The American Spectator

jharp| 3.20.09 @ 11:42AM

"Yet at the same time, more than three-quarters are unhappy with the cost of care."

Hopefully you can now pull your head out of your rear end and understand that THIS IS EXACTLY THE PROBLEM.

Did you really not understand this? Really?

The U.S. health care system costs twice what the rest of the industrialized world costs. And for the same level of care.

Good grief.

DH| 11.13.09 @ 12:19PM

It's by no means the same level of care. The level of care you receive in the US is better than any socialized healthcare system's level of care.

Martin Ellingham| 3.20.09 @ 12:38PM

jharp,

No. The reason the U.S. health care system costs twice what the rest of the industrialized world costs is we get at least twice as much health care. I lived in the UK for four years and was eligible for National Health Service care and luckily had private insurance my employer paid for. The UK papers and television stations would periodically feature sob stories of British citizens who were denied treatment and had to sell or mortgage their house to pay for treatment in the US. They had waiting lists for cancer specialists that were longer than the survivability period for the cancer without treatment. Accident and Emergency centers (their version of an ER) were far less common than those in the U.S. In a major city like London, you had to go across town to get a MRI. Neonatal care was separate from birthing would be sent a hundred miles away. The standard caregiver for births was a midwife (and there is a shortage of those) instead of an OBGYN.

When there are budget shortfalls centers, so if you newborn had an issue in a suburb of London, the child, the first thing that gets cut in the NHS are custodial services. Because of this, the UK has a severe MRSA outbreak in all of their hospitals. Families of patients have to clean their loved ones beds (they don’t have semi-private rooms either, all wards, many of them mixed gender) and maintain 24 hour vigils to keep them clean. Hospital closures and consolidations were made for political reasons due to what ever party their Member of Parliament was from.

NHS was geographically convenient and completely free so I sought them out first when we had an issue. My daughter injured her ankle on a trampoline, we went to our local surgery where a nurse looked at it, poked it and declared it a sprain. She wrapped it with an Ace bandage and provided instruction to come back in two weeks if the swelling hadn’t gone away. We then took our daughter to a private doctor, who x-rayed the ankle and explained children require x-rays due to potential damage to growth plates. We got an air cast and crutches there.

The US has the best health care system in the world because we are willing to pay for it.

jharp| 3.20.09 @ 12:45PM

I agree the UK system is poor. Why don't you look at a good system.

Say Taiwan.

http://content.healthaffairs.org/cgi/content/full/22/3/77

And your claims about the UK are BS. As is the rest of your post. And without a shred of backup.

Great Britain

I include Great Britain not because its health system is very good but because its health system is very cheap. Per capita spending in Great Britain hovers around 40 percent what it is in the United States, and outcomes aren't noticeably worse. The absolute disparity between what we pay and what they get illuminates a troublesome finding in the health-care literature: Much of the health care we receive appears to do very little good, but we don't yet know how to separate the wheat from the chaff. Purchasing less of it, however, doesn't appear to do much damage.

What's interesting is that many of the trade-offs that our health-care system downplays, the English system emphasizes. Where our medical culture encourages near-infinite amounts of care, theirs subtly dissuades lavish health spending, preferring to direct finite funds to other priorities.

This sort of national prioritizing is made easier because Great Britain has a socialized system, wherein the government directly employs most of the providers. Great Britain contains costs in part by paying doctors through capitation, which gives doctors a flat monthly sum for every patient in their practice. Since most patients don't need care in a given month, the payments for the healthy subsidize the needs of the sick. Crucially, though, the fixed pool of monthly money means doctors make more for offering less treatment. With traditional fee-for-service arrangements, like ours, doctors gain by treating more. The British system, by contrast, lowers total costs by lowering the quantity of prescribed care. As University of San Francisco professors Thomas Bodenheimer and Kevin Grumbach write, "British physicians simply do less of nearly everything -- perform fewer surgeries, prescribe fewer medications, and order fewer x-rays."

That may sound strange, but it also means that society pays for fewer of those surgeries, fewer of those medications, and fewer of those X-rays -- and as far as we can tell, the English aren't suffering for it. Indeed, a 2006 study published in The Journal of the American Medical Association found that, on average, English people are much healthier than Americans are; they suffer from lower rates of diabetes, hypertension, heart disease, heart attack, stroke, lung disease, and cancer. According to the study's press release, the differences are vast enough that "those in the top education and income level in the U.S. had similar rates of diabetes and heart disease as those in the bottom education and income level in Great Britain."

