New at Reason

David Weigel | May 26, 2006

Ronald Bailey asks whether people are really healthier in the land of bangers and mash.

Comments

taktix|5.26.06 @ 8:50AM|#

Notice the study said nothing about the life expectancy of British teeth v. US teeth.

Coincidence? I think not...

Dave W.|5.26.06 @ 9:00AM|#

I wonder how much shorter US lifespans would be if the US did not spend twice as much on healthcare. You really gotta wonder whether the additional margin the USians spend beyond the Brits is pure waste. I think JMJ has a theory about this.

Dave W.|5.26.06 @ 9:01AM|#

O and I think they changed the nickname to land of 2-footed cane sugar people.

|5.26.06 @ 9:13AM|#

What a relief once again to be rescued from the terrifying prospect of considering the slighest hint that some flaw in our free-market system might spoil an otherwise perfect picture. Thank you Ron Bailey!

|5.26.06 @ 9:33AM|#

I think what made the study (this came out a little while ago) interesting is the fact that the Brits tend to drink more than us and have a diet that is, well, er... rather aweful. The mild climate probably helps. The lack of stress, compared with the dog-eat-dog libertarian lifestyles we anything but enjoy here, certainly helps. It certainly proves beyond the shadow of a doubt that there universal healthcare system, which costs far less per capita than ours, is infinitely better than what we have. Anyone who doesn't get that is stupid. Perhaps that's the difference - we're just stupider. Also, they drive less and have less violent crime - that keeps the ol' Reaper away. They are better educated - that might help a little. There culture is a little less raucus in general - which is nice. I suppose there are lots of reasons why they're a little healthier than us. The main point here, though, is that they pay much less for the priviledge than we do here. The Brits aren't so stupid and selfish as to profiteer off their own healthcare.

JMJ

|5.26.06 @ 9:36AM|#

Holy shit that was funny.

|5.26.06 @ 9:38AM|#

So Chef, are you going to intentionally miss the point that though they are as healthy if not healthier than us and pay much less for it that proves the need for universal healthcare here, or are you just suffering cognitive dissonance.

JMJ

Dave W.|5.26.06 @ 9:51AM|#

Yanks are sicker than Brits despite the fact that, on average, Americans spend more than twice as much as the British do for health care.

It is also worth noting that we are bandying about this twice-as-much figure, which is horrifying enuf as it is (I remember how horrified I was when I found out this dirty capitalist secret in 2003).

But the point is that this studied compared the health of USians with good coverage to the Brits. I wonder what factor this demographic slice outspent the Brits by? 3? 4? more?

|5.26.06 @ 9:54AM|#

I tend to agree with most of the comments above.

It would be nice if researchers further pursued these findings: "The study also looked at the results of various routine medical tests and found that Americans had higher levels of glycosylated hemoglobin (a measure for diabetes); lower levels of heart protective good cholesterol; and high levels of heart harming C-reactive protein." This isn't a result of more testing, it's genes or environment, or some combination of the two.

|5.26.06 @ 9:54AM|#

Jesus, Jersey, you wandered into the wrong temple. Saying the stuff you're saying is like taking a pee in the middle of a High Mass. What do you think this is, some sort of debating club? Tua culpa, tua culpa, tua culpa. Now pipe down so I can hear the sacred chanting and the organ music.

R C Dean|5.26.06 @ 9:54AM|#

An outsize proportion of our healthcare spending happens during the last year of people's lives, so we do spend a lot on care that doesn't really impact on life expectancy.

But of course, that's the way people want it. I look forward to JMJ telling the docs to pull the plug on his mother because he thinks that, even though she's not that bad today, this could be the beginning of her terminal descent, and he doesn't want to waste the money, thanks.

The other thing that mucks up both infant mortality and life expectancy rates in the US is the fact that our neonatal intensive care is far beyond anyone else's, so births that would be stillbirths in other countries (and so not affect the stats) are live births in this country, even though a fair number of them don't make it.

