Universal Healthcare

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While I'm not overly familiar with either of them I'm not sure how two exceptional hospitals make the case for the entire system though? Are you saying that with universal healthcare these could not exist?

 

WR was not VA. Which is why the guy who resigned in shame was the Army Secretary, not someone from the VA, which is a separate organization.

Sure, the VA developed some serious problems under the Bush Administration; that has more to do with the quality of the administration than anything else. Everything sucked under the Bush administration. The fact that government sucks the way Republicans do it is not evidence that government sucks, full stop. IIRC, the complaints about the actual VA had to do with inadequate outpatient care, not inadequate, like, actual care. Which had to do with their not being enough beds to go around and so on, which had to do with starting two wars and not adequately expanding the organization to cope with the resultant influx of new patients.

America spends substantially more of its GDP on healthcare than any other nation. Our health outcomes are not substantially better than those of the rest of the West.

It's worth pointing out that the system of employer-provided healthcare is itself a distortion of the market, as it resulted from wage freezes during World War II. Companies couldn't compete by offering more pay, so they discovered health benefits. Therefore the notion that continuing the present course is, like, free-market and capitalistic and so on is utter nonsense. The present system exists as an unintended consequence of measures that were taken--successful measures--to better enable this nation to totally pwnz0r j00z Axis n00bz. It's not exactly ideal for, like, peace time. Nor was it ever intended to be.

 

Well, yeah...that was inconvenient verbiage on my part. Many of their patients do qualify for medicaid, though, and the Mayo Clinic accepts government insurance. Like St Judes, they also provide some pro-bono care, but that isn't really the point. Stellar non-profit hospitals like these do not in any way serve as an example of why our for-profit health-care system works. Such clinics and hospitals are the exception, not the rule.

 

These are but two examples of the quality of health care in the US. They are wonderful examples of what health care should be like. I could also mention Harvard, Johns Hopkins, UCLA Medical Center, along with many others -- care facilities where people from all over the world go for specialized care.

The doctors in all of these places make premium salaries (including the non-profits), and the creme of the crop from all over the world work at these medical facilities. That's what having a free market does for medical care. It also drives the cost of care at many of these facilities to beyond what the average person can afford.

 

The Docs at non-profit hospitals may make premium salaries, but with the exception of areas like family practice (family practice docs tend to be underpaid -- often earning the same pay, or even a little more -- in a non-profit), those salaries are still quite a bit lower than what a fee-for-service doctor in the same specialization would make.

 

... but neither are Gov't run.

And as to the 'point', I imagine that depends on who you talk to. The way I see it, the 'point' is a balance between our two concerns: cost and gov't mandating. There are a slew of ways that they could be balanced, but Congress doesn't seem to be considering any of them at the moment. Actually, it kind of looks like they're going to screw us on both at the moment.

 

I agree with you Drew, but Morgoroth asked for examples....

 

...which will remain unchanged by Obama's healthcare reform.

 

In fact, in many cases, they are measurably worse.

 

I don't believe that for a second. Lies, Damned Lies, and Statistics. It is all a matter of what is being looked at and how it is being graded and weighed. Comparing apples to oranges will never give you an accurate result.

 

That's very true. You wonder in a "for profit" system, when we cross the line into vampire capitalism. You can actually be the victim of over-treatment, and it happens all the time, because everybody in the heatlh care food chain wants your money.

 

We spend more than anyone else - but that is the only category where we are ranked #1 in the world. We don't have the longest life span, we don't have the lowest morbidity rate, we don't have the lowest communicable disease rate, we don't have the highest vaccination rate, we don't have the lowest infant mortality rate, we don't have the best cancer survival rate, and I could go on. The WHO released a study ranking the health systems of all 1st world nations, and in 2008 the US ranked 37th - just a shade better than Estonia.

What you chose to believe is your perogative, but I would like to see what you are looking at, what you are grading and how you are weighing it. I'd love to see some apples to apples comparisons that puts the US in the top 5 of any meaningful category, other than cost...

 

I know this also means disease, but I couldn't help but read it as "gruesome, grotesque". Sorry, I just found it amusing....

