to med school selection criteria, makes them better docs. You'd be amazed at how much more we would invest in patient care if we didn't have to deal with paperwork, insurance companies, refusals for payment and denial of service, appeals, change of plans, etc. ... Frankly, I would love more patient time.


No, you're proposing a complete overhaul of 1/5th of the US economy.
Posted by: Chad

we're the only developed country where it even approaches 20% ... most educated people see this alone as a problem requiring resolution.

Posted by: Nads on May 2, 2006 at 4:00 PM | PERMALINK

Because I think that innovation is more important than cost.
Posted by: jb

ah, but you likely have some sort of insurance. The 30 million lacking any insurance, and the millions more who are underinsured, would really just to not go bankrupt in the setting of normal, known illnesses with proven therapies.

Innovation is an important, but ultimately separate, question. Addressing insurance company profiteering with single payer can easily co-exist alongside continued support and funding for biomedical research, as well as private pharm company/biotech initiatives.

Posted by: Nads on May 2, 2006 at 4:04 PM | PERMALINK
Are you guys proposing that everyone should have to take a health course in high school to educate them on healthy lifestyle choices, esp. dietary? No, you're proposing a complete overhaul of 1/5th of the US economy.

The dietary habits of the English are not dissimilar to the dietary habits of Americans, in particular their intact of such things as chips.

Besides, I'd bet were "we" to advocate such a course, people like you would rail against it too.

"Our high schoolers should be learning the three R's, not wasting their time on health classes taught by pantywaists!"

Posted by: SavageView on May 2, 2006 at 4:05 PM | PERMALINK

Did they adjust for American destructive(self & others) tendencies?

Posted by: Michael7843853 G-O in 08! on May 2, 2006 at 4:05 PM | PERMALINK

Kevin writes,

The researchers are careful to say that their study doesn't prove that Britain's healthcare system is better than America's something that would be nearly impossible to demonstrate conclusively with a study like this in any case. But that's not the point. The point is that it's obviously not worse even though the British spend about half as much as we do per capita.

Utter nonsense. How is it "obvious," from this study or any other, that the British health care system is not worse than the American one?

Posted by: GOP on May 2, 2006 at 4:06 PM | PERMALINK

Ooh, there comes the tired argument again:

Waits for breast cancer treatment are getting worse as the NHS battles to meet a key target to speed up access to care, new figures revealed yesterday.

In the period from July to September last year, only 81 per cent of patients urgently referred for treatment for breast cancer were treated within the Executive target of two months - down from 86 per cent in the previous quarter.

In some cases, patients were still waiting more than 200 days for treatment, with the longest wait being 291 days. Waits for all other cancers were either improving or staying the same.

Meanwhile, waits for breast cancer treatment in the United States, for the 48 million Americans who were uninsured last year, were infinite. Well, until they got some emergency room care shortly before dying.

So let's see, that's 28% of Americans without insurance... 100-28... only 72% of Americans were able to have insured breast cancer treatment at all!

Yeah. That sounds really great.

It's so much better than what we've got it's not even funny, and it's among the worst of the many countries whose plans we might use.

Dumbass.

Posted by: S Ra on May 2, 2006 at 4:09 PM | PERMALINK
...but my interest and the American people's interest is in having better health at lower costs.

Sadly, this cannot be achieved within the current construct, in particular using your proposals of more health education and an expanded supply of MDs. The primary source of the inefficiency is the insurance companies, which unnecessarily raise transaction costs.

Posted by: SavageView on May 2, 2006 at 4:10 PM | PERMALINK

Because I think that innovation is more important than cost.
Posted by: jb

I bet you wouldn't feel that way if you couldn't afford medical care for you child ?

How much is a new version of Viagra or
latest cure for Restless Leg Syndrome worth if
you can't afford chemo ?

Posted by: Stephen on May 2, 2006 at 4:13 PM | PERMALINK

Michael784: Did they adjust for American destructive(self & others) tendencies?

Are you implying that the 2000 and 2004 elections could have long-term health risks attached? You may be right...hmmm....

Posted by: shortstop on May 2, 2006 at 4:15 PM | PERMALINK

My interests can be meet by means other than single payer.

Hasn't happened yet. Maybe it's time you got started...

Posted by: Stephen on May 2, 2006 at 4:15 PM | PERMALINK

Though I'm generally in favor of a single payor system, there is a major flaw in this argument: increased access to medical care does not lead to lower rates of illness (or longer life) except in situations like those of developing countries. Above a certain minimum level of health care availability, increased care may lead to improved quality of life (Viagra), reduced quality of life (receiving ineffective back fusion therapy for back pain, or reduced anxiety (getting lots of reassuring, expensive tests), but not necessarily to better health. I was just discussing this today with a colleague in orthopedics who has calculated that eliminating back fusion surgery in our county (a form of surgery probably doesn't work in any but a minority of cases) would pay for all the local uninsured population.

Steven Bratman, MD

Posted by: Steve on May 2, 2006 at 4:23 PM | PERMALINK

jb: Second - our crappy, wasteful, disorganized, unbalanced system is the only one that is consistently and robustly producing medical innovations. Not just NMEs (drugs), but all of the equipment and software and other stuff that goes along with medical practice.

That's because this is where you can make a killing. It is not, however, necessary for a killing to be made for medical innovation to happen.

Your gut may tell you that NHC will not decrease the rate of medical innovation. I say that 90+ years of communist and socialist experimentation has demonstrated that there are only two countries that have been highly innovative over the last century - the US and Japan. Dampening profits dampens innovation. I will admit to being dogmatic about that, because I have yet to see any compelling evidence to the contrary.

Um. Yeah. Well, let's see. Japan, you may notice, has universal health coverage.

Secondly, how much of that innovation was government-funded, i.e. socialist? A whole damn lot of it. NASA. DARPA. NIH. The American University system.

You may point out individual inventions created in socialist economies. And I will simply say that I didn't say all inventions occur in the US and Japan, just most.

And you're able to prove that with some sort of actual data? Or just your dogma?

You may say 'the rate of medical innovation isn't that high right now.' And I will say "As compared to what?" - what magical socialist wand is going to force people to find new ways to creatively come up with drugs? Because so far it doesn't exist. Wishing will not make it so.

All that is necessary for innovation in the provate sector is profit. Not ridiculous profit. Profit at all. Larger profits do not lead to more innovation.

Further, as I say, a huge chunk of the innovation in this country is government funded. Universities, the National Institutes of Health - these are the people coming up with life-saving treatments.

You may say "We don't need all that innovation, really." And I will say "Tell that to my mother, who died of Multiple Sclerosis just a few years before they came out with some of the excellent new treatments."

I'm sorry for your loss. However, I daresay those excellent new treatments are from university and government researchers.

I'm going to let you in on a little secret here: the for-profit medical industry doesn't want you to get better. They don't want to cure you. They want your money. The vast bulk of their research dollars are spent on chronic conditions that you will have to take medicine for the rest of your life. A cure for MS will not make them big bucks. Viagra makes them big bucks. They are not interested in cures, and they are especially not interested in cheap cures.

Which should be obvious. Because they're not out to help you. They are out to make money for their owners. That's their stated and overt goal.

The US medical innovation engine is incredibly messy, wasteful and unpleasant to look at. But if you want to replace it, you had best have compelling reasons why the replacement will be no worse on the innovation side. Because I think that innovation is more important than cost.

I think that innovation and cost are both important, and given the numbers I have seen and previously posted here there is no reason to believe that a single-payer system of national health insurance will impact innovation in the slightest. In fact, by freeing up a huge sum of money which currently is used for paperwork and overhead, more money will actually be available for research.

Posted by: S Ra on May 2, 2006 at 4:24 PM | PERMALINK

S Ra,

Meanwhile, waits for breast cancer treatment in the United States, for the 48 million Americans who were uninsured last year, were infinite.

More nonsense. Do you even understand the meaning of the word "infinite?"

Dumbass.

Posted by: GOP on May 2, 2006 at 4:24 PM | PERMALINK

Did they control for rain?

Did they control for the fact the British drive on the wrong side of the street?

Did they control for non-spherical errors?

Did they use a maximum likelihood estimator?

Did they control for the general lack of Bush-worshipping proto-fascists in Britain?

If all of these factors weren't accounted for, and another 300 can I pull out of the air, I won't believe any of this!!!!!!!! We have the greatest health care system in the WORLD!!!!!!!

Posted by: SavageView on May 2, 2006 at 4:26 PM | PERMALINK

Chad: "If its just that we pay doctors more. . ."

It's not. Its endemic to the whole system because the bottom line is not to provide health care, it's to make money.

jb:"Because I think that innovation is more important than cost."

