No, supply is not infinite. It never was, never will be.
As I see it, you are making several errors.
you keep saying that nationalized health systems are less expensive and just as good as the American system. This is a debateable point. That means that it is not to be taken for granted.
you seem to be under the misconception that once the government has offered to pay this somehow creates capacity. It does not. I refered you already to the recent heat way in France. You yourself mentioned waiting lists in England and Canada. There are such waiting lists in many countries. They exist here for some things. Look around and see if your government does not measure the wait times between diagnosis and treatment for various medical procedures.
Notice that your cure for the problems in England and Canada is to increase the cost. You cannot claim that national healthcare is cheaper and that any problems can be solved by simply increasing the costs.
Not even education services are supplied in an infinite amount. There are teaching and school shortages all the time. One of the truisms in this part of America is that if you have a teaching license, (or a nursing license for that matter) you can get a job in just about any part of the country. See if that is not the case in your country. If so, it is defacto evidence that the supply of medical (or education) services is not sufficient to meet the demand. Whether these shortages mean patients are untreated, or students are uneducated (you know, the shy kid in the back of the class of 40) is a related but differrent question.
To some extent, this is due to the fact that governments are the main purchaser of both services. They do not have to make money or even break even (except in the long term). So, if there is a shortage of teachers (or doctors, or nurses), and since they cannot easily raise the price charged for the service, they may not be as motivated to increase the salaries offered to potential providers.
Again, you have to define very clearly what method you are using to measure the effectiveness of one healthcare system vs. another. Life expectancy is a decent start, but not nearly sufficient.
Actually, some of the market does operate in a way that you would consider a command economy. The DRG (Diagnosis Related Grouping) system developed in the 70s meant that hospitals were required to deliver treatment of a certain expected level for patients who came under a grouping of diagnoses. Which pushed towards the unbundling of services in an effort by doctors and hospitals to maximize their returns.
I don’t know if a market system would necessarily eliminate this.
My take is that Americans want three things from their health care system:
[ul][li]The best care in the world[/li][li]Available to everyone[/li][li]At a reasonable cost.[/ul]They can have any two of those three. At most. But they can’t have all three. Ever. No matter what. [/li]
I would say that national health care cannot be managed efficiently, at least so that it will be more efficient than the free market in the long run.
National health care will almost unavoidably increase the perceived supply. This will almost unavoidably increase demand. This will almost unavoidably increase the cost. Unless we put some hard limits on demand, we will always wind up with rising health care costs. Until we reach the point where we decide we cannot afford more. Then we stop, and simply have to endure the fact that, indeed, people are dying so that we can save money. And in many individual circumstances, the dying and their survivors will have an emotionally compelling reason to get us to spend more.
Lots of reasons. One is what I mentioned earlier, that consumers are shielded from the perceived cost of their health care, either by automatic premium deduction and/or by government funding of health care. A single payer system would continue and increase this tendency. Unless, as I said, we have hard limits on spending that we do not increase.
That means we are going to have to face that the media will always run heart-breaking stories of cute little white kids with obscure diseases who could be saved if every taxpayer would just spend an extra ten cents a day. Or horror stories about how elderly people are dying because we haven’t funded enough home care nurses. Or whatever. As I keep saying, we will need to accept that we are willing to let people die that could have lived in order to save money.
Don’t know how they arrived at that figure. I am wary of the idea that all we have to do is implement universal coverage, and health care costs will drop by $130 billion. I am equally suspicious of the notion of all the money we could save by funding preventative care. School vaccinations are already free or subsidized, and vaccination is by no means universal among school children. Nor have health care costs dropped as a result.
Obviously, this may be due to other factors, but I think it is pretty common that the uninsured don’t do a lot to ensure their own long-term health for the same reason they don’t buy health insurance. Your cite mentions that the largest demographic is 18 to 24 year olds. This is a group notorious for the idea that they are invincible. It is also a group that needs less health care than most others. Most health care costs in America are incurred during the first year, and the last year, of life, and/or the chronically ill. (Cite available on request). Thus, even if we insured everyone, it would not address very much of the rise in costs incurred both by the elderly, and especially by the chronically ill whose diseases cannot be prevented (schizophrenia or asthma, for instance) by medical care. I think obesity is going to be increasingly a factor in health care costs, and I don’t think free medical check-ups are going to address that problem, at least very much.