Great Britain's example proves that it is possible to make economy a guiding virtue of a health system. We could do that on the supply side, through policies like capitation that would change the incentives for doctors, or on the demand side, by making patients pay more up front -- or both, or neither. Americans may not want that system, in the same way that the owner of a Range Rover may not want a Corolla, but we should at least recognize that we have chosen to make health care a costly priority, and were we to decide to prioritize differently, we could.

http://www.prospect.org/cs/articles?article=the_health_of_nations

Taylor| 3.20.09 @ 1:00PM

JHarp:

I can't speak for Europe, Japan or Bangladesh, but I was born and live in Canada. We have a relatively good system, but I can tell you for a fact that we do not receive the same level of care that you do in the U.S. Care is rationed, so patients wait in constant pain for months and years before being treated. People die on waiting lists waiting for cancer treatment. Also, many life-saving drugs from the States aren't approved here (too expensive for the official list). Oh, and should I mention that even though many, many Canadians are unhappy with our system, it is *illegal* to pay out of pocket for better care (it would threaten the "fairness" of the system).

Here in Canada, if you want the best care, you do what wealthy Canadians do: you go to the U.S. to get it. It's what Canadian celebrities and politicians do (case in point: our Liberal ex. Prime Minister's family.)

One reason why your system is so expensive is that countries like ours depend on you to develop the drugs and treatments we use. Good thing, otherwise we'd never be able to afford our "free" health care.

jharp| 3.20.09 @ 1:11PM

You are full of doo doo.

My Canadian friends have stopped travel to the U.S. because of the risk of getting sick here and having to pay for our outrageous health care system.

"many life-saving drugs from the States aren't approved here (too expensive for the official list). "

It's because they aren't safe you stupid jackass. Are you not aware of how many American's have been poisoned by unsafe drugs.

"One reason why your system is so expensive is that countries like ours depend on you to develop the drugs and treatments we use. "

More complete and utter nonsense. Drugs are cheap in Canada because the Canadian government is allowed to negotiate. Something George Bush made sure Medicare and Medicaid couldn't do.

DH| 11.13.09 @ 12:38PM

jharp,

I try to stay respectful on these comments, but I have to say ...you're an idiot. Nothing further...that would be a waste of time. Would be like trying to teach a monkey how to juggle... Sure it can be done, but is it really worth the effort? it's still a monkey...dependent on others for survival because somebody removed from its natural habitat and "took care of it" taking away it's ability to do that for itself. Similar to removing citizens from their free market economy that's built this great nation you yourself say ..."every Canadian should get the; opportunity to visit your incredible country at least once in his or her life."

Taylor| 3.20.09 @ 2:02PM

JHarp:

I must thank you. You made me smile, not an easy thing to do for a leftist. Clearly you don't have much of a grasp on the facts of the legitimate and ongoing debate about free-market vs single-payer health care. Since you've made my day, I'll take the time to provide some of the facts that you seem to ignore.

1) If your supposed "Canadian friends" are too cheap to buy travel insurance, then that's their loss. It's actually pretty cheap and every Canadian should get the opportunity to visit your incredible country at least once in his or her life. I'd suggest they start with the National Mall. Simply breathtaking.

2) The brand-name prescription drugs that are available here are indeed around 50% cheaper than the U.S. However, the opposite is true for generic drugs, which are on average 115% higher than in the U.S. That's because the price is influenced by a regulatory body, not by the market. (http://www.canada.com/story_print.html?id=67eb1c89-da66-42a5-b723-50ab137f8998&sponsor;=)

3) When you put a price ceiling on anything, and that ceiling is below what the market demand would dictate, you will cause shortages (check Econ 101).

The most advanced drugs are costly to develop, and while pharmaceutical R&D is a beneficial undertaking, it isn't a charitable one. Consequently, many of the best, most advanced drugs are also the most expensive to develop. Drugs deemed too expensive for the Canadian single-payer system are simply left off of the approved list.

