Editore"s Note
Tilting at Windmills

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July 13, 2007
By: Kevin Drum

WAITING....OK, OK, I'll never complain about having to wait three months for a dental checkup again. Mark Kleiman, who nearly died thanks to waiting times for his cancer diagnosis, sums up his post about his experience this way:

The claim that replacing the current insurance mishmash with a better-integrated payment and decision-making process would mean more rationing, or even more rationing-by-queuing, is the sort of palpable falsehood that people who are perfectly honorable in real life are only too willing to utter in ideological conflict, especially if paid to do so. Under a single-payer system we'd have an idea who was waiting how long for what, while under the current system no such data are available. In all my waiting, I was never in a formal "queue," and if the cancer had gotten me before the pathologist figured out what it was no one would have counted that death as the result of rationing. But only in wingnut health-policy fantasyland is not measuring a problem the same as not having a problem.

This is a point that's worth keeping in mind when you hear about waiting times in other countries. The only reason we even know they have waiting times is because they measure it. We don't. That doesn't mean we don't have waiting times. It just means we don't know how long they are, which in turn implies that we don't have any interest in reducing them. After all, if we did, we'd measure them, wouldn't we?

Kevin Drum 12:58 PM Permalink | Trackbacks | Comments (73)

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Please keep beating that health-care drum, Drum. Very good stuff!

Posted by: shortstop on July 13, 2007 at 1:01 PM | PERMALINK

Ignorance is bliss -- just as Happy Al!

A grand time to be rich in America!

Posted by: Gore/Edwards 08 on July 13, 2007 at 1:10 PM | PERMALINK

It seems apparent, on purely an anecdotal basis, that some insurers deliberately delay decisions on coverage (effectively delaying treatment) in the hopes of outlasting the patient's ability to stay alive.

I haven't seen any statistics on the waiting times for insurers to decide on coverage issues or how that has affected patient care or survival.

Wonder why. (Not really; I know why - promoters of the status quo don't want anyone to know that their claims about the superiority of US care are based on fallacies.)

Posted by: anonymous on July 13, 2007 at 1:12 PM | PERMALINK

"But only in wingnut health-policy fantasyland is not measuring a problem the same as not having a problem."
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Hey, it works elsewhere. Take Iraq for example. There aren't any civilians dying in the current conflict. Just ask the Pentagon, they're not tallied therefore they're not dying.

Posted by: steve duncan on July 13, 2007 at 1:13 PM | PERMALINK

The other point to make, just as important as the "we don't measure our waiting-times" point, is that every single poor and un-insured American citizens is already on an infinite waiting time.

They can't get access to health care because they can't afford it. They can wait until they hit the lottery, or wait until they die, or wait for the Democrats to do something about it, but right now, if they need a hip-replacement, they are waiting.

So this crap about Canada and France having a waiting period of X weeks for this and that procedure--just remember that for every procedure in America, there is a waiting line of some 40 million people, who cannot get in to see the doctor until something changes.

Posted by: Count Cant on July 13, 2007 at 1:13 PM | PERMALINK

Gore is in celebrity heaven.

Edwards/Obama '08.

Edwards/Clark '08.

Edwards/Webb '08.

Edwards/Clinton '08.

Now you're talkin!

Take your pick.

Posted by: anonymous on July 13, 2007 at 1:16 PM | PERMALINK

Under a single-payer system we'd have an idea who was waiting how long for what, while under the current system no such data are available.

But we do have an idea of how satisfied patients are with the American health care system and, as Dr Sanjay Gupta of CNN explains, Americans have the highest patient satisfaction. We pay more for health care, and that's why we are more satisfied with it.

Link

"So Americans do pay more, but the United States also ranks highest in patient satisfaction."

Posted by: Al on July 13, 2007 at 1:17 PM | PERMALINK

Was supposed to have my injection drug on Wednesday as it is a timed med. Insurance company's pharmacy screwed up and now I'm getting it today, two days late. This is supposedly not uncommon.

The doctors are doing their job. The drug company is doing their's. It's the middleman I can't stand.

Posted by: Me2d on July 13, 2007 at 1:18 PM | PERMALINK

What shortstop said.

But I was wondering; is there a single-payer system for the wingnut whores who write about policy, or are they paid individually by each coporate member of the disease-industrial complex?

Posted by: thersites on July 13, 2007 at 1:20 PM | PERMALINK

This is a fair enough point about waiting times, but what it isn't fair is the implication that only private insurers have "some clerk" deciding what is medically necessary. Any third-party payment system will have clerks deciding what is medically necessary.

And there isn't any reason to think that government clerks will do a better job. When I worked for Legal Aid, there was like 1 client out of 100 who had been screwed over (or claimed to have been screwed over) by his landlord or some private party. The other 99 were all there saying: "The Housing Authority did this" or "The welfare people did that" or "The police did this" or "Social Security did that" etc.

Posted by: sean on July 13, 2007 at 1:21 PM | PERMALINK

The beauty of the free market system is that health care providers have the right not to measure those things if they so choose. Al told me so...

Posted by: dr sardonicus on July 13, 2007 at 1:26 PM | PERMALINK

Gupta seems to have his own numbers .
According to Fox, Americans aren't all that happy with their health care system.
...The study shows that people in the U.S. face longer wait times to see doctors and have more trouble getting care on evenings or weekends than do people in other industrialized countries. At the same time, Americans were more likely to receive advice on disease prevention and self-care than others.
One-third of Americans told pollsters that the U.S. health care system should be completely rebuilt, far more than residents of Australia, Canada, New Zealand, or the U.K. Just 16 percent of Americans said that the U.S. health care system needs only minor changes, the lowest number expressing approval among the countries surveyed....

After a long wait, those people who finally receive care are happy with it. It's, like, yeah!, I'm cured. Sorry about you, pal. Better luck in the next life.

Posted by: Mike on July 13, 2007 at 1:27 PM | PERMALINK

Here's a first-hand account of how my recent broken leg was treated:

July 3: Arrive at Emergency Services (not emergency room), 10:30 pm. Wait 20 minutes to be screened, another 30 minutes to be x-rayed, another 20 minutes for evaluation, splinting, crutches & getting sent home. Paid HMO co-pay ($15). Home by midnight.

July 4: Laid up all day, no doctors or orthopedists available on a holiday.

July 5: Managed to get 2 pm appointment with orthopedist (very luck, I am told), but had to make several urgent calls to family doctor throughout the morning to arrange a required specialist's referral -- by fax -- in order to avoid paying full price at orthopedist. Fax arrived during my orthopedist's appointment. Quick evaluation -- simple non-displacement break, didn't require surgery or pins. Paid $15 co-pay, waterproof cast put on (for an additional $12), out by 3:30 pm.

