Chainpin, please read this

The Coffee Shop
1

Chainpin, I don’t want want to highjack your Iceland thread, but since you’ve slamming government health care again and the Canadian health care system again in particular on that thread may I suggest you read this. No health care system is perfect, but it seems that Canada is doing a fairly good job in comparison to the USA.

"OTTAWA -Canada’s health-care system is as good or better than that of the United States and is delivered at half the cost, new research suggests.
A review in the inaugural issue of online medical journal Open Medicine, which was launched Tuesday by a group of doctors who left the Canadian Medical Association Journal last year over an editorial dispute, examined the results 38 major studies that compared health outcomes of patients in the two countries.
It found that while the United States spent an average of $7,129 US per person on health care in 2006, compared with $2,956 USper person in Canada, more studies favoured the latter country in terms of morbidity and mortality.
They covered a wide range of diseases and conditions including cancer, coronary artery disease.
One of the lead authors of the meta-analysis said while critics advocate moving towards a more American model of private insurance, two-tier medicine and for-profit providers to improve delivery of care here, the evidence suggests it would be a bad move.
“There are issues in our healthcare system, but a lot of the people that are really pushing it to make it sound more dramatic than what it is have the potential to actually gain a lot financially (from for-profit care),” said McMaster University professor Dr. P.J. Devereaux.
“So part of it is to give people a reality check that, in fact, we actually have very good health outcomes in Canada,” he added. “On the whole, they are equal to, and in many situations better than, the Americans’ despite the fact that we’re spending less than half the amount of money they’re spending.”
Devereaux said the results are by no means a suggestion that Canadians can become complacent about care, pointing out well-publicized shortfalls like long wait times continue to plague our system.
However, he argued the solutions lie in finding efficiencies within the not-for-profit, publicly funded system.
“Often times, what’s simply being pushed in Canada is saying (with) an American-type approach … we’ll get rapid access to care,” he said. “Well, once again, no one wants rapid access to inferior care. We can easily drop our wait times in Canada – it’s just a matter of investing in it.”

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odd that you haven’t had a reply to this one yet. . .

it’s striking though, isn’t it? and it really seems to fly in the face of most of the arguments for private health care. whereas many people who are for private health try to argue from a stance of being hard-headed pragmatists, the evidence from this study makes it seem like the main reason to fight for private healthcare is out of blind partisanship. worse results, and substantially more expensive. . . seems like the worst of both worlds!

-mike

3

The other interesting fact is that everyone talks about “socialised” medicine yet the examples they routinely give; the UK, France, Germany and the rest of western europe, Australia and NZ all operate some form of insurance based system with the exception of the UK.

The “socialised” european systems all have varying levels of private sector involvement and whilst the UK does not have the insurance based model, the money is devolved from central government and local physicians choose who to spend it with on behalf of their patients, they can continue to purchase from public sector organisations or any one of hundreds if not thousands of private sector companies from Blue Cross to Kaiser to smaller UK or European based firms.

I’d guess other than Russia and Eastern Europe in the 80’s there’s not a country out there that has truly socialised medicine. It might be more appropriate to say that all these countries that people refer to have Universal Coverage but it is clearly not socialised…

As to the satisfaction and outcome data, the OECD data reflects the same outcomes. This is interesting…

http://www.aarpinternational.org/usr_attach/healthcare08_Osborn_deliveryandquality.pdf

I also saw last year, but can not find it now, that the French as a population are the most satisfied with their healthservice of the countries that were looked at, which included all the usual suspects, so you wonder a) how bad it is and whether the french in general have low expectations (thats not reflected in the outcome data where the French do quite well) or b) whether they are perhaps doing something that almost all the other systems out there could learn from?

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It’s interesting that while the US spends the most on health care, compared to other industiralized countries, we routinely rank relatively low on health indicators. Yet many here insist that our way is the best way. Mind boggling…

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The “socialised” european systems all have varying levels of private sector involvement

Then what’s wrong with doing the same thing in the US, although I’d prefer to see that read “The “Private” American system has some level of government involvement” :slight_smile:

As to the satisfaction and outcome data, the OECD data reflects the same outcomes. This is interesting

I think without doubt the US system needs an overhaul. For the most part however there appears to be “Comparable” care in the US as it is and even considerably more successful in certain areas, according to this study if I’m reading it right.