If the evaluate the quality of health care for the "haves" I'm sure we would find that portion of the US health care system has no equal. But once we start including the people with substandard health insurance (or no health insurance) we find the rankings dropping significantly. While I believe we have the best options money can buy, we have a small percentage of people who can afford those options.

I also don't see that changing significantly with health care reform -- although it will get much better for the 'have nots' they will still be significantly below what the group with top health coverage can get.

 

We have a number of things happening at once that adds to the problem:

Anytime you undergo any medication or medical procedure you are at some degree of risk. But there are a number of things happening at once in the process:

1. Doctors have been trained that they want an almost absolute degree of certainty regarding a patient's condition. While that's a good thing, it can put a patient at risk because the tests themselves can be risky.

2. Doctors, and the health care providers they work for, want to limit their liability. Patients, or their families, can come back later and claim that doctors were not "diligent" enough in their care unless the absolute number of tests and procedures were performed. That's the cost of doing business in a "for profit" environment; just about every business carries some type of liability insurance.

3. Many doctors are now employees of large health care providers (like mine). That means that they have to perform care within the guidelines of their employer. Such as, if a patient complains of X, he/she must undergo A,B, C, and D, as a "provider" requirement, whether or not the doctor feels it is necessary. That ties into #4.

4. Everybody gets paid. If a full battery of tests and procedures are done on a patient, eveyone profits. While this CAN be of benefit to the patient, it sometimes means there is a degree of risk as well, and many providers are more than happy to just take the money (Vampire Capitalism).

As a real life example, a friend of mine, a while back, lost her dad. He was elderly but in good health. And during a regular check-up the doctor recommended a test at a local hospital, "just to be sure." While at the hospital he encountered a rare disease (which was traced back to improper sanitation) and was dead within 3 days. Had he never gone for the test, he would more than likely still be alive. In some ways you have to take a degree of responsibility for your own care. Because you are in the "for profit" health care system, it means you have to be a smart consumer as well as a patient.

 

I would tend to agree - but I think if the study included only the health care that the wealthies of people could receive, it would not be particularly informative, as by definition most people do not have access to the best money can buy.

What would be informative is if a study were conducted exclusively on the basis of haves and have nots. I haven't seen such a study, but I wonder how different the statistics would be if we compared the US to other countries but excluded the 47 million or so uninsured Americans from the equation. Obviously, when you're ranking a country in any type of list, you cannot cherry pick the data, but seeing how people with health insurance compare to other industrialized nations would be informative.

 

As a quick example, This is taken from wikipedia, while not completely authoritive it shows the differences in the way infant mortality rates are calculated. If I were to have a child that was born premature, I can't think of another country's care I would prefer.

Spoiler

The infant mortality rate correlates very strongly with and is among the best predictors of state failure.[3] IMR is also a useful indicator of a country's level of health or development, and is a component of the physical quality of life index. Some claim that the method of calculating IMR may vary between countries based on the way they define a live birth. The World Health Organization (WHO) defines a live birth as any born human being who demonstrates independent signs of life, including breathing, voluntary muscle movement, or heartbeat.

UNICEF uses a statistical methodology to account for reporting differences among countries. "UNICEF compiles infant mortality country estimates derived from all sources and methods of estimation obtained either from standard reports, direct estimation from micro data sets, or from UNICEF’s yearly exercise. In order to sort out differences between estimates produced from different sources, with different methods, UNICEF developed, in coordination with WHO, the WB and UNSD, an estimation methodology that minimizes the errors embodied in each estimate and harmonize trends along time. Since the estimates are not necessarily the exact values used as input for the model, they are often not recognized as the official IMR estimates used at the country level. However, as mentioned before, these estimates minimize errors and maximize the consistency of trends along time."[4]

While the United States reports every case of infant mortality, it has been suggested that some other developed countries do not. A 2006 article in U.S. News & World Report claims that "First, it's shaky ground to compare U.S. infant mortality with reports from other countries. The United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths. In Austria and Germany, fetal weight must be at least 500 grams (1 pound) to count as a live birth; in other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless.[5] And some countries don't reliably register babies who die within the first 24 hours of birth. Thus, the United States is sure to report higher infant mortality rates. For this very reason, the Organization for Economic Cooperation and Development, which collects the European numbers, warns of head-to-head comparisons by country."[6] However, all of the countries named adopted the WHO definition in the late 1980s or early 1990s.[7]