So, basically two days (including one holiday) to set a broken leg, some stress getting an orthopedist's appointment and specialist referral so quickly. I'm told I was very lucky that things moved so quickly.

Posted by: pj in jesusland on July 13, 2007 at 1:34 PM | PERMALINK

Al, I imagine most people sitting in first class in the airplane also give high satisfaction ratings. But for the rest of us schlubs in coach or on the bus, its not so great.

Posted by: Doug-E-Fresh on July 13, 2007 at 1:39 PM | PERMALINK
...Mao Tse Tung never went to a dentist in his entire life...meathead republican at 1:33 PM
No, dumbass. The lesson is, being a Maoist gives you perfect teeth and enables you to swim the Yangtze. Posted by: Mike on July 13, 2007 at 1:42 PM | PERMALINK

Kevin Drum quoting Mark Kleiman >"...only in wingnut health-policy fantasyland is not measuring a problem the same as not having a problem..."

Wrong, it is NOT ONLY in wingnut health-policy fantasyland that this is true as mentioned by those "wide eyed lefties" of the Iraq Study Group

I challenge any and all to show a policy area where this isn`t true of the wingnuts

"...Good policy is difficult to make when information is systematically collected in a way that minimizes its discrepancy with policy goals..." - Iraq Study Group

Posted by: daCascadian on July 13, 2007 at 1:43 PM | PERMALINK

As long as Al gets his lollipop, he's a happy boy.

Keep on suckin', laddy!

Posted by: Kenji on July 13, 2007 at 1:47 PM | PERMALINK

I'm still waiting to have a Bushectomy, but it's been advised that first there has to be a Cheneyectomy, so the Bushitis won't come back later in a more malignant form.

First we have to get the specialist critters to refer me all over the place and you know how they charge just for walking into the same room with ya.

But, we got this radical big mouth named Moore who is pushing them to hurry it up. So, there's still hope we won't all die in a horrible nuclear Armageddon fireball before things get better.

Posted by: MarkH on July 13, 2007 at 1:47 PM | PERMALINK

Let's see -- recent waiting times in our family include: 1)Being told that our PCP was not scheduling physical exams that month (not not _doing_ them, not _scheduling_ them for months down the road). 2)Waiting two weeks for an appointment with a PCP who then gave me a referral to an opthamologist who gave me an appointment in another week. The problem? Possible detached retina! But this was not regarded as even remotely an emergency by the triage nurse who made me go first to the PCP (the opthamalogist was furious and told me to go to the emergency room the next time). 3) Waiting 3 months for an appointment with a psychiatrist (problem, serious depression that got worse). And don't even get me started on ER waits. Basically we don't bother with doctors any more unless the problem looks life-threatening. Anything we might have except cancer will go away by the time we get an appointment. I have a kid who lives in Spain with a wonderful, fully-staffed clinic within walking distance where you are seen within 10 minutes if you just show up. And I think Michael Moore is God and I think it's really disgusting when sick little wingnutters who would rather have us all die than give up a syllable of ideology pick away at the fifth decimal place out on his statistics.

Posted by: jhill on July 13, 2007 at 1:54 PM | PERMALINK

steve duncan: "Hey, it works elsewhere. Take Iraq for example."

"There are three kinds of lies: lies, damned lies, and statistics." - Benjamin Disraeli, British Prime Minister (as attributed by Mark Twain)

Also, look the way the government now measures the inflation rate, which excludes cost factors like housing, food and energy. Is it really all that surprising that it's consistently announced as in the low-to-mid single digits?

Posted by: Donald from Hawaii on July 13, 2007 at 1:54 PM | PERMALINK

I have severe rheumatoid arthritis, and twice have been denied an osteoporosis drug. Isn't that a form of rationing?

I'll take my chances under "socialized medicine," thank you.

Posted by: Paula on July 13, 2007 at 1:55 PM | PERMALINK

WAITING? I have an opinion on WAITING, I am waiting for those two outlaws running this country to leave office immediately, between Bush & Chenney you could not find a brain between them. I also wonder just how much money these two idiots are making off of this war.

Posted by: Al on July 13, 2007 at 1:58 PM | PERMALINK

Ah, Kevin.

Your wrong, Kevin. You want to tell me that insurance companies can't measure all their current enrollees and all the care they've been receiving. These companies have ERP systems that'll slice and dice and data mine the crap out that stuff. And you think some bloated EU manual intensive measurement process frought with human error is going to measure patient care better than American dynamism and productivity?

Talk about rose colored glasses.

Posted by: egbert on July 13, 2007 at 2:01 PM | PERMALINK

egbert, "your" a rose-colored ass.

Posted by: Kenji on July 13, 2007 at 2:08 PM | PERMALINK

Al: "So Americans do pay more, but the United States also ranks highest in patient satisfaction."

Which, no doubt, could be attributed to all those anti-depressants and other pharmaceuticals we're taking.

Thanks for that underhand softball slow-pitch, Al.

Posted by: Donald from Hawaii on July 13, 2007 at 2:09 PM | PERMALINK

But only in wingnut health-policy fantasyland is not measuring a problem the same as not having a problem.

The reverse is true in wingnut educational-policyland. There measuring the problem is the same as having a solution.

Posted by: Davis X. Machina on July 13, 2007 at 2:18 PM | PERMALINK

Oh, egbert, you spoiled mama's boy.

Your perpetually condescending ignorance is particularly tiresome today.

You better hope that Kenji and I don't catch your sorry ass out in the playground at recess time, unless you want the teacher and principal to find you simultaneously "pantsed" and tied face-first to the jungle-gym with your own belt and shoelaces.

Posted by: Donald from Hawaii on July 13, 2007 at 2:24 PM | PERMALINK

On the subject of measuring: the rest of the rational medical world uses something called outcome- or evidence-based decision making for what medical treatments are worthwhile and which are not. The other night, in that little gufflaffle between Gupta and Moore, Gupta thought he had Moore at the end when he used the specter of "not getting your heart bypass surgery" in a timely fashion in the universal health care plan. Cardiac bypass surgery is a great example (along with back surgery) to use against the for-profit type of medicine that the US is addicted to. Bypass surgery if very profitable. Thus, many hospitals that have no business doing bypass surgery in the US do it anyway because it is so profitable. In a rational health care system, yes, a lot fewer people may get their bypass surgery. That does not necessarily mean that more people will die for the lack of it. In fact, the opposite may be true. Further, it has long been established that bypass surgery does not prolong life but only relieves the symptom of angina. It is life improving but not life lengthening. With that in mind medicine has developed better and cheaper methods of treating the acute cardiac episode and the cardiac symptoms. Just keep looking at the longevity data in all the countries that have universal health coverage and compare it to ours. Even if they don't get as many "cabbages" (coronary bypass grafts) as quickly or as often as we do here, there's no evidence that their cardiac survival is any worse. These data need to be looked at carefully. Gupta sounded like a "lay person" rather than a thoughtful physician when he tried that gambit. Unfortunately, Moore wasn't sufficiently knowledgeable of the medical aspects of the issue to catch him on it at the time.