Well, it is also more complicated than that. In national health care, the supply is not infinite, but it is perceived as such. Equally, the demand is not infinite, but it is nearly so. Thus the demand will nearly always rise to meet almost any conceivable increase in the perceived supply. And cost will continue to rise.
You have pretty much summed up the troubles with the American health care system. All problems are seen as addressable by increased spending. And therefore we have what we have.
For Americans with insurance, we already have the best health care in the world. Our pharmaceutical companies keep producing new drugs, our hospitals new treatments and procedures. My son had a nerve severed in his jaw, and he received a new surgery to repair it developed less than five years ago. Is that a good thing? Hell, yes. Did I pay for it? No, it was covered by our HMO. My mother-in-law recovered from breast cancer. Did it increase our national productivity? Not at all, she is 89. Hale and hearty (thank God), but it means she will continue to collect Social Security for a while yet. From a strict cost-accounting point of view, treating her so she can continue to bake communion bread for her church and gamble at the local casinos never made it anywhere near the bottom line. If she had been denied treatment, it would have broken my heart (and my wife’s), and I would have screamed as loud as anyone else.
[QUOTE=Shodan]
My take is that Americans want three things from their health care system:
[ul][li]The best care in the world[/li][li]Available to everyone[/li][li]At a reasonable cost.[/ul]They can have any two of those three. At most. But they can’t have all three. Ever. No matter what.[/li][/quote]
The problem is that our current system has none of the above.
My apologizes, English is not my native language. Of course nothing is infinite, not even the amount of rocks on this planet. What I meant was that the argument that “society cannot afford health care for everybody”, that health care is a resource that has to be rationed because there is not enough to go around - which has been the main argument against national health care -, is wrong. It has been proven wrong by others because they have been able to have supply for their entire population.
We’we already been through this, that the cost of health care in the US is 13.9% of GDP while the cost elsewhere is usually between 8%-9% of GDP. But the US also enjoys a higher GDP per capita than most of the rest the world. So if we look at dollars spent per capita this difference is even bigger:
Make special note of that Luxemburg has a higher GDP than the US, yet end up spending less dollars per capita on health care than the US. And since we’re talking about per capita figures, remember that there is a group in America that cannot afford health care at all. (The numbers are from the OECD report I linked to earlier, except that the GDP figures is a 2002 estimate. The official OECD average in 2001 was $2.100 per capita.)
As for quality, there are no significant differences in life expectancy and infant mortality rates. You said so yourself. But see my last paragraph.
I’m well aware that you cannot wave the magic wand and then you suddenly have supply. It takes time. It takes time in a free market as well, there’s no major difference here. The only difference is that the free market will create supply more efficiently. But you seem to be forgetting that health care services in a national health care system is mainly provided by people in private sector, just as in the US. The difference is that the government has capped prices and that everyone is covered through their taxes.
When I mentioned waiting lists in Britain and Canada, I did so by saying that these waiting lists are exceptions to the norm. What my government does is not that important for the disussion, I prefer looking at the big picture. But since you asked, my government guarantees that every patient will have an appointment with a specialist within 30 days, and that patients shall not wait more than 12 weeks, regardless of illness. In the case the government cannot deliver, the patient could be flown abroad to receive treatment at the government’s expense. Of course, serious illnesses are treated right away.
When the gap in spending between the US and the rest the modern world is as big as it currently is, then yes, I can claim that. But I understand your point, you’re not wrong about it.
There has been some debate recently in Scandinavia about the high quality of health care in Switzerland and to some extent in Germany. Some claim it’s better than in the Nordic countries. Looking at the OECD figures we also see that these two countries are the top two spenders in percentage of GDP in Europe. I don’t think that’s a surprise. However, if you don’t organize health care efficiently, it’s just money down the drain. Canada is a good example of such, they use 9.7% of their GDP. Britain spends only 7.6% of GDP, which is almost only half of what the US spends.
