# Let's talk healthcare

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Some minor discussion of healthcare in other topics has forced me to do some reading on the subject. Since it wasn't the the origional subject in those threads, I thought I had better opportunity to discuss it at length if I created a new topic. So let's see if I can break down what the critics of the US's healthcare system say.

Some people say that America spends more money on healthcare for a lower quality. While it's true we spend more money, I will have to beg to differ on the lower quality. It seems that most of the areas that are chosen to judge quality are chosen on results that they wish to recieve rather than taking into account the reasons for those numbers being the way they are.

In a 2000 WHO study, the US was penalized under several highly subjective categories. Things like fairness, not having a sufficiently progressive tax system, not providing universal healthcare, and having a general paucity for social programs. It seems the study started out negative for the US before it actually even began. Hmmm...

Life Expectancy: This is one I've heard quite a few times. I thought to myself that this couldn't be right. Not as much as our medical technology has advanced. Then once I started reading up, I had read where the American Enterprise Institute found that if you correct for homicides and accidents, the US moves to the top of the list. Hmmm...Try getting a healthcare system that keeps you from getting shot and walking off of a cliff. Maybe that's what we're going for.

Infant Mortality: This is one of the talking points I've heard quite a bit also. It seems that there is a high infant mortality rate in the US. I wonder why...Over the past couple of decades high risk, low birth-weight infants have had a growing chance of survival, due to growing medical advancement. Some die not long after birth, which raises our infant mortality rate. But in other western countries, those high risk, low birth-weight infants aren't included like the US's are. Hmmm...Could it be because many of those countries use abortion to eliminate problem pregnancies? I would consider checking the abortion rate of any country with a low infant mortality rate.

The US clearly out performs the rest of the world with specific diseases suc as cancer,pneumonia, heart disease, aids, etc...Chances of survival are far higher in the US than in other countries.

In fact America has played key roles in over 80% of major medical advancements in the past 3 decades. If this was a matter in technological availability, then I refer you to Japan who has the availability but is not leading in advancement such as the US.

When I think about changing our healthcare system and the way people want to change it, I don't think about it fixing our problems rather adding others. Like France having to raise copay costs to alleviate inflated cost and rising healthcare deficits. Now a French citezen ends up paying around 13 percent of their healthcare costs. Why does that sound familiar? Oh yeah, that's around the average that Americans pay. And we don't even want to mention Italy's system, or Norways for that matter, who have about 23% of all people that are referred for hospital admission waiting 3 months to be admitted.

Just sayin'.

Edited by JustinW

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OK, just a couple of points about the assertions you make

" But in other western countries, those high risk, low birth-weight infants aren't included like the US's are."

How not?

They count dead babies. It's not rocket science.

In many or most countries, the state was funding prenatal care for the women. Do you think they "don't notice" the absence of a baby as an outcome?

"Hmmm...Could it be because many of those countries use abortion to eliminate problem pregnancies?"

How?

Much infant mortality is related to premature birth- and you can't really judge that till it's far too late to consider abortion.

Also, you might want to look at the numbers.

The US has higher abortion rates than most of the West

http://www.johnstonsarchive.net/policy/abortion/wrjp334pd.html

So their high infant mortality rate looks even worse by your criterion.

And, are you sure that "American Enterprise Institute" counts as an unbiased source? Their website didn't look "even handed" to me, but perhaps that's just because I'm not from the US.

While I'm at it perhaps I should respond to this assertion

" It seems that most of the areas that are chosen to judge quality are chosen on results that they wish to recieve"

I posted data on infant mortality and death rates.

I chose those data because they are pretty robust. Diagnostic criteria for "dead" are fairly consistent across the world.

I also chose them because I didn't think anyone would feel the need to question them.

It seems I was optimistic

"In a 2000 WHO study, the US was penalized under several highly subjective categories. Things like fairness, not having a sufficiently progressive tax system, not providing universal healthcare, and having a general paucity for social programs. It seems the study started out negative for the US before it actually even began. Hmmm..."

It is equally valid to say that this is evidence that the USA started out negative before the study began.

Are you saying that fairness etc. is a bad thing?

In respect of this

"Try getting a healthcare system that keeps from getting shot "

I think I already cited this

http://en.wikipedia.org/wiki/The_Impact_of_Legalized_Abortion_on_Crime

"In fact America has played key roles in over 80% of major medical advancements in the past 3 decades. "

You see, you do know how to look after all the people- you just choose not to.

"When I think about changing our healthcare system and the way people want to change it, I don't think about it fixing our problems rather adding others. "

What problems would you add?

Do you understand that the rest of us must have addressed those problems to a degree or we wouldn't have better outcomes?

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I've lived in Australia and the US.

Australia has a government run medical system - a levy is taken out at federal tax time, standardized to taxable income (i.e. you earn more, you pay more medicare levy) which doesn't cover private hospital care, ambulance rides, dental or optical care - for which you need private cover.

