[QUOTE=Yeah]
(3) I think the average U.S. practicing physician may be a little better trained than the average in other countries because medical training in the U.S. is better.
[/QUOTE]
Cite?
Seriously, exactly what do you mean by “better” trained?
Why and how are American doctors better trained?
As a doctor who graduated from an Irish medical school and works in the UK’s NHS, I’m sure I’ll be fascinated by your answer.
[QUOTE=Attack from the 3rd dimension]
On a related note, I find it interesting that the one sector of the US system that has Canadian style health care is the military.
[/QUOTE]
What the military has is not so different from what any other US resident with a long term career for a large employer has, IME, especialy if that employer-provided insurance is through an HMO. Unless there is some other similarity you are aware of and I’m not. The US model works well if at least one family member is continuously employed by a large employer who can negotiate low group insurance rates and spread risk. The big problems arise because people’s families and careers don’t fit that model and when they don’t health insurance is difficult to obtain and expensive.
by CP: One way is to ask, "“Where do people go for healthcare if money and destination are no object, and to which doctors do people turn if money and destination are no object?”
[QUOTE=Throatwarbler Mangrove]
I don’t think this factoid really adds anything meaningful to the discussion - rich people can always get the best health care possible no matter where they are - they could just travel to the US. The best health care is available in the US because the US is the richest country in the world. That doesn’t really have anything to do with the US health care system, other than that the US doesn’t expressly forbid private provision of health care. Rich people by and large are above “the system” no matter where they come from. The comparison between Canadians coming to the US and vice versa is meaningless, because Americans who cannot afford health care generally are not in a position to pull up roots and move to another country on a dime, whereas rich Canadians don’t have that problem - they’re rich. If you want to measure the efficacy of “the system”, then it would only make sense to do so on the basis of how well cared for the POOREST citizens are.
[/QUOTE]
The OP does not ask about the best healthcare “system.”
He asks for evidence our healthcare is “the best” and how to measure and define the quality of healthcare.
My comment lists several criteria by which healthcare can be judged. The whole point is that there is a significant difference between “healthcare” and a delivery “system.” For example, if one were to ask, “Who has the best technology?” one would have to clarify if the question referred to the most complex gadgets or the best distribution mechanism for whatever gadgets are available, or some combination of the two.
Rich people can, in fact, afford the “best” healthcare. And when they are looking for it, they frequently come to the US to get it. By your own post, then, the “best healthcare” is here in the US.
If, in fact, RP is looking for a discussion on the best healthcare system, perhaps he can clarify the OP. His current question is broader than that.
[QUOTE=Chief Pedant]
One way is to ask, “Where do people go for healthcare if money and destination are no object, and to which doctors do people turn if money and destination are no object?” The US would rank high against such a criterion.
A second way is to ask, “Which country has equal access for all to the exact same standard of care?” A country like Cuba would rank above the US using such a ranking..
[/QUOTE]
True. The US has access to the best Medical care.
Not true. Cuba isn’t such a great place for Medical care, despite “Sicko”. You could use Canada, GB, Sweden, and many other Western nations instead.
[QUOTE=glee]
And, to a UK national, it would be free.
[/QUOTE]
**
TANSTAAFL.** Higher taxes pay for it.
[QUOTE=WhyNot]
are our infant mortality rates so high because we delay fetal death by caring for micropreemies and preemies until they die? Would that be considered a death here and a miscarriage in Nigeria?
[/QUOTE]
I’ve heard that it’s this exactly that accounts for our high infant mortality, as well as gun deaths being counted differently in other countries (we count suicides but some places are rumored not to) that skews our statistics. I’d love to know if there’s any truth to either.
[QUOTE=Harriet the Spry]
What the military has is not so different from what any other US resident with a long term career for a large employer has, IME, especialy if that employer-provided insurance is through an HMO. Unless there is some other similarity you are aware of and I’m not. The US model works well if at least one family member is continuously employed by a large employer who can negotiate low group insurance rates and spread risk. The big problems arise because people’s families and careers don’t fit that model and when they don’t health insurance is difficult to obtain and expensive.
[/QUOTE]
At various times, I’ve been covered by the US military, (much of my extended family still is), through an HMO and by the Canadian Health care system. The military and Canadian models both offered a similar experience of ‘walk in, state problem, health care occurs with minimal fuss, bother and paperwork’. I’ve never had a non-exasperating, non-paperwork-laden experience outside of those systems. Perhaps you have had better HMO experiences.
