Slashdot Mirror

So please, don't say our system is better than in the US. People are not dying in the streets up here, but when you have a condition, you better be patient.

Because these systems are always partially or entirely tax-funded this obviously means that wait times for some non-critical operations can be higher, because people in immediate risk take priority but this is true in the states as well. If you actually compare waiting times for a specialist for example, you'll note that US is pretty much on par with the UK, and that Canada is on the slower side of other universal model countries (which, is all advanced countries other than the US). I work for the largest health care district of the Finnish single payer health care system with about a million people under it, I can quote you some numbers (these are from 2015 because they're publicly available (Finnish only though), can't access the current stats from home). Of the 27 most common types of surgery, we had altogether 26 658 people in queue in 2015, of which 19,5 % waited for more than 6 months. The median wait time was 87 days. For the 2 heart-related surgery-types on the list (bypass and percutaneous coronary intervention the median was below 30 days). The question here is: would it be better for the uninsured in the US to wait a bit to get good health care from the existing system with public money, or wait til' they die or go bankrupt? Is it beneficial for the US economy as a whole to remain the only country where people have to go into debt due to medical problems?

Thing to realize is that this is about availability, not quality. Quality-wise the US model is not significantly better nor is it worse. In fact, quality-wise the system is just fine for the people who're insured, the main difference is that the lack of universal public insurance leaves some people outside of the system driving up deaths. And the far more commercialised nature of the systems drives up margins and administrative costs (which is a large part of the huge spending difference (about twice the average spending of comparable countries) between the US and the rest of the world. In fact, medicare for example is already cheaper (per head covered) costs-wise than private options, largely cause it has better costs-management and lower administrative costs).

The are plenty of universal models out there which aren't single payer like Canada or here. All the US would have to do to implement such would essentially be to allow medicare/medicaid like option for all , and it would likely bring total costs down in the long term and better care for everyone.

But sure, keep posting anecdotal stuff about wait times instead of the larger picture., that's always constructive!

Right now, the US pays more per capita than any other OECD country.

What's funny is all the libtards painting the failure of US health system as a failure of the capitalism. Well, here's a hint: capitalism doesn't run on government handouts. What you have there is a statist operation, EVEN MORE SO than in the rest of OECD, that's also badly run. And, ends up being even more of a fail than the less statist systems.

Well, colour my libertarian ass suprised.

Right now, the US pays more per capita than any other OECD country.

Your outcomes are worse.

Low cost preventive care is sort of a myth

The evidence suggests otherwise.
There's a bunch of other articles with lower standards of rigor that all say much the same thing if you google 'cost of preventative care vs emergency care', for example. I'd be fascinated to see evidence to the contrary.

Extremely indulgent free medical services

Straw man. I'm arguing that socialised medical care as used by other OECD countries costs less and has better outcomes. You're arguing some fantastic exaggeration you're calling 'extremely indulgent free medical services'.

You're not even consistent. You argue first that people don't just avoid medical care because of cost, but then argue that were it free, people would use it too much.

The people advocating for universally free non-critical care (i.e 'free checkups') are generally the vendors of said services

Ad hominem.

Just be honest. The hot dog seller in the street is honest about his advocacy, and you can be too.

When you can back up your statement with something resembling facts, and avoid some fairly basic logical fallacies, your adoption of a patronising tone will probably ring less false.

Caveat. I'm from Australia, and while there are problems with our health care, I consider myself damn lucky to be able to live in country and period in history with access to the levels of civilisation that I enjoy. I'm more than happy to pay taxes to fund these services, both for myself and my fellow citizens and recognise that probably makes me a 'socialist' in the eyes of some. I consider the plight of those in the US who cannot afford medical care to be a tragedy. I've nothing to sell, and your assumption that this can be the only motivation for someone to advocate equitable access to the wealth of society says more about your motivations than anything else.

The plural of anecdote is not data. I prefer the Commonwealth Fund's evaluation of 11 advanced economies' health systems:
http://www.commonwealthfund.or...

UK is 1, NL is 3, DE is 8, US is 11.

Plenty of detail of how they did this analysis. It's a 2017 report, and done annually, so it reflects recent changes to the Dutch system.
Report: http://www.commonwealthfund.or...
Excerpt from method statement: "This edition of Mirror, Mirror reflects refinements to methods used in past reports. No report can claim to capture every aspect of the performance of health care systems. Health care systems are complex. Even if a report included thousands of measures, nuances would remain. In that spirit, the report underwent a thorough review by an advisory panel of international, independent performance measurement experts. 11 The framework for Mirror, Mirror 2017 was developed in consultation with the advisory panel from January through December 2016.

Using data available from Commonwealth Fund international surveys of the public and physicians and other sources of standardized data on quality and health care outcomes, we identified 72 measures relevant to health care system performance, organizing them into five performance domains: Care Process, Access, Administrative Efficiency, Equity, and Health Care Outcomes. The criteria for selecting measures and grouping within domains included: that the measure be important, that the data to support the measure be standardized across the countries, and that the results be salient to policymakers and relevant to performance improvement efforts. Most of the measures are based on surveys designed to elicit the public’s experience of its health care system.

