# Nationalized health care vs insane end of life medical costs in the US **URL:** \ **Category:** Great Debates\ **Created:** [May 17, 2009, 1:50am UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701 "2009-05-17T01:50:12Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![Xan](https://avatars.discourse-cdn.com/v4/letter/x/ac8455/32.png) [@Xan](https://boards.straightdope.com/u/Xan)\ **Post date:** [May 17, 2009, 5:34pm UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/21 "2009-05-17T17:34:25Z")
> [@prrzka](#): > > I love when people who have absolutelly no experience with socialized heathcare make statements againts it. It’s soooo easy to scare you with all the lies because you don’t know how it really works. Who came up with this non-sense that government will deny treatments?! Or that the quality will be worse? Or that you’ll pay high taxes? How much does it cost you now with all the deductibles, premiums, co-pays etc? How many of you can’t even afford insurance? Show me an unbiased account of it actually working. ---
**Author:** ![Mr.Moto](https://avatars.discourse-cdn.com/v4/letter/m/9de0a6/32.png) [@Mr.Moto](https://boards.straightdope.com/u/Mr.Moto)\ **Post date:** [May 17, 2009, 5:37pm UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/22 "2009-05-17T17:37:05Z")
> [@prrzka](#): > > Who came up with this non-sense that government will deny treatments?! Or that the quality will be worse? Or that you’ll pay high taxes? How much does it cost you now with all the deductibles, premiums, co-pays etc? How many of you can’t even afford insurance? Pardon me, but I’m not exactly a defender of the status quo. And the fact is that any kind of government run plan will have to ration care somehow, or else costs and yes, taxes will skyrocket. Do you have some sort of cite that your magic system of no denied treatments, excellent quality, and low taxes will work? That’s just wishful thinking - any reputable thought in this area recognizes that there will be tradeoffs. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [May 17, 2009, 6:50pm UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/23 "2009-05-17T18:50:31Z")
> [@smiling\_bandit](#): > > It will ration care, and rationing is never a wise choice in the presence of alternatives. And alternatives do exist. Yes, well, the alternative we’re currently using keeps 40-50 million Americans shut out of all but life-threatening emergency care and gives them an effective waiting time of infinity for any other procedure - a very harsh form of rationing. Also, are you truly stupid enough to think that we _don’t_ have rationing in our current system? Try to get a new kidney lately? Ever hear of a waiting list? > [@](#): > > Our present system has many disadvantages, but overall it does not produce worse (or better) overall treament than the rest of world’s centralized government bureaucracies. Actually, it _does_ produce worse outcomes when measured by such things as overall life expectancy and child mortality. We spend more money, live shorter lives, and more babies die than in those other countries you mention. > [@](#): > > Even better, we have a great deal more opportunity to improve matters here. But taking it to the government is not the right way, and mark my words: before ten years of nationalized healthcare are out you will be screaming and whining piteously about how it didn’t turn out like you wanted. We in Tennessee have direct experience with this. My husband and I are currently enrolled in a state sponsored insurance program that doesn’t break our budget with premiums and provides the on-going care he needs on a timely basis. The only “whining” you’ll hear from me is why couldn’t we have gotten on the program sooner? ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [May 17, 2009, 6:54pm UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/24 "2009-05-17T18:54:18Z")
> [@Mr.Moto](#): > > Pardon me, but I’m not exactly a defender of the status quo. And the fact is that any kind of government run plan will have to ration care somehow, or else costs and yes, taxes will skyrocket. > > Do you have some sort of cite that your magic system of no denied treatments, excellent quality, and low taxes will work? That’s just wishful thinking - any reputable thought in this area recognizes that there will be tradeoffs. You mean, as opposed to our current system which costs more for those who can even get into it, where treatments are denied by private corporations, and if you can’t get private insurance you either get no treatment at all or whatever you can cobble together? You mean our current system where we lag other modern nations in life expectancies? You mean our current system with its higher infant mortality than other modern nations? If those other system ration care perhaps they’re doing it in a sane manner - certainly, some of their outcomes are _better_ than ours. AND they cover everybody in the country, they don’t leave 1 in 6 out in the cold. And they do it for less per person per year. ---
