US reform of healthcare. Good or bad?

Well, they don't do it. Medicare only covers people over 65, for starters. Their insurance status is not involved, second.

Compared with the US, the wait lines are shorter, the funding cuts smaller, and the rationing less significant or damaging, in those countries.

The US has longer wait times, larger funding deficits, and more severe rationing than those countries (in the US, most people - a majority, even with insurance - are screened away entirely from care available on demand to every homeless bum in Paris, for example).

You are mistaken, or something (are you a deliberate propaganda agent?) The US is at no "disadvantage" here.

I'll repeat myself one more time, slowly, in case anyone else is as baffled as you claim to be: the difference in definition of "live birth" does not affect the US ranking in these statisitics, because the event of a dead baby is recorded in some category or another in all these countries. All those categories, added up, rank the US below most other first world world countries in its rate of dead babies - regardless of category. The US ranks low in child mortality, and also ranks low in miscarriage, stillbirth, mother mortality, and most other interruptions of normal gestation and birth. It ranks low in these categories individually and collectively. If you redefine the "live birth" category the US will look a little bit (insignificantly) better in that category, and a little bit (insignificantly) worse in another, and no change at all in the collective.

I confess I had no idea the US was that much worse than the best systems - 4/1000 is huge. That's an extra dead baby in the lives of every ordinary high school graduating class in the country.

They can't save any money that way. They are too few and small, and the insurance trusts alone too large and powerful. What the AFL-CIO in partnership with GM could not do, a local cooperative of small businessmen will not be able to even attempt.

 

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Right on Iceaura. The Republicans plans do nothing that change the healthcare market in any signficant way. The bottom line is that the healthcare consumer needs to have more competitors seeking their dollars.

Buying insurance across state lines does nothing but weaken the integrity of the insurance industry, incenting the insurance industry to take extrodinary investment risk in hopes of a fast profit - similar to the most recent financial debacle.

Letting individuals negotiate their own prices with insurance companies is just plain absured. Individuals will have even less power to negotiate price than their employer has today. The bottom line is, price competition is needed in the industry...something that does not exist today.

 

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Wow, just wow!

Have you any links for the bolded?

I thought we were discussing the differences in the definition of stillbirth...however after reading this...

Categories? There is only one we are talking about. You are either very confused or just have no clue what you are talking about.

 

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You need links for stuff that everybody knows? I'm not going to bother linking confirmation that Medicare and Medicaid don't provide care for the general public in the US.

Wait times - where you get your news from I don't know, but I recommend including some factual and reality based news coverage - what the mainstream sources call "left" or "fringe left". Obviously you've been overlooking them so far, or you'd know stuff like this automatically.

Also,keep in mind the US stats are cherrypicked - the US has a large proportion of people whose waiting time to see a doc is recorded as 0, because they never try, because they can't afford it. No other first world country screens and rations like that. If their waiting times were recorded even as the average of the others, rather than the months until crisis they are, the US numbers would be significantly worse. Keep that in mind.

But here:

http://sickothemovie.com/checkup/
http://www.businessweek.com/magazine/content/07_28/b4042072.htm

http://www.latimes.com/news/opinion/la-oe-klein7-2009apr07,0,3092824.story
http://www.prospect.org/csnc/blogs/...th=07&year=2007&base_name=american_wait_times

http://www.boston.com/bostonglobe/i...nty_of_countries_get_healthcare_right/?page=2

But we don't need to compare the US with upper tier systems like France and the Netherlands (let alone the truly superior such as Norway). We can compare with second level systems like Canada and the UK:

http://www.commonwealthfund.org/Con...national-Comparison--Access---Timeliness.aspx

Mind you, US ciizens are paying the same amount or more in taxes, and twice as much in total cost, for these substandard medical services, as any of the countries surveyed above.

 

An overwhelming majority of people who have received health care from those publically funded providers would disagree. It may be your opinion that they don't provide care for the general public the way you think they should, but that doesn't change the fact that many people recieve health care from medicaid and medicare everyday.

The only thing that makes it factual, to you, is if it agrees with your political bent. The fringe left and right rarely report in facts in reality, but the truth is always found somewhere in the middle.

You criticise the US for cherry picking statistics and then use blogs and opinion pieces to bolster your point, LOL.

Did you even read your link?

So in the US I may wait a little longer to see the doctor if I get a cold, but shorter wait times at the emergency room, to see a specialist or have elective surgery.

Emergency room or a cold? Your joking right?

Even so, 3 out of 4 is pretty good, no?

