national education & health care

[Nereid]

Originally posted by kat
Well, actually I think this is incorrect. I believe there is healthcare available for the poor in the U.S. and many programs to get the poor to college but..it's the middle class (lower middle maybe?) that struggles with health care and the cost of college because they make too much to be eligible for state and federal programs. Are you sure kat?

"WASHINGTON - The number of Americans who don't have health insurance rose sharply in 2002, mainly because of unemployment increases and two straight years of cuts in employer-provided health coverage.

The number of uninsured Americans jumped by 2.4 million to 43.6 million last year, the U.S. Census Bureau reported Monday. That's 15.2 percent of the population, compared with 14.6 percent in 2001. " This is from a 30 Sep 2003 Knight-Ridder news item.

AFAIK, "uninsured" in US-speak, when referring to medical insurance, means that the full costs of *any* medical treatment - even a visit to the local GP - must be paid by the patient ... and even a 15 minute local GP check-up may 'cost' over US$100. But then, what do I know?

[kat]

Originally posted by Nereid
[B]Are you sure kat?

Yeah, I'm pretty sure. Here's a wealth of information http://www.statecoverage.net/who.htm

If you scroll down you'll see a tan box that has a good outlay of who isn't covered.

You'll note that in the first box there are 14 million people uninsured who are eligible but have not accessed available programs. Of those 14 million-13 million have an income less then 200% of the poverty level (or less then about 37k for a family of 4. 1 million of that first 14 million(who are all eligible for state/federal provided insurance programs) have incomes in excess of 200% of the poverty level.

The 9 million people who fall in the middle column are those uninsured who have an income greater then 200% of the poverty level.

Then the final column are the 18 million uninsured individuals who have moderate to high incomes.

[kawikdx225]

Originally posted by pocebokli
I think most of the euro countries guarantee healthcare and higher education relatively cheap or free, which in the US only middle to high class can afford (education).


This is not true. I grew up in a lower class home and my parents didn't have money to put me through college so I went to the state of Pennsylvania for help. They told me my parents made too much money for me to get a grant or partial grant so they gave me a school loan instead. I had a six year grace period before I had to start making payments on the loan and they stretch the loan out over 10 years.

If my parents were really poor then I would have qualified for grant money.

I think anyone who wants an education in the USA can get it.

[Monique]

Yeah, well.. here in the Netherlands education is free. It doesn't cost $30.000 for a single year, no, it costs €1.500 for a year (in the US that could be a single class). The government pays for that too, including the cost of living and transportation. Ofcourse the trick is that you have to gather enough credits for it to become a gift instead of a loan.

Look at Belgium for instance, public transportation is completely free for every citizen of the country.

In Detroit they had to threaten to close down the major receiving hospital, because most of the incoming patients don't have insurance and the government doesn't pick up the bill. It was up to the hospital to help these people and pay everything out of their OWN pocket, leading them to the edge of bankrupty!

How about social security in the US? What happens when you get laid off? What happens if you have back problems and can't work? Will the government pay up to 70% of your income?

A socialist government provides for its citizens, gives subsidies and runs businesses. The US government would be exactly opposite. Why do you think taxes are so low in the US? In western Europe they are notoriously high.

[phatmonky]

Originally posted by kawikdx225

I think anyone who wants an education in the USA can get it.

Absolutely.
I recently quit a successful business to make what I was making 4 years ago. My last years tax return puts me too high for aid, but I don't make enough right now to cover school. Loans it is! No big deal.
I prefer that it is not free. Higher education for free is like giving pearls to swines - none will appreciate it (just as they don't appreciate the 'free' education you get until that point). Those that wish to go to school will pay for it, and will succeed at it because they don't want to waste their money.

[phatmonky]

Originally posted by Monique
1>Yeah, well.. here in the Netherlands education is free. It doesn't cost $30.000 for a single year, no, it costs €1.500 for a year (in the US that could be a single class). The government pays for that too, including the cost of living and transportation. Ofcourse the trick is that you have to gather enough credits for it to become a gift instead of a loan.

2>Look at Belgium for instance, public transportation is completely free for every citizen of the country.

3>How about social security in the US? What happens when you get laid off? What happens if you have back problems and can't work? Will the government pay up to 70% of your income?

4>A socialist government provides for its citizens, gives subsidies and runs businesses. The US government would be exactly opposite. Why do you think taxes are so low in the US? In western Europe they are notoriously high.

1>Only in med school. My medschool is slated to be roughly that each year. It's only about 20,000 for my entire 4 years of undergrad, and I'm still looking for some grant money considering a specific situation I am enduring.
2>cool!

3>Each state handles it's own unemployment insurance. In Texas there is a percentage up until a maximum. Also, there is an account labeled for you with XXXX dollars in it. When that account goes dry, you're out of luck. That account is paid for, in Texas anyways, by the businesses, not the employee. It's all setup as an initiative to make people not just ride the clock waiting to get a new job. You can alos work while being unemployed and make an extra 75bucks each week. That works like this: If you get 400 a week for Unemployment, but also work, you can make 475 a week. You make 300 at your job, you only take 175 out of your account. You make 200 at your job, you only take 275 out of your job. This gets people moving to atleast part time jobs while they are searching for the job they really want.
4>I agree. :) Do you prefer socialism despite it's inefficiency? Prefer capitalism? Or would you like to see a combination of both?

[russ_watters]

Originally posted by pocebokli
well if there were no rich there would be no poor either because you'd loose something to compare with:-) Thats a logical fallacy (I guess thats what the smiley was for), unless of course you choose to define "poor" and "rich" in relation to each other (a flawed definition) - which we do in the US, instead of defining them by an absolute standard of living. As a result, the categorization "poor" has lost all meaning in the US: someone who is "poor" today is vastly richer than someone who was "poor" 40 years ago. And if you really want to make it comical, start comparing "poor" in the US to "poor" in other countries. This is not true. I grew up in a lower class home and my parents didn't have money to put me through college so I went to the state of Pennsylvania for help. I mostly agree, except where you say you were in a "lower class home." Clearly, by the state definition, you were not. I was in what you (and the state) would call a "middle class home," and my parents also had difficulty with paying for college for me and my sister (though not as much as yours). They essentially bribed my sister into going to state school instead of private school.free...free...free...free... Well, of course you know, Monique, "free" is a relative term. SOMEONE has to pay for it: what is your marginal tax rate? That word - I really hate that word. Its a lie fed to the public by politicians. And like candy,* people eat it up even though its not any good for you.

*My local grocery store now sells jelly beans in 5lb bags. Boy, am I screwed now.

[kat]

Originally posted by Monique
is completely free for every citizen of the country.
Hmmm.....
Why do you think taxes are so low in the US? In western Europe they are notoriously high. It would seem that it's not free at all....

[russ_watters]

Originally posted by kat
It would seem that it's not free at all.... Kat, you and I apparently have some weird telepathy thing going...

[phatmonky]

Originally posted by russ_watters
Thats a logical fallacy (I guess thats what the smiley was for), unless of course you choose to define "poor" and "rich" in relation to each other (a flawed definition) - which we do in the US, instead of defining them by an absolute standard of living. As a result, the categorization "poor" has lost all meaning in the US: someone who is "poor" today is vastly richer than someone who was "poor" 40 years ago. And if you really want to make it comical, start comparing "poor" in the US to "poor" in other countries.

The largest health problem with our nation's poor is.....OBESITY! honestly, and that's morbidly comical.

[Monique]

Originally posted by phatmonky
1>Only in med school. My medschool is slated to be roughly that each year. It's only about 20,000 for my entire 4 years of undergrad, and I'm still looking for some grant money considering a specific situation I am enduring. Undergrad, that would be bachelors? How about a master?

4>I agree. :) Do you prefer socialism despite it's inefficiency? Prefer capitalism? Or would you like to see a combination of both? Socialism is good on the citizens, it gives them a confortable live and nothing much to worry about. As I mentioned, the money has to come from somewhere so taxes are high, but it gets distributed evenly across the nation, so I am all for that.