**Author:** ![GIGObuster](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gigobuster/32/421_2.png) [@GIGObuster](https://boards.straightdope.com/u/GIGObuster)\ **Post date:** [May 17, 2009, 7:12pm UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/25 "2009-05-17T19:12:51Z")
> [@auburntiger11](#): > > Name one American government agency run program that you are happy with? Name one that you have dealt with that you were impressed about how well they operate and how easy it is to get things done through the government? Based on what I have gone through I would say none. The Arizona department of vehicles has impressed me, as it is the low income AHCCCS health program, unfortunately because of the economy now the program will get less funding. Of course, when you have had a party that was recently in power, that insisted that “government is the problem”, it is no surprise that the agencies come with issues. > [@](#): > > This healthcare idea might work in other countries, but will simply be a terrible idea to have here in America. I work for the government and will say that the only thing they are good at is wastefully spending money and time. There is no incentive not to because its very hard to get fired and it isn’t their own money. This goes for all agencies, why would we want healthcare to be like this? Because the option that we have right now is more expensive and irrational. It is a system that would only make sense to a medieval feudal lord. And it is a system that is costing us jobs as investors flee the US thanks to the health care cost and new industries begin (if they dare to) with a disadvantage by not being able to offer good benefits to their workers. [http://www.cfr.org/publication/13325/](http://www.cfr.org/publication/13325/) > [@](#): > > Competitive Disadvantage > > The United States spent 16 percent of its GDP in 2007 on health care, higher than any other developed nation. The nonpartisan Congressional Budget Office (CBO) estimates that number will rise to 25 percent by 2025 without changes to federal law (PDF). Employer-funded coverage is the structural mainstay of the U.S. health insurance system. According the U.S. Bureau of Labor Statistics, about 71 percent of private employees in the United States had access to employer-sponsored health plans in 2006. A November 2008 Kaiser Foundation report notes that access to employer-sponsored health insurance has been on the decline (PDF) among low-income workers, and health premiums for workers have risen 114 percent in the last decade. Small businesses are less likely than large employers to be able to provide health insurance as a benefit. At 12 percent, health care is the most expensive benefit paid by U.S. employers, according to the U.S. Chamber of Commerce. > > These ballooning dollar figures place a heavy burden on companies doing business in the United States and can put them at a substantial competitive disadvantage in the international marketplace. For large multinational corporations, footing healthcare costs presents an enormous expense. General Motors, for instance, covers more than 1.1 million employees and former employees, and the company says it spent roughly $5.6 billion on healthcare expenses in 2006. GM says healthcare costs add between $1,500 and $2,000 to the sticker price of every automobile it makes. Health benefits for unionized auto workers became a central issue derailing the 2008 congressional push to provide a financial bailout to GM and its ailing Detroit rival, Chrysler. > > It is difficult to quantify the precise effect high healthcare costs have had so far on the overall U.S. job market. Health care is one of several factors–entrenched union contracts are another–that make doing business in the United States expensive, and it’s difficult to parse the effects of each factor. Moreover, economists disagree on the number of U.S. jobs that have been lost to offshoring–the transfer of business operations across national boundaries to friendlier operating environments. The Princeton economist Alan S. Blinder, in a 2006 Foreign Affairs article, says that judging by data compiled from “fragmentary studies,” it is apparent that “under a million service-sector jobs in the United States have been lost to offshoring