In the US I still pay a compulsory medial care levy as tax, but I am also obligated to pay for health insurance through my employer. My health insurance is approximately an order of magnitude higher than govt. medical + private optional (dental, optical, ambulance) was in Australia. The level of care I have recieved when I've needed a doctor in both places have been adequate but the treatment is the US has been more comprehensive and the waiting times less in most circumstances.

As I see it - health insurance is in reality - a necessity: do you know anyone who could afford health insurance but chooses not to have it? The vast majority of people with no coverage in the US are in such a position because they are unable to afford it. The other reality I see is we pay for uninsured people whether or not it's legitimized by the system or not. Hospitals are obligated to provide acute care to save lives regardless of the ability of the patient to pay - and having to recoup costs for those treated who don't pay - will add this operating costs to the bill for paying patients. The other way we all pay is through liability - people who can't afford to pay their medical bills through having no insurance are left with few options but to try and make someone else pay. It's a motivation for a lot of the frivolous lawsuits the US is notorious for, which chew up a lot of taxpayer funds. A third is the crippling effect on an already downtrodden economy of medical bankruptcies. 60% of all personal bankruptcies in the US are due to medical bills. http://articles.cnn....ce?_s=PM:HEALTH

So, I think the arguments suggesting it is "unfair" to pool medical expenses under a government system are extremely myopic, I think healthcare in the US is exorbitant compared to elsewhere in the world and I think the current status quo has a wide range of indirect negative effects on US society as a whole.

Edited by Arete
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"As I see it - health insurance is in reality - a necessity: do you know anyone who could afford health insurance but chooses not to have it?"

Yes, me.

(and I think most of Europe).

It depends on your definition.

We don't buy insurance because the government acts as an assurer. It has the biggest possible pool among which to spread the risk.

Incidentally, for all practical purposes, it's not insurance it's assurance.

You are going to need healthcare so it's not as if you are gambling that it won't happen to you. It's like life- cover. It's not usually insurance

I was talking to a friend the other day- he has a couple of long-term medical problems. He simply can not get medical insurance for travel outside Europe.

Do our US cousins think that's fair?

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Just a few things. For starters, AEI is a conservative think tank, so it is clearly partisan. Just for reference, the publication they referred to is this one My link (which is not peer reviewed). Now, there are several issue with this. First, the correction for accidents is not trivial. For one, healthcare also affects survival rate of those incidents. Ignoring that the authors used regression analyses to estimate life expectancy instead of removing deaths and re-calculate the life expectancy. Thus the numbers are at best suspect. Note that estimations of life expectancies are a tricky business at best. Regarding infant mortality, there has been much talk about that, too. However, a number of the studies actually have taken the different ways to count infant deaths into account.

But let us look at the life expectancy at age 65 instead. This will remove many of these factors (as accident levels are highest at young age, and obviously infant mortality does not factor in anymore). Looking at OECD from 2007 (I have not found a newer data set that includes the US My link) data the US has a life expectancy of 20.3 years for females, which is better than UK (20.1) but worse than e.g. Germany (20.7), Canada (21.4), Australia (21.6) or Japan (23.6).

For males USA ties with UK and Germany (17.4) but is lower than Canada (18.2), Australia (18.5) or Japan (18.6). According to some reports the US is falling further behind since 2007, but since I was not able to find the source quickly I have omitted those.

Note that at that age people become eligible for medicare. Nonetheless it is clear that despite much higher costs the outcome in the US is not proportionately better than the other systems. Also note that several studies have shown that the health outcome is much more income-dependent than in other countries (for obvious reasons).

I also have a comment regarding the survival rate of cancer. In the US certain screens including mammography as well as PSA test (screen for prostate cancer) are fairly common and occur more often. However, one should note that not all positive detections (which would go into the statistics) result in adverse health effects. In the case of prostate cancer it has been estimated that more men die with prostate cancer than from it. Now this could be seen either way. Early detection in the US helps in intervention and thus increase survival rate. The other is that for the comparative purpose a lot of people are added that have a positive cancer detection, but are finally not at risk from dying from it.

There are studies that these early screens do not, in fact, save lives (which would support the latter hypothesis), but there is still some controversy going on and I do not think that a consensus has been reached yet.

See e.g. Schröder FH, Hugosson J, Roobol MJ, et al. Prostate-cancer mortality at 11 years of follow-up. N Engl J Med 2012;366:981-90

Schröder FH, Hugosson J, Roobol MJ, et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 2009;360:1320-8

Andriole GL, Crawford ED, Grubb RL III, et al. Prostate cancer screening in the randomized Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial: mortality results after 13 years of follow-up. J Natl Cancer Inst 2012;104:1-8.

Andriole GL, Crawford ED, Grubb RL III, et al. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med 2009;360:1310-9.

