The Health Care Debate

[phna]

Blunt?  More like inattentive.  If you were actually paying attention to the discussion, you would find that most my post on the subject are fairly neutral and point out two things:

1)  That health care quality will drop the more people that are brought into coverage.  Based on your post, you think this is an obvious conclusion also.  But it is not obvious to everyone because there are posters and others who believe a government run health care system could offer the same quality of coverage as private industry does to the insured without a drop in the overall quality of health care.   I don't believe I have ever espoused the view that the US system is not broken or that coverage should not be extended to all people, I just think that when it comes, it will come with a consequence.  And I suspect that it will come as a bit of a shock to a significant portion of the population.

2) I disagree and will continue to disagree with those who state that the quality of service offered by national health care systems is as good as what INSURED Americans receive.  I am actually pretty careful with my wording here because quality does not mean efficiency or whether it is the right or wrong system.  I also am pretty careful to only include INSURED Americans as those receiving quality health care (although that is roughly 70% of the population).  If we are going to have a health care debate, it would be good to dispel with the myths that national health care in the UK and other places offer the same QUALITY on a per patient basis as INSURED patients get in the US, they don't. 

As far as offering something objective, I really don't know where you are coming from with your link; the weakness of our health care system from a societal point of view is something I have long acknowledged on this forum.  I make no assertions about the relative morality of our health care system or its efficiency or even it's cost or even whether the current system should be continued.  I am just pointing out the quality of health care for the US insured vs national health care systems.  Yes, it's truly too bad that so many Americans suffered financial ruin as a result of our system but that is not really a health care quality issue; it's a societal issue.  Continue being as blunt and bursk as you wish but I would suggest you are in the wrong argument because nothing you have pointed out has any relevance to anything I have said.         

Inattentive???. I directly quoted you!  Furthermore, On quality, of health care, quotes IOM's from To err is Human several times, prior to this in the very same thread and in other threads. The link provided deals with facts you have glibly overlooked. 

In point 1 you give no facts or supporting evidence and the link I gave directly refutes the conclusion you make.

"Getting Everyone Covered Will Save Lives and Money


The impacts of going uninsured are clear and severe. Many uninsured individuals postpone needed medical care which results in increased mortality and billions of dollars lost in productivity and increased expenses to the health care system. There also exists a significant sense of vulnerability to the potential loss of health insurance which is shared by tens of millions of other Americans who have managed to retain coverage.

Every American should have health care coverage, participation should be mandatory, and everyone should have basic benefits. "

Here are the sources which support that conclusion:

# DeNavas-Walt, C.B. Proctor, and J. Smith. Income, Poverty, and Health Insurance Coverage in the United States: 2007. U.S. Census Bureau., August 2008.
# The Henry J. Kaiser Family Foundation. The Uninsured: A Primer, Key Facts About Americans without Health Insurance. October 2006. http://www.kff.org/uninsured/
# Families USA. Wrong Direction: One Out of Three Americans are Uninsured. September 2007. http://familiesusa.org/assets/pdfs/wrong-direction.pdf
# The Henry J. Kaiser Family Foundation. Employee Health Benefits: 2008 Annual Survey. September 2008. http://www.kff.org/insurance/7672/index.cfm
# Center on Budget and Policy Priorities. The Number of Uninsured Americans is at an All-Time High. 29 August 2006 http://www.cbpp.org/8-29-06health.pdf.
# Clemens-Cope, Lisa, et al, Changes in Employees’ Health Insurance Coverage, 2001-2005, Kaiser Commission on Medicaid and the Uninsured, October 2006.
# The Henry J. Kaiser Family Foundation. The Uninsured: A Primer, Key Facts About Americans without Health Insurance. January 2006. ttp://www.kff.org/uninsured/.
# The Henry J. Kaiser Family Foundation. Employee Health Benefits: 2008 Annual Survey. September 2008. http://www.kff.org/insurance/7672/index.cfm
# Dalrymple, M., “Senators Seek Tax Credit for Unemployed.” Associated Press, 9 October 2003.
# Institute of Medicine. Insuring America’s Health – Principles and Recommendations. The National Academies Press, 2004.
# Institute of Medicine. Care Without Coverage – Too Little, Too Late. The National Academies Press, 2002.
# The Urban Institute. Key Findings from the 2002 National Health Interview Survey. 9 August 2004.
# The Henry J. Kaiser Family Foundation. Access to Care for the Uninsured: An Update. 29 September 2003 http://www.kff.org/uninsured/4142.cfm.
# Institute of Medicine. Hidden Costs, Values Lost: Uninsurance in America. The National Academies Press. 17 June 2003 http://www.iom.edu/Report.asp?id=12313.
# Consumer Reports. Are You Really Covered? September 2007.

In point 2 you give no facts again and the link I provide directly refutes the conclusion you make. Here it is directly.

