The US has the best health care in the world?

[Jimmy Snyder]

My little story was not about health care. It was about the value that people place on things that are 'free'.

 

[mgb_phys]

My little story was not about health care. It was about the value that people place on things that are 'free'.

Funny but perhaps a little too subtle!

 

[Al68]

The performance of the health care system should be judged by the net result. If in the US a lot of older man are diagnosed with prostate cancer which typically doesn't kill if left untreated, while in other countries less of these cancers are detected in the first place (becuase they don't do screening for these cancers), then obviously the US is going to have a seemingly higher "cancer survival rate".

Also, in the US many more people get skin cancer than in Europe. This is usually detected in early stages and usually doesn't lead to death.

So the cancer survival rate isn't indicative of the quality of care, but the overall life expectancy is? Life expectancy isn't a "net result" of health care quality. Cancer survival rates are, even if not a perfect indicator.

 

[mgb_phys]

So the cancer survival rate isn't indicative of the quality of care, but the overall life expectancy is?

Cancer cure rates might be, cancer survival rates just mean you were alive 5years after they declared 'cancer'.

Life expectancy isn't a "net result" of health care quality. Cancer survival rates are, even if not a perfect indicator.

Life expectancy is heavily dependant on childhood and neonatal health so it is also sensitive to nutrition and housing.
Cancer rates only measure those people that get cancer !

 

[Al68]

The current bill would allow Joe, Sarah, Bob, Emily, Frank and Amy to keep private health care if they desired and does not cut funding from medicaid or medicare.

No, it won't, unless you call a private company participating in a government system "private health care". If someone gets a private insurance plan that does not qualify for the government system (because they are against subsidizing the types of things covered, or just because they only need insurance for the unexpected instead of a comprehensive health plan that covers everything under the sun), they will have to pay an income tax penalty (limited to the average cost of a qualifying plan, of course). Simply put, this bill assesses an income tax penalty against any American for failure to prove to government they have a "qualifying" plan. Whether or not the plan meets the standards of the person getting it is irrelevant. You call that "private health care"?

Allowed to keep their current plan, maybe. Allowed to ignore the new law and make their own choice without being penalized, no.

And being able to choose among the "government approved" choices doesn't count as freedom of choice despite the fraud and deception being perpetrated.

Of course the details aren't finalized, but I doubt if they will take out the part that says, "join this system or pay a stiff penalty".

 

[Al68]

Cancer cure rates might be, cancer survival rates just mean you were alive 5years after they declared 'cancer'. Life expectancy is heavily dependant on childhood and neonatal health so it is also sensitive to nutrition and housing.
Cancer rates only measure those people that get cancer !

You're right! Three times! (I assume you agree that 5 years after diagnosis, it's fairly important to the patient whether or not he/she's alive.)

 

[Al68]

First, I think it is a prori reasonable to assume that there is a link between the health care system and life expectancy (although there are other factors that influence life expectancy as wel).

Second, I'm not sure that the 49 countries that have a higher life expectancy than the US, all have more topless beaches than the US.

Maybe not, but they all have a larger percentage of their cancer patients dead after five years.

It's much more reasonable to consider cancer survival rates a much better indicator of health care quality than life expectancy, because life expectancy depends on so many more things completely unrelated to health care quality, such as genetics, lifestyle, eating habits, smoking, drinking, job/family stress, etc.

Cancer survival rates at least mostly can be expected to depend on the quality of medical care received. And the other factors are much less likely to depend on what country you're in, so would be much less relevant.

 

[Count Iblis]

Maybe not, but they all have a larger percentage of their cancer patients dead after five years.

It's much more reasonable to consider cancer survival rates a much better indicator of health care quality than life expectancy, because life expectancy depends on so many more things completely unrelated to health care quality, such as genetics, lifestyle, eating habits, smoking, drinking, job/family stress, etc.

Cancer survival rates at least mostly can be expected to depend on the quality of medical care received. And the other factors are much less likely to depend on what country you're in, so would be much less relevant.

Cancer survival rates also depend on a number of factors that are not directly related to the medical treatment, genetic factors being an important factor.

Another factor is screening. In the US you e.g. screen for prostate cancer. But almost all men who have prostate cancer survive this without any form of treatment. In Europe we don't screen for it. The people who are detected to have it, have prostate cancer that is causing complaints and those cancers are a bit more likely to kill.