Edited by CharonY
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Some people say that America spends more money on healthcare for a lower quality. While it's true we spend more money, I will have to beg to differ on the lower quality.

You're certainly welcome to your own opinion, but not your own facts.

http://www.fareedzakaria.com/home/Articles/Entries/2012/3/19_Health_Insurance_Is_for_Everyone.html

The most striking aspect of America's medical system remains how much of an outlier it is in the advanced industrial world. No other nation spends more than 12% of its total economy on health care. We do worse than most other countries on almost every measure of health outcomes: healthy-life expectancy, infant mortality and--crucially--patient satisfaction. Put simply, we have the most expensive, least efficient system of any rich country on the planet. Costs remain high on every level. Recently, the International Federation of Health Plans released a report comparing the prices in various countries of 23 medical services, from a routine checkup to an MRI to a dose of Lipitor. The U.S. had the highest costs in 22 of the 23 cases. An MRI costs $1,080 here; it costs$281 in France.

<...>

When listening to the debate about American health care, I find that many of the most fervent critics of government involvement argue almost entirely from abstract theoretical propositions about free markets. One can and should reason from principles. But one must also reason from reality, from facts on the ground. And the fact is that about 20 foreign countries provide health care for their citizens in some way or other. All of them--including free-market havens like Switzerland and Taiwan--have found that they need to use an insurance or government-sponsored model. All of them provide universal health care at much, much lower costs than we do and with better results.

It seems that most of the areas that are chosen to judge quality are chosen on results that they wish to recieve rather than taking into account the reasons for those numbers being the way they are.

No, it doesn't seem that way at all. These measures have been the standard for decades. You don't get to change them now merely because you don't like the conclusions we're drawing from them.

Infant Mortality: This is one of the talking points I've heard quite a bit also. It seems that there is a high infant mortality rate in the US. I wonder why...Over the past couple of decades high risk, low birth-weight infants have had a growing chance of survival, due to growing medical advancement. Some die not long after birth, which raises our infant mortality rate. But in other western countries, those high risk, low birth-weight infants aren't included like the US's are. Hmmm...Could it be because many of those countries use abortion to eliminate problem pregnancies? I would consider checking the abortion rate of any country with a low infant mortality rate.

This is a rather broad leap... An unnecessary stretch of logic. Much more simply, our infant mortality rate is high because so many pregnant women are uncovered and cannot afford treatment. Hundreds of thousands of women each year never see a doctor until their water breaks and it's time to deliver. It's those babies that are dying within one year of birth. You don't need to invoke screams of European abortions for this to hold true.

The US clearly out performs the rest of the world with specific diseases suc as cancer,pneumonia, heart disease, aids, etc...Chances of survival are far higher in the US than in other countries.

Countries with universal coverage, though?

In fact America has played key roles in over 80% of major medical advancements in the past 3 decades.

Please try to wrap your mind around this simple truth. Medical research $\ne$ medical coverage. The fact that great technology is available is completely moot when you don't have enough money or any coverage to take advantage of and use that technology.

Edited by iNow
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I think the problem is very simple: in the USA, the poorest people receive less healthcare, because they can't afford it. Other countries often have a nationalized system where everybody receives healthcare, regardless of income.

So, the problem is not that the US has bad doctors/hospitals/equipment/medicine. It's probably among the best in the world, if not the best. The problem is that certain people have only limited access to it, because insurances and hospitals are all privatized.

Disclaimer: I'm no expert, I did not research it, and I have no links to back this up. Seems common sense to me though.

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Seems common sense to me though.

Try not to rely on that too much in the US.

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I think the problem is very simple: in the USA, the poorest people receive less healthcare, because they can't afford it. Other countries often have a nationalized system where everybody receives healthcare, regardless of income.

So, the problem is not that the US has bad doctors/hospitals/equipment/medicine. It's probably among the best in the world, if not the best. The problem is that certain people have only limited access to it, because insurances and hospitals are all privatized.

Disclaimer: I'm no expert, I did not research it, and I have no links to back this up. Seems common sense to me though.