"The United States spends the most money on medical care of all advanced industrialized countries, but it performs more poorly than most on many measures of health care quality.1, 2, 3, 4"

Here is the literature and studies that report that conclusion

# Keehan, S. et al. “Health Spending Projections Through 2017, Health Affairs Web Exclusive W146: 21 February 2008.
# Blendon, R.J., C. Schoen, C.M. DesRoches, R. Osborn, K. Zapert, E. Raleigh, “Confronting Competing Demands to Improve Quality,” Health Affairs, 2004:23(3): 119-135.
# Schoen, et al., “Taking the Pulse of Health Care Systems: Experiences of Patients with Health Problems in Six Countries,” Health Affairs Web Exclusive W5-509, 03 November 2005.
# The Commonwealth Fund Commission on a High Performance Health System, Why Not the Best? Results from a National Scorecard on U.S. Health System Performance, The Commonwealth Fund, September 2006.


To put it bluntly, the argument you present is fallacious besides being without substantiation.  It's not only inconclusive, it is anecdotal, and so it is worthless given the body of work on the issue.

[aknowledgeableperson]

To put it bluntly, the argument you present is fallacious besides being without substantiation.  It's not only inconclusive, it is anecdotal, and so it is worthless given the body of work on the issue.

Behind facts and figures are people.  To belittle another one's argument because it is "anecdotal" because it does not support all of your facts and figures and quotes and all really makes your case weaker.  People do have experiences and those experiences are their "facts", just on a personalized basis.

Now here are some other "facts" to consider.
No health care system is perfect nor will it ever be perfect.  There will be some cracks somewhere in the system (afterall there will be some patients who have a doctor who came in last in his or her class for example for a good reason).
Everyone will not receive the same level of care.  Much like everything else who you know and/or who you are just might give you a higher level of care.
Just because someone has health care coverage does not mean that one always sees a doctor when needed.  Job and/or family demands may make one postpone or not receive medical treatment when needed.

And I am sure that there are some other facts out there than can be taken into account.  Now these facts come from human nature, not from some book that one can quote.  Can US health care be improved?  Yes, it can.  But one has to take into account that the overall improvement does have a cost and that cost just might be a lower level of care for many.  (Isn't there a saying about having the cake and being able to eat it?)

[Highlander]

Inattentive???. I directly quoted you!  Furthermore, On quality, of health care, quotes IOM's from To err is Human several times, prior to this in the very same thread and in other threads. The link provided deals with facts you have glibly overlooked. 

In point 1 you give no facts or supporting evidence and the link I gave directly refutes the conclusion you make.

"Getting Everyone Covered Will Save Lives and Money


The impacts of going uninsured are clear and severe. Many uninsured individuals postpone needed medical care which results in increased mortality and billions of dollars lost in productivity and increased expenses to the health care system. There also exists a significant sense of vulnerability to the potential loss of health insurance which is shared by tens of millions of other Americans who have managed to retain coverage.

Every American should have health care coverage, participation should be mandatory, and everyone should have basic benefits. "

Here are the sources which support that conclusion:

# DeNavas-Walt, C.B. Proctor, and J. Smith. Income, Poverty, and Health Insurance Coverage in the United States: 2007. U.S. Census Bureau., August 2008.
# The Henry J. Kaiser Family Foundation. The Uninsured: A Primer, Key Facts About Americans without Health Insurance. October 2006. http://www.kff.org/uninsured/
# Families USA. Wrong Direction: One Out of Three Americans are Uninsured. September 2007. http://familiesusa.org/assets/pdfs/wrong-direction.pdf
# The Henry J. Kaiser Family Foundation. Employee Health Benefits: 2008 Annual Survey. September 2008. http://www.kff.org/insurance/7672/index.cfm
# Center on Budget and Policy Priorities. The Number of Uninsured Americans is at an All-Time High. 29 August 2006 http://www.cbpp.org/8-29-06health.pdf.
# Clemens-Cope, Lisa, et al, Changes in Employees’ Health Insurance Coverage, 2001-2005, Kaiser Commission on Medicaid and the Uninsured, October 2006.
# The Henry J. Kaiser Family Foundation. The Uninsured: A Primer, Key Facts About Americans without Health Insurance. January 2006. ttp://www.kff.org/uninsured/.
# The Henry J. Kaiser Family Foundation. Employee Health Benefits: 2008 Annual Survey. September 2008. http://www.kff.org/insurance/7672/index.cfm
# Dalrymple, M., “Senators Seek Tax Credit for Unemployed.” Associated Press, 9 October 2003.
# Institute of Medicine. Insuring America’s Health – Principles and Recommendations. The National Academies Press, 2004.
# Institute of Medicine. Care Without Coverage – Too Little, Too Late. The National Academies Press, 2002.
# The Urban Institute. Key Findings from the 2002 National Health Interview Survey. 9 August 2004.
# The Henry J. Kaiser Family Foundation. Access to Care for the Uninsured: An Update. 29 September 2003 http://www.kff.org/uninsured/4142.cfm.
# Institute of Medicine. Hidden Costs, Values Lost: Uninsurance in America. The National Academies Press. 17 June 2003 http://www.iom.edu/Report.asp?id=12313.
# Consumer Reports. Are You Really Covered? September 2007.