MP|5.26.06 @ 10:11AM|#

Jersey and I apparently have something in common, with the shared perspective that everybody is stupid, except me, of course.

|5.26.06 @ 10:12AM|#

RCD,

We have higher infant mortality than almost any first world nation. Also, the Brits and the rest of the first world prolong end of life just as much as we do.

Nice try.

Perhaps you should try putting the rationalizing BEFORE the answer...

JMJ

dhex|5.26.06 @ 10:12AM|#

"compared with the dog-eat-dog libertarian lifestyles we anything but enjoy here"

jersey...i wish i could quit you.

|5.26.06 @ 10:16AM|#

JMJ;

It certainly proves beyond the shadow of a doubt that there universal healthcare system, which costs far less per capita than ours, is infinitely better than what we have.

That's a reach to say the least. I seriously doubt that an indepth analysis of multiple studies would confirm your contention.

Anyone who doesn't get that is stupid. Perhaps that's the difference - we're just stupider.

Speak for yourself.

There culture is a little less raucus in general - which is nice.

They just occasionally beat each other to death over "football".

So how much time have you actually spent in England in particular, or Europe in general? I wouldn't trade our system for theirs under any conditions.

Carrick

|5.26.06 @ 10:21AM|#

isnt that what RCD was saying that we have more live birth's that don't make it a year so theres a higher IMR because its per 1000 live births, or am i missing something

|5.26.06 @ 10:26AM|#

Well, Carrick, working for many years in international trade, I know many Brits, very well. You're just being stupider - better check your glucose! ;)

JMJ

|5.26.06 @ 10:28AM|#

Also, they drive less and have less violent crime...

Actually Jersey the violent crime rate in GB is higher than that of the US.

You're thinking perhaps of homicides, which are only a part of overall violent crime.

Carrick, Jersey is one of those people who likes to spout off a lot about other countries without the benefit of actual facts about them.

And Bob is just an asshole who needs to read the fucking article.

|5.26.06 @ 10:33AM|#

Just speculating on why US infant mortality may be worse;

1) abortion is more permissive in some European nations. If we believe that babies with significant health problems are more likely to be aborted that would lead to fewer sicker babies that might pass away early in life.

2) America has a more permissive immigration policy. In addition to bringing economic prosperity, immigrants from poor nations have had worse health care and import some of those health issues. My parents, for example, immigrated from post-war Korea and had exposure to some very nasty chemicals and diseases early in life. These issues may result in sicker children and a potentially higher level of infant mortality.

|5.26.06 @ 10:33AM|#

Actually, I think R C is right on the money. The amount of cash spent on the last weeks for my grandmothers was insane. And they were doomed, anyway (for different reasons). I think we tend to pour a lot more money into lost causes than other cultures do. Which has implications at either extreme of the aging process. Not to mention, our greater wealth means more things like breast implants.

Virtually everyone I've known who lives under socialized healthcare (well, more socialized than us, anyway) has had serious complaints about it. Not that they necessarily concede that our way is better, but they think their way really sucks. The fact is, really advanced medicine costs a lot. Getting people to practice medicine who are any good at it also costs a lot. If you choose not to pay those costs, then the quality simply must go down.

In any event, the U.S. is 50% socialized right now, I'm sure. So calling our healthcare system a "free market system" is silly and avoids seeing the damage that the government has helped to do. We're already partially living in the wonderful world of socialized healthcare, which means we're getting the worst of both systems.

|5.26.06 @ 10:34AM|#

Well, Carrick, working for many years in international trade, I know many Brits, very well.

JMJ

But you didn't answer the question. Have you actually set foot in Europe?

Carrick

|5.26.06 @ 10:37AM|#

Well, Carrick, working for many years in international trade, I know many Brits, very well.

JMJ

But you didn't answer the question. Have you actually set foot in Europe?

