Its clearly the right time to slash the social safety net

[DanS]

the spending on Medicare (arguably the largest percentage of "socialized" expediture in the U.S.)

Medicare spending is about the same as Medicaid spending, if you add in state expenditures for Medicaid. Also must include veteran's affairs health spending and CHIP in the socialized portion. All told, socialized medicine (very socialized medicine) accounts for about half of the US system.

[PLATO]

Medicare spending is about the same as Medicaid spending, if you add in state expenditures for Medicaid. Also must include veteran's affairs health spending and CHIP in the socialized portion. All told, socialized medicine (very socialized medicine) accounts for about half of the US system.

I couldn't find any data on Veteran's health care, but the info I provided was for "Medicare and Medicaid". Sorry for the omission on that. However, if we look at the 2005 data (which is kind of the base line I am using as that is the last year I have found WHO comparative data for), it appears that Medicare/Medicaid is about 4% of GDP. The 2005 expediture for health care was 15.2% of GDP. That would put Veteran's spending at about 3.5-3.6% of GDP. That sounds a bit high to me. Are these the figures that you are using or are you categorizing all socialized non-medicare/medicaid spending into the 3.5-3,6% range?

[kentonio]

I assume that you are referring to the 11 year old data that WHO provided? Included in the components of this data are items such as the health of the people. With Americans leading the unhealthy lifestyles they do, then it is no suprise that they ranked 72 in that category. However, if you will take the time to peek at it, the U.S. ranked #1 in the responsiveness of its health care system. The 37th ranking has a bit more to it than you read into it.

No, the OECD released a load of data this November. I can't find a handy ranking system for overall quality, but theres tons of specific data.

http://www.oecd.org/document/11/0,37...407,00.html#B3

Check out the pdf called 'Chart set for Health at a Glance 2011 (PowerPoint)'. It shows the US at 27th in life expectancy for one thing.

Basically dude there isn't a way to view the US quality of care and coverage as anything other than substandard for a first world nation. That's not a dig at America, you guys deserve better and should get better, but it isn't going to happen until you accept you're being ripped off and do something about it.

[PLATO]

Thanks kentonio! That is some amazing data. I don't think that the life expectancy is as far off as the ranking alone would indicate. The U.S. is at 78.2 years versus 79.5 years for OECD average.

In addition, the data sheds some significant light on why costs in the U.S. are high and some of the specific results. Hospital spending and administrative costs are the two line items that seem significantly higher than OECD averages. Easily, these could be attributable to higher regulation and litigation costs for the administrative costs, and the significant gap in diagnostic equipment available in the U.S. versus the OECD average. Further, the number of Doctors per capita in the U.S. is significantly lower than the average for OECD countries. This would seem to indicate eithier a higher standard to become a Doctor or a higher cost of being a Doctor (once again...litigation?). The U.S. seems to be doing marvelously well in Cancer survival rates. The U.S. seems to be much more responsive in admissions to hospitals for things like asthma and COPD (although the study points out that many of these admissions could be handled on an out patient basis as is more common in OECD countries). The U.S. seems to be a leader in quality of life surgeries (such as knee replacements).

Far from being ripped off, I think the data you have provided shows that the U.S. system works wonderfully well, but is subject to some unique costs that other OECD countries do not have.

The data seems to confirm that the U.S. model of non-socialized medicine is the way to go, but that there needs to be some adjustments made on the cost side (i.e. tort reform) to bring costs down.

I am really not sure why you looked at the same data that I did and come to the conclusion that the care was substandard, but I can certainly agree that some work could be done of the cost side.

[kentonio]

Just look at the section headed 'Access to Care' for the answer to that. America has always had wonderful provision for those able to afford it, but you have an unforgivable number of people without healthcare access, which is what Obamacare is intended to try and fix. You also pay far too much for what you get due to your lack of single payer, and even if you have insurance you risk the insurance companies trying to find ways to screw you out of coverage by any means they can find. It's also a far, far more complex payment system for the patient.