In point 2 you give no facts again and the link I provide directly refutes the conclusion you make. Here it is directly.

"The United States spends the most money on medical care of all advanced industrialized countries, but it performs more poorly than most on many measures of health care quality.1, 2, 3, 4"

Here is the literature and studies that report that conclusion

# Keehan, S. et al. “Health Spending Projections Through 2017, Health Affairs Web Exclusive W146: 21 February 2008.
# Blendon, R.J., C. Schoen, C.M. DesRoches, R. Osborn, K. Zapert, E. Raleigh, “Confronting Competing Demands to Improve Quality,” Health Affairs, 2004:23(3): 119-135.
# Schoen, et al., “Taking the Pulse of Health Care Systems: Experiences of Patients with Health Problems in Six Countries,” Health Affairs Web Exclusive W5-509, 03 November 2005.
# The Commonwealth Fund Commission on a High Performance Health System, Why Not the Best? Results from a National Scorecard on U.S. Health System Performance, The Commonwealth Fund, September 2006.


To put it bluntly, the argument you present is fallacious besides being without substantiation.  It's not only inconclusive, it is anecdotal, and so it is worthless given the body of work on the issue.

Once again you are not even involved in the same debate I am.  I do not know where you are even coming from.  Everyone of those reports take into account uninsured Americans and I have purposefully limited my discussion to the quality of health care for insured Americans.  What does it take to make that clear to you?  I am out of this discussion because there really is no discussion to have.  I say the sky is blue and you come back and tell that I am wrong because the forest is actually green.  Adios. 

[phna]

Once again you are not even involved in the same debate I am.  I do not know where you are even coming from.  Everyone of those reports take into account uninsured Americans and I have purposefully limited my discussion to the quality of health care for insured Americans.  What does it take to make that clear to you?  I am out of this discussion because there really is no discussion to have.  I say the sky is blue and you come back and tell that I am wrong because the forest is actually green.  Adios.   

Au revoir.

This is the assertion made, which evidence already given directly refutes.

"1)  That health care quality will drop the more people that are brought into coverage." Its obvious that means the uninsured.  Thus, the argument is on point.

Also the IOC report "Too Err is Human" points out the major problems with quality, which affects insured and uninsured.

You also did  xenocomparisons to the US Health System of which some of those systems are Universal coverage Single payers.  There was a small British study which supported that notion that the subjects of study were healthier than their American counter parts.

Here are some links to  reports of that study:

British healthier than Americans in middle age: study
http://www.redorbit.com/news/general/48 ... age_study/

Blimey! Americans sicker than the Brits
More in U.S. suffer chronic diseases despite more health care spending
http://www.msnbc.msn.com/id/12595624/from/ET/

Jolly Rogers Why are British men healthier than American ones?
http://www.slate.com/id/2141648/

Im sure the study will be (and should  be) replicated. Until then, adios.

[Highlander]

Au revoir.

This is the assertion made, which evidence already given directly refutes.

"1)  That health care quality will drop the more people that are brought into coverage." Its obvious that means the uninsured.  Thus, the argument is on point.

Also the IOC report "Too Err is Human" points out the major problems with quality, which affects insured and uninsured.

You also did  xenocomparisons to the US Health System of which some of those systems are Universal coverage Single payers.  There was a small British study which supported that notion that the subjects of study were healthier than their American counter parts.

Here are some links to  reports of that study:

British healthier than Americans in middle age: study
http://www.redorbit.com/news/general/48 ... age_study/

Blimey! Americans sicker than the Brits
More in U.S. suffer chronic diseases despite more health care spending
http://www.msnbc.msn.com/id/12595624/from/ET/

Jolly Rogers Why are British men healthier than American ones?
http://www.slate.com/id/2141648/

Im sure the study will be (and should  be) replicated. Until then, adios.

Key quote in the British men are healthier articles you provided:  "Considerably more middle-aged Americans suffer from chronic illnesses than their British counterparts, probably because more Americans are obese, researchers said on Tuesday."

That has generally nothing to do with health care quality (unless you want to argue that the NHS system here somehow encourages men to stay in shape; they try to but so do we).  It has much more to do with several cultural differences such as 1) Brits walk more.  Cities are denser which fosters less driving and more walking.  2) Exercise is much more common, british men bike to work quite often and the streets are full of runners at lunch 3)  Restaurants are expensive and people eat out much less.  When they do eat out, portion sizes are much smaller and meals somewhat less fatty.  4) and men generally spend less time sitting in the office (where there is very little if any vending).  I won't go into poverty and education because the studies supposedly controlled for those variables. 