So, if you compare survival rates for prostate cancer in the US to survival rates for prostate cancer in Europe, you're not measuring a difference in the effectiveness of any treatment.

 

[Al68]

Cancer survival rates also depend on a number of factors that are not directly related to the medical treatment, genetic factors being an important factor.

I agree. But the number and extent of the other factors affecting life expectancy is much greater than for cancer survival rates. My point was that cancer survival rates were a much better indicator than life expectancy, not that it was a perfect indicator.

Another factor is screening. In the US you e.g. screen for prostate cancer. But almost all men who have prostate cancer survive this without any form of treatment. In Europe we don't screen for it. The people who are detected to have it, have prostate cancer that is causing complaints and those cancers are a bit more likely to kill.

So, if you compare survival rates for prostate cancer in the US to survival rates for prostate cancer in Europe, you're not measuring a difference in the effectiveness of any treatment.

I agree that prostate cancer survival rates aren't very indicative of anything. But based on your post, the lack of early detection seems to be a relevant factor in Europe, since prostate cancer rarely kills within 5 years if detected early, before it causes complaints.

 

[mheslep]

Cancer survival rates also depend on a number of factors that are not directly related to the medical treatment, genetic factors being an important factor.

You are likely confusing cancer incident or mortality rates (very dependent on non medical system factors) with outcomes (which are not). They are two very different things.

 

[mheslep]

Another factor is screening. In the US you e.g. screen for prostate cancer. But almost all men who have prostate cancer survive this without any form of treatment.

That's completely false. Prostrate is slow moving, but it will inevitably kill you without treatment and is the second leading cause of cancer death in the US.
http://www.cancer.org/docroot/CRI/c...atistics_for_prostate_cancer_36.asp?rnav=cri"
5 year 100%
10 year 91%
15 year 76%

http://info.cancerresearchuk.org/cancerstats/types/prostate/survival/"
5 year 90%
10 year 70%
15 year 55%
Also, from the same UK source:

The increase in prostate cancer survival rates is particularly pronounced in the 1990s when PSA testing became more prevalent.

but In Europe we don't screen for it.

If that's true in general for Europe then it is at the cost a greater death rate for prostrate cancer.

 

[mheslep]

Cancer cure rates might be, cancer survival rates just mean you were alive 5years after they declared 'cancer'...

What are you talking about? Physicians don't use the word 'cure' in connection with cancer.
Look, a woman is diagnosed with breast cancer. In the US her chance of dying inside five years is essentially zero. In the UK, 1 chance in 5 she's dead in five years.

...Life expectancy is heavily dependant on childhood and neonatal health...

and also dependent on
-driving after 19 pints 'o Guiness,
-being capped in the head by a jealous husband,
-eating 14 donuts at every meal,
-whether or not a parent died of a heart attack at 39

... so it is also sensitive to nutrition and housing.
Cancer rates only measure those people that get cancer !

That may be true, but the thread is not about nutrition and housing in any major way. My Medicare taxes and your NHS taxes don't go to food and housing. The thread is about _health care_, as in that which is provided by doctors, nurses, and hospitals, in hopes of informing decisions about the make up the _heath care_ system.

 

[cristo]

In the US her chances of dying in five years is essentially zero.

Of those that are known about, yes. But what happens to the person who is uninsured and can't afford to pay the fees to go to hospital. The bean counters will never know that her illness existed, it will never have been diagnosed, since she can't afford to get it diagnosed. In the UK, such a person will be diagnosed, and thus will be counted in the statistics. Thus, as with all statistics, they must be taken with a pinch of salt.

Incidentally, these are the people that a health care system should be supporting: those who cannot afford to support themselves. However, it appears to me, that in the US these are the people that are forgotten about. It brings me back to the same point that I make whenever such a topic is discussed, namely, what is the metric you choose to measure the "best in the world"? Is the best system the one that offers assistance to everyone, or is the best system the one that has the most effective treatment in the world for those who can afford it?

 

[mheslep]

...It brings me back to the same point that I make whenever such a topic is discussed, namely, what is the metric you choose to measure the "best in the world"? Is the best system the one that offers assistance to everyone, or is the best system the one that has the most effective treatment in the world for those who can afford it?

All of the above, and answered I believe back in #55 (Sen. McConnell statement).
https://www.physicsforums.com/showpost.php?p=2280345&postcount=55
The US has lousy cost performance compared to other countries, insurance coverage problems, but the effectiveness of the medical practice itself can reasonably be called the 'best in the world.'