The indicators were carefully selected from among the best-available measures with comparable data across the included countries. The selected measures cover a wide range of performance domains. Mirror, Mirror is unique in its use of survey measures designed to gather the perspectives of patients and professionals—the people who experience health care directly in each country every day."

The plural of anecdote is not data. I prefer the Commonwealth Fund's evaluation of 11 advanced economies' health systems:
http://www.commonwealthfund.or...

UK is 1, NL is 3, DE is 8, US is 11.

Plenty of detail of how they did this analysis. It's a 2017 report, and done annually, so it reflects recent changes to the Dutch system.
Report: http://www.commonwealthfund.or...
Excerpt from method statement: "This edition of Mirror, Mirror reflects refinements to methods used in past reports. No report can claim to capture every aspect of the performance of health care systems. Health care systems are complex. Even if a report included thousands of measures, nuances would remain. In that spirit, the report underwent a thorough review by an advisory panel of international, independent performance measurement experts. 11 The framework for Mirror, Mirror 2017 was developed in consultation with the advisory panel from January through December 2016.

Using data available from Commonwealth Fund international surveys of the public and physicians and other sources of standardized data on quality and health care outcomes, we identified 72 measures relevant to health care system performance, organizing them into five performance domains: Care Process, Access, Administrative Efficiency, Equity, and Health Care Outcomes. The criteria for selecting measures and grouping within domains included: that the measure be important, that the data to support the measure be standardized across the countries, and that the results be salient to policymakers and relevant to performance improvement efforts. Most of the measures are based on surveys designed to elicit the public’s experience of its health care system.

The indicators were carefully selected from among the best-available measures with comparable data across the included countries. The selected measures cover a wide range of performance domains. Mirror, Mirror is unique in its use of survey measures designed to gather the perspectives of patients and professionals—the people who experience health care directly in each country every day."

Fortunately, these studies have been done time and again, and the result is that the UK spends about 7% of GDP on healthcare vs 15%+ in the US.

http://www.commonwealthfund.or...

Posting AC to preserve moderation awarded...

The National Health Service in the UK is having a particularly bad winter, following 7 years of Conservative party "reforms" and budget cuts. Broken eggs all over the place, no omelette in sight.

Still, if you want to compare the UK NHS outcomes and spend/capita with those from other countries, there's people working on that:
http://www.commonwealthfund.or...

"I can't imagine many other systems that could manage to keep alive a group of people as chronically unhealthy as the Americans."

One big reason U.S. citizens are "chronically unhealthy": They work too much.

Another reason: Women in the U.S. are often anti-male. That results in children who have poor parenting. Those children become unhealthy adults.

There seems to be a general agreement that U.S. health care is TERRIBLE. One article: Healthcare's Perfect Storm of Greed and Incompetence (Oct. 16, 2014).

Quote: "As the U.S. healthcare system slips further into the cellar of metrics for quality and outcomes among the advanced nations of the world, and does it at more than twice the average per capita cost,..."

That article links to 2014 Update: How the U.S. Health Care System Compares Internationally

Result: Of 11 developed countries, the U.S. is last.

"I can't imagine many other systems that could manage to keep alive a group of people as chronically unhealthy as the Americans."

One big reason U.S. citizens are "chronically unhealthy": They work too much.

Another reason: Women in the U.S. are often anti-male. That results in children who have poor parenting. Those children become unhealthy adults.

There seems to be a general agreement that U.S. health care is TERRIBLE. One article: Healthcare's Perfect Storm of Greed and Incompetence (Oct. 16, 2014).

Quote: "As the U.S. healthcare system slips further into the cellar of metrics for quality and outcomes among the advanced nations of the world, and does it at more than twice the average per capita cost,..."

That article links to 2014 Update: How the U.S. Health Care System Compares Internationally

Result: Of 11 developed countries, the U.S. is last.

German healthcare:

FTL; "Coverage is universal for all legal residents. About 85 percent of the population is covered by social health insurance and 10 percent by substitutive private health insurance. The remainder (e.g., soldiers, policemen) are covered under special programs. Undocumented immigrants are covered by social security in case of illness. All employed citizens (and other groups such as pensioners) earning less than €4,237.50 (US$5,422.80) per month (€50,850.00 [US$65,074.00] per year) as of 2012 are mandatorily covered by SHI, and their dependents (nonearning spouses and children) are covered free of charge. Individuals whose gross wages exceed the threshold, civil servants, and the self-employed can choose either to remain in the publicly financed scheme on a voluntary basis (and 75% of them do) or to purchase private health insurance. "

Sorry, the second link went AWOL.

Most people will point back to this report http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective claiming that we spend more than 2x everyone else on our health care. But look carefully at the numbers as it's divided into public (e.g. the government pays) and private spending (a citizen pays out of pocket) and they note that 34% of the us citizens are on public programs - and the public number would be higher if they counted employer-mandated health care.

What does that mean? It means that the US is actually spending $4,000 per capita, either publicly or privately, NOT the $9,000 claimed by the report. Our cancer outcomes are much better than anyone in the world, but we get dinged by the report for having lower quality of life and worse outcomes with obesity-related diseases.

