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Hidden truths about American health care

19 January 2010

Some hidden truths about the American health care system, lost amidst the noisy debate.  At the end are links to other posts about our health care system.

  1. It’s among our most serious problems, the largest single component of the $70+ trillion government liability (including Federal, State, local).  It will bankrupt us if not fixed.
  2. It’s the easiest of our major problems to fix, since we can learn from — or even copy — long-proven successful systems of other western nations (e.g., German, France, Switzerland).
  3. It will be not bankrupt us.  We will fix it, eventually (as I said, it’s easy to fix).
  4. The solution probably will involve some sort of soft default.  That is, the promise of almost unlimited health care to the elderly probably cannot be kept.  As the boomer age in their vast numbers, some sort of rationing will become inevitable.  Although unlike, perhaps even death panels — if we delay solutions until desperate measures become necessary.
  5. Most important:  our inability (alone among the developed nations) to fix this problem illustrates the deeply dysfunctional nature of the US political system — which means the weakness in mind and spirit of the American people.  Us.  We must do better to survive — let alone prosper — in the 21st century.

Here are some valuable articles illustrating aspects of this problem.

  1. Vital information, from the OECD’s stats:  “How American awfulness stacks up“, Left Business Observer, July 2009 — Ugly, but the numbers are what they are.
  2. Important information, vital to understand:  “Overconsuming health“, Left Business Observer, August 2009 — In “1978, consumption was 61.5% of GDP; in the second quarter of 2008, it had risen to 70.3% (+8.8 points). Well over half that increase, 5.0 points, came from spending on medical care. The share of GDP devoted to spending on goods actually fell by 4.7 points over that 30-year period.”  (Hat tip to Brad Delong)
  3. Best graphic for the day, with a brief powerful explanation:  “The Cost of Care“, National Geographic, 15 December 2009 — International comparison of heath care expenditures nad life expectancy.
  4. Ugly numbers about US health care spending:  “‘Big Government’ Health Care“, David Leonhardt, blog of the NY Times, 12 January 2010
  5. Dumbest post of the week, even among right-wing propaganda:  “The High Cost of No Price“, Veronique de Rugy, 12 January 2010 — The rest of the developed world has equal or larger government funding of health care, and spends far less.  The opposite of what her theory predicts.

Other posts on the FM website about American health care

Afterword

Please share your comments by posting below. Per the FM site’s Comment Policy, please make them brief (250 word max), civil and relevant to this post. Or email me at fabmaximus at hotmail dot com (note the spam-protected spelling).

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28 Comments leave one →
  1. Greg permalink
    19 January 2010 6:59 am

    FM: “Most important: our inability (alone among the developed nations) to fix this problem illustrates the deeply dysfunctional nature of the US political system — which means the weakness in mind and spirit of the American people. Us. We must do better to survive — let alone prosper — in the 21st century.

    I enjoy it when you offer your usual hopey-happy solutions; it excites the nihilistic part in me. “We must do better….” Humans simply do not make any changes until the Pain is right there….and then only for a short time, usually. Ask any Health Care provider.

    We simply aren’t “there” yet. We are foolishly spending our “Principal”, our “capital”, our generational wealth. Not too much left but still a few years worth. The Corporate Hospitals are ignoring this
    Doctors are starting to see it…but sure do not want to accept a declining income quite just yet but they do know their kids who are in Med School are in for it. Boomers? Oh heavens, they will get theirs and to heck with their grandkids! (Just like their parents—the greatest generation!) Dysfunctional Governing Cabal/System?

    “We pretend to vote and they pretend to govern.”
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    FM reply: We do vote, but that’s not enough to make the wheels of democracy turn. Greater levels of involvement are required. If we choose not to make the effort, we cannot complain that others rule us.

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  2. 19 January 2010 7:00 am

    FM: “It’s the easiest of our major problems to fix, since we can learn from — or even copy — long-proven successful systems of other western nations

    This should be correct, but bitter experience suggests that it will not be. Look instead for a boom in medical tourism, as people increasingly travel to foreign countries such as India, where they can receive care at a fraction of what it would cost here. This would be consistent with the outsourcing trend which is so much a feature of the current economy.

    I’m not advocating this development – far from it. I’m just calling it the way I see it.
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    FM reply: When we finally are forced to change — when the bills rolls in as the boomers age — I suspect we’ll be astonished how easy the system is to fix. The longer we wait, the greater fiscal damage done, of course.

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  3. Thomas Jackson permalink
    19 January 2010 7:36 am

    Pathetic. If one examines the economic situations of the nations mentioned one finds their dbt problems are worse than ours. As someone who had to endure socialized medicine anyone advocating it simply doesn’t understand the problem.
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    FM reply: In fact the liabilities of the major western nations are quite similar. Some are larger, some have larger foreign components. As for your remark about “socialized medicine”, a large body of research has found not substantial difference between health care results among the major western nations. Some are better, some are worse (the US and UK being at the bottom), depending on the criterial used. The primary difference is that our system costs more. All the conservative lies and propaganda cannot change the facts.

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  4. Greg permalink
    19 January 2010 7:41 am

    FM offers: “It’s among our most serious problems, the largest single component of the $70+ trillion government liability (including Federal, State, local). It will bankrupt us if not fixed.

