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| 2007/7/17-19 [Health/Dental, Health/Disease/General] UID:47308 Activity:moderate |
7/17 Americans actually wait *longer* for health care than in
countries with socialized medicine:
http://www.csua.org/u/j5t
\_ While this may be true, don't forget that Americans get
HIGHER quality health care, like Cialis and Viagras. No
other countries enjoy sexual lives like we do.
\_ This blog is a joke, and so is Krugman. Every study I've seen shows
the opposite to this. Bring a few more and I'll start to care.
-emarkp
\_ Both of them are professors in Economics, but they disagree with
your opinions, so they are "a joke." Hers is a study quoted in
Busness Week, no doubt another "joke"
http://www.csua.org/u/j5u
Where are all these studies you have seen? I have not seen them.
\_ This is the blog which was saying that tax cuts tanked the
economy pointing to the post-2001 drop, while ignoring other
events of 2001 (like say certiain terrorist attacks).
http://www.csua.org/u/j3f
The studies I've seen are about how long it takes to go from a
GP to a specialist in socialized systems. Like how long it
takes to get an MRI.
http://csua.org/u/i1p
Note: also an economist. -emarkp
\_ No, the entry you point to does not claim or even infer
that "tax cuts tanked the economy." How did you even
possibly get that from that entry? What it does claim
is that the post-2001 recovery was very weak. The economy
was already in recession before 9/11, you know that right?
The actual economic effect of the WTC attacks was very
slight, but I guess you can try and claim that it retarded
the recovery somehow, though you are the first person I
have ever seen make that claim.
slight, but I guess you can say that it retarded the
recovery somewhat, though most economists disagree:
recovery somewhat:
http://www.fas.org/irp/crs/RL31617.pdf
\_ Waiting times in Canada are shorter for critical
treatment (oncology) and longer for elective treatment
(plastic surgery, hip replacement).
(plastic surgery, hip replacement). Note that your
article does not compare Canadian waiting time to
US waiting times.
http://www.csua.org/u/j5y
\_ I'd be willing to fund preventative care (e.g. checkups) for
everyone, but nothing beyond that basic. That's basically what
dental plans cover. If you implement universal care then you
will see costs spiral even more out of control like they have
in Europe. There was a time two decades ago when European health
care was better than in the US, but that time passed once they
had to deal with immigration from poor countries in the same
way we have.
\_ Waiting times less in Canada than the US:
http://www.csua.org/u/j5v
Recent statistics from the Institution of Healthcare Improvement
document "that people are waiting an average of about 70
days to see a provider."
"In many circumstances, people initially diagnosed with
cancer are waiting over a month, which is intolerable."
And you know that Germany and France spend *less* per capita
than the US, right?
\_ I don't know about Germany and France, but I do know that
I wouldn't seek out care in Spain or Canada and that
health care in the Netherlands (see below) is not exactly
improving over time. By the way, do you know anyone who
had to wait 70 days to see a doctor? I don't, unless it
was some specific doctor they wanted to see.
\_ I know people who have completely been denied medical
care they needed because they didn't have insurance.
I don't know if that counts as more than 70 days or not...
\_ It shouldn't.
\_ I had a chance to talk to this guy last night
since I had dinner with him and his daughter.
He is waiting on average two months for his
appointments. He is impoverished and has to
depend on SF General for all his care. He has
some kind of kidney problems.
\_ We spend twice as much, per capita, as other countries on
health care, so it's our costs that are spiraling out of
control, not theirs. Universal health care just creates the
largest insurance pool possible, do you also want to make
private insurance illegal (except for basic dental services)?
Whether you pay premiums to your for-profit insurance company
or taxes to the government really doesn't make that much
difference except the government doesn't have a profit motive.
\_ One of the main reasons health care in the United States is
so expensive is we spend the bulk of money over the lifetime
of a human on medical care, in the last 6 months of life. Near
The End, American doctors order heroic tests and procedures
to prolong the life of the patient, often cutting short
those expected 6 months. In those glorious socialist paradises
those expected 6 months. In the glorious socialist paradises
of Europe, near The End, the doctor tells the family, and orders
pain killers to keep the patient comfortable. How would
pain killers to keep the patient comfortable. How
would the United States gradually move closer to the European
model? I have absolutely no idea.
\_ Can you back this up with any data? I'm wondering if
your source is legitimate or just word-of-mouth or
speculation.
\- San Francisco has many sidewalks.
\- Do you have some data to back that up?
\_ I have seen it both ways. American doctors told my aunt to
go home and die while Dutch doctors tried heroic measures
that saved her life. I also have seen Dutch doctors give up
on elderly patients and euthanize them. I think it depends
on the age of the patient. (My aunt was in her 40s at the
time.) Dutch medicine then was much better than in the US,
but my aunts living there now say it is no longer the case
and that benefits have been slashed from what they used to be.
I have aunts in France and Holland, a friend who is a doctor in
Greece, and ex-coworkers in Mexico, Japan, Korea, France,
and Spain, and US health care (with the exception of some
experimental treatments the FDA will not approve) is the
best in the world. It is also not free. Imagine that. The
Socialist Paradises in Europe and Japan are facing an upcoming
nightmare that makes the US Social Security problem seem
\- the people who know what they are
talking about all agree Medicare
is a much bigger financial liabiliy/
problem than Soc Sec.
small in comparison. They just cannot provide the services
they used to when faced with larger, less wealthy populaces
of the sort that the US has been absorbing for a long time.