But I would argue that's often not a health system failure, but a cultural failure. We don't slow down enough to sit and eat our meals, we eat them on the go or in our cars or while writing emails on our personal devices and cope by drinking sugar and caffeine to keep us going.

About the "government is accountable" claim, it's bunk when the citizens won't hold them accountable, in fact it's worse as a company needs to be lean enough to turn a profit where the government can play the shell game to just reach further into our pockets. Judging by how medicare is going, once single-payer comes into play, there will be mainly large corporate players who are the medical providers as they'll be able to absorb the cost via volume rather than your neighborhood doctor who won't be able to afford the cut rates and high paperwork overhead that will be demanded.

We need real solutions - single payer may be one, but we need to have an honest discussion about what that means and what we will be willing to both pay for in tax increases and take in cuts to our current level of care.

Sebastion,
The US System is not government run, it's government regulated, for now. Both links you included, don't show what you are claiming.
The medicaid expansion you reference did not statistically improve the health of relatively healthy people, big surprise. It did give them better financial and mental health outcomes. I wouldn't call that a failure.
The VA link, talks about the recent problems, but it also included information about the lack of VA funding. The VA's patient load increased way faster then funding. Poor outcomes are not surprising. Veteran's love the VA, they just want it funded properly so it provides the services they were promised. It's certainly the least expensive way to provide those services.
Here's a link for you.
You can see that American's have less doctor visits, they spend more without getting better treatment. What is to like about the pre-ACA system? How did the ACA do anything to make this worse? It's clearly an attempt at improving multiple things and in a perfect world it would have been fixed over the next few years instead of being symbolically repealed about 176 times to pander to a misinformed base.

The US already leads the world (as in, top 2-3 countries) on public spending per capita, in both education and healthcare. Source of the first, source on the second. Money isn't the problem, it's the state of the system overall, that is the problem.

There are several areas in which the USA provides world class care. To the rich. In most areas, it's rather depressing to look at the figures though.

Here is the summary from a report by The Commonwealth Fund, which was set up to improve healthcare in the USA in 1918: US healthcare from a global perspective

Highlights:
- High U.S. health care spending due to greater use of medical technology, health care prices
- U.S. spends more on health care than other high-income countries but has worse outcomes
- Health care spending as % of gross GDP, USA vs Canada: 17.1% versus 10.7% (2013)

Some causes:
"Data published by the International Federation of Health Plans suggest that hospital and physician prices for procedures were highest in the U.S. in 2013.10 The average price of bypass surgery was $75,345 in the U.S. This is more than $30,000 higher than in the second-highest country, Australia, where the procedure costs $42,130. According to the same data source, MRI and CT scans were also most expensive in the U.S. While these pricing data are subject to significant methodological limitations, they illustrate a pattern of significantly higher prices in many areas of U.S. health care.

Other studies have observed high U.S. prices for pharmaceuticals. A 2013 investigation by Kanavos and colleagues created a cross-national price index for a basket of widely used in-patent pharmaceuticals. In 2010, all countries studied had lower prices than the U.S. In Australia, Canada, and the United Kingdom, prices were about 50 percent lower.11"

But perhaps, if you pay more, you get more?

"On several measures of population health, Americans had worse outcomes than their international peers. "

Okay, but we know a lot of Americans have been smoking more than other folks, and are more... big-boned. Right?

"The Institute of Medicine found that poorer health in the U.S. was not simply the result of economic, social, or racial and ethnic disadvantages—even well-off, nonsmoking, nonobese Americans appear in worse health than their counterparts abroad."

But cancer care is top notch in the USA.

"One area where the U.S. appeared to have comparatively good health outcomes was cancer care. Other research based on survival rates also suggests that U.S. cancer care is above average, though these studies are disputed on methodological grounds."

However: "The opposite trend appears for ischemic heart disease, where the U.S. had among the highest mortality rates in 2013—128 per 100,000 population compared with 95 in the median OECD country."

To summarize: if you state that Canada has inferior care (imploying that it goes across the board), despite research suggesting the opposite is true, I'd like to see citations.

You're so full of shit its coming out your eyes. When people get sick in other countries they come HERE for help. America has the best health care on planet earth and because of that you pay a premium for it. If you want reduced costs go to your shitty third world communist paradise, please.

wrong

We have the best infrastructure on Earth too. I never understand what you fucking idiots mean by "crumbling infrastructure".

I can only assume you have never traveled outside you borders. http://www.businessinsider.com...

I am guessing based on these wildly inaccurate statements that you are also a Donald Trump supporter...

Nope. From your description you don't have any experience with the US health care system. You opted to leave the US rather than make use of it.

My family member was in a US hospital. The costs were exorbitant and the standard of care was, at best, no better than the UK. Even with the flight cost, the UK hospital was the better option. But hey, don't take my word for it.

I've literally never heard that from anybody in person. UK folks coming here complain about cost, and office wait times if they pick bad hospitals or doctors, because they're not used to having a choice. Everyone else has been pleased with their service, and the quality of the care itself, as long as they were able to pay for it.

Nope. From your description you don't have any experience with the US health care system. You opted to leave the US rather than make use of it.

My family member was in a US hospital. The costs were exorbitant and the standard of care was, at best, no better than the UK. Even with the flight cost, the UK hospital was the better option. But hey, don't take my word for it.