Carrick

|5.26.06 @ 10:39AM|#

I don't how it compares with England but I've seen estimates that as much as 40% of our medical expenses are on people in their last year of life.

|5.26.06 @ 10:41AM|#

Well, Carrick, working for many years in international trade, I know many Brits, very well. You're just being stupider - better check your glucose! ;)

JMJ

|5.26.06 @ 10:48AM|#

I've read (sorry, I can't remember where) that the reason for the (slightly) higher life expectancy in the UK is that they have fewer minorities. Since minorities typically have a lower life expectancy (based largely on poverty), they bring the US average down. Since the US receives more immigrants than all other nations combined, and most of those immigrants are from poor countries, it's no big surprise that we will continue to have a lower life expectancy. This isn't because our system is worse, but because our system is more compassionate.

Garth|5.26.06 @ 10:48AM|#

It seems clear to me that the reasons brits have a leg up are:

1) they walk more/drive less, they garden or otherwise get some modicum of physical activity. In general brits of the generation in question move about quite a bit more than their american peers.

2) While the study did control for bmi/weight to compare pairs to pairs, my understanding is that the american diet is a) higher in calories; b) more processed; c) and has a much higher component of processed corn that the british do. They eat their cane sugars and we eat high fructose corn syrup.

3) Stress. We have more, the brits have less.

|5.26.06 @ 10:51AM|#

JMJ,
Learn the difference between "there" and "their".

|5.26.06 @ 10:54AM|#

I think what made the study (this came out a little while ago) interesting is the fact that the Brits tend to drink more than us and have a diet that is, well, er... rather aweful. The mild climate probably helps. The lack of stress, compared with the dog-eat-dog libertarian lifestyles we anything but enjoy here, certainly helps. It certainly proves beyond the shadow of a doubt that there universal healthcare system, which costs far less per capita than ours, is infinitely better than what we have. Anyone who doesn't get that is stupid. Perhaps that's the difference - we're just stupider. Also, they drive less and have less violent crime - that keeps the ol' Reaper away. They are better educated - that might help a little

Holy crap JMJ...you have clearly NEVER been to the UK.

|5.26.06 @ 10:58AM|#

Al this talk about human health is fine, but it's obvious the real health crisis is with the reason server squirrels.

We must find a cure now. Or at least identify the disease. :)

R C Dean|5.26.06 @ 10:59AM|#

It certainly proves beyond the shadow of a doubt that there universal healthcare system, which costs far less per capita than ours, is infinitely better than what we have.

I find it interesting that the very wealthy travel to the US for treatment far more than they travel anywhere else. That would tend to indicate to me that the quality of the healthcare in the US is better than anywhere else - the people who can get care literally anywhere come to the US.

The only reason anyone travels to a universal healthcare state for care is because (a) they want to mooch off the welfare state or (b) there is a treatment there not approved in the US. Not because the quality of care is better in state-run healthcare systems.

We have higher infant mortality than almost any first world nation.

Way to totally miss the point of why this statistic is what it is - not because out neonatal intensive care is worse than anyone else's (an assertion that will draw howls of laughter from any professional in the field), but because it is better, and so the risk profile that makes it into our statistical pool is so much worse.

Also, the Brits and the rest of the first world prolong end of life just as much as we do.

First, this is factually wrong. Universal health care rations care by enforcing waiting lists, which automatically filter out a lot of end of life cases even when they don't do so explicitly by assigning end-of-life care a lower "futility" priority.

Second, it misses the point that high end-of-life care costs, which people want, nay, insist on, do not translate into longer life expectancy. The attempt to marry total expenditure stats to life expectancy stats is fundamentally flawed for this reason alone.

|5.26.06 @ 10:59AM|#

Threadjacking, I admit, but perhaps Brits enjoy such good health because of their salubrious culture?

|5.26.06 @ 11:00AM|#

Guys,

OK, firstly the UK sucks. So none of this romantic overseas guff. We have just as many dipshits, rapists, terrorists and sex pests as you guys. Plus, yes, our teeth are far, far worse.