Well, I think it’s revealing that education is paid for by the government and is available to all, no matter the number of children needing it, while it’s perceived as impossible to do the same with health care. The government is heavily involved in education, they hire extra teachers and build new schools all the time. They are also closing down schools which are no longer needed. Some might say that: “education is about children, it’s not the same”, but there are millions of children without health insurance in the US. Some might argue that “we can afford education for all, but not health care”, but apparently the rest of the modern world can afford it.
Health care services are “global”. It’s the same drugs being used in my home country as in the US, the same method of for that cancer surgery. The MRI machines used on me could very well be made in the same factory as the MRI machines your health provider is using. So it comes down to the quality of medical personnel, first and foremost. I think infant mortality rates are an excellent method of comparing health care systemes since most births take place at hospitals/clinics and babies are very vulnerable. And looking at the figures, I see no major difference, do you?
I think the line “our health care services is so much more better than others” are a lie sold to us by our governments. In the US this lie comes just as much from the health care industry.
You have hit upon a good point. The US spends more money covering a smaller % of their population. Where does the money go? And if more people were covered would less of the GDP% go those currently covered and more to those not covered? In a sense to “even things out”?
I think the costs are high in the US because we have more extensive tests, treatments, drugs, and we (the doctors) are more willing to prescribe, test, operate, treat. Some of the GDP we spend may be wasted on paperwork, etc. But most of it is in treatments etc. And I don’t think it would be accurate to say the excess of GDP is in “profit”. There’s alot of competition in the system and companies won’t provide services without “profit”, even if it’s a governement system.
Anyway, basically my point is people in the US are customed to receive very expensive, no effort spared, “costs be damned” care. If you put them in a government system with care limited to what gov’t doctors prescribed was correct, then US citizens who currently are covered would feel they are getting less than they used to. That’s pretty much the only way to get the GDP down. Spend less. Now peolple who are not covered would probably get better care, but it would be a tradeoff…less medical GDP on those covered now and more on those not covered, to make the total GDP the same.
Alternatively we could have a system where EVERYONE was given top dollar care. But then the total medical GDP would rise…the society as a whole would simply purchase much more medical care with its government dollars. Where would the money come from? Taxes or deficits.
So basically socialized health care says to current covered people “you’ll pay the same and get less (so others can be covered)” or “you’ll pay more and get the same (so others can be covered)”. Since most people are covered I don’t know how popular that would be.
Also I worry about the government being ripped off due to fraud. How carefully is the gov’t minding the tests being recommended etc. Based on medicare history, probably not carefully enough. This worries me.
Additionally, I think that the increasing cost for health care is due to many factors, lawsuits, excess tests, defensive medicine in general, unneccessary operations, heroic efforts on the very old, but one of the positive reasons is that there are more treatments available. Years ago, if someone had cancer, they were basically told to go home and die. Now they may be cured, which is great, but the costs of tests, treatments, operations, etc…are well, costs that must be paid.
I could see a sort of “community clinic” approach where poor people’s basic needs were covered - a prevention type of thing. But giving everyone in the country gold plated care will simply cost more - no way around it. Not, as you noted, because prices go up- they probably won’t, but just because there is more healthcare being provided.
Long term, the only realistic solution is for people to be in a kind of HMO where doctors are freed from being ruined by lawsuits, have no incentive to order excess tests, operations etc., but also don’t have the incentive to undertreat. That would reduce costs significantly. But how to go from where we are now to there?
Well, such systems have not proven the argument wrong. There are fiscal problems in all of the systems you are talking about. The drive to increase costs and privatize more aspects of such systems is widspread. More importantly, the presence of waiting lists does prove that not everyone is covered. Now, it may be true that you prefer waiting lists to emergency room care. I can understand that argument. But claiming that everyone is covered as much as they need is just as fallacious as society cannot afford healthcare for everyone. Notice, I have not said this. I have only been trying to say that healthcare for everyone will not be cheap. Nor will it necessarily be cheaper or better than the system we have now.
Yes. But you seem to keep ignoring the fact that there is not an apples to apple comparison. I understand that the US spends more on healthcare than most industrial countries. This does not mean that we waste huge amounts on unnecessary paperwork, nor that the system is rife with parasites. See kennybath post for a longer discussion of this.