\_ In what way is the US health care system the best in the
world? Do you have any evidence for that, other than your
assertion? The government pays for about half of all
healthcare in the US, btw, so your comment that it is
not "free" is somewhat misleading. In places like Germany
and France, the government pays for about 3/4 of all
health care costs.
\_ I am surprised nobody is discussing the RAND healthcare study, which
found that on average, medical spending has no effect on health (!):
http://www.overcomingbias.com/2007/05/rand_health_ins.html
http://www.rand.org/health/projects/hie
If this study is correct, discussions of comparative health care
quality would have to come with some serious qualifiers.
-- ilyas
\- yes, obviously something complicated like this comes
with qualifiers. for example the US's infant mortality
rate is "higher than it should be" because "the US"
tries to save some high-risk newborns, while in certain
(poorer) countries with allegedly lower IM rates, these
DOA cases get listed in a different column. however, that
doesnt change the large scale incentive issues here, e.g.
insurance companies foot dragging ... just like TIH hasnt
solved the cable problem, "the market" wont magically
"solve" the pathologies in insurance [actually it is not
exactly like cable, which is due to concentration, but this
is a problem of moral haz and adv selection also] and
it's not clear what "solve" means, since there are competing
public policy goals here.
\_ It seems that if spending doesn't result in statistically
significant return, AND there's isn't a lot of noise to
figure out why and correct this (or at least clamor for
bigger studies), then return isn't what
the spending is about. Hanson has some conjectures on
the reasons for our common attitudes about healthcare
spending. -- ilyas |
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| www.csua.org/u/j5t -> economistsview.typepad.com/economistsview/2007/07/paul-krugman-th.html The Waiting Game, by Paul Krugman, Commentary, NY Times: Being without health insurance is no big deal. "I mean, people have access to health care in America," he said last week. This is what you might call callousness with consequences. The White House has announced that Mr Bush will veto a bipartisan plan that would extend health insurance ... to an estimated 41 million currently uninsured children. After all, it's not as if those kids really need insurance -- they can just go to emergency rooms, right?... willful ignorance here is part of a larger picture: by and large, opponents of universal health care paint a glowing portrait of the American system that bears as little resemblance to reality as the scare stories they tell about health care in France, Britain, and Canada. The claim that the uninsured can get all the care they need in emergency rooms is just the beginning. declared recently that "the poorest Americans are getting far better service" than Canadians or the British... We look better when it comes to seeing a specialist or receiving elective surgery. In Canada and Britain, delays are caused by doctors trying to devote limited medical resources to the most urgent cases. In the United States, they're often caused by insurance companies trying to save money. LA, who nearly died of cancer because his insurer kept delaying approval for a necessary biopsy. here's no question that some Americans who seemingly have good insurance nonetheless die because insurers are trying to hold down their "medical losses" -- the industry term for actually having to pay for care. On the other hand, it's true that Americans get hip replacements faster than Canadians. But there's a funny thing about that example, which is used constantly as an argument for the superiority of private health insurance over a government-run system: the large majority of hip replacements in the United States are paid for by, um, Medicare. That's right: the hip-replacement gap is actually a comparison of two government health insurance systems. American Medicare has shorter waits than Canadian Medicare (yes, that's what they call their system) because it has more lavish funding -- end of story. The alleged virtues of private insurance have nothing to do with it. The bottom line is that the opponents of universal health care appear to have run out of honest arguments. All they have left are fantasies: horror fiction about health care in other countries, and fairy tales about health care here in America. I see specialty centers in Finland, Canada and Thailand are doing hernia operations and other routine stuff, undercutting the multimillionaire surgeons here. So Americans are actually traveling outside the country to get their specialty care, not for convenience, but for price. LA, who nearly died of cancer because his insurer kept delaying approval for a necessary biopsy. You must excuse me, but I've lived in France much too long. You see, it is quite impossible to imagine (here) that an insurance should decide what medical treatment is necessary or not and when. If they do, then they must assume the legal consequences. If the GP is exaggerating (which has been known to happen all to often) at least the consequence is not dramatic. And, of course, they are risking their license to practice. An excerpt: In Sicko, Moore lumps France in with the socialized systems of Britain, Canada, and Cuba. In fact, the French system is similar enough to the US model that reforms based on France's experience might work in America. The French can choose their doctors and see any specialist they want. Doctors in France, many of whom are self- employed, are free to prescribe any care they deem medically necessary. "The French approach suggests it is possible to solve the problem of financing universal coverage... reorganizing the entire system," says Victor G Rodwin, professor of health policy and management at New York University. France also demonstrates that you can deliver stellar results with this mix of public and private financing. In a recent World Health Organization health-care ranking, France came in first, while the US scored 37th, slightly better than Cuba and one notch above Slovenia. They've had, at one time or another, all sorts of health care means -- from private to religious to state. The present one is the fruit of a great deal of experience in the matter. I've got some good news for you: you can do a great deal BETTER than France. Because, you see, in France we see a lot of problems with the medical system. We may have more hospital beds but we reckon we don't have enough, for example. Still, many of the problems are tricky and have no easy solution, so here is one way to make sure you get better: You could replicate the system with just one difference: how you manage the "numerus clausus". That is, the number of people accepted to medical studies each year. You see, in France we are appalling at being anti-cyclical. So that, despite the fact that