    This is where you’re supposed to yell: Yikes! Right? … there’s no way to escape the thought that America is bankrupt in more ways than one. Maybe?
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    FM reply: Remember the key fact about bankruptcy, esp for nations — it’s the beginning not the end. What follows bankruptcy shows the strength of the people, and determines the future.

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  5. Ulenspiegel permalink
    19 January 2010 7:57 am

    The graphics in National Geographics should be adjusted for purchase power, then the US system is only slightly more expensive than the Swiss. This does of course not change the differences in quality.
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    FM reply: That’s a legitimate point, but difficult in practice (which is why comparisons of health care as a % of GDP are more useful, IMO). Determining the relative purchasing power of US vs. Euro medical services is difficult. Broadly speaking, I suspect the Euro and S. Franc today are overvalued on a ppp basis vs. the dollar, which means that the adjustment raises US prices — not lowers them — vs. those nations.

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  6. Indian Investor permalink
    19 January 2010 9:42 am

    If Martha Coakley loses then there won’t be any Obama healthcare bill. Then it would just be totally unlikely that he’ll be re elected. Repubs believe in nuclear power and drilling for oil in the US to solve the US external debt issues. Obama is the green technology guy. The idea of green technology is to slow down the transition of the developing countries from export oriented growth to domestic fiscal expansion.
    Ergo, if Martha Coakley loses, Repubs will come to power and their first step will be to invade Iran. Strategic Command has been itching for years and years to invade Iran, remember? But that’s good for the developing countries because they won’t need to abstain from using their new found oil and gas resources just to keep the US Treasury from defaulting.
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    FM reply: Only fools believe that the US could increase domestic oil production sufficiently to “solve the US external debt issues.” There is zero evidence supporting this fantasy. Unfortunately that does not mean you’re wrong, as some Repubicans might believe this.

    “Repubs will come to power and their first step will be to invade Iran”

    Total nonsense. I don’t anybody of consequence advocating invading Iran, esp with our ground forces over-committed in Iraq and Afghanistan. If the Republicans take control of the White House and Congress in 2012 they might bomb Iran. But they didn’t do so under Bush Jr, when the conditions were more favorable. Today Iran probably would get explicit support from China and perhaps Russia. Few nations in Europe would support us.

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  7. Elle permalink
    19 January 2010 9:54 am

    I am failing to see why the government needs to be involved in health care at all. Did I miss this part of the Constitution that says the government owes me health care?Is government health care somewhere in the Bill of Rights? And why my life and services-or lack there of should be determined by some government bureaucrat panel?This is my choice after all and you are asking me to leave it to the government you say is so dysfunctional? If we were to make it quid pro quo,the citizenry would sit on a panel to determine the life-or lack there of,of the government bureaucrats on those panels.

    As far as the euro-healthcare, it’s already unsustainable and reducing services and increasing rationing while soaring in costs and will not be getting better. This is a solution? The solution doesn’t lie in government run health care at all.People would be best served if the government got out of the health care business altogether and returned to it’s normal dysfunctionality.Let the health care market sort itself,I think we will be surprised by the innovation of the citizenry to fill the void.
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    FM reply: I recommend you get a subscription to The Economist, then you’d know a bit more about these things. As we saw in your previous comments in this health care thread, you know almost nothing about these things. That does not make you a bad person, just an unreliable source of information about these things.

    (1) “I am failing to see why the government needs to be involved in health care at all.”
    Because we have elections every 2 years, and a large majority of US voters approve of Medicaid, Veterans Care, and Medicare. If you disapprove of these things, I suggest starting a petition to cancel them. You’d have better luck trying to repeal the Law of Gravity.

    (2) “As far as the euro-healthcare, it’s already unsustainable and reducing services and increasing rationing while soaring in costs and will not be getting better”
    Nonsense. Most G-10 nation’s health care system is in far better financial shape than ours.

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  8. Burke G Sheppard permalink
    19 January 2010 10:36 am

    Fabius wrote: “It’s the easiest of our major problems to fix, since we can learn from — or even copy — long-proven successful systems of other western nations (e.g., German, France, Switzerland).

    If it were easily fixable, it would have been easily fived long ago. Rather, it’s easy for people to imagine ways to fix it, but getting those solutions implemented is difficult, because a great many people, patients, doctors, insurers, etc., have a large stake in the outcome, and raise a stink over whatever “simple” solution has been proposed. It’s easier to implement “simple” solutions in countries where the government finds it easier to disregard the objections of the serfs.

    Obamacare, which is neither simple nor a solution will be implemented, if it is, because of the secrecy and disregard of republican precedent that has surrounded the process, combined with the willingness of the Democrats to nationalize one sixth of the economy on a party line vote.
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    FM reply: Not quite. I said this was the “easiest of our major problems to fix.” We have not solved the others either, let alone “fixed them long ago.”

    “it’s easy for people to imagine ways to fix it”
    Yes, and we will when we’re forced to fix it.

    “Obamacare, which is neither simple nor a solution will be implemented”
    It is just a band-aid. Progress, esp in extending coverage to many of those now uninsured, of no long-term significance.

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  9. Ulenspiegel permalink
    19 January 2010 1:12 pm

    @Elle

    The interesting observation in countries with mixed systems like Germany is, that the governmental health insurance works usually much better than the private ones and,therefore, your “solution” seems IMHO a little bit strange.

    You have to show evidence that in a health care system with its triangle of customer, insurance company and doctors/hospitals the market really works and if you rally can expect a positve impact of the forces of this market.

