# side effects of socialized health care **URL:** \ **Category:** Great Debates\ **Created:** [June 4, 2004, 8:02pm UTC](https://boards.straightdope.com/t/side-effects-of-socialized-health-care/248690 "2004-06-04T20:02:45Z")\ **Posts on this page:** 20\ **Page:** 8
**Author:** ![clairobscur](https://avatars.discourse-cdn.com/v4/letter/c/839c29/32.png) [@clairobscur](https://boards.straightdope.com/u/clairobscur)\ **Post date:** [June 9, 2004, 3:05pm UTC](https://boards.straightdope.com/t/side-effects-of-socialized-health-care/248690/141 "2004-06-09T15:05:15Z")
> [@GorillaMan](#): > > šŸ˜• > > There is no ā€˜world socialised drug systemā€™. Public-funded health systems have to by patent drugs from the companies the same as any private company has to, American or not. And itā€™s one of the reasons public funding of healthcare goes through the roof. Governments of countries with public-funded healthcare systems usually negociate the price of the drugs sold. So, the reasonning is that since pharmaceutical companies make more money on the american market by selling their drugs at a higher price, the research is funded mostly by the american consummer. However, this is limited by the fact that a company could always choose not to lower the cost of their drugs, and that the healthcare authorities couldnā€™t just refuse that a drug which is proven to be efficient could be sold. So, to clear up this issue, it would be necessary to understand quite well the dynamics of the system, and why the pharmaceutical companies accept to lower their prices. In develloping countries, itā€™s easy to understand : either the price will be lowered, either it wonā€™t be sold at all because people canā€™t afford it. In industrialized countries which can afford them and with a population which wouldnā€™t accept that an useful drug couldnā€™t be available, the reasons why it work this way I donā€™t really grasp. ---
**Author:** ![pervert](https://avatars.discourse-cdn.com/v4/letter/p/bbe5ce/32.png) [@pervert](https://boards.straightdope.com/u/pervert)\ **Post date:** [June 9, 2004, 6:36pm UTC](https://boards.straightdope.com/t/side-effects-of-socialized-health-care/248690/142 "2004-06-09T18:36:16Z")
> [@clairobscur](#): > > Governments of countries with public-funded healthcare systems usually negociate the price of the drugs sold. So, the reasonning is that since pharmaceutical companies make more money on the american market by selling their drugs at a higher price, the research is funded mostly by the american consummer. Thank you for restating this so well. > [@](#): > > However, this is limited by the fact that a company could always choose not to lower the cost of their drugs, and that the healthcare authorities couldnā€™t just refuse that a drug which is proven to be efficient could be sold. Iā€™m not really sure this is true. Authorities could in fact refuse to allow the selling of a drug. Especially if their efficacy approval system was closely tied to their price regulation system. > [@](#): > > [ā€¦]the reasons why it work this way I donā€™t really grasp. I agree entirely that the whole thing is outlandishly complex. I fail to grasp most of it most of the time. šŸ˜‰ > [@](#): > > Iā€™m not convinced since these people could go to the private sector, and find the best, more willing to prescribe/test/whatever doctors, and pay for the difference. [ā€¦] So, in theory, thereā€™s no reason for the extent of the care received to necessarily drop. One problem with this assertion, is that the private healthcare increases in cost in countries with universal coverage. Look at British again. Private healthcare is only for the rich (this is certainly a generalization). > [@](#): > > And I would even ask : are you really sure that the american doctors prescribe more drugs/tests, spare less efforts than doctors in other western countries with a public healthcare system. Well, as has been pointed out many times, we do spend a lot more per patient than other countries. While I agree that there are inefficiencies which account for some of this, they do not account for nearly all of it. The rest simply has to be additional medical services. I agree that there does not seem to be any great difference in life expectancy. However, I think this has much more to do with the fact that the healthcare system of any society has less to do with life expectancy than we might like. Lifestyle and other societal habbits have much more to do with it. I always like to ask the question: ā€œWhat is the most profound medical breakthrough in the western world in the last 2 centruies?ā€ My answer: ā€œSewers. They have done more to decrease the death rates than any other medical advance.ā€ Somehow, I donā€™t think expenditures for sewers ever makes it into an analysis of the difference in life expectancies. šŸ˜‰ > [@alaricthegoth](#): > > Health care must be rationed somehow; it is at present, but through a lottery system tied to the accidents of employment, income, etc. I must object to the characterization of capitalism as a lottery system. Suggest that resources are not allocated by need if you must, but this alone does not mean that capitalism is inherently random. > [@](#): > > On the other hand, the free market is a wretched allocator of resources in this instance, and has a twenty percent vig imposed on top of the delivered benefits I should note, that the free market is not very free in this industry. I should also note that the life expectancy numbers bandied about in this thread show that the American system is not exactly wretched either. There, youā€™ve made me use two arguments I find distastful. Are you happy? šŸ˜‰ ---
**Author:** ![alaricthegoth](https://avatars.discourse-cdn.com/v4/letter/a/4bbf92/32.png) [@alaricthegoth](https://boards.straightdope.com/u/alaricthegoth)\ **Post date:** [June 9, 2004, 10:19pm UTC](https://boards.straightdope.com/t/side-effects-of-socialized-health-care/248690/143 "2004-06-09T22:19:27Z")
> [@pervert](#): > > hank you I must object to the characterization of capitalism as a lottery system. Suggest that resources are not allocated by need if you must, but this alone does not mean that capitalism is inherently random.\* > > I should note, that the free market is not very free in this industry. I should also note that the life expectancy numbers bandied about in this thread show that the American system is not exactly wretched either.\*\* > > There, youā€™ve made me use two arguments I find distastful. Are you happy? šŸ˜‰ \*something of a ā€œreductioā€, donā€™t you think? We have a system of some federal government intervention (medicaid) administered state to state, some county patchwork interventions (ie, yourt coverage varies with the vagaries of location) a variety of excresencse on an employment based deliverty system that evolved with no particular reason other than the circumvention of wage controls ā€¦ \*\*american health outcomes suck. ---