those studies take around 10 years to complete, the number of students was almost always decided based on the situation at the time. There was a huge number of new medical students around 1968 and therefore too many doctors in France for years. Guess what, they had a very low numerous clausus until VERY recently. When I started my studies, the message from my father (a cardiologist) had always been that there were too many doctors in most of the country and that some of them were making patients come back without need, something I would never do, so I never thought I would become one. Meaning that doctors either shorten their consultations, or (for those having a licence allowing them to do so) raise their fees. I am 31 now and had I chosen to become a doctor I would have an open road ahead. But not too many regrets: it would also mean being on emergency call 3 nights a week... A higher clausus in the past 10 years would have meant cheaper and better care. So yes, France has a FAR better system than the US, but if you don't like it all that much, feel free to do even better, it's possible. Excerpted from the NYT article above regarding policy discussions amongst the chattering Dems, and good talking points: But the latest populist resurgence is deeply rooted in a view that current economic conditions are difficult and deteriorating for many people, analysts say, and it is now framing debates over tax policy, education, trade, energy and health care. So, let's see what we've covered in Mark's thoughtful posting of past commentaries on these subjects: 1) Health Care - Amply discussed and the point of this present thread. But, Hillary is not about to take on the AMA and a rabid K-street lobby - only to be savaged again in mid-campaign for the presidency. The health care system is so much a prisoner of vested interests, it will have to be rebuilt from the bottom up. And, it is so lucrative for those vested interests, I don't see its reformation being practicably possible. Maybe this could work: For the 15 to 20% who are without health care, provide a separate clinic-based service for those who need it, that is totally financed from both state and federal budgets. Within this parallel system, practitioner and pharmaceutical prices are mandated. Watch this catch on - then expand it upward with a French style system (that is financed by employee contributions as well). Employees chose the system they want, employer (insurance) based or the alternative described here. Only 33% of the American population has a university degree, so what about the rest of them? Education/training, as the body bags coming back from Iraq attest to, is NOT free, gratis and for nothing. Professional training in selected areas of skill-set shortfall (nursing, for instance) is one proposition. Giving low interest loans is one idea, but how about writing off the debt once the degree is obtained? marginal income taxes on the exaggeratedly high incomes. Besides, the discussion are footnote-posts about "percentages" and how they are constituted. How about a provisional first-year budget estimate of a Democratic administration - where the windfall from a no... |
| www.csua.org/u/j5u -> www.businessweek.com/magazine/content/07_28/b4042072.htm The Doctor Will See You--In Three Months HEALTH The Doctor Will See You--In Three Months The health-care reform debate is in full roar with the arrival of Michael Moore's documentary Sicko, which compares the US system unfavorably with single-payer systems around the world. Critics of the film are quick to trot out a common defense of the American way: For all its problems, they say, US patients at least don't have to endure the endless waits for medical care endemic to government-run systems. The lobbying group America's Health Insurance Plans spells it out in a rebuttal to Sicko: "The American people do not support a government takeover of the entire health-care system because they know that means long waits for rationed care." In reality, both data and anecdotes show that the American people are already waiting as long or longer than patients living with universal health-care systems. Take Susan M, a 54-year-old human resources executive in New York City. She faithfully makes an appointment for a mammogram every April, knowing the wait will be at least six weeks. She went in for her routine screening at the end of May, then had another because the first wasn't clear. That second X-ray showed an abnormality, and the doctor wanted to perform a needle biopsy, an outpatient procedure. "I couldn't imagine spending the summer with this hanging over my head." After many calls to five different facilities, she found a clinic that agreed to read her existing mammograms on June 25 and promised to schedule a follow-up MRI and biopsy if needed within 10 days. A full month had passed since the first suspicious X-rays. Ultimately, she was told the abnormality was nothing to worry about, but she should have another mammogram in six months. If you find a suspicious-looking mole and want to see a dermatologist, you can expect an average wait of 38 days in the US, and up to 73 days if you live in Boston, according to researchers at the University of California at San Francisco who studied the matter. A 2004 survey by medical recruitment firm Merritt, Hawkins & Associates found the average time needed to see an orthopedic surgeon ranges from 8 days in Atlanta to 43 days in Los Angeles. "Waiting is definitely a problem in the US, especially for basic care," says Karen Davis, president of the nonprofit Commonwealth Fund, which studies health-care policy. All this time spent "queuing," as other nations call it, stems from too much demand and too little supply. Only one-third of US doctors are general practitioners, compared with half in most European countries. On top of that, only 40% of US doctors have arrangements for after-hours care, vs. Consequently, some 26% of US adults in one survey went to an emergency room in the past two years because they couldn't get in to see their regular doctor, a significantly higher rate than in other countries. There is no systemized collection of data on wait times in the US That makes it difficult to draw comparisons with countries that have national health systems, where wait times are not only tracked but made public. However, a 2005 survey by the Commonwealth Fund of sick adults in six nations found that only 47% of US patients could get a same- or next-day appointment for a medical problem, worse than every other country except Canada. The Commonwealth survey did find that US patients had the second-shortest wait times if they wished to see a specialist or have nonemergency surgery, such as a hip replacement or cataract operation (Germany, which has national health care, came in first on both measures). But Gerard F Anderson, a health policy expert at Johns Hopkins University, says doctors in countries where there are lengthy queues for elective surgeries put at-risk patients on the list long before their need is critical. "Their wait might be uncomfortable, but it makes very little clinical difference," he says. The Commonwealth study did find one area where the US was first by a wide margin: 51% of sick Americans surveyed did not visit a doctor, get a needed test, or fill a prescription within the past two years because of cost. Few solutions have been proposed for lengthy waits in the US, in part, say policy experts, because the problem is rarely acknowledged. But the market is beginning to address the issue with the rise of walk-in medical clinics. PTMK ) and other stores--so many that the American Medical Assn. just adopted a resolution urging state and federal agencies to investigate such clinics as a conflict of interest if housed in stores with pharmacies. These retail clinics promise rapid care for minor medical problems, usually getting patients in and out in 30 minutes. The slogan for CVS's Minute Clinics says it all: "You're sick. |