The thing lacking is incentive. You mentioned it too, if education is free, you take it for granted. If you fall into unemployment, you still make a decent living. If you feign to have a back problem, you get even more money. That is one of the biggest problems at the moment: wáy to many people are in 'unemployment disability welfare'. The taxpayer is providing all these people with a living, while all these people would be perfectly able to find a job themselves, but why wóuld they? So very soon the government is going to implement more rigorous reexaminations of all people in disabilty (under the age of 55).

But yes, I still like a government who takes taxes and uses it for the things I mentioned.

[kat]

Originally posted by russ_watters
Kat, you and I apparently have some weird telepathy thing going...
Great minds and all that...[;)]

[Monique]

Originally posted by kat
Hmmm.....
It would seem that it's not free at all.... I am a student: yes it is free! When you start to earn a living, do you get to pay taxes and do you start to provide the country with the means to provide a service like that. As I said: taxes are higher, but they are not equal to all.

[Nereid]

Onto our favourite (oops, 'favorite' for phatmonky and Russ [;)] ) topic, yes?

Re health: the US's ~14% of GDP spent on health produces what ~100% better health outcome than the Netherlands' ~7% of GDP spent on health?

Life expectancy at birth? (no)
5-year survival rate from major cancers? (no)
Incidence of heart disease? (no)
Average years of old age spent in rude health? (no)

[Edit: fixed typo]

[Monique]

Originally posted by Nereid
Onto out favourite (oops, 'favorite' for phatmonky and Russ [;)] ) topic, yes?

Re health: the US's ~14% of GDP spent on health produces what ~100% better health outcome than the Netherlands' ~7% of GDP spent on health? Not sure what you mean to say there..

US
Life expectancy at birth? 77.14 years
Death rate: 8.44/1000 (median age 36)
Infant mortality rate: 6.75/1000
Literacy: 97%
GDP per capity: $36300 (2002)
Unemployment rate: 5.8%
NL
Life expectancy at birth? 78.74
Death rate: 8.66/1000 (median age 38)
Infant mortality rate: 4.26/1000
Literacy: 99%
GDP per capity: $27200 (2002)
Unemployment rate: 3% (underestimation)

taken from the CIA website

[phatmonky]

Originally posted by Nereid
Onto out favourite (oops, 'favorite' for phatmonky and Russ [;)] ) topic, yes?

Re health: the US's ~14% of GDP spent on health produces what ~100% better health outcome than the Netherlands' ~7% of GDP spent on health?

Life expectancy at birth? (no)
5-year survival rate from major cancers? (no)
Incidence of heart disease? (no)
Average years of old age spent in rude health? (no)

I'll humour (;) ) you.

First answer this:
Does the Netherlands' have the queues that Canada, Australia, and England have for doctors visits and surgeries?

I'm trusting an honest answer here.

[Monique]

We don't directly step the the specialist, so cases that don't really require a specialist relieve the burden there. Also, what I have heard is that the General Practicioner to population ratio is especially favorable in NL (although there still is a shortage). Yes, there are waiting lists, but only for specialists. If I wished to I can show up in my doctor's office any time.

[Nereid]

Originally posted by phatmonky
I'll humour (;) ) you.

First answer this:
Does the Netherlands' have the queues that Canada, Australia, and England have for doctors visits and surgeries?

I'm trusting an honest answer here. Last time I was in England and Australia (and Hongkong, and several other countries), there were no queues for doctor's visits or surgeries. Last time I was in the US, I couldn't go to see a doctor or a surgeon without having a) a valid credit card, and b) proof that I belonged to a health plan (quite an unnerving experience!)

In all cases, except for emergencies, I needed to make appointments. In only one case have I had difficulty making a doctor's appointment (that I can recall), and that was in the US.

Fortunately, when I've been in the Netherlands and Canada, I've not needed to visit a doctor (touch wood).

So, how about those figures on the ~100% increased average (health) benefit in the US, for the 2x greater health spend? Monique has already given us data on
> life expectancy: NL 1, US 0

[Monique]

Originally posted by Nereid
Last time I was in the US, I couldn't go to see a doctor or a surgeon without having a) a valid credit card, and b) proof that I belonged to a health plan (quite an unnerving experience!) Oh don't get me started about US health care system, especially for aliens. I don't have a license and a passport is not a valid method for identification in the US, apparently :S I had proof that I belonged to a healthplan, but it was Dutch: soooo: they don't take it. Having to wait for HOURS in the waiting room, having to wait another hour in the small waiting room. Not getting service, having to pay... how much was it? $75 I believe for a 10 min consultation.

[phatmonky]

Originally posted by Nereid
Last time I was in England and Australia (and Hongkong, and several other countries), there were no queues for doctor's visits or surgeries. Last time I was in the US, I couldn't go to see a doctor or a surgeon without having a) a valid credit card, and b) proof that I belonged to a health plan (quite an unnerving experience!)

In all cases, except for emergencies, I needed to make appointments. In only one case have I had difficulty making a doctor's appointment (that I can recall), and that was in the US.

Fortunately, when I've been in the Netherlands and Canada, I've not needed to visit a doctor (touch wood).

So, how about those figures on the ~100% increased average (health) benefit in the US, for the 2x greater health spend? Monique has already given us data on
> life expectancy: NL 1, US 0

Well I'm glad you have had such a great luck with those countries. My girlfriend from Toronto has been through the system and I know it all to well with great detail. But I will leave this alone, as I do not need to worry about the queues for my case. It was an attempt at just an extra point. BTW, what US city were you in? [:)]


1> Diminishing returns. A smaller country will cost less per person to keep well. Transport, population density, etc. all have to factor in. Again though, this is just to take in to account. I'm just knocking away at that 100% percentage difference right now.

2> Looking at your figures, you mention the infant mortality rate.
This is up for grabs. At the end of 2003 the EU, via Peristat Research, found that the mortality is actually 7.4/1000. Still not 100%, but we are working on showing where that extra money is going. Now why is it 7.4? Well the research points to lifestyles...ohh, that's a good one for my next point! [;)]

3>Dealing with life expectancy. You cannnot pin lifestyles or outside influences on the healhcare system. The US murder rates are 4 times that of the netherlands, with the aggravated assault rates 20 times. This all factors into the cost.

.....
WOAH, I'm not continuing.....

Well I'll be. While I was sitting here reading some figures I came to this....
http://society.guardian.co.uk/futureforpublicservices/story/0,8150,687030,00.html

But the government's targets are clear enough and the electorate will be able to tell whether it is delivering.

The maximum waiting time for an operation is due to fall from the current 15 months to six months by 2005, in time for the next general election.

Ministers say waiting times will be down to three months by 2008, when there will be at least 15,000 more doctors, 35,000 more nurses and 30,000 more therapists and scientists. The government is also promising 10,000 more hospital beds.

These are not soft targets. Without the money they could not be delivered.



15 months?! 6 months?! 3 months is a goal?! Granted, this is England, before finding this, you would have me believe that their system is fine and dandy.

Then I come across australia http://www.smh.com.au/articles/2003/10/15/1065917483680.html?from=storyrhs


Then research on waiting in Canada and the fact that they use US hospitals to alleviate some of the wait...
http://oldfraser.lexi.net/publications/critical_issues/2000/waitingyourturn/section_07.html



Sadly, as a smaller country, not a lot of statistics about the netherlands could be found easily.

http://www.google.com/search?q=cache:hk1il5b7h0UJ:www.oecd.org/dataoecd/13/35/16584600.pdf+elective+surgery+waiting+netherlands&hl=en&ie=UTF-8

But looking at that, the netherlands has 15.2% of patients waiting for more than 12 weeks.
On the other hand, the US only has 5% waiting over 16.