This is a bit off subject, but you can use me as a lame link, one way or the other. Since I've been retired (a few years now) and my health care plan has been negotiated at least three different times through my (business) handlers, progressivly national rates have gone up while my coverage has gone down. Late Nov. 2011, I had a mishap when stepping out onto my front porch that caused terrible contusions to both my knees, which I didn't realise until later. By 3AM the following morning the pain was so intense I would have screamed, but I didn't want to wake my neighbors. Couldn't walk, so; called my daughter and waited for the EMT. About fifteen minues later thay took me to the hospital. The trip, 1.2 miles. Total time, less than 20 mins. They take me to the ER and are gone. So, first things first. Do you have insurance Mr.Rigney? With whom? Then the waiting begins. After about 30 Mins. the nurse, clerk or what ever comes back in to tell me that I have been delivered to the wrong hospital. My daughter looks at me out of pure curiosity??? Can you beat that, I'm in the wrong hospital! My God! my family has been associated with this hospital for over forty years. (New health care coverage). The one they should have taken me to is another 22 miles further out. Fortunately for me an un-extended stay in this hospitals ER is acceptable. To shorten up on this tear jerker, I was in the ER for seven hours. During that time my knees were x-rayed, and my left knee was drained of fluid. Eventually I was wheeled to the exit, where my daughter and an attendant helped me into my daughters car. She drives me home, helps me up my 7 back steps and eventually into bed. What a day. EMT trip $550.00, co-pay$75.00. ER stay and treatment $1,530.00, co-pay$50.00. And I'm to feel blessed?. An indigent from off the street would have receiveded the same care for no price at all. I'm blessed only in the fact that I had the $125.00 to cover the co-pays. Of course my bourbon intake has been limiter for the next few months. ##### Link to comment ##### Share on other sites "As I see it - health insurance is in reality - a necessity: do you know anyone who could afford health insurance but chooses not to have it?" Yes, me. Sorry, given the OP I forgot to explicitly state I meant in the US. ##### Link to comment ##### Share on other sites This is a bit off subject, but you can use me as a lame link, one way or the other. Since I've been retired (a few years now) and my health care plan has been negotiated at least three different times through my (business) handlers, progressivly national rates have gone up while my coverage has gone down. Late Nov. 2011, I had a mishap when stepping out onto my front porch that caused terrible contusions to both my knees, which I didn't realise until later. By 3AM the following morning the pain was so intense I would have screamed, but I didn't want to wake my neighbors. Couldn't walk, so; called my daughter and waited for the EMT. About fifteen minues later thay took me to the hospital. The trip, 1.2 miles. Total time, less than 20 mins. They take me to the ER and are gone. So, first things first. Do you have insurance Mr.Rigney? With whom? Then the waiting begins. After about 30 Mins. the nurse, clerk or what ever comes back in to tell me that I have been delivered to the wrong hospital. My daughter looks at me out of pure curiosity??? Can you beat that, I'm in the wrong hospital! My God! my family has been associated with this hospital for over forty years. (New health care coverage). The one they should have taken me to is another 22 miles further out. Fortunately for me an un-extended stay in this hospitals ER is acceptable. To shorten up on this tear jerker, I was in the ER for seven hours. During that time my knees were x-rayed, and my left knee was drained of fluid. Eventually I was wheeled to the exit, where my daughter and an attendant helped me into my daughters car. She drives me home, helps me up my 7 back steps and eventually into bed. What a day. EMT trip$550.00, co-pay $75.00. ER stay and treatment$1,530.00, co-pay $50.00. And I'm to feel blessed?. An indigent from off the street would have receiveded the same care for no price at all. I'm blessed only in the fact that I had the$125.00 to cover the co-pays. Of course my bourbon intake has been limiter for the next few months.

So rigney, does this mean you would support an initiative to start a government sponsored risk pool system that would offer substantially lower rates on medical insurance to everybody, a system that would be dedicated to 1) meeting the healthcare needs of all policyholders, 2) reducing administrative costs through sound business measures, and 3) paying on claims to doctors in a normal, timely fashion (net 30-60 days)?

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Well, since we're talking about our personal experiences here ...

I've had health care in three different countries: Canada (as a Canadian); Turkey (we paid out of pocket for pre-natal and delivery); and now the United States. I found the waiting times and level of care in Canada and the U.S. to be about the same. The only two differences I've found have been that a) doctor trips in the U.S. take a lot longer because I have to wait in line to pay my co-pay at the end and b) in Ontario your choice of doctor is limited by who's available whilst in the US your choice of doctor is limited by your insurance company.

Interestingly, I had really good care in Turkey, and it wasn't that expensive. My doctor's office was in the hospital where all the tests were done, he performed the ultrasounds in his office, so it was simple and easy to make decisions. He gave me a flat monthly rate for pre-natal (approx \$70) + tests. Don't get me wrong, it wasn't a fancy birth with a private room or whirlpools, but it was a safe birth and the doctor was great at attending to my emotional needs as well as my physical needs.

In contrast, I find the system in the US to be more bureaucratic and segregated, and less patient-oriented (as it probably is in Canada). Each doctor has their own little niche and I've found it difficult to talk to my main doctor the day tests results are given. For example, I've had an ongoing problem for about 2 weeks in which I pretty much know what's wrong, and I still have to wait until tomorrow to just meet with my doctor to hear what the options are. With my doctor in Turkey, this would have been taken care of by now.

NOTE: I'm not saying that overall, Turkey has a better health care system than the US or Canada. It doesn't. And I know people who've had bad experiences there (mostly doctors pushing c-sections on what could be healthy normal births). I just appreciated the patient-centered care I received, and paying out of pocket there was much less expensive than the insurance premiums I'm paying now.