**Author:** ![clairobscur](https://avatars.discourse-cdn.com/v4/letter/c/839c29/32.png) [@clairobscur](https://boards.straightdope.com/u/clairobscur)\ **Post date:** [June 10, 2004, 12:02am UTC](https://boards.straightdope.com/t/side-effects-of-socialized-health-care/248690/144 "2004-06-10T00:02:33Z")
> [@pervert](#): > > Well, as has been pointed out many times, we do spend a lot more per patient than other countries. While I agree that there are inefficiencies which account for some of this, they do not account for nearly all of it. The rest simply has to be additional medical services. Not necessarily. Besides the administrative costs and the lawsuits/insurance costs (which by the way are rising here too, in particular for obstetricians, who have seen their insurance premium raised by up to 200% last year), the higher price of drugs, the higher income of physicians, the profit margin of the private hospitals, etcā€¦ may play a significant part too. We would need a breakdown of the overall cost of healthcare in various countries in order to make a valid comparison. Assuming that such figures are actually available. And also informations about the relative cost of the same medical acts in these countries. So, we would know if there are actually more medical acts in the US, and if these acts are more costly and why. ---
**Author:** ![clairobscur](https://avatars.discourse-cdn.com/v4/letter/c/839c29/32.png) [@clairobscur](https://boards.straightdope.com/u/clairobscur)\ **Post date:** [June 10, 2004, 12:09am UTC](https://boards.straightdope.com/t/side-effects-of-socialized-health-care/248690/145 "2004-06-10T00:09:05Z")
Just thought about it, but also what are these medical acts, exactly? I would assume there are vastly more breast implants placed in the US, for instance, since it seems to be a relatively widespread practice, while itā€™s not very common over here. If these are included in the healthcare costs, it could also distort the picture. ---
**Author:** ![pervert](https://avatars.discourse-cdn.com/v4/letter/p/bbe5ce/32.png) [@pervert](https://boards.straightdope.com/u/pervert)\ **Post date:** [June 10, 2004, 12:32am UTC](https://boards.straightdope.com/t/side-effects-of-socialized-health-care/248690/146 "2004-06-10T00:32:31Z")
> [@clairobscur](#): > > Just thought about it, but also what are these medical acts, exactly? I would assume there are vastly more breast implants placed in the US, for instance, since it seems to be a relatively widespread practice, while itā€™s not very common over here. If these are included in the healthcare costs, it could also distort the picture. This is an outstanding point. I had not thought of this difference. The numbers used to show national expenditures on healthcare do not seem likely to diferentiat well between cosmetic surgeries and other medical procedures. As to your other note, I agree that we would need a breakdown to know for sure. But the earlier estimates of profits of 20% or so, do not seem to jive with the idea that we spend up to twice as much on medical care. It seems we would have to find quite a price difference to explain that gap. I do not, however, deny that higher prices for doctor services and drugs contribute to this spending difference. I am not claiming that the whole gap is explainable by additional medical procedures. ---
**Author:** ![Alien](https://avatars.discourse-cdn.com/v4/letter/a/57b2e6/32.png) [@Alien](https://boards.straightdope.com/u/Alien)\ **Post date:** [June 10, 2004, 9:54pm UTC](https://boards.straightdope.com/t/side-effects-of-socialized-health-care/248690/147 "2004-06-10T21:54:10Z")
> [@clairobscur](#): > > We would need a breakdown of the overall cost of healthcare in various countries in order to make a valid comparison. Assuming that such figures are actually available. And also informations about the relative cost of the same medical acts in these countries. So, we would know if there are actually more medical acts in the US, and if these acts are more costly and why. **clairobscur** , did you read the OECD report cited on page two, and the breakdown per capita earlier here on page three about this? Is that what youā€™re looking for? ---
**Author:** ![Alien](https://avatars.discourse-cdn.com/v4/letter/a/57b2e6/32.png) [@Alien](https://boards.straightdope.com/u/Alien)\ **Post date:** [June 10, 2004, 9:58pm UTC](https://boards.straightdope.com/t/side-effects-of-socialized-health-care/248690/148 "2004-06-10T21:58:55Z")
> [@clairobscur](#): > > Governments of countries with public-funded healthcare systems usually negociate the price of the drugs sold. So, the reasonning is that since pharmaceutical companies make more money on the american market by selling their drugs at a higher price, the research is funded mostly by the american consummer. We had an interesting discussion about price regulation and subsidizing of drugs around the world. Apparently there are many different methods in place. The thread was: ā€œDoes less restricted drug pricing in the US subsidize the rest of the world?ā€, at > **[Does less restricted drug pricing in the US subsidize the rest of the world?](https://boards.straightdope.com/sdmb/showthread.php?t=212739)** > > Per the article referenced below many industrialized nations, including Canada, seem to have much lower drug prices via their quasi-nationalized health programs that have drug price ceilings of various sorts. The price differential is so marked that... ---