Basically I don't understand why you would think non-socialized medicine is in any way desirable, you pay more, you have millions with no coverage and unless you are wealthy you recieve a generally poorer coverage than you would in the socialized countries. What exactly is so great about the for profit system unless you are an insurance company shareholder?

[kentonio]

I mean really dude, 39% of below income people '1. Either did not visit doctor with medical problem, did not get recommended care or did not fill/skipped prescription.'? That's crazy.

[Imran Siddiqui]

Btw, Tort Reform only consists of 1% of insurance costs from all studies I've seen, IIRC.

The massive admin costs is because each hospital and insurance company has to have a duplication of administration that wouldn't necessarily be the case in a socialized system.

And US Access to Care is abysmal.

[OneFootInTheGrave]

Since I have time, here is a short summary

There are 34 members of OECD, the bottom 10 being countries such as
Turkey
Chile
Czech Republic
Estonia
Greece
Hungary
Mexico
Poland
Portugal
Slovakia

Not exactly world class right? Not to mention that the bottom is spending on average less than half the % of GDP comparing to the US, and given that they are well below US per capita earning, it turns out that US is spending more than 4x per capita comparing to that list, for very bottom of the list Mexico and Turkey factor is 8x less for spend per capita.

Such countries bring OECD average down in principle so the OECD average itself is not that "great" as it might sound at first sight, especially if you are the highest spender on that list by far. It is not an average of developed nationalized health care systems.

So what does US get for such a high spend in that short summary?

Below OECD average:
*Life expectancy below OECD average
*Infant mortality below OECD average
*Second highest rate of diabetes (no prevention policies?) of all on the list
*Second worst for asthma admittance?!?
*Bottom half for OECD in number of physicians per capita
*You do most cervical cancer screening per capita but have survival rates in the bottom of the list for OECD?!? (that is well... suprising)_survival rate which infact decreased!!! comparing to the period from 1997-2002 in US itself.
*Average for acute care
*Fourth worst for health care coverage in OECD, only Turkey, Mexico and Chile are worse with Mexico and Chile not having a nationalized healthcare system either.
*Highest "unmet need" due to cost - which I guess is not surprising
*Health coverage most swayed towards high income earners - again as expected


Above OECD average:
*Waiting times for elective surgery, while better from some "not sorted" Socialized Medicine systems; They are in line with some more organized ones like Switzerland and France, or even worse than the best in that regard like Netherlands or Germany
*Top half for diabetes control for the population (and there just middle of that top pack, there are quite a few others who spend a lot less yet have better control)
*You are top for breast cancer survival rates, and even there you haven't actually improved over the last 10 years much, while the others were playing catch up with you to start with (I guess there are some good historical policies in US with regards to this type of cancer), and have for most more developed natinalized systems pretty much caught up (2-3% points gap compared to about 10% gap 10 years ago).

Reading this Plato got to the statement:

The data seems to confirm that the U.S. model of non-socialized medicine is the way to go, but that there needs to be some adjustments made on the cost side (i.e. tort reform) to bring costs down.

To me it reads more like: The results should be taken with consideration for the fact that the US outspends everyone else, thus they should expect better results in return. Clearly that is not the case, they are at best average in that diverse group which means that in comparison to the developed nationalized health care systems they are almost always significantly worse for outcome, while at the same time being much more expensive. US citizens should ask themselves "why", would only tort reform bring you back from underperforming so badly? Higly doubtful that the issues with the US system are so simple.

[Dr Strangelove]

And US Access to Care is abysmal.

Fer sure, and if anyone posting on this forum would know by personal experience it would be me. I recently got a lady sent to me by the ER after treatment for an STD. Inexplicably there had been no testing for HIV, probably because the test is expensive, she had no insurance and the company which owns the ER also owns the local lab so they didn't want to eat the cost. Her Western Blot lit up the sky, her CD 4 count was 7. That's right, 7. She had been in the ER several times over the past few months, and of course she's probably been HIV positive for many years. My problem with this? She had an STD, in standard practice that warrants an HIV test.
I had a guy dragged into my office by his family. He had had neck pains for about 6 months, hadn't walked for 2 months, but he hadn't been able to find a doctor. He had a ruptured disc in his neck impinging on his cervical spinal cord. When he called around trying to find someone to help he he got nada.
I've got more, lots more.