Posted by: digitusmedius on July 13, 2007 at 2:31 PM | PERMALINK

Every time I read posts like these I can't decide, based on my own experiences and those of friends and family, whether we've all been incredibly lucky or others have been incredibly unlucky or have in some ways failed to be proactive enough in their own health care.

Fifteen years ago when I was diagnosed with a herniated lumbar disk, I had it removed in just a couple months after it was determined that physical therapy, which often works, wasn't going to help. This was when I was living in bad 'ol NYC and using an HMO. The only downside of the experience was I found that I couldn't read whilst self-medicating on a morphine drip (made me dizzy).

When I was diagnosed with malignant melanoma eight years ago, I was in surgery within a week, and in a drug trail within a month. Our coverage at that time, through Aetna, was also an HMO plan.

Then this last spring I sustained a minor concussion while skiing (which included a 30 minute or so "black out" period). This resulted in a fifty mile trip by aid car to the local hospital and a CT scan. No one asked my about health insurance. It all just got done. The only pain involved was the cervical collar and the backboard - I've decided those things actually cause neck and back problems.

I'm not posting this to gloat. I just wonder about other people's choices with insurance and, more important, their doctors and dentists. I know ours aren't reimbursed anything near the full charge, but that hasn't meant that they quit offering or limit services. This is true for the clinics in the two hospitals we use for primary care, the specialist we have seen, our two optometrist, and our three dentists.

I find it hard to believe that everyone is receiving such bad health and dental health care. Part of the general disgruntlement (leaving aside the true crisis of the uninsured) surely results from ridiculous expectations of what medicine can and should do for us (Viagra or Zoloft anyone?). I think it is true that we are already one of the most over-medicated societies and that we are near the top in the world of doctor and hospital visits, and the use of "life-extending" care. Though not fully explaining or nullify the problems that do exist with insurance companies and some percentage of hospitals and health care professionals (they've not all become scheming and uncaring incompetents), is there really a general health care crisis or just one affecting the working poor and unemployed?

Posted by: JeffII on July 13, 2007 at 2:46 PM | PERMALINK

Don -

Egbert doesn't have shoelaces. Mom still puts in him velcro tennis shoes.

Posted by: NSA Mole on July 13, 2007 at 2:50 PM | PERMALINK

The "highest patient satisfaction" numbers are a ruse. They conveniently leave out anyone who doesn't receive health care (how can someone be satisfied with something they never use?). We all know, even Al, that large amounts of Americans don't receive the health care they need because they can't afford it. The HPS number conveniently sweeps those people under the rug. Just the way Republicans like it, I suppose.

Posted by: Joshua on July 13, 2007 at 3:19 PM | PERMALINK

It would seem to me to be fairly simply to know waiting times at various points in the delivery system: ask the people doing the waiting. My guess, because I don't know all the research, is that this is fairly carefully measured at decent health care institutions. Certainly the Institute for Healthcare Improvement, IHI, which focuses on operational excellence in healthcare delivery would have some metrics in this area. I do know that my friend who is in the midst of cancer treatment in the Boston medical system is satisfied that she is being well managed and not waiting for resources. In fact she asked whether the situation would be the same if the cancer were more aggressive and was told very clearly that things would be very different under those conditions: treatment would be faster, second opinions would be quicker, and action would proceed rapidly. Obviously not everyone, even me, lives in the Boston area, but it can be done and can be done in America.

Posted by: bboot on July 13, 2007 at 3:22 PM | PERMALINK

In response to JeffII, I would say that the issue shouldn't be that health insurance in this country works "pretty well" for most people who have it. Rather, it should be, why doesn't it work like it seems to have worked for everyone? After all, we're told that our private health insurance system is the envy of the world. It is not. As just a small example of the morass that our so-called superior health system is I offer this story of just a small and non-life threatening ordeal that the insurance Rube Goldberg that we have puts some of us through. My daughter's university determined that our health care insurance (one of those individual, high deductible HSA policies that Bush extols so often)was inadequate coverage and required that we purchase a separate policy through the university. She had the misfortune to land in the ER at a local hospital and we provided the appropriate information about the school's health insurance. Months later when the bills started arriving at our doorstep we laboriously went through the process of discovery which led us to find out that the school's coverage is only secondary. We had to resubmit all of the bills to our insurance company, wait for the inevitable denials of coverage, and then resubmit them. Six months and $1,000+ of "copays" later it finally got ironed out. It's a complete mess. Even if you get care in our system, it's often enough to create a mental health condition, which, of course, will NOT be covered by your plan in all likelihood.

Posted by: digitusmedius on July 13, 2007 at 3:33 PM | PERMALINK
....I find it hard to believe that everyone is receiving such bad health and dental health care....JeffII at 2:46 PM
Believe baby: ...Compared with five other nations—Australia, Canada, Germany, New Zealand, the United Kingdom—the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives. The U.S. is the only country in the study without universal health insurance coverage, partly accounting for its poor performance on access, equity, and health outcomes. The inclusion of physician survey data also shows the U.S. lagging in adoption of information technology and use of nurses to improve care coordination for the chronically ill....

USA USA! We're number last!

Posted by: Mike on July 13, 2007 at 4:05 PM | PERMALINK

Like JeffII, I have also been fortunate for the most part with insurance coverage and with treatments. That's because I worked for the University of Arizona for 32 years, whose HR department, in concert with that of Arizona State University and Northern Arizona University, works aggressively with insurance companies and HMOs to get decent coverage for employees.

BUT. In 1995 I suffered acute otitis interna in my left ear. I sustained cochlear damage leaving me partially deaf in that ear.

There was no problem with treatment except that antibiotic treatment should NEVER include neosporin as that is damaging to the ear and increased my deafness. But I digress.

I received an audiogram and a tonogram, both tests for hearing, in a visit to an ENT guy. My insurance company denied coverage of these tests, saying that they hadn't been pre-approved. I called them up, puzzled by this since my primary doc HAD pre-approved the visit to the ENT. The clerk who answered my phone call told me that the trip to the ENT was authorized for diagnosis but not for treatment!