I wonder why they didn't shed light on the results of those other wait time statistics, instead of just focusing on wait times to see the doctor?

But there's no cherry picking going on.

 

It's not a matter of opinion. There are lots of uninsured and underinsured people in the US, younger than 65, and Medicare or Medicaid does not pay for their medical care. That's why people say the the US lacks "universal coverage" - because these people have no health insurance. None. Medicare does not cover them. This is a truly bizarre assertion of yours, and I don't understand why you are making it.

The physical facts about US health care are found in the reporting from what the major media calls the fringe left. They are not found in the middle. That's why you are surprised by them.

No, not just a cold - any illness that brings you to your family doctor. The wait times are longer for medical care when you are sick, in the US, than in most other first world countries. That's why the US has the highest rate of people who have doctors, who have insurance, going to emergency rooms because they couldn't get in to see their doctor in time.

Wait times are longer in the US, when you get sick and try to see a doctor, than in most Western industrialized countries. You didn't know that before, you do now.

And that is without counting the "wait time" for those simply denied a doctor visit, unable to pay. There are no such people in any other modern country, so the question of how to work them into the wait time stats is trouble. One way might be to include the time between the onset of the problem that would have taken them to a doc if they had money, and the crisis that lands them in the emergency room. Another might be to simply assign them the average wait time of the people with insurance - make them "neutral" in the stats. Either of those options removes the misleading statistical advantage the US enjoys by failing to provide health care, and drops the US even farther below the ordinary ranges of a first world country's health care system.

And the punch line? The US government pays more tax money for health care per capita than almost any other country, and covers only about 30% of its citizens with it. The rest must pay yet more, after already paying as much as the French or Danes in health care taxes, for private insurance.

 

Only because they don't qualify, they make too much money. Many people choose not to insure themselves.

Here is the fringe right perspective of those 46 million uninsured Americans.

First it was important to put the number of people we are discussing into perspective, based on the facts, IMO 20-25 million. For me, there are smaller steps than can be taken than this monstrosity of a bill laden with god knows what. The country is not ready for a single payer system and as long as it is written in secret, it never will be.

No, I am surprised somebody would put their integrity behind that much spin. Do you consider yourself an elitest?

People are lazy. Why go to the doctor when your not really sure, besides if it gets too bad I can just go to the emergency room and the wait will be shorter than all those other countries you linked to. I wonder how many times people don't go to the doctor because ultimately, they feel better?

I do agree with you, however, that this is an area that needs reform, But more government beauracrasy is not the way to do it.

 

Norsefire, that is a pile and you know it. Actually, I have an American acquaintance who used to come to Sweden regularly for the summer.
His mom fell ill, had some operations and it nearly bankrupt him.
He now permanently moved out of America to Sweden. Its a fair assumption to make that had he not moved, his mom would be dead or he destitute ... or both

 

I already gave him the numbers:
medical tourism in to the USA: 65,000-80,000
medical tourism out of the USA: 750,000+

 

If you noticed, the category is "insured or underinsured" - many US people who do insure themselves do not have coverage for ordinary first world medical care (everyone I work with on both my jobs, for example). We in this debate are counting those who do not receive first world medical care because they do not or cannot pay for it, in the US. That's what affects the stats, etc.

In all other first world countries, that percentage is essentially 0. In the US, it is at least 10, and more pragmatically surveyed 50 and up. This is in spite of the fact that the US taxpayer is paying more than almost every other first world taxpayer, in taxes alone, for public health care - and must then purchase health care for themselves privately, on top of that.

But let's go through the one small example of the completely uninsured, rather than the much larger fraction of partly insured to second world standard or the like, more closely:

Medicaid and S-Chip does not provide ordinary first world medical care, even to those who receive it. The existence of S-Chip proves that, btw - if Medicaid worked as ordinary first world insurance, S-Chip would have had no customers. Look up "MinnesotaCare", for an example of a State level attempt to deal with the uncovered by Medicaid.

And not everyone who is theoretically eligible can receive them - surely you recall the controversy surrounding S-Chip funding recently, in which we discovered that the monies appropriated for even that limited and specialty coverage were insufficient by half or more, nationally?

Meanwhile, they are not going to the doc for some reason. Any idea why not? (and btw: why do people have to "enroll" in Medicaid, if it covers the general public as you claim? )

They are working and living in the community. They are imported because the community, the agribusinesses, and the cheap labor corporations want them. Expecting these entities to pay for their medical care is perfectly reasonable - and an important defense against undercutting local labor and the local citizenry.