I hope the flight wasn't for cancer, heart disease, or a stroke, because then your country's insurance cheaped out on what would have almost certainly been the superior US treatment.

There's a reason the rich often come to the US when the shit hits the fan.

You need to read up a bit on healthcare in the rest of the world - How the U.S. Health Care System Compares Internationally

From the first sentence of the executive summary: "The United States health care system is the most expensive in the world, but this report and prior editions consistently show the U.S. underperforms relative to other countries on most dimensions of performance. Among the 11 nations studied in this report—Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States—the U.S. ranks last, as it did in the 2010, 2007, 2006, and 2004 editions".

However when it comes to higher education, there is no disputing the fact that making it more accessible to people across the board (which requires investment) reaps dramatic rewards. People make more money,

There is a correlation between tertiary education, higher incomes, and lower crime, but you cannot conclude at all from that that tertiary education causes higher incomes and lower crime rates. (In fact, even the "people make more money" idea is misleading because while people may make more money, they often end up less wealthy.)

Not by dollar spent, it isn't. Most of the money is on the private side

Yes, by dollar spent! US per capita spending is $4197 (public), $1074 (out of pocket), and $3442 (private). Note that US per capita public spending alone is about the same as total per capita spending in France, Australia, or Canada.

Have you actually listened to anything Sanders has said? He has been calling for expansion of medicaid, which would be exactly that. Initially it would require more taxes

Have you listening to anything I said? The fact that Sanders say that this would "initially require more taxes" is what brands him as a bullshit artist. The fact is that the US public system alone already has more than enough money to cover every American at the same level as Australia, the UK, Japan, or France. It fails to cover every American because it is so horribly inefficient (it only covers one third of Americans). If Sanders claims he can fix the US public health care system, he should be able to do so without raising taxes. The fact that he says he needs to raise taxes shows that he is either incompetent or simply lying.

Your second paragraph is so ridiculously wrong that I won't comment but here's some education about health-care spending.

This analysis draws upon data from the Organization for Economic Cooperation and Development and other cross-national analyses to compare health care spending, supply, utilization, prices, and health outcomes across 13 high-income countries: Australia, Canada, Denmark, France, Germany, Japan, Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. These data predate the major insurance provisions of the Affordable Care Act. In 2013, the U.S. spent far more on health care than these other countries. Higher spending appeared to be largely driven by greater use of medical technology and higher health care prices, rather than more frequent doctor visits or hospital admissions. In contrast, U.S. spending on social services made up a relatively small share of the economy relative to other countries. Despite spending more on health care, Americans had poor health outcomes, including shorter life expectancy and greater prevalence of chronic conditions.

I said "so basically you're saying that Americans are too dumb to decide for themselves what is in their best interests."

I'm shocked that you would have to ask this question at all. Have you seen the level of intelligence of the average American? Isn't the existence of the Kardashians or Honey Booboo or Duck Dynasty or Donald Trump as a Republican front-runner more than enough evidence for you? Americans, on average, are not at all intelligent, barely making it into double-digit IQs, and that average idiocy is force-multiplied by the fact that there are so many of us. I mean, Equatorial Guinea might have a much lower IQ, but there are fewer than a million of them, so the damage they can do to the rest of the world is quite limited. America is a global superpower, and the fact that a plurality can so easily be led by their basest instincts without any critical thought whatsoever has huge negative implications on the rest of the world.

Basic math tells us that single payer is more effective; basic economics tells us that for a product with intricate, expensive infrastructure in which everyone must participate by virtue of their biology (i.e. power, water, health care), a natural monopoly exists, and it is most efficient, and must be highly regulated. (and no, I did not say "perfectly efficient", or even "adequately efficient", simply "most efficient"). Anyone who claims health care in this country is anything close to a "free market" is a babbling idiot, so if it isn't a free market anyway, why isn't it a market that is structured to benefit the most people rather than the fewest?

That the average American doesn't know this, and will swallow the line that we should not move to single payer in America, even though it is working in EVERY SINGLE FIRST WORLD COUNTRY, providing roughly double the value at half the cost to the population because SOSHULIZM!!!! just boggles my mind and saddens me.

He's right though. We spend much more per person on healthcare than even the yuuros do, and we die sooner despite that (fig 1). That's not to say that our hospitals are bad (though some states really fail at not killing people), or that we aren't awesomely good at treating specific diseases, but none of that means you'll live any longer than the slackers across the pond.

Even worse, despite being a nominally private healthcare system, our government still spends more per person than even the UK (fig 3). As in, we'd have less government in medicine if we went full-retard universal care.

That's not to say I'm a fan of single payor systems--our nanny state is already trying to micromanage how many ounces are in a soda even when they're not paying for your fat ass. But, it's simply wrong to say that the single-payor systems don't provide better care for less money.

That said, I'd much rather we emulate Singapore. They make you pay for everything out of pocket from a savings account drawn off your paycheck. Paying cash for everything keeps prices in check, the mandatory contributions mean no one's "uninsured," and no insurer or HMO limits what you can buy. Subsidies help the truly indigent, and you can draw on it like a 401(k) in your dotage should you prove unusually resilient.

