Can you name a single policy change in the US that followed the route you described? (Originated in Germany, imposed on the EU, imposed on the UN, imposed on the US). Sources would be super! Thanks
The Obama response that would feel most fitting to your absurd comment comes straight from Fawlty Towers, 1min22secs into this clip: https://www.youtube.com/watch?...
"Socialist hell that brought us a Great Recession"! You should think about a career in comedy
It takes a special kind of stupid to read my comment and think it represented a *conservative* point of view, but congratulations, you just achieved it. I was, seeing as you were too stupid to notice, responding to a ridiculous authoritarian will-of-the-people nobility-of-the-working-man screed, not a left-of-centre argument. But never mind, you carry on being angry with the wrong people about the wrong things.
1. This is an article about black cabs and London. Why would I try to get money out of yellow cabs? Black cabs are subject to mystery shopping exercises and a cabbie can lose their licence if they do what you suggest 2. Legally discoverable my fat ass. As if more than about three customers in the history of Uber has ever bothered trying to pursue that particular line. I mean, really.
Uberâ(TM)s app *routinely* picks long and slow routes in London. I frequently have to redirect the driver based on my own knowledge or Waze. And of course thereâ(TM)s absolutely zero transparency about fare calculations â" I have to trust that the fare was calculated the way it was promised to be calculated. Meters in black cabs are regulated by a third party, by contrast.
This notion of "real"-ness is really fucking irritating. The shits that blue-collar workers shite are no more or less real than the shits that college-educated workers shite. They stink the same. The same is true of the rest of people's lives. Intelligence is by no means the preserve of the college-educated, but neither is it the preserve of blue-collar workers. Stop spouting cliches and accept the world for what it is: a complex place.
You began your post with the words "my experience has been". If that wasn't an argument from personal experience, it was a pretty fucking dumb choice of phrase.
What's happened so far: 1. I assert that patient co-pays for primary care are a really bad idea because patients wait too long to see their doctor and by the time they are diagnosed and treated, the disease has progressed, outcomes are worse, and costs to treat are higher. This is a pretty well documented phenomenon. Germany introduced co-pays in 2004, and poorer people in particular put off seeing the doctor, resulting in a greater burden of disease and exacerbated health inequalities. 2. You assert that your experience demonstrates that the real reason patients don't see doctors early is that seeing a doctor early simply results in being told a disease is psychosomatic.
That is such a spectacularly bad response to what I posted, it's almost a work of art. It doesn't address my assertion *at all*. Not even slightly. A coherent -- but still very wrong -- response to my assertion would be that there is *no value* in seeing a doctor early, because psychosomatic diagnosis blah blah -- in other words primary care doctors have such high Type 2 error rates at early stages, there's no use seeing them (although I suspect you believe these are not errors but deliberate malpractice / negligence). The evidence does not support this *at all*. Instead, the evidence is that Type 1 and 2 error rates are fairly low for primary care, and that primary care leading to early diagnosis and intervention is the single most value-adding component of any health system beside public health interventions.
But of course, that's not what you argued. You didn't argue there would be no value in seeing a doctor early; you argued patients have already made that conclusion for themselves and don't see doctors early. Which is obviously not true even for you, as your original post described you seeing doctors for multiple conditions early on, when they failed to diagnose.
It's very sad to hear that the horrid doctors couldn't help you with your various problems until it got really serious. But I'm not sure you're really ready to jump into making health policy just yet.
Oh bullshit. You don't know peers of these authors, or you wouldn't talk about "kids fresh out of school". Nico Henke is in his 60s; Jean Drouin is in his mid40s. And if you think what either of them does is "rudimentary analysis" and they only have a "skin-deep exposure" to the topic of evaluation of different health systems, you're letting your prejudice hang out. And if you think what you're linking to is "science", you're indulging in more of the same.
Go on, name the "peers of these authors" that you know. The ones who are "kids fresh out of school".
Narrow is exactly the word I'm looking for. You're talking about the depth of sophistication of analysis for CO2e -- honestly, that's a hoary old subject by this point, and comprehensive lifecycle analysis is well understood. But I'm saying that no matter whether the analysis of CO2e is done brilliantly or poorly, any analysis that concludes an ICE with the Mazda engine is cleaner than an EV based on evaluating CO2e alone is inherently narrow and thus flawed, because it does not account for particulate emissions, NOx, noise, etc.