This is true. Dispite the fact that Americans are shot far more often than people in the other countries. Notice that dispite this, we do not have significant differences in life expectancy. Does this not point out to you a possible difference in our medical systems?
But capped prices is one of the things you yourself mentioned as something characteristic of a command economy. How fast do the price caps the government uses adjust to the needs of the population?
Well, the lengths of them certainly are. But the fact that waiting lists exist in each and every industrialized nation (includeing the US) means that they are not really a fundemental exception. That is, they are not so different from everyone else.
I did not mean to obscure the big picture. When I asked about your government, it was to provide more data. I can find many articles about Canadian or British healthcare. I find I am at a loss to do so regarding your country. I appreciate the information. To put it in perspective, however, I need to know the average wait times. British health services guarantee similar wait times (although I think they are a little longer). The question is how often are those limits reached?
Well, that would indeed be ironic if anyone had claimed that it was impossible to do this with healthcare. And of course if everyone was happy with the state of public education. Neither of these is true, however. I have merely been saying that universal healthcare is not the panacea you claim it to be. For precisely the same reason that public education is not the panacea education should be.
No, it does not. It comes down to how many of the machines in question are available. It comes down to how often they go down for repair, which is related to the amount of money allocated to maintaining them. It comes down to the likelyhood that a doctor will use such machines. The fact of the matter is that the US spends more on medical care because we spend more on medical care. There are inefficiencies in the system (just as there are in other countries). But the evidence that these ineficiencies are solveable by government fiat is not compelling. To me at least.
Well, yes I do. The US seems to have a worse rate than other countries.
Specifically, what this means is that some countries count some babies as still births while others would have counted the same birth as a live baby which died later. I remember reading about a rise in infant mortality in the US when the statistic was changed to define a live birth as any birth which survived for a certain number of hours. This meant that the heroic efforts to try and save babies which only a few years ago would have been given up for dead actually increased the number of infant mortality in the US. Almost as if a slight increase in infant mortality was a measure of how good the medical system was at preserving life.
I realize this is a rather perverse interpretation. But it indicates how difficult comparing internation medical systems can be.
I agree entirely. I hope I have not given the impression that I think the American system is totally superior to any other. I am simply arguing that nationalized health care is not necessarily better. Certainly it is not obviously better.
This is an important point (welcome to the SDMB!), and a major reason why I doubt that a single payer system would be successful in the US.
The Shah of Iran once was asked why his country was ruled with such severity, while Switzerland was not.
His response was, “When my people behave like the Swiss, they can be governed like the Swiss.”
It is much like that with the US health care system. We have very high expectations of it - almost to the point that we think it can cure anything - or should. This leads to the “spare no expense” attitude kennybath mentioned, as well as both lawsuits for negative outcomes, and - a key point - the defensive medicine that leads to all the tests for “zebras” when everyone knows that nine times out of ten, it is “horses”. If we could somehow address those issues, we could have a reasonable system that covered most of what we want, and not incur the enormous marginal cost of trying to wring another six months of life on a ventilator for a patient everybody knows will die - except the family.
The trouble with the US health care system is that at least 30% of the total cost is wasted - but nobody can agree on which 30%.
Have you ever heard of Robinson’s Law of Trauma Centers? Doug Robinson (IIRC) was head of the American Hospital Association a while back. His law was:
His rationale was that less than two miles, your trauma patients would be admitted with blunt force trauma - auto accidents, and they often have insurance. Further away than that, and you got mostly penetrating force trauma - bullet and knife wounds. Those patients rarely or never have health insurance, and thus the hospital would not get paid. But implementing single-payer isn’t going to save any money in these cases. Either the hospital is paying for those cases (and losing money), or your other patients are paying for them with higher hospital costs. Under single payer, the same people would pay the same amount (or more), except thru higher taxes. Probably much higher. But, as kennybath points out, receiving no more care for it than before. Probably less.