[phatmonky]

I'm not going to continue. I think the facts are clear. Murder, car accidents, research investment, and unhealthy diets all play into the healthcare costs.

The one thing I have found that is fully to blame on the healthcare system is waiting times. It is insanely excessive, just as I had predicted, in the countries mentioned.

Oh, and 15% is 3 times 5% - I think that'll cover the 100% difference you were looking for.

[phatmonky]

Hey Zero, can you cut this thread in half and save this train wreck?

[phatmonky]

I prefer a privatized healthcare system no matter what. When I say that, that doesn't mean I woudl be against looking at alternatives to the insurance setup. It means I am against having doctors and hospitals all put under government control,pay, etc.

I believe that doctors need to be given the autonomy to do what is best for the patient. Ask a doc who has worked in a heavily beaurocratic hospital, and you will know that they are told to stop ordering so many CTscans and other tests.

I also would like to see a revamp of our medicare/medicaid system. I believe that all children should have healthcare access,and I believe that for extremely high cost/income ratios there needs to be some sort of aide given.

With that all said, I don't support any system that will limit the patients ability to pay for the most superior service available, if they are so inclined. I also don't like the idea of a socialized healtcare because of the lack of incentives to NOT go to the doctor. I have spoken with canadian doctors who tell me about abuse of the 'free' system. The nurses would chew people out because they come up there with mosquito bites wanting a benadryl shot to stop the itching. How can such a system work, when people are so obese and unhealthy here already? The answer is, that it can't. Not without raising costs evenmore.

Cover children and extreme cases. Give selection, incentives to stay healthy, and doctor autonomy. Then you have the perfect system.

[phatmonky]

Originally posted by Nereid

All of which leads to: how does one measure the cost-efficiency of health care?


Well, it is a slippery slope. There have been studies done, but there a too many factors.

Obviously the first 1000 dollars gets you a lot more than the next.
Some studies indicate that we could accompolish the same end results we have now for 50% less for every dollar spent over 1 trillion. This could be done simply through investment in greater technology for patient records (cutting down indirect overhead). That is a 300 billion dollar savings at our current rate.

[phatmonky]

Originally posted by Monique
Undergrad, that would be bachelors? How about a master?
[/B]

whoops, yes, that's bachelors.
A Masters is going to vary. We charge per class, and usually that is based upon the hours a week that class takes and the level of class.
My friend is persuing a Masters in psychology and it will be about 8,000 to get that on top of the Bachelors. However, he did very well in his undergrad studies and was got a partial scholarship for it. So he is paying less than that amount.

I'm sure an MBA (Masters of Business Administration) would cost a severely higher amount from any of the Ivy league schools. But that's why they run off to be consultants making 100,000/yr after the first 3 years :)

[kat]

I moved this over from the other thread because evidently much of what I was responding to was moved here whle I was responding...I'm not sure the post I quoted is here ...but anyway..my 2 cents.

Originally posted by Nereid
Am not sure I follow all that you've said, but in summary it seems to be:
-> the unhealthy lifestyle in the US drives up health-care costs (guns, cars, obesity, etc); if these were accounted for (how?), then the far greater per-capita GDP spend on health would largely disappear
-> waiting times are an acceptable trade-off; i.e. $ for $ of per-capita GDP the average *health* of citizens of a nation improves for each day-for-day reduction in waiting times (for surgery of all kinds).
I'm not sure I agree with this, I believe that one of the most significant contributers to higher medical cost are 1. Administrative costs. Simplifying and devloping uniform billing forms for all insurance companies would cut administrative cost by a large percentage. That may be on of the most significant savings that socialized medicine recieve..in that they are not billing multiple companies, needing different procedures and forms for each (talking dozens or more companies?) The other of course is the cost derived from the high cost of liability insurance. I could be wrong, and I don't have the numbers atm...but I'm pretty sure I'm correct.


More broadly, to the extent that phatmonky, Monique, kat, Russ (?), Nereid, etc have a choice, which country seems preferable, in terms of the health-care system?

For the avoidance of doubt on this last one, I'll take 'socialised medicine' (is that what it's called in the US?) thank you. Well, I've been very pleased with my health care. I've lived in many states, many cities in the United States...My situation during my lifetime has fluctuated from dealing with unemployment and no insurance to having short term fallen below the national standard and being elligible for state insurance with 2 children..to having very good insurance through work. At no time have I not recieved adequate care, at no time have my childrens needs not been met..and in fact more often then not our health care has been above and beyond what one would deem neccesary.
They only comparision I have with a foriegn country is spain and japan..japan I went on the airforce base and recieved excellent care. Spain I went to a local hospital in Constantina and recieve decent care..but it was a frightening experience because my spanish wasn't as good as it probably should have been [;)] With socialized medicine.. I have to admit..I've heard horror stories and whether they are true or not I don't know..I'll stick with what I know, from past experience...works well for me.

[motai]

This isnt normally my area of expertise, but I thought of a way to help the government pay for all of these expenses.

Put a graduated income tax on large corporations. This will keep small businesses from going under and will also help out the corporations' employees as they will be healthy (less downtime) which means more productivity.

Will this work? Is it feasable?

[Dissident Dan]

Maybe the longer waiting times in countries with socialized medicine are due to the fact that more people have the option of surgery. In the US, a poor guy with coronary heart disease will probably die from it, while a rich guy might have his life extended with bypass surgery.

...It damn sure would be nice if I had the money to take care of this cavity...

[phatmonky]

Originally posted by Dissident Dan
Maybe the longer waiting times in countries with socialized medicine are due to the fact that more people have the option of surgery. In the US, a poor guy with coronary heart disease will probably die from it, while a rich guy might have his life extended with bypass surgery.

...It damn sure would be nice if I had the money to take care of this cavity...

Only if that poor guy isn't smart enough to sign up with any of the state or Federal programs, and then decided he was too good for the emergency room.
I highly doubt your hypothesis to be correct. The more probable reason is the work hours of our physicians compared to other countries. Also, as has been stated, we pur more emphasis on specialists, than on generalists. (the doctor population is skewed more towarsds specialist in our country than the above mentioned)

[Nereid]

Originally posted by Dissident Dan
Maybe the longer waiting times in countries with socialized medicine are due to the fact that more people have the option of surgery. In the US, a poor guy with coronary heart disease will probably die from it, while a rich guy might have his life extended with bypass surgery.

...It damn sure would be nice if I had the money to take care of this cavity... That may well be true ... elementary economics - how to keep demand down? raise the price!

Back to the main question - what (other than, possibly, shorter waiting periods for elective surgery) does the extra ~$US3k* per capita buy you, if you live in the US?

I've read that the same medicines - made by the same phamaceutical companies, even in the same factories! - cost Joan and John much more in the US than Pierre and Paula have to pay, just across the border in Canada.

*~14% of $36k - ~7% of $27k (Monique's figures)

[Bystander]

Originally posted by Nereid

*~14% of $36k - ~7% of $27k (Monique's figures)

Huh? $3k/head? You wanta check that? I ain't got a horse in this race, but the numbers on the racing sheet are "sceereeewwwed up."

[Evo]

Having friends and relatives in different parts of the world, I have to say that I am very happy that I live in the US!

My best friend lives in Sicily. The medical coverage is socialized there. Last year his father was very ill and needed an MRI for diagnosis. He was put on a waiting list for 6 weeks!! I talked my friend into flying his father out of the country to get the MRI and pay for it himself. That would not have happened here in the US. I am terrified of my friend getting seriously ill in Italy, he will not get the treatment he needs in time. Socialized medicine is the worst.

Where I live, if I need to see the doctor, I can usually get an appointment within a couple of hours. When I get there, I am seen exactly at my appointment time, no waiting. It costs me $10. If I need medicine, generic prescriptions cost me $5. There is no waiting if I need a procedure like an MRI, it is done immediately.

[ShawnD]

Originally posted by phatmonky

Does the Netherlands' have the queues that Canada, Australia, and England have for doctors visits and surgeries?