Surely we should be more interested in health outcome than innovation for innovation's sake. That is just a diversion and the belief that behind every problem is a technological solution. Not saying innovation isn't a good thing, but outcomes is tha actual product of a healthcare system. It might be cheaper and more cost effective to tweak the production line rather than replace it. Wasn't there just an article about how many new drugs are NOT an improvement over previous drugs, but, since the research is done by the manufacturer, adverse results are supressed. Way to go FDA! There's a joke.

DelBoy: might want to look up the figures for the US, and how many poeople go untreated, or get a diagnosis too late, period.

Posted by: notthere on May 2, 2006 at 4:26 PM | PERMALINK

No one here addresses the awkward issue that having more doctors actually raises health care costs so while we might lower individual MD salaries by increasing supply, the system is hurt by a rise in aggregate cost due to more referrals to each other and tests (and this is not even counting increased training costs, etc. which the govt, through residency programs shoulders the cost of)...matt yglesias brought this up in the past when pointing out that Miami (I think--bear with me since this is based on recollection) has a ton of doctors but Medicare's costs are still a lot higher because doctors tend to defer to one another if they feel there is more specialized knowledge available, which of course there would be with more docs around...now if there was some overall health benefit to having more doctors around, this increased cost due to more supply might be justifiable but that seems unproven to say the least...

Posted by: v on May 2, 2006 at 4:26 PM | PERMALINK

GOP: More nonsense. Do you even understand the meaning of the word "infinite?"

I'd say "let me know when you finish reading that paragraph", but I don't really care.

Posted by: S Ra on May 2, 2006 at 4:27 PM | PERMALINK


Yes, what is S Ra talking about?

Has this program been shut down? http://www.ny.gov/governor/press/02/oct1_4_02.htm

I guess it's a lot easier to type the word "Dumbass" than it is to actually do some research.

And why do people post personal insults in the comments anyway? Do they think it helps advance their argument?

Posted by: albert on May 2, 2006 at 4:27 PM | PERMALINK
Do you even understand the meaning of the word "infinite?"

I can't speak for his understanding of the word infinite. I do note, however, that based on your earlier posting, you clearly do not understand the meaning or concept of inference.

Posted by: SavageView on May 2, 2006 at 4:28 PM | PERMALINK

Another thing one doesn't need to worry about is the
lawsuit when you slip and fall at the pool. If you are covered completely, you don't need to sue for medical expensences... Countries with Socialized medical have far fewer lawsuits of this nature.

Posted by: Rittler on May 2, 2006 at 4:31 PM | PERMALINK

SavageView,

I do note, however, that based on your earlier posting, you clearly do not understand the meaning or concept of inference.

I understand it perfectly well. You clearly have no idea what it means.

Posted by: GOP on May 2, 2006 at 4:32 PM | PERMALINK

But there are always two ways to look at this:

One, the commie liberal perspective: this is the result of the health care system (government), and that the only solution is a government one -- universal health care.

Two, the rational conservative perspective: this is the result of the obviously genetic inferiority of the American populace (individual), and that the only solution is the eliminate the genetically weak American race from the gene pool.

There, I think that just about covers it. Any questions?

Posted by: Dicksknee on May 2, 2006 at 4:33 PM | PERMALINK

Stefan,

I notice that you conveniently neglected to include the following statement in your carefully-selected set of quotes from the WaPo article:

"However, Britain's universal health-care system shouldn't get credit for better health, Marmot and Blendon agreed."

Posted by: GOP on May 2, 2006 at 4:37 PM | PERMALINK

DelBoy:
And just so peole know, The Shetlands are the most isolated part of the UK along with The Hebrides, and the Grampians the second most isolated mountain range after the Western Highlands.

As mentioned above, waiting lists are a constant topic of debate in the UK, unlike, until very recently, the poor and uninsured here. And this only because the vast middle class is seeing its coverage eroded.

Like everything, you pay for what you get and you set priorities as we have here. We pay more and we get less.

Posted by: notthere on May 2, 2006 at 4:37 PM | PERMALINK

Kevin
Daily KOS has a frightening post on the "ENZI" Bill. Here it is. Is it this bad? and why havn't anyone else blogged on it?http://www.dailykos.com/story/2006/5/2/151127/2173

Posted by: Dr on May 2, 2006 at 4:38 PM | PERMALINK
Utter nonsense. How is it "obvious," from this study or any other, that the British health care system is not worse than the American one?

Given the observations in Kevin's post, you cannot make this statement and possibly understand the concept of inference. Go back to school.

Posted by: SavageView on May 2, 2006 at 4:38 PM | PERMALINK

S Ra,

I'd say "let me know when you finish reading that paragraph", but I don't really care.

Anyone who thinks a year = "infinity" is clearly so ignorant of basic vocabulary that nothing he says need be taken seriously.

Posted by: GOP on May 2, 2006 at 4:40 PM | PERMALINK

SavageView,

Given the observations in Kevin's post, you cannot make this statement and possibly understand the concept of inference. Go back to school.

No, it's quite obvious that you don't understand the meaning of inference.

Go back to kindergarten.

Posted by: GOP on May 2, 2006 at 4:42 PM | PERMALINK

notthere,

Like everything, you pay for what you get and you set priorities as we have here. We pay more and we get less.

No, we pay more and we get more.

Posted by: GOP on May 2, 2006 at 4:43 PM | PERMALINK

The reason Brits have better health than you Yanks is so obvious I can't believe no one's mentioned it yet: it's the TEA!! My old Mum is 90, and is still swigging tea and she's healthy as a horse! Cor blimey.

Posted by: ExBrit on May 2, 2006 at 4:44 PM | PERMALINK

jb on May 2, 2006 at 3:57 PM:

that's why the death rate in the US went down by 4% last year, primarily driven by drug therapy.

Cite, please.

Second - our crappy, wasteful, disorganized, unbalanced system is the only one that is consistently and robustly producing medical innovations.

Novartis, Roche, Schering, Akzo Nobel...All American companies, right?

Your gut may tell you that NHC will not decrease the rate of medical innovation.

And my gut is usually right, except when it comes to women...Then I'm a glorious fool.

I say that 90+ years of...blah blah blah.

The search to find the cures for the common cold, cancer, and AIDS will still go on...The only difference is that people will be able to afford the treatment.

I will admit to being dogmatic about that, because I have yet to see any compelling evidence to the contrary.

Yet those horrible socialist Canadians manage to rank around 4th in the world in healthcare technology development...Can't remember the source; sorry.

And I will simply say that I didn't say all inventions occur in the US and Japan, just most.

So your earlier point is, well, invalid?

...what magical socialist wand is going to force people to find new ways to creatively come up with drugs?

Same way a lot of research is funded currently - government grants.

You may say "We don't need all that innovation, really."

Sorry about your Mom, but apparently the idea of trying to cure illnesses without a profit motive eludes you. Must really suck to go around always asking 'What's in it for me?' all the time.

The US medical innovation engine is incredibly messy, wasteful and unpleasant to look at. But if you want to replace it..

No one wants to replace 'innovation', just the system that uses the product of that innovation.

Because I think that innovation is more important than cost.

All the innovation in the world will do you no good if you can't afford to use it.

Posted by: grape_crush on May 2, 2006 at 4:45 PM | PERMALINK

Matt: There are a lot of things more valuable than good health, and liberals who suddenly think choosing worse health is not allowed have to explain why I am therefore allowed to wear tennis shoes without shoelaces.

Having read many of your posts, I think that, for your own safety, you should never be allowed to have shoelaces.

Posted by: alex on May 2, 2006 at 4:47 PM | PERMALINK

Kevin, you really are a moron.

1. Your cite states:

However, Britain's universal health-care system shouldn't get credit for better health, Marmot and Blendon agreed. Both said it might explain better health for low-income citizens, but can't account for better health of Britain's more affluent residents. Marmot cautioned against looking for explanations in the two countries' health-care systems. "It's not just how we treat people when they get ill, but why they get ill in the first place," Marmot said.

2. All white people really don't look (or age) alike.

The stupidity of this article (and your touting of same) is that white white people in Great Britain are NOT the same as white people in America. We have a far more varied genetic pool of white citizens.

Now, if the study isolated for that (WASPs of English descent, only), then it might be interesting.

The only thing we can learn from this article and your post, is that you're a moron.

But, we knew that.

Posted by: Norman Rogers on May 2, 2006 at 4:58 PM | PERMALINK

jb wrote: "...our crappy, wasteful, disorganized, unbalanced system is the only one that is consistently and robustly producing medical innovations. Not just NMEs (drugs), but all of the equipment and software and other stuff that goes along with medical practice."

Wrong. That's our formerly excellent (and incredibly socialistic) National Institutes of Health, not our medical care practicioners.

Of course, as the Bush cabal ratchets back NIH spending, the ratio of US to European papers in top journals is declining.

Posted by: John on May 2, 2006 at 5:09 PM | PERMALINK

"Explain to me again why we're afraid of this?"