I won’t be completely convinced about nationalized medicine until an entire generation or two has been raised under it, and died under it, precisely because such expectations will change. But I’m pretty much completely convinced, depending on the implimentation, and I don’t think time will tell any new, interesting tales.
But there will be interesting tales to tell regarding research. Or rather, perhaps, not so many new tales to tell. There is evidence now that Americans subsidize the worlds socialized drug systems. If we simply adopt the expedient of forcing drug companies to sell to Americans at the same rate they sell to other countires, I think changes will happen.
I think you have a point about waiting for a couple generations to pass. I’m afraid, however, that such a strategy will not generate optimul results. People can get used to, and even come to enjoy, an awful lot of things which are not good for them.
Evidence? Maybe. I’m not all that convinced. My company sells instruments for pharma research, and it sells more than a few in Europe. Our sister company started in the UK and has been doing ok this whole time. America is a larger market, though, no question about that. So there’s definitely research being done in Europe. As for whether or not the costs of that are subsidized by America… well. Taxes are cheaper here, too, as far as I know. Which pays for the huge fountain outside Eli Lilly in Indianapolis? Who pays for the acres and acres of land Boehringer Ingelheim has in CT (there’s a deer reserve there!)? Seems there’s expenses that can be cut and they can still turn a buck. Lots of cheap land available in PA…
I was recently at an IPO for a California company. It was a surprise company meeting for the announcement of how it went, so while my client was in there I was outside listening. Lots of thank yous, lots of congratulations… to everyone who was a part of it except the scientists.
I guess I have no particular love of pharmas or how they allocate their resources. But I’ve bitched about that in more than a few threads already, anyway.
There is no ‘world socialised drug system’. Public-funded health systems have to by patent drugs from the companies the same as any private company has to, American or not. And it’s one of the reasons public funding of healthcare goes through the roof.
To your last claim, I agree - a market driven system will always outperform a government-run system, if we compare them by efficiency. My first question would be how much better a market-driven system really is. As for now, I maintain that a nationalized system can perform fairly well when organized correctly. Don’t forget that the bulk of health care services within such a system is usually delivered in private sector, not public sector.
But there are other things that should factor into this as well. There is lack of a standardized system. Insurance terms shielding patients from parts of the available supply, keeping prices up. There is a loss of productivety (and tax revenue) from ill people that cannot afford treatment, as witnessed by DoctorJ on the third page of this thread. I don’t know how much impact this has (I’ll be off to find some cites later, I agree that the cite I provided is inadequate), or what sort of people they are, those without insurance. But based from the limited news I have read, it’s not hopeless cases of people with substance abuse problems, but rather people with common illnesses such as breast cancer, complications stemming from untreated diabetes and severe back pain.
So far we have been discussing economic impact, but there’s a moral side to this also. Can we, as a modern society, say to a 35 year old woman without insurance but with breast cancer and two small children that we could treat her, but that she must die? Once upon a time not long ago it was the family who took care of their members. The Big Society has taken over much of this role, for better or worse.
To some extent, national health care put limits on demand, as in: you only get what the doctor deems necessary. Not all health care problems are covered by the system either, fatness surgery for instance is not covered in my home country. But it does pretty much cover everything else.
In a post to pervert which I’m also writing on right now, I try to make a point out of that there is a difference in claiming that everyone is covered as much as they need, as opposed to as much as they want. In two-tier system, national health care covers people as much as they need, if they want more they have to go private, to go outside the system.
Obviously, no society can give people as much as health care as they want.
You may also have to ask yourself: Are there inefficiencies in the system already, and if so, will they go away with national health care? According to your argument, the US, which already are using 13.9% of it’s GDP on health care, will use even more with national health care. Let’s say for the sake of argument that the US adopts the Swedish system bit by bit and then the costs rose to 18% of GDP. So, you have a system identical to Sweden at the cost of 18% of GDP, while the Swedes only spend 8.7% on the same system. It doesn’t make sense. I know this is bad argument, but I just can’t see where all the money are going.
Well, I don’t agree. There was a time when the public didn’t now of the dangers of smoking, out of ignorance probably. I do think that public campaigns against smoking have been for the good. As for school vaccinations, maybe, maybe not. I know that several dangerous diseases which were common in the past, like polio and smallpox, are extinct now, at least in the western world. Due to vaccinations. We are talking about longterm effects here that are very hard to measure.