to date.” Blinder goes on to predict that somewhere between 28 million and 42 million U.S. jobs are “susceptible” to offshoring in a future where technology allows the more efficient transfer of jobs. Many other economists, however, have shied away from making such estimates, and some have criticized Blinder’s approach. > > It is clear, however, that healthcare expenses affect every level of U.S. industry. For large corporations they mean the massive “legacy costs” associated with insuring retired employees. For small business owners they can be even more devastating. “In many places, you have small businesses that simply cannot afford to offer coverage,” Sarbanes says. Often, he says, healthcare expenses make it impossible for small business owners to hire candidates they would otherwise desire. ---
**Author:** ![Sam\_Stone](https://avatars.discourse-cdn.com/v4/letter/s/ecccb3/32.png) [@Sam\_Stone](https://boards.straightdope.com/u/Sam_Stone)\ **Post date:** [May 17, 2009, 8:34pm UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/26 "2009-05-17T20:34:02Z")
Something to consider about the ‘last year of life’ statistics: - Any radical treatments to help people with otherwise terminal diseases contribute to the ‘last year of life cost’ statistics - but sometimes those treatments cure people or extend their lives for many years. - Many breakthroughs in medicine start off being tested by people in the more dire circumstances. New treatments are both expensive, and often don’t work. But some do. By simply ‘giving up’ on people with terminal diseases, what happens to research? New experimental cancer treatments, for example, are almost always first applied to people who will otherwise die. Should we just give up on those as well? - Once a terminal diagnoses is turned into a huge cost-saving measure, there will be perverted incentives which may increase the range of ‘terminal’ diagnoses used to deny treatment. - Don’t be too sure that a private system will be allowed to coexist with a public system. If the public system provides average care, but the private system provides great care, the same activists calling for a public system now will start complaining that the private system is siphoning off the best doctors and facilities, create a two-tier health care for the ‘haves’ and ‘have-nots’. That’s exactly what happened in Canada, and I think the forces pushing that will be even stronger in the U.S. - The rich currently spend a lot of money on health care - especially in the area of extreme life-saving measures like artificial hearts and such. Take away their ability to spend the kind of money they want by eliminating private health care, and you’ll kill funding for medical breakthroughs. Public health care systems around the world are free riding on American innovation and investment in health care. That’s one reason they can still provide decent services. America will have no such advantage. ---
**Author:** ![auburntiger11](https://avatars.discourse-cdn.com/v4/letter/a/bbe5ce/32.png) [@auburntiger11](https://boards.straightdope.com/u/auburntiger11)\ **Post date:** [May 17, 2009, 8:44pm UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/27 "2009-05-17T20:44:24Z")
> [@GIGObuster](#): > > The Arizona department of vehicles has impressed me, as it is the low income AHCCCS health program, unfortunately because of the economy now the program will get less funding. > > Of course, when you have had a party that was recently in power, that insisted that “government is the problem”, it is no surprise that the agencies come with issues. > Because the option that we have right now is more expensive and irrational. > > It is a system that would only make sense to a medieval feudal lord. > > And it is a system that is costing us jobs as investors flee the US thanks to the health care cost and new industries begin (if they dare to) with a disadvantage by not being able to offer good benefits to their workers. > > [http://www.cfr.org/publication/13325/](http://www.cfr.org/publication/13325/) Im glad to see a well running government program that is a first. Yeah, we might spend a terrible amount of money on healthcare but that is why we have a very very impressive system. This career is overall is one of the highest paid in the world because you must be good at what you do and high risks are involved. Unlike goverment agencies where you must get an act of congress to get you fired. Why do we have soo many people come to America to get treatment? ---