The Little Red Dot lets you be as much of a fat-ass as you care to pay for, and ain't that the American way. Japan, in the meanwhile, has an honest-to-God fat tax.

And the further down it goes, beyond the bottom of the graph

tl;dr of the report above: US is the worst and most expensive healthcare system in the modern developed world.

even the vaunted European social democracies (the ones with the 'free' healthcare' are scratching their heads trying to figure out how to afford everything

As a citizen of the democracy with the "best healthcare system in the world", (the UK NHS) we already worked out how to afford everything - have a single-payer system that can negotiate a sensible price, and don't waste money on all that insurance bureaucracy.

We spend less than half what the USA does, and get better outcomes.

The problem is that the medical-industrial complex has worked out that obviously, people are willing to spend a lot more, and have contrived with our politicians to try and destroy the NHS so that they can profit.

This article says Canada's healthcare is only slightly better than the USA's, but scores them much better on 'Cost-related problems'.

Surprised to see Australia score so badly on Cost-Related Problems.

Head and shouldes above the rest? Yes, if you like to go bankrupt on the simplest procedure.

The USA spends more on health care than most other countries, and gets less "health" in return.

Heck, even the French pay less per person than the US, and gets better results. Don't believe me? Fine, read it and weep.

Also totally relevant: Breaking Bad could not happen in Europe. Wrap your mind around this one.

and you make the same tired argument that youre better off with no insurance.
the myth of the young invincible is jsut that, a myth.

you may be fine...until you actually need it. and thats a huge gamble to take with your life and your financial well being.
medical costs are the number one cause of bankruptcy in this nation.

"A 2011 study from the Commonwealth Fund found that more than half of uninsured young adults reported having a medical problem but not seeking treatment. Among insured young adults, that number was 19 percent. ( http://www.commonwealthfund.org/Surveys/2012/Jun/Health-Insurance-Tracking-Survey-of-Young-Adults.aspx ) That same survey found that 51 percent of uninsured young adults had difficulty paying medical bills, with 26 percent having been contacted by a collection agency."

"One Centers for Disease Control and Prevention study found that 17 percent of women ages 18 to 29, and 13 percent of men, have a chronic condition such as cancer or diabetes. Federal data show that young adults have higher rates of car accidents, which could lead to pricey medical bills."

Or this story: http://www.salon.com/2013/09/23/why_nobody_without_insurance_should_skip_obamacare/

its neither a huge scam, nor are you the intended target of these plans.
the ACA was not intended to bring healthcare to the entire nation.
it was intended to fill the gaps, to cover the uninsured and uninsurable, not to bring insurance to those who already have it.
its not some communistic redistribution scam...
(though the very idea and concept of Insurance itself IS A REDISTRIBUTION CONTRACT....becauses thats teh concept of how insurance works!!!)

You dont pay more than your fair share for anyone. it is not welfare.
AND ITS NOT FOR YOU, IF YOU ALREADY HAVE INSURANCE.

You're just another typical right wing nut, completely misinformed about the ACA, its purpose, what it does, and who it affects.
in short, you're an idiot, and so is whoever modded you insightful

> You mean like Medicare (single-payer) or the VA (government-run?) Both have high satisfaction ratings.

You must be joking? The VA with high satisfaction ratings? And Medicare is an insurer of LAST RESORT, of course people are going to at least appreciate that aspect of it. It's that or NOTHING.

No, I am not joking:

http://www.defense.gov/News/NewsArticle.aspx?ID=14560
http://www.commonwealthfund.org/News/News-Releases/2009/May/Elderly-Medicare-Beneficiaries-Give-Their-Coverage-Higher-Ratings.aspx

I don't know where you get your numbers but UK healthcare spend is 8% of the economy while in the US it is over 15%. You can compare all of these stats and more at the Commonwealth Fund.

Hey, how about some graphs to illustrate the point?

http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2011/Jul/PDF_1533_Anderson_multinational_comparisons_2010_OECD_pfd.pdf

The doctors aren't the ones bringing home the money. It's the administration and the SHARE HOLDERS. The whole BUSINESS is a racket. This is also why the United States ranks the lowest overall in health care.

"...while getting mediocre results..."

Your utterance of this phrase tells me immediately that you're full of ...

Actually, that was probably the most well-sourced part of my statement. If anything, I was being generous. Just go check out any comparative survey of health care quality or results. For example, this survey from the World Health Organization in 2000 ranked the USA 37th of 191 (but we were #1 in % of GDP spent on it!): decidely mediocre. This one from The Commonwealth Fund in 2010 ranked the USA dead last of the 7 nations studied (but again, first in expense!).

What you actually meant to write:

I'm pretty sure he actually meant this: "Studies evaluated in this systematic review do not support the claim that the private sector is usually more efficient, accountable, or medically effective than the public sector; however, the public sector appears frequently to lack timeliness and hospitality towards patients." (low and middle income countries)

Or this: "Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries. This reportâ"an update to two earlier editionsâ"includes data from surveys of patients, as well as information from primary care physicians about their medical practices and views of their countries' health systems. Compared with five other nationsâ"Australia, Canada, Germany, New Zealand, the United Kingdomâ"the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives. The U.S. is the only country in the study without universal health insurance coverage, partly accounting for its poor performance on access, equity, and health outcomes."