I didn't blame the clerk for not knowing what a tonogram was, but an audiogram? So my tone was not the friendliest when I retorted that both were hardly TREATMENTS, but instead were TESTS, used for diagnosis. She replied that I was not to get snippy with her.

Fortunately for me, I go to church with someone who used to work for that insurance company, and she got this particular charge dropped. But someone in a position of approving or denying coverage really ought to recognize THE common test used for hearing acuity, no?

Posted by: Wolfdaughter on July 13, 2007 at 4:11 PM | PERMALINK

The most jaw-dropping part of Kleiman's piece is that he was diagnosed with any kind of "Stage IV-B" cancer and was successfully treated, and is healthy several years later. Admittedly my family's experience is with lung cancer, but what he says about the implications of that diagnosis is quite true.

Posted by: DonBoy on July 13, 2007 at 4:21 PM | PERMALINK

Wolfdaughter, one of my doctors told me that she refused to speak to anyone at an insurance company who was not a college graduate. She just didn't want to take time to explain her diagnoses and treatment recommendations to people who didn't have the educational background to understand what she was saying.

I'd think it would be possible to provide on-the-job training that would enable employees to deal with specific situations such as yours, but my doctor, like you, didn't feel that the people she was supposed to deal with were being given any such training and decided to use educational attainment as a decision rule in determining who to explain herself to.

Posted by: THS on July 13, 2007 at 4:25 PM | PERMALINK

By the way, everyone, I just wanted to remind y'all that Michael Moore is FAT.

Posted by: osama_been_forgotten on July 13, 2007 at 4:36 PM | PERMALINK

I want to add to digitusmedius's report the fact that a lot of the people seeking care are, um, sick and, double-um, sick and old.

If you're in either of these conditions, dealing with contradictory instructions, excess paperwork, ill-informed staff, blah, blah, blah is extremely difficult.

I'm in my 50s and have mostly had good insurance, but the insurance that's generally been best for me has been the PPO variety, which generally involves more paperwork than HMOs. It's been a big drag, and becomes ever more so.

Even worse, however, is what happens w/ my parents, who are their 80s. If they didn't have adult children to help them navigate the healthcare system, they'd have been dead years ago.* Having no children, I imagine myself sitting on a sidewalk drooling at some point in the future.


*Some might argue that extending their lifespan--or that of anyone their age--might not be a net good, a position with which I might agree. But such outcomes shouldn't occur because the patient is unable to fill out forms or ask questions and remember the answers.

Posted by: THS on July 13, 2007 at 4:40 PM | PERMALINK

Believe baby: ...Compared with five other nations—Australia, Canada, Germany, New Zealand, the United Kingdom—the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives. Posted by: Mike

I didn't write that we had the best health care system in the world, and your use of the study, while interesting in of itself, is generalized.

While the U.S., lacking universal health care coverage, ranks 6th in the group (but still in the top 5% overall in the world), it still ranks first in the world in access to specialized treatment - which is universally rationed or nearly non-existent in countries with national health insurance. Canada and the U.K. are notoriously slow for advanced diagnostic treatment and care. So, someone has trouble getting in to see his or her doctor for a non-life threatening illness. Elsewhere in the world you might die before you got treatment for something serious but treatable. Which is more important in the larger scheme of health care? People in both the U.K. and Canada, who can afford to, pay out of pocket for "private" treatment rather than use the national health systems. This suggests that, while they may be necessary for certain segments of society, they may not be the panacea that so many people claim.

Yes, we should have the best health care in the world given the levels of per capita spending (which is a misleading number in itself), but to read posts like Klein's you'd think we lived in Uganda.

Posted by: JeffII on July 13, 2007 at 5:02 PM | PERMALINK

By the way, everyone, I just wanted to remind y'all that Michael Moore is FAT. Posted by: osama_been_forgotten

Poorly dressed, too!

Posted by: JeffII on July 13, 2007 at 5:06 PM | PERMALINK

JeffII again inadvertently exposes one of the flaws of our for-profit health care contraption: the easy access to specialized care. We are now down to about 10% of medical school graduates going into primary care. Our top heavy specialist load in this country is one of the key reasons that ours is the most expensive. Yes, people can get the surgery du jour pretty damn easy in this country. And, yet, we still have worse health statistics than any of the industrialized countries with universal health care. Go figure.

Posted by: digitusmedius on July 13, 2007 at 5:14 PM | PERMALINK

Ever notice that we rarely hear statistics about job layoffs. We hear news headlines here and there about this or that company, but no more nationwide data about job layoffs. Why?

Because early in the Bush Administration, they decided to no longer measure that data. Voila! No more troublesome information that might make people realize that corporate profits is not the only measure of the health of the economy.

Posted by: coltergeist on July 13, 2007 at 5:18 PM | PERMALINK

JeffII again inadvertently exposes one of the flaws of our for-profit health care contraption:
the easy access to specialized care.

And what was our health care system 25, 50 or 100 years ago - all pro bono?

We are now down to about 10% of medical school graduates going into primary care. Our top heavy specialist load in this country is one of the key reasons that ours is the most expensive.

No. Specialized care is expensive because it require more lab testing and greater use of hugely expensive machinery, and because it is readily available when compared to all other countries. And because we simply won't let people die, but too often take extraordinary and pointless measures to prolong lives when the body has lost its ability to live for itself.

Yes, people can get the surgery du jour pretty damn easy in this country. And, yet, we still have worse health statistics than any of the industrialized countries with universal health care. Go figure. Posted by: digitusmedius

Yes. Go figure. Our health care is in such a shambles that our longevity is increasing along with the rest of the industrialized worlds' (except for Russia and some of the former members of the Soviet Union), even while we are getting fatter!

Again, I'm not saying I think the U.S. health care system in the world, though it's done all right by me. I've used the Japanese health care system a bit and it was fine, too, though I sure wouldn't want to be hospitalized there or seriously ill (hospital stays are overlong and secondary infection rates much higher than in the U.S. due to the over prescription of anti-biotics, but I digress).

Yes. U.S. health care could improve. But don't count on it happening from the top down. Americans have tolerated the most incompetent administration in my life time and perhaps in the country's history without becoming outraged. So, don't expect any grassroots efforts any time soon to improve health care. If the majority Americans are willing to allow the government to piss away millions of dollars daily in Iraq, then they really have the health care (education system, transportation system, environmental protection, etc., etc.) they deserve.

Posted by: JeffII on July 13, 2007 at 5:37 PM | PERMALINK

"No. Specialized care is expensive because it require more lab testing and greater use of hugely expensive machinery, and because it is readily available when compared to all other countries."