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  10. Elle permalink
    19 January 2010 2:04 pm

    @Ulenspiegel

    Thank you! You have eloquently illustrated a solution: customer+insurance company+doctors/hospitals+market=solution. Perhaps another way is: customer+insurance company+doctors/hospitals+market-government=solution. Of course the government health insurance run as a monopoly with strict regulation designed to keep out competition works well in Germany.How could it not,it’s almost the only game in town?

    My question to you is,is it sustainable? Here is another question,can we think out of the government solution box?Do we have the courage to do this?Or must everything be government approved? Could it not be Hegelian government regulations that got us into this in the first place? How well is medicare working,or the VA for that matter?Are either of these government solutions working well or sustainable? And if,as is stipulated in FMs post the government is dysfunctional,why on earth would we look to the government for a solution?

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  11. 19 January 2010 4:39 pm

    With respect, the problem with American health care is not illustrated by any of the articles (with the tangential exception of de Rugy’s piece) that you post. The problem is that most Americans do not understand the cost of health care. I am not talking about the fee for service or co-pay, I am talking the actual cost.

    Western Democracies pay less per person on health care because they understand the cost–which they pay in much higher taxation levels than Americans are used to. Americans have a system of low (relatively) tax rates, low personal payments for health care services and a largely hidden subsidy in the guise of employer provided health care.

    The cost of care, loosely speaking, is a combination of all of those factors and most Americans don’t understand the subsidy of the third. Interestingly, if the Obama health care plan passes and is implemented, Americans will finally come to understand the costs and probably not ready to accept it either.
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    FM reply: I agree, that’s an important aspect of the problem.

    “if the Obama health care plan passes and is implemented, Americans will finally come to understand the costs and probably not ready to accept it either.”
    Why?

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  12. 19 January 2010 5:39 pm

    One of the primary hurdles facing something like John Robb’s Resilient Communities project would be providing healthcare. We simply are going to have to set up an alternative structure to deliver social services – somewhat like the medieval church served as an alternative structure – but don’t push that analogy too far. Who knows, out of the hell that is now Haiti we can learn something – howto provide social services in the face of a dysfunctional state. And we can take those lessons and start applying them back here.
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    FM reply: IMO that’s just a nightmare, without any factual foundation. Just another of the doomster fantasies that have taken hold of so many folks, part of the long western fascination with eschatological dreams.

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  13. Rick Caird permalink
    19 January 2010 6:36 pm

    I just checked two of the references and they both leave a lot to be desired. The first one was the poverty reference that claimed the US had a poverty rate of 38%. If you dig into the piece, you find the poverty line is drawn at 1/2 the median income. But poverty is relative. So are median incomes. Since overall incomes in the US are higher than in European or Canada, the poor in the US fare better than those in Canada and Europe. It is hard to say the people with shelter, food, a large screen TV, and a car are really poor.

    “The cost of care” is even worse. This one claims 45,000 premature deaths, but if you go to the source, it is filled with “mays” and “mights”. It was also released by a group advocating national health insurance. Further, the claim of life span is also incorrect. If you remove accidents and homicides, the US compare favorably. We also beat everyone else in survival rates for cancers and heart disease. If you get breast cancer, you better live in the US rather than Canada or England.

    Sure, we spend a lot on health care. But, we want to. We do not want to wait months for an MRI or elective surgery. Remember, after the government covers everyone, then the objective of the politicians is to reduce costs and manipulate the statistics. No thank you.
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    FM reply: Can you give us more information who said what. This gives too little information to respond.

    “But, we want to. We do not want to wait months for an MRI or elective surgery”
    There is a massive body of research that shows this extra expenditure buys nothing in terms of better outcomes.

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  14. 19 January 2010 7:06 pm

    “We do not want to wait months for an MRI or elective surgery./”

    I’m too depressed and pissed off right now to look up the statistics, but Americans actually do wait quite a while for many treatments.
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    FM reply: The uninsured wait quite a while for anything but necessary surgery.

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  15. Rick Caird permalink
    19 January 2010 7:23 pm

    Duncan,

    I just had a quadruple bypass on 12/4. I went to my doctor on Monday, and he sent me for a stress test the next day, which I failed. I was sent directly to the emergency room and admitted to the hospital. I had a catheterization on Wednesday to find the blockages and tests on Thursday to make sure I was strong enough for the operation. The operation was done Friday. Whenever my wife or I have needed an MRI, PET scan, or X Ray, it scheduled within a week. The US has far more MRI machines per capita than England or Canada. Does that cost more? Sure, but what does it cost to wait? I really, really do not want the Post Office or DMV providing my health care. Nor do I want NICE providing my health care. Government health care works well as long as you are not sick.
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    FM reply: Again, this is absurd. The plural of anecdote is not data.

    “Government health care works well as long as you are not sick”
    Do you have any evidence for this? Perhaps stats on people using Tricare, Vet, or Medicare? Data on the French, German, or Swiss health care system? Or are you an uncritical consumer of lies and propaganda? There is a massive body of research showing this to be a lie.

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  16. Xiaoding permalink
    20 January 2010 3:44 am

    Rick in comment #15: ““Government health care works well as long as you are not sick” … “I just had a quadruple bypass on 12/4…”

    You do not mention, did you have health insurance, or was alll this done on charity? Try it without insurance. Then, get a job, and then try to get NEW health insurance. Then, you will realize what “leper” means! Sadly, it’s not treatable right now. I just LOVE reading stories from people who have oodles of health care, though, do continue! God does feed the rich, does he not?