| www.csua.org/u/j3f -> economistsview.typepad.com/economistsview/2007/06/bruce_bartlett__1.html I compared the state of the economy today to where it was at the exact same point during the previous business cycle. Thus, according to the National Bureau of Economic Research, the most recent recession ended in November, 2001. For example, real GDP has risen at a 31 percent annual rate since the end of the recession. But in areas such as this, there are no objective criteria for saying what is a good performance from a bad one; First, when Bill Clinton ran for president in 1992, he repeatedly said that the economy was the worst since the Great Depression, and he continued saying so well after he took office--two years into the recovery. In other words, the recovery from the 1990-91 recession was so anemic that voters elected a new president in order to get the economy moving. Therefore, we are not comparing today's economy to one that was historically robust, but one that was widely viewed as being exceptionally weak. Second, the data raise serious questions about the role of taxes. Republicans are convinced that the Bush tax cuts saved us from doom. But there is really no evidence whatsoever to support this claim. Unless one believes that there would have been no recovery at all and that we would still be mired in recession without the tax cuts, it is hard to find any positive evidence of their economic impact. Investment stinks, employment growth has been mediocre, and even the stock market increase is nothing to brag about. Third, it is worth remembering that Clinton raised taxes right out of the box in 1993. Every Republican opposed it and virtually every conservative economist predicted disaster. Yet it is hard to find any evidence that the tax increase had any negative effect whatsoever. One can easily argue the opposite based on the economic results. I am not arguing for a reversal of the tax cuts or in favor of a tax increase. I am just saying that one has to do more than mindlessly repeat mantras about the benefits of tax cuts or the horrors of tax increases if you want to be taken seriously in this debate. I also wish the mindless repetition of false mantras would end, but I don't expect it to change much. In the media, the commodity being sold is entertainment, not information, so it shouldn't be too surprising that the two will come into conflict even on shows labeled as news. Still, I would have thought there would be more market discipline than exists now. There seems to be little penalty for providing false or misleading information (even if it leads to war) so long as the entertainment value is high enough (unless you count even more bookings and more exposure in the media as a penalty). I wish I knew how to bring the information and entertainment objectives into better alignment, we need it, but I don't know what the answer is. But one area that could stand improvement is the level of competition in the market for news and entertainment. We need to ensure that robust competition is present in this marker so that whatever market discipline does exist with respect to the presentation of accurate information and informed analysis has a chance to fully express itself. "First, when Bill Clinton ran for president in 1992, he repeatedly said that the economy was the worst since the Great Depression" Yes, he lied then and kept lying right through his 8 years. The recession of the early 80's was FAR worse than the extremely mild recesion of 1991 "It is obvious that by every standard, the recovery and expansion after the 1990-91 recession was significantly better than that after the 2001-01 recession" And late into that recession there were tax cuts, the capital gains tax cuts of 1997 were a huge economic stimulus for the expansion of the late 90's. "but one that was widely viewed as being exceptionally weak" Widely viewed "exceptionally weak" only by the ignorant, the economy had already been growing strong before clinton took office, and actually grew more the year before he took office than the year he took office. "Republicans are convinced that the Bush tax cuts saved us from doom. But there is really no evidence whatsoever to support this claim." There is overwhelming evidence, the Bush tax cuts of the lower three tax brackets were enacted in mid 2001 and for almost the next 2 years we had negative job growth and anemic GDP growth. Almost immediately after the top two tax bracket cuts were enacted in June 2003 the economy exploded into growth and since then we have a net gain of over 9 million jobs created. And now, as in the expansion of the 90's, real wage growth comes in late in the expansion and we have had very solid wage growth. "Third, it is worth remembering that Clinton raised taxes right out of the box in 1993. Every Republican opposed it and virtually every conservative economist predicted disaster. Yet it is hard to find any evidence that the tax increase had any negative effect whatsoever" Hard to find evidence? Only if your eyes are closed, look at the massive slow down of economic growth in 1995, no negative effect? "I am just saying that one has to do more than mindlessly repeat mantras" Yes and will you and your kind stop mindlessly repeating your idiotic mantras of tax cuts don't work. bruce bartlett, as always, reminds us what an honest conservative looks (and thinks) like. TB reminds us what a dishonest shill of the american right-wing looks like. sadly, as our host noted, the ignorance of the TBs rules our discourse, while the honesty of bruce bartlett got him fired from a supposed think tank. TB - As an unreconstructable left winger, I'll admit I'm biased toward thinking that tax cuts for high income brackets don't usually stimulate the economy, but I'm open to being convinced. Now you have brought forth quite a bit of evidence to support your thesis that the Bush tax cuts for the rich did stimulate the economy. To