But do please continue to spout ideology-addled "corrections" that contradict reality. It amuses the hell out of the rest of us to watch you do it. And keep on losing those elections while you're at it!

http://www.openmedicine.ca/article/view/8/1
http://www.commonwealthfund.org/Publications/Fund-Reports/2010/Jun/Mirror-Mirror-Update.aspx
http://umaine.edu/ble/files/2011/01/US-healthcare-system.pdf

That covers three different dimensions for measurement, and we lose in every one.

I think you miss the point. When Joe Sixpack doesn't have to pay for Product X, he doesn't care whether Product X costs $10 or $10,000,000.

Health insurers pass the cost on to employers, who have to keep paying the increased premiums to keep their employees happy. If Joe Sixpack had to pay for their own health insurance, then he would object when they doubled the premiums to cover those $10,000,000 products that could have been bought in a free market for $10.

Maybe you've been out of the job market for a while, but where are these happy employees?

Employers Push Higher Health Insurance Costs Onto Workers

Employees Get Pinched: Health Insurance Costs More

Workers paying more for health insurance as costs rise

New State-By-State Report: Employer Health Insurance Premiums Increased 50 Percent From 2003 to 2010; Employees' Share of Premiums Increased 63 Percent

Employers shift health insurance costs onto workers

The whole "debate" on the viability of the NHS is just a convenient justification for recently passed Tory-led reforms that many consider "privitisation through the back door". The increase in funding earlier on the last decade has started to show results, and heath outcomes are generally on the rise - why we are looking at another complete overhaul of NHS structure is beyond most observers.

The NHS performs quite well compared to any other system in the developed world - it also allows the UK to have the lowest cost as a percentage of GDP (in the developed world, adjusted for demographics) due to the nationalised/socialised nature of the organisation.

http://www.commonwealthfund.org/Surveys/2011/Nov/2011-International-Survey.aspx

Reality seems to contradict you. The US healthcare system is neither cheap (most expensive on the planet) nor efficient/good (usually towards the bottom of the list when ranking 1st world countries). In contrast, many of the cheapest and best systems for healthcare are either national healthcare systems (e.g., Canada and UK) or hybridized systems (e.g., the Netherlands).

I'm confused, how are they competing again? They're making people get private insurance... There's no government health care plan (a la Canada, UK, AU, Sweden, France, &c, &c...).

My sarcastic point was that many politicians bitch that the private sector is better, more efficient and cost-effective than government alternatives, yet this guy implies that the private sector cannot compete with those alternatives.

As for health care, the US has universal health care plans for two of the three segments of the population: Medicare for those 65+ and TriCare for the military. One of the ideas for last third was to extend Medicare to everyone, but some people complained that private insurance provided better care, was more efficient and cost-effective (which it isn't - Medicare's overhead is just 2%).

A poll in 02/2009 here and here shows that +60% favor giving anyone the option of signing up with Medicare. In addition, another poll in 05/2009 shows those with Medicare overwhelmingly like it better and get better service than those with private insurance:

• Medicare beneficiaries are more satisfied with their insurance coverage. Only 8 percent of elderly Medicare beneficiaries rated their insurance "fair or poor," in contrast with 18 percent of individuals with employer-based insurance. Thirty-two percent of Medicare beneficiaries had at least one negative insurance experience, compared with 44 percent of those covered by an employer plan.
• Medicare beneficiaries report easier access to physicians. Ten percent of Medicare beneficiaries' physicians did not accept their insurance, compared with 17 percent of respondents with employer-sponsored plans.
• Medicare beneficiaries are less likely to report not getting needed services. Twelve percent of elderly Medicare beneficiaries reported going without care, such as prescribed medications or recommended tests, because of cost restraints. Of individuals with employer-based plans, 26 percent reported experiencing these cost/access issues.
• Medicare beneficiaries are sicker and poorer but report fewer medical bill problems. Elderly Medicare beneficiaries were more likely to rate their health as fair or poor than the employer-coverage group (28% vs. 11%); more likely to have multiple chronic conditions (38% vs. 11%); and more likely to have incomes below 200 percent of the federal poverty level (51% vs. 27%). Yet, Medicare beneficiaries were less likely to report a medical bill problem than those covered by employer plans.

I'm not saying that Medicare (or a state-run ISP) is absolutely and/or always better than the private sector, but the reverse isn't a given either. As for Medicare, there may be fraud and waste - by the users - but there's also probably not the greed and lack of compassion of the private sector. You might get denied something my Medicare, but it's probably because of the rules, not concern for the quarterly profits.

Personally, I think the lack of universal health care is a crime against our general population perpetrated by the rich and greedy - who can afford private health care. For the rest of us, it's a carrot and stick used by our employers to keep us in line.

Here's the way regulation works. Private business tries something, people hate it. Customers can't get the companies to change their ways because all of the companies are doing it - there's no competitor to jump to. So now the government has to put a stop to it.

Write the bill and send it to your Congress critter.

It's quaint and charming when my friends tell me how writing a thoughtful letter to their elected representatives will accomplish something. Even intelligent people believe that.