I think a “Direct” comparison is very difficult and saying “Well it works there, it will work here” is a dangerous statement.

Again we need to make some serious changes, but in most cases scrapping the program and starting over is not the best option, especially when speaking of system that is relatively successful.

~Matt

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It’s interesting that while the US spends the most on health care, compared to other industiralized countries, we routinely rank relatively low on health indicators.

And what are the mitigating factors on cost in “those other countries”? Could they have laws that protect their “Socialized” doctors and hospitals to a greater extent than there is in the US? Could Americans actually be a bit less interested in actually being healthy?

I’m not defended the US system or even claim that “It’s the best”, but clearly saying “We are less healthy and pay more” is not cause and effect relationship to “Our system is no good”.

~Matt

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Nothing, I’ve never suggested otherwise, all I’ve ever advocated was universal coverage and that the current system is overly bureacratic leading to inflated costs. Bear in mind that certainly our system is in part based on the original costing formula that was developed in the US, the difference is that in any given hospital / practice we use one code to bill one organisation, they may use one code but have to deal with dozens of different organisations and different cost plans within those different organisations.

There is no question the US does better in certain areas, cancer has always been one, on the other hand access is poorer, outcomes across a broad range of conditions are poorer and coverage is not universal and it what coverage there is costs substantially more than comparable systems.

Primary care and preventative medicine is extremely poor, to the point of being on the verge of a crisis with respect to the fact to few MD’s are going in to PC.

8

odd that you haven’t had a reply to this one yet. . .

it’s striking though, isn’t it? and it really seems to fly in the face of most of the arguments for private health care. whereas many people who are for private health try to argue from a stance of being hard-headed pragmatists, the evidence from this study makes it seem like the main reason to fight for private healthcare is out of blind partisanship. worse results, and substantially more expensive. . . seems like the worst of both worlds!

-mike

I don’t know much about that so called “journal” and I haven’t seen the study(maybe you should ask Andrew if this rag is up to his high standards), but what I do know is that the following is illogical:

Major Premise: Socialism is a complete and abject failure.

Minor Premise: Capitalism is the most successful economic system.

Conclusion: If we socialize healthcare it will be a success.

Somebody please tell how the three above statement could possibly be true simultaneously.

That in the long run socialism fails and fails miserably is a fact. Shortages in Canada are a natural, expected, and inevitable result of a socialist system. When the price of a good is zero people will demand more of it, thus, as demand increases, shortages arise. You can argue about data on wait times ad infinitum, but you can’t ignore basic economic laws.

Socialism fails because it ignores the price mechanism, rejects private property rights, and does not capture profits or losses. More importantly, it fails because it ignores the reality that is human nature and behavior.

So to somehow think that a privatized healthchare system is inferior to a socialzied one, simply does not stand up to logical reasoning. Centrally planned economies are failures, and while the short term allure of centralized medicine is appealing, how can it too not fail?

The bottom line is that socialism fails and capitalism succeeds. Any program that models itself along socialist principles WILL fail, to think otherwise is to defy the laws of economics and rudimentary logic.

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I’m not sure that we are any less healthy than the US, we have a massive obesity (no pun intended) problem developing.

They have taken steps successfully to start to tackle it:

http://www.telegraph.co.uk/health/dietandfitness/3353715/The-French-children-learning-to-fight-obesity.html

Its interesting that like the UK, and other universal systems, they have the infrastructure in primary care to start to tackle problems like these, I am not sure that the same structure is in place in the US.

As to protecting MD’s, I’d guess our liabilities are less though still enormous when you look at the amount of money put aside to deal with future claims.