Good to hear it has turned out well for your family. I know there are americans that claim that their health care is not the best in the world, but I suspect that at least the US is the place to go to to get the state of the art treatment for that special disease.
We’re pretty much talking about the colors of apples here. There will always be fiscal problems in government-funded systems. Not everyone can afford a big screen tv either. And to continue the nitpick, the presence of waiting lists does prove that everyone is covered, it’s an acknowledgement of the right to treatment. But waiting lists also prove that :
a) there are not enough resources (as is the case with long waiting lists), or:
b) there are priorities, as in removing a tumor is more important than removing a mole (while the patient with the tumor will get surgery next week, the one with the mole will have to wait 3 months)
There is also a difference in claiming that everyone is covered as much as they need, as opposed to as much as they want. In a two-tier system, national health care covers people as much as they need, if they want more they have to go private, to go outside the system. Personally, I have done both.
To continue the need versus want argument: Obviously, in the US you could remove that mole right away, something I would have to pay more money to do. On the other hand, if you kept it for 3 months, it didn’t really affect your ability to work, did it? In the meantime, the guy with the tumor could be stuck in an argument with his insurance company, and he could be unable to work. If he had insurance at all.
Good point. But I’ll have to ask: Do you have any cites about the impact of gun shots on life expectancy? (sorry)
Yes I did. And in my opinion national health care is a command economy, with a couple of exceptions. Most importantly, it’s two-tier system (not in Canada). This means that a doctor will have to choose if s/he wants to be part of the system (accepting price caps, getting more clients) or work outside the system (free prices). The government has to keep prices at a reasonable level too attract doctors to work inside the system. So it’s still market driven to some extent. And we do have private health insurances over here too.
I’m not quite sure what you mean by “adjusting to the needs of the population”. In my home coutry prices are usually adjusted once a year as part of the national budget, but I think they can do it whenever they want.
I would like to hear more about waiting lists in the US. Do you have any info?
As for the availability of info, it probably is because Britain and much of Canada are using the English language. It’s sad actually, because neither countries are doing well in this regard. Especially Britain is bad, but then again Britain has quite a lot of problems.
I’ll have to get back to you with average time on waiting lists. I can give you x-rays out of the top of my head because of my personal experience, - anything in particular you were thinking about? As for reaching the limits, it’s my understanding it’s rare, nowadays. The region I’m living in did so only once or twice per one thousand patients last year.
Yes, I forgot you have problems with elementary education as well. Something about property taxes …?
But my point was, no majority is claiming that you should give up on public education. They don’t claim that children that doesn’t do well at school or have poor parents shouldn’t be allowed public education. And I ask: Why? Why should people who don’t pay taxes have the right to put people in public schools? Why should my tax money go to someone elses education when my health care money isn’t going to that poor kid who was minding his own business until he was hit by a car last week, and the driver is nowhere to be found?
All good points. Are you claiming that there are less functional MRI machines per 100.000 citizens in a national health care system, for instance? You might be right. But the cite I gave you earlier suggests that there isn’t much of a difference in the amount of resources available, and that it actually may go both ways, the quote was:
This is the problem with statistics, thanks for providing it. I did know that the US has a higher infant mortality rate, but I didn’t think the difference was big enough to justify an argument.
preview way to long to do more than scan-sorry for any redundancies, but on the other hand I will be uncharacteristically brief and clear.
We already have “socialized” one part of medicine, the big dollar risk.
viz, everyone who survives to 65 becomes medicare’s problem 95% of medical costs occur in the last six months of life. (numbers good, but grant me a margin of error of 20% plus or minus, and then we don’t have to chase cites, mkay?)
I’m sure the percent of gdp allocated to health care issue has been parsed, as well as the competitive disavantage to General Motors having to pull one large out of each car to pay health care premiums that don’t similarly afflict Rolls Royce
This suggest to me that it would be cost effective to promote earlier intervention since we are already going to pick up the catastrophic sequelae at age 65 for the poor diet and smoking at age 25.