However, we are nowhere near as fat as you pudgy yankoids. We're getting there, but we have a couple of generations before we start topping the scales like you guys. Then I reckon the stats should be about the same. Of course, you lot will probably be fatter by that point so you still might have your noses out in front.

R C Dean|5.26.06 @ 11:00AM|#

It certainly proves beyond the shadow of a doubt that there universal healthcare system, which costs far less per capita than ours, is infinitely better than what we have.

I find it interesting that the very wealthy travel to the US for treatment far more than they travel anywhere else. That would tend to indicate to me that the quality of the healthcare in the US is better than anywhere else - the people who can get care literally anywhere come to the US.

The only reason anyone travels to a universal healthcare state for care is because (a) they want to mooch off the welfare state or (b) there is a treatment there not approved in the US. Not because the quality of care is better in state-run healthcare systems.

We have higher infant mortality than almost any first world nation.

Way to totally miss the point of why this statistic is what it is - not because our neonatal intensive care is worse than anyone else's (an assertion that will draw howls of laughter from any professional in the field), but because it is better, and so the risk profile that makes it into our statistical pool is so much worse.

Also, the Brits and the rest of the first world prolong end of life just as much as we do.

First, this is factually wrong. Universal health care rations care by enforcing waiting lists, which automatically filter out a lot of end of life cases even when they don't do so explicitly by assigning end-of-life care a lower "futility" priority.

Second, it misses the point that high end-of-life care costs, which people want, nay, insist on, do not translate into longer life expectancy. The attempt to marry total expenditure stats to life expectancy stats is fundamentally flawed for this reason alone.

Garth|5.26.06 @ 11:06AM|#

Many of you should read the study. It compares similarly aged white people of similar weight. Please don't try to say the stats say what they say bcse the US has more minorities or are fatter. This is compating Homer and Marge Simpson in the Midwest to Homer and Marge Simpson of the Midlands

"Design, Setting, and Participants We analyzed representative samples of residents
aged 55 to 64 years from both countries using 2002 data from the US Health
and Retirement Survey (n=4386) and the English Longitudinal Study of Aging (n=3681),
which were designed to have directly comparable measures of health, income, and
education. This analysis is supplemented by samples of those aged 40 to 70 years from
the 1999-2002 waves of National Health and Nutrition Examination Survey (n=2097)
and the 2003 wave of the Health Survey for England (n=5526). These surveys contain
extensive and comparable biological disease markers on respondents, which are
used to determine whether differential propensities to report illness can explain these
health differences. To ensure that health differences are not solely due to health issues
in the black or Latino populations in the United States, the analysis is limited to
non-Hispanic whites in both countries."

Garth|5.26.06 @ 11:09AM|#

compating = comparing.

Also:

"Results The US population in late middle age is less healthy than the equivalent British
population for diabetes, hypertension, heart disease, myocardial infarction, stroke,
lung disease, and cancer. Within each country, there exists a pronounced negative socioeconomic
status (SES) gradient with self-reported disease so that health disparities
are largest at the bottom of the education or income variants of the SES hierarchy. This
conclusion is generally robust to control for a standard set of behavioral risk factors, including
smoking, overweight, obesity, and alcohol drinking, which explain very little of
these health differences. These differences between countries or across SES groups within
each country are not due to biases in self-reported disease because biological markers
of disease exhibit exactly the same patterns. To illustrate, among those aged 55 to 64
years, diabetes prevalence is twice as high in the United States and only one fifth of this
difference can be explained by a common set of risk factors. Similarly, among middleaged
adults, mean levels of C-reactive protein are 20% higher in the United States compared
with England and mean high-density lipoprotein cholesterol levels are 14% lower.
These differences are not solely driven by the bottom of the SES distribution. In many
diseases, the top of the SES distribution is less healthy in the United States as well."

Dave W.|5.26.06 @ 11:10AM|#

Jesus, Jersey, you wandered into the wrong temple.

Its Bailey's fault. He should be trying to lipstick up this particular pig. He should get extra "combat schwag" for these kinds of blogentries tho.