[aknowledgeableperson]

  There was a small British study which supported that notion that the subjects of study were healthier than their American counter parts.

I would tend to agree with Highlander in his response to this.  Yes, the Brits may be "healthier" but that health may not be the result of health care provided.  Health is a very subjective topic and has many variables and factors that affect "health".  Besides, quoting a "small study" does not actually prove a point.  Unless that study has been repeated by others with the same results.

What would be a more appropriate comparison (at least to me) would be how ailments and illnesses are treated and the success rates, or lack of success, of those treatments.  For an example, how would a mid-fifties male with stage I prostate cancer be treated and the success rates of treatments after 5 years?  Or a 70 year old male with stage III prostate cancer?  How often are hips and knees replaced and under what conditions?  How is heart disease treated and how agressive is the treatment given the age of the patient? 

I also love the studies concerning infant mortality rates and how old people live.  Higher infant mortality rates can be the result of higher drug usage not a reflection of care actually given and received.  And how long one lives can be a reflection of diet, exercise, levels of violence, drug usage and other factors that do not reflect the health care given or received.

[LenexatoKCMO]

That has generally nothing to do with health care quality (unless you want to argue that the NHS system here somehow encourages men to stay in shape; they try to but so do we).  It has much more to do with several cultural differences such as 1) Brits walk more.  Cities are denser which fosters less driving and more walking.  2) Exercise is much more common, british men bike to work quite often and the streets are full of runners at lunch 3)  Restaurants are expensive and people eat out much less.  When they do eat out, portion sizes are much smaller and meals somewhat less fatty.  4) and men generally spend less time sitting in the office (where there is very little if any vending).  I won't go into poverty and education because the studies supposedly controlled for those variables. 

Precisely - I suspect that if you could find a study with the stats for miles walked per day/per adult amongst the American and English populations, you would probably find the reason for most of the difference and then some. 

[phna]

It is the Height of Hypocrisy to point to the flaws or limitations of an objective evidenced based study when, in the argument to which it clearly refutes, there was no study, fact or data to support it otherwise. 

Ok, health care is subjective, that is precisely the reason studies are done and statistical modifications are applied; to weed out variable factors to enable comparisons. Health Care inherently desires to be Evidence based "to the greatest extent possible, the decisions that shape the health and health care of Americans– by patients, providers, payers and policymakers alike—will be grounded on a reliable evidence base, will account appropriately for individual variation in patient needs, and will support the generation of new insights on clinical effectiveness."1

Obviously too, they can be done with more specificity, and if they are done with more specificity then the conclusions are only valid to that range. In this case it doesn't necessarily prove an point, but it is more than sufficient to refute an assertion made that has no evidence to support it, especially when the objective evidence actually point to the contrary. So,  An anecdotal assertion (sample size 1) is presented vs a flawed study of broad scope (sample size 8000),  who can sensibly argue the latter is less objective or evidence based?????  Criticizing the flaws of the study only makes it more obvious that the anecdotal assertion is of little value in the discussion of the subject of Health Care.

So with little support for the assertion, the only defense of the argument made anecdotally is to contend that the objective evidence is not topical, in this case, that the study has nothing to do with quality, and prior to that it was not topical to the "insured" population. This tactic is as inept as the anecdotal argument it attempts to defend.  Furthermore, without the definition of quality established, how can it be contended it isn't on point?

If fact, it is easier to assert the study is topical--with a definition of quality--than it is to contend the contrary without evidence . Furthermore, it can be definitively argued the assertion "that health care quality will drop the more people that are brought into coverage"* is false. Previously, The Institutes of Medicine report--"Too Err is Human" was referenced.  This important study "put the spotlight on how tens of thousands of Americans die each year from medical errors and effectively put the issue of patient safety and quality on the radar screen of public and private policymakers". 2  The IOM followed that report with "Crossing the Quality Chasm: The IOM Health Care Quality Initiative" In that report we find Quality, as it pertains to health care, defined as" The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge."2

The study is on point with regards to quality. The study reports about  2 populations: one American and one British with health outcomes that are comparable because of the design of the study. Since the study shows that the Brits have lower incidences of disease (diabetes in particular), or a better health outcome, it follows that for these populations, Health services in Britian probide better quality. . Furthermore, since everyone is covered in Britain, which has better quality per the IOM's definition and objective evidence, the assertion above* is false.