Come on Kevin, you know the answer is profits.

Posted by: Chris Brown on May 2, 2006 at 5:09 PM | PERMALINK

white white people in Great Britain are NOT the same as white people in America. We have a far more varied genetic pool of white citizens.

Oh, I see. Our white population is diseased and inferior, because it contains more Jews, Polocks, Italians and other undesirables. That's why our health care system costs more.

Kevin: the reason we're still debating this is that the GOP is still paying trolls to "debate" it.

Posted by: brooksfoe on May 2, 2006 at 5:09 PM | PERMALINK

One of the most irritating arguments about medical innovation and profits is it implication that innovators are in it primarily for the money. This is true for some business people, but not for many medical researchers and other scientists. Perhps the best example was Jonas Salk who devloped a polio vaccine and refused to patent it, so it could quickly be employed against that disease. Most scientists do not do science for the bucks. And the importance of shareware and the like in the net is further evidence that innovators in general often do not seek lots of money, though they rarely turn it down.

Public funs are an excellent way to fund medical research - and have the added advantage of not needing to grant monopoly patents to the companies claiming discovery.

Posted by: Gus on May 2, 2006 at 5:10 PM | PERMALINK

Innovation?

How many of the major research labs are in England (like Glaxo SmithKline's is) of Belgium (GSK again), or France (SanofiAventis) or Switzerland (Roche)? Not to mention Norway (NovoNordisk).

How many of them are in universities(too many to list here).

How many of them are publicly funded (NIH, to name just one of many).

Do a little research, and you find out that many of the wonder drugs sold by major pharma are in fact products they licensed from university labs, or got from the government. If you read the small print in the annual report, you can trace the money. While you're doing that, look at the advertising budget. It's almost always larger than the research budget.

Posted by: CN on May 2, 2006 at 5:10 PM | PERMALINK

Norman wrote: "The stupidity of this article (and your touting of same) is that white white people in Great Britain are NOT the same as white people in America. We have a far more varied genetic pool of white citizens."

Then, according to what we know about genetics, the expected result is that our hybrid vigor would make us healthier than the more inbred Brits.

Sorry, Norman, but correcting for genetics just makes the US healthcare system look even worse.

Posted by: John on May 2, 2006 at 5:11 PM | PERMALINK

I am also relieved to find that GOP is still unable to assimilate or process actual information. As Stephen Colbert puts it, just go with your gut, GOP - ignore all those stupid facts.

Posted by: brooksfoe on May 2, 2006 at 5:11 PM | PERMALINK

Doesn't pass the sniff test. British lower class has betetr health than American upper class? That doesn't make any sense based on any comparison of the two health systems. No one denies that the affluent get great care in the US. Where are they conceivably lacking where the British lower class gets better care?

So something else is going on here, something that is quite possibly contaminating the other results as well.

Particularly since my experience of English lower class was how many chain smokers they have, which has to have a devastating impact on their health in the long run. (Which points to the flaw in "it obviously isn't worse" arguments. I could use the exact same logic to "prove" as a result of this study that higher smoking don't lead to more deaths".)

The main explanation that jump out at me is exercize. Brits walk a lot - they have to. Even the affluent. I dropped 15 pounds living in London for four months just because of all the walking I had to do every day, even living in a tonier part of London. Towns aren't designed well for traffic. And mass transit goes almost everywhere you want.

Plus, the BBC sucks, cable/satellite access is more limited and homes are cramped spaces with no room or design for things like home theaters. So the typical entertainment experience involves walking somewhere.

Meanwhile, most Americans are quite sedentary. Even if you control for obesity you aren't controlling for the amount of exercize, which has a substantial impact on major killers like heart disease.

Not that I am opposed a single payer system. I am increasingly convinced that we don't have another choice. But I wouldn't hang your hat on one study that raises more questions than it answers.

Posted by: Raskolnikov on May 2, 2006 at 5:13 PM | PERMALINK

Enough with the "limited resources" B-S.

Near Seattle, two local hospital empires are battling public authorities because the empires want to build more hospitals, and the law says they can't.

This law was passed because when there are too many hospital beds, they mainly sit empty, and the cost is imposed on the actual patients, making their stay more expensive than it need be.

Now, whatever you call it when private enterprise healthcare wants to build too many hospitals, it ain't "limited resources".

Do the world a favor and whenever you see that "limited resource" meme pop up, club it in the head with the nearest available facts. I know, it's like pulling dandelions, but every litle bit helps.

Posted by: serial catowner on May 2, 2006 at 5:15 PM | PERMALINK

Though I'm generally in favor of a single payor system, there is a major flaw in this argument: increased access to medical care does not lead to lower rates of illness (or longer life) except in situations like those of developing countries.

I defer to Steven Bratman, MD's presumably greater knowledge of the US healthcare system. But if more healthcare doesn't much improve health, isn't it all the more imperative that we get it as cheaply as possible - i.e. via a single-payer system?

Posted by: brooksfoe on May 2, 2006 at 5:16 PM | PERMALINK

I'm very skeptical of NHC. Tell me again how it saves money?

Posted by: the fake Fake Al on May 2, 2006 at 5:18 PM | PERMALINK

If everyone has health care how do you separate the people with money from the riff-raff?

Also... getting ill is natural.

If we had less illness what would that do to our economy?

Also.... all white people aren't created equal.
The less equal ones are the ones that get sick.

I don't think we owe them a living.
Or even medicine.

Everybody has a right to get sick and die.

You shouldn't ask others to help them get healthy.

That's worse than trying to play policeman to the world.

That's like trying to tell other countries what kind of government they should have.

Posted by: Norman's republican wife on May 2, 2006 at 5:18 PM | PERMALINK

No, we pay more and we get more.

Posted by: GOP on May 2, 2006 at 4:43 PM | PERMALINK

If you can bring yourself to agree that health outcome is what we need from a healthcare system (not profits. If not, define what) then what "more" do we get?

Innovation? Nothing wrong with the drug companies in Europe last time I looked. Also teaching/research hospitals seem also to make the news.

And why do these creeps immediately associate universal health care with socialism when they then go on to talk as if it's communism? Talk about non-sequiturs and ill-defined word use.

I have't seen it brought up the couple of months I've been writing here, but there is also the economic benefit to the nation from better health care. A healthier work force is more productive, less lost production, etc.

Posted by: notthere on May 2, 2006 at 5:20 PM | PERMALINK

Explain to me again why we're afraid of this?

It will cost the Americans Who Matter lots of money, which is why some will be taught to say that it's a bad idea, others will listen to them, and most will go on be misinformed and confused.

The problem isn't meant to be solved, it's meant to be profitable. And that is enough.
.

Posted by: Grand Moff Texan on May 2, 2006 at 5:24 PM | PERMALINK

"Explain to me again why we're afraid of this?"

Because the Politic of Fear (tm Republican't Party) extend to health care policy?

Posted by: Cal Gal on May 2, 2006 at 5:24 PM | PERMALINK

The only thing we can learn from this article and your post, is that you're a moron.

But, we knew that.

Posted by: Norman Rogers on May 2, 2006 at 4:58 PM | PERMALINK

Er . . . better look in the mirror.

Britain is a bunch of mongrels just like us. Read their history and look at recent immigration. If the researchers did isolate for racial purity or semi-purity, we would likely come out even worse against French, Germans and Nordics, who, though not quite as cheap as the UK, have even better outcomes.

Posted by: notthere on May 2, 2006 at 5:26 PM | PERMALINK

I have a chronic illness that is under control (Type I Diabetes).

I have work-provided health insurance under which I am covered, which provide extensive coverage. I have no problem paying co-pays (I make good money) and am happy to pay extra for better service. I happily pay EXTRA to have enhanced insurance. I don't expect 100% coverage of my costs, only some cost relief.

As a result of my (genetic, not lifestyle) condition, I must see doctors frequently for PREVENTITAVE care (Endocrinologist 4x per year, Eye exam by Opthamologist 1x per year, Cardiologist semiannually, annual Physical). I eat right, exercise, and keep my body in good shape. My diabetes is completely under control. I am a model patient.

The health care system in this country is utter shit. It still takes MONTHS in advance to arrange for doctors appointments. Yes, months. I cannot see any doctor in my area, a major city, without making an appointment 4 weeks in advance or more. When people tell me you 'have to wait' in Canada, I laugh my ass off. They obviously never try to see a doctor here and assume they waltz right in. WRONG. I can't tell you how many times I have made an appointment 4 months in advance, had the doctor cancel on me, then be told I could see the doctor three months later.

Prescriptions? For a long time they paid in full for insulin ($0 copay) but completely refused to pay for NEEDLES for the insulin (you must have needles to inject the insulin). I literally need insulin to live, but apparently getting it in my body is my problem. This is not boner pills or allergy relief. I die if I go without insulin, it can;t get any more medically necessary than that.