**Author:** ![Alien](https://avatars.discourse-cdn.com/v4/letter/a/57b2e6/32.png) [@Alien](https://boards.straightdope.com/u/Alien)\ **Post date:** [June 10, 2004, 10:04pm UTC](https://boards.straightdope.com/t/side-effects-of-socialized-health-care/248690/149 "2004-06-10T22:04:55Z")
> [@pervert](#): > > If you will excuse the gushing for a second, Iā€™d just like to say thank you to everyone who has participated in this thread. I have waded several times into this subject on this board since I started posting. This has to be the most civil, informative and enjoyable thread I have been a part of. Of course, I am willing to take partial credit. šŸ˜‰ But I think it has much more to do with all of you discussing instead of yelling. Thank you very much. > > Ok, gushing over. šŸ™‚ I agree. This has turned out to be one of the most enjoyable threads Iā€™ve participated in. Now, on to page 4 ā€¦ ---
**Author:** ![Alien](https://avatars.discourse-cdn.com/v4/letter/a/57b2e6/32.png) [@Alien](https://boards.straightdope.com/u/Alien)\ **Post date:** [June 10, 2004, 10:09pm UTC](https://boards.straightdope.com/t/side-effects-of-socialized-health-care/248690/150 "2004-06-10T22:09:10Z")
> [@jshore](#): > > This last aspect is in fact a huge inefficiency in a private system and is the reason why (as I cite I posted earlier shows) the U.S. spends much more of its health care dollars on bureaucracy than Canada does. Hereā€™s a little anecdote along those lines: When I lived in Vancouver, I knew someone who was a doctor there and he explained to me that in a practice of several doctors, they had one person who spent part of her time on billing / reimbursement issues. He said for a similar size practice in the states, doctors there that he knew had a few people working full time on this. Yes, and this goes to the heart of the matter. I would like to emphasize something I posted earlier. If we look at the amount of dollars spent per capita, as I posted a cite on (on page three of this thread), and factor in **Sam** ā€™s NYT cite that 45% of health care spending in the US is public spending, then we get the following: Total per capita: (roughly) $5.000 / 45% = $2.250 per capita in public spending in the US The OECDā€™s reportā€™s average for 2001 was $2.100 per capita in _total_ spending for western countries. In other words, the USG is using the same or more in public spending per capita _alone_, than other western countries are using on their entire national health care programs. Then there is private spending by americans on top of that. Which again leads me to ask the same question Iā€™ve asked a couple of times in this thread already: Are there any reliable data out there outlining where all the health dollars in the US go? Not a snippet here and a snippet there, but some sort of summary somewhere? I know thereā€™s lots of information in the Agency for Health Care Research and Qualityā€™s database (including cost per specific treatment diveded into commercial, Medicare, etc), at [http://hcup.ahrq.gov/HCUPnet.asp](http://hcup.ahrq.gov/HCUPnet.asp), but I havenā€™t had time to dig into the information yet. Anyone? ---
**Author:** ![Alien](https://avatars.discourse-cdn.com/v4/letter/a/57b2e6/32.png) [@Alien](https://boards.straightdope.com/u/Alien)\ **Post date:** [June 10, 2004, 10:19pm UTC](https://boards.straightdope.com/t/side-effects-of-socialized-health-care/248690/151 "2004-06-10T22:19:07Z")
Well, Iā€™m back šŸ™‚ > [@pervert](#): > > We have to stop the long posts. Iā€™ll try and be brief. > But there is evidence that procedures are not limited to moles. Way back someone posted links to problems with cancer treatments. > > The information is not collected nationally like it is in Britain. But I did post a link to a story about a young woman who had to wait several weeks to have a portion of her skull put back into her head. > > Not directly. I just remember that gun deaths and gun accidents seem to happen much more often in the United States than in other countries. At the same time, it seems that life expectancy is not greatly different. I donā€™t think that problems with a certain kind of cancer in a certain country at a certain time says much about the quality of national health care, or private health care for that matter. Just as I donā€™t think that your story about the woman that had to wait 4 months (??) before they put that piece of her skull back into her head means much. There are always horror stories and there always will be. As for the impact of guns on life expectancy. Itā€™s a valid point, but without any cites Iā€™m tempted to disregard it. I could counter your argument with high suicide rates. And you can point out that the US has the highest overall fire death rate of all industrialized countries. Among american teenagers, the three leading causes of death are unintentional injuries, homicide, and suicide. Of course all of these things have an impact, but is the impact _significant_? We need better numbers to determine that. > [@pervert](#): > > What I mean is how accurately can the government measure the demand for medical services. > > Agreed. That is why I was so eager to hear from you and **clairobscur** about the systems in your respective countries. Just providing some information here: In the sort of national health care system we got (itā€™s two tier) the following applies to those who are part of the system: - Ordinary doctors are in private practice. When I visit such a doctor, thereā€™s a co-payment (no paperwork), and the doctor sends a bill to the goverment for the rest (standardized paperwork). Besides prescribing medication, doctors also issue requisitions for diagnosis, or refer the patient to a specialist. Note, I canā€™t visit a specialist inside the system without a requisition from a doctor whose also inside the system. - Specialist are also in private practice. They specialize in treatments (like physio, minor surgery) and diagnosis (like x-ray, blood testing, neural even). Note: public hospitals have identical services, but the bulk of these services (at least in the cities) are carried out by specialists in private sector. When I visits a specialist thereā€™s a co-payment similar to doctor payments, the rest of the bill is sent to the goverment. - Hospials are, very roughly, 98% public, 2% private business. They handle surgery, or pretty much anything really. Demand & Supply: For ordinary doctors and specialists, demand is set by the market by clients. The government can adjust supply by putting more money into public education or raise