Questions for Americans: Socialised Health Care


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pres man wrote:
yellowdingo wrote:
QXL99 wrote:
Americans already have a healthcare system that is managed by bureaucrats--the bureaucrats in question work for insurance companies and HMOs. And yes, they can be heartless (resulting in lawyers getting richer).
With Universal Healthcare, the Bureaucrats would no longer be from insurance companies and HMO's. There would be no need for Medical Insurance and HMO's. Therefor they would not in anyway be comprimised in the nature of their decision making processes.
I wonder if we shut the insurance companies down, what effect the loss of that many jobs would have on the economy. I wonder how does the number of employees at insurance companies compare to those at the automotive companies? Would we end up having to bail out the companies we were trying to put out of business?

Well, to use a neo-liberal economics argument; the money that is tied up in healthcare provision would be freed up, making US companies more competative in general. This would allow the displaced employees to find work else where as other industries grow thanks to the reduced burden.

After all, general motors has more than once been described as a healthcare provider, that incidentals makes cars.


Sebastian wrote:

GET OFF MY LAWN!!!

Damn kids these days, no respect. Ruining the world with their internet and sexting. Back when I was a kid, we satisfied our bestial urges by smashing our dicks in a bible. And we liked it.*

*But not in a sick S&M way. In a holy way.

*mutter* *mutter*

HEY! I SAW THAT YOU PUNK!!! MY LAWN!!! OFF OF IT!!!

Edit: When did "dick" stop being a four-letter word. Wait...it still has four letters... Ok, when did it become okay to say "dick". It seems like I only ever heard the word "dick" in movies when I was a kid, but now I hear it on television. If that's not evidence of the decline of Western civilization, I don't know what is.

Dang it you little whippersnapper! You stole my line!!!! Hell, boy, why don't ya just steal my cane and my teeth while you're at it. Maybe knock me down a flight of stairs, then kick me while I lay there bleeding! Younguns like you ain't got no respect for yer elders.

Little bastards.


Jeremy Mac Donald wrote:


Well its worth pointing out that a system without enough checks and balances is generally even worse. The last thing one needs for stability is a country that goes from the extreme right to the extreme left every 4 years.

For all its flaws America does have a pretty good political system. Checks and balances are insanely frustrating but, at the end of the day, the American political parties absolutely need to figure out where the exact center of the political spectrum is and then array themselves on that centre and then over to whichever side (right or left) they represent. Winner grabs the centre and either party that fails to do that starts loosing elections.

That said I think one of the reasons things seem particularly contentious in America these days is that the centre has shrunk. I suspect in Britain and Canada you have a centre thats roughly 40% of the population with the right and left each taking up around 30% of the population while America's centre is more like 20% of the population with the right and left being closer to 40% each. Hence you have two powerful blocks trying to sway a small group in the middle and very much opposed to the other side. In other states you have this massive group in the middle and smaller groups on each side trying to sway the middle group to see things more like they do.

I'm not sure I can honestly agree Jeremy. Perhaps the reason America possesses such strong fringes on the left and the right is because both sides know they can propose anything they want and the gridlock built into our system will prevent them from ever having to actually back up the claims they make. I know many liberal politicians have slowly been backing away from liberal positions suddenly since Obama has won and there has actually been a chance they will have to actually deliver on some of their claims.

Consider that we have more veto points in our system than nearly any other Western nation (maybe more than any Western nation?) Our Senate is built explicitly to give disproportionate power to smaller states.

Did you know the "Gang of Six" that are currently holding up health care reform in our Senate represent only 2.74 percent of America's population? That is less than New Jersey, and less than 1/5th of California. What is good to let less than 3% determine the fate of the other 97%?

America has gotten plenty of things right, but we get a lot wrong too. I suppose it is like that everywhere, but that shouldn't stop us from calling out the problems when we see them.


Mandor wrote:


I must have missed something. What spending controls did they vote against?

I remember them lying down and playing dead with the Stimulus and the Omnibus bills which massively added to our debt. They rolled over for the Cap and Trade bill. It looks like they finally became active recently with healthcare and the federal reserve's refusal to open their books because they are afraid of getting voted out of office next year. Until then, I didn't know they existed.

Here are two links discussing Blue Dogs complaining in the same breath about A) the cost of health care reform and B) proposals for lowering health care reform.

Secondly, it seems to me the Blue Dogs either seriously misunderstand the structure of politics or don't really care about getting voted back into office. If health care reform fails, expect the next election or two to be very bad for the Democrats. Being on the margins as is, Blue Dogs are going to be exactly who get picked off in such a case, just as the liberal Republicans were almost voted to extinction in '06 and '08 elections.


pres man wrote:


Supports the idea that Dems are not being totally truthful. This lack of honesty is part of the reason so many distrust what is being pushed through. If you have to lie about it, there must be something wrong, is what alot of people think.

Death panels. Forced euthanasia. Racist medicine. Eugenics.

If you have to lie about it, there must be something wrong. Right?


pres man wrote:


I imagine you take the data that you are using to calculate the average, put it in numeric order and figure out the middle value, and there is the median. How is that so much harder than taking all the values, adding them together and then dividing by the population?

Not really. No one actually has a list of how much each (of the 300+ million) people in the US spent on health care for the year. It isn't as easy as just looking at the same data, sorting it, and then taking the middle value.

Averages are MUCH easier to construct than medians or modes when dealing with real world fuzzy statistics. I'm not sure I've ever seen a median or mode reported for any real world purposes.


David Fryer wrote:
Not to mention that the majority of countries that are usually listed in these examples have small and relatively homogenous populations. Neither Japan, or Switzerland has anywhere near the size of population or cultural and genetic diversity found in the United States. It's like comparing apples to watermelons.