I've had multiple situations where doctors refused me care when I offered to pay cash to avoid an insurance company hassle. Did you all know that many insurance companies PROHIBIT plan doctors from seeing people on a cash basis? Yes, prohibited on pain of being dropped from the plan.

As far as I can see, I have rationing with long waits AND I can't see the doctor I prefer if they are not on my plans. My prescriptions are sometimes covered, sometimes not with no medical or cost savings rationale. Paying cash for doctors is not an option according to the insurance company's own rules.

It is clinically proven that preventitive care will keep me from needing very expensive treatments (like organ transplants), yet all insurance companies make me jump through a million hoops to see doctors who can help me because they are "specialists". Even though I have a chronic, incruable condition, I am treated like I am 'doctor shopping' for invented complaints even though I am following the care guidelines the INSURANCE COMPANY recommends.

Speaking as someone who uses the healthcare system frequently (which most of you do not, luckily), I can state with certainty that it is NOT set up to deliver healthcare, even if you can pay for it. Insurance companies would be thrilled if you died without billing them for medical care. Remember, I HAVE A PROFESSIONAL JOB, and am not the Welfare Boogeyman or some Senior on death's door.

I'm switching jobs in a few months, so I will get to learn a whole new set of rules because I cannot take my insurance plan with me. If I am very lucky I will be able to keep seeing my excellent doctors on the new plan.

Also, how many of you realize that if you go to an off-plan doctor EVERYTHING they treat you with is not covered? It's not just the doctor's visit you pay for ($100). It's $500-$1000 in labwork added to that, because you went to the 'wrong' doctor. If that off-plan doctor discovers you have cancer, and starts you on chemo immediately, you are royally fucked.

I better pray I never lose my job, because no one will insure me- I have a pre-existing condition. No matter how much money I want to throw at insurance companies, they do not want me. If everyone had insurance I would be part of a large risk pool and my extra costs would not matter much. There are so many uninsured with diabetes it looks like a condition that leads to very expensive complications all the time. WRONG. Preventative care can keep all that from happening.

When a white, well-educated, well-paid person with insurance living in a major city can't get decent medical care, something is seriously wrong. I have every advantage, I am (mostly) not sick, and am getting what amount to checkups yet there are constant roadblocks, hassles, and instances where I just can't get care. You better all hope and pray you never have a serious chronic illness.

If you think the healthcare system is good, you are fucking crazy or, more likely, you never actually use it, which is why you are happy. Funny, I never see cancer survivors or people with MS crying about 'socialized medicine'.

News flash- everyone gets old or sick eventually.

Posted by: Longtime Reader on May 2, 2006 at 5:31 PM | PERMALINK

The disparity in health outcomes,in a country with an infant mortality rate that ranks in the twenty something range among the industrialized countries but I digress,is readily explainable through the gene pool. By having a country that has taken the tired,the poor,the hungry masses,it says so right by the front door,we set ourselves up genetically for poor health outcomes. Either that or the intelligent designer put us down for good natural resources,lousy overall health. Single payer makes sense to me,I can always find some doctor willing to refuse to see the nationally insured as readily as the presently insured,and make money in private practice. Any place there's a market there's a black market.

Posted by: TJM on May 2, 2006 at 5:32 PM | PERMALINK

"The CEO of HealthUnited has 1.6 billion in unexercised stock options. $1.6 billion of the money we spend on "healthcare" is aimed at this one guy's pocket. "

Just wanted to repeat that. That right there (and the myriad other guys just like him in our "health care" system, is why we pay twice as much. Why we're not as healthy is another question.

On a slightly different point, I betcha a LOT of doctors would welcome single payer. Based on no evidence other than talking to doctors, who all seem to revile the health insurance companies and their meddling and paperwork.

Posted by: Cal Gal on May 2, 2006 at 5:35 PM | PERMALINK

We can afford and implement a good national health program. Why are we afraid of it? Damn good question.

Coincidentally, I know a number of farily rich people who are afraid of such a system. I can't think of any low income or lower middle class folks afraid of it.

Posted by: little ole jim from red country on May 2, 2006 at 5:40 PM | PERMALINK

hough I'm generally in favor of a single payor system, there is a major flaw in this argument: increased access to medical care does not lead to lower rates of illness (or longer life) except in situations like those of developing countries. Above a certain minimum level of health care availability, increased care may lead to improved quality of life (Viagra), reduced quality of life (receiving ineffective back fusion therapy for back pain, or reduced anxiety (getting lots of reassuring, expensive tests), but not necessarily to better health. I was just discussing this today with a colleague in orthopedics who has calculated that eliminating back fusion surgery in our county (a form of surgery probably doesn't work in any but a minority of cases) would pay for all the local uninsured population.

Steven Bratman, MD

Posted by: Steve on May 2, 2006 at 4:23 PM

And one of the advantages of a universal health care system is that lifetime tracking of patient outcomes can make it easier to determine which treatments, tests and drugs are most effective and which look good in clinical trials but have poor long-term results when implemented more widely.

This is one of the reasons why the VA health care system has gone from a major disaster to one of the best health care systems in the United States.

Posted by: tanj on May 2, 2006 at 5:43 PM | PERMALINK

I urge you to read Dr. Marmot's book, The Status Syndrome. It will change the way you think about health, well-being and longevity. We are even more the social creature than we once thought. The quality and egalitarianism of our social relationships have enormous influence on our well being.

Posted by: Dale on May 2, 2006 at 5:45 PM | PERMALINK

I'm switching jobs in a few months, so I will get to learn a whole new set of rules because I cannot take my insurance plan with me.

good luck.

at the beginning of the year, my employer Company A, switched providers. so, i had to get all new prescriptions and fill out new paperwork everywhere - not a big deal, just a small hassle. and, of course, higher premiums.

then, in Feb, Company A sold us to Company B. then we had to get all new prescriptions and fill out new paperwork - and, of course, higher premiums . and this time, some of my long-time prescriptions weren't covered, and rather than pay $150/mo for the drugs that were working for me, i switched to something else, which doesn't work quite as well.

then, in March, i quit Company B and joined Company C. another round of new prescriptions and forms, more non-covered drugs, new out-of-plan doctors - and, of course, higher premiums.

so, that's four different insurance plans in 4 months. the doctors don't know which insurance company to send the bills to (they don't send the bills quick enough to keep up with our changing insurance coverage), so 3rdparty providers, like LabCorp, are sending PAST DUE!!! notices for services insurance policies 1,2 and 4 wouldn't cover (3 would, but they didn't know to bill 3 because that policy was only in effect for two weeks).

having a single policy (that i could afford) that was tied to me and not to my employer or my employer's annual budget crisis would be totally fucking awesome, and i bet the providers would like it too - it would sure cut down on the amount of paperwork they have to keep track of.

Posted by: cleek on May 2, 2006 at 5:52 PM | PERMALINK

From right up at the top:

"Did they normalize for religion? Maybe god just likes Anglicans more than Baptists and Catholics?"

I'm sorry but NOBODY goes to church here (well very few). On the other hand there is a lingering feeling that God is an englishman

Posted by: Ewan Husarmee on May 2, 2006 at 5:53 PM | PERMALINK

I notice that you conveniently neglected to include the following statement in your carefully-selected set of quotes from the WaPo article:

Probably because Neil had just included that quote at 2:42 PM a few posts above mine....

But "carefully selected"? Nothing of the sort, I just randomly cut and posted portions without even looking at them.

Posted by: Stefan on May 2, 2006 at 6:13 PM | PERMALINK

"It's not just how we treat people when they get ill, but why they get ill in the first place," Marmot said."

And here's a point: a system that doesn't exclude is usually a system that tries to ensure that people don't get ill in the first place. That's the advantage of not being able to kick people out of the pool.

Posted by: ahem on May 2, 2006 at 6:13 PM | PERMALINK

Longtime Reader: great post.

My wife is a breast cancer survivor. She had chemo last year and she met all her deductible/caps/copays of a major Texas insurer. Midway through treatment the surgeon drops the insurance company over payment levels, presumably.

The surgeon 'works' with us and offers to stay on the case for only an additional $1000 over the insurance payment. My wife's peace of mind was worth the additional grand so we agreed.

Then she had surgery at a major Austin hospital.

Surprise! The hospital used a lab that is not part of our insurance company's network. We were not offered a choice, we were not told until we got the bill: $1400 more out of pocket. So we got to haggle with the hospital, lab and insurance company for several months to reach a settlement of about half.

Then the surgeon's office bills us $1800. They claimed the $1000 was a 'ball park estimate.' We get to haggle some more and eventually pay just the extra grand.