    “As far as the euro-healthcare, it’s already unsustainable and reducing services and increasing rationing while soaring in costs and will not be getting better”

    And ditto socialist governments, the Euro welfare state, etc. All I can say is, I have been hearing this, or some variant of it, my whole, entire, live long, LIFE. It’s pure crap, every bit of it. It’s a total lie. Otherwise, those countries would have exploded into unsustainable land a long time ago, right? Yet they still exist! And get MORE vacation time!

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  17. 20 January 2010 3:52 am

    @FM: I am curious- where does the constitution give the legislative branch the authority to direct fund health care? Not that anybody gives whit about the constitution anymore, but you do (here)seem sympathize with the sentiment.
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    FM reply: Article I, section 8: “The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States”. Provide for the general welfare aptly describes health care.

    More broadly, this is a reasonable extentions of the government’s power made by elected representatives, with widespread long-term support of the American people. This is unlike unelected judges taking actions, esp when opposed by our representatives. On the State level (e.g., California) often overturning legislation and public referenda.

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  18. Rick Caird permalink
    20 January 2010 4:13 am

    I had health insurance for which I pay about $1K month. On the other hand, a friend of mine w/o health insurance had a similar experience to mine. H even went to the same hospital.

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  19. Rick Caird permalink
    20 January 2010 4:29 am

    Oh, and FM, take a look at NICE. Take a look at the problems with English hospitals and their statistics. If you love waiting in the hallways for a room, it will be right up your alley. As I said, if you don’t need medical care, socialized medicine is great. But, just don’t get sick. I live in South Florida. Every year, Canadians leave early to go home because they have a doctor’s appointment and if they miss it, it will take a long time to reschedule. Invariable, if I call my primary, I can get in that day. Try that in Canada or England.

    The problem with FM and Xiaoding is they seem to expect the same level of health services, but just a different payer. No, that is not the way it will work. We already have doctors opting out of Medicare because of low reimbursement levels and the many denials by Medicare. We simply cannot have the same level of care we have now at a reduced price. Both England and Canada import many of their doctors and still they are understaffed.

    Oh, and FM,do you want the statistics on cancer survival rates between the US and both Canada and England? They are readily available. Here are some to start:
    Average cancer survival rate in U.S: 68% in Canada: 55% in Europe: 45%
    Prostate cancer survival rate in U.S: 81% in Britain: 43%
    Average breast cancer survival rate in U.S: 83.9% in Europe: 73.1% in the U.K: 69.7%

    I hardly think that is absurd. You complain about anecdotes and data but give us those spurious references which are easy to deconstruct. Brother, log, eye.
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    FM reply: I don’t know where you get this stuff, repeating propaganda that’s been disproven here and a hundred other times. First, some general points.
    * You give no source for your numbers, which as far as I’m concerned makes this noise (I doubt you’re writing this from memory, so why not add the source). If you’ll look at the posts on this site you’ll find links to a wide range of expert studies.
    * There is relatively little difference in broad health care outcomes among the nations I’ve mentioned. You’re cherry pickking by picking cancer (something the US does well), amongst a broad range of illnesses. It means nothing by itself.
    * As has been repeated many times, the UK is at the bottom of the range in western outcomes. Focusing so relentlessly is agitprop for morons. Which is why I repeated suggest comparisons to nations in the middle and upper ranges – like France, Germany, etc.

    Second, making these comparisons is complex. The best effort I’ve see for this is “Cancer survival in five continents: a worldwide population-based study (CONCORD)”, Lancet Oncology, August 2008 (PDF here, text here). Some results:
    * The differences between US, Canada, Japan, and France are small.
    * Canada has good results. As does Cuba (considering its tiny budget), which the highest survival rate for some cancers (e.g., breast, colorectum, colon in women, rectum in women).
    * “The differences in cancer survival between blacks and whites of both sexes in the USA are large, and remarkably consistent in 16 states and six metropolitan areas.” For example, “the age-adjusted pooled estimate of 5-year survival for breast cancer was 84·7% for whites (range 80–90%) and 70·9% for blacks.”
    * Some (not all) of the higher survival rates in the US results from data collection limitations, with areas having higher care overrepresented in previous studies.

    Third, you miss the central point in this debate: we spend far more than anyone else — but get broadly similar results. Dozens, perhaps hundreds of studies verify this. For example, “Health Status, Health Care and Inequality: Canada vs. the U.S.“, June E. O’Neill and Dave M. O’Neill, National Bureau of Economic Research, September 2007. Conclusion: similar outcomes, with “The need to ration resources in Canada, where care is delivered ‘free’, ultimately leads to long waits. In the U.S., costs are more often a source of unmet needs.” But they spend 10.0% of GDP; we spend 16.4% of GDP (and our GDP is larger).

    “We simply cannot have the same level of care we have now at a reduced price”
    I marvel at the God-like certainty with which you say this, esp as other developed nations have the same level of outcomes at far less than we pay.

    “but give us those spurious references which are easy to deconstruct”
    You have hardly “deconstucted” anything.