Lobbyists know the system better than you or I ever will, they have contacts, but most of all they have money. They can contribute tens of millions of dollars to the Dem and Republican parties, and to individual candidates. That money can make the difference in paying for enough attack TV ads to bring a candidate over the top in a close race.

You, on the other hand, can send no more than a few letters, and if you're really charismatic you may be able to organize a dozen or a hundred of your friends to do the same. Meanwhile, you can't pay the millions of dollars for campaign costs which your elected official really needs.

There was a book that one a political science prize called "The Congressman," written by a former congressman turned political science professor, who said that the first priority for an elected official has to do is get re-elected. Otherwise they won't be an elected official any longer.

No matter how well-meaning, your congressman will either do whatever it takes to get re-elected, or he won't be a congressman. And it takes tens of millions of dollars.

Getting between a congressman and his millionaire contributors is like getting between a grizzly bear and her cub.

The example I understand best is health care reform.

According to the polls, the American public supported a single payer system (like other countries with better health care systems have) by over 50%, in multiple polls. They like Medicare and (by majorities) they wanted Medicare extended to people under 65.

During the Democratic primary, I saw a rundown of campaign contributions from the health care industry. Recalling from memory, it was:

Hillary Clinton $8.8 million

Barak Obama $8.4 million

Dennis Kucinich $40,000 (from the California Nurses Association).

Kucinich supported single payer.

As soon as Obama got into office, he broke his promise to support a single payer system. He came up with a compromise (public option), then a compromise of that compromise, and finally threw government-funded health care under the bus. The current plan is the same private insurance system, with subsidies for the private insurance industry to prevent it from collapsing immediately.

All of the touching letters to Obama didn't make any difference. He followed the interests of his financial contributors rather than the interests of the people who elected him. Now we're paying twice as much for health care as the next most expensive country, for care that isn't even always as good. http://abcnews.go.com/Health/HealthCare/wireStory?id=10987822 http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2010/Jun/Mirror-Mirror-Update.aspx

The best explanation I've seen for this was at Bill Moyer's Journal. http://www.pbs.org/moyers/journal/12182009/watch.html Moyers said that Obama never *wanted* a meaningful reform. He never *wanted* single payer. He *wanted* to cut a deal with the insurance industry.
 

That doesn't mean government being in charge will be any better.

Assuming the US government can do as good a job as the governments of other first world countries, it should be.

Of course, maybe the US will simply fail where so many others have succeeded. That's always a possibility... but if that happens, at least it should put an end to the "US is always the best at everything" triumphalism memes.

ind any government agency that's tried to do exceptionally well and you'll find that the smaller the scope of their responsibility the better they did. Medicare, Medicaid, Social Security, Postal Service, any regulatory agency - you get the picture. The federal government simply doesn't have a good resume; you can't blame the unbiased peoples for not loving the idea of the government running yet another program.

Simply not true. The Defense Department, for example, is probably the most enormous government agency in the world, and by all accounts it does a fine job in providing defense services. And more to the point: which provider of health services gets the highest marks for patient outcomes and patient satisfaction? That would be the VA. Which insurer has the lowest costs and highest customer satisfaction? That would be Medicare.

The meme of the federal goverment being ineffective is popular, but it has no basis in reality.

I won't argue that it takes away from freedom of choice, as does an income tax and any other kind of tax or anything else that benefits the public collectively at taxpayer expense. It's unpopular, but so are denials based on preexisting conditions, and voters overwhelmingly want that practice stopped. But we can't have one without the other.

The problem with the "car insurance paying for oil changes" analogy is that if your car breaks, you can buy a new one. Fundamentally, car insurance is about protecting *other people* from *you*. Health insurance is about protecting yourself.

I agree that the best cost reduction mechanism is certainly not addressed in the legislation. More information on that is in this incredible (and like yours, nonpartisan) New Yorker article. I've skimmed yours, and will do a more thorough read after work.

What the article I've linked says is that it's unnecessary procedures that are the biggest cost. Bureaucracy, depending on your sources and whether you talk about Medicare (whose admin costs are less) or private insurers will run anywhere between 3% to 15%, which is significant but static--it's not a growing percentage, and it's not nearly enough to account for such growth in premiums (119% since 2000).

Driving costs down from where they are expected to be (not down absolutely, but bending the curve a little) can be done in part by ensuring that we cover preventative care, which is a good part of the base package proposed in this health reform.

And for the record, sometimes routine expenses can be catastrophic. I work for the pharmaceutical industry. One of our drugs (which my stepfather happens to be on) costs upwards of $400 a bottle. With insurance it's a manageable $30 or $40. Just because it's recurring (like, say, insulin) doesn't mean it shouldn't be insured, since I'd wager that recurring expenses of that size can add up to bankruptcy for the majority of people. And bankruptcy doesn't fix your health issues, so even after that, how do you keep paying?

On another level, insurance that pays for routine expenses is, in some sense, paying to protect the both the insurer and the insured against catastrophe in the future. That's the idea of preventative medicine.

But a government-run monopoly (like medicare) is far far worse.

Is that so?