My wife is now healthy. The quality of care was excellent. The chemo nurses were awesome. We were very lucky and the entire treatment fit in a single year so we only had one set of deductibles to meet. But our out of pockets for the year were daunting and the business experience was unbelieveably disappointing.

If this is the best this country can do, we are screwed.

And to echo a point made above: preventive procedures are not covered by my insurance. With extremely high deductibles/out of pockets a routine such as a colonoscopy costs a lot. People avoid these procedures due to cost.

Posted by: Nat on May 2, 2006 at 6:17 PM | PERMALINK

brooksfoe,

am also relieved to find that GOP is still unable to assimilate or process actual information. As Stephen Colbert puts it, just go with your gut, GOP - ignore all those stupid facts.

I'm relieved to learn that brooksfoe is still unable to read simple English.

Go with your emotions, brooksfoe - ignore all those stupid facts.

Posted by: GOP on May 2, 2006 at 6:19 PM | PERMALINK

Shorter GOP - "I know you are, but what am I?"

Followed of course by sticking fingers in his ears to make sure any facts don't leak in.

Posted by: tanj on May 2, 2006 at 6:27 PM | PERMALINK

notthere,

If you can bring yourself to agree that health outcome is what we need from a healthcare system (not profits. If not, define what) then what "more" do we get?


See, for example, this article from a British health economics professor:

"Rationing involves depriving patients of care from which they could benefit and which they wish to consume. The British are much more vigorous than Americans are in "drawing the line," as Henry Aaron, William Schwartz, and Melissa Cox show in Can We Say No? ...

"Then and now the authors show that the British spend less on health care and consequently provide less care for their citizens....

"relative gaps in provision remain large and have increased since the 1984 book. So while the funding of care for patients with chronic renal failure in the NHS has given elderly patients increased access to dialysis, provision in this and other specialist areas remains inferior to that in the United States....

"The authors examine relative provision in a number of other areasincluding hemophilia, stem cell transplantation, hip replacement, cardiac revascularization, and intensive carewhich affect the relative quality and length of life of patients in the two countries. In all of these areas, although the United Kingdom is providing absolutely more care than in 1984, the gap between British frugality and American generosity is widening."

If you want yourself or your loved ones to die early of cancer, heart disease, kidney disease, etc., and to suffer years of chronic pain and disability before that happens because the government denies you health services you need, by all means move to Britain or Canada or some other country with government-run health care.

Posted by: GOP on May 2, 2006 at 6:30 PM | PERMALINK

The really sad thing about the US system is apparently the lack of mental health benefits in Texas.

Posted by: shortstop on May 2, 2006 at 6:31 PM | PERMALINK

shorter tanj: I'm a moron.

Posted by: GOP on May 2, 2006 at 6:31 PM | PERMALINK

I'm not terribly suprised that even well off people will have poorer healthcare in the US than even poorer people in Britain.

The higher income people being discussed probably aren't Dick Cheney rich, healthcare analysts don't tend to care much about the super rich because they are such a tiny minority. It is more likely that they are talking about the top 20% or something, and most of those people still have jobs and get healthcare not dramatically different from any american who happens to have health insurance. Sure it is a bit better than average, they will have dental, vision, higher coverage levels, more choice and they won't lack coverage often but generally they are still in the private insurance system.

In addition poor people in Britain have NHS coverage from birth to death, some top fifth americans will have been bottom half americans when they were young (just because older people make higher salaries and have more investments). Even if they weren't they still have to switch providers when they change jobs, when thier company changes thier plan, etc. Americans don't tend to go to the same doctor for very long and that makes some kinds of preventative care difficult to provide. Health care is almost entirely about regular and consistent cheap preventative care and that is something universal coverage provides and our system fails to provide.

Posted by: jefff on May 2, 2006 at 6:34 PM | PERMALINK

ahem,

And here's a point: a system that doesn't exclude is usually a system that tries to ensure that people don't get ill in the first place. That's the advantage of not being able to kick people out of the pool.

The authors deny that the study supports the idea that the statistical differences in health status between the two countries are attributable to their health care systems:

"However, Britain's universal health-care system shouldn't get credit for better health, Marmot and Blendon agreed."

Posted by: GOP on May 2, 2006 at 6:37 PM | PERMALINK

Attention friends!

Be advised that 'GOP' is the same commenter who used to post under the handle 'Don P.'

He is a psychopath. Fortunately, our old friend Pale Rider outed him back in December 2005 in the 'Narnia' thread. See below:

D.H.Griffin of Texas Clears
Louisiana State Office Buildings

At exactly 9:00 am on Saturday November 29, 2003, NADC members D.H. Griffin of Texas, Inc. (DHGT) and Demolition Dynamics, Inc. imploded the Education and the Land & Natural Resources Buildings located in downtown Baton Rouge, Louisiana for the State of Louisiana's Department of Facility Planning and Control.

The "Education" Building was a 14-story steel structure that was 180 feet tall. The "Land & Natural Resources" Building was a 14-story steel structure that had a 6-story penthouse on top and stood 220 feet tall. Workers prepared the structures for the explosives by precutting the steel members and loading 592 explosive charges in 388 positions. The implosions were initiated to go off four seconds apart, the Education Building first and the Land & Natural Resources four seconds later. The separation in the implosions lessened the concussion.

Hey, maybe I'll ask this guy if he knows a kooky, violent ex-con named Donna...

alan@dhgt.com

Address:
8690 Lambright Road
Houston, Texas 77075

Telephone Numbers:
Texas 713-991-4444
Outside of Texas 888-234-3448
Fax 713-991-4445

Internet Mail:
General Inquiries generalinfo@dhgt.com

President
John F. Angelina jfa@dhgt.com

Estimating/Business Development
Joe LeClair jel@dhgt.com

Environmental Affairs
Dr. William L. Holt drwholt@dhgt.co

Posted by: Pale Rider on December 12, 2005 at 3:00 PM | PERMALINK

Posted by: obscure on May 2, 2006 at 6:39 PM | PERMALINK

The U.S. will never have universal health care -- it is simply not in the American mentality to consider the health and well being of others. Period.

Now, universal gun ownership is another thing.

I suggest that if you want to institute universal health care I suggest that Congress write into the law a provision where everyone who signs up gets a free AK 47 Assault Rifle.

The idea of being able to pump holes in your fellow citizen will overcome the negative effects of knowing your fellow citizen can go to the doctor without worrying whether they will be covered.

Posted by: Dicksknee on May 2, 2006 at 6:41 PM | PERMALINK

jefff,

I'm not terribly suprised that even well off people will have poorer healthcare in the US than even poorer people in Britain.

Well off people don't have poorer healthcare in the US than even poorer people in Britain.

In addition poor people in Britain have NHS coverage from birth to death,

That doesn't mean they get better health care than poor people in the U.S.

Even if they weren't they still have to switch providers when they change jobs, when thier company changes thier plan, etc.

That isn't necessarily true. Obviously, many employers use the same providers.

Americans don't tend to go to the same doctor for very long and that makes some kinds of preventative care difficult to provide.

Show me your evidence for this claim.

Health care is almost entirely about regular and consistent cheap preventative care and that is something universal coverage provides and our system fails to provide.

No, health care is not almost entirely about that. No, our system doesn't fail to provide it.

Posted by: GOP on May 2, 2006 at 6:43 PM | PERMALINK

The disparity in health outcomes,in a country with an infant mortality rate that ranks in the twenty something range among the industrialized countries

International comparisons of infant mortality rates are problematic because of differences in definitions and recording practises between countries. Many deaths that are recorded as infant mortalities in the U.S. would be recorded as stillbirths or perinatal deaths in other countries. This inflates the official U.S. infant mortality rate in comparison to those of other countries.

Posted by: GOP on May 2, 2006 at 6:48 PM | PERMALINK

Maybe because we have to run to the doctor every time we have a sniffle or just don't feel good that morning.I have not been to a doctor in 13 years and before that twice in my life I still pay through the nose for health care.I say everytime you go see doc It should cost you more.

Posted by: Booo on May 2, 2006 at 6:49 PM | PERMALINK

obscure,

[GOP] is a psychopath.

obscure is criminally insane.

Posted by: GOP on May 2, 2006 at 6:51 PM | PERMALINK

What GOP/Don P is really about is jerking the chains of the 'liberals' here at Kevin's blog.

He hasn't recovered from wounds inflicted months ago by notable posters such as cmdicely and Secular Animist.

Evidently he works for DH Griffin in Houston, Tx.

Posted by: obscure on May 2, 2006 at 6:52 PM | PERMALINK

GOP wrote: Show me your evidence for this claim.

You never, ever, ever provide any evidence for any of your claims.

Posted by: Don P. on May 2, 2006 at 6:53 PM | PERMALINK

Aris: "...you should feel free to add more responses so that we can have a more comprehensive list for next time."

My contribution.