 

[cristo]

The US has lousy cost performance compared to other countries, insurance coverage problems, but the effectiveness of the medical practice itself can reasonably be called the 'best in the world.'

Fine, but then to go around and say your health care system is the best in the world (which is what people who are opposed to nationalised health care systems do) is incorrect. The metric to judge whether a health care system is the best in the world is a combination of the health care available and the ability for every resident of that country to access it. It's all well and good having fantastic health care, but when the use of that health care is restricted to the wealthy, you've got to be asking questions about the system.

 

[mheslep]

...Incidentally, these are the people that a health care system should be supporting: those who cannot afford to support themselves. However, it appears to me, that in the US these are the people that are forgotten about...

Yes, you've so stated a few times. A reminder: US state and federal government Medicaid (single payer health care for the poor) spending was some http://www.hhs.gov/news/press/2008pres/10/20081017a.html" .

Edit: and the U.S. EMPTALA law that mandates nobody can be turned away from an emergency room.
BTW, I don't really think any of the programs are a good idea, as they are.

 

[drankin]

Fine, but then to go around and say your health care system is the best in the world (which is what people who are opposed to nationalised health care systems do) is incorrect. The metric to judge whether a health care system is the best in the world is a combination of the health care available and the ability for every resident of that country to access it. It's all well and good having fantastic health care, but when the use of that health care is restricted to the wealthy, you've got to be asking questions about the system.

It's not restricted to the wealthy. I'm not wealthy. I have "fantastic" health care, that I pay for.

 

[mheslep]

Fine, but then to go around and say your health care system is the best in the world (which is what people who are opposed to nationalised health care systems do) is incorrect.

A reasonable take on what people say is that which I quoted from the opposition leader - a statement addressing the strengths and weaknesses.

The metric to judge whether a health care system is the best in the world is a combination of the health care available and the ability for every resident of that country to access it.

Interesting that you left out quality. My metric is quality, affordability, availability - all three.

It's all well and good having fantastic health care, but when the use of that health care is restricted to the wealthy,

'Restricted' is not an apt description of the gaps in the system.

you've got to be asking questions about the system.

Obviously we are.

 

[mheslep]

Speaking of the 'forgotten', I'm reminded of the splendid essay by Prof WG Sumner, The Forgotten Man, written in (I think) 1896. It's historically relevant because Franklin Roosevelt alluded to it and the "Forgotten Man" in his inaugural speech, though FDR changed the meaning a bit in his version. As I hope you'll agree, I think it worthy of insertion in this thread.

Briefly: Sumner broke down the construct of government based social programs algebraically: 'A' wants to help 'X'. 'B' wants to help 'X'. Then comes the problem when 'A' and 'B' conjure some legislation to force 'C' to help 'X'. 'C' then, per Sumner, is the man who pays, the man who prays, the man who is not thought of.

http://www.blupete.com/Literature/Essays/Best/SumnerForgotten.htm

"The Forgotten Man"
By William Graham Sumner.

The type and formula of most schemes of philanthropy or humanitarianism is this: A and B put their heads together to decide what C shall be made to do for D. The radical vice of all these schemes, from a sociological point of view, is that C is not allowed a voice in the matter, and his position, character, and interests, as well as the ultimate effects on society through C's interests, are entirely overlooked. I call C the Forgotten Man.
...
the characteristic of all social doctors is, that they fix their minds on some man or group of men whose case appeals to the sympathies and the imagination, and they plan remedies addressed to the particular trouble; ... They are always under the dominion of the superstition of government, and, forgetting that a government produces nothing at all, they leave out of sight the first fact to be remembered in all social discussion - that the State cannot get a cent for any man without taking it from some other man, and this latter must be a man who has produced and saved it. This latter is the Forgotten Man
...
go and search for the Forgotten Man. He will be found to be worthy, industrious, independent, and self-supporting. He is not, technically, "poor" or "weak"; he minds his own business, and makes no complaint. Consequently the philanthropists never think of him, and trample on him...
...
The fallacy of all prohibitory, sumptuary, and moral legislation is the same. A and B determine to be teetotalers, which is often a wise determination, and sometimes a necessary one. If A and B are moved by considerations which seem to them good, that is enough. But A and B put their heads together to get a law passed which shall force C to be a teetotaler for the sake of D, who is in danger of drinking too much. There is no pressure on A and B. They are having their own way, and they like it. There is rarely any pressure on D. He does not like it, and evades it. The pressure all comes on C. The question then arises, Who is C? He is the man who wants alcoholic liquors for any honest purpose whatsoever, who would use his liberty without abusing it, who would occasion no public question, and trouble nobody at all. He is the Forgotten Man again, and as soon as he is drawn from his obscurity we see that he is just what each one of us ought to be.