The other criticism, that the difference in the higher outcomes for the British population of the study, can be attributed to obesity of Americans, is also false.  Notwithstanding the logical argument that obesity could be reduced by factors of denser cities, walking more, exercising, biking, eating sensibly, and so forth.  It is anecdotal (more Brits running more in the streets) statement without fact to contend with the objective evidence.  Anyway, it is moot, since "The researchers crunched numbers to create a hypothetical statistical world in which the British had American lifestyle risk factors, including being as fat as Americans. In that model, the researchers found Americans still would be sicker."3

So, not only is the argument anecdotal, it is just false based upon the objective evidence that directly refutes it. This comes as no surprise, as anecdotal arguments tend to be biased by the person making the statements.  The second assertion: "that the quality of service offered by national health care systems is [not] as good as what INSURED Americans receive" is not supported by evidence either and strongly refuted here; however, to avoid the topicality tactic the latest report (2/2009) from the IOM should put this debate to rest too.  And yes, it is topical and certainly more scientific than an anecdote.

America’s Uninsured Crisis: Consequences for Health and Health Care

http://www.iom.edu/Object.File/Master/6 ... %20web.pdf

[aknowledgeableperson]

  Anyway, it is moot, since "The researchers crunched numbers to create a hypothetical statistical world in which the British had American lifestyle risk factors, including being as fat as Americans. In that model, the researchers found Americans still would be sicker."3

And that is the weakness - it is a model and not something real.  Numbers are crunched and a hypothetical world is created.  And the way the numbers are crunched and the world is created can be altered to reflect the results one desires.

Not saying the numbers are "fixed" in this case but all it takes is crunching numbers alittle differently and adjusting the weight of factors and a different model is created.

Now, I agree that the lack of health care results in a sicker society because uninsured people will tend not to use the health care services.  But at the same time there are people who do have health insurance but also tend not to use health care services for whatever reason until it is too late.  What we can agree on is that we are at Point A, which is the present, and we wish to be at Point B at some time in the future where more people do have access to health care, whether or not they use it.  Some people wish to travel on one path to Point B and other wish to travel on any number of paths to Point B.  Of course we can also have a discussion on what the cost of Point B is to society and compare that to now.

To me what is the most important data is what is this society spending on health care now and how is it spending that amount.  At one time in the 90's there was some data that a very large portion of health care costs incurred during the last year of one's life.  Some of those funds were spent because of doctors refusing to accept a death of a patient and doing everything possible to prolong life and some of those funds were spent because loved ones refused or would not instruct the doctor to not implement DNR orders.  Or in the case of newborns the costs incurred in the care of premies has grown with the new medical advances of their care.  And it would be nice to know what the costs are to treat sports injuries suffered by our weekend warriors.  Important information would also be what are the costs of malpractice, in terms of insurance, claims, and followup treatment.  Compare the costs of preventive medicine to the actual treatment of patients.

In other words we need to know how we spend our money now, and compare that to others to see where we spend the money and where we can possibly save. 

[aknowledgeableperson]

  Since the study shows that the Brits have lower incidences of disease (diabetes in particular), or a better health outcome, it follows that for these populations, Health services in Britian probide better quality.

From a newsletter from one of my financial advisors:

The National Center for Policy Analysis has published a study, "10 Surprising Facts about American Health Care."  It shows what Americans get for the dollars spend.  We wanted to share their findings with you.  They are:

• "Americans have better survival rates than Europeans for common cancers." Breast cancer mortality is 52% higher in Germany and 88% higher in the United Kingdom than in the United States.  Prostate cancer mortality is 604% higher in the U.K. and 457% higher in Norway.  Colo-rectal cancer mortality is 40% higher among Britons.

• "Americans have lower cancer mortality rates than Canadians." Rates for breast cancer (9%), prostate cancer (184%) and colon cancer among men (10%) are higher than in the U.S.

• "Americans have better access to treatment of chronic diseases than patients in other developed countries." Roughly 56% of Americans who could benefit are taking statin drugs. Only 36% of the Dutch, 29% of the Swiss, 26% of Germans, 23% of Britons and 17% of Italians who could benefit receive them.

• "Americans have better access to preventive cancer screenings than Canadians." Nine of 10 middle-aged American women have had a mammogram; 72% of Canadian women have. Almost every American woman (96%) has had a pap smear; fewer than 90% of Canadian women have. Roughly 54% of American men have had a prostate cancer test; less than one in six Canadian men have. Almost a third of Americans (30%) have had a colonoscopy, while only 5% of Canadians have had the procedure.

• "Lower-income Americans are in better health than comparable Canadians." Nearly 12% of America’s seniors, with below-median incomes, self-report being in "excellent" health. 5.8% of Canadian seniors say the same thing.

• "Americans spend less time waiting for care than patients in Canada and the United Kingdom." Canadians and Britons wait about twice as long, sometimes more than a year, to see a specialist, have elective surgery or get radiation treatment.

• "People in countries with more government control of health care are highly dissatisfied and believe reform is needed." More than seven in 10 Germans, Canadians, Australians, New Zealanders and Britons say their health systems need either "fundamental change" or "complete rebuilding."