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  20. Ulenspiegel permalink
    20 January 2010 7:17 am

    @Elle

    You miss the point, in Germany there are a lot of private insurance companies. However, their performance is – despite their ability to cherry-pick their customers (!)- worse than the performance of the “government” insurance programs.

    My father was police officer, when he retired in 1996 my mother had to join either a private insurance or a gov. insurance which would cover the other 50% that my dad’s insurance doesn’t. My mother chose a private comapny which offered in 1995 slightly better service for the same moeney. 13 years later the service of the private company is not longer better, only twice as expensive as a gov. program. This is not a single case but quite common. For my mother with a pension of 1400 EUR a insurance fee of 250 EUR (compared to 130 EUR) means a lot.

    I have no principle problens with private programs, but I still have to find one that works better than the goverment programs, therefore, my pragmatic approach would be to copy the better one :-)
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    FM reply: And that’s for people who can get care. The others are dogs to Elle. Sick people who live in the of “preexisting conditions”, unable to get coverage. People earning too much for Medicare but unable to get insurance (with jobs not providing employer health care). Folks denied coverage but unable to afford an attorney to sue the bastards. Etc.

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  21. Pete permalink
    20 January 2010 7:23 am

    FM wrote of the healthcare cost crisis, “I said this was the “easiest of our major problems to fix.”

    Fabius, what specific measures do you support to handle this ‘easily fixable’ problem? I think you’ll find that it is far from a simple puzzle to solve, because it involves such a large segment (1/6th) of the American economy, with so many competing interests. Morever, there is nothing so personal as control of one’s own body… so emotions are bound to run high. The debate over whether or not to use “socialized medicine” is to an extent, misleading. We already have government-run healthcare, only the government runs it via surrogates such as the Joint Commission, the FDA, USPS, EPA, SSA/Medicare/Medicaid, and in the insurance industry. This is self-evidently true for anyone who has ever worked in a large urban medical center, as I have. The amount of red tape, paperwork, government regulations and the like imposed on caregivers has to be seen to be believed. We have had a semi-socialist system for decades; the debate is whether or not the third party interposed between the patient and physician is an insurer or a government employee. I prefer neither be interjected into the very private doctor-patient relationship, but forced to make a choice, would choose an insurer. Morever, we already have rationing of healthcare, and will face more as the boomers age. The real issue is who will make decisions pertaining to what care you get and how much it will cost; you and your caregiver, the two of you plus an insurer, or the two of you plus a government bureaucrat, or perhaps the doc, patient, insurer and government bureaucrat. If rationing is to occur, I’d prefer to make such decisions myself, in consultation with my physician, and not have some distant paper-pusher who isn’t a medical professional make those choices.

    I’ll await your answer, but while I do, consider this question: veterinary medicine is every bit as advanced as human medicine, the training every bit as difficult (vet school is tougher to get into than medical school). Yet, costs are not out of control, procedures are usually paid out-of-pocket by the consumer, and are priced to reflect market conditions by the DVM. There is minimal interference in the market by government, insurers, and other third-parties. I hear no calls for reform of the system, the neighbor’s dog and cat apparently get first-rate care. While on its surface such a comparison seems ludicrous, it isn’t. It is how medical care for humans used to be delivered in this country, before employers and the government got involved in healthcare markets.

    The current system is, at bottom, a massive game of “hot potato,” in which everyone wants the best of everything, but does not want to pay for it, and upon being presented with the bill, hands it as quickly as possible to his neighbor. The healthcare market is so distorted that price signals no longer work to change demand. If efficient price signals were in effect, a terminally ill cancer patient (to name one example) would have a consultation, learn the costs versus benefits of each treatment, and then make a choice on that basis. No such consultation is possible today; physicians and surgeons cannot even quote prices for their services with any certainty before delivering them. If you are in the mood for some easy humor, before your next surgical procedure, ask him/her what it costs, then wait for the baffled look on his face.
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    FM reply: Why do you believe this is so difficult for America, but easily solved for everybody else? A mutant form of American exceptionalism? The Bell Curve at work, with us dumber than everybody else? I see lots of moaning, but no answer to this.

    “{Vet care} It is how medical care for humans used to be delivered in this country”
    Why didn’t anyone else suggest this! Put down the children of sick people, just like horses are being put down because their owners can no longer afford them (see Time’s article). I cannot believe you didn’t know this: before Medicare/Medicaid the poor had little access to health care. You might be nostalgic for that era, but few of the rest of us share that callousness.

    There are a wide range of solutions sitting on the shelf. Seeing this as a dicotomy (private sector or socialism) is nuts. As you note, the government already spends (from memory) 45% of our health care dollars.We’re just too dysfunction to fix this (or any other) problem at this moment. When we can no longer borrow at 0%, have a 10% deficit plus rising Medicare costs — then we’ll do something fast. For example, we could xerox a copy of France’s system and solve the problem STAT (i.e., over a few years, albeit not painlessly). Or we’ll do something else. Then we’ll work on the other problems, which are difficult.

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  22. Al L. permalink
    20 January 2010 8:40 am

    FM commented to pete: “As you note, the government already spends (from memory) 45% of our health care dollars.

    If my memory serves me correctly, private insurance only covered about 40% of the total cost of medical care in this country a couple of years ago (maybe less now). The rest is covered by the Fed govt, state govt, local govts, write offs by healthcare providers, charity and patients. Thats partly why our system is expensive, it’s a shell game where the private insurers spend a lot on administrative work (charged to the customer of course) to pick who fits the 40%. The other entities get stuck with the pool the private insurers don’t want and they pass around a lot of paperwork shuffling the costs around (sometimes they pass the actual patient around too).