[Tupac Shakur]

kentardio

I like this and hope it sticks.

[kentonio]

Do you and HC ever fall out over who's turn it is? I mean KH only has one **** presumably, so you can't both be sucking it at the same time. This must cause issues sometimes.

[regexcellent]

My recollection is that the US has higher life expectancy when only natural causes are taken into account. The United States also has significantly higher cancer survival than anywhere in Europe, or anywhere in the world for that matter.

Quick google turns up this debunking of the "US has lower life expectancy" schtick:

http://www.commentarymagazine.com/article/the-worst-study-ever/

tl;dr http://www.commentarymagazine.com/wp...Expectancy.png

As for the cancer survival, here's a source:

http://www.medscape.com/viewarticle/561737

By the way, by "health care coverage" I hope you're not counting all uninsured people as being uncovered.

EDIT: It seems when following the medscape link there's a paysite block; it didn't do that from google so here's a copy of what was in the article:

Spoiler:

August 22, 2007 — New reports from EUROCARE suggest that cancer care in Europe is improving and that the gaps between countries are narrowing. However, comparisons with US statistics suggest that cancer survival in Europe is still lagging behind the United States. The reports are published online August 21 in Lancet Oncology and scheduled for the September issue .

One of the main messages from both reports is that in Europe, "for most cancers, survival has increased and between-country survival differences have decreased over time," notes an accompanying commentary by Mike Richards, CBE, from the United Kingdom's Department of Health. However, the differences between countries are not trivial, and "many more lives could be saved if the outcomes of all countries were brought up to the standards of the best" (ie, Norway, Sweden, and Finland), he comments. The United Kingdom in particular comes out badly in the tables, showing cancer survival rates that are among the worst in Europe. The findings suggest that the national cancer plan for England, which began in 2000, is not working, a second editorial comments.
Survival Rates Significantly Higher in United States Than in Europe
One of the reports compares the statistics from Europe with those from the United States and shows that for most solid tumors, survival rates were significantly higher in US patients than in European patients. This analysis, headed by Arduino Verdecchia, PhD, from the National Center for Epidemiology, Health Surveillance, and Promotion, in Rome, Italy, was based on the most recent data available. It involved about 6.7 million patients from 21 countries, who were diagnosed with cancer between 2000 and 2002.
The age-adjusted 5-year survival rates for all cancers combined was 47.3% for men and 55.8% for women, which is significantly lower than the estimates of 66.3% for men and 62.9% for women from the US Surveillance, Epidemiology, and End Results (SEER) program ( P < .001).
Survival was significantly higher in the United States for all solid tumors, except testicular, stomach, and soft-tissue cancer, the authors report. The greatest differences were seen in the major cancer sites: colon and rectum (56.2% in Europe vs 65.5% in the United States), breast (79.0% vs 90.1%), and prostate cancer (77.5% vs 99.3%), and this "probably represents differences in the timeliness of diagnosis," they comment. That in turn stems from the more intensive screening for cancer carried out in the United States, where a reported 70% of women aged 50 to 70 years have undergone a mammogram in the past 2 years, one-third of people have had sigmoidoscopy or colonoscopy in the past 5 years, and more than 80% of men aged 65 years or more have had a prostate-specific antigen (PSA) test. In fact, it is this PSA testing that probably accounts for the very high survival from prostate cancer seen in the United States, the authors comment.
Further analysis of these figures shows that, in the case of men, more than half of the difference in survival between Europe and United States can be attributed to prostate cancer. When prostate cancer is excluded, the survival rates decreased to 38.1% in Europe and 46.9% in the United States. For women, the survival rate of 62.9% for all cancers in the United States is comparable to that seen in the wealthiest European countries (eg, 61.7% in Sweden, 59.7% in Europe), and the slightly higher survival in the United States was largely due to better survival for colorectal and breast cancer, the authors comment.
The differences in survival are due to a variety of reasons, Dr. Verdecchia and colleagues write. They include factors related to cancer services — for example, organization, training, and skills of healthcare professionals; application of evidence-based guidelines; and investment in diagnostic and treatment facilities — as well as clinical factors, such as tumor stage and biology.
For hematological malignancies, except for non-Hodgkin's lymphoma, the survival rates in Europe and the United States were comparable. The authors suggest that the reason may be that "these malignancies are usually referred to specialist centers for treatment, in accordance with evidence-based guidelines, and they are frequently included in international clinical trials."
Wide Variations Across Europe Are Narrowing
Dr. Verdecchia and colleagues comment that their analysis of the most recent cancer survival data available in Europe suggests that the wide variations across countries, which have persisted for many years, "might be on the verge of decreasing."
The authors of the other report, which considered earlier data, from 1995–1999 (the EUROCARE-4 study), are more positive in their conclusions. Franco Berrino, MD, from the Fondazione Istituto Nazionale dei Tumori, in Milan, Italy, and colleagues say their findings show that "the gap in cancer survival in Europe is narrowing . . . and suggests substantial improvement in cancer care in countries with poor survival."
Nevertheless, both reports show that survival is worst in Eastern Europe and best in Western and Northern countries. Dr. Berrino et al comment that a consistent finding of all of the EUROCARE studies is that between-country survival differences are small for relatively uncommon treatable cancers, such as testicular cancer and Hodgkin's disease, and also for cancers with a very poor prognosis. By contrast, for cancers with an intermediate prognosis — for which early diagnosis is typically an important determinant of outcome — the survival rates "still differ markedly, and probably unacceptably, between countries in Europe."
"Understanding the reasons for these persistent (but diminishing) differences is important for the public health response to cancer in Europe," Dr. Berrino and colleagues write. The EUROCARE approach to disentangling these possible determinants of survival includes high-resolution studies, which use information accessed from clinical records. So far, these studies suggest that most of the survival differences for breast and colorectal cancer are attributable to differences in disease stage at diagnosis, while survival differences for testicular cancers seem to be due mostly to differences in access to appropriate treatment.