I'm not sure why size of population or cultural/genetic diversity (and I'm not even sure I buy the genetic diversity argument) matter. We're looking at per capita spending; why should more people mean that we spend more per person for poorer results? Why is American culture (or genetics?) so inferior compared to other countries that utilize socialized or single-payer health care systems?


in the UK, we have a multi-party system, with more than just Labour (our left-ish party) and Concervative (our right-ish party) - both are to the left of american parties, and the lines are fairly different. Labour is left-wing-but-coseyed-up-to-big-business, Concervative is right-wing-but-all-about-social-mobility - however, they are clustered, very close together, in the centre, and at times you can't slip a credit-card between their policies. now, the main "flow" of power bounces between these two, but the smaller parties give us a bit more fluidity as well as standing on the edges. Now, this isn't a comprehensive list of the smaller parties, but It gives a good idea of how it falls. Also, as it's a parlimentary system, not a presidential one, many of these parties do have a smidge of power, some in parliment, some on a county/city level

Liberal Democrats - a kind of mix of liberal, left-wing and center ground. very keen on social responsibility and redistribution, but also local acountability and a strong degree of realism. it's frequently said "they will never get real power, as they are too nice" - they get about 20% of the vote in most elections

SNP/Plyd Cymru - Scottish/Welsh Nationalist parties (respectivley), strong in their own regions. fairly left-wing over-all, but can be a bit single issue. Both do have seats in parliment, however

Then, with local, but not national power, you have two right-wing parties

BNP - officially British National Party, but lots of people call them the British Nazi Party, which more or less sums up their policies. they won two seets in my county election this year, which has lead to a massive campaign against them. they are very anti-muslim, anti-gay, anti-jewish and anti-black. most of their activists, including their leader, have criminal records

English Democrats - a Christian-right nationalist party, with one mayor in the north-east. he has, more or less, made a total fool of himself in the three months he has been elected as he never expected to win, doesn't have a clue as to what he's doing, and makes one gaff after another. if it wasn't true it would be funny. His first radio interview was, however, hillarious, as the presented pointed out that of his first 5 policy announcements, 4 were illegal (and, one of them he had even broken employment law by announcing) and the fith would be a massive hit to local business (basically, he wanted to ban the local pride march to save money, even though the council's overheads came to about £1500, but the event brought in about £30,000 in revenue)


Patrick Curtin wrote:

I think this distills down the issue I have with government taking over health care system. I personally would rather have a business in control than a government bureaucracy. I don't think the government will be trying to get rid of me by curing me, I think they will be making as much paperwork as they can to justify their existance. They will want patients in the system, as this will make them look busy. Insurance companies have a large bureaucracy, but it is profit driven. Underperforming employees at least can be fired, unlike government bureaucrats. Government bureaucrats are almost immune to firing, and they manage to accrue more and more benefits as they go.

I think we can reform the insurance model without constructing yet another massive government bureaucracy that siphons tax money into their pockets via pay and benefits. There are better ways to reform what's wrong than tossing it into the government sector. making non-profit co-ops like the Group Health Cooperative in Seattle that handles 600K members might be an option. I'd rather give a one-time start up disbursement of cash to establish some national cooperatives than have to pay for more bureaucrats.

I guess to some level I can understand your point Patrick, but doesn't it bother you that the reason those under performing employees are fired is because they aren't efficient enough in denying coverage to people who need it?

A private company exists to make a profit. This means they ARE very efficient. But a private health care insurance company makes a profit by getting lots of people who don't use health care to buy insurance while making sure no sick people need their services. And they've been getting better and better at making sure that if there is any way they can deny you coverage, they will.

Isn't it a problem that if you are sick and don't have insurance, then your best option is to actually bankrupt yourself so you can get Medicaid? I hate being the stereotypical "bleeding heart liberal" here, but isn't there a moral component to seeing that people can get the health care they need?

We already insist that hospitals treat any emergency cases that walk through their doors, even if they can't pay. This is a very inefficient way of seeing that everyone can receive health care, and is no replacement at all for people with long lasting emergencies, like cancer or HIV. Why is it so unreasonable to try and make the above requirement more both cheaper and more useful, by moving this care from the ER to actual doctor's offices?


Loztastic wrote:

How does it work over there for "social health" issues?

Say I was a heroin addict (which i'm not). Over here, I could walk into a clinic and ask to be put on a programme - there is currently a wait (a couple of weeks), but after that time i'd see the nurse (who would take bloods for BBV's and LFT's) and do an analysis of what I'm taking. once the results came back (again, about a week) I'd be in to see the doctor - who would perscribe a programme of Methadone, Subutex (if i was strong enough) or Naltraxone (if i was brave enough and strong enough). I could tghen apply for funding to do either a residential detox or a residential rehab - however the money IS very limited, only a few people a year in each city get to go

many prisons also have a rehab wing - run more like a rehab unit than a prison. more or less isolated from the rest of the prison, volutary transfers only to the unit, and for people serving long sentences for drug/alcohol related crime

... I'm guessing over there means America? I'm under the impression that these kinds of clinics are largely on the decline throughout America. As is we can barely get Needle Exchanges going without people wringing their hands over promoting drug use. On top of that, Methadone clinics have a bad case of NIMBY.

Sadly, both political parties are still committed to plunging us head first off the Drug War cliff. There are some rumblings on the left (and in libertarian circles as well) but not much traction on a national level, at least not yet.

But our completely twisted Drug War policies probably should be spun into their own thread, rather than cluttering up this one.


Oof. We need some kind of multi-quote option here, to avoid me having to post a half-dozen replies to posts that went up while I was gone. Sorry for the flood guys.


Sigh, I can't help myself. I was going to let someone else talk for a while, but then I mosey on over to one of my favorite political sites and what is article #1?

Tort Reform Unlikely to Cut Health Care Costs

That link is for you Patrick! :)

Dark Archive

David Marks wrote:
David Fryer wrote:
Not to mention that the majority of countries that are usually listed in these examples have small and relatively homogenous populations. Neither Japan, or Switzerland has anywhere near the size of population or cultural and genetic diversity found in the United States. It's like comparing apples to watermelons.
I'm not sure why size of population or cultural/genetic diversity (and I'm not even sure I buy the genetic diversity argument) matter. We're looking at per capita spending; why should more people mean that we spend more per person for poorer results? Why is American culture (or genetics?) so inferior compared to other countries that utilize socialized or single-payer health care systems?