the fixed price for consultations. There are also a few public county doctors, and the county administration can raise salaries for these. Hospitals, while state owned, are now run pretty much like companies. Thereā€™s a fixed price for every treatment, and the hospital administration has to keep cost down to go break even (which is their goal). What this means is that the hospital at the beginning of a fiscal year has a projected budget (derived from the national budget). This budget outlines the expected number of patients and treatments to be carried out. However, hospitals are also required by law to provided treatment for most illnesses, and may receive more patients than they anticipated. In that case, they request more money, which btw could involve discussions about cutting costs. As for the number of doctors and nurses employed, the hospital administration employs the people they feel they need, and itā€™s not uncommon to hire from abroad if supply is scarce. The anticipated demand of health services _for hospitals_ is measured based on historical data of demand (both emergency patients and ordinary patients), and on data about last yearā€™s wating lists (which _only_ includes ordinary patients). A waiting list is simply _the number of people who has a case which has not been closed_, which doesnā€™t mean that they are necessarily waiting at home for treatment (more about this in a later post). According to the latest data, the waiting list is about 8% of the capacity, meaning that if there are 100 beds (all occupied), there are 8 people waiting for a bed. Note: All this is in my home country (Norway), and I can guarantee you itā€™s not the same all over. > [@pervert](#): > > But remember, when you say things like this, that the life expectancy measures we were looking at before do not show significant differences for Canada or Britain. The point being, that life expectancy may not be a useful measure of healthcare efficiency or efficacy. Excellent counterargument. I think we can conclude that life expectancy is not useful to measure health care quality. Some interesting numbers could be: - the number of doctors per 100.000 - the number of nurses per 100.000 - the number of hospital beds per 100.000 - the capacity versus order reserve (waiting lists) ratio - the percentage of the population seeking treatment for certain diseases - the sucess rate of treatment for certain diseases - net cost per patient > [@pervert](#): > > Not really. Just fishing for any sort of information. You might look into the delay between diagnosis and treatment by oncologists. That seems to be something Britain has problems with. But it could be any sort of national statistic really. Iā€™m just curious. Learning things like this is what this board is all about (for me). Iā€™m currently processing some data about time elapsed between request and diagnoses, and between diagnosis and treatment, for certain diseases. Look for a follow up post > [@pervert](#): > > But my tax money does go to the poor kid when he is hit by a car. This is another fallacy. The idea that poor people go without major medical care. This is simply not true. I have read many times - over many years - about patients (for instance cancer patients), who are are not treated because they donā€™t have insurance. I know about Medicare and Medicaid, though I donā€™t know enough about them. I have heard that there are roughly 15 million americans covered by the government through public programs, but Iā€™ve also heard that 45 million americans donā€™t have any coverage at all. Can you tell me more about this? ---
**Author:** ![ralph124c](https://avatars.discourse-cdn.com/v4/letter/r/8797f3/32.png) [@ralph124c](https://boards.straightdope.com/u/ralph124c)\ **Post date:** [June 10, 2004, 10:20pm UTC](https://boards.straightdope.com/t/side-effects-of-socialized-health-care/248690/152 "2004-06-10T22:20:55Z")
ā€¦in the USA, doctors and medical personnel have to carry enormously expensive malpractice insurance. There are 1 million practicing lawyers in the US and they are hungry! Some medical specialists like neurosurgeons have to spend \>$100,000 per year on insurance! What i would like to knowā€¦if the state takes over medical care (assigns your doctor, etc.) does that mean that the state can be sued for malpractice? High rates of lawsuits and malpractice insurance are a major factor in health care costs in the US. of course, the ABA says there is no such problemā€¦it is all because insurance companies make BAD investments@ :smack: ---
**Author:** ![pervert](https://avatars.discourse-cdn.com/v4/letter/p/bbe5ce/32.png) [@pervert](https://boards.straightdope.com/u/pervert)\ **Post date:** [June 11, 2004, 12:23am UTC](https://boards.straightdope.com/t/side-effects-of-socialized-health-care/248690/153 "2004-06-11T00:23:32Z")
> [@Alien](#): > > I donā€™t think that problems with a certain kind of cancer in a certain country at a certain time says much about the quality of national health care, or private health care for that matter. Just as I donā€™t think that your story about the woman that had to wait 4 months (??) before they put that piece of her skull back into her head means much. There are always horror stories and there always will be. Agreed. That was just a suggestion of a possible place to start. > [@](#): > > As for the impact of guns on life expectancy. Itā€™s a valid point, but without any cites Iā€™m tempted to disregard it. I could counter your argument with high suicide rates. And you can point out that the US has the highest overall fire death rate of all industrialized countries. Among american teenagers, the three leading causes of death are unintentional injuries, homicide, and suicide. Of course all of these things have an impact, but is the impact _significant_? We need better numbers to determine that. Also, agreed. > [@](#): > > Just providing some information here: Your system sounds almost identical to ours. I would also call our system a two tier system. Most hospitals are not for profit. Meanwhile most doctors are in private practice. I do have a couple question. What sort of incentives motivate hospitals to keep costs down. You suggested that breaking even is their goal, what happens if they do not? > [@](#): > > Excellent counterargument. I think we can