I live in Canada so I can speak from experience here.

1. Canada does not have queues to see the doctor. When something is sort of wrong and I have to see the doctor, I go to the private clinic where I have to wait maybe 30 minutes. If it's sort of an emergency (like I'm bleeding really bad), they'll treat me immediately.

2. Waiting line for surgery also depends on urgency. My friend shattered his arm once and he was under the knife within 50 minutes of arriving at the hospital (that's including time it took for them to determine that his arm was shattered and needed surgery). If you need surgery that is not too important, such as fixing carpel tunnel syndrome, you can expect to wait about 3 weeks or so.

[Nereid]

Originally posted by Bystander Nereid: *~14% of $36k - ~7% of $27k (Monique's figures)
Huh? $3k/head? You wanta check that? I ain't got a horse in this race, but the numbers on the racing sheet are "sceereeewwwed up." Originally posted by Monique*SNIP
GDP per capita: $36300 (2002)
GDP per capita: $27200 (2002) 0.14 x 36200 = 5068
0.07 x 27200 = 1904
5068 - 1904 = 3164 ~=$3k

[Zero]

Originally posted by Evo
Having friends and relatives in different parts of the world, I have to say that I am very happy that I live in the US!

My best friend lives in Sicily. The medical coverage is socialized there. Last year his father was very ill and needed an MRI for diagnosis. He was put on a waiting list for 6 weeks!! I talked my friend into flying his father out of the country to get the MRI and pay for it himself. That would not have happened here in the US. I am terrified of my friend getting seriously ill in Italy, he will not get the treatment he needs in time. Socialized medicine is the worst.

Where I live, if I need to see the doctor, I can usually get an appointment within a couple of hours. When I get there, I am seen exactly at my appointment time, no waiting. It costs me $10. If I need medicine, generic prescriptions cost me $5. There is no waiting if I need a procedure like an MRI, it is done immediately. This sort of thing happens in the US too, you know. It depends on where you live, and how busy the doctor is.

[phatmonky]

Originally posted by Zero
This sort of thing happens in the US too, you know. It depends on where you live, and how busy the doctor is.
6 weeks for an MRI? My ***! Maybe somewhere in the middle of montana.
The fact is that we have more MRI's per capita than Italy.
We also treat out healthcare more efficiently.
I'm not sure what the rest of the country is doing, but I have viewed a growing trend throughout Texas (Houston, Austin, Dallas, Brownsville, and El Paso) of a hierarchial setup that allows a single doctor to handle 15 patient rooms. This is done through a 'stacking' of roles with a large number of nurses, a slightly smaller number of PA's, a nurse practitioner or two, and at the very top, a single doctor.
TO the patient, it looks like this:
Nurse runs you through triage and brings you into the exam room.
The PA comes in and does the diagnoses.
The Doctor comes in and makes sure that he concurs with the PA's findings, rights prescriptions, makes referal to another doctor, etc.

This setup is insanely efficient in moving patients through the process quickly. The down side, is as has been stated, it cost more for all that man power. However, it results in a much quicker program than the old process of nurse directly to doctor, in which a doctor would often only see 5-6 exam rooms at a time.

[phatmonky]

Originally posted by ShawnD
I live in Canada so I can speak from experience here.

1. Canada does not have queues to see the doctor. When something is sort of wrong and I have to see the doctor, I go to the private clinic where I have to wait maybe 30 minutes. If it's sort of an emergency (like I'm bleeding really bad), they'll treat me immediately.

2. Waiting line for surgery also depends on urgency. My friend shattered his arm once and he was under the knife within 50 minutes of arriving at the hospital (that's including time it took for them to determine that his arm was shattered and needed surgery). If you need surgery that is not too important, such as fixing carpel tunnel syndrome, you can expect to wait about 3 weeks or so.


The research says different.
My girlfriend was misdiagnosed at Toronto General for having acute angular glaucoma. They couldn't get her in for 5 days. If they had diagnosed her properly, she would be blind right now.
Or when she had to have a splenectomy, she was given the option of almost 2 months later. Luckily, her doctor was able to find a doctor who had a patient cancel and she got in a week later, since her spleen was so far inflamed that docs told her to stay in bed for fear of rupture. The fact is, counting on someone cancelling should never be the only option to getting a surgery that your doctor deems vitally important.

[Zero]

Are we going to pretend that American medicine is magical, and everyone else's healthcare system is horrible?

[phatmonky]

Originally posted by Zero
Are we going to pretend that American medicine is magical, and everyone else's healthcare system is horrible?


Nope, but when it comes so efficiency and expiediancy we take the prize.
I've already outlined my wants in a healthcare system, and it doesn't match the US's system or a fully socialized one :)

[Monique]

Originally posted by Evo
Where I live, if I need to see the doctor, I can usually get an appointment within a couple of hours. When I get there, I am seen exactly at my appointment time, no waiting. It costs me $10. If I need medicine, generic prescriptions cost me $5. There is no waiting if I need a procedure like an MRI, it is done immediately. lol, are you serious? I required antibiotics for a gum infection in the US and I had to wait for TWO MONTHS!! To see a $^#^&* doctor. I protested, they didn't care. If I required immediate attention, I should go to the emergency room in a hospital, they said!

That is not an isolated case, every single doctor visit was a disaster. Having to wait for three hours past my actual appointment time. Not getting to see anyone. Having to wait for TWO MONTHS to get the result from a simple blood test which I needed for work!! Again I protested: get me a nurse to give me the results I said. No, you have to wait and make an appointment, which won't be until two months from now. Get me another doctor I said, no can't do. I stood there and argued for 30 minutes, until they finally gave up.

I could go on, but I won't :P

[Zero]

Originally posted by phatmonky
Nope, but when it comes so efficiency and expiediancy we take the prize.
I've already outlined my wants in a healthcare system, and it doesn't match the US's system or a fully socialized one :) uh huh... so, do you want poor children to get no health care?

[Zero]

I don't think isolated cases are worth mentioning, on either side.

I also think that insurance companies are in the business of lowballing hospital care. Competition doesn't improve health care, it makes it worse, because the insurance companies real customers are, frankly, stockholders, not patients.

[Njorl]

Originally posted by phatmonky
I'll humour (;) ) you.

First answer this:
Does the Netherlands' have the queues that Canada, Australia, and England have for doctors visits and surgeries?

I'm trusting an honest answer here.

I live in the US with our marvelously quick health care system. It often takes over 3 months wait to see a specialist. We are not paying more to have better health care, we are paying more so that we can have lots of fraud.

Individual patients defraud insurance companies.
Medical providers defraud insurance companies, patients and the government.
Insurance companies defraud their customer base.
Pharmaceutical companies defraud everyone by manipulation of patent laws.

The theory in health care is that insurance companies will act to counter the health care providers to keep prices low. The truth is that they merely fight over who gets how much. Because we feed two pigs instead of one, the cost is actually higher, not lower.

When the Clinton administration took office, health care costs were 20% of GNP and had an annual inflation rate of 19%. After the Clinton health care initiative was proposed, the associated inflation rate dropped to 1%. This clearly indicated that competition was not working to keep costs down. The only thing capable of affecting costs was the fear that health care would be nationalized. Threats work for only so long. Eventually, you have to follow through with action.


Njorl

[Nereid]

Originally posted by Zero
I don't think isolated cases are worth mentioning, on either side.