Dave W.|5.26.06 @ 11:11AM|#

Jesus, Jersey, you wandered into the wrong temple.

Its Bailey's fault. He should not be trying to lipstick up this particular pig. He should get extra "combat schwag" for these kinds of blogentries tho.

|5.26.06 @ 11:13AM|#

Carrick and Isaac prove the old saying - when you have no argument, resort to accusations and pointless qualifications!

Tsk tsk...

JMJ

|5.26.06 @ 11:13AM|#

|5.26.06 @ 11:15AM|#

when you have no argument, resort to accusations and pointless qualifications!

You're just being stupider - better check your glucose! ;)

JMJ

|5.26.06 @ 11:18AM|#

RCD,

"I find it interesting that the very wealthy travel to the US for treatment far more than they travel anywhere else. That would tend to indicate to me that the quality of the healthcare in the US is better than anywhere else - the people who can get care literally anywhere come to the US."

That's stupid. All it shows is that we have the best high-end care in the world. To extrapolate anything else would be stupid. Cuba once had the finest resorts in the world - does that mean they had the best accommodations in the world for everyone? Stupid.

"The only reason anyone travels to a universal healthcare state for care is because (a) they want to mooch off the welfare state or (b) there is a treatment there not approved in the US. Not because the quality of care is better in state-run healthcare systems."

And even more stupid. There's no welfare for immigrants in most of those countries.

"Way to totally miss the point of why this statistic is what it is - not because our neonatal intensive care is worse than anyone else's (an assertion that will draw howls of laughter from any professional in the field), but because it is better, and so the risk profile that makes it into our statistical pool is so much worse."

That is so incredibly stupid, I just don't know what to say.

"First, this is factually wrong. Universal health care rations care by enforcing waiting lists, which automatically filter out a lot of end of life cases even when they don't do so explicitly by assigning end-of-life care a lower "futility" priority."

This shows just plain ignorance. The Brits and the rest of the first world prolong life just as much as we do and the proof is in the longevity.

Nice post-rationizations. You should work for the Intelligent Design folks.

JMJ

|5.26.06 @ 11:20AM|#

Nice post-rationizations. You should work for the Intelligent Design folks.

JMJ,

You should work for McDonalds.

|5.26.06 @ 11:22AM|#

It's a simple question Jersey. Yes or no, have you ever set foot in Europe?

Carrick

|5.26.06 @ 11:25AM|#

It's a simple question Jersey. Yes or no, have you ever set foot in Europe?

And going to the mock-up Venice in Las Vegas doesn't count.

|5.26.06 @ 11:25AM|#

You know, with all of the foolishness going on about needing a War (read: litigation) against Obesity, it's easy to forget that we are getting a little tubby hereabouts. And we eat some nasty stuff. I think the real culprits are greater wealth and overall food options and not anything inherently "wrong" with our culture or psychology. And I do think it's true that kids are less active today than in the past (maybe ever, if you're looking across classes)--my girlfriend's kids don't spend a tenth of the time outside that my generation did, and we had video games (sorta), too!

I'm not making any moral judgments, but I do think we have some real problems that probably do affect our long-term health. Not that that matters, because the U.S. will be offering gene therapy and cyborg parts to overcome our deficiencies soon enough :)

|5.26.06 @ 11:30AM|#

American per capita expenditure on medical care is $5,274 a year compared with $2,164 in Britain, according to the article.

Of course, we have no idea what makes up either of these figures. The footnote goes to another study, which, frankly, I just don't have time to read right now. Does this include US pharma R&D? Does the British figure just look at budgets from UK programs? We don't know.

There are a lot of stats bandied about and loaded words are being used to represent statistical statements which may or may not accurately reflect the true nature of the conclusion. "Healthier" and "sicker" are subjective terms. Yes, I know that these are quantified within the report, but how many people are going to read (or understand) the report? They just hear the word(s) and that's that.