conclude that life expectancy is not useful to measure health care quality. Some interesting numbers could be: > > - the number of doctors per 100.000 > - the number of nurses per 100.000 > - the number of hospital beds per 100.000 > - the capacity versus order reserve (waiting lists) ratio > - the percentage of the population seeking treatment for certain diseases > - the sucess rate of treatment for certain diseases > - net cost per patient Those are excellent options. I also noted a study which claimed to measure the disability rate of people over 65. Perhaps numbers showing disability rates amongst various age groups could be used to show how well healthcare systems deal with disabilities. > [@](#): > > I have read many times - over many years - about patients (for instance cancer patients), who are are not treated because they donā€™t have insurance. I know about Medicare and Medicaid, though I donā€™t know enough about them. I have heard that there are roughly 15 million americans covered by the government through public programs, but Iā€™ve also heard that 45 million americans donā€™t have any coverage at all. Can you tell me more about this? One report I looked at mentioned offhad that 39 million are covered by medicare (which is supposed to cover retirees). Apperently Medicaid covers about 14% of the population under 65. Is that another 30 million or so? If I remember correctly, Medicare covers anyone who worked for 10 years with medicare coverage and is over 65 (if your spouse worked, you qualify too). Medicaid is supposed to be for poor people who cannot afford insurance. It varies from state to state, but I think covers people who ear about 66% of the poverty level (around $20,000 per year). [This cite (Warning pdf)](http://www.kff.org/uninsured/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=29340) contains a lot of information about the uninsured. (From page 7) The number of Americans without medical insurance was 43.3 million in 2002. 36% (15.8 mil)of these were poor people (those with incomes below the poverty level which is $29,000 yearly). Another 28% (12.1 mil) were those with incomes twice the poverty level. 24% (10.4 mil) came from families with incomes at 2-4 times poverty level. and the last 12%(5.2 mil) are people at 4 times or more of the poverty level. I did not see where the document broke down the number of people in this who qualify for medicaid. It is generally about 2/3rds of the poverty level. So, some of those in the first group should qualify. I asked **clairobscur** about this, so I should ask you. You mention a copay. Can you give me an idea how big they are? What happens to those who cannot afford this? And, of course, do you have any idea how many such people there are? **clairobscur** , did I ask you if you could find out how many people cannot affort to pay upfront for medical coverage? I understand that such numbers of people would be pretty small. [This is an old money article which talks about how much America spends on healthcare and were. It is not comprehensive. In fact it is really just a quick article.](http://money.cnn.com/2003/10/08/pf/health_myths_1/index.htm) I hope you find this information useful. ---
**Author:** ![jshore](https://avatars.discourse-cdn.com/v4/letter/j/b5e925/32.png) [@jshore](https://boards.straightdope.com/u/jshore)\ **Post date:** [June 11, 2004, 1:43am UTC](https://boards.straightdope.com/t/side-effects-of-socialized-health-care/248690/154 "2004-06-11T01:43:10Z")
> [@ralph124c](#): > > High rates of lawsuits and malpractice insurance are a major factor in health care costs in the US. of course, the ABA says there is no such problemā€¦it is all because insurance companies make BAD investments@ :smack: Well, you can make fun of this claim. But, more convincing would be if you backed up your claims about the high rates of lawsuits and the idea that bad investments arenā€™t an issue. [Here](http://www.uhcanohio.org/reports/fact_malprac.html) is an Ohio group that provides some info on the subject: > [@](#): > > In a March 13, 2002, press release, the American Insurance Association (AIA), a major insurance industry trade group, stated, ā€œThe insurance industry never promised that tort reform would achieve specific premium savings.ā€ This echoes a similar admission by American Tort Reform Association three years earlier. [see [What's New - Americans for Insurance Reform](http://www.insurance-reform.org/issues/aiaatra.html)]. > > ā€¦ > > The AIR study found that medical malpractice premiums have risen and fallen in cycles for the past thirty years that correspond to fluctuations in the economy. that premiums charged by insurance companies do not correspond to increases or decreases in payouts on medical malpractice claims. Rather, premiums rise and fall in concert with the state of the economy. [ā€œMedical Malpractice Insurance: Stable Losses/Unstable Rates,ā€ Americans for Insurance Reform, October 10, 2002, at [www.insurance-reform.org](http://www.insurance-reform.org)]. > > Furthermore, a comprehensive report of premiums since the 1990ā€™s, by the national Center for Justice & Democracy, found that ā€œtort reformā€ laws did not reduce insurance costs. [ā€œPremium Deceit - the Failure of Tort Reform to cut Insurance Prices,ā€ by actuary J. Robert Hunter, former Commissioner of Insurance for the State of Texas and former Federal Insurance Commissioner under Presidents Carter and Ford, at [www.insurance-reform.org](http://www.insurance-reform.org)]. > > The Cleveland Plain Dealer and others point to the insurance industryā€™s ā€œquestionableā€ business practices as a factor in the crisis. When the stock market was rising in the 1990ā€™s, medical malpractice insurers offered rates that didnā€™t cover their costs, in the effort to bring in premium dollars. They then invested the premium dollars in the stock market. Then the stock market plummeted. ā€œIt appears likely that medical malpractice insurers are gouging physicians now to make up for their stockmarket losses,ā€ says UHCAN Ohio Executive Director Cathy Levine. ---