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(double post)

So rigney, does this mean you would support an initiative to start a government sponsored risk pool system that would offer substantially lower rates on medical insurance to everybody, a system that would be dedicated to 1) meeting the healthcare needs of all policyholders, 2) reducing administrative costs through sound business measures, and 3) paying on claims to doctors in a normal, timely fashion (net 30-60 days)?

that sounds lovely.

Edited by jeskill
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So rigney, does this mean you would support an initiative to start a government sponsored risk pool system that would offer substantially lower rates on medical insurance to everybody, a system that would be dedicated to 1) meeting the healthcare needs of all policyholders, 2) reducing administrative costs through sound business measures, and 3) paying on claims to doctors in a normal, timely fashion (net 30-60 days)?

Not at all! Just saying that, when everyone become indigent; everything sure as hell will be equal. And a risk pool? Isn't that what they use in France, England Italy and Canada?
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Not at all! Just saying that, when everyone become indigent; everything sure as hell will be equal.

Private insurance costs more because businesses need to make a profit. But healthcare insurance is antithetical to normal business models. You pay the business for future needs, holding funds that you'll be counting on when the time comes, but this particular business uses part of those funds to pay people to deny your claims.

You pay for the service but it's in the business' best interests to keep as much of that money as possible. They're supposed to provide healthcare funding, but they're better off if you drop dead. What other business is hoping their long-time customers die quickly? Funeral homes don't count.

And a risk pool? Isn't that what they use in France, England Italy and Canada?

All insurance is a risk pool. Pooling together member monies for individual needs to minimize the risks. Part of the risk is that you may never need it, or will need a smaller amount than others. Insurance is a gamble, but one that many people feel is worth it.

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John,

How not?

They count dead babies. It's not rocket science.

In many or most countries, the state was funding prenatal care for the women. Do you think they "don't notice" the absence of a baby as an outcome?

So you think they include abortions in the infant mortality rating? Why would they include abortions and not still births or micarriages?

How?

Much infant mortality is related to premature birth- and you can't really judge that till it's far too late to consider abortion.

Yes and the US delivers more premature babies than any other country due to higher levels of technology and better care. Do you not think that is a major factor to be contributed to the stats. So it isn't that more babies are dying for lack of care in the US, it's more at risk babies are being brought to term and given a chance to survive.

Also, you might want to look at the numbers.

The US has higher abortion rates than most of the West

http://www.johnstons.../wrjp334pd.html

So their high infant mortality rate looks even worse by your criterion.

Looking at the numbers only strengthened my claim as far as I can see. Even the example I gave (Cuba) was only the fifth one down. You don't think that abortion rate coupled with the amount of care for "at risk" pregnancies can be a reason that the US's numbers look so bad?

I chose those data because they are pretty robust. Diagnostic criteria for "dead" are fairly consistent across the world.

I also chose them because I didn't think anyone would feel the need to question them.

I think you chose them because they were the ones that make the US's medical care seem insufficient. And no, the criteria for "dead" is not the same everywhere. Different countries have different criteria for reporting. Some say that this has no bearing on the statistics, but I don't see how it can't.

Are you saying that fairness etc. is a bad thing?
No I'm saying reports like that shouldn't be used when arguing for a universal healthcare system, especially when the report automatically gives negative remarks for not having one. Seems a little one sided doesn't it?

In respect of this

"Try getting a healthcare system that keeps from getting shot "

I think I already cited this

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I had left out a word in that sentence. I meant to say "Try getting a healthcare system that keeps someone from getting shot", because I felt it was also invalid to use a report as an arguement for a universal system that includes factors that healthcare cannot be judged on. Such as suicides, homicides, accidents, etc... Sure people can survive some of those things, but the study doesn't determine whether they were dead before they even got to the hospital.

"In fact America has played key roles in over 80% of major medical advancements in the past 3 decades. "

You see, you do know how to look after all the people- you just choose not to.

That's an unfounded, disinginous statement if I've ever heard one.

What problems would you add?

Do you understand that the rest of us must have addressed those problems to a degree or we wouldn't have better outcomes?

To a degree? Frances inability to control their healthcare deficit, Along with Italy's monetary problems and insufficient facilities, or Norway's 3month waiting period to even be admitted into a hospital. But the list can go on, but it doesn't matter, they've been adressed to a degree.

Arete,

A third is the crippling effect on an already downtrodden economy of medical bankruptcies. 60% of all personal bankruptcies in the US are due to medical bills. http://articles.cnn....ce?_s=PM:HEALTH

Doesn't it seem funny that this data was taken at a time when unemployment was soaring. Do you think that there might have been different factors involved and that medical bills might have just been the easiest excuse to claim bankruptcy?

iNow,

I couldn't get anywhere with the link you provided. It just said "No results found", could you provide another. But to comment from the quote you have provided, spending is a problem that has resulted from several different factors. I don't see the need for such a broad change to fix a problem that can be dealt with on a lower scale. And any studies that put Cuba's healthcare quality above the US's should be rejected out of hand. It's just rediculous.

