Healthcare & rationing

[TallDave]

You lead this exchange with a single anecdote, and held it out as evidence of the horrors of socialized medicine.

I didn't hold it out as evidence of anything, I just mentioned it. It wasn't the lead, either.

I haven't seen any evidence of the horrible scenarios you are mentioning.

Which horrible scenarios? Am I making up the cancer survival rates? The lack of MRIs? The organ transplant ratios? The infection rates?

No it is weird because you're paying 3x more for the same service than you could be.

No, we're paying 3x more for better service. But hey, it's only your life, right?

Cost per capita for U.S. healthcare versus those of socialized countries, and life expectancy in U.S. versus those socialized countries. I

Costs have lower marginal utility as you do more care (the first dollar goes much further than the 1,000th, etc). Life expectancy correlates much more strongly to lifestyle than quality of medical care, so is a poor criteria for judging the latter.

That means you can only save 1/3rd of the people. There's no other way to look at it I'm afraid.

Oh dear God. Please head back to Econ 101, and stop at a stats class on the way. Next you'll tell me since we spend 3x as much on food as Cuba that 1/3 more people will starve in the U.S.

[KitemanSA]

I liked the system set up in the science fiction book Child of Fortune.

Thanks for the referral. I'll see if I can find it somewhere other than Amazon (personal preference).

[vankirkc]

Furthermore, you dismiss life expectancy as a measure of success or failure of a healthcare system. What yardstick are we to use to compare these systems?

I don't dismiss them, actuaries do.

What are good measures? Cancer survival rates. Availablity of MRIs, other diagnostics and specialist care.

1. Americans have better survival rates than Europeans for common cancers. Breast cancer mortality is 52 percent higher in Germany than in the United States and 88 percent higher in the United Kingdom. Prostate cancer mortality is 604 percent higher in the United Kingdom and 457 percent higher in Norway. The mortality rate for colorectal cancer among British men and women is about 40 percent higher.

Nine out of ten middle-aged American women (89 percent) have had a mammogram, compared to fewer than three-fourths of Canadians (72 percent).

Nearly all American women (96 percent) have had a Pap smear, compared to fewer than 90 percent of Canadians.

More than half of American men (54 percent) have had a prostatespecific antigen (PSA) test, compared to fewer than one in six Canadians (16 percent).

Nearly one-third of Americans (30 percent) have had a colonoscopy, compared with fewer than one in twenty Canadians (5 percent).

9. Americans have better access to important new technologies such as medical imaging than do patients in Canada or Britain. An overwhelming majority of leading American physicians identify computerized tomography (CT) and magnetic resonance imaging (MRI) as the most important medical innovations for improving patient care during the previous decade—even as economists and policy makers unfamiliar with actual medical practice decry these techniques as wasteful. The United States has thirty-four CT scanners per million Americans, compared to twelve in Canada and eight in Britain. The United States has almost twenty-seven MRI machines per million people compared to about six per million in Canada and Britain.

6. Americans spend less time waiting for care than patients in Canada and the United Kingdom. Canadian and British patients wait about twice as long—sometimes more than a year—to see a specialist, have elective surgery such as hip replacements, or get radiation treatment for cancer. All told, 827,429 people are waiting for some type of procedure in Canada. In Britain, nearly 1.8 million people are waiting for a hospital admission or outpatient treatment.

Or how about R&D?

10. Americans are responsible for the vast majority of all health care innovations. The top five U.S. hospitals conduct more clinical trials than all the hospitals in any other developed country. Since the mid- 1970s, the Nobel Prize in medicine or physiology has gone to U.S. residents more often than recipients from all other countries combined. In only five of the past thirty-four years did a scientist living in the United States not win or share in the prize. Most important recent medical innovations were developed in the United States.

