Alright, so we have now demonstrated that you do not in fact understand what “single-payer” means…
Oh yeah, I* thought * this thread was seeming familiar…we’ve been here before!!. This is the part where you post a link to some glurge from a Libertarian website, then I take the time to read the crap, write a detailed and extensively cited rebuttal, then you suddenly vanish! I don’t think I want to play that game again, thanks; but if you want to resurrect the above thread, feel free.
Certainly. The document most often cited in this debate is the 2000 WHO report “Health Systems: Improving Performance” If you’re having trouble sleeping, you can read the entire thing here in PDF form. In this document, the U.S. ranks 37th in the world in health system performance. They used a lot of variables to get their rankings, but the one we are discussing, life expectancy at birth, can be found on page 172 of the PDF (page 163 of the report). The figures used for the US are 73.8 years for males and 79.7 years for females. The report does go on to break out deaths by type for different regions, but the gross numbers are what was used when calculating the score for each individual country. For comparison purposes, here is a PDF of a report by the CDC showing total life expectancy numbers for 2003 ( I couldn’t find the numbers for 1999 in about 5 minutes of Googling, and reading through statistical reports is boring so I gave up when I found 2003), the numbers are virtually identical-74.7 for males and 80.0 for females. Note that in both cases the numbers used are the total life expectancy, not LE adjusted for anything.
The second big problem with the WHO study is that it placed a lot of weight on how “fairly” health care is “distributed” without factoring in the quality of that care, thus a country that has widely available but lower quality health care ranks higher than a country (like the US) with generally high quality care available if that care is “unequally distributed”. In other words, the study is slanted to favor socialized systems of health care delivery.
Finally we come to the big number that is constantly tossed around in these debates, the final factor that hurts the US’ rankings: 45 million uninsured. That number is based upon data supplied by the US Census Bureau, but upon closer examination of the data we fund that 33% of these 45 million have government programs available to them already, but they are not utilizing them. That leaves (round numbers) 30 million uninsured. 20% are not citizens (not our problem), which takes us down to 21 million and a further 37% have annual household incomes in excess of $50,000 (in my mind if you make over $50K you should be able to buy your own insurance, but just in case you want to claim that $50K doesn’t go as far as it used to and that it’s not enough to pay for health insurance, be aware that 19% make over $75K), leaving us with a final total of either 5 or 12.5 million uninsured, depending on which number you use. This is a problem, to be sure, and something that needs to be addressed, but things are not nearly as bad as the naysayers like to make out.
A high income doesn’t help if you are deemed uninsurable, and $50K doesn’t go very far if you live and work in an area with a high cost of living.
One of the problems with the current system is that many people get sick, and then lose their job and any health care coverage they may have had.
focusonz, I really have a hard time understanding whatever point it is you are trying to make. Can you try to express it a bit more clearly? It seems like what you are doing is saying that I meant the exact opposite of what I said, or something like that.
Weirddave that cite (or at least what you relay of it) does not support your contention that US life expectancy is higher than other industrialized nations if you factor out “fatal injury rates.”
OTOH I do know of studies that show that our amazingly high health care costs buy us very little.
A comparison teasing out rates for different causes of morbidity and mortality specifically between Canada and America does not do America proud.
Now mind you I am not advocating the Canadian system for us (maybe that’s my self-interest shining through) but your claim that our life-expectancy is actually better is not born out by the data.
Weirddave, your numbers on the uninsured are not off and how I have seen them presented before, but I’d certainly read them differently than you do. You may think that 50K or even 75K per year of income should give someone no excuse, but the fact that family coverage costs 10 to 15% of that annual income makes it a difficult purchase indeed, along with the fact already mentioned, that illness causes job loss for many and with it insurance loss for those with coverage previously, just as they need it.
The cite linked above also does a good job documenting some of the costs of the uninsured.
Let’s see, a single-payer system means a “single-payer” – basically the government – pays for health care. Yes, we do not have a single-payer system in the U.S. for everyone. But we do have a single-payer system in the U.S. for some of the poor and middle class (Medicaid) and the elderly (Medicare).
If that undestanding of single-payer doesn’t meet your definition, then please let me know.