Our capitalist medical system is great for research and idea generation, but the free-rider problem allows other competing countries to stay pretty much up to date without having to spend the bucks. We have the best doctors and technology available, but at what cost? Specialists are tools of the rich only.
The U.S. health insurance system is a complete mess and it makes me feel ill just thinking about it…an office needs more insurance clerks than doctors, and it costs a fortune
While ‘best’ is subjective, most expensive is a fact. Some change is needed to make US health care more affordable.
The World Health Organization’s 2000 Assessment of world health systems used the following criteria to define ‘best’:
Their conclusion for The US:
[WHO 2000 Health Care Rankings](http://www.photius.com/rankings/healthranks.html):
1 France
2 Italy
3 San Marino
4 Andorra
5 Malta
6 Singapore
7 Spain
8 Oman
9 Austria
10 Japan
...
36 Costa Rica
37 United States of America
38 Slovenia
2003 Per Capita Health Expenditures in $US sorted by WHO 2000 ranking
1 -- 2,902 - France 10.5% 27,500 gdp per capita
2 -- 2,266 - Italy 8.4% 26,800 gdp per capita
3 -- NA - San Marino
4 -- NA - Andorra
5 -- 1,436 - Malta 8.4% 17,000 gdp per capita
6 -- 1,156 - Singapore 4.8% 24,000 gdp per capita
7 -- 1,853 - Spain 8.4% 22,000 gdp per capita
8 -- 419 - Oman 5% 8,300 gdp per capita
9 -- 2,306 - Austria 8.4% 30,000 gdp per capita
10 - 2,244 - Japan 8% 28,000 gdp per capita
...
37 - 5,711 - United States 15.1% 37,800 gdp per capita
note: no working link to the 2003 data.
[2004 per capita data here](http://hdrstats.undp.org/indicators/52.html)
Among the countries with the most successful health care systems according to the WHO’s 2000 findings only about 9% of their GDP goes to health care. The difference in cost between our 15.1% per capita vs 9% totals to a staggering $750 billion dollars every year and is likely much higher today.
It seems that the higher ranked countries according to the WHO’s guidelines have some form of Universal Health Care.
[QUOTE=glee]
And, to a UK national, it would be free.
[/QUOTE]
Yes and no. It’s not free, and it’s a serious error to think it is. It’s paid for through taxes, and UK tax rates are significantly higher than US tax rates, especially for mid-income ranges.
It’s not the cost per se, it’s the allocation of costs. By the way, even a comparison of (say) costs for a specific drug or operation will not yield a fair comparison, because research and costs in the UK are largely subsidized by government (i.e., taxes.)
In Thailand and most of Asia, for instance, many functions in a hospital are taken over by families: there’s still an extended family, and family members provide food, wash and clean the patient, etc… thus significantly lowering hospital costs compared to the US where such services are provided by paid hospital staff.
There’s also the basic underlying national culture or philosophy: in the US, each person (or their employer) pays for their own health care; those who can’t are either shit-outta-luck or rely upon state programs for the destitute. Services are available to those who pay (or are paid for, whether by employer or state.) Health care is thus seen as a commodity, to be bought and sold.
In the UK and the rest of the civilized world, costs are born by society (through taxes), and medical care is perceived as a service – like the police, say – to be used by those in need and paid for by everyone.
As others have said, the question of “where to get the best health care” is basically not a question that has a simple yes/no answer. (If this were Great Debates, I’d probably comment that I’m not surprised that Republican Presidential Candidates would think that there are simple answers.)
[QUOTE=Chief Pedant]
If, in fact, RP is looking for a discussion on the best healthcare system, perhaps he can clarify the OP. His current question is broader than that.
[/QUOTE]
No, you’re right about what I’m looking for, which is rather narrower than what is the best system. I was looking for evidence for the claim that the care, when attained, is better than elsewhere. By my count, so far that evidence includes: rich foreigners visit to get care and medical training.
I suppose it would also be interesting to probe whether the access issues are intrinsically tied to the better care (i.e. can’t increase access without lowering care), but that is more GD than GQ.
[QUOTE=Chief Pedant]
A second way is to ask, “Which country has equal access for all to the exact same standard of care?” A country like Cuba would rank above the US using such a ranking.
[/QUOTE]
If by “exact standard of care” you mean “substandard”, and by “equal access” you mean “those with dollars and power get decent care, everyone else gets crap”, then I guess you might be right.