The argument is that, for example, culturally Asian people have a healthier diet, mainly because red meat was not avaliable in many regions until the 1800's. So is their longer life expectancy and lower incident of some times of diseases due to the fact that they have a universal health care system or is it due to some other factor, such as diet. Comerica we have a diet that is high in fat, cholesteral, and fast food. So any plan that does not address these factors is not likely going to have a substantive positive effect on life expectancy and disease rates, because it is not address the underlying issue involved.

It not so much a matter of American culture or genetics being inferior, it is more a mtter of there being a whole lot more of us. Consider that the United States has the third largest population in the world. The Unitd Kingdom, which is the most often cited as having a good Universal coverage plan has the 22 largest population and is only roughly equal to 17% of the U.S. population. Canada which is the other most commonly cited system ranks #33 and is roughly equal to 11% of the U.S. population. Even Switzerland, which has the best system in the world according to most sources I have read, is about equal to 3% of the U.S. population.

So basically my point is that something that works on a small scale does not always work when scaled up. If it did, we would be running our governmentusing the Athenian Democracy model that works so well in the Rural American Northeast. I believe that we need to find a distinctly American solution, because I am not convined that the ame plan that wrks well for 33 million people, or 61 million people, will work as well for 308 million people. I have found that if something is advertised as one size fits all, it usually doesn't.

Dark Archive Bella Sara Charter Superscriber

Cranky McOldGuy wrote:


Dang it you little whippersnapper! You stole my line!!!! Hell, boy, why don't ya just steal my cane and my teeth while you're at it. Maybe knock me down a flight of stairs, then kick me while I lay there bleeding! Younguns like you ain't got no respect for yer elders.

Little bastards.

Aw, man. Go back inside you dirty old fossil. Nobody cares what someone your age thinks. You don't understand what my generation has gone through - you managed to trademark all the good lines before I was even born. I'm taking back "Get off my lawn" for my generation.

Stinky old fart. Doesn't understand me or how much harder my life has been. What did he do? Survive the depression? I have to pay for internet at Starbucks these days. Pffft.

Silver Crusade

Sebastian wrote:

GET OFF MY LAWN!!!

Damn kids these days, no respect. Ruining the world with their internet and sexting. Back when I was a kid, we satisfied our bestial urges by smashing our dicks in a bible. And we liked it.*

*But not in a sick S&M way. In a holy way.

*mutter* *mutter*

HEY! I SAW THAT YOU PUNK!!! MY LAWN!!! OFF OF IT!!!

Edit: When did "dick" stop being a four-letter word. Wait...it still has four letters... Ok, when did it become okay to say "dick". It seems like I only ever heard the word "dick" in movies when I was a kid, but now I hear it on television. If that's not evidence of the decline of Western civilization, I don't know what is.

This is the best rant ever.

Sebastian wins the internet yet again.


Bill Dunn wrote:


Thurgon wrote:
3) Our current debt level is so high without it that I would rather see real progress on that be done before creating even more. Basically we are already being unfair to the next generation enough to bail out our own mistakes. I don't want them to have to pay for another huge government program that may collapse before they even get to benifit from it.

The next generation will be eligible for coverage under a public option as soon as it is operational. A larger proportion of them may, in fact, be covered than any other age cohort given the number of kids living uninsured now.

They wont get anything if we can't pay for it.

Let me put it this way. 47 million based on the Presidents numbers out of a nation of what 307 million. Of course not all those 47 are counted in the 307 because even based on the President's number what some 10 million or so are illegals. So then you are really talking about 37 million, or which another 7 are covered by current plans but for some reason they have no applied for the coverage or turned it down. So now your talking about 30 million, about 10%. Which is also about the same as the unemployment percent. I would argue that if unemployment were lowered so would this number be. And more jobs in service and government are not the way to go, those jobs are not sustainable without a strong manufactoring base, which we lack.

So I would put forth that creating jobs in the right sectors would likely do more for healthcare coverage then any current plan in the house or senate.

Creating jobs also inceases the tax income for the government and thus long term reduces the debt.

The plans in the house and senate well I haven't seen them completely I can't say if they will decrease the debt long term, certainly in the short term they will increase it. The higher it goes the greater the risk of inflation. Thus my fear that the next generation will pay for our healthcare then loose their own when they can't pay for it any more.


David Marks wrote:
pres man wrote:


I imagine you take the data that you are using to calculate the average, put it in numeric order and figure out the middle value, and there is the median. How is that so much harder than taking all the values, adding them together and then dividing by the population?

Not really. No one actually has a list of how much each (of the 300+ million) people in the US spent on health care for the year. It isn't as easy as just looking at the same data, sorting it, and then taking the middle value.

Averages are MUCH easier to construct than medians or modes when dealing with real world fuzzy statistics. I'm not sure I've ever seen a median or mode reported for any real world purposes.

Look at the housing market. It often has the average home price and the median home price for a given market. That is because a single $10 million home can throw of the average if most of the other homes are in the $60-$100 thousand range.


David Marks wrote:
pres man wrote:


Supports the idea that Dems are not being totally truthful. This lack of honesty is part of the reason so many distrust what is being pushed through. If you have to lie about it, there must be something wrong, is what alot of people think.

Death panels. Forced euthanasia. Racist medicine. Eugenics.

If you have to lie about it, there must be something wrong. Right?

Sure. Though, there may be some truth to racism and how medicine is done. I think studies have shown that minorities often get worse care. Of course some of that may also be issues of socio-economic things as well. Sometimes it is hard to separate the two, especially since minorities groups are often in lower socio-economic groups.


David Marks wrote:
David Fryer wrote:
Not to mention that the majority of countries that are usually listed in these examples have small and relatively homogenous populations. Neither Japan, or Switzerland has anywhere near the size of population or cultural and genetic diversity found in the United States. It's like comparing apples to watermelons.
I'm not sure why size of population or cultural/genetic diversity (and I'm not even sure I buy the genetic diversity argument) matter. We're looking at per capita spending; why should more people mean that we spend more per person for poorer results? Why is American culture (or genetics?) so inferior compared to other countries that utilize socialized or single-payer health care systems?

Sickle-cell isn't real?


Perhaps it would be simpler if you just left all the decision to I Julien, your king.