When using the data to argue for a universal system it seems that the way the data is collected and the contributing factors for the numbers should matter when you "so haphazardly" draw your conclusions. When someone pulls up infant mortality rates and uses them as an arguement to support a universal system, then I think the contributing factors for those numbers matters greatly. Especially when it can be said that those numbers are greater because we have a better system that allows us to bring at risk pregnancies to term.

Care to inlighten me with some data? Maybe some numbers that aren't just off the cuff? I haven't seen a whole lot of this, so I find it a little hard to believe. You would think that out of the "hundreds of thousands" that this is happening to I would have at least heard about it. I'm surprised Michael Moore didn't mention it.

Yes. Why don't you try and get a hospital bed in Norway these days. I wonder how long you would have to wait?

Oh you got me there...What happens when the government runs out of money to pay the doctors or fund medical research? This is happening all over europe. They are running into huge deficits when it comes to healthcare. What do we do when this happens to our government, and please don't say print more money.

Captain,

That is incorrect. We have programs for those that can't afford it to make it available to them.
There is a thing called Medicaid. If you make less than a certain amount per year, you and your children qualify for medical treatment.

iNow,

Not when your basing that sense on false information and misconcieved perceptions.
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"So you think they include abortions in the infant mortality rating?"

No.

I think that they count dead children. They count them in the US and they count them here too.

And there are more of them (statistically) in the US.

What you seemed to be saying was that they somehow counted wrongly.

Specifically what you said was "Over the past couple of decades high risk, low birth-weight infants have had a growing chance of survival, due to growing medical advancement. Some die not long after birth, which raises our infant mortality rate. But in other western countries, those high risk, low birth-weight infants aren't included like the US's are. "

Now, do you actually have any evidence for that?

"Yes and the US delivers more premature babies than any other country due to higher levels of technology and better care."

No. That's nonsense.

premature babies might be though of as bad luck, or they might be thought of as evidence of poor maternal health care.

If it's luck then the US should have pretty much the same rates as the rest of the world- the foetus doesn't know what country it is in and that it should arrive early or stay put accordingly.

Better health care leads to fewer premature babies- more or less by the definition of "better" and "health".

So obviously my answer to " Do you not think that is a major factor to be contributed to the stats." is no.

And again with your assertion that "So it isn't that more babies are dying for lack of care in the US, it's more at risk babies are being brought to term and given a chance to survive." you have missed the point.

Any baby born prematurely will be counted among the live births. If it soon dies it is counted towards infant mortality.

If the US actually has a higher incidence of premature birth (and I remind you that you have offered no supporting evidence for that suggestion) then it is failing the mothers as well as the children. If more of them die that's because they were already disadvantaged by whatever led to their premature birth.

"Looking at the numbers only strengthened my claim as far as I can see. Even the example I gave (Cuba) was only the fifth one down. You don't think that abortion rate coupled with the amount of care for "at risk" pregnancies can be a reason that the US's numbers look so bad?"

No. Some of the babies will be aborted because they are found to have congenital problems.

But an aborted foetus isn't counted towards the infant mortality rate.

So, if the US were offering , for example, better screening and this was the reason for the higher number of abortions (and I'm willing to bet it isn't) then the infant mortality rate would be lower in the US.

It isn't.

The US has a lot of abortions compared to the rest of the Western world (which is, in itself, not a positive indicator on healthcare)

It has a higher infant mortality rate which also indicated poor healthcare.

"I think you chose them because they were the ones that make the US's medical care seem insufficient. "

I told you why I chose them. Don't call me a liar.

Incidentally, they are fairly widely used as an indicator.

"And no, the criteria for "dead" is not the same everywhere. "

Get a grip.

It's not a big challenge to find out if a baby dies- you can often ask the mother who will generally know.

"No I'm saying reports like that shouldn't be used when arguing for a universal healthcare system, especially when the report automatically gives negative remarks for not having one. Seems a little one sided doesn't it?"

Not to me. It seems quite sensible.

It looks at first glance like begging the question but it's not because the decision to include it was based on the evidence. Countries with universal healthcare are generally healthier (mutatis mutandis).

"I had left out a word in that sentence. I meant to say "Try getting a healthcare system that keeps someone from getting shot", because I felt it was also invalid to use a report as an arguement for a universal system that includes factors that healthcare cannot be judged on. Such as suicides, homicides, accidents, etc... Sure people can survive some of those things, but the study doesn't determine whether they were dead before they even got to the hospital."

I guessed that was what you meant and I answered the question. You can have a healthcare system that significantly reduces the chances of you being shot or murdered. It doesn't involve asking people how much money they have before considering the appropriate medical treatment.

"That's an unfounded, disinginous statement if I've ever heard one."