ConservativeThink:
The Communists have universal health care.
The Communists are Godless.
Therefore, God hates universal health care.

Posted by: PTate in MN on May 2, 2006 at 6:55 PM | PERMALINK

I need my lithium!

Posted by: obscure on May 2, 2006 at 6:58 PM | PERMALINK

Medical students start getting socizalized (pardon the pun) into thinking that one-payer health care is the devil in medical school. I met my doc ex-husband in 1957 when he was a freshman and I was a nursing student and by 1958 he was against it and remains so to this day at age 73! Some of our most voiciferous fights had to do with this subject until we divorced 10 years after we married in 1971.

Until we win the docs over who think it is not in their self-interest, the politicians won't touch this with a 10 foot pole.....unless the present system collapses and everyone sees we can't go on this way.

Medicare works pretty well. However, I live in one of the "richest" counties in Texas (Collin) with not too many old folks (66) like me. Most great docs won't take Medicare because they don't get paid enough for it so I have to treck 30 miles into Dallas to get high quality health care. There are more Medicare recipients there so more docs take it. Interesting, most specialists do take Medicare around here but they don't advertise it. Being older is like having leprosy here!

Posted by: Rain on May 2, 2006 at 7:12 PM | PERMALINK

I'm surprised no one yet has mentioned that the Brits may be healthier because they have six weeks vacation a year and work a shorter day than Americans.

Posted by: meffie on May 2, 2006 at 7:27 PM | PERMALINK

I think rain is on to something--part of the resistance to universal coverage stems from the AMA, medical training and the socialization given doctors. We assume the capitalist model works with health care.

Medicine is a very high status job that pays very well. At least it pays specialists very well. The med students and interns live on nothing for years and work nightmare hours. How many times have you heard a doctor rationalize his income by talking about paying his dues during the years of lean? And the highest paid doctors are the technocrats--the brain surgeons, the heart surgeons, the anesthesiologists. They have no incentive to support a health care system that emphasizes preventitive care over the high tech gizmos that make them rich.

If the docs got behind a universal health care system, it would have a better chance of becoming real.

Posted by: PTate in MN on May 2, 2006 at 7:30 PM | PERMALINK

From GOP:

"International comparisons of infant mortality rates are problematic because of differences in definitions and recording practises between countries. Many deaths that are recorded as infant mortalities in the U.S. would be recorded as stillbirths or perinatal deaths in other countries. This inflates the official U.S. infant mortality rate in comparison to those of other countries."

Source??

Posted by: smuggler on May 2, 2006 at 7:35 PM | PERMALINK

meffie: I'm surprised no one yet has mentioned that the Brits may be healthier because they have six weeks vacation a year and work a shorter day than Americans.

That's even more un-American than Red Commie Socialist Medicine.

Posted by: GOP on May 2, 2006 at 7:35 PM | PERMALINK

Well off people don't have poorer healthcare in the US than even poorer people in Britain.

Show me your evidence for this claim.

That doesn't mean they get better health care than poor people in the U.S.

Show me your evidence for this claim.

That isn't necessarily true. Obviously, many employers use the same providers.

Show me your evidence for this claim.

No, health care is not almost entirely about that [regular and cheap preventative care]. No, our system doesn't fail to provide it.

Show me your evidence for this claim.

Posted by: Stefan on May 2, 2006 at 7:41 PM | PERMALINK

No, we pay more and we get more.

Show me your evidence for this claim.

Posted by: Stefan on May 2, 2006 at 7:43 PM | PERMALINK

Stefan: Show me your evidence for this claim.

I don't have to show anybody any evidence for any of my claims. I'm the GOP.

Posted by: GOP on May 2, 2006 at 8:02 PM | PERMALINK

GOP, you ignorant git. You love picking one thread without looking at the whole weave.

In GOP's world it's all well and good to quote from a book review without reading the book (6:30 PM).

content.healthaffairs.org/cgi/content/full/24/6/1677

But here's how the reviewer sums it up:

"With relative parsimony in the NHS and relative generosity in the U.S. health care system, rationing remains ubiquitous and unavoidable. The American rich clearly do not like this notion even though spendthrift, evidence-free care can create a damnable quality of life and an unpleasant death.

"This book is a well-written and insightful analysis of the challenges facing decision-makers in both countries. The authors focus on the inevitability of rationing, on funding what is a proven benefit to patients, and on the better incentivization of efficiency is welcome. God grant us all a humane and well-supported demise with a minimum of evidence-free, expensive high-technology intervention when we die in our affluent societies!"

===========
There are innumerable examples of how awful the US system can be too, and that's STILL IGNORING the uninsured.

Posted by: notthere on May 2, 2006 at 8:03 PM | PERMALINK

Stefan,

In order...

Show me your evidence for this claim.

Certainly. Just as soon as Jefff provides his evidence that "even well off people will have poorer healthcare in the US than even poorer people in Britain."

Show me your evidence for this claim.

It just doesn't follow logically. The premise "poor people in Britain have NHS coverage from birth to death" doesn't support the conclusion that they get better health care than poor people in the U.S.

Show me your evidence for this claim.

Large health insurers like Kaiser and UHC provide health care coverage for hundreds or thousands of employers.

Show me your evidence for this claim.

Emergency care, for example, is not preventive care.

Show me your evidence for this claim.

I already did. See my post of 6:30pm

Posted by: GOP on May 2, 2006 at 8:06 PM | PERMALINK

notthere,

GOP, you ignorant git.

notthere, you worthless piece of trash...

In GOP's world it's all well and good to quote from a book review without reading the book (6:30 PM).

Yes, it is. And your point is....?

There are innumerable examples of how awful the US system can be too, and that's STILL IGNORING the uninsured.

This is a complete nonsequitur. You asked, "What "more" do we get?" and I cited and quoted from the article to answer that question.


Posted by: GOP on May 2, 2006 at 8:11 PM | PERMALINK

smuggler,

Source?

See, for example, Wikipedia's entry on infant mortality:

"Comparing statistics for IMR across countries can be a useful indicator of their level of health and development, but the method for calculating IMR often varies widely between countries based on the way they define a live birth. The World Health Organization defines a live birth as any born human being who demonstrates independent signs of life, including breathing, muscle movement, or heartbeat. Many countries, however, including certain European states and Japan, only count as live births cases where an infant breathes at birth, which makes their reported IMR numbers somewhat lower and raises their rates of perinatal mortality."

Posted by: GOP on May 2, 2006 at 8:15 PM | PERMALINK

Great discussion guys. Even GOP was doing ok until he started refusing to proviude even the thinnest rational for his statements of seeming fact.

Then... not so much.

Posted by: CK Desxter Haven on May 2, 2006 at 8:21 PM | PERMALINK

And he thinks that post documents his statement about how the US defines infant mortality v how GB does.

It just gets better and better.

Posted by: CK Dexter Haven on May 2, 2006 at 8:23 PM | PERMALINK

"lack of mental health benefits in Texas"

Aw, that's good.

Posted by: little ole jim from red country on May 2, 2006 at 8:27 PM | PERMALINK

"Certainly. Just as soon as Jefff provides his evidence that "even well off people will have poorer healthcare in the US than even poorer people in Britain."

Despite my mangled sentence you might recall that this thread was inspired by a report about a study which makes that claim, among others.

If you want evidence of their claim read their study.

If you want evidence of my lack of suprise the post is it.

Sheesh you have made 20 posts in this thread alone over the past 4 hours.

Posted by: jefff on May 2, 2006 at 8:36 PM | PERMALINK

So why are rich Americans as sick as poor Britons?
All I can think of is that our system must be actually warping the medical care itself in some way.

Posted by: Kevin on May 2, 2006 at 2:59 PM | PERMALINK

Someone else posted above about the stress of being less secure, as in job insecurity, financial insecurity, home insecurity, fear, fear everywhere. The upper class are just as anxious worrying about their money lest the people who do the work to make that profit want to share in some of it.

In other words, it's not just the medical system that is warped, it's our whole culture that is warped.

Posted by: NeoLotus on May 2, 2006 at 8:46 PM | PERMALINK

jefff,

Despite my mangled sentence you might recall that this thread was inspired by a report about a study which makes that claim, among others.

Er, where does the report say that the study claims that "even well off people will have poorer healthcare in the US than even poorer people in Britain?" Did you even read the report?

Posted by: GOP on May 2, 2006 at 8:50 PM | PERMALINK

GOP, you ignorant git,

because a book review, by definition, if it includes any statistics at all, is exclusionary of the whole. A book review in the National Review is probably a different view from New Society. That's why I included the reviewer's sumary, to which you had no reply.

You don't make an argument, you are a propagandist.

Posted by: notthere on May 2, 2006 at 8:51 PM | PERMALINK

notthere,

GOP, you ignorant git,

notthere, you pathetic piece of garbage

because a book review, by definition, if it includes any statistics at all, is exclusionary of the whole.