 

[cristo]

Speaking of the 'forgotten'

It's not a matter of people being 'forgotten'. Americans know that these people exist, but choose to ignore them. The two notions are entirely different.

 

[cristo]

Interesting that you left out quality.

I meant to say

a combination of the [quality of the] health care available and the ability for every resident of that country to access it.

 

[mheslep]

I meant to say

a combination of the [quality of the] health care available and the ability for every resident of that country to access it.

Well then there we generally have common ground on the goals.

 

[mheslep]

Americans know that these people exist, but choose to ignore them.

And here we don't. As per the Sumner essay above, I don't agree that enacting an anonymous social program, funded by forced taxation, is particularly paying attention to my fellow man.

 

[drankin]

And here we don't. As per the Sumner essay above, I don't agree that enacting an anonymous social program, funded by forced taxation, is particularly paying attention to my fellow man.

Agreed (following your response to cristo), and the assumption that fellow men are "forgotten" is bologne. In this country, you have the right to become "forgotten" if you so chose (to an extent, of course). It's not that they are ignored but we respect their desire to be ignored.

cristo, please point out these folks that are intentionally ignored. Provide some references.

 

[cristo]

cristo, please point out these folks that are intentionally ignored. Provide some references.

For example...

 

[Count Iblis]

That's completely false. Prostrate is slow moving, but it will inevitably kill you without treatment and is the second leading cause of cancer death in the US.
http://www.cancer.org/docroot/CRI/c...atistics_for_prostate_cancer_36.asp?rnav=cri"
5 year 100%
10 year 91%
15 year 76%

http://info.cancerresearchuk.org/cancerstats/types/prostate/survival/"
5 year 90%
10 year 70%
15 year 55%
Also, from the same UK source:



If that's true in general for Europe then it is at the cost a greater death rate for prostrate cancer.

Utter nonsense. It is well known that a large fraction of men have prostate cancer at the time of their death without it being a factor in their death. The reason why we don't screen in Europe is because of false positives in intial test, the cumbersome follow up tests and then, even if you detect prostate cancer, it is very unlikely to kill you.

Then, The major reason why prostate cancer survival rates appear to be much better in the US, is not because the early detection makes treatment better. It is simply the trivial statistical effect caused by the undetected prostate cancer survivors in Europe.

 

[Ivan Seeking]

I just wanted to post and say how thrilling it is to see the town hall meetings in the last couple of days. The crowds are still emotional, but things have calmed down a bit and we are now seeing some of the most engaged public discussion of a serious issue that I have ever seen in this country. Some of the critics are saying that the issue is spiralling out of control, but my view is the opposite. I think we are seeing the best of democracy in action. This is wonderful!

I for one want to see a bipartisan solution. I don't want the Dems to ram this through as long as the Republicans are being reasonable. However, if the Reps show that they only want to "hand Obama his Waterloo", not to arrive at an equitable solution in the best interest of the people, then the Dems will have no choice.

 

[turbo]

I for one want to see a bipartisan solution. I don't want the Dems to ram this through as long as the Republicans are being reasonable. However, if the Reps show that they only want to "hand Obama his Waterloo", not to arrive at an equitable solution in the best interest of the people, then the Dems will have no choice.

Unfortunately, one of the biggest GOP players on the bi-partisan effort (Grassly) is ramping up the fear factor, saying that people should fear that the government would "pull the plug on Granny". That is just vile.

 

[Ivan Seeking]

Unfortunately, one of the biggest GOP players on the bi-partisan effort (Grassly) is ramping up the fear factor, saying that people should fear that the government would "pull the plug on Granny". That is just vile.

Hopefully that boils down to nothing more than the following question: Should a government plan include payment for assisted suicide where it is legal? I would have to say no. While the States have the right to allow assisted suicide, there should be no impetus on the taxpayers who object to assisted suicide, to pay for it; unless the SC rules that assisted suicide is a right protected by the Constitution, and not a matter for the States.