*SNIP Aw come on Zero, isolated cases are what gets our blood racing! [;)]Originally posted by Evo
Where I live, if I need to see the doctor, I can usually get an appointment within a couple of hours. When I get there, I am seen exactly at my appointment time, no waiting. It costs me $10. If I need medicine, generic prescriptions cost me $5. There is no waiting if I need a procedure like an MRI, it is done immediately.I have a friend, who's over 50, who was recently laid off ("force adjusted" in PC-speak), and has joined the 'transition' group in the language of the link which kat posted earlier (previous income >300% FCL (whatever), present income <200% poverty level). He has coverage, paid from his own savings (>$7,000 pa, annualised), provided by his previous employer, under something called COBRA (no, it's not snake oil). He pays $25 "copay" just to see the doctor, and recently paid $75 for a generic medicine (£6.80 in the UK), and *might* get a rebate of ~$40 when the health plan gets around to sorting out its records (by then his coverage will have ended, no doubt, and he'll get nothing). I suggested that he go work in China (his kids are grown) - plenty of jobs teaching English - but he says he can't speak Mandarin.

Maybe he should move to near where you live Evo.Originally posted by Njorl *SNIP
health care costs were 20% of GNP ... even higher than what I recalled! (~14% of GDP)

[Evo]

Originally posted by Monique
lol, are you serious? I required antibiotics for a gum infection in the US and I had to wait for TWO MONTHS!! To see a $^#^&* doctor. I protested, they didn't care. If I required immediate attention, I should go to the emergency room in a hospital, they said!

That is not an isolated case, every single doctor visit was a disaster. Having to wait for three hours past my actual appointment time. Not getting to see anyone. Having to wait for TWO MONTHS to get the result from a simple blood test which I needed for work!! Again I protested: get me a nurse to give me the results I said. No, you have to wait and make an appointment, which won't be until two months from now. Get me another doctor I said, no can't do. I stood there and argued for 30 minutes, until they finally gave up.

I could go on, but I won't :P I would have gone ballistic if I had to deal with that. Health care in the US will vary greatly depending on where you are and who you see and what kind of insurance coverage you have. I know for you it was even worse being a foreign national.

I am a dual national, I have both US & French citizenship. My uncle and cousin are both doctors in Paris and they have to deal with the socialized medicine there. I have lived in Europe, and may live there again, but my personal experience with medical care has been much better here in the US. I'm not saying that there isn't superb medical care in Europe, it's just that it is not always easy to obtain. But that can be true in the US if you do not have adequate insurance.

I have never had difficulty in getting immediate medical attention for anything, but I also choose not to live in a crowded metropolitan area. I live 8 minutes from 2 of the finest hospitals in the region. I have had to go to the emergency room twice (once to each) and both times there were no other patients and I was seen immediately. If I lived in downtown Chicago or Detroit, etc...it would have been a much differnt scenario.

Nereid, yes, your friend should live here, I selected this area for these specific reasons.

COBRA was enacted to guarantee employees that lose employment the possibility to extend their previous employer's health insurance plan temporarily so that they are not suddenly left without insurance. He might be better off trying to buy health insurance himself.

Zero, you're absolutely right about insurance being the driving force behind many of the problems within the health care industry.

Let's not forget the costs and issues created by out of control medical malpractice lawsuits in the US that have driven malpractice insurance through the roof. Now there are added costs from HIPPA.

[Zero]

Now, let's not place the blame for malpractice on anyone but the doctors who are screwing people up. Plus, of course insurance companies blow the problem all out of proportion in order to justify rate increases above and beyond covering malpractice costs.

[phatmonky]

Originally posted by Zero
uh huh... so, do you want poor children to get no health care?

Why don't you take the time to go read my posts instread of putting words in my mouth?[zz)]

[phatmonky]

Originally posted by Zero
I don't think isolated cases are worth mentioning, on either side.

I also think that insurance companies are in the business of lowballing hospital care. Competition doesn't improve health care, it makes it worse, because the insurance companies real customers are, frankly, stockholders, not patients.


Hence the reason I spent all the time posting link after link from sources like the OECD showing average wait time for various countries and procedures.

[phatmonky]

Originally posted by Zero
Now, let's not place the blame for malpractice on anyone but the doctors who are screwing people up. Plus, of course insurance companies blow the problem all out of proportion in order to justify rate increases above and beyond covering malpractice costs.

Just 5 percent of U.S. doctors are responsible for 54 percent of all malpractice. ( National Practitioner Data Bank)
The problem isn't with doctors in general. It is a very select few. I read somewhere (wish I could find the link) that the averag doctor in that 5% has settle 4 malpractice cases. Now the question is, when will their be a doctorial review board setup to remove these licenses?
Medicine is as much an art, as it is a science, and thus things can not always be predicted. There are legitiamte malpractice cases, but there are plenty that aren't.

Then you have people like john edwards who goes through 41 expert witnesses until he can find one that will say what is needed to win billions in law suits .....but that just pisses me off. I don't want to even get into it.

[Zero]

Originally posted by phatmonky
Hence the reason I spent all the time posting link after link from sources like the OECD showing average wait time for various countries and procedures. Average wait time isn't the only measure, though...wasn't it you who claimed that American doctors also call for unneeded procedures on a regular basis?(if it wasn't, just ignore that part)

Other measures would have to include infant mortality, missed work days, etc.

[Zero]

Originally posted by phatmonky
Just 5 percent of U.S. doctors are responsible for 54 percent of all malpractice. ( National Practitioner Data Bank)
The problem isn't with doctors in general. It is a very select few. I read somewhere (wish I could find the link) that the averag doctor in that 5% has settle 4 malpractice cases. Now the question is, when will their be a doctorial review board setup to remove these licenses?
Medicine is as much an art, as it is a science, and thus things can not always be predicted. There are legitiamte malpractice cases, but there are plenty that aren't.Then blame the AMA, not the victims.

Then you have people like john edwards who goes through 41 expert witnesses until he can find one that will say what is needed to win billions in law suits .....but that just pisses me off. I don't want to even get into it. Good, don't bother getting into it, because if you think that the insurance companies don't have doctors on the payroll to say whatever will get them off the hook, you are fooling yourself.

But, it does bring up a good issue...blame the victim, blame the lawyers, even blame the doctors...can we not blame the insurance companies for dragging out the lawsuits to the point that no one can afford to sue for reasonable damages, they are forced to sue for millions upon millions in order to recoup any of their expenses? That's why the insurance companies want a $250,000 cap on lawsuits...because they can drag out a lawsuit until you run out of money and are frced to drop the case.

[Zero]

Originally posted by phatmonky
Why don't you take the time to go read my posts instread of putting words in my mouth?[zz)] Why don't you answer the question?

[phatmonky]

Originally posted by Zero
Average wait time isn't the only measure, though...wasn't it you who claimed that American doctors also call for unneeded procedures on a regular basis?(if it wasn't, just ignore that part)

Other measures would have to include infant mortality, missed work days, etc.


No, it was me who said that overly beauracratic hospitals tie the hands of the doctor by telling them they are ordering too many tests (for the budget). My point is that I want more doctor autonomy, and I don't see that happening with a fully socialized system in this very political country.


The reason I mentioned the wait times agian, was that your post came in response to mine(mentioning specific incendents). In that post, I first mentioned the research I had posted earlier concerning the topic.

[phatmonky]

Originally posted by Zero
Why don't you answer the question?

Because, as USUAL, you are unable to read the thread you wish to participate in. I'm tried of having to hold your hand, like a child, through all the big bad discussions......


FROM THIS VERY SAME THREAD:

Originally posted by phatmonky
I prefer a privatized healthcare system no matter what. When I say that, that doesn't mean I woudl be against looking at alternatives to the insurance setup. It means I am against having doctors and hospitals all put under government control,pay, etc.

I believe that doctors need to be given the autonomy to do what is best for the patient. Ask a doc who has worked in a heavily beaurocratic hospital, and you will know that they are told to stop ordering so many CTscans and other tests.

I also would like to see a revamp of our medicare/medicaid system. I believe that all children should have healthcare access,and I believe that for extremely high cost/income ratios there needs to be some sort of aide given.