Well, bully for your personal experience. But when you look at populations as a whole, rather than your random skin condition, cancers caught late are much more likely to kill you; diabetes treatment is much more effective if you don't wait for the retinopathy to develop; etc etc.
I'm more convinced by the McKinsey analysis that RCA begins with than the rest of that article. And the Stiglitz report it links to doesn't prove what is claimed, at all.
I haven't forgotten. But you apparently have forgotten the comment you made in the post I replied to: "Obama and the Democrats would rather stay in power than give us decent healthcare."
Implying the moral thing to do was to give up power and give the US decent healthcare. Those are, um, incompatible actions.
The NHS has had 8 years of being shat on by the Tories, so it's pretty ropey right now. At the end of the Brown era, patient satisfaction was at an all-time high and it was tremendously successful.
But it's never been anywhere near as terrible as the US.
The Commonwealth Fund report looks at total cost of care, including both public and private, across countries to do an apples-to-apples comparison.
The notion that US consumers are subsidising global pharma research is sweet but really quite wrong. Take a look at the gross margins of Pfizer et al: there's plenty of fat in there.
I understand the argument but it's more difficult. EVs can be expected to have longer lifetimes than ICE cars due to fewer moving parts and vibration. And if you replace the battery, it can have a second use or be recycled, while the chassis can continue to be used. So there's no sensible apples-to-apples comparison.
No, don't do some numbers. Accept that these particular numbers need more than a rough calculation and require some serious expertise, and then look at the peer-reviewed journals for that.
I listed a bunch of externalities that they *don't* take account of. They only take account of one: CO2e. That's the whole point of that part of my post. What are the "many" externalities that you think they are taking account of?
I agree with what the other poster said in reply to you.
Additionally, you may be able to see a meaningful difference between a system of mandatory savings that can only be spent on one thing that the government deems is in your interest, and taxes, but it eludes me.
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."
Slashdot Mirror
Can you name a single policy change in the US that followed the route you described? (Originated in Germany, imposed on the EU, imposed on the UN, imposed on the US). Sources would be super! Thanks
The Obama response that would feel most fitting to your absurd comment comes straight from Fawlty Towers, 1min22secs into this clip:
https://www.youtube.com/watch?...
"Socialist hell that brought us a Great Recession"!
You should think about a career in comedy
Wait, you think O'Hare runs "just fine"?? That is, to put it mildly, not the experience I have heard from most people, nor my own
It takes a special kind of stupid to read my comment and think it represented a *conservative* point of view, but congratulations, you just achieved it. I was, seeing as you were too stupid to notice, responding to a ridiculous authoritarian will-of-the-people nobility-of-the-working-man screed, not a left-of-centre argument. But never mind, you carry on being angry with the wrong people about the wrong things.
That was probably the least effectual rejoinder I've seen on Slashdot so far.
1. This is an article about black cabs and London. Why would I try to get money out of yellow cabs? Black cabs are subject to mystery shopping exercises and a cabbie can lose their licence if they do what you suggest
2. Legally discoverable my fat ass. As if more than about three customers in the history of Uber has ever bothered trying to pursue that particular line. I mean, really.
Uberâ(TM)s app *routinely* picks long and slow routes in London. I frequently have to redirect the driver based on my own knowledge or Waze. And of course thereâ(TM)s absolutely zero transparency about fare calculations â" I have to trust that the fare was calculated the way it was promised to be calculated. Meters in black cabs are regulated by a third party, by contrast.
This notion of "real"-ness is really fucking irritating. The shits that blue-collar workers shite are no more or less real than the shits that college-educated workers shite. They stink the same. The same is true of the rest of people's lives. Intelligence is by no means the preserve of the college-educated, but neither is it the preserve of blue-collar workers. Stop spouting cliches and accept the world for what it is: a complex place.
I beg your fucking pardon.
You began your post with the words "my experience has been". If that wasn't an argument from personal experience, it was a pretty fucking dumb choice of phrase.
What's happened so far:
1. I assert that patient co-pays for primary care are a really bad idea because patients wait too long to see their doctor and by the time they are diagnosed and treated, the disease has progressed, outcomes are worse, and costs to treat are higher. This is a pretty well documented phenomenon. Germany introduced co-pays in 2004, and poorer people in particular put off seeing the doctor, resulting in a greater burden of disease and exacerbated health inequalities.
2. You assert that your experience demonstrates that the real reason patients don't see doctors early is that seeing a doctor early simply results in being told a disease is psychosomatic.