Gibberish. What part of "the British spend less on health care and consequently provide less care for their citizens" don't you understand?

Posted by: GOP on May 2, 2006 at 9:03 PM | PERMALINK

But then...we could not fund NATO, etc... Needed or not, we direct most of our economy into defense, no matter who is in power. Secondly, I believe the "health care industry" would fight a national health care system tooth and nail, they have up to this point.

Posted by: Ben Merc on May 2, 2006 at 9:07 PM | PERMALINK

GOP, you ignorant git,

"At every point in the social hierarchy there is more illness in the United States than in England and the differences are really dramatic," said study co-author Dr. Michael Marmot, an epidemiologist at University College London in England.

....The upper crust in both countries was healthier than middle-class and low-income people in the same country. But richer Americans' health status resembled the health of the low-income British.''

as quoted at the top. And, as also implied, the cultural and other influences that may bring about health outcome differences are hard to quatify. I looked around last night for another thread and didn't come up with much to help. But Wikipedia and your assertions do not count for much either.

Try this to show some actual national differences:

www.who.int/docstore/bulletin/pdf/2000/issue6/buo585.pdf

Posted by: notthere on May 2, 2006 at 9:08 PM | PERMALINK

Please don't feed the trolls.

Posted by: alex on May 2, 2006 at 9:10 PM | PERMALINK

This thread is proof positive that Americans are getting the health care they deserve -- the worst and most expensive of any industrialized country on the planet (at least according to the WHO).

So, stop fucking complaining and die a miserable death already. At least the rest of the world will be free of your fucking wars, your stupid sense of justice (none) and your laissez-faire ignorance.

Don't you get it -- the rest of the world doesn't care any more. You want private health care that only the rich can afford? You can have it. You want to make every nation on the planet hate you? You've already done it.

Just fucking shut up already. We're all so fucking tired of hearing about you Americans complaining. You're too lazy to vote the assholes out, so you're stuck. Who cares?

Posted by: Estaban on May 2, 2006 at 9:17 PM | PERMALINK

notthere,

GOP, you ignorant git,

notthere, you pathetic piece of garbage

as quoted at the top.

What about that quote? What's your point? Did you miss this:

"However, Britain's universal health-care system shouldn't get credit for better health, Marmot and Blendon agreed."

Posted by: GOP on May 2, 2006 at 9:19 PM | PERMALINK

Gop, you ig.....,

From same article as yours:

"Americans had higher rates of diabetes, heart disease, strokes, lung disease and cancer _ findings that held true no matter what income or education level.

Those dismal results are despite the fact that U.S. health care spending is double what England spends on each of its citizens."

So those are a few problems the US has "more" of. Never did get an answer on that. Also, if they keep dieing off for lack of care, how come they live longer on average, men and women, tha we do?

You Are Hopeless.

Posted by: notthere on May 2, 2006 at 9:20 PM | PERMALINK

Right, alex!

Posted by: notthere on May 2, 2006 at 9:22 PM | PERMALINK

notthere,

Try this to show some actual national differences:www.who.int/docstore/bulletin/pdf/2000/issue6/buo585.pdf

Again, your point is....what?

Posted by: GOP on May 2, 2006 at 9:23 PM | PERMALINK

notthere,

So those are a few problems the US has "more" of.

Right. The study found that in general Americans seem to be sicker than Britons. But the authors of the study deny that these differences in health are attributable to the health care systems. The article proposes several other possible causes of the difference.

Posted by: GOP on May 2, 2006 at 9:26 PM | PERMALINK

GOP

As i think I was the first to say here: "Maybe they just walk more."

You still haven't made one argument to show we're better off with the status quo or cited one decent source for anything stated.

Go for one. It might do you good.

Posted by: notthere on May 2, 2006 at 9:36 PM | PERMALINK

notthere,

You still haven't made one argument to show we're better off with the status quo

You haven't made one argument to show that we're not.

Posted by: GOP on May 2, 2006 at 9:39 PM | PERMALINK

GOP: You haven't made one argument to show that we're not.

Same old crap and nary a solution from you damned obstructionist Democrats.

Posted by: has407 on May 2, 2006 at 9:45 PM | PERMALINK

Innovation, innovation, innovation...all these people who think that we are the leaders in health care innovation and we'll lose that lead if we go to single payer. Except that it isn't really the case that we lead in medical innovation. We only lead in innovation in treatments that cost lots of money and therefore generate huge profits.

For example, the cutting edge research on type I diabetes, where a cure probably won't make anyone very much money, is being done right now not here but in (drumroll) the United Kingdom.

Posted by: Jay on May 2, 2006 at 10:04 PM | PERMALINK

Jay,

You can probably find lots of individual examples of diseases and treatments where America does not lead the world in research and innovation, but overall I strongly doubt that any other country does more health research and innovation than the U.S. We have a much bigger population than any other advanced democracy, a much bigger GDP, and we spend a higher proportion of GDP on health.

Posted by: GOP on May 2, 2006 at 10:23 PM | PERMALINK

http://www.washingtonmonthly.com/archives/individual/2006_05/008728.php#878768

Posted by: Angry on May 2, 2006 at 10:24 PM | PERMALINK

Where this tribalism came from, in my mind is actually from American religion, which has always, to some degree more or less encouraged tribalism, which makes it acceptable.

Actually, I'd argue that it doesn't. For all the problems of American evangelicalism and fundamentalism I can't blame America's hostility towards the poor and racial minority on them. America already has a lot of racist and tribal undercurrents that play a role in preventing initiatives that would help everyone from getting passed, but I can hardly blame this on the churches. Any role American religion plays in this is only because they've made the mistake of internalizing the worst instincts of American culture that were already there.

Posted by: Constantine on May 2, 2006 at 10:25 PM | PERMALINK

If you think the healthcare system is good, you are fucking crazy or, more likely, you never actually use it, which is why you are happy.

Thank you, Longtime Reader.

By having a country that has taken the tired,the poor,the hungry masses,it says so right by the front door,we set ourselves up genetically for poor health outcomes. - TJM

Somebody needs to warn the GOP Politburo to stop recruiting their trolls from the Aryan Brotherhood mailing lists. They're going way off message.

I shall only note in passing that by forcing our population to survive an arduous journey to get here, we obviously improved our genetic stock. Anybody who made it through a boat trip from Hamburg to NY in 1905 was much more likely to be resistant to typhus than average Europeans, and anybody who makes it through the Mojave today probably has a fantastic circulatory system. No doubt that's what the Minutemen have in mind -- weed out the weak ones.

Posted by: brooksfoe on May 2, 2006 at 10:46 PM | PERMALINK

I shall only note in passing that by forcing our population to survive an arduous journey to get here, we obviously improved our genetic stock.

This statement is at least as much like something the Aryan Brotherhood would say as anything in the post you're responding to.

Posted by: e1 on May 2, 2006 at 11:18 PM | PERMALINK

e1, I was being facetious. Obviously the whole thing is utter nonsense.

Posted by: brooksfoe on May 2, 2006 at 11:24 PM | PERMALINK

Hey, perhaps your guns and obesity have to do with it?

Posted by: McA on May 2, 2006 at 11:48 PM | PERMALINK

The size of government matters. The history of the last 75 years has shown that government grows year by year, as a percentage of the GDP, with seemingly no way to slow it down. The primary driver is the welfare state. Medicare, Medicaid, TANF, Food Stamps, Social Security, Corporate Welfare, Farm Welfare, Tax loopholes, Earmarks for all sorts of stuff, housing vouchers, public housing, and so on.

As this problem worsens, GDP growth slows as in western Europe today. Unemployment rates soar and labor force nonparticipation rates increase as well.

If the great challenge of the 21st century is to contain the runaway welfare state, how does nationalizing the health care system reduce the growth of this welfare state? To me, it seems to be one more thing going in the wrong direction.

Posted by: Dan Morgan on May 3, 2006 at 12:44 AM | PERMALINK

Hi,

My name is Dan Morgan and I am an idiot.
About an hour after this thread die I posted
my little comment on ending the growth of the
welfare state. As you can see the "welfare state"
is anything I don't like or understand. I should
also be apparent that I have no clue about single-payer healthcare.
Sometimes I wonder why I post -- it must be because it makes me feel important.
Thanks

Posted by: Dan's organ on May 3, 2006 at 5:26 AM | PERMALINK

My wife's knee swelled up on arrival in the UK last week. She was taken immediately to a physician, who had her admitted to a hospital where the knee was drained, allowing her to continue her vacation. At no point was the question of paying even raised. This is the way a civilized society takes care of its members and its visitors.