With that all said, I don't support any system that will limit the patients ability to pay for the most superior service available, if they are so inclined. I also don't like the idea of a socialized healtcare because of the lack of incentives to NOT go to the doctor. I have spoken with canadian doctors who tell me about abuse of the 'free' system. The nurses would chew people out because they come up there with mosquito bites wanting a benadryl shot to stop the itching. How can such a system work, when people are so obese and unhealthy here already? The answer is, that it can't. Not without raising costs evenmore.

Cover children and extreme cases. Give selection, incentives to stay healthy, and doctor autonomy. Then you have the perfect system.


EDIT- HOw funny, it's even the thread you referenced concerning doctors ordering tests.

[Zero]

Originally posted by phatmonky
No, it was me who said that overly beauracratic hospitals tie the hands of the doctor by telling them they are ordering too many tests (for the budget). My point is that I want more doctor autonomy, and I don't see that happening with a fully socialized system in this very political country.


The reason I mentioned the wait times agian, was that your post came in response to mine(mentioning specific incendents). In that post, I first mentioned the research I had posted earlier concerning the topic. Ok, cool...carry on. Of course, I don't see the difference between insurance companies screwing us over and teh government screwing us over...with the possible exception that there should be more money for health care compared to private insurance, since a government program would be not-for-profit, and no CEO would be skimming off our premiums to but a home in Aspen.

(can anyone spell bureaucratic?!?)

[Zero]

Originally posted by phatmonky
Because, as USUAL, you are unable to read the thread you wish to participate in. I'm tried of having to hold your hand, like a child, through all the big bad discussions......


FROM THIS VERY SAME THREAD:




EDIT- HOw funny, it's even the thread you referenced concerning doctors ordering tests. Thanks for answering the question...[:D] You didn't have to be rude about it, though. You can stop being a poopyhead anytime you like.

[phatmonky]

Originally posted by Zero


(can anyone spell bureaucratic?!?)

I can now.

[Zero]

Originally posted by phatmonky
I can now. So can I, now, thanks to dictionary.com...let's see how long it lasts, though.

[Monique]

Originally posted by Evo
I would have gone ballistic if I had to deal with that. I know, they run those places like it's a business and they don't need the customers.

Nereid, yes, your friend should live here, I selected this area for these specific reasons. See, this is a major difference between the US and (western) Europe. In the US it is all privately owned and people flock to the areas that are most profitable and comfortable to live in. About a year ago I read about a research which showed that certain areas in the US have a grave shortage of doctors, while other areas are completely overcrowded by them. Ofcourse Europe consists of all small countries, so coverage is much more uniform.

Zero, you're absolutely right about insurance being the driving force behind many of the problems within the health care industry. Oh, I agree here too, if doctors don't want to see you because the TYPE of insurance that you have, that is just rediculous and shouldn't even be on their mind.

[Zero]

Originally posted by Monique

Oh, I agree here too, if doctors don't want to see you because the TYPE of insurance that you have, that is just rediculous and shouldn't even be on their mind. Unfortunately, the free market leads to consolidation, uniformity of service, and a health care field run by accountants.

[adrenaline]

Originally posted by Monique
I know, they run those places like it's a business and they don't need the customers.

See, this is a major difference between the US and (western) Europe. In the US it is all privately owned and people flock to the areas that are most profitable and comfortable to live in. About a year ago I read about a research which showed that certain areas in the US have a grave shortage of doctors, while other areas are completely overcrowded by them. Ofcourse Europe consists of all small countries, so coverage is much more uniform.

Oh, I agree here too, if doctors don't want to see you because the TYPE of insurance that you have, that is just rediculous and shouldn't even be on their mind. [/B]


Unfortunately, many times a doctor can't see a patient with a particular insurance because they are not on the "plan". Not out of choice....for instance, United for Seniors HMO dropped eastern Georgia because they were losing money in that region. Doctors did not drop it. If a United for Seniors wanted to see a doctor, they could, but would have to pay a office visit (say $75) and if any tests had to be ordered, the ordering doctor, who is not part of United for Seniors ,cannot get the referral and precertification so that the insurance can pay for it. This is becoming more and more common. Instead, these poor folks have to drive 45 miles into Atlanta to see a doctor or hospital on their plan.

As for medicine being a business, unfortunately, it has to be so..... in part. With one doctor requiring ancillary staff of at least 2 phone people, 2 nurses (one to take care of patients and one to take care of referrals), an insurance specialist, a check in person to verify and ask permission from the insurance each time, a person to pull files, an office manager, a computer specialist etc. (our practice of three docs have over 20 ancilllary staff..... they cannot be asked to work for free.)

They want their raises, 401K, dental and medical and disability insurance, workman's comp, disability insurance, three weeks of paid vacation and paid continuing medical ed ,uniform allowance and this is in addition to malpractice premiums more than half a doc's salary, a rent of $25,000 a month, 18 phone lines (always busy) costing over three thousand a month etc. Docs are taking it out of their paychecks (as I stated, Georgia docs average less than plumbers and chiropractors) but still the overhead grows. If we don't keep ourselves in business, there is no service to the patients if we go out of business and move to another state...as it is already happening.

I don't like our system as it is. It is broken. We need to salvage it. We have alot to learn from socialized medicine...negatives and positives. The AMA, American Medical Association, favors a nationalised health insurance...just getting rid of the bureaucratic nonsense with all the different paperwork and rules will be more cost effective. Medicare is already a form of it, though wrought with bureaucracy, it is the same from patient to patient. The rules and regulations change from one private insurer to another.

Uninsured patients are bankrupting our local hospitals as insured patients don't necessarily pick up the difference anymore.

However, a socialized medical system won't work for the simple reason that americans will not give up the right to sue, so that's out. (Can't expect a doc to pay for huge malpractice premiums on a civil servant's salary. ) In addition, we are too big and inhomogenous.

The Canadian medical system is pretty good until you get very sick and the "limit" has been spent. They have a back door.... us, which is why they work. (For instance, a 8 year old with a leukemia that is 80% curable could not be treated in Canada until the new year came around due to the budget deficit in her area hospital. She was in a blast crisis and waiting 3 months was sure death. Her mother took her 3 hours south to Dartmouth Hithcock medical center in New Hampshire, and had her treated successfully with induction therapy within 2 weeks.) That is just one small sample.

However, socialized medicine has it right when it allocates care to children and infants, and denies protracted, futile care in those who are elderly. (50% of all medicare dollars are spent on the last year of a elderly person's life.) Right now, if you want your 99 year old mother to have full artificial resuscitation and life suuppport costing $10,000 a day in the ICU, you have every right to it...and trust me, this happens.

Don't know what the answer is but just the acknowledgment that we are not the best system in the world will be a first step........In short, Canada's health care system achieves more for less than the U.S. system. But to be perfectly honest, neither country is close to the top of the heap when you look around the globe. Back in 2000, if memory serves, the World Health Organization ranked countries' medical systems on the basis of how much bang they got for their buck. The world leaders were the French and Spanish. Canada ranked 30th; the U.S., 37th.

[Nereid]

I was wondering how long it would be for adrenaline to post to this thread. Great post, as always ... too few of us know what it's like from the POV of a dedicated doctor.

On another aspect, I realise (thanks to some PMs) that the gross economic inefficiency of the US health-care sector hasn't been well described.

I ask Njorl, SelfAdjoint and others who understand these concepts well to please jump in and amplify/clarify/correct.

In economics, the activity of an industry sector can be described in terms of the proportion of the national GDP which it accounts for. This activity encompasses all aspects of the sector, and all players. While there is always room for disagreement over definitions and accuracy of statistics, economists generally have a pretty good handle on both the data and concepts, at least in developed economies like the US, the countries of the EU, Japan, Australia, etc.

When you examine the level of economic activity by industry sector, you find a most extraordinary result - the US spends* approx twice as much as other developed economies on health care.

By itself this isn't particularly noteworthy; the theory of economic advantage says (for example, caveats apply) that global economic utility is maximised by each economy concentrating its economic activity in sectors where it has a comparative advantage (this does NOT mean where it is cheapest! note the word 'comparative').