me, however your evidence seems largely circumstantial. Other factors were involved, including exceptionally low interest rates, and a massive increase in government spending. This means that it's hard to prove your point with macroeconomic evidence. What puzzles me the most is exactly what have the very rich done with all the money that Bush has left them? In fact, what hits the headlines is companies buying back their stock, because they don't know what to do with their money. My impression is that the very rich are simply contributing to speculative bubbles while US industry continues getting hollowed out. You seem to be a proponent of faith based economics, which is often an important positive factor. So please restore my faith that capitalism is good for America. That was no evidence whatsoever: in the Clinton case, TB claims that 93 tax increases were responsible for a slowdown in 95, but that 2003 tax cuts on the very rich were responsible for immediate growth. So, the real message is: when there is a tax increase, we'll say that the next slump in the future is clear proof of the destructive effects of taxes, and when there is a tax cut, well any growth (however sluggish compared to previous recoveries) in the future or indeed at the very same time, even though there will not have been any time for investment to take place, shows us that tax cuts pay for themselves. Cyrille, in simple times, TB's lag times for the effects of tax cuts / increases to work through the economy are different. Farrar R is spot on in saying it is erronous to state only one thing led to the economic growth that occured, while we all know reality is quite complex and a bunch of factors influence to a greater / lesser extent the economy at any particular time. Bruce Bartlett is quite right in analysis, since both the general extent of growth and even more so the quality of growth from the recession end in November 2001 has been inferior to that after the recession ending in 1991. The extent to which the middle class has gained since 2001 is distinctly inferior to gains made after 2001. The question of how economic structure has changed since 2001, limiting general economic growth and the ways in which the proceeds of growth are being shared is continually masked by looking beyond domestic economic structu... |
| csua.org/u/i1p -> www.townhall.com/columnists/WalterEWilliams/2007/02/14/do_we_want_socialized_medicine Post Your Comments Problems with our health care system are leading some to fall prey to proposals calling for a nationalized single-payer health care system like Canada's or Britain's. There are a few things that we might take into consideration before falling for these proposals. London's Observer (3/3/02) carried a story saying that an "unpublished report shows some patients are now having to wait more than eight months for treatment, during which time many of their cancers become incurable." Another story said, "According to a World Health Organisation report to be published later this year, around 10,000 British people die unnecessarily from cancer each year -- three times as many as are killed on our roads." Health Insurance, Not Health Care The Observer (12/16/01) also reported, "A recent academic study showed National Health Service delays in bowel cancer treatment were so great that, in one in five cases, cancer which was curable at the time of diagnosis had become incurable by the time of treatment." The story is no better in Canada's national health care system. The Vancouver, British Columbia-based Fraser Institute has a yearly publication titled, "Waiting Your Turn." Its 2006 edition gives waiting times, by treatments, from a person's referral by a general practitioner to treatment by a specialist. Canadians face significant waiting times for various diagnostics such as computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound scans. The median wait for a CT scan across Canada was 43 weeks, but in Prince Edward Island, it's 9 weeks. Finally, the median wait for an ultrasound was 38 weeks across Canada, but in Manitoba and Prince Edward Island it was 8 weeks. Despite the long waiting times Canadians suffer, sometimes resulting in death, under federal law, private clinics are not legally allowed to provide services covered by the Canada Health Act. Regardless of this prohibition, a few black-market clinics service patients who are willing to break the law to get treatment. In British Columbia, for example, Bill 82 provides that a physician can be fined up to $20,000 for accepting fees for surgery. According to a Canada News article, "Shortage of Doctors and Nurses Could Hurt Medicare Reforms" (3/5/03), about 10,000 doctors left Canada during the 1990s. According to a Canadian Medical Association Journal article, "US Hospitals Use Waiting-List Woes to Woo Canadians" (2/22/2000), "British Columbia patients fed up with sojourns on waiting lists as they await tests or treatment are being wooed by a hospital in Washington state that has begun offering package deals. A second US hospital is also considering marketing its services." One of the attractions is that an MRI, which can take anywhere from 10 to 28 weeks in Canada, can be had in two days at Olympic Memorial Hospital in Port Angeles, Wash. Some of our politicians hold up the Canadian and British nationalized health care systems as models for us. You can bet that should we ever have such a system, they would exempt themselves from what the rest of us would have to endure. That cure is not to demand more government but less government. I challenge anyone to identify a problem with health care in America that is not caused or aggravated by federal, state and local governments. And, I challenge anyone to show me people dying on the streets because they don't have health insurance. By Walter E Williams Wednesday, February 14, 2007 Problems with our health care system are leading some to fall prey to proposals calling for a nationalized single-payer health care system like Canada's or Britain's. There are a few things that we might take into consideration before falling for these proposals. London's Observer (3/3/02) carried a story saying that an "unpublished report shows some patients are now having to wait more than eight months for treatment, during which time many of their cancers become incurable." Another story said, "According to a World Health Organisation report to be published later this year, around 10,000 British people die unnecessarily from cancer each year -- three times as many as are killed on our roads." The Observer (12/16/01) also reported, "A recent academic study showed National Health Service delays in bowel cancer treatment were so great that, in one in five cases, cancer which was curable at the time of diagnosis had become incurable by the time of treatment." The story is no better in Canada's national health care system. The Vancouver, British Columbia-based Fraser Institute