**Author:** ![GIGObuster](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gigobuster/32/421_2.png) [@GIGObuster](https://boards.straightdope.com/u/GIGObuster)\ **Post date:** [May 17, 2009, 9:07pm UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/28 "2009-05-17T21:07:39Z")
> [@auburntiger11](#): > > Im glad to see a well running government program that is a first. Nah, there are others, the fact is that if the government not had the FDIC in pace we would be talking about a depression or even more banks going up in smoke. > [@](#): > > Yeah, we might spend a terrible amount of money on healthcare but that is why we have a very very impressive system. This career is overall is one of the highest paid in the world because you must be good at what you do and high risks are involved. Unlike goverment agencies where you must get an act of congress to get you fired. > > Why do we have soo many people come to America to get treatment? What old news are you reading? > **[Lower costs lure U.S. patients abroad for treatment - CNN.com](https://www.cnn.com/2009/HEALTH/03/27/india.medical.travel/index.html)** > > "I was a walking time bomb. I knew I had to get on that plane if I wanted to be around to see my grandkids." Lower costs lure U.S. patients abroad for treatment > [@](#): > > Sandra Giustina is a 61-year-old uninsured American. For three years she saved her money in hopes of affording heart surgery to correct her atrial fibrillation. “They [U.S. hospitals] told me it would be about $175,000, and there was just no way could I come up with that,” Giustina said. > > So, with a little digging online, she found several high quality hospitals vying for her business, at a fraction of the U.S. cost. Within a month, she was on a plane from her home in Las Vegas, Nevada, to New Delhi, India. Surgeons at Max Hospital fixed her heart for “under $10,000 total, including travel.” > > Giustina is just one of millions around the world journeying outside their native land for medical treatment, a phenomenon known as “medical tourism.” Experts say the trend in global health care has just begun. Next year alone, an estimated 6 million Americans will travel abroad for surgery, according to a 2008 Deloitte study. “Medical care in countries such as India, Thailand and Singapore can cost as little as 10 percent of the cost of comparable care in the United States,” the report found. > **[Find Private Clinics in Canada for Walk in Clinics in Montreal, Toronto,...](https://www.findprivateclinics.ca/resources/general/medical-tourism.php)** > > Travelling to Canada for surgery or medical treatment such as cosmetic surgery, general operations and cancer treatment from the United States US will help save money on health care costs and you'll recieve some of the best health care in the world. > [@](#): > > Medical tourism is a rapidly growing industry that attracts people to travel abroad to get medical, dental, and surgical care, along with an enjoyable and luxurious vacation in the country. > People from developed countries such as Canada, Bolivia, Brazil, Cuba, Costa Rica, Hungary, India, Lithuania, Malaysia, Thailand, Belgium, Poland and Singapore have world class, cost-effective healthcare. Traveling to Canada for medical care just makes sense. > Why Canada? > People traveling to Canada for medical reasons are mostly from the United States. Medical care in United States is almost double the cost of what it is in Canada, making Canada an attractive medical tourism destination for Americans. > However, those who are still skeptical about standard of care in America and Canada, should take a close look at the facts provided: > • Average in-hospital treatment costs are nearly twice as much in the U.S. ($20,673 U.S. vs. $10,373) ---
**Author:** ![auburntiger11](https://avatars.discourse-cdn.com/v4/letter/a/bbe5ce/32.png) [@auburntiger11](https://boards.straightdope.com/u/auburntiger11)\ **Post date:** [May 17, 2009, 11:41pm UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/29 "2009-05-17T23:41:04Z")
> [@GIGObuster](#): > > Nah, there are others, the fact is that if the government not had the FDIC in pace we would be talking about a depression or even more banks going up in smoke. > What old news are you reading? > > [Lower costs lure U.S. patients abroad for treatment - CNN.com](http://www.cnn.com/2009/HEALTH/03/27/india.medical.travel/index.html) > Lower costs lure U.S. patients abroad for treatment > > [Find Private Clinics in Canada for Walk in Clinics in Montreal, Toronto, Calgary and Vancouver](http://www.findprivateclinics.ca/resources/general/medical-tourism.php) Thats news to me. I would still be very concerned about travelling to these countries to do operations. I would be willing to bet that just as many people leaving this country for operations, there are that many coming over here for treatment. My point was, cost aside, I believe that in this country we have the best hopstitals and doctors in the world, this is because it costs so much. You can’t put a price on a human life or your basic health needs. I guess if it really came down to it, I would have done what that woman did about her heart situation. IMO, I wouldn’t want to be visiting a poor or not very well paid doctor. ---