Sorry I have a life that exists elsewhere. I was unaware I was obligated to respond to your every post. It’s the nature of a message board like this. Either continue the debate here or don’t. I’m sure no one will really care either way.
Renob, by that definition of “single payor” we also have single payor for the subpopulation of those covered by BC/BS. No it does not apply.
Since single-payer advocates want to have the government pay for services (although not necessarily provide those services, depending on the advocate), I think it makes sense to look at both Medicaid and Medicare, which follow this model exactly for certain segments of the population.
I am no expert but, I am building a knowledge base and and inference engine to apply syllogism, deductive and inductive reasoning to assist me in making my decision on how the US health care system should be fixed if it is even broken at all.
My posts are in sections as described below
lets parse this
I first breakdown the post into its pertinent facts or truisms or opinions and convert them into terms and components that make up the health care industry and a free market economy
Points
If I have a point to add based upon my experience and observations, they are here.
They are of course debatable. And as I go through all the posts I may find the same point being made which adds credence and substantiation and elevates it to a fact. If multiple observers see the same thing then it must be true.
Conclusions
This is where inference is done based upon the facts. Syllogism, deductive reasoning, and inductive reasoning is done here.
Dope
These are my opinions related to the conclusions.
Research and calculations:
If a fact in the parsing is suspect this is where I report my research and perform any necessary calculations to refute or uphold it.
Health care problem
Based upon the conclusions I enumerate problems with the health care system and the free market as it pertains to health care.
**It is not my purpose to distort what people say. The parsing however is somewhat terse and difficult to understand because there is a language translation evolved in that section.
Please reply with your specific opposition and we can see if we talk the same lingo.**
(musing)
You know, I always wonder in these debate. Why is it that the pro-socialization folks can pull out any damn cite they wish without question, but when studies that dispute any of the the sacred cows worshiped by the UHC kool-aid drinkers are presented they are dismissed as coming from “an insurance industry front group” or a “glurge from a Libertarian website” without even examining the facts they present. Odd that.
(/musing)
Now, Dseid. I said that the figures used in the WHO report were the gross LE figures. Do you contend that the cites I provided don’t show that? If so, how, because they clearly do. Can you clear that up so I can respond please?
Second, you seem to take issue with my statement that the US LE jumps if we adjust for “fatal injury” rates (Homicide and transportation deaths). Are you taking issue with that statement in general, the idea that the US has higher homicide rates and traffic deaths than the rest of the western world or what? Because you then proceed to cite data talking about infant mortality (another skewed stat) and breast cancer, Hodgkin’s disease, and peptic ulcer, asthma, cervical cancer, hypertension/cerebrovascular disease, ischemic heart disease, tuberculosis, and appendectomy, cholecystectomy, and hernia. I’m sorry, but I just don’t see the connection with what I was talking about. Could you clarify please?
I DO disagree, strongly. Health insurance, at least in states that have not interfered with the free market process until everything is distorted beyond recognition (like NY and NJ, for example), is just not as expensive as people make it out to be. The $11,000/year figure that is bandied about is the cost of employee sponsored health insurance which is generally much more expensive than paying for coverage yourself. Employers frequently give employees gold plated health insurance plans as a form of compensation, saying that “that’s what health insurance costs” is like claiming that “cars cost $75,000” because you drive a Mercedes. A quick look at ehaelthinsurance.com showed that my family of 4 can get an HSA qualified health plan, which is all anyone really needs, for $273/month. Our maximum possible yearly liability under that plan, meaning worst case, how much would it cost us, premiums + out of pocket expenses, would be $5776. That is 10% of someone making $50,000/year’s pocket, but that is total possible health care costs, not just premiums. It’s just not as bad as the naysayers try to make it out to be. That’s not to say that it’s prefect, far from it, there need to be major reforms in the areas of pre-existing conditions, group availability, the “tweener” poor(people who make too much to qualify for Medicade and similar programs, but not enough to cover themselves) and a few other areas, but the system is not as broken as people like Michael Moore would like us to believe.