has a yearly publication titled, "Waiting Your Turn." Its 2006 edition gives waiting times, by treatments, from a person's referral by a general practitioner to treatment by a specialist. Canadians face significant waiting times for various diagnostics such as computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound scans. The median wait for a CT scan across Canada was 43 weeks, but in Prince Edward Island, it's 9 weeks. Finally, the median wait for an ultrasound was 38 weeks across Canada, but in Manitoba and Prince Edward Island it was 8 weeks. Despite the long waiting times Canadians suffer, sometimes resulting in death, under federal law, private clinics are not legally allowed to provide services covered by the Canada Health Act. Regardless of this prohibition, a few black-market clinics service patients who are willing to break the law to get treatment. In British Columbia, for example, Bill 82 provides that a physician can be fined up to $20,000 for accepting fees for surgery. According to a Canada News article, "Shortage of Doctors and Nurses Could Hurt Medicare Reforms" (3/5/03), about 10,000 doctors left Canada during the 1990s. According to a Canadian Medical Association Journal article, "US Hospitals Use Waiting-List Woes to Woo Canadians" (2/22/2000), "British Columbia patients fed up with sojourns on waiting lists as they await tests or treatment are being wooed by a hospital in Washington state that has begun offering package deals. A second US hospital is also considering marketing its services." One of the attractions is that an MRI, which can take anywhere from 10 to 28 weeks in Canada, can be had in two days at Olympic Memorial Hospital in Port Angeles, Wash. Some of our politicians hold up the Canadian and British nationalized health care systems as models for us. You can bet that should we ever have such a system, they would exempt themselves from what the rest of us would have to endure. That cure is not to demand more government but less government. I challenge anyone to identify a problem with health care in America that is not caused or aggravated by federal, state and local governments. And, I challenge anyone to show me people dying on the streets because they don't have health insurance. |
| www.csua.org/u/j5y -> www.medicalnewstoday.com/articles/76295.php Recommended Actions For Increased Nanotechnology Safety Require Commitment From The EPA 17 Jul 2007 Waiting times in US hospitals and clinics are becoming so lengthy that even one of the nation's biggest insurers, Aetna, has admitted to its investors that the US healthcare system is "not timely" and patients diagnosed with cancer wait "over a month" for needed medical care, said two leading organizations of doctors and nurses recently. Lost in the recent flurry of attacks on Canada and other nations with publicly funded healthcare systems, spurred by the popularity of Michael Moore's "SiCKO," is the reality of the huge hurdles faced by many American patients, said the Physicians for a National Health Program and the California Nurses Association/National Nurses Organizing Committee. "As the cost and service failures of the US health system become unbearable, those who profit from the system - the private health insurance giants and big drug companies - are bringing out the propaganda attacks on the experience in the many countries which have chosen a public insurance plan. As always, half truths and lies are the scare tactics of these profiteers," said Quentin Young, MD national coordinator of PNHP. "There's been a lot of clamor lately about delays in care in some other countries. But if you want to see some really unsightly waiting times, look at US medical facilities," said Deborah Burger, RN, president of the 75,000-member CNA/NNOC. While the problem has been largely overlooked by the major media, it was quietly exposed by the chief medical officer of Aetna, Inc. In his talk, Troy Brennan conceded that "the (US) healthcare system is not timely." He cited "recent statistics from the Institution of Healthcare Improvement... that people are waiting an average of about 70 days to try to see a provider. And in many circumstances people initially diagnosed with cancer are waiting over a month, which is intolerable," Brennan said. Brennan also recalled that he had formerly spent much of his time as an administrator and head of a physicians' organization trying "to find appointments for people with doctors." While Brennan's comments went unreported by the media, his data matches several studies and a report in a June 22 Business Week article which opened by citing the case of a New York woman who had to fight for a timely second exam following suspicious results from a first mammogram and then still had to wait a full month. A Commonwealth Fund study of six highly industrialized countries, the US, and five nations with national health systems, Britain, Germany, Australia, New Zealand, and Canada, found waiting times were worse in the US than in all the other countries except Canada. And, most of the Canadian data so widely reported by the US media is out of date, and misleading, according to PNHP and CNA/NNOC. In Canada, there are no waits for emergency surgeries, and the median time for non-emergency elective surgery has been dropping as a result of public pressure and increased funding so that it is now equal to or better than the US in most areas, the organizations say. Statistics Canada's latest figures show that median wait times for elective surgery in Canada is now three weeks. "There are significant differences between the US and Canada, too," said Burger. "In Canada, no one is denied care because of cost, because their treatment or test was not 'pre-approved' or because they have a pre-existing condition." "Furthermore, when a service problem emerges in Canada, prompt analysis and resource deployment is mobilized to resolve the problem," noted PNHP's Young. "In the US, the situation only worsens each year, hence we are presently in an enormous crisis. That's why we a need a single payer system, such as HR 676 which is now before Congress, that can respond to new demands." Furthermore, US statistics fail to account for the even longer waits for the nation's 44 million uninsured and tens of millions of insured Americans who put off needed medical care due to their high co-pays or deductibles, CNA/NNOC and PNHP noted. Canada also surpasses the US in a broad array of health barometers, including life expectancy, infant mortality rates, adult mortality rates, deaths due to HIV/AIDS, mortality rates for cardiovascular diseases, and years of life lost to injuries and communicable diseases, according to data from the World Health Organization and the Organization of Economic Co-operation and Development. "As nurses, we never worry about costs, billing, whether a procedure will be covered or anything like that. I never have to worry about whether one of my patients will get the treatment or care they need," wrote Bev Dick, RN, vice president of the United Nurses of Alberta wrote in a Portsmouth (NH) Herald commentary July 1 "That's the reason nurses are so supportive of our public system. |