Sebastian wrote:
Stinky old fart. Doesn't understand me or how much harder my life has been. What did he do? Survive the depression? I have to pay for internet at Starbucks these days. Pffft.

Aw, boo hoo! You should be happy with yer dang internet whippersnapper, even if ya gotta pay for it.

Back in my day, we didn't have no internet, and we ain't had computers neither. We had newspapers! Good, old fashion, tree-killin newspapers. First you had to fight for one. Up hill! Both ways! And then you'd read it, getting ink all over your hands. And sometimes we'd have to use the left over newspaper as TP! Or even burn it during winter just to stay warm! You kids got it too damn easy!

Little bastards!


As an American living in Switzerland for nearly five years, I think I have something to add to this conversation.

First off, European models for health care (and economics) differ fairly dramatically between countries. Switzerland happens to share a great number of economic liberal ideals with the U.S., and their health care system reflects this. The major points:

* All insurance is private, with over 100 providers competing for customers. The companies are a mix of non-profit and for-profit (although the exact situation depends on the canton), and all must offer the same plans. After the deductible is met, all coverage is 90/10. No deductible is greater than 2,500 CHF (~2350 USD).

* Employers must pay a second insurance called "accident insurance." Insurance companies can fight over a particular claim that doesn't fall squarely in one plan or the other, arguing the accident or health insurance should pick up the tab. Problems are uncommon, but this is a negative for sure.

* Purchasing insurance is mandatory, with minor penalties for failing to do so. If someone refuses, the government will typically purchase a plan for them, and then send them the bill. Failing to pay that bill leads to a visit from the police. This is highly atypical, as there is little reason not to comply. (argh, my liberty to take on risk, denied! how dare they!)

* If you can't afford insurance, the government subsidizes or picks up the tab.

* Caregivers are a mix of public and private, but private care is common. Costs are much lower than in the States. My last hospital trip cost me 120 CHF, no coverage from insurance since I was below my deductible. The associated drugs cost another 60 CHF, and the wheelchair I needed for two weeks was 120 CHF. Try getting those prices in the U.S.

* I pay 167 CHF a month, non-subsidized (foreigners are not allowed subsidy anyway), 2500 CHF deductible. It's one of the cheaper plans, and a more middle of the road price would be 180-190 CHF. 200-300 CHF for lower deductibles.

* Eye and dental are separate, but cheap. I don't carry it, so I'm not up to date on costs, but they are in the low double digits a month.

The Swiss see the competition in the market as key to costs. Indeed, costs have actually gone *down* slightly for me during the five years here. DOWN. That's stunning. The mix of non-profits is key, as it keeps the for-profit guys honest. That makes me a strong supporter of a real public option in the U.S., in the hopes that it could do the same. But for-profit can compete and still make money, which should put right-wing fears to rest. The industry is healthy here, and competition well beyond what you can find in most U.S. states.

The biggest problem is a lack of doctors, but every Western country currently suffers from the same. Other issues? Well, none that I am aware of. The system is hugely popular, particularly since Switzerland had a horrid system just 20 years ago, very similar to the current U.S. situation. The Swiss right-wing fought hard against the current regulations, lost, and now largely embrace them as fundamental to Swiss life. There was a fabulous interview with the head of one of the center-right parties a year ago where he discusses how important the modern Swiss system is to the economic health and social well-being of the country, and basically apologizes for campaigning against it.

So, from my angle, I have an amazingly hard time understanding the fear rife in the U.S. The data doesn't support it. If Switzerland and the rest of Europe are any indicators, well regulated or single-payer health insurance is key to bringing costs down, covering everyone, and in the Swiss case, increasing competition. I beg that people who are currently against real reform actually read the social statistics.


pres man wrote:
David Marks wrote:
David Fryer wrote:
Not to mention that the majority of countries that are usually listed in these examples have small and relatively homogenous populations. Neither Japan, or Switzerland has anywhere near the size of population or cultural and genetic diversity found in the United States. It's like comparing apples to watermelons.
I'm not sure why size of population or cultural/genetic diversity (and I'm not even sure I buy the genetic diversity argument) matter. We're looking at per capita spending; why should more people mean that we spend more per person for poorer results? Why is American culture (or genetics?) so inferior compared to other countries that utilize socialized or single-payer health care systems?
Sickle-cell isn't real?

Hey, you have no more of a serious claim to increased diversity of genetic disease that the UK, and yet we still rank better with WHO and spend less per capita.


Zombieneighbours wrote:
pres man wrote:
David Marks wrote:
David Fryer wrote:
Not to mention that the majority of countries that are usually listed in these examples have small and relatively homogenous populations. Neither Japan, or Switzerland has anywhere near the size of population or cultural and genetic diversity found in the United States. It's like comparing apples to watermelons.
I'm not sure why size of population or cultural/genetic diversity (and I'm not even sure I buy the genetic diversity argument) matter. We're looking at per capita spending; why should more people mean that we spend more per person for poorer results? Why is American culture (or genetics?) so inferior compared to other countries that utilize socialized or single-payer health care systems?
Sickle-cell isn't real?
Hey, you have no more of a serious claim to increased diversity of genetic disease that the UK, and yet we still rank better with WHO and spend less per capita.

Of course, the NHS is not rainbows and unicorns for everyone.

Edit: I know the answer will be that every system has it's horror stories, but this appears tio be a systimatic faliure involving an entire city.


As i have pointed out time and time again, the NHS is not perfect.

And your right, Glasgow is f~~!ed. There really isn't another term for it. But the NHS in scotland is fighting a war of attrition against poverty, social exclusion, drugs, violent crime and an entire subculture who thinks that deep fried pizza and battered mars bars sound like good nosh. If the underlying population is doing everything in its power to destroy itself, even best health professionals in the world are not going to be able to do much. I would not be supprised if local failings contribute, but atleast the failings of one cities primary care trust can be raised, discussed and acted upon here.

I can be fairly comfident in saying that the same city, under the american system would be in infinately worse shape.


Twings wrote:

* Purchasing insurance is mandatory, with minor penalties for failing to do so. If someone refuses, the government will typically purchase a plan for them, and then send them the bill. Failing to pay that bill leads to a visit from the police. This is highly atypical, as there is little reason not to comply. (argh, my liberty to take on risk, denied! how dare they!)