**Author:** ![Alien](https://avatars.discourse-cdn.com/v4/letter/a/57b2e6/32.png) [@Alien](https://boards.straightdope.com/u/Alien)\ **Post date:** [June 11, 2004, 1:53am UTC](https://boards.straightdope.com/t/side-effects-of-socialized-health-care/248690/155 "2004-06-11T01:53:38Z")
**Pervert** asked for more specific info about waiting lists in national health care system, so Iā€™ve done some digging. First of all, Iā€™ve discovered that waiting lists are not such a clear cut case as they seem to be: [ul] [li] Waiting lists include both patients waiting for consultation or treatment, AND patients who has received consultation or treatment, _but whose case is still open_ (for example pending final diagnosis)[/li] [li] Waiting lists do not include patients classified as ā€œemergency careā€ (giving birth, broken bone, appendicitious, heart attack). According to one hospital, this amounted to 41% of all _admissions_ at the hospital; (numbers from the source: 17774 out of 43349. In total, 280.000 patients were served in that hospital that year, so emergency care amounted to 6.3% of total number of patients).[/li] [li] Waiting lists appear as a little longer than they really are because some patients reschedule appointments for a later date, while other patients are too weak and are rescheduled for later.[/li] [li] And finally, waiting lists are not lists of _patients_, but lists of _tasks_. About 4% of the patients had multiple requests in the system.[/li][/ul] **A good method to analyse waitings lists (which are essentially order reserves) is as percentage of total capacity.** Currently, the size of waiting lists in Norway is at 8% of the capacity in the system. Further, to understand waiting lists one should understand the process behind an ordinary case. As an example, letā€™s look at a requisition for an MRI scan sent directly to the hospital by the doctor (NOTE: the patient can also take the requisition and make arrangements her/himself, cutting down wait time to a week): 1. The doctor refers the patient to an MRI. At the hospital the case is screened by medical personnel, who prioritize important cases. Time: One week (longer in clearly unimportant cases) 2. The patient has a right to receive notice about scheduled appointment some time ahead. Currently 2 weeks notice is given. 3. Hospital personnel reviews the MRI images. Time: One week 4. Possible step: The patients is recalled for a sum up consultation. At least 2 more weeks (notice time ++). So, the process in a typical unimportant MRI case, handled by the hospital, would normally take at least 4-6 weeks, and during all this time the patient is on a ā€œwaiting listā€. Itā€™s only when a case goes _beyond_ this that there is actually ā€œwaitingā€ or delays in the system. Now, on to the juicy stuff. **Pervert** asked for delays between diagnosis and treatment by oncologists. By ā€œtreatment by oncologistsā€ I gather he means cancer surgery. As I suspected, this was not as simple as it seemed, because there are many types of cancer, several types of treatments, and some cancer patients are further along than others. Last year the Norwegian government launched a public database, available on the web, which consists of 87 common _consultation and treatment indicators_ and 9 _quality indicators_. The patient can pull a nationwide list of clinics offering a certain treatment, including updated lists of expected wait time, listed per treatment per clinic. Wating periods are even diveded into examination/consultation, daycare bed treatment, and admission (overnight stays). The 9 quality indicators represent 4 patient satisfaction indicators about service and treatment, as well as 5 other indicators, including percentage of people who got an infection at a certain clinic and average number of days in bed after surgery, listed per clinic. Thereā€™s quite a lot of data available, even though the database is less than a year old. However, cancer surgery does not seem to be one of the 87 indicators currently in the database (but see end of post). So I just pulled some random data. The following is _average wait time in weeks_ for a few examinations and treatments: Note on my format: ā€œ0 - 0 - 2ā€, means weeks to wait are 0, 0 and 2 at clinic 1, 2 and 3, respectively ā€œ8x \<= 4wā€, means 8 clinics with equal to or less than 4 weeks to wait, etc Chemotherapy: Total listed: 6 clinics Simple care: Wait time: 0 - 1 - 2 - 3 - 3 - 3 Daycare bed: Wait time: 0 - 2 - 3 - 14 Overnight stay: Wait time: 0 - 1 - 1 - 3 - 3 - Heart, bypass surgery: Total listed: 6 clinics Simple care: Wait time: - Daycare bed: Wait time: - Overnight stay: Wait time: 1 - 1 - 1 - 4 - 4 - 8 Lungs, unspecified: Total listed: 50 clinics Simple care: Wait time: 8x \<= 4w, 17x \<= 8w, 36x \<= 12w, 14x \>= 13w Daycare bed: Wait time: 1 - 2 - 2 - 3 - 12 Overnight stay: Wait time: 0 - 0 - 0 - 0 - 1 - 1 - 2 - 3 - 3 - 4 - 4 - 9 - 12 - 12 Gastroskopi, examination: Total listed: 59 clinics Simple care: Wait time: 5x \<= 4w, 35x \<= 8w, 50x \<= 12w, 9x \>= 13w Daycare bed: Wait time: 20 Overnight stay: Wait time: 0 - 4 Cruciate Ligament: Total listed: 50 clinics Simple care: Wait time: 4x \<= 4w, 13x \<= 8w, 32x \<= 12w, 18x \>= 13w Daycare bed: Wait time: 3 - 6 - 8 - 10 - 10 - 12 - 12 - 12 - 20 Overnight stay: Wait time: too many to list Kidney disease, unspecified: Total listed: 36 clinics Simple care: Wait time: 6x \<= 4w, 15x \<= 8w, 30x \<= 12w, 6x \>= 13w Daycare bed: Wait time: 4 - 4 - 8 - 12 - 12 - 16 Overnight stay: Wait time: 3 - 4 - 4 - 4 - 6 - 6 - 8 - 9 - 12 - 24 - 26 MRI, standard scan: Total listed: 48 clinics Simple care: Wait time: 16x \<= 2w, 32x \<= 4w, 42x \<= 8w, 6x \>= 9w Daycare bed: Wait time: 0 - 0 - 1 Overnight stay: Wait time: 0 - 0 - 1 - 1 - 1 - 1 Enjoy! In addition to the above, Iā€™ve also been able to finds some data about treatment of cancer mammae (breast cancer) and cancer coli (colon cancer) in Norway. According to two studies the average wait time upon receiving an external requisition to surgery is done, is 28-30 days. You draw your own conclusions. ---
**Author:** ![Johnny\_L.A](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/johnny_l.a/32/1084_2.png) [@Johnny\_L.A](https://boards.straightdope.com/u/Johnny_L.A)\ **Post date:** [June 11, 2004, 1:59am UTC](https://boards.straightdope.com/t/side-effects-of-socialized-health-care/248690/156 "2004-06-11T01:59:11Z")
> [@](#): > > if the state takes over medical care (assigns your doctor, etc.) Just to be clear: When I talk about UHC, I do _not_ mean that oneā€™s doctor is