We do not know how related the two are, though it is reasonable to examine cost and outcomes to determine what is providing good value for money and the US system is comparably weak internationally. Now you do have to ask whether the Americans are somehow weaker willed and more suseptable to rampant consumerism and fast food than other developed nations. In my experience the answer is no, you walk down any street in any major metropolitan area in the western world and fast food is the norm, obesity is rising throughout europe, though it might be a little behind the US, so I’m not sure that one can say that the explanation for poor outcomes is that Americans are somehow more likely to be unhealthier than elsewhere. I am just not sure that the evidence is there to support it, and even if it were, that it could explain such massive discrepancies in cost and outcomes.

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It’s interesting that while the US spends the most on health care, compared to other industiralized countries, we routinely rank relatively low on health indicators. Yet many here insist that our way is the best way. Mind boggling…
Maybe it’s because there are many other factors that go into what you call “health indicators.”

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We prefer to have socialized banks, auto manufacturers and insurance companies.

But since we don’t have government controlled medicare, no one can accuse us of being socialist.

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So in the face of the overwhelming evidence on outcomes, cost and mortality you are going to claim that every study thats drawn the conclusion that systems that provide universal coverage are comparble or superior to the privatised system in place in the US are wrong because of the line of logic presented in your post?

Do you even understand how any of these other countries fund or run their health care systems? do you know how much private involvement there is? do you know what the opportunity to make a profit or loss is within primary care in France, Germany or anywhere else? do you know which ones have insurance based systems, for profit and not for profit hospitals, what percentage of providers come from the private sector?

Do you really think that all these countries health systems are run by civil servants who are paid centrally by the government?

Apparently you also fail to understand the difference between the words “socialism” and “universal”. I am not aware that any single country has a “government funded” only system, other than perhaps Cuba, but feel free to point me in the right direction with respect to countries in europe or the rest of the western world that are centrally run and funded only systems.

As a side note its interesting that you talk about shortages, but if you look at the commonwealth fund data, access in Canada and the other “socialised” systems (really universal but you cant seem to get your head round that) is easier than in the US. Appears there are shortages in the US, must be those laws of capitalism at work…

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Again, without doubt, and I think we agree here, the US system has issues. That being said, by the numbers, so does every system on the planet to one extent or another, I don’t think a “the sky is falling” approach is the best route.

I think there are many “Reasonable” steps that would have major impact without dumping the entire system into the trash and starting over and depending on the government to “Do it right”.

**I am just not sure that the evidence is there to support it, and even if it were, that it could explain such massive discrepancies in cost and outcomes. **

I’m not saying “Health” is THE reason I’m simply pointing out health and litigation as two attributing factors. The “Gap” is not so huge between comparable systems and the US system that it can’t or wouldn’t be closed by several relatively minor differences.

Again I’m not saying that is or isn’t the case, merely pointing it out as a possible explanation other than “The system doesn’t work” and that there is likely more to work with in the existing system than people are willing to accept. Even something as simple as media influence could radically alter the “Are you happy with…” type of survey questions. If people are bombarded on a daily basis with stories of how terrible the system is, they are bound to be “Less happy” than if they were shown “How great the system is”.

Again my point is pretty simple. There’s no doubt we have huge room for improvement, but show me a system that doesn’t. I would no more expect the UK to trash their system and start over because they have problems than I would expect the US to, makes no sense.

But as stated above, and some of those things I’ve listed, there are reasonable steps that can be made and include the current system.

~Matt

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wow. . . i’m kind of speechless. i get that you think socialism is always doomed to failure. you’ve stated that opinion many times (though always stated it as fact).

but why then would the US spend significantly more on health care than any other country, and not have the best health outcomes or patient satisfaction?

i get the feeling i’m about to start smashing my head against the wall. . .

-mike

p.s - and this is a total aside: have you ever visited a ‘socialist’ country, like in western europe, the nordic countries, or canada?

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Nothing, I’ve never suggested otherwise, all I’ve ever advocated was universal coverage and that the current system is overly bureacratic leading to inflated costs. Bear in mind that certainly our system is in part based on the original costing formula that was developed in the US, the difference is that in any given hospital / practice we use one code to bill one organisation, they may use one code but have to deal with dozens of different organisations and different cost plans within those different organisations.