• "Americans are more satisfied with the care they receive than Canadians." More than half (51.3%) of Americans are very satisfied with their health care services, while 41.5% of Canadians hold the same view of their system.

• "Americans have much better access to important new technologies like medical imaging than patients in Canada or the U.K." There are 34 CT scanners per million Americans. There are 12 per million in Canada and eight per million in Britain. The U.S. has nearly 27 MRI machines per million. Britain and Canada have 6 per million.

• "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 single developed nation; the most important recent medical innovations were developed here.

Can the nationalized, universal systems in Britain, Canada or anywhere else improve on this?  No!  However, we can ruin our health care by following the policies of countries where medical treatment is far below the American standard.  This is not a recipe for success in caring for our aging population, and they certainly deserve better. 
Change, for changes sake, no matter how well intentioned, always carries with it unintended consequences.  It is no different this time, than any other time in history.

[phna]

From a newsletter from one of my financial advisors:

The National Center for Policy Analysis has published a study, "10 Surprising Facts about American Health Care."  It shows what Americans get for the dollars spend.  We wanted to share their findings with you.  They are:

• "Americans have better survival rates than Europeans for common cancers." Breast cancer mortality is 52% higher in Germany and 88% higher in the United Kingdom than in the United States.  Prostate cancer mortality is 604% higher in the U.K. and 457% higher in Norway.  Colo-rectal cancer mortality is 40% higher among Britons.

• "Americans have lower cancer mortality rates than Canadians." Rates for breast cancer (9%), prostate cancer (184%) and colon cancer among men (10%) are higher than in the U.S.

• "Americans have better access to treatment of chronic diseases than patients in other developed countries." Roughly 56% of Americans who could benefit are taking statin drugs. Only 36% of the Dutch, 29% of the Swiss, 26% of Germans, 23% of Britons and 17% of Italians who could benefit receive them.

• "Americans have better access to preventive cancer screenings than Canadians." Nine of 10 middle-aged American women have had a mammogram; 72% of Canadian women have. Almost every American woman (96%) has had a pap smear; fewer than 90% of Canadian women have. Roughly 54% of American men have had a prostate cancer test; less than one in six Canadian men have. Almost a third of Americans (30%) have had a colonoscopy, while only 5% of Canadians have had the procedure.

• "Lower-income Americans are in better health than comparable Canadians." Nearly 12% of America’s seniors, with below-median incomes, self-report being in "excellent" health. 5.8% of Canadian seniors say the same thing.

• "Americans spend less time waiting for care than patients in Canada and the United Kingdom." Canadians and Britons wait about twice as long, sometimes more than a year, to see a specialist, have elective surgery or get radiation treatment.

• "People in countries with more government control of health care are highly dissatisfied and believe reform is needed." More than seven in 10 Germans, Canadians, Australians, New Zealanders and Britons say their health systems need either "fundamental change" or "complete rebuilding."

• "Americans are more satisfied with the care they receive than Canadians." More than half (51.3%) of Americans are very satisfied with their health care services, while 41.5% of Canadians hold the same view of their system.

• "Americans have much better access to important new technologies like medical imaging than patients in Canada or the U.K." There are 34 CT scanners per million Americans. There are 12 per million in Canada and eight per million in Britain. The U.S. has nearly 27 MRI machines per million. Britain and Canada have 6 per million.

• "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 single developed nation; the most important recent medical innovations were developed here.

Can the nationalized, universal systems in Britain, Canada or anywhere else improve on this?  No!  However, we can ruin our health care by following the policies of countries where medical treatment is far below the American standard.  This is not a recipe for success in caring for our aging population, and they certainly deserve better. 
Change, for changes sake, no matter how well intentioned, always carries with it unintended consequences.  It is no different this time, than any other time in history.

Avoiding the previous hypocritical statement (criticizing the the flaws of the study without anything but an anecdotal opinion otherwise) doesn't avoid the glaring pitfalls of this "data".  The statements offered are just talking points from a source that is a biased to finding a solution one way. The argument that was made is not whether a market approach or single payer approach is better, or that Country A is better than country B, but that no evidence to conclude either was given and the opinion being offered was actually directly refuted by objective evidence. Furthermore, it doesn't contend the US should not offer universal coverage. In fact this really says nothing at all.

This "group" the quotes are taken from wants to advocate a particular solution and provides poor evidence to suggest any conclusion. Using a % to compare populations is the worst statistic that can be used to base conclusions for anything!** The previous study being standardized in order to facilitate comparison also allowed an argument to be made to refute a baseless opinion. It wasn't a proof, but a clear refutation.

To offer the above as proof of superior health performance (or anything) is hypocritical too, given the previous criticism the data "can be altered to reflect the results one desires"  and the above just cherry picked for effect. First, what is offered above isn't data and two, unlike the British study isn't objective.  Even the authors of the British study, if one actually read the links to the report of it, admit to the limitations of it and never asserted it as fact, the source above only wants an uncritical reader, like a financial advisor, to believe what is offered is indeed fact.