assigned. This is one of the major things I hate about some insurance plans Iā€™ve had. This is how I would work it: Instead of an employeeā€™s share of insurance premiums being deducted from his paycheque, there would be a Universal Health Care Contribution; just like Social Security. This tax (yes, tax!) would be used to pay the insurance premium instead. Unemployed people would not pay this tax, of course; if theyā€™re unemployed, there is no paycheque to deduct it from. However, they would still be covered my UHC. People would not be assigned a doctor or dentist. They would go to the doctor of their choosing, just as they do when they have better private insurance (and which seemed to be more common 20 years ago). The patient would present his Social Security number, or other form of identification that would show who they are in order for the administrators to count their beans and so that their treatment can be tracked so as to provide better health care. Some people donā€™t have ID. For example, homeless people might not have ID. No matter. People without ID are still human beings. ā€œOh!ā€ the naysayers will say, ā€œThen everyone will go to the most exclusive doctor in town! Theyā€™ll all want to be treated at Cedars Sinai!ā€ I donā€™t belive this is true. For one thing, with more government oversight and less focus on the bottom line, hospitals would be in danger of government sanctions if their health care is not sufficient. And as I said earlier, most people would not simply go to the doctor because itā€™s ā€œfreeā€ or because they feel it would be a fun outing. When I had insurance I almost never went to the doctor. No reason to change under UHC! What _would_ change is that people would not have to live in _fear_ of illness because of lack of coverage. Peopleā€™s lives would not be in danger just because their job went to India or their company otherwised downsized them onto the streets. This country was founded because people objected to paying their fair share of taxes. Weā€™ve done quite well since then, so perhaps it was the right thing to do at the time. Today, the right thing to do is to take care of the citizens that make this one of the more desireable countries in which to live. ---
**Author:** ![clairobscur](https://avatars.discourse-cdn.com/v4/letter/c/839c29/32.png) [@clairobscur](https://boards.straightdope.com/u/clairobscur)\ **Post date:** [June 11, 2004, 2:01am UTC](https://boards.straightdope.com/t/side-effects-of-socialized-health-care/248690/157 "2004-06-11T02:01:05Z")
[QUOTE=ralph124c What i would like to knowā€¦if the state takes over medical care (assigns your doctor, etc.) does that mean that the state can be sued for malpractice? :[/QUOTE] Thereā€™s no reason to expect that the state would assign you a doctor. But concerning your question, I doubt it would change a thing. Itā€™s mostly a cultural issue, IMO. You can sue your private practitionner or your public hospital for malpractice here too, but apparently thereā€™s way less such lawsuits (though one might assume thereā€™s as much cases of actual malpractice), and courts award much less damages. I also heard about lawyers wandering around hospitals in the USA, and trying to convince people to sue. I donā€™t know if itā€™s a caricature or an actual fact, but itā€™s unheard of here, for instance. But as I wrote above, it becomes a growing concern here too (not only in the medical field, by the wayā€¦people seem to be much more eager to find someone whoā€™s responsible for what happenedā€¦for instance, France is divided in 30 000 or so ā€œcommunesā€-roughly former parishes- headed by a mayor, which means that in many little places, the mayor is a regular guy who has to some spare time left and some interest in doing something part-time for his little community. In the recent years, following a significant increase of lawsuits on teneous basis against the mayors, the number of willing candidates in little places has significantly dropped). So it could be, unfortunately, that weā€™re heading to the same lawsuits/insurance problems than in the USA, on the long run. I noted in a previous post that practitionnerā€™s insurance had significantly risen recently, in particular in some medical fields. And barring an overall change of attitude regarding lawsuits generally speaking in the US, I can only assume that a public healthcare system wouldnā€™t result in less money being spent on insurances. Possibly even more, if we assume there will be more medical acts. ---
**Author:** ![Alien](https://avatars.discourse-cdn.com/v4/letter/a/57b2e6/32.png) [@Alien](https://boards.straightdope.com/u/Alien)\ **Post date:** [June 11, 2004, 2:18am UTC](https://boards.straightdope.com/t/side-effects-of-socialized-health-care/248690/158 "2004-06-11T02:18:46Z")
> [@ralph124c](#): > > ā€¦in the USA, doctors and medical personnel have to carry enormously expensive malpractice insurance. There are 1 million practicing lawyers in the US and they are hungry! Some medical specialists like neurosurgeons have to spend \>$100,000 per year on insurance! > What i would like to knowā€¦if the state takes over medical care (assigns your doctor, etc.) does that mean that the state can be sued for malpractice? > High rates of lawsuits and malpractice insurance are a major factor in health care costs in the US. of course, the ABA says there is no such problemā€¦it is all because insurance companies make BAD investments@ :smack: Yes, you can sue the government for malpractice at a public hospital, but you will not receive the kind of compensation you would in the US. Itā€™s typically between $100.000 and $1.000.000. I think the biggest payout ever has been around $1.500.000 (and itā€™s tax free if Iā€™m not completely mistaken, and the lawyer donā€™t take anything of compensation, heā€™s normally paid as a public defender or the government would have to cover his bill). You can sue doctors in private practice as well, so I would reckon many of them has insurance. Itā€™s not commom to sue doctors though. ---