    If you think about it, there is a huge effort put into avoiding being the entity who must cover the costs of the least desirable patients, who end up being those who want insurance but can’t get it. Interestingly, under our system the least desirable patients aren’t as a group the most costly, the most costly are already by and large covered by Medicare or Medicaid.

    Quite the screwed up mess.

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  23. Elle permalink
    20 January 2010 12:22 pm

    FM-“just an unreliable source of information about these things”

    Of course I am an unreliable source of information,I am not here to provide information.I am trying to gain understanding of the issues you present.You have a wonderful opportunity with your blog and background to educate people here.

    In your statements you say in regards to health care “It will bankrupt us if not fixed.” Then you say your solution “will not bankrupt us” Further in you say “The solution probably will involve some sort of soft default.” Which sounds like “soft bankruptcy” to me. And you say we should emulate the euro-system because it is better.But it is still costly. Then you say the government is dysfunctional but that is the only source of our solution. Quite frankly these conflicting statements confuse me.

    Then you proceed to excoriate your commentators because we are somehow not as compassionate,informed or enlightened as you.

    Your proposed solution may have merit,but if you can not explain it to a simple blond in the mojave desert,then you are facing the same issue the government is having selling their plan to the American people.And reacting the same way.And this doesn’t even begin to address to the pork and earmarks hidden in the current bill that have nothing to do with health care.

    If their is some type of required education level or special information required to view your blog or comment here,by all means post it at the top of your blog-so I won’t bother you with questions,try to understand what you are saying or comment anymore.It is,after all your blog,which you have opened up to the public.
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    FM reply: Just read the post carefully (and some of the links) and it will be clearer. Here are a few tips.
    “soft bankruptcy” — what is this?
    “But it is still costly” — compared to what?
    “you say the government is dysfunctional” — No, I said “the US political system” is dysfunctional, not the government (a telling confusion on your part). We are the key component of the political system.
    “if you can not explain it to a simple blond in the mojave desert” — Many things in science, politics, and life in general cannot meet that test.
    “we are somehow not as compassionate as you”” — I suggest you read “A modest proposal” by Jonathan Swift. If Christian, there are several relevant passages in the New Testament. Or discuss this with someone in any other developed nation, none of whom have our problem with the uninsured.

    “And this doesn’t even begin to address to the pork and earmarks hidden in the current bill that have nothing to do with health care.”
    This suggests that you have totally missed the point of the post.

    Like

  24. Rick Caird permalink
    20 January 2010 12:30 pm

    FM: Due to the length of this, I’ve inserted comments into the text.

    Here are statistics on MRI and wait times: here here here

    *** Since this point has been raised and answered a dozen times, I conclude that you are a fine example of the effectiveness of modern propaganda! All you can see are the Canadian and UK health care systems, from which you generalize grand but bogus conclusions. This just in: there are other systems, most of which work quite well! You can ignore them all you want, but they still exist.

    “FM reply: The uninsured wait quite a while for anything but necessary surgery.”

    I have already given you the counter example of my friend w/o health insurance who got immediate heart surgery. He now has a large debt, but he is alive and working. I would like to see your reference on wait times for the “poor”. From what I know, once a Medicaid patient gets into the system, he gets about the same service level as anyone else.

    *** I cannot imagine why you believe anyone should consider your single anecdote evidence of anything.

    The claim of 45,000 excess deaths is unsupportable. Factcheck American Thinker.

    *** Quote from the first article you cite:

    “Now, on to the tough question: Is the 45,000 figure accurate? We can’t say for sure, but scores of other studies also conclude that persons without health insurance have a higher chance of dying prematurely than those with health insurance. … The 45,000 estimate is at the high end of estimates, but earlier studies also have put the number of excess deaths from lack of insurance coverage in the thousands…” {FM note: the estimates from the other studies cited are actually in the tens of thousands}

    Now, please read this next reference closely. The anecdote is of a guy who avoided going to the doctor, but his surgery was paid for by Medicaid. So, what happened. We don’t know because the anecdote didn’t tell us. Was he covered by Medicaid all along or not? Did he not bother to apply for Medicaid or was it just too much trouble? CBS news story

    *** That’s good advice not to bother reading this stuff. It’s anec-data, useful as propaganda but little else.

    The takeaway (at the end of course) about the 45,000: “I think you can’t trust the results,” Goodman said. “Having said that, we ought to do something for the uninsured.”

    *** What is your point here? I don’t see one.

    Denial is a big deal and occurs with or without insurance. I lost two friends last year, both of whom were insured, but refused to go to the doctor for 6 months. One died of a heart attack in his sleep 6 months after his obvious symptoms started. The second died of throat cancer because he waited 6 months for the problem to go away and when he saw a doctor, it was too late. So, when the claim is of 45,000 additional deaths, we would need to know how many of those simply refused to go to the doctor even if they could afford it.

    *** These little stories mean nothing. They merely serve to re-enforce one’s own preconceptions. This is why experts do research.