You left out the fact that specialists are compensated by a factor of >10 compared with primary care docs in this country. That takes us back to why medical school graduates flock to the specialties. In a profit driven system, we would we be surprised that the people entering it wouldn't be driven by the profit motive. Just another basic internal flaw of for-profit medicine. The practitioners tend to be there for the profit, not the calling. That might explain a bit why we have such a draconian malpractice situation since that's the only thing left to counterbalance the built-in greed factor. It's appalling, on all levels.

Posted by: digitusmedius on July 13, 2007 at 5:59 PM | PERMALINK

JeffII, I'm well aware that our system works really well for some people. Since I started grad school, I've thought my medical care was great.

So I'd just like to mention one of the most unlucky things that can happen to you given our current medical system: Getting sick right after you've accepted a new job, before your health-insurance kicks in.

This happened to both me and my girlfriend. In both cases it was bacteria. I like to rock climb, got a cut on my finger, didn't wash it as I should've, and ended up with a pretty serious infection. I let it go on about a week too long, because I didn't have medical care, but finally decided I'd rather pay a ton of money that lose my finger. The doctor told me I needed antibiotics (which I knew), and wrote me a subscription for pills that cost about 35$.

My hospital bill was about 2000$. For being told that I needed antibiotics. Which was obvious.

A few years later my gf got a UTI. Her insurance hadn't kicked in too. Her bill, for being told she needed about 70$ worth of antibiotics: 6000$. I am not making this up.

Since we had incomes we didn't qualify for state assistance. But we didn't have our own insurance yet either. I realize we were extremely unlucky, but I'm not clear why our system should have these potholes in it.

Posted by: DBake on July 13, 2007 at 6:47 PM | PERMALINK

So, if we in the US are not measuring wait times in the first place, how was anybody able to come up with an *average* wait time of 38 days for a dermatologist? You cannot have an accurate average if you aren't keeping accurate measurements.

Posted by: SoCalAnon on July 13, 2007 at 7:02 PM | PERMALINK

JeffII is okay and never had any troubles, so I guess there is no problem. Al will bring the drinks and the DMT or whatever he takes to get where his cognitive space is so.....Al-ish.
Everyone else is just a grumbler, commie pinko, malcontent or whiner. Why not mix your Social Darwinism with some real natural selection action?

Posted by: Biff Spaceman on July 13, 2007 at 8:41 PM | PERMALINK

osama_been_forgotten: "By the way, everyone, I just wanted to remind y'all that Michael Moore is FAT."

Small wonder, after watching him swallow whole both CNN's Wolf Blitzer and Sanjay Gupta on CNN's Situation Room, and then later spit out the bones and fur on Larry King Live.

Posted by: Donald from Hawaii on July 13, 2007 at 8:58 PM | PERMALINK

Any country that can burn through $2 billion every week, occupying a desert country where we are despised and slaughtering innocent people by the hundreds, can and should afford universal health care coverage for it's citizens.

Posted by: The Conservative Deflator on July 13, 2007 at 10:55 PM | PERMALINK

"Some might argue that extending their lifespan--or that of anyone their age--might not be a net good, a position with which I might agree. But such outcomes shouldn't occur because the patient is unable to fill out forms or ask questions and remember the answers."
Posted by: THS on July 13, 2007 at 4:40 PM

It is the fool 'em and fuck 'em system and attitude of the private health insurance companies, yet again. Even the Medicare drug benefit had to turn into a Byzantine labyrinth of plans and options that did nothing but confuse the shit out of everybody, just to please the private insurance industry. Get these GODDAMN BASTARDS out of our system forever, people!

Posted by: Doc at the Radar Station on July 14, 2007 at 1:02 AM | PERMALINK

"one might argue that extending their lifespan--or that of anyone their age--might not be a net good, a position with which I might agree. But such outcomes shouldn't occur because the patient is unable to fill out forms or ask questions and remember the answers."

Why not? When you're so old that you can't enjoy anything physical anymore, and the mind is gone, it seems to be me that precisely the time to pull the plug.

Of course, I say this because I'm young and healthy now. And no-one is so old that they cannot hope to live another day. But still....

Posted by: diana on July 14, 2007 at 1:07 AM | PERMALINK

JeffII: "Is there really a general health care crisis or just one affecting the working poor and unemployed?"

Is there a difference? If there is a health care crisis for the working poor then there is a health crisis. If a sixth of the country has no health insurance and 18,000 people a year die in this country because they don't have health insurance, then there is a health care crisis.

JeffII: "While the U.S., lacking universal health care coverage, ranks 6th in the group (but still in the top 5% overall in the world)"

No, the U.S. ranked sixth in that group of six countries. The U.S. ranks 37th out of the 191 countries in the world. Not even close to the top 5%.

Posted by: Ben on July 14, 2007 at 1:12 AM | PERMALINK

I work in this system and I want to laugh everytime I hear about the long waits in Canada or the UK. I have had one patient who waited for six months for a very necessary surgery. One waited for a month for a complicated eye problem. One waited for 4 months for surgery. Another medicaid patient had a very hard time even finding a doctor to accept the insurance. There are tons of times where i have patients who can't get authorization for medications. Most PCP's cannot be seen for a month. If it's a non-911 emergency but significant and you happen to know the right person at the office and the physician has the time they may fit you in within a few days. ER room care without a 5 hr wait(except for chest pain/severe trauma) is highly unlikely. Most of the time ER wait is 10hrs, and even greater in the winter. I think decreasing ER care would be a huge savings in a socialized system. There are way too many people who go to the ER for primary care because they don't have insurance. I try to push my folks to go to urgent care centers if at all appropriate. Our system is far far from perfect. I have no idea why phyicians are against single payer/universal healthcare. From what I can see they would save $$$ in administrative costs and malpractice costs which should offset the decrease in income. The problem with our healthcare is that there are a lot of times when stuff is done for maximum profit rather than maximum efficiency. There are then also the make work doctors and PCPs and hospitalists who refer patients to specialists unnecessarily(to create work for their buddies) and furthermore, explain to me why a patient who is stable has to go to a specialist every 3/6 months to get a new rx for meds. Why is the PCP not doing the routine care and the stable patient goes to the specialist every 6/12 months instead. I have had a few patients(non rx patients but wellness issues) who finally decide to get off the merry-go-round and decide that they are not going to go to the specialist unless there's a problem.

Posted by: mainame on July 14, 2007 at 3:13 AM | PERMALINK

JeffII: "Is there really a general health care crisis or just one affecting the working poor and unemployed?"

Is there a difference?

Yes. See, a general health care crisis would mean it was affecting the general population, which is notionally understood to mean the majority of the population as opposed to one group or another. There is no evidence that this is the case.