**Author:** ![GIGObuster](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gigobuster/32/421_2.png) [@GIGObuster](https://boards.straightdope.com/u/GIGObuster)\ **Post date:** [May 17, 2009, 11:54pm UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/30 "2009-05-17T23:54:11Z")
> [@auburntiger11](#): > > My point was, cost aside, I believe that in this country we have the best hopstitals and doctors in the world, this is because it costs so much. We are getting less service and the cost is increasing with very little to show in quality. [http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2008/Jul/Why-Not-the-Best--Results-from-the-National-Scorecard-on-U-S--Health-System-Performance--2008.aspx](http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2008/Jul/Why-Not-the-Best--Results-from-the-National-Scorecard-on-U-S--Health-System-Performance--2008.aspx) > [@](#): > > Overall, the National Scorecard on U.S. Health System Performance, 2008, finds that the U.S. is losing ground in providing access to care and has uneven health care quality. The Scorecard also finds broad evidence of inefficient and inequitable care. Average U.S. performance would have to improve by more than 50 percent across multiple indicators to reach benchmark levels of performance. > > Closing performance gaps would bring real benefits in terms of health, patient experiences, and savings. For example: > > ``` > * Up to 101,000 fewer people would die prematurely each year from causes amenable to health care if the U.S. achieved the lower mortality rates of leading countries. > * Thirty-seven million more adults would have an accessible primary care provider, and 70 million more adults would receive all recommended preventive care. > * The Medicare program could potentially save at least $12 billion a year by reducing readmissions or by reducing hospitalizations for preventable conditions. > * Reducing health insurance administrative costs to the average level of countries with mixed private/public insurance systems (Germany, the Netherlands, and Switzerland) would free up $51 billion, or more than half the cost of providing comprehensive coverage to all the uninsured in the U.S. Reaching benchmarks of the best countries would save an estimated $102 billion per year. > > ``` > > Studies further document the cost in lives and lost productivity from the nation’s failure to provide secure health insurance to all. Based on areas within the U.S. that achieve superior outcomes at lower costs, it should be possible to close gaps in health care quality and access, and to reduce costs significantly. > [@auburntiger11](#): > > You can’t put a price on a human life or your basic health needs. I guess if it really came down to it, I would have done what that woman did about her heart situation. > > IMO, I wouldn’t want to be visiting a poor or not very well paid doctor. You would have done it or not? Gone to another country for care? ---
**Author:** ![gonzomax](https://avatars.discourse-cdn.com/v4/letter/g/e8c25b/32.png) [@gonzomax](https://boards.straightdope.com/u/gonzomax)\ **Post date:** [May 17, 2009, 11:55pm UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/31 "2009-05-17T23:55:02Z")
> [@Grumman](#): > > Wouldn’t denying you coverage lead to you denying him income? Insurance company coverage is by contracts paid monthly. They get paid in good and bad months the same. Denying services saves immediate money. The more they can weasel out of ,the more they make. The mantra is Deny..Deny..Deny. ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [May 18, 2009, 12:27am UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/32 "2009-05-18T00:27:12Z")
> [@auburntiger11](#): > > My point was, cost aside, I believe that in this country we have the best hopstitals and doctors in the world, this is because it costs so much. Why is this a matter of opinion? (Sorry, I know I just flogged this horse in another thread, but I’m sick and tired of this “everyone’s entitled to their opinion, man!” idea that’s plaguing the internet.) It’s not a matter of belief. By every rational measure - infant mortality, c-section rate, hospital acquired infections, life expectancy and rates of depression - American health care is \*not \*the best in the world, not by a long shot. Insisting that it is isn’t belief or opinion, but jingoistic nonsense. > [@](#): > > You can’t put a price on a human life or your basic health needs. Don’t be ridiculous, of course you can. Your insurance company already has; they call it the Lifetime Maximum Benefit. Probably either 2 or 5 million, depending on your policy. ---