This link speaks directly to your comment about MRIs. Remember, Japan's healtchare is socialized. Perhaps you should open your mind and reconsider your position.

http://www.npr.org/templates/story/stor ... d=89626309

[TallDave]

The Japanese Health Ministry tightly controls the price of health care down to the smallest detail. Every two years, the health care industry and the health ministry negotiate a fixed price for every procedure and every drug

This is the free rider problem I mentioned a few pages back. Also, electronics tend to be cheap in Japan anyway.

It's great that we're rich enough to shoulder this burden for everyone else, but if we stop doing it no one is going to pay for drug R&D.

I also don't think we want a system where doctors make so little they operate vending machines. Japan has a tightly-knit prestige culture that may make that viable for their society, but it's not a rational economic choice.

I haven't seen any response to the mass of facts I posted other than to call them "nonsense." The evidence is overwhelming that free markets work.

[TallDave]

Here's a non-anecdotal Great Moment In Socialized Healthcare.

The babies born in hospital corridors: Bed shortage forces 4,000 mothers to give birth in lifts, offices and hospital toilets

Thousands of women are having to give birth outside maternity wards because of a lack of midwives and hospital beds.
The lives of mothers and babies are being put at risk as births in locations ranging from lifts to toilets - even a caravan - went up 15 per cent last year to almost 4,000.

[MSimon]

Tall Dave Said:

10. Americans are responsible for the vast majority of all health care innovations. The top five U.S. hospitals conduct more clinical trials than all the hospitals in any other developed country. Since the mid- 1970s, the Nobel Prize in medicine or physiology has gone to U.S. residents more often than recipients from all other countries combined. In only five of the past thirty-four years did a scientist living in the United States not win or share in the prize. Most important recent medical innovations were developed in the United States.

This link speaks directly to your comment about MRIs. Remember, Japan's healtchare is socialized. Perhaps you should open your mind and reconsider your position.

http://www.npr.org/templates/story/stor ... d=89626309

Yes. But is that true in Canada? Or GB? Or France?

BTW I think paying 3X as much and getting a LOT of innovation is a good thing. I think paying 3X as much and getting quick service for all (if not equal treatment) is a good thing.

I think government deciding what you can and can't have is a bad thing.

Tyranny, like hell, is not easily conquered; yet we have this consolation with us, that the harder the conflict, the more glorious the triumph. What we obtain too cheap, we esteem too lightly; 'Tis dearness only that gives every thing its value, Heaven knows how to set a proper price upon its goods; and it would be strange indeed, if so celestial an article as freedom should not be highly rated. Thomas Paine, The American Crisis, No 1, 12/19/1776

Americans (most of us) are different.

We, therefore, the Representatives of the united States of America, in General Congress, Assembled, appealing to the Supreme Judge of the world for the rectitude of our intentions, do, in the Name, and by Authority of the good People of these Colonies, solemnly publish and declare, That these united Colonies are, and of Right ought to be Free and Independent States, that they are Absolved from all Allegiance to the British Crown, and that all political connection between them and the State of Great Britain, is and ought to be totally dissolved; and that as Free and Independent States, they have full Power to levy War, conclude Peace, contract Alliances, establish Commerce, and to do all other Acts and Things which Independent States may of right do. — And for the support of this Declaration, with a firm reliance on the protection of Divine Providence, we mutually pledge to each other our Lives, our Fortunes, and our sacred Honor.

http://www.ushistory.org/declaration/document/index.htm

You see Americans place different values on things than most of the rest of the world. And we are still attracting people who share our values. Which is why there are so few (relatively) in the rest of the world. Good for us.

[vankirkc]

Here's a non-anecdotal Great Moment In Socialized Healthcare.

The babies born in hospital corridors: Bed shortage forces 4,000 mothers to give birth in lifts, offices and hospital toilets

Thousands of women are having to give birth outside maternity wards because of a lack of midwives and hospital beds.
The lives of mothers and babies are being put at risk as births in locations ranging from lifts to toilets - even a caravan - went up 15 per cent last year to almost 4,000.