* If you can't afford insurance, the government subsidizes or picks up the tab.

See if we did that in the US, maybe dropped in a few regulations about how people with pre-existing conditions have to be taken on (perhaps randomly assigned to various insurance companies like car insurance is done for some high libility folks), and make it harder to lose their insurance, that would solve most problems.

Of course, Prez Obama has a hard time saying he is for mandatory healthcare since he made a big deal in the election that he wasn't for it for adults (but mandatory for kids was acceptable). Though we all know he wants to make it mandatory. He's said things like "everybody in" and if there was a government run insurance "you'd still have to pay premiums". This is actually what the insurance companies want if they have to take on people with pre-existing conditions. "Sure, we'll take on these high risk folks, just as long as you force all those young healthy people also to get insurance so we can spread out the risk."


Zombieneighbours wrote:

As i have pointed out time and time again, the NHS is not perfect.

And your right, Glasgow is f#!#ed. There really isn't another term for it. But the NHS in scotland is fighting a war of attrition against poverty, social exclusion, drugs, violent crime and an entire subculture who thinks that deep fried pizza and battered mars bars sound like good nosh. If the underlying population is doing everything in its power to destroy itself, even best health professionals in the world are not going to be able to do much. I would not be supprised if local failings contribute, but atleast the failings of one cities primary care trust can be raised, discussed and acted upon here.

I can be fairly comfident in saying that the same city, under the american system would be in infinately worse shape.

I think there are plenty of US cities that could be describe almost exactly as you stated above. "poverty, social exclusion, drugs, violent crime and an entire subculture who thinks that deep fried pizza and battered mars bars sound like good nosh." I'm not sure about the fried pizza or mars bars, but we have things at least as bad. And in those, probably most of the folks use the already provide government health care system.


Zombieneighbours wrote:

As i have pointed out time and time again, the NHS is not perfect.

And your right, Glasgow is f**%ed. There really isn't another term for it. But the NHS in scotland is fighting a war of attrition against poverty, social exclusion, drugs, violent crime and an entire subculture who thinks that deep fried pizza and battered mars bars sound like good nosh. If the underlying population is doing everything in its power to destroy itself, even best health professionals in the world are not going to be able to do much. I would not be supprised if local failings contribute, but atleast the failings of one cities primary care trust can be raised, discussed and acted upon here.

I can be fairly comfident in saying that the same city, under the american system would be in infinately worse shape.

I could not find in concrete statistics, but I did find a Harvard study that does talk about how where you live and other cultural factors affect life expectancy and rates of disease. One thing it shows is that urban dwellers in the United Sates, in areas similar to Glasgow, have a life expectancy of 71 years. Two things that authors of the study said that stand out to me.
The Medical News wrote:
According to the study, race, income and access to health care alone cannot explain the differences in life expectancy among the eight groups. Premature deaths of young and middle-aged adults, in large part from chronic diseases and injuries, account for most of the differences in life expectancy among the eight groups, the study finds. Christopher Murray, director of the Harvard Initiative for Global Health and lead author of the study, said that income did not account for the differences in life expectancy among the eight groups because whites "living below the median incomes in northern states have the best level of health among whites," adding, "That runs counter to everything we know"...Murray said that many government health care programs focus on children and seniors and that few focus on at-risk young and middle-aged adults. "Where we fall down is delivering health care for young and middle-aged adults," Murray said. He added, "This really requires a rethink about what is the focus of health care policy discussions in the U.S.


David Marks wrote:

Here are two links discussing Blue Dogs complaining in the same breath about A) the cost of health care reform and B) proposals for lowering health care reform.

Secondly, it seems to me the Blue Dogs either seriously misunderstand the structure of politics or don't really care about getting voted back into office. If health care reform fails, expect the next election or two to be very bad for the Democrats. Being on the margins as is, Blue Dogs are going to be exactly who get picked off in such a case, just as the liberal Republicans were almost voted to extinction in '06 and '08 elections.

So you couldn't find any actual votes? Which means your statement "they consistently vote against all proposals to control spending!" is not true.

Liberal republicans generally represented more liberal constituencies where the only way for a republican to get elected is to be a centrist. They got voted out, along with other republicans, because the republican party did a great job of angering voters with the Iraq war and the culture of corruption.

The Blue Dogs are going to be in a similar situation in '10. As democrats in more conservative districts they will be facing their constituents' anger over out-of-control deficit spending and the culture of corruption.


Mandor wrote:
So you couldn't find any actual votes? Which means your statement "they consistently vote against all proposals to control spending!" is not true.

"Absence of Evidence is Not Evidence of Absence"


pres man wrote:
Zombieneighbours wrote:

As i have pointed out time and time again, the NHS is not perfect.

And your right, Glasgow is f#!#ed. There really isn't another term for it. But the NHS in scotland is fighting a war of attrition against poverty, social exclusion, drugs, violent crime and an entire subculture who thinks that deep fried pizza and battered mars bars sound like good nosh. If the underlying population is doing everything in its power to destroy itself, even best health professionals in the world are not going to be able to do much. I would not be supprised if local failings contribute, but atleast the failings of one cities primary care trust can be raised, discussed and acted upon here.

I can be fairly comfident in saying that the same city, under the american system would be in infinately worse shape.

I think there are plenty of US cities that could be describe almost exactly as you stated above. "poverty, social exclusion, drugs, violent crime and an entire subculture who thinks that deep fried pizza and battered mars bars sound like good nosh." I'm not sure about the fried pizza or mars bars, but we have things at least as bad. And in those, probably most of the folks use the already provide government health care system.

And i don't denigh it, but glasgow really is an exceptionally messed up city, between secterian violence, food culture that resists all attempts at reform. There is also a number of geographic factors, such as(from memory) the fact that on average glasgow gets about the same amount and strength of direct sunlight the edge of the arctic cicle, due to cloud cover.