[QUOTE=Wendell Wagner]
I wouldn’t call you middle class. You’re working class. If you have to choose between eating enough in a week and going to a doctor, you’re not middle class. I don’t like the habit in the U.S. of using middle class in an overly wide fashion. You’re not in the same social class as a family of four who makes $150,000. Your needs are vastly different from theirs.
[/QUOTE]
Perhaps that’s true - and if you notice, I wrote “middle working” to hedge my bets here. 
While we consistently show up as “middle-class” on economists charts and magazine articles, it always makes me gigglesnort a little. I agree that my concerns are far different than a family making $150,000 a year. They’re also different than a family making $13,000 a year. My point was simply that the idea that you need to look at the *poorest *for an indicator of how good a health care system is seems intuitive, but doesn’t work for the US. It’s the people somewhere in the middle that are screwed.
[QUOTE=Attack from the 3rd dimension]
At various times, I’ve been covered by the US military, (much of my extended family still is), through an HMO and by the Canadian Health care system. The military and Canadian models both offered a similar experience of ‘walk in, state problem, health care occurs with minimal fuss, bother and paperwork’. I’ve never had a non-exasperating, non-paperwork-laden experience outside of those systems. Perhaps you have had better HMO experiences.
[/QUOTE]
OK, I agree about the paperwork for non-HMO US insurance. For HMOs, my experience has been along the lines of ‘locate in-network provider*, walk in, state problem, health care occurs with minimal fuss, bother, and paperwork, pay copay of $5-20.’ This once included surgery and a 10-day hospitalization and the $20 charge was actually for the phone in my room. HMOs do become paperwork-laden and exasperating for out of network care.
*I believe the military also uses a network, albeit a large one, correct?
My point was more about the actual coverage available being similar between US military and long-term employee of large company. I agree with your point that the process of getting care is often smoother for the Canadian or military system.
I thought the beloved SCHIP (Hillarycare-lite) was going to solve all these issues? I guess it doesn’t go far enough…
[QUOTE=gonzomax]
The World Health Organization's ranking of the world's health systems, by Rank Depends on criteria. We are way down on many of them.
The poor do not get decent health care. It is difficult to obtain. Spending your day in an emergency room to get care is not a good deal. Preventative health care is unobtainable for most of the poor.
We do constantly claim it loud and long convincing ourselves it is true.
[/QUOTE]
[QUOTE=DrDeth]
Higher taxes pay for it.
[/QUOTE]
Come, come, gentlemen! :rolleyes:
I was referring to the specific example of Desert Nomad, who had no insurance, needed minor surgery and had to pay $12,000 for it. He commented that it would cost about $800 in Thailand.
I pointed out it would cost the patient nothing.
I have paid National Insurance for 40 years and understand perfectly well how the UK NHS is financed. I know about rich people going private and which categories of patient do not have to pay for prescriptions.
Nevertheless a person with no insurance or savings can get medical treatment in the UK. Those of us who can afford it pay for this. I think this clearly is part of the debate on providing best health care.
If there are people in the US who cannot get insurance and cannot afford to pay for health care and therefore do not get treatment, then that matters.
umm…tax rates are significantly higher in any country with a national health care system, so the taxpayers are paying for it. gotta love income redistribution.
[QUOTE=glee]
And, to a UK national, it would be free.
[/QUOTE]
…only, you have to be either:
-on welfare
-and illegal alien
-a criminal
to get it. Hospitals provide millions in free care to such people, who rarely (if ever) have insurance. That’s the big problem-there is an unlimited demand for “free” healthcare; once you have to pay for it, demand drops off.
[QUOTE=ralph124c]
..only, you have to be either:
-on welfare
-and illegal alien
-a criminal
to get it. Hospitals provide millions in free care to such people, who rarely (if ever) have insurance. That’s the big problem-there is an unlimited demand for “free” healthcare; once you have to pay for it, demand drops off.
[/QUOTE]
Negative. Unless you count being on disability as “welfare.” Disabled people are not by that fact alone either illegal or criminals. Nor are children.
I really hope that neither you nor any member of your family gets a disease or injury that prevents being able to work for a living. I really do. However, if that happens you will be paid back for calling such unfortunate people criminals.
[QUOTE=clouded_leopard]
umm…tax rates are significantly higher in any country with a national health care system, so the taxpayers are paying for it. gotta love income redistribution.
[/QUOTE]
What are the comparitive rates of tax in the US vs the UK?