    FM also claims that the “General Welfare” clause allows the US to take over health care. If that is true, we have just discarded the 10th amendment and the concept of enumerated powers. We might as well get rid of the states then. The Feds can do anything they want as long as they believe it in the “General Welfare”

    *** This is nuts. In any case, we have these programs because the American people support them and their elected represenatives vote for them. It’s called democracy.

    Then, FM, you start to get nasty. The Lancet study (same people as the deaths in Iraq misestimate) has only a summary which is not very helpful. Did you actually spend the $31.50 to buy it?
    *** I gave two links to free text versions. Both worked fine for me.

    Then, too, the abstract for “Health Status, Health Care and Inequality: Canada vs. the U.S.“ included this part that you left out:

    “Does Canada’s publicly funded, single payer health care system deliver better health outcomes and distribute health resources more equitably than the multi-payer heavily private U.S. system? We show that the efficacy of health care systems cannot be usefully evaluated by comparisons of infant mortality and life expectancy. We analyze several alternative measures of health status using JCUSH (The Joint Canada/U.S. Survey of Health) and other surveys. We find a somewhat higher incidence of chronic health conditions in the U.S. than in Canada but somewhat greater U.S. access to treatment for these conditions. Moreover, a significantly higher percentage of U.S. women and men are screened for major forms of cancer. Although health status, measured in various ways is similar in both countries, mortality/incidence ratios for various cancers tend to be higher in Canada. “

    *** What is your point? My summary said the same thing. Similar helath outcomes, but we pay half as much more (as a % GDP, more in absolute costs).

    I guess that is propaganda, too. Right? As long as you don’t have cancer, you are OK?

    *** Your inability to understand the term “broad health outcomes” is strange. Your focus on cancer is a fine example of confirmation bias.

    I claim we spend more on health care because we want to. We do not want the delays for treatment and we want the best and the latest. Who develops the drugs that most of the rest of the world uses? Notice, too, the upper classes in other countries come to the US for treatment. Wasn’t there a member of the Canadian parliament who went to California for treatment of her breast cancer rather than wait for the Canadian health care system? Buffalo gets a lot of medical tourists from Ontario who do not want to wait. I also fail to understand why you believe we can cut our % of GDP spent on health care by 37.5% and get the same result. I see no reason at all to believe government can do a better job than individuals. Adam Smith would be horrified at that belief.

    *** It does not matter what you believe. Facts are facts, even if you refuse to believe them. Your obsession with the UK and Canadian system is odd, perhaps due to excessive reading of propaganda. Try broadening your vision to other nations.

    I also claim that Medicare and Medicaid are free riders on our health care system. They both underpay and force the insured to pay more for the same service which they pay through their premiums.

    *** Why not start a petition in your community? I suspect you’d have better luck repealing the law of gravity.

    For the record, I am not opposed to more general health insurance. I am opposed to the current bills and I am opposed to a government take over of the health care system. I can see a tax credit for health insurance and counting the company supplied health care in taxable income. I can see a government subsidy for preexisting conditions. I do see this once, though. That means, you cannot go uninsured, then subsidized insurance and then uninsured again. Look, there are lots of things we can do to improve access to the health care system without putting the politicians in charge. Politicians are frightening creatures.

    Like

  25. Rick Caird permalink
    20 January 2010 8:51 pm

    So FM, anyone who disagrees with you is just spouting “propaganda”. That is certainly quite a convenient epithet.

    I wonder why you believe any US system would not look like the Canadian or English systems. I can also add New Zealand which refused to provide a new and more effective breast cancer drug because it “cost too much”.

    I focus on cancer because it is the second highest cause of death, after heart disease, in the US. And, we have readily available statistics. I am surprised you think that is too narrow a focus.

    I was appalled to see you claim “*** This is nuts. In any case, we have these programs because the American people support them and their elected representatives vote for them. It’s called democracy.” So, you are now claiming the Constitution does not matter nor does any polling data on the health care bills because we are a “democracy”. That sounds like a Chavez style “democracy”.
    BTW, ask Coakley about “democracy” and health care. It worked out so well for her.

    FM said “*** What is your point? My summary said the same thing. Similar helath outcomes, but we pay half as much more (as a % GDP, more in absolute costs).” I did not see a “similar” health outcome. Reread the part of the quote you left out, particularly regarding chronic diseases and cancer. You might also ponder the statement “efficacy of health care systems cannot be usefully evaluated by comparisons of infant mortality and life expectancy.” One of claims by the left, and one of your your references is based on life expectancy.

    Finally, you do not like my beliefs, but have no qualm about throwing out your beliefs. You sound like an academic used to bullying students.
    .
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    FM reply: You’re just making stuff up at this point. We’re done here.

    “I focus on cancer because it”
    Focus does not mean make up numbers (which is all we can assume by your refusal to cite a source).

    “I wonder why you believe any US system would not look like the Canadian or English systems”
    Probably because the systems in the developed world are mostly better. Also, we are the last to adopt such systems, and gain from their experience. What’s odd is your certainty that our system would be among the worst. You have little confidence in America, it seems.

    “claiming the Constitution does not matter nor does any polling data on the health care bills because we are a “democracy”.”
    For most people Medicare/Medicaid fit the meaning of “”provide for the general Welfare” — as good or better justification than much of what the government does. Also, elections are not the same as “polling data.”

    “That sounds like a Chavez style “democracy”.”
    You have not given any basis for this crazy comparison. Yes, we’re done here.