Let's have the equivalent stats for the U.S., including women who have no healtchare because they can't afford it and don't qualify for public assistance. Then we can compare and see if it's really an inferior system.

Sensational headlines are just marketing tools. Ask the average person in the U.S. if they would trade their healthcare system for ours and I bet they will very nearly all choose what they have.

[TallDave]

Let's have the equivalent stats for the U.S., including women who have no healtchare because they can't afford it and don't qualify for public assistance. Then we can compare and see if it's really an inferior system.

You generally cannot be refused treatment in the U.S. The worst that can happen is you are asked to pay back what has been provided for you. Churches often have charity drives for such people.

[vankirkc]

[quote="MSimon]
Yes. But is that true in Canada? Or GB? Or France?[/quote]

The facts:

https://www.cia.gov/library/publication ... 2rank.html

US is #50 on that list.

Canada is #8, France is #9, and the ever popular whipping boy UK is #38. Japan is #3, and the highest industrialized country.

I would say that the evidence is compelling that whatever it is that those countries are doing is working better than what we're doing, AND it's costing them less.

BTW I think paying 3X as much and getting a LOT of innovation is a good thing. I think paying 3X as much and getting quick service for all (if not equal treatment) is a good thing.

I think government deciding what you can and can't have is a bad thing.

You misunderstand the public system. Nothing stops you from going outside the system, spending more if you like, to get whatever it is that you want that they don't provide. As I keep saying, there are private healthcare providers here, large and small, including specialists, who will service you completely outside the public system. It costs more, but it's there for the taking if you have the means and the inclination.

Tyranny, like hell, is not easily conquered; yet we have this consolation with us, that the harder the conflict, the more glorious the triumph. What we obtain too cheap, we esteem too lightly; 'Tis dearness only that gives every thing its value, Heaven knows how to set a proper price upon its goods; and it would be strange indeed, if so celestial an article as freedom should not be highly rated. Thomas Paine, The American Crisis, No 1, 12/19/1776

Tyranny is what we have currently.

We, therefore, the Representatives of the united States of America, in General Congress, Assembled, appealing to the Supreme Judge of the world for the rectitude of our intentions, do, in the Name, and by Authority of the good People of these Colonies, solemnly publish and declare, That these united Colonies are, and of Right ought to be Free and Independent States, that they are Absolved from all Allegiance to the British Crown, and that all political connection between them and the State of Great Britain, is and ought to be totally dissolved; and that as Free and Independent States, they have full Power to levy War, conclude Peace, contract Alliances, establish Commerce, and to do all other Acts and Things which Independent States may of right do. — And for the support of this Declaration, with a firm reliance on the protection of Divine Providence, we mutually pledge to each other our Lives, our Fortunes, and our sacred Honor.

http://www.ushistory.org/declaration/document/index.htm

And the point of this little bit of flag waving is?

[MSimon]

Let's have the equivalent stats for the U.S., including women who have no healtchare because they can't afford it and don't qualify for public assistance. Then we can compare and see if it's really an inferior system.

You generally cannot be refused treatment in the U.S. The worst that can happen is you are asked to pay back what has been provided for you. Churches often have charity drives for such people.

I was uninsured for my first son's birth. It cost about $20,000 for some of the finest care in the world including a cesarean after 24 hours of hard labor by my mate. I paid on the bill until it got down to about $2,000 and the balance was forgiven when we hit an economic rough patch.

BTW there was no request for cash to get the job done. And I got birthing/breathing classes out of it as a bonus.

And on top of that I was in the operating room holding my mate's hand while the surgery was going on. In addition I was the first in my family to hold my new born son. His liver didn't start working right away and he had to be kept in the hospital for 7 days.

My experience with the system is that it is expensive but the care is first rate and timely.

Which of course is just an anecdote.

My most exciting experience was the birth of my #3 son. The mate delivered rather quickly and so the hospital provided 2 really cute female doctors who flirted with me the whole time the delivery was going on (I had a ring side seat). Our regular doctor arrived later and the two cute females were off to other things. Sigh.