Historically, until the 1990s Russia and other countries of the former Soviet Union did not count as a live birth or as an infant death extremely premature infants (less than 1,000 g, less than 28 weeks gestational age, or less than 35 cm in length) that were born alive (breathed, had a heartbeat, or exhibited voluntary muscle movement) but failed to survive for at least 7 days.[8] Although such extremely premature infants typically accounted for only about 0.005 of all live-born children, their exclusion from both the numerator and the denominator in the reported IMR led to an estimated 22%-25% lower reported IMR.[9] In some cases, too, perhaps because hospitals or regional health departments were held accountable for lowering the IMR in their catchment area, infant deaths that occurred in the 12th month were "transferred" statistically to the 13th month (i.e., the second year of life), and thus no longer classified as an infant death.[10]

Another challenge to comparability is the practice of counting frail or premature infants who die before the normal due date as miscarriages (spontaneous abortions) or those who die during or immediately after childbirth as stillborn. Therefore, the quality of a country's documentation of perinatal mortality can matter greatly to the accuracy of its infant mortality statistics. This point is reinforced by the demographer Ansley Coale, who finds dubiously high ratios of reported stillbirths to infant deaths in Hong Kong and Japan in the first 24 hours after birth, a pattern that is consistent with the high recorded sex ratios at birth in those countries and suggests not only that many female infants who die in the first 24 hours are misreported as stillbirths rather than infant deaths but also that those countries do not follow WHO recommendations for the reporting of live births and infant deaths.[11]

Another seemingly paradoxical finding is that when countries with poor medical services introduce new medical centers and services, instead of declining the reported IMRs often increase for a time. The main cause of this is that improvement in access to medical care is often accompanied by improvement in the registration of births and deaths. Deaths that might have occurred in a remote or rural area and not been reported to the government might now be reported by the new medical personnel or facilities. Thus, even if the new health services reduce the actual IMR, the reported IMR may increase.

 

I do not know if there is any difference in care, though - that would depend on the overall quality of the hospital, the training of the staff, availability of resources, etc. To the best of my knowledge there are few (if any) cases where a prematurely born child is denied help because it would not count as a live birth. As a parent, how your child is reported statistically matters little.

 

TGS - An interesting read. However, I thought the point of the WHO guidelines was to, as the article states, "use an estimation methodology that minimizes the errors embodied in each estimate and harmonize trends along time. Since the estimates are not necessarily the exact values used as input for the model, they are often not recognized as the official IMR estimates used at the country level. However, as mentioned before, these estimates minimize errors and maximize the consistency of trends along time."

If that's what they are doing, shouldn't part of that standardization be factoring in different counting methods by different countries? For example, the article states that many European countries consider extremely premature infants (weigh less than one pound, are less than 12 inches long, and have less than 26 weeks of gestation) who die within the first 24 hours after birth to be lifeless, while the US defines them as live births. The article goes on to state that even though such births are small in number, by not counting those births, you can reduce your IMR by 25%. If WHO knows this, and even can quantify it, then why isn't it part of their standardization process?

Let's do the work for them. Let's run the numbers for something closer to an "apples to apples" comparison. You see, if the US IMR was 25% higher than other nations, we could explain it by this difference. We count more infants as live births, so of course we are going to have a higher IMR. The US IMR in 2008 was 6.26. However, different counting methods employed can account for a 25% reduction in IMR, if we apply that to the US, the IMR would now be reported as 4.69. That would rise our ranking from 46th in the world, all the way up to 27th in the world*. That's a big improvement, but I'd still expect better than 27th given how much we spend. I'd like to see us in the top 10.

* According to the CIA Factbook which was linked to the wiki page you posted

 

I haven't had a chance to read this entire article yet, but it looks interesting. It is an analysis of how the WHO rankings are determined and if it is accurate then it makes sense that the U.S. would rank poorly as our system isn't set up that way.

Link

 

The wiki article however also mentiones this:

If this is true won't that make comparisons between these countries accurate?