So the question is, does one extreme outlayer with a great deal of special circomstance attatched, in a system that i have already described as Imperfect, change the fact that the system on the whole costs considerably less and provides a better WHO ranking on healthcare?


pres man wrote:
Mandor wrote:
So you couldn't find any actual votes? Which means your statement "they consistently vote against all proposals to control spending!" is not true.
"Absence of Evidence is Not Evidence of Absence"

Absense of evidence may not be Evidence of Absence, but it certainly does leave a situation where we have no reason to accept the proposition.


David Marks wrote:

I guess to some level I can understand your point Patrick, but doesn't it bother you that the reason those under performing employees are fired is because they aren't efficient enough in denying coverage to people who need it?

A private company exists to make a profit. This means they ARE very efficient. But a private health care insurance company makes a profit by getting lots of people who don't use health care to buy insurance while making sure no sick people need their services. And they've been getting better and better at making sure that if there is any way they can deny you coverage, they will.

Isn't it a problem that if you are sick and don't have insurance, then your best option is to actually bankrupt yourself so you can get Medicaid? I hate being the stereotypical "bleeding heart liberal" here, but isn't there a moral component to seeing that people can get the health care they need?

We already insist that hospitals treat any emergency cases that walk through their doors, even if they can't pay. This is a very inefficient way of seeing that everyone can receive health care, and is no replacement at all for people with long lasting emergencies, like cancer or HIV. Why is it so unreasonable to try and make the above requirement more both cheaper and more useful, by moving this care from the ER to actual doctor's offices?

I guess to some level I can understand your point Patrick, but doesn't it bother you that the reason those under performing employees are fired is because they aren't efficient enough in denying coverage to people who need it?

A private company exists to make a profit. This means they ARE very efficient. But a private health care insurance company makes a profit by getting lots of people who don't use health care to buy insurance while making sure no sick people need their services. And they've been getting better and better at making sure that if there is any way they can deny you coverage, they will.

Isn't it a problem that if you are sick and don't have...

And I understand your point David, and I recognize that the way Americans receive health care is flawed. We just have differing ideas on what is the best way to go about fixing it. I join these debates to learn things and challenge my assumptions. Since starting in on trying to keep up with the debates, I have been made aware of the co-op model of health care insurance. I like it for several reasons, to wit:

  • It is member run, not government run
  • It has already been proven to work in the marketplace.
  • It is non-profit, and any money left over from paying for costs is reinvested in the infrastructure of the cooperative
  • Members have a say in the adminstration
  • As it is non-profit, it removes the incentive for the company to deny service to save money, one of the worst problems in healthcare as it stands today.
  • As a member-owned company it is accountable to its members, and must be somewhat transparent in its dealings
  • Several coops can be set up to compete.
  • The costs to the taxpayer would be a start-up cash disbursement, that might actually be repaid eventually as the system gets moving.

I am not heartless. I understand that this is an emotional issue. I just do not think that throwing healthcare into the government's hand is going to do us any better over the long haul.

Government bureaucracies may start small and lean, but they never stay that way. Waste and bloat come over time with them like cats having kittens. Also, there is the real underlying issue of how to pay for all this. Government is not some separate entity sitting on a dragon hoard of gold. Government is you and me. The money it collects comes from us, or it borrows it from other governments. We are running our country like a college kid with a pre-approved gold card. The bill comes due sometime, but instead of our parents having to pay it, our children will. I find that horrific. Leveraging our needs on the backs of our children is a scummy way to do business.

Unfortunately, we have no options when it comes to government, except to vote every two years. Even then, if you live in a state antithetical to your politics, you're shouting into the storm. Especially if you support a third-party, which is frequently mocked as foolish. But at least we have some semblance of choice, which is more than most governments around the world can say ...

The Exchange

Patrick Curtin wrote:
Government bureaucracies may start small and lean, but they never stay that way. Waste and bloat come over time with them like cats having kittens. Also, there is the real underlying issue of how to pay for all this. Government is not some separate entity sitting on a dragon hoard of gold. Government is you and me. The money it collects comes from us, or it borrows it from other governments. We are running our country like a college kid with a pre-approved gold card. The bill comes due sometime, but instead of our parents having to pay it, our children will. I find that horrific. Leveraging our needs on the backs of our children is a scummy way to do business.

You say this a lot. Thing is, this is sounding like a presupposition rather than an observation. (At the risk of repeating myself) the UK socialised system is much cheaper than the US system. It is obviously the case that state bureaucracies can be very inefficient but that is not to say that company bureaucracies can't be too, or that a state-mediated provider can't actually be quite efficient. The evidence does not particularly bear out your position. And an insurance premium is not much different to a tax - it is money out of your pocket. Yes, taxes will probably need to go up to support universal healthcare in the US. But if it brings about a significant reduction in insurance premiums, and increased tax receipts because sick poor people can get treatment, that is (ok, may be) a net gain.

Sometimes, in order to get a socially desirable result, and even an economic one, there needs to be government intervention - an example in the UK is the building of new power supplies, which has been left to the market. However, over reasonable timescales there isn't much payback in the short term on power stations so now we are facing the possibility of blackouts in the UK in the next few years if demand continues to increase. Similarly, there isn't much payoff in the medical treatment of poor people - they are poor, probably a bad risk, but actually it is probably both socially and economically desirable to have them healthy and able to work. This is again the role of government to deal with that.

The Exchange

David Fryer wrote:

The argument is that, for example, culturally Asian people have a healthier diet, mainly because red meat was not avaliable in many regions until the 1800's. So is their longer life expectancy and lower incident of some times of diseases due to the fact that they have a universal health care system or is it due to some other factor, such as diet. Comerica we have a diet that is high in fat, cholesteral, and fast food. So any plan that does not address these factors is not likely going to have a substantive positive effect on life expectancy and disease rates, because it is not address the underlying issue involved.

It not so much a matter of American culture or genetics being inferior, it is more a mtter of there being a whole lot more of us. Consider that the United States has the third largest population in the world. The Unitd Kingdom, which is the most often cited as having a good Universal coverage plan has the 22 largest population and is only roughly equal to 17% of the U.S. population. Canada which is the other most commonly cited system ranks #33 and is roughly equal to 11% of the U.S. population. Even Switzerland, which has the best system in the world according to most sources I have read, is about equal to 3% of the U.S. population.