And to be sure my mate knows what happened (she was kind of out of it during the birth) and is still amused.

Or the birth of the #1 daughter who had her umbilical cord choking her on exit and the doctors gave her a twirl and got her unchoked in seconds. I had a very good view of that one. Then I got to snip the cord.

I don't know how it is in other countries (except for what I read) but I'm pretty happy with the American system.

I'll let you know how I like the American socialized medicine system in a year or three. I will be forced on Medicare in a few months.

[MSimon]

Yes. But is that true in Canada? Or GB? Or France?

The facts:

https://www.cia.gov/library/publication ... 2rank.html

US is #50 on that list.

Is genetic variation accounted for? Variations in climate? Or is it just raw ranking?

[vankirkc]

Let's have the equivalent stats for the U.S., including women who have no healtchare because they can't afford it and don't qualify for public assistance. Then we can compare and see if it's really an inferior system.

You generally cannot be refused treatment in the U.S. The worst that can happen is you are asked to pay back what has been provided for you. Churches often have charity drives for such people.

I was uninsured for my first son's birth. It cost about $20,000 for some of the finest care in the world including a cesarean after 24 hours of hard labor by my mate. I paid on the bill until it got down to about $2,000 and the balance was forgiven when we hit an economic rough patch.

BTW there was no request for cash to get the job done. And I got birthing/breathing classes out of it as a bonus.

And on top of that I was in the operating room holding my mate's hand while the surgery was going on. In addition I was the first in my family to hold my new born son. His liver didn't start working right away and he had to be kept in the hospital for 7 days.

My experience with the system is that it is expensive but the care is first rate and timely.

Which of course is just an anecdote.

My most exciting experience was the birth of my #3 son. The mate delivered rather quickly and so the hospital provided 2 really cute female doctors who flirted with me the whole time the delivery was going on (I had a ring side seat). Our regular doctor arrived later and the two cute females were off to other things. Sigh.

And to be sure my mate knows what happened (she was kind of out of it during the birth) and is still amused.

Or the birth of the #1 daughter who had her umbilical cord choking her on exit and the doctors gave her a twirl and got her unchoked in seconds. I had a very good view of that one. Then I got to snip the cord.

I don't know how it is in other countries (except for what I read) but I'm pretty happy with the American system.

I'll let you know how I like the American socialized medicine system in a year or three. I will be forced on Medicare in a few months.

My wife and I just had another son last year. It cost $4000 U.S. equivalent. Done in a first rate hospital, regular checkups and I was there for the birth. Fortunately it was normal delivery, but if it hadn't been it would have been free.

[MSimon]

The point of flag waving is that Americans may by culture and genetics place a higher value on liberty than people elsewhere.

BTW not all countries report infant mortality the same way. This can have a big effect on mortality statistics. IIRC America has rather stringent rules compared to many other countries in reporting infant mortality.

[vankirkc]

Yes. But is that true in Canada? Or GB? Or France?

The facts:

https://www.cia.gov/library/publication ... 2rank.html

US is #50 on that list.

Is genetic variation accounted for? Variations in climate? Or is it just raw ranking?

You can't be serious. France and the U.K. are almost as melting pot as the U.S., and the Canadians have virtually the same lifestyle as Americans.

You just want to quibble over details because you don't like the fact that that table squashes your argument completely.

[MSimon]

I was happy to pay the bill and thought it fair for services rendered.

I could have gone on welfare (I was out of a job at the time) and had zero bill too. But I willingly paid to get the service providers and service I and my mate wanted.

The doctor we had was extraordinary. She let my mate "push" for six more hours than is usual because my mate really wanted a "normal" delivery. Then she came to me and said - "we have to cut" I said yes and in a few minutes my mate was in the operating room and I got to watch as much as I wanted. Including the counting of the instruments and sponges.