**Author:** ![athelas](https://avatars.discourse-cdn.com/v4/letter/a/5e9695/32.png) [@athelas](https://boards.straightdope.com/u/athelas)\ **Post date:** [May 18, 2009, 12:37am UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/33 "2009-05-18T00:37:21Z")
> [@WhyNot](#): > > By every rational measure - infant mortality, c-section rate, hospital acquired infections, life expectancy and rates of depression - American health care is \*not \*the best in the world, not by a long shot. Insisting that it is isn’t belief or opinion, but jingoistic nonsense. Remember that healthcare costs are partly a result of lifestyles and genetics. Countries benefit not just by having good healthcare systems, but from having a healthy population (see Japan, which has a crappy universal healthcare system but a population that it’s cheap to treat in general.) US healthcare-bashers like to quote infant mortality statistics, but the fact is that if you compare the white US population with Europe, the US comes out ahead. Blacks, for genetic reasons, have a higher incidence of miscarriages and infant mortality, and if you make the demographics proportional the critics’ case collapses. It’s more fair to compare Scandinavia to, say, Minnesota, than it is to compare it to the US as a whole. ---
**Author:** ![GIGObuster](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gigobuster/32/421_2.png) [@GIGObuster](https://boards.straightdope.com/u/GIGObuster)\ **Post date:** [May 18, 2009, 12:52am UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/34 "2009-05-18T00:52:20Z")
> [@athelas](#): > > Remember that healthcare costs are partly a result of lifestyles and genetics. Countries benefit not just by having good healthcare systems, but from having a healthy population (see Japan, which has a crappy universal healthcare system but a population that it’s cheap to treat in general.) US healthcare-bashers like to quote infant mortality statistics, but the fact is that if you compare the white US population with Europe, the US comes out ahead. Blacks, for genetic reasons, have a higher incidence of miscarriages and infant mortality, and if you make the demographics proportional the critics’ case collapses. It’s more fair to compare Scandinavia to, say, Minnesota, than it is to compare it to the US as a whole. You know, for some reason you reminded me why the government’s plan to benefit all soldiers, the GI bill, came close to not be approved because some representatives and senators \*\*hated \*\*that the GI bill was going to benefit also black soldiers. I would have to say that IMHO, unfortunately, there are remnants of that feeling in the current efforts to defeat any efforts to make sure that all Americans are insured. I would say that poverty and lack of early treatment are more likely the reasons why miscarriages and infant mortality are prevalent in minorities. ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [May 18, 2009, 2:01am UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/35 "2009-05-18T02:01:19Z")
> [@athelas](#): > > R Blacks, **for genetic reasons** , have a higher incidence of miscarriages and infant mortality, and if you make the demographics proportional the critics’ case collapses. (bolding mine) Really? Do you have a citation for this? But, okay, I’ll take it on faith for the moment. [The c-section rate in Minnesota is 28%](http://feyder.blogspot.com/2008/11/twin-cities-hospital-cesarean-rates.html). [The c-section rates in Denmark and Sweden are less than 10%](http://74.125.95.132/search?q=cache:unf75OTQzvEJ:medind.nic.in/jaq/t06/i4/jaqt06i4p298.pdf+denmark+c-section+rate&cd=9&hl=en&ct=clnk&gl=us&client=firefox-a) The WHO views a c-section rate of 10-15% as indicating optimal prenatal care and maternal health. Response? ---