So basically my point is that something that works on a small scale does not always work when scaled up. If it did, we would be running our governmentusing the Athenian Democracy model that works so well in the Rural American Northeast. I believe that we need to find a distinctly American solution, because I am not convined that the ame plan that wrks well for 33 million people, or 61 million people, will work as well for 308 million people. I have found that if something is advertised as one size fits all, it usually doesn't.

I really can't agree with this. The UK isn't some tiny state, there are 60 million people living there, and (I think) in the top ten of the biggest economies in the world. The NHS is a big organisation - second in size to the People Army of China so I read somewhere (and that obviously causes problems) - but I really fail to see how it couldn't be scaled up. The challenges in the US are not terribly different from those in the UK, albeit that the US is probably less urbanised in places (which is probably both good and bad). That said, I don't see anyone actually suggesting that you implmenet an NHS-type system anyway, they want to reform the insurance system you have.


Thurgon wrote:

So I would put forth that creating jobs in the right sectors would likely do more for healthcare coverage then any current plan in the house or senate.

Creating jobs also inceases the tax income for the government and thus long term reduces the debt.

Morning everyone. Here comes another couple of posts from me! :)

Thurgon, this is totally the wrong way to go about trying to fix health care. We want less of a link between your job and your health care, not more. The fact that when you lose your job, you also lose your health care makes things like the recession we are slowly crawling out of all the more painful for everyone involved. It hobbles our domestic companies (automakers, anyone?) versus international competition. And it makes self-employment a risky business for many people.

Less job-reliant health care, please.

Scarab Sages

I found this piece by Charles Krauthammer to be interesting.

Let’s Be Honest about Death Counseling


pres man wrote:
David Marks wrote:


Look at the housing market. It often has the average home price and the median home price for a given market. That is because a single $10 million home can throw of the average if most of the other homes are in the $60-$100 thousand range.

Arglbarl. I hate it when the board eats a post. ><

Well, I had a lot written out here, but the short of it is: the housing market and the health care market are two different things, with their values measured differently for several reasons. Basically, your comparison doesn't hold.

I do get that extremely high numbers can inflate an average, just as extremely low numbers can deflate it. Are you trying to say you think that is going on here?


This is the end of life counselling booklet used by the V.A. Something similar would be used under Section 1233.


pres man wrote:


Sure. Though, there may be some truth to racism and how medicine is done. I think studies have shown that minorities often get worse care. Of course some of that may also be issues of socio-economic things as well. Sometimes it is hard to separate the two, especially since minorities groups are often in lower socio-economic groups.

Sorry I wasn't clearer. The racist medicine part was an accusation I heard recently that health care reform would lead to disproportionate treatment of blacks at the expense of whites. Because Congress hates white people or something, I suppose. Obviously this idea belongs in the list of absurd fairy tales I listed it with.

You are correct that, even after factoring socio-economic effects, racial minorities do perform worse in health care outcomes, which is a separate matter from what I was thinking of.


Aberzombie wrote:

I found this piece by Charles Krauthammer to be interesting.

Let’s Be Honest about Death Counseling

*sigh* Just read it in my morning paper at work myself. I think he is really underestimating the power of the living will and the intelligence of those who rely upon it. I have to deal with it and other similar documents at work all the time(advance directives mainly), and since part of my job is to make sure that the people on my caseload are ready for that VERY rare case that they feel that they need to go into the hospital(as opposed to having someone put them in there), I can attest to their necessity and utility. His arguement shoots itself in the foot when he states the importance of updating ones living will every five years- in my opinion it should be done once a year depending on said person's health- but provided you actually DO keep it regularly updated instead of just talking about it or dismissing it entirely, it will work as intended.


pres man wrote:


I'm not sure why size of population or cultural/genetic diversity (and I'm not even sure I buy the genetic diversity argument) matter. We're looking at per capita spending; why should more people mean that we spend more per person for poorer results? Why is American culture (or genetics?) so inferior compared to other countries that utilize socialized or single-payer health care systems?

Sickle-cell isn't real?

Sadly, it is. But I don't think it is something specific to America. I'm sure any country that has a sizable African population has to deal with sickle-cell. Based on some quick Googling + Wikipedia-ing, I would estimate that Britain has 1/6th our population, but 1/5th our cases of sickle-cell, which would make me think sickle-cell has a heavier per-capita burden on them than it does us.


pres man wrote:


See if we did that in the US, maybe dropped in a few regulations about how people with pre-existing conditions have to be taken on (perhaps randomly assigned to various insurance companies like car insurance is done for some high libility folks), and make it harder to lose their insurance, that would solve most problems.

See, this is the thing pres. The regulations you say might solve most problems? Yeah, those are totally in the bill that everyone is protesting! I've posted them at least once, maybe twice in this thread.

Under the bill currently being considered, we'll be transitioning to something similar to what the Swiss have, with mandatory regulated private insurance for most people. Not my first choice, but far and beyond better than what we have now.


Mandor wrote:


So you couldn't find any actual votes? Which means your statement "they consistently vote against all proposals to control spending!" is not true.

Liberal republicans generally represented more liberal constituencies where the only way for a republican to get elected is to be a centrist. They got voted out, along with other republicans, because the republican party did a great job of angering voters with the Iraq war and the culture of corruption.

The Blue Dogs are going to be in a similar situation in '10. As democrats in more conservative districts they will be facing their constituents' anger over out-of-control deficit spending and the culture of corruption.

I'm not sure I know of anywhere where committee votes are tracked and tallied; if you do I'll try and track down the actual votes for you. As is, I'm happy to take their words on what they oppose at face value. Unless you're trying to imply they criticized it in public and voted for it in private?

As to your second point, that is mostly what I was saying. If health care reform is defeated, their conservative voters will "thank" the Blue Dogs for their efforts by replacing them with Republicans. To stay in office, their best bet is to get a bill out so that public opinion of Democrats is high going into the next election.