He's double counting here, but regardless: A fifty year old US city living woman with diabetes who tries to buy first world standard private health care insurance on three times the poverty income will end up living under a bridge.

It is the same as not receiving routine care, not being able to afford drug prescriptions, not having a family doctor and good medical records, not having ready access, and so forth. It is a lower level of care than is provided by first world standard systems.

On the one hand, you think we're OK because you think single payer systems already in place cover the general public - Medicaid and Medicare. On the other hand, you think this new health care bill is some kind of a single payer plan. Topping it off, you think it is written in secret. This fantasy world of yours touches on reality almost nowhere.

Many on the left would agree with you that this bill is a monstrosity of little benefit. And we agree with you that smaller and more obvious steps would work better. How about if we agree to gradually expand Medicare in five year intervals until it covers everyone? It's standard first world care, it's dirt cheap compared with the same in private insurance, there is no new bureaucracy, it maintains the current system of private hospitals and doctors and medical companies and so forth, and in general it works almost as well as the top-tier systems of others - it's almost world class.

What say you?

 

Can you clarify what you mean by "first world medical care"?

Yet the government systems stay in the red.

Ok.

Laziness, they feel fine, rather drive a new car, they are here illegally and fear being found out, there could be many reasons other than having to pay for it themselves.

Charts and records are a good thing, no?

$33k is not alot, but she wouldn't be living under a bridge either.

As long as the government sets the guidelines for wait lines and rationed care, that makes it "first world healthcare"?

Huh? Single payer is not in place, I can cancel my current policy and purchase one from a different provider on a whim and I am part of the general public. The short answer, I think the health care exchange sets the ground work in place for single payer. It allows the government to set guidelines that mandate providers become milque toast. The providers that choose to sell insurance, not under these fed guidelines, ie, but not limited too, "cadillac plans" are subject to excessive taxation. The will effictively leave the success of these providers in the hands of the government.

Isn't that Oreilly's line?

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Seriously though, I fear I might miss the target without a little clarification.

Shouldn't we first fix the problems with Medicare before we start expanding it?

Why cover everyone and not just those that truly can't afford it?

Which top tier systems set your standard of world class?

 

What the citizens of most first world countries expect when they get sick. Attention from a doctor, availability of hospital care and drugs etc, ordinary procedures and treatments as are received by randomly chosen citizens of modern industrialized countries.

So?

Seems odd those reasons are only found in America. In countries where the money is no factor, people don't skip going to the doc when they are sick and injured.

She would, unless the bankruptcy lets her keep her house. It happens, in America.

It doesn't. Medicare is single payer - does the exchange set the ground work in place for Medicare?

Sure, but we wouldn't have to. It would be a drastic improvement as is.

To save billions and billions of dollars and improve the delivery quality.

The four or five best of the European setups sound like what the US should have (Norway's, say) - but the average of the best 25 would be more in the range of worth shooting for, if we are talking about reforming the US setup. That would take some hard work and radical changes, but in a few years I think we could do it.

 

What about emergency rooms, elective surgeries or seeing a specialist?

Everybody I work with gets first world care under your definition. There is a small percentage in all countries that don't recieve proper health care for a number of different reasons. To imply the US does not have first world health care is like pounding sand.

I guess wait lines and rationed care are meaningless to you?

Nothing odd about differing priorities. Some people don't feel health care is important until they need it.

Better than dieing in a wait line, it happens in single payer systems.

:bugeye:

Ever heard of the law of unintended consequences?

Wait, you have made the claim that there is a large percent of Americans who don't go to the hospital because they can't afford it. Now your claiming giving them all free access is going to save billions of dollars at the same time?

Ok, Norway does seem to have an efficient system that provides quality care, but how do you square that with proponents of the single payer system.?

 

Emergency room services depend a lot on their existence - the US is rich, and has many. Other rich countries also provide good emergency room service. But US emergency room services are very expensive, and far over used due to the absence of ordinary medical care in the surrounding communities. So that is a significant source of the extraordinary high cost of US medical care.

Most first world countries provide much better access to elective surgeries than the US, where lots of people who cannot pay are thereby prevented from receiving such care at all, ever. I work with several such men. They have insurance. The wait times for elective surgery are shorter in the US, true - but only if you can pay. For the large number of people who can't, the wait times are very long - years, a lifetime.