| www.csua.org/u/j5v -> sfgate.com/cgi-bin/article.cgi?file=/c/a/2007/07/10/EDG6QQ4VGD1.DTL Sunday Insight What country endures such long waits for medical care that even one of its top insurers has admitted that care is "not timely" and people "initially diagnosed with cancer are waiting over a month, which is intolerable?" Scrambling for a response to the popular reaction to Michael Moore's "SiCKO" and a renewed groundswell for a publicly financed, guaranteed single-payer health care solution, such as SB840, the big insurers and their defenders have pounced on Canada, pulling out all of their old tales of people waiting years in soup kitchen-type lines for medical care. But, here's the dirty little secret that they won't tell you. Waiting times in the United States are as bad as or worse than Canada. And, unlike the United States, in Canada no one is denied needed medical care, referrals or diagnostic tests due to cost, pre-existing conditions or because it wasn't pre-approved. US waiting times are the elephant in the room few critics care to address. But, listen to what the chief medical officer of Aetna had to say in March. Speaking to the Aetna Investor's Conference 2007, Troy Brennan let these pearls drop: The US "health care system is not timely." Recent statistics from the Institution of Healthcare Improvement document "that people are waiting an average of about 70 days to see a provider." "In many circumstances, people initially diagnosed with cancer are waiting over a month, which is intolerable." In his former stint as an administrator and head of a physicians' organization, he spent much of his time trying "to find appointments for people with doctors." But some reports are now beginning to break through, spurred by the debate "SiCKO" has spawned. com/technology/content/jun2007) that "as several surveys and numerous anecdotes show, waiting times in the United States are often as bad or worse as those in other industrialized nations -- despite the fact that the United States spends considerably more per capita on health care than any other country." org), the United States and five nations with national health systems (Britain, Germany, Australia, New Zealand and Canada) found waiting times were worse in the United States than in all the other countries except Canada . There's something else you probably don't hear about Canada. Most of the wait-time problems derive from funding cuts by conservative national or provincial governments, or from the siphoning off of resources by private providers. But precisely because the Canadian system is publicly administered, Canadians are able to force their elected officials to fix problems, or get voted out of office. Throughout Canada, there are multiple pilot programs that have succeeded in slashing wait times. Canada's latest statistics show that median wait times for elective surgery in Canada is now three weeks -- that's less time than Aetna's chief medical officer says Americans typically wait after being diagnosed with cancer. It also doesn't have 44 million people who are uninsured because everyone has a national health-care card guaranteeing health care from any doctor or hospital they choose. And it doesn't burden those with insurance with rising deductibles or co-pays. A study reported by Health Affairs, a policy journal, for example, found that out-of-pocket costs to US consumers jumped 76 percent this year over last year alone. Canada also surpasses the United States in a broad array of health barometers, including life expectancy, infant mortality rates, adult mortality rates, deaths due to HIV/AIDS, mortality rates for cardiovascular diseases and years of life lost to injuries and diseases, according to data from the World Health Organization and the Organization of Economic Co-operation and Development. No wonder some people are so afraid we'll learn the real comparative story about Canada's system -- and our own. Deborah Burger, RN, is president of the California Nurses Association. |
| www.overcomingbias.com/2007/05/rand_health_ins.html How useful is medicine, to the average person, wondering if he should go to the doctor or skip it? We have perhaps a million medical studies, but how do we combine them into a total estimate of the value of medicine? It is hard to see how to correct for many potential biases such as fraud, funding bias, treatment selection bias, publication selection bias, and so on. These biases can be partially overcome by focusing on studies of the aggregate effects of medicine on the general population, some of which compare millions of people over years. usually find no health effect of more medicine, but most are correlation studies, so one may doubt if they controlled for enough relevant factors. Fortunately, there has been one large randomized experiment on aggregate medicine. RAND health insurance experiment, where from 1974 to 1982 the US government spent $50 million to randomly assign 7700 people in six US cities to three to five years each of either free or not free medicine, provided by the same set of doctors. The plan was to compare five measures of general health, and also 23 physiologic health measures. New England Journal of Medicine article: For the average person enrolled in the experiment, we observed two significant positive effects of free care relative to cost-sharing: corrected far vision ... was better by 01 Snellen lines (p = 0001) and diagnostic blood pressure was lower by 08mm HG (p = 003). any true differences would be clinically and socially negligible. For the five general health measures, we could detect no significant positive effect of free care for persons who differed by income .. Among participants who were judged to be at elevated risk with respect to smoking habits, cholesterol levels, and weight, free care had no detectable effect. For persons who were in the upper quartile of the distribution of risk factors included in the risk of dying index, the risk of dying was 10 percent lower on the free than the cost-sharing plans (p = 002). It has long been obvious that eyeglasses help people see better, and eyeglasses are basically physics, not "medicine," so that result should be set aside. Since this experiment looked at thirty measures in total then just by chance one of them should seem significant at the three percent level, explaining the blood pressure result. The bottom line is that thousands of people randomly given free medicine in the late 1970s consumed 30-40% more medical services, paid one more "restricted activity day" per year to deal with the medical system, but were not noticeably healthier! So unless the marginal value of medicine has changed in the last thirty years, if you would not pay for medicine