If the British study  can be  criticized as "being a model and not something real",  then the data "talking points" just presented can be called a pile of steaming scat and offer no solution to the major problems of the US Health Care system.

The major problems of the US system are cost^, quality*, and access3!

On cost this source and others show:

"The U.S. health care system is already the most expensive in the world, by far, and total health spending is projected to double by 2020—rising from a projected $2.6 trillion in 2009 to $5.2 trillion by 2020 to consume 21 percent of the nation's economic resources (gross domestic product)."




On quality:  98,000 deaths per year*. Definition of quality given previously from IOM's report

On Access (Coverage)3'4,5:

• 45.7 million Uninsured
• Poorer health quality among uninsured
• when a community-level rates of uninsurance are relatively high, insured adults in those communities are more likely to have difficulties obtaining needed health care and to less satisfied with the care they recieve
• Nearly 40 percent of the uninsured population reside in households that earn $50,000 or more. A growing number of middle-income families cannot afford health insurance payments even when coverage is offered by their employers.
• Lack of insurance compromises the health of the uninsured because they receive less preventive care, are diagnosed at more advanced disease stages, and once diagnosed, tend to receive less therapeutic care and have higher mortality rates than insured individuals.[li]5

Solving these problems requires dispassionate objective research to suggest a solution, not out of political concern, but toward a better Health System, with less waste, better outcomes, and lower cost.  Debates about System A is better than system B are superfluous in that goal without a basis of comparison that is objective. The British Study, while flawed, was far better as a comparative tool than the quotes above.

America is more innovative in health care! But what good is innovation that is not accessible to everyone, or, if used causes more harm than good and at cost so high it's use is unsustainable?

^ http://www.commonwealthfund.org/Content ... ystem.aspx
*Read the IOM's Report. "Too Err is Human". At least, The executive summary. This has been quoted several times. It's fair to say this is fact!
**The only standardized stat from the quote above was the CT and MRI statistics. Given the IOM's assertion that as uninsured populations grow, resources tend to be clustered closer to the insured populace, it is easy to surmise that this is the covered population that is getting access to these resources. There is no clear indication otherwise.

3http://www.iom.edu/Object.File/Master/6 ... %20web.pdf
http://www.nchc.org/facts/coverage.shtml4
Institute of Medicine. Care Without Coverage – Too Little, Too Late. The National Academies Press, 2002. 5

[phna]

Daily Red Meat Raises Chances Of Dying Early
Study Is First Large Analysis Of Link With Overall Health



http://www.washingtonpost.com/wp-dyn/co ... 01626.html

Conclusion: Change your diet to reduce red meat consumption.

[aknowledgeableperson]

The major problems of the US system are cost^, quality*, and access3!

Fine and dandy.

Yes, there is a problem in the US concerning "access" to health care and there will be quite lively discussions in Congress and in the public concerning a solution or solutions for this situation.

Yes, our costs are high but at the same time maybe part of the reason is the aggresiveness of the medical field in the treatment of illnesses, the equipment available for treatment, and other items.  Bullet points  3, 4, 6, 9, and 10 if reasonably accurate would reflect an increase the costs in the US compared to other countries.

Now, quality is another matter.  You seem to focus on only one item concerning quality, the number of deaths related to medical errors and such.  OK, but what about bullet points 1 and 2.  Does the US have better results or not with regards to treatment of cancers?  Or to put it bluntly, do I have a better chance of surviving prostate cancer in the US or in Canada, Norway, or the UK?

Are bullet points 5, 7, and 8 materially wrong or are they close to accurate?  If they are close to accurate then a single-payer, government sponsored health program might not be the way to go.

Yes, all sides concerning this subject will throw all kinds of studies, reports, etc. into the discussion, especially to prove their positions and/or to sway the undecideds.  However, and this is just a guess on my part, more people will be swayed to the position that uses the KISS principle in its talks as opposed to the side that tries to influence the public with all kinds of technical talk that most do not understand or want to hear. 

The statements offered are just talking points from a source that is a biased to finding a solution one way.

 

One of the things I found out in my life is that even though someone may have an agenda that does not mean the material presented by that someone is inaccurate or misleading.  So, yes, one has to consider the source and at the same time be careful not to discount the information because of the source.

[beautyfromashes]

Some suggestions:

* Open up competition across all states.  Instead of having just a few options for coverage in Kansas City (BCBS, United), allow us to purchase insurance from anywhere in the US.
* Tort reform to decrease the fastest growing aspect of health coverage, liability insurance.  Cut the lawyers out of the expense of insurance.
*  Catastrophic government coverage where any citizen is covered if they get a catastrophic, life-threatening disease (cancer, heart disease)
*  Employee required secondary coverage.  These costs should be less because the catastrophic aspect would be covered by the governement and nationwide purchasing options should drive down the currently regional colluded prices. 
*  Make it impossible to drop someone with a pre-existing condition or raise rates on a business or employee when they develop an expensive condition.