That is such a spectacularly bad response to what I posted, it's almost a work of art. It doesn't address my assertion *at all*. Not even slightly. A coherent -- but still very wrong -- response to my assertion would be that there is *no value* in seeing a doctor early, because psychosomatic diagnosis blah blah -- in other words primary care doctors have such high Type 2 error rates at early stages, there's no use seeing them (although I suspect you believe these are not errors but deliberate malpractice / negligence). The evidence does not support this *at all*. Instead, the evidence is that Type 1 and 2 error rates are fairly low for primary care, and that primary care leading to early diagnosis and intervention is the single most value-adding component of any health system beside public health interventions.
But of course, that's not what you argued. You didn't argue there would be no value in seeing a doctor early; you argued patients have already made that conclusion for themselves and don't see doctors early. Which is obviously not true even for you, as your original post described you seeing doctors for multiple conditions early on, when they failed to diagnose.
It's very sad to hear that the horrid doctors couldn't help you with your various problems until it got really serious. But I'm not sure you're really ready to jump into making health policy just yet.
Oh bullshit. You don't know peers of these authors, or you wouldn't talk about "kids fresh out of school". Nico Henke is in his 60s; Jean Drouin is in his mid40s. And if you think what either of them does is "rudimentary analysis" and they only have a "skin-deep exposure" to the topic of evaluation of different health systems, you're letting your prejudice hang out. And if you think what you're linking to is "science", you're indulging in more of the same.
Go on, name the "peers of these authors" that you know. The ones who are "kids fresh out of school".
I think you may be confusing me with someone who gives a shit about arguing economics with you.
You say what you like. I'll rely on McKinsey and Stiglitz, thanks.
Also, you mention Legatum as a data source. I mean, really.
https://www.mckinsey.com/~/med...
Narrow is exactly the word I'm looking for. You're talking about the depth of sophistication of analysis for CO2e -- honestly, that's a hoary old subject by this point, and comprehensive lifecycle analysis is well understood. But I'm saying that no matter whether the analysis of CO2e is done brilliantly or poorly, any analysis that concludes an ICE with the Mazda engine is cleaner than an EV based on evaluating CO2e alone is inherently narrow and thus flawed, because it does not account for particulate emissions, NOx, noise, etc.
Well, bully for your personal experience. But when you look at populations as a whole, rather than your random skin condition, cancers caught late are much more likely to kill you; diabetes treatment is much more effective if you don't wait for the retinopathy to develop; etc etc.
Are you seriously claiming that early interventions in healthcare *isn't* a method that delivers cheaper care with better outcomes?
Yeah, no.
I'm more convinced by the McKinsey analysis that RCA begins with than the rest of that article. And the Stiglitz report it links to doesn't prove what is claimed, at all.
Nah, lots of RE100 companies have this kind of challenge.
I haven't forgotten. But you apparently have forgotten the comment you made in the post I replied to: "Obama and the Democrats would rather stay in power than give us decent healthcare."
Implying the moral thing to do was to give up power and give the US decent healthcare. Those are, um, incompatible actions.
The NHS has had 8 years of being shat on by the Tories, so it's pretty ropey right now. At the end of the Brown era, patient satisfaction was at an all-time high and it was tremendously successful.
But it's never been anywhere near as terrible as the US.
The Commonwealth Fund report looks at total cost of care, including both public and private, across countries to do an apples-to-apples comparison.
The notion that US consumers are subsidising global pharma research is sweet but really quite wrong. Take a look at the gross margins of Pfizer et al: there's plenty of fat in there.
I understand the argument but it's more difficult. EVs can be expected to have longer lifetimes than ICE cars due to fewer moving parts and vibration. And if you replace the battery, it can have a second use or be recycled, while the chassis can continue to be used. So there's no sensible apples-to-apples comparison.
No, don't do some numbers. Accept that these particular numbers need more than a rough calculation and require some serious expertise, and then look at the peer-reviewed journals for that.
Que?
I listed a bunch of externalities that they *don't* take account of. They only take account of one: CO2e. That's the whole point of that part of my post. What are the "many" externalities that you think they are taking account of?
It's mad as a box of frogs.
I agree with what the other poster said in reply to you.
Additionally, you may be able to see a meaningful difference between a system of mandatory savings that can only be spent on one thing that the government deems is in your interest, and taxes, but it eludes me.
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."