**Author:** ![Interconnected\_Series\_of\_Tubes](https://avatars.discourse-cdn.com/v4/letter/i/13edae/32.png) [@Interconnected\_Series\_of\_Tubes](https://boards.straightdope.com/u/Interconnected_Series_of_Tubes)\ **Post date:** [May 18, 2009, 2:21am UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/36 "2009-05-18T02:21:22Z")
I’m not educated enough on the subject to have a dog in the fight, but this debate is one I have followed with some interest. I would ask what cesarean section rates have to do with health service quality (and cost, of course) at all. It would seem to me that c-sections are primarily preformed when they are medically necessary (due to complications, which could be used as a quality metric) or personally preferred (which cannot.) Perhaps Minnesotans simply decide to have more c-sections than Scandinavians. I’d imagine the United States in general has one of the higher rates of elective c-section. Again, just looking for a clarification as to how the statistics in question relate to the debate. ETA: Don’t want to drag this tangent too far off topic, but c-section rates in the US are high and have been [growing significantly](http://www.cfpc.ca/local/user/files/%7BCB26B78C-E421-4510-A76E-BA338489A90D%7D/CS%20US%20Meneker%20%20and%20Declerque.pdf) for a few decades. ---
**Author:** ![athelas](https://avatars.discourse-cdn.com/v4/letter/a/5e9695/32.png) [@athelas](https://boards.straightdope.com/u/athelas)\ **Post date:** [May 18, 2009, 2:37am UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/37 "2009-05-18T02:37:20Z")
> [@WhyNot](#): > > (bolding mine) Really? Do you have a citation for this? A cursory Google turns up [This PDF from the March of Dimes](http://www.marchofdimes.com/files/AA_PTB_Report_FINAL(1).pdf) pointing to high premature births in blacks, that cannot be attributed to differences in socioeconomic status. At the same time, black premature births are [more likely to survive](http://www.sciencedaily.com/releases/2006/01/060103183741.htm) than their white counterparts, pointing to an evolutionary adaptation to shorter gestation periods, albeit a weak one that cannot close infant survival gap. > [@](#): > > [The c-section rate in Minnesota is 28%](http://feyder.blogspot.com/2008/11/twin-cities-hospital-cesarean-rates.html). > > [The c-section rates in Denmark and Sweden are less than 10%](http://74.125.95.132/search?q=cache:unf75OTQzvEJ:medind.nic.in/jaq/t06/i4/jaqt06i4p298.pdf+denmark+c-section+rate&cd=9&hl=en&ct=clnk&gl=us&client=firefox-a) > > The WHO views a c-section rate of 10-15% as indicating optimal prenatal care and maternal health. > > Response? [This Google Book entry](http://books.google.com/books?id=YjhaiKnQLt4C&pg=PA88&lpg=PA88&dq=c-section+america+europe&source=bl&ots=uz30ttzyyU&sig=u37t5IpwsacA-5igtuyCJlpH3ts&hl=en#PPA98,M1) points out that Swedish births are often delivered by midwives, rather than in hospitals. However Medicaid covers only hospital bills, not mdiwifery. “Medicaid expansion ,” the book notes, “may also have had the effect of increasing the use of four procedures - C-section, fetal monitoring, induction of labor, and ultrasound - among women likely to have moved from the status of no insurance to Medicaid.” And [this USA Today article](http://www.usatoday.com/news/health/2008-01-07-csections_N.htm) pinpoints another cause of the increase in C-sections: > [@](#): > > But what if the woman is a first-time mother with no childbirth track record? Is scheduling a cesarean section a safer bet than planning to deliver vaginally? > > Apparently, some pregnant women think so, and **they’re reportedly asking for C-sections** even though there is no medical reason for one. > > How much so-called maternal request cesareans have contributed to the soaring C-section rate isn’t known, but \*\*growing numbers of women are delivering their first babies via surgery, researchers say. \*\*And for virtually all of them, once a C-section, always a C-section. Last month, the government announced the U.S. rate hit another all-time high in 2006. So the reason Americans are getting more C-sections is because women _want_ them. Now you can say that we should overrule the patient - and in that case you’d better be consistent in defending medical paternalism in other cases - but it’s clear that the difference stems in patient preferences rather than being some indication that we have third-world healthcare. Enough throwing out of random, barely-understood statistics. Give me a hard one. ---
**Author:** ![GIGObuster](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gigobuster/32/421_2.png) [@GIGObuster](https://boards.straightdope.com/u/GIGObuster)\ **Post date:** [May 18, 2009, 3:25am UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/38 "2009-05-18T03:25:33Z")
> [@athelas](#): > > A cursory Google turns up [This PDF from the March of Dimes](http://www.marchofdimes.com/files/AA_PTB_Report_FINAL(1).pdf) pointing to high premature births in blacks, that cannot be attributed to differences in socioeconomic status. The complete remark mentions that genetic predispositions are only \*\*one \*\*of the factors being investigated; that is, this is part of ongoing research, not even a conclusion. ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [May 18, 2009, 4:51am UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/39 "2009-05-18T04:51:16Z")