out of your own pocket, then don't bother to go when others offer to pay; on average such medicine is as likely to hurt as to help. Why is this shocking news unknown to most readers of the weekly health section of the newspaper? RAND Health Insurance Experiment: Comments I don't think that's quite what they conclude. Here's a paper written by two profs from U of Chicago that summarizes the RAND study and other studies as well. A few quotes: If you are talking about whether or not the people currently not covered by health care would benefit from it, I think the answer is yes... "Another lesson from this literature is that the size of the effect of health insurance on health depends very much on whose health we are talking about. Vulnerable populations such as infants and children on the fringes of Medicaid eligibility or low-income individuals in the RAND experiment have the most to gain from more resources, and do appear to benefit from them." Furthermore, when you say, "These biases can be partially overcome by focusing on studies of the aggregate effects of medicine on the general population, some of which compare millions of people over years. Such studies usually find no health effect of more medicine, but most are correlation studies, so one may doubt if they controlled for enough relevant factors. Fortunately, there has been one large randomized experiment on aggregate medicine." "The results of small quasi-experimental studies provide only mixed evidence that health insurance affects health, while larger quasi-experimental studies and the RAND Health Insurance Experiment provide consistent evidence that health insurance improves health. Only one large-scale quasi-experimental study (Perry and Rosen) fails to show a relationship between health insurance and health, and this study may not have adequate power to rule out the possibility that health insurance improves health. Taken as a whole, these high-quality studies of the health effects of health insurance strongly suggest that policies to expand insurance can also promote health." May 08, 2007 at 10:06 AM More tomorrow on the RAND experiment. One issue (that is often touched upon in the weekly health section of the newspaper) is given by the line in the study "Confidence intervals were wider for subgroups of persons with low income or initially in poor health; therefore we cannot rule out clinically meaningful changes in particular subgroup". May 08, 2007 at 10:13 AM Technically, if you would not pay out of pocket for medicine *if it was offered at 1970s prices and with 1970s quality* you shouldn't use it if someone else is paying. However, healthcare price has gone WAY up relative to median income and quality has also probably risen, so a this modifier is relevant. May 08, 2007 at 10:15 AM Ah, thanks Chuck, you answered my question before I asked it. Just to be sure - "more resources" means free or lower cost health insurance? May 08, 2007 at 10:17 AM Chuck, I am talking about our actual data, not about commentary from "two profs from U of Chicago." My post above shows the inaccuracy of the claim you quote, that "RAND Health Insurance Experiment provide consistent evidence that health insurance improves health." But if the ratio of helpful to harmful medicine has not changed, for medicine that price subsidizes induce folks to consume, the claim stands. May 08, 2007 at 10:39 AM "Chuck, I am talking about our actual data, not about commentary from "two profs from U of Chicago." "" The paper from the University of Chicago (link might have been stripped or I forgot to include it, I'll try to include it again) is by Helen Levy and David Meltzer. Both have PhD's in economics, one from the University of Chicago and the other from Princeton, and also various other degress from Yale, etc, in economics and health. Metzler is also an MD Their paper is titled "WHAT DO WE REALLY KNOW ABOUT WHETHER HEALTH INSURANCE AFFECTS HEALTH?" These two educated specialists in this field are commenting on the same data as you in a scholarly article and seeming to reach different conclusions. I wonder, for example, if the *average* person in the quote you cited is average for the study, or average for the population as a whole? Furthermore, what is the distinction between "free care vs. Are we comparing two groups of people who have coverage, but it is paid for in different ways? I was under the impression we were comparing people without insurance to people with insurance. paper you cite cites the blood pressure result I mentioned, but notes "One caveat is that the analyses do not control for the presence of multiple comparisons (that is, hypothesis tests for multiple health outcomes)." That is, they are aware of but just choose to ignore the fact that we should have expected some such result by chance. May 08, 2007 at 11:16 AM Robin, not to dispute your overall conclusion, but the pragraph you wrote seems suspicious: It has long been obvious that eyeglasses help people see better, and eyeglasses are basically physics, not "medicine," so that result should be set aside. Since this experiment looked at thirty measures in total then just by chance one of them should seem significant at the three percent level, explaining the blood pressure result. The "risk of dying index" effect is mainly just the blood pressure effect, and the index came from a 1976 paper on heart attack risk, which was chosen well after the RAND experiment started, so the statistical significances... |
| www.rand.org/health/projects/hie -> www.rand.org/health/projects/hie/ Optimum graphic presentation of this site requires a modern standards-friendly browser. The browser you are using may not display exactly as we intended, but you will still be able to access all of our content. Stay Informed - Subscribe now for news and announcements by email | RAND's Health Insurance Experiment (HIE) The RAND Health Insurance Experiment (HIE), the most important health insurance study ever conducted, addressed two key questions in health care financing: * How much more medical care will people use if it is provided free of charge? The HIE project was started in 1971 and funded by the Department of Health, Education, and Welfare (now the Department of Health and Human Services). It was a 15-year, multimillion-dollar effort that to this day remains the largest health policy study in US history. The study's conclusions encouraged the restructuring of private insurance and helped increase the stature of managed care. A summary of the major findings of the RAND Health Insurance Experiment can be found in the publication below: The Health Insurance Experiment: A Classic RAND Study Speaks to the CurrentHealth Care Reform Debate -- 2006 Robert H Brook, Emmett B Keeler, Kathleen N Lohr, Joseph P Newhouse, John E Ware, William H Rogers, Allyson Ross Davies, Cathy D Sherbourne, George A Goldberg, Patricia Camp, Caren Kamberg, Arleen Leibowitz, Joan Keesey, David Reboussin. |