It is founded on the basis that, as you pointed out the US certainly has the medical knowledge to offer better treatment to many of it's citizens.

Since the US is reasonably democratic, the people have chosen not to.

What problems do you have with the foundation of my statement?

"To a degree? Frances inability to control their healthcare deficit, Along with Italy's monetary problems and insufficient facilities, or Norway's 3month waiting period to even be admitted into a hospital. But the list can go on, but it doesn't matter, they've been adressed to a degree."

It's better than not even addressing them to a degree.

If you think Italy's problems are due to healthcare spending you have not thought it through.

Norway has a relatively large fraction of elderly citizens.

Fig 6 here

http://www.oecd.org/dataoecd/34/49/1864965.pdf

which , together with the fact that it only spends roughly half as much on healthcare (per capita) as the US may explain the waiting lists.

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any studies that put Cuba's healthcare quality above the US's should be rejected out of hand. It's just rediculous.

Why?

When someone pulls up infant mortality rates and uses them as an arguement to support a universal system, then I think the contributing factors for those numbers matters greatly. Especially when it can be said that those numbers are greater because we have a better system that allows us to bring at risk pregnancies to term.

I look at the economics of the question. I look at the morality of the question. I then look at the outcome of the care. We do worse on many measures, and to suggest otherwise means you are not approaching this discussion in good faith. I have no patience for that.

Care to inlighten me with some data? Maybe some numbers that aren't just off the cuff? I haven't seen a whole lot of this, so I find it a little hard to believe.

You've been provided data and chosen to argue instead that it's flawed, even though the experts in the field accept it as valid. Given your concession that you know little and have seen little, I'm inclined not to waste any more time here.

You would think that out of the "hundreds of thousands" that this is happening to I would have at least heard about it. I'm surprised Michael Moore didn't mention it.

Are you suggesting that hundreds of thousands of woman who get pregnant do NOT lack health coverage? There are at least 35 million americans without coverage. It's not much of a stretch to think that a lot of them get pregnant and don't get to doctors... When your base number is 35 million, "a lot" turns out to be several thousand or hundreds of thousands.

Yes. Why don't you try and get a hospital bed in Norway these days. I wonder how long you would have to wait?

Not long. They admit patients immediately like any other ER. Also, given the nature of your argument, how about I refute it at its core? You're saying wait times are lower in the US than in countries with universal care, and you are again wrong (don't you get tired of being wrong and some day hope to change your position so it stops happening?).

http://www.commonwealthfund.org/Maps-and-Data/ChartCart/View-All.aspx?charttopic=Access+++Equity

In 2007, the Commonwealth Fund released a report that compared U.S. health care against several other countries based on a variety of benchmarks. The data were principally derived from statistically random surveys of adult residents and primary care physicians from 2004 to 2006, in the following countries: United States, Canada, New Zealand, United Kingdom, Germany, and the Netherlands. This is what the researchers found:

* Canada had the highest percentage of patients (36%) who had to wait six days or more for an appointment with a doctor, but the United States had the second highest percentage (23%) who reported that they had to wait at least this long. New Zealand, Australia, Germany, and the U.K. all had substantially smaller numbers of people reporting waits of 6 days or longer. Canada and the United States, in that order, also had the lowest percentage of persons who said they could get an appointment with a doctor the same or next day.

* The United States had the largest percentage of persons (61%) who said that getting care on nights, weekends, or holidays, without going to the emergency room, was “very” or “somewhat” difficult. In Canada, it was 54%, and in the U.K, 38%. Germany did the best, with only 22% saying that it was difficult to get after-hours care.

<...>

The take-away message is that both the United States and Canada do pretty poorly, compared to most other industrialized countries, on how long patients have to wait to get a regular appointment with a primary care physician or after-hours care, but the U.S. does better than most on having shorter wait times for diagnostic procedures, elective surgery, and specialty care. Each of these countries, though, with the exception of the United States, has universal health insurance coverage, funded and regulated in large part by the government, so it doesn’t seem likely that government-subsidized health care, in itself, is the sole factor in determining how long patients are stuck in The Waiting Place. Other factors, like the numbers of primary care physicians and specialists in each country, may be more important.

The US has lower wait times for specialist work, but longer wait times for immediate needs. Hmmm... Which would I prefer as a patient? Hmmm...

Edited by iNow
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BTW, I'm particularly amused by this juxtaposition

" any studies that put Cuba's healthcare quality above the US's should be rejected out of hand."

and

" It seems the study started out negative for the US before it actually even began. "

Amusing, but not any use to anyone trying to find out the truth.

I presume he only wants studies that assume the USA is the best in the world and represents good value for money, which explains why he cites the American Enterprise Institute.

Edited by John Cuthber
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Also from my link above in post #18:

You're being so incredibly inarguably wrong would not be so annoying if you weren't so damned proud and indignant about it.