I'm always skeptical of these types of statements. We are told over and over again that Americans are more obese than ever, but left out of this statement is that the definition of obese was changed a few years back. I haven't seen any study to suggest that we are actually heavier than we were 10 years ago, (that's not to say there isn't, I just haven't seen any) just that more of us are "obese." That's an important distinction.

Furthermore, there are so many mitigating factors, the frequency and accuracy of testing and reporting for instance, that could skew the results one way or another, that it's unlikely that any meaningful conclusion could be made from data as it stands.

That's not to say people won't make hay of it, just that it won't mean all that much.

|5.26.06 @ 11:45AM|#

Can't we just fall back on the simple fact that socialized medicine is morally wrong?
If the government pays for our medical care, then the government will tell us what to eat, what to drink (or not to drink), that we can't smoke, etc....because in the end, they will be the ones paying for our bad health. It's not just a slippery slope, it's an abyss, and we're standing on the edge of it.

|5.26.06 @ 11:51AM|#

Another factor that I'm not sure is considered by studies like this one is the cost-shifting that happens within pharmaceuticals.

Pharmaceutical company develops a new drug. UK socialized healthcare system picks a price it will pay for drug, take it or leave it. Pharma company looks at US market, determines that they can charge enough here to make up for their losses in selling it at the strongarm-negotiated price there, and takes it.

We wind up subsidizing the most vibrant and innovative system of developing new care regimens that the world has ever seen, and the rest of the world rides our coattails.

|5.26.06 @ 12:01PM|#

"Way to totally miss the point of why this statistic is what it is - not because our neonatal intensive care is worse than anyone else's (an assertion that will draw howls of laughter from any professional in the field), but because it is better, and so the risk profile that makes it into our statistical pool is so much worse."

That is so incredibly stupid, I just don't know what to say.

I'm guessing that you didn't fully comprehend this point, and so you just dismissed it as "stupid."

Do you understand basic statistics? Can you grasp that when you take two populations, one with exceptionally sick babies, and one that excludes those babies (because they're dead), more of the ones that make it into the higher-risk statistical pool will die?

Your level of discourse is even lower than usual today, so I'll repeat my common refrain.

Fucking dumbass Marxist.

R C Dean|5.26.06 @ 12:01PM|#

I just don't know what to say

Jersey, seeing as you are stuck on "stupid" (I count 5 repetitions in your response to me alone), this is pretty apparent.

|5.26.06 @ 12:04PM|#

smalls, you're exactly right, of course.

There's another side of it, too -- if medical care is a "right," since we all need it, then won't single-payer food and single-payer housing be close on its heels?

Nothing that must be seized from another is a "right." Nothing.

|5.26.06 @ 12:04PM|#

"So Chef, are you going to intentionally miss the point that though they are as healthy if not healthier than us and pay much less for it that proves the need for universal healthcare here, or are you just suffering cognitive dissonance."

Actually, as the authors of the JAMA study point out, access to health care does not seem to be driving the differences. As the Comment describes, the study is cross-sectional, so it does not account for past differences that may affect the result. Of particular interest may be that obesity has emerged as a significant problem in the UK more recently that the USA: "only in recent years has the obesity epidemic hit the United Kingdom, where prevalence of obesity rose from 7% to 23% between 1980 and 2003, whereas the corresponding changes for the United States were from 15% to 31%." This would indicate that the obese members of the American sample may have been obese longer, thus had a higher cumulative chance to develop the conditions measured. Other possible factors of interest they cite include childhood disease incidence, the limited set of behavioral risk factors considered, social conditions, and impact of illness on earning potential, so there's no absence of factors that may explain the disparities. What this study does tell us is that the set of factors it looked at (SES, the risk factors measured, screening) were inadequete to explain the differences on their own and that variation over SES is not entirely due to differences in screening.

But don't let that prevent anybody from jumping to ideologically convenient conclusions.

|5.26.06 @ 12:09PM|#

Stop asking the question Carrick. The answer is no. Jersey has never been to Europe.