No, the U.S. ranked sixth in that group of six countries. The U.S. ranks 37th out of the 191 countries in the world. Not even close to the top 5%. Posted by: Ben

The WHO study you are getting your rankings from is rubbish. First of all nearly every country ranked above the U.S., excepting Japan, has at most 1/4 the population. How can one possibly compare the health care systems of

3 San Marino
4 Andorra
5 Malta
8 Oman (Yeah, right.)
13 Monaco
15 Iceland
16 Luxembourg
17 Netherlands
19 Ireland
20 Switzerland
21 Belgium
22 Colombia (Yeah. Right again.)
24 Cyprus

to the U.S.? Most of these countries have populations less than the state of California and have little or no immigration to speak of (homogeneity of a population makes a huge difference in health maintenance). The first three aren't even real countries. They simply have no numerical strains on the system.

Again, I have never contended that the U.S. has the best health care system in the world. But it is hardly in the crisis state described by some here and elsewhere.

Posted by: JeffII on July 14, 2007 at 3:20 AM | PERMALINK

Jeff II:

Here is a report that summarizes an extensive program of research on the quality of care throughout the United States. The quality measures have to do with the extent to which the care people receive is consistent with evidence-based practice guidelines. Since this is a summary, the methods are described only briefly, but there are links to the publications on which this report is based.

The report, issued by the RAND Corporation, concludes that whether insured or uninsured, the care that Americans receive is not at all consistent w/ these guidelines. Essentially, our healthcare system is not providing us w/ appropriate care no matter what our circumstances.

Given the quality problems and the problems with access and cost, I think it's fair to conclude we're in a situation that is far from desirable. Large proportions of Americans are not living in crisis mode, but many are, and more will be if nothing changes.

It's also worth noting the precariousness of our circumstances. A serious illness, a life-changing accident, a job loss . . . and everything that is holding your life together can change. I believe Michael Moore is right in saying that the most frequent cause of personal bankruptcy is a medical crisis.

Posted by: THS on July 14, 2007 at 4:43 AM | PERMALINK

As I write this, I'm listening to an interview w/ Michael Moore conducted by David Brancaccio on NOW, the PBS news show. It's a couple weeks old; has been sitting on my DVR.

The difference between this presentation and his two appearances on CNN is, to say the least, striking. He sounds extraordinarily reasonable and knowledgeable. Gupta's challenges on the Larry King show were ridiculous, but Moore's boorishness undermined his credibility. I wish more people could see this interview.

Posted by: THS on July 14, 2007 at 4:51 AM | PERMALINK

You can find the video of the Michael Moore interview that I mentioned above here.

Posted by: THS on July 14, 2007 at 5:02 AM | PERMALINK

"..better-integrated payment and decision-making process .."

He means the federal government.

Posted by: Matt on July 14, 2007 at 6:12 AM | PERMALINK

JeffII:

Congratulations on getting timely treatment for your back problem, your melanoma, and your concussion. I can't say whether the good results were the result of luck, good coverage, or what. But I can report that there are a great many cases where people with standard medical insurance receive sub-standard treatment. I could refer you to my father, a cardiologist who sat on a state BCBS review panel, or my mother, a public health nurse. In fact, if you want to know more about their horror stories, e-mail me, and I'll tell you what you want to know.

For now, I'll just point out that when my stepson broke his middle finger ten days before Christmas last year, it took only about an hour to get an appointment with his primary care physician, and less than half an hour to get the x-rays which convinced the physician to refer us to a specialist. Unfortunately, it took almost a week to get our carrier to authorize a visit to the specialist (in fact, I ended up going without approval, in part because the broken finger had begun to set into a position that would have had the finger crossing over the index finger).

The first specialist immediately referred us to a hand surgeon, who declared that the finger had a spiral fracture and needed to be operated on right away, as it had already begun to set. The insurance company said that they couldn't authorize the procedure until after the holidays, at which point the finger would have to be rebroken before it could be set, a stupid and unnecessary procedure which had a significant chance of causing nerve damage.

The hand surgeon declared that he would schedule the surgery anyway, and would figure out a way to deal with the insurance company later. It's clearly not a good use of this guy's time to have to spend hours on the phone with corporate yahoos who want to go on vacation, in order to justify an emergency surgery that really can't be put off, but that's what he and his office staff ended up doing.

As it turns out, yet another physican performed the operation, which was a complete success, but we had to spend the next five months arguing with the insurance company about every item after the initial x-ray. At one time or another, they denied payment for every subsequent office visit, for the surgery, for anesthesia, for post operative care, for a splint, for a cast, .... And we were probably fortunate that the arguments over payment were done after only five months; it turned out that one of the people dealing with our case was possibly a distant relative of my wife (it's a loooong story), and she helped us "speed" things up.

Now, what do you think would have happened if the hand surgeon hadn't pushed our case so aggressively? We had coverage, and every medical professional we encountered recognized that my stepson needed treatment a.s.a.p. and were willing to provide that treatment. But he would have ended up -- at the advanced age of 14 -- with serious problems using his writing hand, because the treatment would have been too late. And if we had somehow lacked insurance altogether, what then?

P.S. your list of "small and homogeneous" countries includes the Netherlands, which has quite a large immigrant population. And if size and homogeneity are so important, then just look at the U.S. at the state level. I think you'll find that small states and ethnically homogeneous states aren't necessarily those with the best health care outcomes.

Posted by: keith on July 14, 2007 at 8:06 AM | PERMALINK

Yes. See, a general health care crisis would mean it was affecting the general population, which is notionally understood to mean the majority of the population as opposed to one group or another. There is no evidence that this is the case.

Nonsense. First, a crisis doesn't have to affect the majority in order to be generalized. Are you suggesting, for example, that if 48% of the US suffered from some ravaging diseases that that wouldn't be considered a general crisis? By that standard there has never been, and hardly could ever be, a general health care crisis -- and by that same standard gun violence, obesity, AIDS, etc. are not crises because they don't affect the majority of the population. Hell, by that standard the Black Plague wasn't a general health care crisis since it only killed about one-third of the population.

Second, the crisis doesn't effect merely one "group" in a limited medical sense -- it effects every group across the demographic spectrum, young, old, male, female, black, white, Asian, healthy, unhealthy, etc. A crisis which has reach across so many disparate population groupings, which can strike anyone, is surely general.

First of all nearly every country ranked above the U.S., excepting Japan, has at most 1/4 the population.

So? As long as the sample size is large enough it's easy enough to compare statistics across differently population groups.

How can one possibly compare the health care systems....?

Easy enough. Why not?