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When I see these numbers, I'm not surprised that the US does so poorly in comparison. But I am p.o-ed that Canada is doing so poorly.

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Don't feel too bad. At least they still cover their ENTIRE population for less cost per citizen than the US... who doesn't cover vast swaths of people and bankrupts quite a number of others (1 out of every 2 bankruptcies in the US are the result of healthcare costs, and of those people bankrupted by healthcare costs, 70% had active coverage through a health insurance provider... and still went bankrupt when they got sick... yay, go us!! U.S.A! U.S.A! U.S.A!).

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It probably isn't fair to blame the US, but ah what the hell. If Canada wasn't so physically close to the US, I bet our health care would be better.

(Why, you ask? Perhaps the brain drain of the 90s, when Canadian doctors were moving to the US? Or perhaps we're always so busy arguing that our healthcare is better, we never bother to fight for better healthcare at home? Perhaps when people talk about fixing Canadian healthcare, we talk about making it more like the US instead of making it more like the UK?)

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Insanely, the current UK government is trying to make the UK health system more like the US one.

If I remember rightly, something like 27 of the 30 members of the cabinet are millionaires and don't need to worry how bad public healthcare is. As such, it seems they are elected unrepresentatives.

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Computer's been down, took me a couple of days to respond.

John,

Now, do you actually have any evidence for that?

Scroll down to "comparing infant mortality ratings" http://english.turkcebilgi.com/Infant+mortality+rate

And this one http://www.prb.org/Articles/2009/prematurebirths.aspx helps to explain why we have a higher preterm birth rate.

Any baby born prematurely will be counted among the live births. If itsoon dies it is counted towards infant mortality.

Again it is more than likely that countries have a different way of reporting classifying what exactly constitutes being alive.

Better health care leads to fewer premature babies- more or less by thedefinition of "better" and "health".

Show me something that can back up that statement. There are theories about causes for preterm percentages going up, but I haven't seen anything definite on the matter.

No. Some of the babies will be aborted because they are found to havecongenital problems.

But an aborted foetus isn't counted towards the infant mortality rate.

So, if the US were offering , for example, better screening and this was thereason for the higher number of abortions (and I'm willing to bet it isn't)then the infant mortality rate would be lower in the US.

It isn't.

My point on this was, that if the US's technology is gaining ground in the area of saving at-risk pregnancies, then countries that are behind in that area will have more abortions due to the fact that the odds of saving the child are lower. Therefoe would have fewer at-risk births lowering their rate, while the US is having MORE at-risk births upping their rate. Does that make sense?Because now when a doctor finds something wrong in a sonogram, they will have a way to fix it rather than automatically thinking of abortion. Where in a less advanced country abortion may be the option thought of first. This can affect that rate.

It has a higher infant mortality rate which also indicated poorhealthcare.

And again you're missing my point.

You can have a healthcare system that significantly reduces the chancesof you being shot or murdered. It doesn't involve asking people how much moneythey have before considering the appropriate medical treatment.

This makes absolutely no sense.

It is founded on the basis that, as you pointed out the US certainly hasthe medical knowledge to offer better treatment to many of it's citizens.

Since the US is reasonably democratic, the people have chosen not to.

How so?

Get a grip.

It's not a big challenge to find out if a baby dies- you can often ask themother who will generally know.

Feeling a little cheeky are we? I think I answered this above.

For an answer to spending percentages and amounts, let me ask a question of my own. What's wrong with this? http://politicalcalc...ate-part-1.html

iNow,

I look at the economics of the question.

speaking of economics, I'll ask you the same question. What's wrong with this? http://politicalcalc...ate-part-1.html

I then look at the outcome of the care. We do worse on many measures, and to suggest otherwise means you are not approaching this discussion in good faith. I have no patience for that.

http://politicalcalc...-in-united.html who's outcome iNow?

You've been provided data and chosen to argue instead that it's flawed, even though the experts in the field accept it as valid. Given your concession that you know little and have seen little, I'm inclined not to waste any more time here.

I'm not saying the datas flawed. I'm saying the arguement based on the datas flawed, and I gave my reasons.

Are you suggesting that hundreds of thousands of woman who get pregnant do NOT lack health coverage?
You're good at pulling up graphs...show me some numbers that support your assertion that "pregnant women lose their babies for lack of healthcare". PLEASE. Just so you can live up to your own standards when I make assertions based on a seeming assumption.

Not long. They admit patients immediately like any other ER. Also, given the nature of your argument, how about I refute it at its core? You're saying wait times are lower in the US than in countries with universal care, and you are again wrong (don't you get tired of being wrong and some day hope to change your position so it stops happening?).

Not really.http://www.newsinenglish.no/2010/09/01/hospital-waiting-lists-keep-growing/

http://www.ncbi.nlm....pubmed/10503101

http://nahealth.blog...ian-system.html

Edited by JustinW

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