Just thoughts.  Open to change as this is a huge issue to work out.

[DaveKCMO]

* Open up competition across all states.  Instead of having just a few options for coverage in Kansas City (BCBS, United), allow us to purchase insurance from anywhere in the US.

i would think you would have to eliminate state regulations on providers to make this palatable to the industry. what probably makes some states cheaper is the lack of regulations for other items you mention. if you require insurers to cover pre-existing conditions or eliminate benefit caps on a nationwide basis, those cost differences may disappear.

[knucklehead]

As someone who is planning on retiring well before age 65 I would love to have the option of buying into medicare at age 55.

I do not understand why that would be controversial. Who in the hell would oppose that? I am willing to pay my full premium. I just want an insurance carrier that is not going to jack my premiums way up if I do happen to come down with cancer or deny coverage for things I need.

I want real insurance, not the phoney baloney crap the insurance companies are currently offerring to individuals.

The lack of a trust worthy medical insurance product for people that are self-employed is hurting our economy. That is one reason why the percentage of people who are self employeed is substantially lower in the United States than in europe. People cling to their jobs with big corporations to keep their medical benefits. They know if they quit to free lance, they are basically on their own. the product they get isn't health insurance at all. It doesn't pool risks, it is just a gussied up levalized payment plan.

[DaveKCMO]

the obama team indicated today they may be willing to drop the public plan in lieu of non-profit co-ops.

[grovester]

they've said that from the beginning, just seem to push and pull the issue as needed depending on the current press.  Going to need some safeguards built in to prevent the co-ops from ultimately being swallowed up by big health companies.

[aknowledgeableperson]

Considering what is going on this year with the health care debate if what is said in the attached article beomces true then it will be quite a year, especially since it will be an election year.

http://articles.moneycentral.msn.com/In ... spx?page=1

Social Security crunch coming fast

The debate over health care has captured everyone's attention, but it appears the next big government program that needs to be addressed will be Social Security. That's the focus of the July 30 article "The next great bailout: Social Security" by Allan Sloan, Fortune's senior editor at large.

...

"Perhaps as early as this year, Social Security, at $680 billion the nation's biggest social program, will be transformed from an operation that's helped finance the rest of the government for 25 years into a cash drain that will need money from the Treasury. In other words, a bailout."

...

Past projections were for a cash-flow surplus of about $87 billion this year and $88 billion next year. But new projections show those figures may drop to around $18 billion or $19 billion, which could easily go negative. And once the red ink starts spilling (a temporary bounce into the black in the next couple of years notwithstanding), that deficit will grow for the next 20 or so years unless something is done to halt it.

...

In other words, the government spent it. Throughout all those years in the 1980s and 1990s, when folks worried about the budget deficit, it was reported to be lower than it would have been had the Social Security Trust Fund's money not been going into government coffers, thereby reducing the size of the deficit. Also untenable is the projected worker-to-retiree ratio, which will jump from 30 Social Security recipients per 100 workers in 1990 to 46 per 100 in the next 20 years.

...

And Social Security funding isn't the only time bomb. Sloan notes that "when it comes to problems, Medicare makes Social Security look like a walk in the park, even though at about $510 billion this year, it's far smaller. Not only are Medicare's financial woes much larger than Social Security's, but they're also much more complicated. . . . Medicare is more convoluted, because the health-care system is much more complex than Social Security. Which, when you think about it, involves only money."

[splash]

This is what I don't quite understand.  Is the main reason that people are against government funded health care is because they don't want the currently uninsured to have insurance in the form of a government handout?  I am uninsured and would really like to have insurance, but have never been able to afford it.

I had a job several years ago and was looking forward to finally having insurance.  Once I had worked there for a year and was finally eligible, I got all the forms and information.  I discovered that the monthly premiums equaled over 25% of my gross pay and I simply couldn't afford that. 

The next job I had, I asked about the details after a couple of months.  Six months in, I was told that, based on my hiring date, I wouldn't be eligible for benefits for two years (I would have been one week shy of being there a year and eligible for benefits). 

When I got married, my husband and I decided I would go on his plan.  Several months before we got married, his company switched plans and we figured out that would cost more than we could afford for me to be on his plan (it was somewhere in the range of half our mortgage payment).


The easy answers are to either get higher paying jobs (working on it) or cut back spending in other areas (already done), so that we can afford insurance, I guess.  To me, the issue is about affordable coverage.  I don't want a government handout, but I would rather not have to make the choice between having health insurance and paying my rent.  I feel like there has to be some kind of middle ground, but it seems that the only thing either sides wants to do is scream at the other, rather than actually discussing the issue.