> [@athelas](#): > > And [this USA Today article](http://www.usatoday.com/news/health/2008-01-07-csections_N.htm) pinpoints another cause of the increase in C-sections:But what if the woman is a first-time mother with no childbirth track record? Is scheduling a cesarean section a safer bet than planning to deliver vaginally? > > Apparently, some pregnant women think so, and they’re reportedly asking for C-sections even though there is no medical reason for one. > > > [@](#): > > > > **How much so-called maternal request cesareans have contributed to the soaring C-section rate isn’t known,** but growing numbers of women are delivering their first babies via surgery, researchers say. And for virtually all of them, once a C-section, always a C-section. Last month, the government announced the U.S. rate hit another all-time high in 2006. > > So the reason Americans are getting more C-sections is because women _want_ them. Now you can say that we should overrule the patient - and in that case you’d better be consistent in defending medical paternalism in other cases - but it’s clear that the difference stems in patient preferences rather than being some indication that we have third-world healthcare. > > Enough throwing out of random, barely-understood statistics. Give me a hard one. bolding adjusted The medical community has already debunked the theory that increases in c-section rates are due to maternal request, although certainly they do happen. [CBC posts Archive | National Partnership for Women & Families](http://www.childbirthconnection.org/article.asp?ck=10456) : > [@](#): > > To explain this steady rise, health professionals and journalists often point the spotlight on mothers themselves. Many assume that leading factors in the trend are: 1) more and more women are asking for c-sections that have no medical rationale, and 2) the number of women who genuinely need a cesarean is increasing. Neither appears to account for a large portion of the increase. > > Despite a lot of talk about “maternal request” cesareans, few women appear to be taking this step. Childbirth Connection’s national Listening to Mothers survey of women who gave birth in hospitals in 2005 was the first study to poll women about these decisions in the United States. When we asked mothers who had had a cesarean why they had it and who had initiated it, just one woman among nearly 1600 survey participants reported that she had had a planned first c-section with no medical reason at her own request (Declercq et al. 2006a). Those who have looked at this question in other countries have found similar results (McCourt et al. 2007). **Interconnected Series of Tubes** , the reason that infant mortality and c-section rates are often brought up in these threads is that medical professionals in the World Health Organization use c-section rate to estimate the quality and availability of medical care in a country. With good antenatal care and responsible doctors (and yes, I include saying no to a patient who wants major abdominal surgery when it’s not medically required as “responsible”), c-section rates should be between 10 and 15% of all live births. When that number goes up, it’s a sign that the doctors are screwing up or the mothers aren’t getting good care. A sign, in other words, that the medical system she’s part of isn’t doing well. [http://www.who.int/whosis/indicators/compendium/2008/1bcn/en/](http://www.who.int/whosis/indicators/compendium/2008/1bcn/en/) : > [@](#): > > Rationale for use > > The percentage of births by caesarean section is an indicator of access to and use of health care during childbirth. ---
**Author:** ![Grumman](https://avatars.discourse-cdn.com/v4/letter/g/43a26b/32.png) [@Grumman](https://boards.straightdope.com/u/Grumman)\ **Post date:** [May 18, 2009, 9:51am UTC](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701/40 "2009-05-18T09:51:47Z")
> [@gonzomax](#): > > Insurance company coverage is by contracts paid monthly. They get paid in good and bad months the same. They only get paid the same if they don’t convince you that you’re better off cancelling your coverage. If you cancel your coverage, they don’t get paid. [Previous page](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701.md?page=1) [Next page](https://boards.straightdope.com/t/nationalized-health-care-vs-insane-end-of-life-medical-costs-in-the-us/496701.md?page=3)