Garydee wrote:
Jeremy Mac Donald wrote:


Obesity and drugs are pretty much standard fare in the entire western world. We are all pretty much facing an obesity epidemic and we all tend to have serous and significant issues with the influx of illegal drugs. Canada's culture, in particular, is really not that different from what you see in northern states that border Canada. By and large we eat the same stuff (too much junk food from McDonalds) have serous exercise issues (too much time in front of computers) and generally partake of too many drugs. Probably all at levels comparable to our southern cousins. Every country in the western world is facing a healthcare crisis - its just that America is facing one thats far more dramatic (because its far more expensive) then other western states.
Even beyond this its not clear that America could not get better stats for the hefty contribution. Japan has these phenominal stats partly because they spend their large health care expenditures on convincing their population to engage in healthy practices. Its a good system if thats what you want - or, if having the government telling you to stop wolfing down cheeseburgers is too invasive then you can adopt something closer to the Canadian system - crap stats but a whole lot cheaper.
Actually you guys are 35th in the world when you come to obesity. Look where America is.

Interesting - I have us at 11th

From the same site the UK is 3rd.

Surprisingly Mexico is 2nd - not a country I normally associate as being rich and fat.


Patrick Curtin wrote:

And I understand your point David, and I recognize that the way Americans receive health care is flawed. We just have differing ideas on what is the best way to go about fixing it. I join these debates to learn things and challenge my assumptions. Since starting in on trying to keep up with the debates, I have been made aware of the co-op model of health care insurance...

...Government bureaucracies may start small and lean, but they never stay that way. Waste and bloat come over time with them like cats having kittens. Also, there is the real underlying issue of how to pay for all this. Government is not some separate entity sitting on a dragon hoard of gold. Government is you and me. The money it collects comes from us, or it borrows it from other governments. We are running our country like a college kid with a pre-approved gold card. The bill comes due sometime, but instead of our parents having to pay it, our children will. I find that horrific. Leveraging our needs on the backs of our children is a scummy way to do business.

Unfortunately, we have no options when it comes to government, except to vote every two years. Even then, if you live in a state antithetical to your politics, you're shouting into the storm. Especially if you support a third-party, which is frequently mocked as foolish. But at least we have some semblance of choice, which is more than most governments around the world can say ...

The problem with co-ops is that they will largely lack the ability of a public option to use market leverage to bargain for lower prices. The big problem, though, is that the co-op idea was designed to be a compromise between those advocating the public option and those against. Ignore that the public option itself was designed to be a compromise between those advocating single-payer and those against. Instead, notice that when support for the public option began to waver, already those against reform began pushing against it. Those against the public option will fight any co-op just as vigorously.

Secondly, however, I'm not sure why you're so anti-government here Patrick. Non-governmental bureaucracies can also be largely inefficient and bloated. Do you know how the hospital and your insurance currently handles payments? A single-payer or socialized system could seriously streamline that entire process and largely reduce all of that inefficiency.

Strict assumption that government bureaucracy = bad means sometimes having to accept substandard solutions to satisfy your preconceived ideals.


pres man wrote:
Jeremy Mac Donald wrote:
pres man wrote:


I would be interested in seeing the median spent on health care as opposed to the average.

Thats a request that is impossible to fulfill. I mean how would you even go about collecting the raw data? Send an expert to visit every single person in America and ask them? How do you verify that what they tell you is correct? Even if they are telling you what they believe is the correct amount how do you track how much that individual costs in terms of all the hidden expenses which the the common joe has absolutely no idea about?

The median, for all countries, exists only in a theoretical context. Its data that is simply impossible to collect, hence it'll never be known.

Beyond that I'm really unsure what we'd do with the Median even if we had it. Most of the population does not see a doctor very often. Usually we are not sick or pregnant etc. or at least not sick enough (or pregnant enough?) to bother with doctors. I suspect that the number of people not seeing a doctor in any meaningful amount (you see your doctor once a year for a checkup - if that) is more then 50% of the population for every country in the western world.

Hence the median is likely to be $0 or very close to $0 (whee - fun with statistics!).

I imagine you take the data that you are using to calculate the average, put it in numeric order and figure out the middle value, and there is the median. How is that so much harder than taking all the values, adding them together and then dividing by the population?

I covered above why its so hard to gather the data for the median above. Its not the same data - for the average we just need total costs which, because its being paid is a known quantity. For the median we need every individual input so we can rank them. That means figuring out all the costs associated with every individual thats used the system, its near impossible to collect.

For example a new MRI machine is part of the total cost - but how much of the total cost of a new MRI machine does each individual that used it account for? Furthermore even if we did work that out and did the same for every piece of equipment or worker each individual came into contact with you'd still hit walls. That MRI machine might last 7 and a half years but its cost was taken into account as part of routine upgrading to equipment during the course of only year X, So is its cost per patient only for the year its bought or do we divide by all patients that will use it during its life time?


Aberzombie wrote:

I found this piece by Charles Krauthammer to be interesting.

Let’s Be Honest about Death Counseling

I read that this morning in the paper. Wow, does that guy give bad advice.

Warning to everyone: don't write a living will and just assume doctors won't follow it, as Mr. Krauthammer seems to imply. If you have a legitimate signed and notarized living will, doctors WILL follow it. This isn't a toy to play around with.

Secondly though, we can see the gradual changing of the death panel lie here. Sure, they may not be death panels NOW. But maybe they'll be death panels later, am I right? Of course, the doctor has no reason to favor one kind of end result or another; they are being paid for providing couseling, not for advising you to deny treatment. He's just pulling things from nowhere.


More thoughts on tort reform.

Part II (I posted Part I earlier) and Part III.


David Fryer wrote:


Not to mention that the majority of countries that are usually listed in these examples have small and relatively homogenous populations. Neither Japan, or Switzerland has anywhere near the size of population or cultural and genetic diversity found in the United States. It's like comparing apples to watermelons.

Thing is size is probably a big advantage when it comes to something like healthcare. Here economies of scale are really useful in keeping the costs per individual down. I noted earlier in this thread that Canada often sends patients to the US in part to save costs. Those savings come about because we don't have enough people to justify building some facilities and instead opt for very expensive fee's to American facilities. Buying drugs is cheaper if your buying 10's of millions of units instead of just a million units. I could go on but you get the point. Maybe Japans Infant Mortality statistics are out of reach but the ability to give good healthcare at very reasonable rates is something that America actually has a comparative advantage in.

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