Weirddave, my request was for a cite backing up your claim that once adjusted for “fatal injury rates” the US has a higher life expectancy than “nearly every other industrialized nation.” If your cite shows that then I am missing how. Please clear this up.
As to your understanding of what people “need” and what constitutes a “Mercedes” … no, most employer plans are not gold-plated. As an employer as well as an employee I can tell you first hand that benefits are going down while costs are going up (both employee shares and co-pays and deductables). Going to your ehealthinsurance.com and trying it out for a family of four, I find little as cheap as you find. This is as cheap as I can find. $269/mo and it provides coverage only after you’ve met the $10K deductible. About $13K/yr if you actually need services. Eh, there’s another similar one for a few bucks less a month. And you do realize that HSA’s can be cheaper for now because they are only an attractive option for those who currently have low health care costs? If it wasn’t for that self-selection they’d be much higher.
focusonz, sorry but I have neither the time nor inclination to master your new literary form for the purposes of this debate. Quickly looking over what you wrote - no your “parsing” is not an accurate breakdown of my post. And given that it is so far off from what I said I won’t expend any more energy decoding your post into English.
I can look for the stats later on LE, I don’t have time now, but I think you have HSAs exactly backwards. If you run the numbers, total out of pocket cost, they are most attractive for people with high health care costs. Why do you claim otherwise?
(BTW, the figures I used were for my family in my state; things are going to vary greatly state to state, this is exactly where excessive government regulations screw the consumer)
I will illustrate with my personal circumstance. Our company offers an HSA, a PPO, and an HMO option for different amounts of employee contribution. My wife has ongoing medical issues. Nothing life-threatening but chronic stuff. Two of my children and myself are on daily medications of different sorts. Between those we probably have 10 -15K of real costs … maybe more. I’d spend the whole 10K and then insurance would kick in. With the PPO option my out of pocket is less than that per year. OTOH, if none of us had any known issues then the money could build in the HSA and my only expense would be the monthly premium. In that case the HSA choice would be great.
suits me but I will offer another take on what you said.
Reponse in order of my bolding
(1) I hope so, you pledge to the Hippocratic Oath.
(2) I being a taxpayer don’t like it when a doctor can deny treatment to a Medicaid patient or any patient for that matter. The government devised fair payment rates based on national averages by procedure and treatment should be provided at the lowest level in the health care system. By this I mean why go to a hospital emergency room for a damn nose bleed just because a Doctor or clinic on main street USA don’t take Medicaid. Because of greed your action has raised health care costs for everyone.
(3) You can’t buy insurance that covers the basics!
When you do the math you either pay the insurance co or you pay the care provider and the cost ends up being equal for the likely procedures you will need.
As an example Using Blue Cross Blue Shield the premium is $705 per month with deductible of $3000 for a family of four. Now it would be typical that this family might have a leg broken/crushed, hysterectomy, stitches, or sniffles in one years time. Well I will have paid nearly $10,000 in that year and none of these typical procedures cost that much. So what am I paying $10,000 to the insurance co for? nota zilch zero.
Now if I pay $705 per month over ten years I will have paid in $84,000. In this case I am betting the insurance company that I am going to break my frigging neck or come down with some sort of frigging cancer which costs way more than the $87,000 to treat and also in those 10 years, if I cancel my insurance or miss a payment and they cancel my insurance or they cancel my insurance at their whim then I am out $84,000. That kind of gamble makes no sense to me at all. Especially when we are dealing with incurable crap and crap where quality of life is so reduced that it makes no sense in living.
So UHC is a crock. The key for us all is to reduce the cost of health care by eliminating waste and duplication and overhead in the health care system.
We end up paying all health care costs in the long run anyway.
Also, frequent medical checkups should be mandated so that cures can be effected early on when they are the least costly to treat.
(4) You like the pain and suffering of the patient during and ER catastrophe. I hope not.