Medicare out-performs private sector plans in terms of patients' satisfaction with quality of care, access to care, and overall insurance ratings. The survey found that elderly Medicare beneficiaries are 2.7 times more likely than enrollees in employer-sponsored plans to rate their health insurance as excellent and less likely to report negative experiences with their insurance plans. Medicare beneficiaries are also one-third as likely to say they couldn't get health care because of cost than are those covered by employer private insurance plans. The survey also found that elderly Medicare beneficiaries were more likely to report being very satisfied with the care they received compared to those with private insurance (62% vs. 51% respectively).

The government is at least potentially answerable to the people it serves. Corporations are only answerable to their share holders (and often not even that). Government run services are also run for the common good, whereas corporations are run for private profit. The two seldom intersect.

Sorry, but as a physician, you come to the table with a prior of zero credibility in a discussion of financial matters.

Most physicians ought to try working in any other profession besides the guaranteed-high-salary-MD-world before commenting on who it is that lives in a parallel universe.

Physicians in the US have created a closed system that requires a *state license* to enter, and then they earn 3-10+ times the median salary:
http://www.payscale.com/research/US/People_with_Jobs_as_Physicians_%2F_Doctors/Salary
commensurate with remarkably low unemployment (while the rest of the US are now around 9.4% and rising).

I'm a strong supporter of anyone who creates high value earning as much as possible. When one builds value or manages high responsibility, they get the money.

Unfortunately, physicians in the US are not creating significant value despite the costs and their salaries. The costs to the US society have gone now above 17% of the nation`s Gross Domestic Product (GDP), and rising at rising four times faster on average than workers` earnings since 1999. That means more than 1 in 6 of *EVERY* dollar of value created in the US goes to this racket (sic). High cost, by itself, not a problem: health is extremely important BUT, health results in the US are not very good, on a cost comparison basis with other 1st world countries:
http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2006/Sep/Why-Not-the-Best--Results-from-a-National-Scorecard-on-U-S--Health-System-Performance.aspx

For all this expense, and all those salaries, US health is not as good. Why?

Becuase care providing is a controlled, state-sponsored monopoly. In any other industry physicians would all have been fired and improved long ago for such a horrible financial mess coupled with such poor comparative results. As a physician you and your peers created and profit directly from the high costs in the system.

I agree with any of your assessment of EMRs. They are dead on - but interested physicians driving this technology forward with a sincere interest in human health and not solely on protecting their business and on profits would have made EMRs a priority more then 30 years ago when research in this area first started, and solved all those issues.

And as for "Medical care in most locales in the US has long been collaborative, team-based system" - that`s comic. A physician`s definition of "team" and what everyone else in the work world means with that word are miles apart.

A country that cares about its citizens doesn't try to take over the health care industry, it allows people to get the amount or level of insurance they want and don't overload the system by making it free for all. Free for all means mediocre or poor for everyone.

Whereas the system as it stands in the US currently seems to be that:

• the many, who can afford it,
  1. pay a substantial percentage of their income in insurance premiums,
  2. get a mediocre system and mediocre outcomes
• the few, who can easily afford it,
  1. pay a small percentage of their income in insurance premiums,
  2. get a good system and mediocre outcomes
• a sizable minority,
  1. cannot find insurance with affordable premiums,
  2. get a dire system and mediocre outcomes

  Your example of Hawaii seems irrelevant. One incompetent attempt at implementing a system does not invalidate the system itself; it only serves to demonstrate the incompetence of that particular implementation.

  Compare the seven months of the Hawaiian system with sixty years of the British system (not perfect, but a damn sight more efficient than the US system), the French system, the German system...

  More importantly, compare the overall US performance with five other developed countries. http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=482678

  Lastly, it is pointless to draw Obama into the discussion. He's a politician, he'll say anything his campaign advisors tell him will win votes. He probably hasn't a clue what his proposals would really cost, nor where the money would come from. But then his opponent has no real clue either...

  K.

It's better than the American health care system, so that would be a plus compared to going to the USA.

The fact that the WHO decided those criteria are indicators of good health care does not make it any more objective. Statistics on mortality rates are next to worthless when comparing highly industrialized nations (eg, US, UK, Australia, etc). Statistics on equity has nothing to do with the quality of a healthcare system (in fact, this 1999 WHO paper clearly has equity and quality as two orthogonal characteristics, and the US as 15th best, on the same statistical plane as most of Europe). On this report, they have the US dominating in really the most important category (and the only important characteristic in quality), which is effective care. There was another recent chart a few months ago which I can't locate that had the US on the second tier (with about five tiers), but the US health care system's worst marks came in equity, which has nothing to do with quality.

The WHO is ranking apples vs. oranges. They put the US at 37, so what? It's pretty much meaningless.

It compares pretty well. Two years ago the US spent (in nice round numbers) USD5200 per person on healthcare. At current exchange rates, that's GBP2600-ish. Using a two year old exchange rate it was GBP4200.

The US has the most expensive per capita healthcare in the world, and Canada comes in second. The U.S. ranks only 37th in the world in quality health care - yet nationally America spends 82% more per person on health care than others. Canada also fails to fully benefit from the money spent, so I don't think either is a model for healthcare efficiency.

There are countries which perform better than the US while still spending less than the US government already spends. You'd be better looking at New Zealand, the UK and Australia to see what works.