We also need to acknowledge that the dollar value of an additional year of life rises asymptotically to infinity the closer it gets to the last year, and the closer it gets to me.
We have to stop the long posts. I’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.
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.
What I mean is how accurately can the government measure the demand for medical services.
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.
Agreed. That is why I was so eager to hear from you and clairobscur about the systems in your respective countries.
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.
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. I’m just curious. Learning things like this is what this board is all about (for me).
LOL. No, the problem I have with public education is the same I have with public health care. Namely philosophical.
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.
Mind you, I’m not exactly sure the difference is big enough to mean much either. I was just pointing out that the number by itself may not mean much when comparing healthcare systems.
Well, certainly some early intervention would be benificial. But this is a much more complex question than you think. If you promote jogging to affect the rate of heart attacks, for instance, watch your rate of knee replacements go up instead. Everything has a tradeoff. The hard truth is that there are no free lunches.
My argument was that this might be true, but it might also be true that providing early tests for everyone in order to catch the small percentage of people with long term dibilitating conditions may not, in fact, be cost effective.
If you will excuse the gushing for a second, I’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. But I think it has much more to do with all of you discussing instead of yelling. Thank you very much.
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. Here’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.
there is that, as well as the lifestyle issues that have been mentioned already.
Plus, if mortality is extended, quality of life interventions that might otherwise be considered "luxuries " become more qppropriate (ie, replace the hip of an 80 yr old. what if there’s 20 more years to live, why be in a wheelchair (which would, of course, guarantee death within six months)
Health care must be rationed somehow; it is at present, but through a lottery system tied to the accidents of employment, income, etc.
Certainly we would rather vaccinate ten million children than replace one hundred hearts secondary to the results of fifty pack years of tobacco consumption.
(I think–but then I quit a three pack a day habit and I still dream about cigarettes, so I cast no aspersions…)
How we achieve some system of allocating care dollars, let alone choosing a level of dollars to spend, is a decision that we fear delegating to a committee subject to political processes for very sound reasons.
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
All I am sure of is that with medicare in place, we are already primed to pick up gthe vast majority of the\costs, and the incremental costs of pushing the date of coveragte back 65 years would be trivial compared to the likely savings, granting that one of the “benefits” would be greater longevity, and, ultimately, new and bigger costs (maybe–molecular medicine may be very cheap to practice–think Dr. McCoy with his little multizapper),.
I’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. For instance, I mentionned in this thread that here, the social security reimburse what doctor charge only up to a given amount. However, I’ve a complementary insurance, so I can visit a doctor who will charge more. I could even shop for the complementary insurance which covers the most costs. I also can visit a dozen doctors (whether or not they charge the fixed amount) until I find one who’s willing to prescribe me whatever test I want (though precisely the governement would want people to stop doing so. So, in theory, there’s no reason for the extent of the care received to necessarily drop.
On the other hand, it might be a cultural issue. For instance, american doctors could be accustomed to prescribe much more tests, exams, etc…even if it’s only marginal useful than french doctors. So, perhaps that when I’m going to shop around, it will be much more difficult to find a doctor who will be willing to prescribe, say a RMI, even if I don’t mind paying a lot (And I would have first to know that a RMI can be somewhat useful, something I’m not going to guess without a doctor telling me, usually).
And similarily, if the USA adopted tomorrow a public healthcare system, doctors would probably go on doing what they’re accustomed too, and the medical expenses wouldn’t drop at all, or perhaps would rise, everybody having access to this level of care.
On the other hand, statistics don’t seem to show that this “no effort spared” attitude has any significant positive result on the population health.
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. I believe it’s true for the use of medical heavy equipment, like the aforementionned RMI(*), ). Is it also true for drugs, for instance? For surgery? I would need some evidences to believe it’s more than an opinion of yours.
(*)Though I’ve been told also that these precriptions are to some extent related to the need of private hospital to rentabilize such equipment, that they must have in order not to lose “customers” to other hospitals, while with a public healthcare system, such equipment will be bought depending on the global demand. So hospital X will have one, but nearby hospital Y won’t because there’s not enough need to duplicate the equipment