Most of these countries have populations less than the state of California and have little or no immigration to speak of (homogeneity of a population makes a huge difference in health maintenance).

Many of the countries that outrank us are not in fact homogenous and many have large immigrant populations. Even when we control for that, however, and look within distinct homogenous subgroups the US underperforms. For example, a recent study showed that the health statistics of the wealthy in this country (a largely Caucasian and relatively homogenous group) are worse than the statistics of a similarly situated wealthy, Caucasian subgroup in the United Kingdom.

They simply have no numerical strains on the system.

The US health care crisis is not due to numerical strain. Our problem is not overpopulation, it's poor management and the artificially created insurance system.

Posted by: Stefan on July 14, 2007 at 10:39 AM | PERMALINK

See, a general health care crisis would mean it was affecting the general population, which is notionally understood to mean the majority of the population as opposed to one group or another. There is no evidence that this is the case.

Keep in mind, too, that the health care crisis of the minority can very quickly become the health care crisis of the majority when we introduce fast-spreading infectious diseases into the mix, as in the SARS crisis a few years ago. The uninsured who develop such a disease won't receive treatment in time and may very well go on to infect a larger group. Purely for self-interest we should be pushing to get everyone easily available medical care.

Posted by: Stefan on July 14, 2007 at 10:43 AM | PERMALINK

I'm wondering just how bad it would have to get for JeffII to wake up. From his arithmetic approach it appears that we'd have to wait until 150,000,000 people are uninsured and 70,000 people die every year for lack of insurance. Our lousy way of doing health care in this country keeps getting worse by the year so I guess we won't have to wait too long for those numbers to be actual.

Posted by: digitusmedius on July 14, 2007 at 12:12 PM | PERMALINK

As I write this, I'm listening to an interview w/ Michael Moore conducted by David Brancaccio on NOW, the PBS news show. It's a couple weeks old; has been sitting on my DVR.

The difference between this presentation and his two appearances on CNN is, to say the least, striking. He sounds extraordinarily reasonable and knowledgeable. Gupta's challenges on the Larry King show were ridiculous, but Moore's boorishness undermined his credibility. I wish more people could see this interview.
Posted by: THS on July 14, 2007 at 4:51 AM
-----
THS, I just finished watching it-thanks for the link. He's extraordinary reasonable IMO because he isn't there fighting with somebody. He expects a major assault because of all the money that is behind the status quo. One of the highlights of the interview was when David Brancaccio reads the letter of response from the Insurance Industry where they "recognize" that changes need to be made. Moore's response to that was spot on-the Insurance Industry wants a mandate for us to purchase insurance from THEM. The big battle that is looming is whenever one of the Dem candidates gets behind a single-payer plan... Will it be Hillary? She was the one recently that mentioned "the usual suspects" (big pharma and Insurance) that will be poised to battle. I've never been a single issue voter in the past, but I think this is so vital that I will vote for whoever comes up with a single-payer plan in the primary.

Posted by: Doc at the Radar Station on July 14, 2007 at 12:52 PM | PERMALINK

I'm fortunate enough to have pretty good health insurance coverage, and I still have disgustingly long waiting times. The last time I scheduled an appointment to see my personal physician, I had to wait over 2 weeks! I wasn't even going in for a procedure.

People who claim we have good health care with limited or no waiting lines are deluded or lying.

Posted by: Jake on July 14, 2007 at 2:50 PM | PERMALINK

And the worst waiting time of all is the "no money, no insurance" waiting time. I had a fried who had abdominal pains and could not eat because it made him ill. He was losing weight madly.

"Go to a doctor!"
"I am waiting until I have insurance!"

Ten days after he saw the doctor he was dead. 40 years old. Cancer that ate him alive. He was killed by a lack of insurance and an unwillingness to bankrupt his family.

This country is rotting.

Posted by: Scorpio on July 15, 2007 at 8:16 AM | PERMALINK
...only in wingnut health-policy fantasyland is not measuring a problem the same as not having a problem.

Also, whenever they cover their eyes up with their hands, they believe that they are invisible.

Posted by: El Cid on July 15, 2007 at 11:20 AM | PERMALINK

First of all nearly every country ranked above the U.S., excepting Japan, has at most 1/4 the population.

So? As long as the sample size is large enough it's easy enough to compare statistics across differently population groups. Posted by: Stefan

No. By that reasoning, you're saying crime statistics would be the same in a small, Midwestern town as in a large metropolitan area. Size matters.

Many of the countries that outrank us are not in fact homogenous and many have large immigrant populations.

Actually, no. While the Netherlands has a fair degree of ethnic diversity, it's population and geography are so small compared to the U.S. that it, again, supports my believe that disaggregating the information that this survey was based upon would should results different than the overall ranking purport to show. Ditto for the U.K. being ranked above the U.S., even with it's truly heterogeneous population. The rest of the first 30 or so nations on the list have small populations and little ethnic diversity. Again, this matters a great deal.

Even when we control for that, however, and look within distinct homogenous subgroups the US underperforms. For example, a recent study showed that the health statistics of the wealthy in this country (a largely Caucasian and relatively homogenous group) are worse than the statistics of a similarly situated wealthy, Caucasian subgroup in the United Kingdom. Posted by: Stefan

You need to document this because I find it impossible to believe.

Posted by: JeffII on July 16, 2007 at 2:40 PM | PERMALINK

You need to document this because I find it impossible to believe.

England beats US in health stakes
FT.com
By Clive Cookson in London

Published: May 2 2006 18:46 | Last updated: May 2 2006 18:46

Middle-aged English people are “much healthier” than their American counterparts, even though the US spends far more on medical care than the UK, according to a large international study published on Tuesday in the Journal of the American Medical Association.

Americans have significantly higher rates of diabetes, heart disease, stroke, lung disease and cancer than English people in the 55 to 64 age group.

Sir Michael Marmot, professor of epidemiology at University College London, who led the British arm of the study, said the findings would surprise international health policy experts. His US colleague, James Smith of the Rand Corporation in California, added: “You don’t expect the health of middle-aged people in these two countries to be too different, but we found that the English are a lot healthier than the Americans.”

The researchers who were funded by several US and UK government agencies, set out to look at the social and economic factors affecting health but shifted emphasis when large differences emerged between the two countries. The study looked both at the way people reported their own health and – to guard against any bias from self-reporting – at objective biological markers of disease from blood tests. Altogether there were about 15,000 participants.

Samples in both countries were limited to whites and excluded recent immigrants, so as to control for racial and ethnic factors.

“This study challenges the theory that the greater heterogeneity of the US population is the major reason the US is behind other industrialised nations in some important health measures,” said Richard Suzman, programme director at the US National Institute on Ageing, which co-funded the research.