**Author:** ![pervert](https://avatars.discourse-cdn.com/v4/letter/p/bbe5ce/32.png) [@pervert](https://boards.straightdope.com/u/pervert)\ **Post date:** [June 11, 2004, 2:35am UTC](https://boards.straightdope.com/t/side-effects-of-socialized-health-care/248690/159 "2004-06-11T02:35:19Z")
> [@Alien](#): > > You draw your own conclusions. Thank you very much for an excellent post. Outstanding. It is much appreciated. Let me say that I agree entirely that the existance of a ā€œwaiting listā€ is almost useless in determing the effectivness of a nationā€™s healthcare system. I agree entirely that the case is much more complicated than that. > [@clairobscur](#): > > I also heard about lawyers wandering around hospitals in the USA, and trying to convince people to sue. I donā€™t know if itā€™s a caricature or an actual fact, but itā€™s unheard of here, for instance. Yea, this is pretty much a characture. We have a term for it, it is called ā€œambulance chaserā€. Although that usually refers to a lawyer who seeks out accident victims in search of someone who wants to sue whoever caused the accident. It can apply to lawyers who look for people who want to sue their doctors. Malpractice is a significatn contributor to the increase in health costs. I recall a study which claimed that something like 7% of the increase in medical costs in the last decade or so can be attributed to malpractice lawsuits. > [@Johnny L.A.](#): > > This is how I would work it: Instead of an employeeā€™s share of insurance premiums being deducted from his paycheque, there would be a Universal Health Care Contribution; just like Social Security. This tax (yes, tax!) would be used to pay the insurance premium instead. Unemployed people would not pay this tax, of course; if theyā€™re unemployed, there is no paycheque to deduct it from. However, they would still be covered my UHC. So, what sort of options would people have? Would all employers be required to make these witholdings? Would all workers be required to participate? At what rate do you think it would be necessary? During the transition phase, how much of the health insurance premiums would be withheld? Some companies now simply pay all of the costs for their employers. An expense they can deduct from their taxes. How much of this employer contribution would you want to collect? How would you offset the tax deductions to the businesses? Thatā€™s a lot of questions, **Johnny L.A.**. I hope it does not look like a pile on or anything. Iā€™m turly just asking. ---
**Author:** ![Johnny\_L.A](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/johnny_l.a/32/1084_2.png) [@Johnny\_L.A](https://boards.straightdope.com/u/Johnny_L.A)\ **Post date:** [June 11, 2004, 3:44am UTC](https://boards.straightdope.com/t/side-effects-of-socialized-health-care/248690/160 "2004-06-11T03:44:59Z")
> [@](#): > > So, what sort of options would people have? As far as medical care? The same as the insured have now. The same as citizens of other countries like France and Sweden have. > [@](#): > > Would all employers be required to make these witholdings? Are all employers required to withhold Social Security taxes? Yes, all employers would be required to withhold UHC tax. > [@](#): > > Would all workers be required to participate? Again, the UHC tax would be deducted just like any other required deduction. > [@](#): > > At what rate do you think it would be necessary? Any specific rate I could come up with would be meaningless. However, I think that an amount equal to the current amount that is being withheld to pay the premiums on current private insurance sounds like a good starting point. This way, the tax would be transparent to the employee. > [@](#): > > During the transition phase, how much of the health insurance premiums would be withheld? There is a story about how Sweden went from driving on the left side of the road to the right side. A date and time were announced, and it simply changed. I think the transition to UHC could be done the same way. One week, the premiums would be paid by the employer to the insurance company, and the next week it would go to the UHC Administration. Now the question is this: What happens to the insurance companies when they lose all of this revenue? Tough question. One way I can think of would be this: UHC would mandate standards similar to the ones in, say, France. Each insurance company would be required to pay for the services mandated by UHC. In return, the government would pay the premiums out of the funds collected from UHC Withholding. People would be free to buy additional insurance directly from the insurance companies, if they feel they need it. Eventually the companies that give good value for the premiums paid on private policies would survive. Those that did not, would not. Over time the UHC Administration would ā€œcut out the middle manā€ and provide the standardised care to all out of the tax they collect. Now, what could insurance companies offer that UHC doesnā€™t? I donā€™t know. Better to ask one of the European Dopers who live in countries that have UHC _and_ private insurance. > [@](#): > > Some companies now simply pay all of the costs for their employers. An expense they can deduct from their taxes. How much of this employer contribution would you want to collect? How would you offset the tax deductions to the businesses?[/ Iā€™m not a tax expert, but I doubt that an employer that pays $1 million per year to cover their employees deduct $1 million from the taxes they owe. Instead, they deduct $1 million from their gross to come up with their taxable income. Itā€™s true that reducing taxable income reduces the amount of taxes paid. Letā€™s take an extremely simple example. I own a company that makes widgets, and my taxes are 30%. In this simple model, my income after deducting all costs except health insurance is $1 million. Now letā€™s say I pay $1 million in health care expenses. My net income after _all_ deductions is zero. 30% of zero is zero. No taxes. But letā€™s say that Iā€™m no longer paying my employees health care premiums because we now have UHC. Suddenly my net is $1 million. Now I have to pay $300,000 in taxes. After taxes, Iā€™m left with $700,000. Thatā€™s _extremely_ simple, and as we all know taxes are much more involved than that. But it seems to me that being taxed on money not given away might not be such a bad thing. [Previous page](https://boards.straightdope.com/t/side-effects-of-socialized-health-care/248690.md?page=7) [Next page](https://boards.straightdope.com/t/side-effects-of-socialized-health-care/248690.md?page=9)