The nutty side of this is the claim that payment for "end of life counselling" is somehow related to euthanasia. The provision related to counselling describes coverage already provided by many private insurers. The true intent of providing terminal patients with options and information has been palinized to mean something completely different than it does.

 

[Ivan Seeking]

I also think there is legitimate concern [in principle] wrt language in the plan that would open the door to problems later. That is to say that while I don't think there are any dark motives, unintended consequences are always a potential problem. There will always be people who try to abuse the system for their own selfish purposes - up to and including pulling the plug on grandma.

 

[mheslep]

... It is well known that a large fraction of men have prostate cancer at the time of their death without it being a factor in their death.

Yes, it is said that if a man lives long enough it is certain that eventually he will contract prostate cancer. People no doubt carry many fatal ailments to the grave that because because some ailments are slower than others to act. So what?

... even if you detect prostate cancer, it is very unlikely to kill you.

http://www.cancer.org/docroot/CRI/c...atistics_for_prostate_cancer_36.asp?rnav=cri"

Prostate cancer is the second leading cause of cancer death in American men, behind only lung cancer. About 1 man in 35 will die of prostate cancer. Prostate cancer accounts for about 10% of cancer-related deaths in men.

It appears you are mistaking the fact that prostate cancer is often very slow growing with the equally true facts that a) even when slow growing it eventually can and will kill, and b) prostate cancer can also spread quickly though not commonly.

Then, The major reason why prostate cancer survival rates appear to be much better in the US, is not because the early detection makes treatment better. It is simply the trivial statistical effect caused by the undetected prostate cancer survivors in Europe.

I think you are referring to survivor time bias here, that is, the survivor statistics should be differentiated by the cancer stage at diagnosis as was discussed above in https://www.physicsforums.com/showpost.php?p=2304039&postcount=295". I agree that for especially for slow cancers like prostate time bias will skew the stats. I'll come back here w/ something by stage.

 

[Al68]

The metric to judge whether a health care system is the best in the world is a combination of the health care available and the ability for every resident of that country to access it.

Based on such a definition, the U.S. does not have a good or a bad system. There simply is no such system. And there never has been.

Historically, in the U.S., most health care has been private, not part of a system.

It's just faulty logic to refer to a bunch of individual private voluntary agreements as a "system", when they're not in fact part of any real system, then blame them for shortcomings in a "system" that they were never intended to have anything to do with.

 

[Al68]

While the States have the right to allow assisted suicide, there should be no impetus on the taxpayers who object to assisted suicide, to pay for it...

What about all the other things that a plan must cover to be a "qualifying" plan, that many Americans object to paying for, and will have to pay an income tax penalty if they don't participate?

I know the details aren't finalized, but some examples might be: abortion, sterilization, Ritalin, etc.

There is an exception for members of recognized religious "sects" (Amish?), but many non-sect belonging people would object to participating as well.

 

[mheslep]

For example...
...

Amusing advertisement from Gordon Brown state TV.

BTW, Brock, the orgnizer of that clinic also comments:

He is also seriously thinking of returning to Britain - with a team of RAM volunteers.

He has heard his old country has a shortage of NHS dentists.

"I am sure we'll get just as large a crowd as we're getting here in the US," he says.

http://news.bbc.co.uk/2/hi/americas/7420744.stm

 

[mheslep]

...Then, The major reason why prostate cancer survival rates appear to be much better in the US, is not because the early detection makes treatment better. It is simply the trivial statistical effect caused by the undetected prostate cancer survivors in Europe.

...I think you are referring to survivor time bias here, that is, the survivor statistics should be differentiated by the cancer stage at diagnosis as was discussed above in https://www.physicsforums.com/showpost.php?p=2304039&postcount=295". I agree that for especially for slow cancers like prostate time bias will skew the stats. I'll come back here w/ something by stage.

I can't quickly locate by stage stats on prostate, so here are the five year survival rates by stage for breast cancer, which is also faster acting than prostate:
http://www.imaginis.com/breasthealth/statistics2.asp#5"
0 100%
I 100% (in situ)
IIA 92%, IIB 81%,
IIIA 67%, IIIB 54%
IV 20%

http://www.guardian.co.uk/lifeandstyle/besttreatments/breast-cancer-survival-rates-for-breast-cancer"
I 88%
II 69%
III 43%
IV 12%

Overall 5 year survival rate is http://repository.upenn.edu/cgi/viewcontent.cgi?article=1012&context=psc_working_papers" (the overall figure is as of 2001-2003 for the UK)