Posted by: bob h on May 3, 2006 at 6:32 AM | PERMALINK

It is time to part with our ideologic beliefs in "market forces", "individual responsibility", "government bureaucracy", "lower taxes", "socialism" and every other objection to universal health care. American health care is a disastrous failure and needs immediate and drastic change. Everybody needs food, water, shelter and health.

Posted by: C. Tulin, MD on May 3, 2006 at 10:53 AM | PERMALINK

GOP wrote: "You haven't made one argument to show that we're not."

Actually, we have. Quite a few arguments, actually. You just don't like the results, so you pretend that they don't exist. Must be nice to keep your head buried in the sand that way; you never have to actually think or face any unpleasant truths.

Posted by: PaulB on May 3, 2006 at 11:06 AM | PERMALINK

PaulB wrote: You just don't like the results, so you pretend that they don't exist.

That's what I've always done. Why shouldn't I? I'm the GOP.

Posted by: Don P. on May 3, 2006 at 11:26 AM | PERMALINK

Umm... Kevin, did you even read the Post article? The authors go out of their way to say that the findings of the study do not vindicate the British system. I don't necessarily disagree with your conclusion, but the authors of the study certainly do.

Posted by: Sam on May 3, 2006 at 1:07 PM | PERMALINK

Kevin didn't actually argue that the study proves the british system is better, he just drew the obvious conclusion that it isn't leading to worse health outcomes than in the US. He then went to on to express some his own views, which I would argue are every bit as valid as the musing of this study's authors on issues that they didn't actually look at - i.e. "maybe this has something to do with income insecurity in the US". I believe this post makes appropriate use of the article.

Posted by: aidan on May 3, 2006 at 1:37 PM | PERMALINK

I don't entirely disagree. It's certainly worth noting the specific claims made by the authors which discredit such analysis: e.g., the health of Americans was worse across the socioeconomic spectrum - we'd expect better health among the poor if differences in the systems (or income insecurity, as you suggest) are to blame.

The fact is, study seemed to show that the American lifestyle (stress, vacations, etc) is less healthy than that of the British. Again, I'm sympathetic to Kevin's suggestions about our health care system, but the study's authors came to an explicit conclusion that the system wasn't to blame for the health disparities.

Posted by: Sam on May 3, 2006 at 3:31 PM | PERMALINK

GOP

Yawn.

Zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz.

Posted by: blowback on May 3, 2006 at 10:36 PM | PERMALINK

I don't suppose anyone's reading at this point, but could the difference between health in these US and UK groups be due to other factors, such as the fact that British people walk a lot more in their daily lives than Americans do (i.e., less dependent on personal autos to get around)? Also, the average british guy in this age group has an easier time popping 'round to the pub and getting away from the wife on a regular basis -- probably improves the health and extends the life of both spouses.

Posted by: BN on May 3, 2006 at 11:28 PM | PERMALINK

The history of the last 75 years has shown that government grows year by year, as a percentage of the GDP, with seemingly no way to slow it down.

As a percentage of GDP, government spending has consistently hovered around 20% for the past 55 years. From 1992-2000 alone it dropped about 4 percentage points, from 22 to 18 percent of GDP.

The primary driver is the welfare state. Medicare, Medicaid, TANF, Food Stamps, Social Security, Corporate Welfare, Farm Welfare, Tax loopholes, Earmarks for all sorts of stuff, housing vouchers, public housing, and so on.... If the great challenge of the 21st century is to contain the runaway welfare state

So-called "welfare state" spending peaked in the early 80s at around 4.5 percent of GDP, and has since retreated to under 3.5 percent of GDP.

You really should do some fact-checking before you leap to conclusions.

http://www.whitehouse.gov/omb/budget/fy2007/sheets/hist01z2.xls

Posted by: BB on May 3, 2006 at 11:29 PM | PERMALINK

BB,

I don't see how your link is supposed to show social welfare spending as a percentage of GDP.

You must include state, local, and federal governments. They were 10% of GDP in 1930, 25% in 1960, and 34% in 1990. A temporary slowing of growth was only due to the drop in military spending after the Cold War.

All forecasts for the next few decades project steady growth in welfare state spending due to Social Security, Medicare, and Medicaid. See CBO projections here:
http://www.cbo.gov/showdoc.cfm?index=3521&sequence=0

Posted by: Dan Morgan on May 4, 2006 at 12:54 AM | PERMALINK

You must include state, local, and federal governments.

OK, take a look at it from the national accounts:
http://bea.gov/bea/dn/nipaweb/TableView.asp?SelectedTable=14&FirstYear=1947&LastYear=2006&Freq=Ann

Same as I said.

Projections forward are speculative, so I take your reference with a grain of salt. Reagrdless, your original claims about there having been a "runaway welfare state" with respect to GDP growth simply aren't supported by the data.

Posted by: BB on May 4, 2006 at 1:01 AM | PERMALINK

I am an American who has lived in France since 1978. Contrary to Dr. Bratman, who appears to deny the importance of access to health care in the developed countries, a study at the University of North Carolina concludes that the excellence of French health is primarily due to the access of children to compulsory medical and dental examinations in French schools.

Question: Why do Americans always compare their health system only to those of Canada or Britain? The French system is ranked first in the world by the World Health Organization (the U.S. comes in 37th). Except occasionally for elective surgery, there is no waiting in France. Why does an otherwise useful study like the one commented on in this blog "control" for race? Race and ethnic origin are not removed from the stats of other countries, not all of which are as homogeneous as Americans imagine. As the U.S. educator E.D. Hirsch has pointed out, many French classrooms are as ethnically "diverse" as any in the U.S. The fact to keep your eye on is this: The infant mortality rate-- generally considered the single best indicator of the quality of a country's health system -- is rising for ALL segments of U.S. society. That is a disturbing regression.

Posted by: Daniel Birnbaum on May 4, 2006 at 1:03 AM | PERMALINK

First America's health care system is rated 35th by the World Health Organization. It is not the best in the world.

Second I use the French health care system and have never ever waited for anything. I can even get a doctor to come to my home for about $35. An office visit is about $25. And insurance reimburses 75% of that. It is a fast efficient service and is rated best in the world by the World Health Organization.

And frankly if someone has a contagious disease I want them to go to the doctor before they pass it on to me.

Frankly, I left the US for a better quality life and found it.

Posted by: Donna-Lane Nelson on May 4, 2006 at 3:25 AM | PERMALINK

BB,

I am not sure why you are arguing that net government has not grown steadily. The link you provide is not consistent with all other data that I have seen. See here for example:
http://www.heartland.org/Article.cfm?artId=387

Extracted from this link:
Total government in 1900 = 8.2% of GDP
Total government in 1930 = 11.8% of GDP
Total government in 1960 = 23.1% of GDP
Total government in 1990 = 31.4% of GDP

"Projections forward are speculative."

Everyone knows that as babyboomers retire that significantly higher government expenses are going to occur.

It is reasonable to predict, without major program cutbacks, that by 2050 that the total government will be 50% of GDP. France and Germany are around 50% today. The point is that reform in these countries is now very difficult. Is that where we want to end up? You get slow GDP growth, high unemployment rates, and high labor force nonparticpation rates.

Most of the growth in government will be due to the welfare state. Yes, I'd call that a "runaway welfare state".

Posted by: Dan Morgan on May 4, 2006 at 11:28 PM | PERMALINK

From living in different parts of the country and observing the lifestyle habits of people therein, I can tell you that I have a pretty firm personal assessment of this situation.

It's been stated above, but let me clarify a little. It isn't JUST that brits "walk" a lot (as if that explains itself), or that they drink tea. It's the entire lifestyle and diet which is a result of the core belief systems in place. America's belief systems - while heroic in many areas - are ultimately flawed when it comes to physical well being.

They say they controlled for weight. Weight - while not meaningless - isn't a very accurate measurement for ones health, especially amongst those who are not obese. What I mean to say is, did they control for body fat vs. muscle ratio? My gut tells me that the average 150lb american has more fat weight, and less muscle or bone weight, than the average 150lb Brit.

America, as a country, values property over all else. That is to say, money.

I'm an American, I am cognizant of this problem and I therefore attempt to compensate for this imbalance by telling myself that I am not like the others. Unfortunately it isn't true. Sure, I am not as bad as most middle-class white males, but the role which "toys" (bought with money) play in my goal list is still unharmoneous with the things I know should be taking priority, but somehow don't, in my life.

Concordantly, the richer American's are more sick than lower class brits because they are even MORE affluent and tied up making their money piles bigger and better, and have even less time to exercise, watch their diet, and less reason as well. Why walk when you can drive a BMW? Why drive when someone else can do it for you? Why exercise after work while eating a well prepared and balanced meal, when you can go to a dinner party, eat caviar and get smashed on champaign, and then worm your way into another sweetheart side deal instead?

Posted by: David G on May 5, 2006 at 8:04 PM | PERMALINK




 

 

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