    “efficacy of health care systems cannot be usefully evaluated by comparisons of infant mortality and life expectancy”
    This is a standard comment in health care research, as I mentioned in comment #19. The best method for cross-nation analysis is detailed comparison of individual illnesses, adjusted for age and other relevant factors, — as done in the Lancet study I cited. But few comparisons on that basis are available, so we use a range of data — such as otucomes for specific illnesses, inflant mortality, and life expectance. As done in the very article I cite (from the abstract of which you extract this quote).

    “you do not like my beliefs, but have no qualm about throwing out your beliefs.”
    I dislike the fact that you just make stuff up. If you actually read my comments, you will see that is the basis for my objections.

    Like

  26. Pete permalink
    20 January 2010 11:07 pm

    “Why didn’t anyone else suggest this! Put down the children of sick people, just like horses are being put down because their owners can no longer afford them..”

    Fabius, that’s known as an ad hominem attack, of which you ought to know better. Moreover, you are in effect inserting words into my mouth. Actually, you fulfilled my prediction; I made a bet to myself before posting my comments, that you would lapse into ridicule… and you have. You are getting predictable. At no point, did I say anything about denying access to medical care to the poor, nor that people should be treated like animals. After setting up your straw-man, you then deflected my question by referring me to Time magazine, and saying that we could copy the French system. Not good enough. If you take “Time” seriously as a source of independent, unbiased news, you’ve got bigger problems than our disagreement over healthcare. That magazine abandoned any pretense of objectivity long ago, and is now a de facto organ of the Democratic Party and the political left. As far as France is concerned, link me a source, which desribes their system in detail, and I’d be happy to review it and comment after. However, for the time being anyway, you haven’t managed to do any better than those you criticize, in solving the healthcare crisis, or proposing realistic solutions. Being a Monday-morning quarterback is such good duty, isn’t it?
    .
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    FM reply: Several things in reply.

    “that’s known as an ad hominem attack,”
    (1) It is not an ad hominem attack to mock what you say. I make no reference to you personally.

    “you would lapse into ridicule”
    (2) Bogus. You recommended vet care as a model for our medical system. The plant on my desk could predict that most people would respond with ridicule. I recieved several emails asking if I planted your email.

    (3) You ignore what I said about your using vets as a model, substantive comment in addition to the well-deserved ridicule.

    (4) “deflected my question by referring me to Time magazine … seriously as a source of independent, unbiased news, you’ve got bigger problems”
    You believe horses are not being abandoned? It’s a nationwide phenomenon, with many articles. Call up your local SPCA to confirm it. (I suspect you’re just spouting, and did not bother to look at the story.

    (5) “As far as France is concerned, link me a source, which desribes their system in detail, and I’d be happy to review it and comment after”
    As if I care. Do your own research.

    Like

  27. Xiaoding permalink
    20 January 2010 11:44 pm

    “As far as France is concerned, link me a source, which desribes their system in detail, and I’d be happy to review it and comment after.”

    Dude, your on the freakin internet, use it yourself. I love these “send me a link” types!

    Like

  28. Fred permalink
    21 January 2010 2:19 am

    FM reply at 20: “Folks denied coverage but unable to afford an attorney to sue the bastards.”

    Generally if a party to a contract breaches the contract, then the other party can sue either for damages caused by the breach or for specific performance of the contract or to rescind the contract. Typically both sides to the case pay their own attorney fees and costs.

    As insurance is a contract, an insured can sue the insurer for breach of contract. Because of the nature of insurance contracts, most states (maybe all) permit an award of attorney fees and costs to the insured if the breach by the insurer is found to be in bad faith.

    However, the Employee Retirement Income Security Act of 1974 (ERISA) (Pub.L. 93-406, 88 Stat. 829, enacted September 2, 1974) does not permit awards of attorney fees and costs to an insured in a health insurance case notwithstanding the extent of the bad faith. This law under the doctrine of the federal pre-emption of conflicting state law trumps all fee-shifting state law.

    As a result, health insurance companies can nickle and dime their insureds on virtually all claims. For example, if your health insurance plan promises free annual mamograms, but then your claim is denied, you can either relentlessly hassle the customer service representative in the hope the claim will finally be paid, or try to find a lawyer to sue for the cost of the mamogram, or file suit yourself, or pay the bill out of your own pocket. As the cost of a mamogram is low, many people tire of the hassle and just pay the bill.

    Because the proponents of reform insist that the reform should be “comprehensive” (or it’s not worth doing at all), multiple bills with multiple amendments have been introduced which prevents any regular person without a masters degree in conversational Sanskrit from understanding whether any of the competing bills or amendments have any value.

    This conveniently permits every member of Congress to say anything they want about any proposal on the table. And they do. There may be a few Congressmen or Senators with hearts of gold, but how can any sheep know for sure.

    So “comprehensive” reform should be abandoned until there has been a full and fair debate in Congress on the limited reform of repealing the fee-shifting ban in ERISA. It doesn’t have to pass. It just needs to be debated, as there is very little wiggle room for anyone in Congress on this issue. Weasel language will be clearly seen for what it is, whether said by a democrat or a republican.

    Afterwards the sheep will be much better able to identify the most cynical whores in both parties, which just might result in a bipartisan purging of Congress in the next election(s).
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    FM reply: Thanks for the additional color on this. Also many HMO’s and such have mandatory binding arbitration, often in their own private kangaroo court.

    Like

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