The US does very well at providing access to specialists, if you can pay. That is because the fee structure and political setup of US medicine is such that most doctors specialize, doubling their income and halving their workload. That is one of the causes of the US subpar performance in delivery of regular GP care - with long wait times and high prices and poor access, and so many people simply denied care one way or another.

Only in America do so many of them end up in emergency rooms with expensive crisis situations, instead of taking care of their problems easily and cheaply in time.

Yep. That's how it works everywhere else on the planet, and I see no reason this place would be any different.

Somewhere between 20 and 40% of your medical dollar goes to screening out people who can't pay, and covering the complexities of the contracts etc for the people who can. Denmark doesn't spend a nickel on that shit.

Norway has a single payer system. It's cadillac, and very expensive - the US would only save a couple of thousand dollars a year per capita with Norway's system, instead of the 3 or 4 thousand we would save with the French or German setups. The US does not need all those bells and whistles - spa treatments, etc. Ordinary Medicare would do for us.

Sure. I doubt it was the intention of the corporate execs who blocked single payer back in the 50s to drive the US automobile industry into bankruptcy, or motivate foreign investors to site their car factories in Canada, or produce a work force with such a high absenteeism rate from medical issues, or end up paying such high taxes for public medical and still have to buy private insurance for their work force, for example.

 

I thought we were discussing wait times:bugeye:

from your link...

That hopium was some good stuff, but dude

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oke:

No

http://www.politifact.com/truth-o-meter/statements/2009/sep/09/matt-miller/analyst-says-netherlands-switzerland-achieve-unive/

Debating this with you has become tedious. There are so many unfactual satements in your posts, I spend most of my responses correcting them, and too tired to even begin discussing things like the criteria required by the UK to recieve dialysis, the rationing of drugs like Tarceva or cancer treating drugs, QALY, which country leads the world in fighting diseases and funding for medical R&D...These all reflect the quality of healthcare, not who can and cannot afford it.

 

Are you unaware that your link doesn't say anything about Norway? It's all about Switzerland and the Netherlands. Neither of which even border Norway.

Norway most definitely has a single payer system.

 

I was starting to wonder. I am glad to see somebody actually verifying an assertion, I am just surprised iceaura didn't jump on my gaffe sooner.

Norway is definately a single payer and probably the best model to look at if thats what your in favor of. It is not, however, free from problems and Norway's population is 1% of the US, so its really hard to know if it would work that well with that many people.

 

That's where you have to look at the cherrypicking of data. The US does not systematically track delays in receiving elective surgery, and in surveys like that the only people reporting on elective surgeries in the US are the people attempting to schedule elective surgeries - those who can pay out of pocket, those who have very good insurance, etc. The large fraction of the US population that has no access to many elective surgeries is not counted as having an infinite wait time. The large fraction of people in the US who must delay elective surgeries - for years, often - until they can pay for them somehow do not have this delay counted as wait time. There are no such people, in those other countries, and that further skews the numbers already compromised by the better record keeping of top flight systems found in those other countries.

Countries in which everyone has access to important elective surgeries get points for better access than the US system provides, even if the appointment wait is slightly longer, right?

Consider that they are only paying half price, compared with the US system. Many of them are much poorer countries.

 

Its not cherry picking when your comparing apples to oranges.

There is few criteria that can be used, to compare a capitalist market driven health care system and a single payer system, and make an accurate assessment of the quality of health care. One measure that cannot be politicized is the effectiveness of the care recieved by the sick.

The Us ranks #1.

Prevention, chronic care, primary care, and hospital care and coordination.

Those are real indicators of health care quality with no political ideology poisoning the results.

 

? I'm comparing the health care received by the citizens of the US with that received by the citizens of other countries. All the citizens.

Why not compare a capitalist market driven single payer system, with your capitalist market driven private insurance payers system? What Medicare would be if the government quit coddling the private insurance companies and drug companies by refusing to allow Medicare to bargain in the market?

Apparently you think you have avoided "politicization" by refusing to include the non-patients and denied patients in your system comparisons - thereby leaving out one of the two biggest defects peculiar to the US system (the other is cost).

For admitted patients - people who can pay the US prices for the treatment of whatever ails them.

The mother of all cherrypicking manuevers, that. I'm quite sure that the guy I work with who has the dislocated collarbone will receive fine care - as good or better than any in the world - if he ever manages to save up enough money to get down to the Mayo Clinic and get it fixed. He'd better - he's already paid for French level care, through taxes, and his doubled extra expenditures should buy him some boost in quality over the French. Meanwhile, the level of care he has received should be included in the averages for the US health care system.