***The catch 22
When I go to the doctor and pay cash I am paying a higher rate then the insurance co reimbursement for same procedure. The insurance co have their hands in my pocket either way I go. And that sucks. Cite: http://www.cbsnews.com/stories/2004/04/05/health/main610269.shtml
Health care pricing works exactly the way credit cards work. The shop keeper has a price for a product and if he allows payment by credit card the price includes the 2%-3% markup paid to the credit card company If I pay cash for a product the shop keeper cannot discount the price by that 2%=3% because it is so written in the VISA/MC merchant agreement.***
let us parse this
Doctor Income Canada less than doctor income US – of unknown validity
Canada has no shortage of doctors - of unknown validity
points:
These are an attempt to base UHC decision on experience of neighboring country having presumed similar demographics.
In particular it would be interesting to know if Canadian doctors are more or less monetarily motivated and whether the doctors compensation have a supply and demand relationship
The unverified statements indicate that there exist an over supply of doctors in Canada therefore they are willing to accept a lower income.
Research and calculations:
US Canada
per capita income US $46,000 Canada $38,000 2007 est.
population US 301 million Canada 33 million 2007 est.
labor force US 132 million Canada 18 million cite #1 & #5
health occupations US 10.1 million $29 per hr Canada 869,000 $23 per hour cite #2 & #4
doctors US 418000 $184000 Canada 61800 income is in cite #3 & #4 for fee
health occ/pop US .0335 Canada .0263
doctor/population US .00138 Canada .00184
labor/pop US .4385 Canada .5454
NOTE: Not included in these figures are health insurance and malpractice insurance business segments. These should be included if these costs. (see ‘dope section’ below)
US Federal Civilian Employment (civil servants) – 2.9 million cite #6
US military employment – 1.4 million in uniform and following orders cite #7
US DOD Civilian Employment – 879 thousand giving orders cite #6
US Health and Human service Employment – 63 thousand cite #6
US health occupations – 10.1 million cite #4
US Federal budget – $3.01 trillion 2009 budget cite #9
US defense budget per annum - $573 billion per annum cite #10
US budget for Medicare & Medicaid - $662 billion cite #10
US health care industry - $1.9 trillion cite #8
NOTE: does dollar expenditure in health care industry encompass insurance?
conclusions:
Canada has more doctors per capita than US
US has more people in health care occupations than Canada
Canada has more people in labor force than US (yet unemployment is nearly the same)
US has a higher per capita income than Canada. This is also seen in $ per hr in health occupations
US cost of living is higher than Canada
Assume HHS is expanded from Medicare and Medicaid to encompass the US Health care industry in a UHC then total employment of HHS would be 190 thousand based on dollar expenditures ratios (guesstimate).
dope
why-is-health-care-so-expensive-in-us
http://kriswager.blogspot.com/2007/04/why-is-health-care-so-expensive-in-us.html
Health care problem #4
To attempt to justify a UHC system based on Canada is inappropriate because the scales are widely different. 10 million health care workers in US vs 869000 in Canada serving 301 million population in US vs 33 million in canada.
Health care problem #5
Health care needs to be more efficient.
Using Canada as an example: Canada has more people in workforce to pay for health care and provides health care with fewer people.
cites #1 http://www40.statcan.ca/l01/cst01/labr69a.htm
cites #2 http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=statistics_results_topic_physicians_e&cw_topic=Health%20Human%20Resources&cw_subtopic=Physicians
cites #3 http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=AR82_2006intro_e
cites #4 http://www.bls.gov/oes/current/oes_nat.htm#b29-0000
cites #5 http://www.bls.gov/oes/current/oes_nat.htm#b00-0000
cites #6 http://www.opm.gov/FedData/Factbook/2005/factbook2005.pdf
cite #7 http://www.nationmaster.com/country/us-united-states/mil-military
cite #8 http://www.cdc.gov/nchs/fastats/hexpense.htm
cite #9 United States federal budget - Wikipedia
cite #10 http://www.cbo.gov/ftpdocs/90xx/doc9015/Selected_Tables.pdf
Well, focusonz I’ll try to play along.
Actually I did the Oath of Maimonedes, but similar thing. So agreed that while few docs feel that they do not deserve to be fairly compensated for what they do, that many, if not most, are not solely, or even mainly, motivated by avarice. Perfect we aint, but we really do have some aspirations to do good.