However, when it comes to health-care, where almost all the economic activity is domestic (ie no significant imports or exports), the benefits are not purely economic - most of us don't seek good health in order to work harder! So, what are the (economic or other) returns on the disproportionately large 'investment' that the US economy (not people!) makes in health care?

That's the paradox; apparently none (of any significance):
- no increase in life expectancy
- no decrease in infant mortality
- no reduction in incidence of major cancers
- no increase in 5-year survival rates from major cancers
- no decrease in incidence of heart disease
- no increase in 'quality of life' for seniors
- etc, etc, etc.

Note that we're not talking about a few % at the margin; the contrast with ALL other advanced economies is stark.

Some links:
Health spending (US$ PPP) by economy (http://www.economist.co.uk/research/backgrounders/displaystory.cfm?story_id=80699)
A major business opportunity (http://www.economist.com/globalExecutive/Education/displayStory.cfm?story_id=1762557)

*this is measured as % of GDP (a measure of total economic activity) per capita (a.k.a. population), expressed in $PPP (purchasing power parity; basically this metric removes distortions due to differences in exchange rates and the fact that the same basket of goods and services cost very different amounts in each economy, even when measured in constant (inflation-adjusted) US$).

Oh, and just to forestall some likely questions, my sources are that well-known left-wing, all-but-communist publication, The Economist (http://www.economist.com/), among whose avid readers are most Economics Nobel Prize winners, Henry Kissenger, Pascal Lamy, Robert Zoellick, Tony Blair, Gordon Brown, ... (but not a certain Bush from Texas)

[Nereid]

The US health-care sector is quite mysterious because, AFAIK, there are no* other large sectors of the US economy that are so far out of whack (cf other advanced economies).

*well, there's one other - agriculture (US farmers are grossly inefficient - economically, on average - when compared to those in other countries). However, this sector is well understood, and the gross inefficiencies far from unique - e.g. French farmers are far worse - and the EU's CAP is even worse for *everyone* (except a few thousand rich farmers) than the US's agricultural subsidies.

[phatmonky]

That's the paradox; apparently none (of any significance):
- no increase in life expectancy
- no decrease in infant mortality
- no reduction in incidence of major cancers
- no increase in 5-year survival rates from major cancers
- no decrease in incidence of heart disease
- no increase in 'quality of life' for seniors
- etc, etc, etc.

I would like to see other country's statistics for cancer rates, murder rates, obesity rates, obesity related illnesses (all of which are typically assumed to be higher in the US than other industrialized nations).
I'm not arguing our system is perfect, I am trying to help you pin point the answers to your questions

[Nereid]

Originally posted by phatmonky
I would like to see other country's statistics for cancer rates, murder rates, obesity rates, obesity related illnesses(all of which are typically assumed to be higher in the US than other industrialized nations).
I'm not arguing our system is perfect, I am trying to help you pin point the answers to your questions I'm sure someone can dig these up - a few hours with google (and a good nose for BS and agendas) should do it. From memory:
- cancer rates: no significant differences
- murder rates: US way higher (murders involving firearms), but when age adjusted (young men seem especially prone to murder), not that much different
- obesity rates: I don't know
- obesity related illnesses: ditto.

The comparisons that need to be made involve many other economies. For example, the murder rate in Japan is way lower than that in the US. However, does that difference contribute in any significant way to a 2x difference in the economic efficiency of the health-care sector? I rather doubt it. First, I'd guess that murder has next to no impact on either economy's health-care costs (it would've been far, far different in WWII). Second, if it were a significant contributor, the effect should show up in the health care spending in the UK (say), where the murder rate is significantly higher than in Japan.

In the same way, other demographic differences should (could?) matter too. For example, the Japanese population is significantly older than that of the US (look at the age demographics; look at the life expectancies), and older people are heavier consumers of health-care than the rest of the population. You would thus expect that health-care would be a greater proportion of per-capita GDP in Japan than the US (cet. par.). It isn't.

[GENIERE]

Monique seems oblivious to the imminent failure of Belgium’s health care system and her government’s serious investigation into “privatizing” healthcare.

The present system is described as free but in reality is costing Monique and others 3.5% or more of their income not including the insidious co-payments demanded of the poor. It is not mentioned that her government is seriously pursuing “privatizing” healthcare. Industry in her country will soon face severe competition from within the EU and will have to relocate to friendlier countries to remain competitive. Monique’s parents may enjoy the fruits of Monique’s labor but it is not likely that Monique will.

Adrenaline is fortunate to be attending med school in the US. If she were from Belgium, the government might have prevented her from attending a med school or even a pharmacy school.

From MarketResearch.com:

“This report covers detailed socio-demographic, market analysis, and business evaluation for private medical insurance coverage in Austria, Belgium, France, Germany, Italy, Ireland, Netherlands, Portugal, Spain, Switzerland, Czech Republic, Hungary and Poland.

The rising cost of medical treatment and aging populations are putting enormous strains on public funding for health. Governments are under increasing pressure to encourage people to subscribe to private cover and alleviate the burden on state facilities.”

The US is to a great extent subsidizing and improving healthcare the world over. American companies develop most technological advances via research paid for by the US worker.

[Nereid]

Er, I think that Monique lives in the Netherlands, not Belgium. [;)]

[Nereid]

GENIERE wrote: The US is to a great extent subsidizing and improving healthcare the world over. American companies develop most technological advances via research paid for by the US worker. Evidence?

[Nereid]

{I don't want to copy the whole post again}

That some European governments are having difficulties funding the health-care of their aging populations isn't the point.

To repeat: why does the US spend - on average, per capita, PPP, inflation adjusted $$ - *twice* as much as the Netherlands, UK, Japan, Australia, Canada, Switzerland, Singapore, ... for essentially the same outcome (health-wise)? That's why it's called "gross economic inefficiency".

Especially as this same thing is not observed in any other significant economic sector (the US gets more bang for its $buck than most other economies), other than agriculture.

[GENIERE]

Er, I think that Monique lives in the Netherlands, not Belgium.

My apologies to Monique.

Evidence?

Good point, I’ll try to provide it although I’m tempted to utilize the liberal ploy of having someone prove the negative.

[phatmonky]

Originally posted by Nereid
I'm sure someone can dig these up - a few hours with google (and a good nose for BS and agendas) should do it. From memory:
- cancer rates: no significant differences
- murder rates: US way higher (murders involving firearms), but when age adjusted (young men seem especially prone to murder), not that much different
- obesity rates: I don't know
- obesity related illnesses: ditto.

The comparisons that need to be made involve many other economies. For example, the murder rate in Japan is way lower than that in the US. However, does that difference contribute in any significant way to a 2x difference in the economic efficiency of the health-care sector? I rather doubt it. First, I'd guess that murder has next to no impact on either economy's health-care costs (it would've been far, far different in WWII). Second, if it were a significant contributor, the effect should show up in the health care spending in the UK (say), where the murder rate is significantly higher than in Japan.


However, when you mention things like life expectancy, murders, car wrecks, and obesity will all play a large part when the numbers are as high as ours our. That's all I was getting at :)

[adrenaline]

Nereid is spot on. Why can't the US direct its outstanding talents in so many other market forces to correct the dismal iefficiency of our medical system with what we have now?


I believe it comes down to our expectation. For the last 30 years, health-care costs have been rising 6 percent to 8 percent a year—more than double the inflation rate in the rest of the economy—because demand keeps outstripping supply. As people's real income rises, they expect more medical care; our society is aging, so people need more care; and with new technologies treating formerly intractable conditions, people want more care.

In practice, almost everyone, insured or not, has access to health care, especially in emergencies. Insurance affects how much people actually use health services:

The access of the uninsured involves inconveniences and costs that encourage them to underconsume medical services, sometimes with grim results.