There is no question the US does better in certain areas, cancer has always been one, on the other hand access is poorer, outcomes across a broad range of conditions are poorer and coverage is not universal and it what coverage there is costs substantially more than comparable systems.

Primary care and preventative medicine is extremely poor, to the point of being on the verge of a crisis with respect to the fact to few MD’s are going in to PC.

It is ironic, and a tad bit comical, that you mentioned that since it is a socialist program that is responsbile for the decline in PCP’s:

"Blame Medicare for making worse an ongoing primary care doctor shortage that affects Massachusetts and states across the country, according to a new study.
Harvard Medical School researchers at the Cambridge Health Alliance determined that payments from government health insurers overpaid specialists compared to primary care doctors.

Specifically, the authors determined that payments for geriatrics, hematology-oncology, nephrology and rheumatology — specialties that make more than half of revenue from government sources — varied widely.

Geriatricians, for example, averaged $165,000 in annual income but hematologists made $504,000 on average.

The study authors argued that higher government payments for specialists help make a primary care doctor shortage worse.

The Journal of General Internal Medicine released the study online, and will publish details in the September 2008 edition. "

Again, this is what happens when the price mechanism is not allowed to function freely. As I stated before, socialism does not work because it ignores human nature and it ignores incentives. The shortages of PCP’s speaks for itself.

In this case, doctors have no incentive to enter PC and so they don’t, or, if they are in PC, they leave.

A simple, elegant example of socialized medicine failing–thanks for helping shed a little more light on this issue!

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So in the face of the overwhelming evidence on outcomes, cost and mortality you are going to claim that every study thats drawn the conclusion that systems that provide universal coverage are comparble or superior

Keeping in mind that you have admitted that most of the “Existing systems” that are called “Socialised” are truly a “Hybrid” Keep in mind that what is called “Private” in the US is really a Hybrid. Also keeping in mind the statement “Comparable or superior”. Does this not all mean that in the “Big picture” it’s probably not necessarily “Socialist” or “Capitalism” that are the determining factors, rather implementation of the system and a plethora of other influential factors?

Again my point is that there is little doubt that a “Private” (Again a hybrid) system, implemented properly, could provide services “Comparable or superior” to more “Socialized” (Again hybrid) leaning systems.

~Matt

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wait: where did you prove that socialized medicine fails?

-mike

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Apples and oranges in many ways. The pharmaceuticals produced here are sold to Canada and other countries at 1/3 the cost we pay, the (failed) tort reform that GWB pushed for would have addressed another limiter on reduction of costs, choice is still much greater here than in most of these other systems, etc, etc.
On the UK model in particular, I recently read a story that polled docs in one specialty (I forget which), they asked about alternative procedures that were not covered by NHS. Roughly a quarter of the respondents did not know about these other, more effective, treatments, another fourth knew, and let the patients know that it was out there, the remaining half had knowledge of better alternatives in treatment, but chose not to inform patients because the NHS would not pick up the tab.

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Just to pick a nit - most American companies actually have their own production facilities in Canada - often with their own research divisions. Given the differing regulatory issues you would have a hard time producing a drug outside of jurisdiction. I have written Q&A statistical code for sever Canadian branches of US pharma industries - you are a bit off on the statement.

Perhaps you meant to say developed as opposed to produced.

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I think that what you will find is that the distribution of quality of care provided in all systems is enormous, I know of one doctor who failed to refer any patient to a specialist for more than 2 years. This was not because his patients were fitter, healthier or did not need care but as a result of pur negligence and as a result that individual no longer practices.

I think if you look hard enough you can find the failings in every system.

As to what is covered / is not covered, that is all laid out by NICE (National Institute of Clinical Excellence) essentially they evaluate all new medications and procecures and determine whether they provide good value for money, if they approve it, you can get it on the NHS, if they do not, you can now pay for it your self privately.