When a skilled specialist doctor is payed a government-mandated rate, as opposed to the market rate for his/her services, that doctor will be incentivised to move to a country where the price for the service offered is more reasonable. There is a shortage of doctors in Canada, in part because they are moving to the U.S., as would I if I could work in the world's leading industry at a more equitable level of pay.

4) Why are there shortages of timely, quality medical care in Canada (and elsewhere) but no shortage of veterinarians? Two words: "free market".

CH| 3.20.09 @ 2:45PM

Harpy doesn't have a grasp on his own sanity let alone the status of health care in this country. Just another marxist moron out to harm his own people.

MT| 3.20.09 @ 2:47PM

Thanks, Taylor for shutting up the clown. With marxists it's all about power--they don't care about people.

jharp| 3.20.09 @ 2:51PM

Taylor| 3.20.09 @ 2:02PM

Taylor. Your ignorance makes me frown.

Or are you just a right wing hack liar?
Oh, Canada!

As described by the American press, Canada's health-care system takes the form of one long queue. The line begins on the westernmost edge of Vancouver, stretches all the way to Ottawa, and the overflow are encouraged to wait in Port Huron, Michigan, while sneering at the boorish habits of Americans. Nobody gets to sit.

Sadly for those invested in this odd knock against the Canadian system, the wait times are largely hype. A 2003 study found that the median wait time for elective surgeries in Canada was a little more than four weeks, while diagnostic tests took about three (with no wait times to speak of for emergency surgeries). By contrast, Organisation for Economic Co-operation and Development data from 2001 found that 32 percent of American patients waited more than a month for elective surgery, and 5 percent waited more than four months. That, of course, doesn't count the millions of Americans who never seek surgery, or even the basic care necessary for a diagnosis, because they lack health coverage. If you can't see a doctor in the first place, you never have to wait for treatment.

Canada's is a single-payer, rather than a socialized, system. That means the government is the primary purchaser of services, but the providers themselves are private. (In a socialized system, the physicians, nurses, and so forth are employed by the government.) The virtue of both the single-payer and the socialized systems, as compared with a largely private system, is that the government can wield its market share to bargain down prices -- which, in all of our model systems, including the VHA, it does.

A particularly high-profile example of how this works is Canadian drug reimportation. The drugs being bought in Canada and smuggled over the border by hordes of lawbreaking American seniors are the very same pharmaceuticals, made in the very same factories, that we buy domestically. The Canadian provinces, however, bargain down the prices (Medicare is barred from doing the same) until we pay 60 percent more than they do.

Single-payer systems are also better at holding down administrative costs. A 2003 study in The New England Journal of Medicine found that the United States spends 345 percent more per capita on health administration than our neighbors up north. This is largely because the Canadian system doesn't have to employ insurance salespeople, or billing specialists in every doctor's office, or underwriters. Physicians don't have to negotiate different prices with dozens of insurance plans or fight with insurers for payment. Instead, they simply bill the government and are reimbursed.

The downside of a single-payer system in the Canadian style is that it constructs a system with a high floor and a low ceiling. If you don't like the government's care options, there's no real alternative. In this, Canada is rare. As we'll see with both France and Germany, other countries are able to preserve a largely nationalized system with universal access while allowing private options at the upper levels.

http://www.prospect.org/cs/articles?article=the_health_of_nations

Taylor| 3.20.09 @ 4:14PM

Thank you, MT and CH. I must admit that I can't recall anyone ever calling me "stupid" or a "jackass" before -- I'd like to think because of my intelligence and not my size -- but whether I'm right or wrong, I'm glad that at least my comments aren't cut and pasted from someone else's propaganda.

Charley Feher| 7.16.09 @ 4:26PM

The following paragraphs are from the CNN poll article that weren't mentioned in the article above, with bracketed commentary from myself:

Half of all Americans questioned in the poll said they are very confident that no one in their household will lose health insurance. However, 29 percent said they are very confident that they could meet their bills if someone in the household had a major medical emergency. [that leaves 71% not confident]

"It suggests a prescription for health care reform that Americans can swallow -- start by addressing health care costs while allowing Americans to keep their current coverage and their current health care providers," Holland added. [I agree that if health care costs were lowered and more affordable, a 'universal' system wouldn't be needed.]