By contrast, people with insurance often have such broad access that many overconsume those services. People are running to the doc after two days of dealing with a viral upper respiratory infection. These consumption patterns drive the price increases that ultimately shrink insurance coverage. No politician is going to put it straight to the public. Anyway, who gets elected president by telling people that their health-care costs will soar so long as everybody has access to the most expensive forms of care?

Health care's path began when employers in World War II, desperate to attract workers without breaching wage controls, first offered health insurance as an untaxed fringe benefit. This approach took strong root.

Over time, these beginnings brought most people into an insurance system that insulated them from the full cost of each treatment; they also left government as the insurer for everyone outside the work force, notably retirees and the poor. All insurance markets are subject to "moral hazard," where the small personal cost of using the insurance—a co-payment in this case—encourages people to overuse it for minor complaints. The hazard is intensified in the case of health care, because people don't pay for the insurance directly. To be sure, working people ultimately pay for their coverage in lower and slower-rising wages, but the cost of premiums is still subsidized by its tax-free treatment; when I write the checks for my employees, they don't even feel the pinch directly when premiums go up. (Imagine how much less coverage many would accept if we all had to write annual premium checks for $4,000 or $5,000.) These hazards are even greater in public-sector health care, where the retirees and poor consuming most of the services don't bear most of the taxes financing them.

Individual costs are rising, but other forces continue to undercut greater price discipline. In most markets, for example, this discipline also depends on people having the information required to judge the value of goods or services before they buy them. In health-care markets, how many people have the information to say no to a more expensive test for diabetes or a treatment for a heart murmur? The norms of the medical profession are supposed to align a doctor's incentives with a patient's medical interests (especially when the prospect of a malpractice suit reinforces these incentives). But there's no mechanism to align the financial interests of doctors and their patients. (So doctors can deliver sound health services in ways that maximize their billings. )

When prices rise unusually fast in other markets, people can usually find and substitute cheaper products: Beef prices rise and people eat more chicken, or a real-estate bubble drives up housing prices and people downsize their residential ambitions. That doesn't work nearly as well in health care, when patients are told that the alternative to a costly test or procedure is poor health or even premature death.


As a society we determine how much health care we want . Unfortunately, our desires have no relation to what we would spend. The current system has no balances. Universal health care would not improve that problem, it would only shift the locus of control.
Our health care insurance system is broken. Perhaps we could look at ways to improve that system, and in some way link behaviors with costs (e.g., smokers and the obese would pay higher insurance) and expenditures with graduated co-pays. I can tell you right now, it is the medical treatment and expense of two of my employees, one a smoker and one obese, who has driven up our premiums for the whole office. Only when each individual starts to understand costs will market forces apply. Without the power of market forces, I suspect that we will be continuing this debate forever.

[Njorl]

Originally posted by Nereid
I ask Njorl, SelfAdjoint and others who understand these concepts well to please jump in and amplify/clarify/correct.

In economics, the activity of an industry sector can be described in terms of the proportion of the national GDP which it accounts for. This activity encompasses all aspects of the sector, and all players. While there is always room for disagreement over definitions and accuracy of statistics, economists generally have a pretty good handle on both the data and concepts, at least in developed economies like the US, the countries of the EU, Japan, Australia, etc.

When you examine the level of economic activity by industry sector, you find a most extraordinary result - the US spends* approx twice as much as other developed economies on health care.

By itself this isn't particularly noteworthy; the theory of economic advantage says (for example, caveats apply) that global economic utility is maximised by each economy concentrating its economic activity in sectors where it has a comparative advantage (this does NOT mean where it is cheapest! note the word 'comparative').

However, when it comes to health-care, where almost all the economic activity is domestic (ie no significant imports or exports), the benefits are not purely economic - most of us don't seek good health in order to work harder! So, what are the (economic or other) returns on the disproportionately large 'investment' that the US economy (not people!) makes in health care?

That's the paradox; apparently none (of any significance):
- no increase in life expectancy
- no decrease in infant mortality
- no reduction in incidence of major cancers
- no increase in 5-year survival rates from major cancers
- no decrease in incidence of heart disease
- no increase in 'quality of life' for seniors
- etc, etc, etc.

Note that we're not talking about a few % at the margin; the contrast with ALL other advanced economies is stark.

Some links:
Health spending (US$ PPP) by economy (http://www.economist.co.uk/research/backgrounders/displaystory.cfm?story_id=80699)
A major business opportunity (http://www.economist.com/globalExecutive/Education/displayStory.cfm?story_id=1762557)

*this is measured as % of GDP (a measure of total economic activity) per capita (a.k.a. population), expressed in $PPP (purchasing power parity; basically this metric removes distortions due to differences in exchange rates and the fact that the same basket of goods and services cost very different amounts in each economy, even when measured in constant (inflation-adjusted) US$).

Oh, and just to forestall some likely questions, my sources are that well-known left-wing, all-but-communist publication, The Economist (http://www.economist.com/), among whose avid readers are most Economics Nobel Prize winners, Henry Kissenger, Pascal Lamy, Robert Zoellick, Tony Blair, Gordon Brown, ... (but not a certain Bush from Texas)

That's a good question.

I think there are a few things that affect the huge amount of money we pay.

THE TRAGEDY OF THE COMMONS. If there is a plot of land that anyone can graze their cattle upon, I should send my cattle there. I realize that if everyone does it, the commons will be destroyed. But if I forego this right, there is no guarantee that others will do as I do, so the commons will be destroyed regardless of my actions. One way, the commons is destroyed but I gain a small benefit. The other way, I derive no benefit, but the commons is destroyed anyway.

The fact that we are heavily insured makes it less painful to have more done. I've already paid my $2500 in premiums, so I'm very willing to pay a $10 copay to get $100 worth of medical tests. I realize that if everyone acts this way, it drives up premiums, but I have no guarantee that others will refrain just because I refrain. In game theory, I think it corresponds to the tragedy of the commons.

Cheap procedures are the commons. Paying my insurance premium gives me rights to the commons. The destruction of the commons is increased costs for next year. We need to come up with a system that does not encourage waste. This system does not just encourage it, it nearly demands it.



YOU CAN'T PUT A PRICE ON GOOD HEALTH. We are taught this from birth. The problem is, it is wrong. If you don't put a price on good health, you will pay too much for it. If you pay too much for good health today, you will not have enough money to pay for it tomorrow. People who point this out are thought of as ghoulish. We need to develop more sophistication in our everyday morality.



A UNIQUELY AMERICAN PARADOX - Money can buy you anything, everybody has a right to good healthcare. These combine to, everybody deserves the best possible healthcare that money can buy. Obviously, that just can't be.

Njorl

[Zero]

Originally posted by adrenaline
Nereid is spot on. Why can't the US direct its outstanding talents in so many other market forces to correct the dismal iefficiency of our medical system with what we have now?


The simple answer, I think, is this: the inefficiency of the system profits the insurance companies. Think about it: you have a middle man who provides no concrete service, makes huge scads of cash, and has no interest in the success or failure of any specific medical situation. Say 1000 people pay the insurance company $2500 apiece per year, for 5 years. That's $12.5 million dollars, that is being invested and profited on, compared to the absolutely tiny amount of money the average person will ask back. As soon as one of those people gets seriously sick, though, the insurance company will limit the person's health care, raise what they have to pay in, and drop them as soon as possible. There isn't a whole lot of interest in making sure a person gets well, because the insurance company already has their money.

[Njorl]

I agree Zero. The incentives of the insurance companies runs counter to the interests of everyone else in the business.

The purpose of the insurance company was originally to diversify risk, and combine purchasing power to obtain better prices from medical providers. This is a fine purpose. The problem is, the profitability of the insurance industry is dependent upon the helplessness and insecurity of the healthcare consumer. So, while an individual insurance company prospers by keeping it's own costs down, the industry as a whole thrives by driving prices up. This is where industry-wide lobbying comes in.

Njorl

[adrenaline]

I think Zero and Njorl got it right.