As expected, people with higher socio-economic status, as measured by their income and education levels, tended to enjoy better health. But because the national differences were so great, those at the top of the education and income scale in the US suffered diabetes and heart disease at a similar rate to those at the bottom of the scale in England.

....Prof Marmot suggested that, while the healthcare provided by the British state health service was not superior to the private US system, it provided important psychological reassurance.

As the researchers say in the journal paper: “To a much greater extent England has set up programmes whose goal is to isolate individuals from the economic consequences of poor health in terms of their medical expenditure and especially earnings and wealth reduction.”


http://www.ft.com/cms/s/6c9dee06-d9ff-11da-b7de-0000779e2340.html


Posted by: Stefan on July 16, 2007 at 3:49 PM | PERMALINK

No. By that reasoning, you're saying crime statistics would be the same in a small, Midwestern town as in a large metropolitan area.

Certainly they could, on a per capita basis. That's why, for example, crime ins worse in small, Midwestern Gary, Indiana than in my hometown of New York. There may be more crime total in New York, but there's also a lot more people, so the individual chance of being a crime victim is much lower in New York than in Gary.

Size matters.

Only to the degree that the sample size is large enough. If size mattered to such a degree you'd never be able to do comparative statistics.

Actually, no. While the Netherlands has a fair degree of ethnic diversity, it's population and geography are so small compared to the U.S. that it, again, supports my believe that disaggregating the information that this survey was based upon would should results different than the overall ranking purport to show. Ditto for the U.K. being ranked above the U.S., even with it's truly heterogeneous population. The rest of the first 30 or so nations on the list have small populations and little ethnic diversity. Again, this matters a great deal.

Why? You keep claiming that it does, but offer no explanation for why you think this is a factor.

Posted by: Stefan on July 16, 2007 at 4:13 PM | PERMALINK

You need to document this because I find it impossible to believe.

Want to be healthier? Move to Britain
Experts suggest health system, exercise could be key
By JOHN FAUBER
jfauber@journalsentinel.com
Posted: May 2, 2006

Compared with the British, white, middle-aged Americans are substantially less healthy, according to a study published today in the Journal of the American Medical Association.Pick the disease - diabetes, heart disease, stroke, cancer, lung disease, high blood pressure - and Americans are much more likely to have it than their counterparts on the other side of the pond.

...."In some cases, the wealthiest Americans were sicker than England's poorest," said Julie Mitchell, an assistant professor of medicine at the Medical College of Wisconsin who practices at Froedtert Memorial Lutheran Hospital. "That's crazy."

Indeed, when the researchers divided people from the two countries by both education and income levels, Americans with higher incomes and who were more educated often had higher rates of ailments such as diabetes, cancer and heart disease than English who were in the bottom strata.


http://www.jsonline.com/story/index.aspx?id=420431

Posted by: Stefan on July 16, 2007 at 4:20 PM | PERMALINK

Certainly they could, on a per capita basis. That's why, for example, crime ins worse in small, Midwestern Gary, Indiana than in my hometown of New York. There may be more crime total in New York, but there's also a lot more people, so the individual chance of being a crime victim is much lower in New York than in Gary.

Stefan, Gary isn't a small town, but a nasty "suburb" of Chicago with a population of over 100,000. However, if you compared Gary's crime rate to that of the Bronx or Brooklyn, it would be about the same.

(And we accuse wingnuts of cherry-picking.)

Some of the nations ranked above the U.S. in the WHO study have populations of less than a million - Malta, Andorra, Monaco, and Cyprus, for example. Those aren't countries but cities with a lot of real estate.

Only to the degree that the sample size is large enough. If size mattered to such a degree you'd never be able to do comparative statistics.Posted by: Stefan

Comparative statistics are fine as long as you are comparing things of the same category and magnitude. The only thing you achieve with comparing a nation of 300 million to one of less than 17 million (the Netherlands) is showing how much things can and do change on a larger scale. Again, Japan is the only country with a significant population that has a good national health system. That being said, as with most Japanese statistics, the health care statistics are probably fudged a bit, as are Japan's unemployment rate and crime statistics.

I'll concede your points about healthy upper-middle Brits, but otherwise you are treating populations as is if they were generic and that statistics are the same across category. That's just sloppy.

And, again, I never said that the U.S. has the best health care system in the world. What I said, and nothing contributed here by anyone has shown otherwise (no one else's ancedotal "data" is any more valid than mine), is that the U.S. health care system is not in crisis, and that it is stupid to compare the U.S. system against those in small nations or even not so small nations.

According to the CDC's statistics in 2006, 16.1 percent of Americans had no health insurance. http://www.cdc.gov/nchs/fastats/hinsure.htm

That's too high a number. But when you disaggregate it, you find that about 36% of this total are households with incomes of $40K or higher, and that nearly 17% of the uninsured have incomes greater than $50K. What is one to conclude from this?
http://covertheuninsured.org/factsheets/display.php?FactSheetID=123

As I posited before, while we have a bit over 16% of the population uninsured (but with more than a third of the uninsured having incomes that could pay for some insurance), is that the "crisis" in health care is not a general crisis, but one primarily for the unemployed and working poor.

Posted by: JeffII on July 16, 2007 at 6:55 PM | PERMALINK

JeffII--

Unfortunately, the good lord did not make sovereign nations of all the same size. But you can't just simply state that because some nations are smaller than others that they are in a completely different analytical category. This is classic obfuscation, because of course there is NO country which has a similar population and GDP per capita as the US. As you say, the closest one would be Japan, but even Japan has less than half the population of the US. All the other nations with comparable populations to ours are much poorer than us. So where exactly do you draw the line? Are you just outlawing all comparative studies?

It is your burden to prove that the change in scale has a significant impact. If a nation of 17 million (Netherlands) and a nation of 60 million (France) and a nation of 120 million (sorry maybe that's off a bit for Japan, anyway, more than 100 million) can enact similar policies and get similar good results, then you are the one that has to prove that scaling up to 300 million would throw everything out of whack. The wide variety in population BETWEEN nations with national health care systems is a strong argument AGAINST the idea that the US is somehow too "big" for national health care. It is your burden to explain the mechanism by which one last scale-up would doom the system. You can't just throw up your chaff and expect no one to call bullshit on it.

It sort of reminds me of those Russian political theorists who used to say that Russia was "too big" for democracy. And it's true that no country as big in area as Russia has ever had much success with democracy. Of course, there isn't any other country as big as Russia, but that's exactly the point.

Posted by: kokblok on July 16, 2007 at 10:22 PM | PERMALINK




 

 

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