I do believe that we physicians each have an obligation to do our fair share of taking Medicaid but obviously if those fees that were decided upon were “fair” then there would be no problem getting docs to sign up. No doctor has an ethical obligation to provide non-emergent care to every person who presents when they know they won’t pay them for the service, or who won’t pay them fairly. Whether you like that or not. Someone stiffs me I can (with adequate notice) dismiss them from my practice. Someone is abusive to my staff? Same thing. I don’t have to take their insurance or payment source if it doesn’t pay me to my satisfaction.
Certainly there are insurance products that cover “the basics” … the debate of course would be what constitutes “the basics” …
Is there waste in the current system? Certainly. Huge administration costs. And despite the fact that I think that a Canadian style system would significantly hurt my self-interests (I can’t say “No” to a single payor unless I get out of the business) I acknowledge that it is indeed a much more cost-effective model. I also see no way that it will happen in America anytime soon.
Please reread my comment that you snark about on your point 4. We like people having “the option of dealing with things before they are ER catastrophes” - not people being ER catastrophes. Sheesh.
As to your final point, you are indeed at least partly right, and that is indeed part of how our current system is so broke, perversely broke. The only ones who are asked to pay “full retail” are those least able to afford it. For the health insurance product MegaCorp gets a discount for the same product compared to individual Joe Blow who has to buy it on his own. Individual Joe Blow also doesn’t get his health insurance purchase subsidized by paying for it with pre-tax dollars (and the higher the income the bigger that subsidy is!). The insurance company doesn’t pay the listed price: they pay a discount rate that they have decided upon or your rate whichever is less. Of course for each plan there are some codes that they pay well on and some that they pay poorer on but as long as the doctors rates are above each of those prices they’ll average out okay- maybe 80% of charges. Of course Joe Blow who can’t afford insurance has to be charged the listed price - full retail.
A side comment on your discussion with BG. Be careful to compare apples to apples. My understanding is that the US is specialist heavy compared to Canada. You may be best off comparing specialty to specialty incomes.
The problem being, at the moment, it is not possible for some of us in certain jobs/careers to afford to take that responsibility. Well, no, that’s not exactly it. If I go to the emergency room for something major, I’ll be billed for it, and pay for it (over a long period of time).
I would not be gung-ho for UHC if there was a realistic expectation that folks making minimum wage, folks making $12.50/hr part time, and those making $18/hr without benefits could realistically afford to buy health insurance without it becoming a major expense (or unaffordable expense).
And, frankly, I don’t expect minor tweakings of the current system to work in any meaningful way. We’ve either got to make health care affordable for all income levels, or we’ve got to pay for it through taxes. I’d be happy with either option, but no one shows any real interest in doing the former.
Thank you. My parsing was right on except I misunderstood that point 4.
Covering the basics is “early detection”, because as you say ER catastrophies are just that and cost tons and tons of money and all that effort often time ends all for naught, the patient dies.
I presume that the insurance companies cough up the money even if the patient dies, right?
Health care problem #6
Can’t buy insurance from reliable underwriter at reasonable cost to cover basics.
You can buy full collision insurance with $300 deductible on $20,000 automobile for $50 per month but you can’t buy collision on your body for that price.
Health care problem #7
Patients fail to follow preventative medicine practices to detect illnesses, that have potentially catastrophic outcomes if not treated early, just as early as is technically possible. The early the detection the cheaper the cure in most cases.
Is it not wiser to treat 10 cases of disease diagnosed early for $1M or 1 case of same disease diagnosed late for $1M
Living in Michigan I know a lot of Canadians. None of them would want to switch to what we have. Bitching is human nature for some people. That does not indicate the system is screwed up.
http://www.ourfuture.org/blog-entry/mythbusting-canadian-health-care-part-i Learn.
focusonz one nit to pick, not all preventative is cost-effective, as a link given by someone else earlier pointed out. Some save money, some save lives or quality of life cost-effectively, but some are very expensive for what they do. Our approaching these recommendations from an economically rational POV is a work that isn’t even yet in progress. But agreed with the principle. Dealing with things early is better than dealing with them later.
Some information for you and BG to mull over in your consideration of Canadian doctor salaries: A significant number of Canadian docs are coming to America.