Lancet Oncol. Published online August 21, 2007

[Kidlicious]

Fer sure, and if anyone posting on this forum would know by personal experience it would be me. I recently got a lady sent to me by the ER after treatment for an STD. Inexplicably there had been no testing for HIV, probably because the test is expensive, she had no insurance and the company which owns the ER also owns the local lab so they didn't want to eat the cost. Her Western Blot lit up the sky, her CD 4 count was 7. That's right, 7. She had been in the ER several times over the past few months, and of course she's probably been HIV positive for many years. My problem with this? She had an STD, in standard practice that warrants an HIV test.
I had a guy dragged into my office by his family. He had had neck pains for about 6 months, hadn't walked for 2 months, but he hadn't been able to find a doctor. He had a ruptured disc in his neck impinging on his cervical spinal cord. When he called around trying to find someone to help he he got nada.
I've got more, lots more.

I don't know how you deal with all that, but thank you.

[Kidlicious]

If you go back to the early 1990-1996 when the welfare reform act was debated and finally passed, the thinking of people that won the day was exactly the two concepts you disagreed with above.

That's besides the point. The fact that you choose to ignore is that there aren't jobs for everyone on welfare. In fact welfare reform proves this.

[Kidlicious]

But what was learned was that offering unlimited money did encourage some to not seek employment.
So there was value.

And to answer Kentonio. Full unemployment benefits offer something like 1600 a month. So it's worth more than if all you can find is a minimum type wage job. Or if the difference is only a few dollars an hour, why work 40 hours when you can lay around the house. Back before welfare reform the benefits were less than 1600 a month, and it discouraged those on it to find employment.

This is something you don't get. When someone loses their job they still have bills. If those bills don't get paid it hurts YOU. Someone who was getting paid 100k a year can't pay their bills with a minimum wage job.