This is not to say that he is not an expert on the British healthcare system as he has worked for many years in international trade. Although I am a little perplexed if this means that he is a mergers and acquisitions attorney or if he occasionally sells items on e-bay to the occasional Brit. Either way, I am not sure how that makes someone an expert. Several of my close family members were raised in France, I have no clue how their health system works in practice.

Anyway, some important points to consider.

1. What is the cost of end of life care in Britain vs. the US?

2. The Dutch had a reputation for accepting physician assisted suicide, significantly reducing continuing health care costs. Where do the Brits stand regarding this issue?

3. In Britain, how prevalent are proceedures to correct non-life threatening conditions? For instance, hip replacement surgery. In my office of 100 people, two of these operations resulted in our insurance payments shooting through the roof.

4. Does Britain's easier access to abortion reduce the overall healthcare costs.

I assume that the answers to these four factors, especially 3, are what drives up the costs in this country. However, I don't have these answers and I assume no one else has them either.

|5.26.06 @ 12:11PM|#

Can't we just fall back on the simple fact that socialized medicine is morally wrong?

Because in JMJ/Bob's twisted world, robbing the productive to feed, clothe, shelter, and provide medicine for society's losers is "morally right."

|5.26.06 @ 12:13PM|#

Stop asking the question Carrick. The answer is no. Jersey has never been to Europe.

This is not to say that he is not an expert on the British healthcare system as he has worked for many years in international trade. Although I am a little perplexed if this means that he is a mergers and acquisitions attorney or if he occasionally sells items on e-bay to the occasional Brit. Either way, I am not sure how that makes someone an expert. Several of my close family members were raised in France, I have no clue how their health system works in practice.

Anyway, some important points to consider.

1. What is the cost of end of life care in Britain vs. the US?

2. The Dutch had a reputation for accepting physician assisted suicide, significantly reducing continuing health care costs. Where do the Brits stand regarding this issue?

3. In Britain, how prevalent are proceedures to correct non-life threatening conditions? For instance, hip replacement surgery. In my office of 100 people, two of these operations resulted in our insurance payments shooting through the roof.

4. Does Britain's easier access to abortion reduce the overall healthcare costs.

I assume that the answers to these four factors, especially 3, are what drives up the costs in this country. However, I don't have these answers and I assume no one else has them either.

|5.26.06 @ 12:14PM|#

Stop asking the question Carrick. The answer is no. Jersey has never been to Europe.

This is not to say that he is not an expert on the British healthcare system as he has worked for many years in international trade. Although I am a little perplexed if this means that he is a mergers and acquisitions attorney or if he occasionally sells items on e-bay to the occasional Brit. Either way, I am not sure how that makes someone an expert. Several of my close family members were raised in France, I have no clue how their health system works in practice.

Anyway, some important points to consider.

1. What is the cost of end of life care in Britain vs. the US?

2. The Dutch had a reputation for accepting physician assisted suicide, significantly reducing continuing health care costs. Where do the Brits stand regarding this issue?

3. In Britain, how prevalent are proceedures to correct non-life threatening conditions? For instance, hip replacement surgery. In my office of 100 people, two of these operations resulted in our insurance payments shooting through the roof.

4. Does Britain's easier access to abortion reduce the overall healthcare costs.

I assume that the answers to these four factors, especially 3, are what drives up the costs in this country. However, I don't have these answers and I assume no one else has them either.

|5.26.06 @ 12:15PM|#

In Britain, how prevalent are proceedures to correct non-life threatening conditions? For instance, hip replacement surgery. In my office of 100 people, two of these operations resulted in our insurance payments shooting through the roof.

Depends how long you're prepared to wait. If people have the money then they inevitably go private.

As for essential health care e.g heart ops. I think, although I am not 100% sure that this current government is pleased as it's managed to push the waiting lists under 18 months. Could well be wrong though (normally am).

As for the other thread about penis enlargement. I hope I can get that on the NHS.

Int. Hospital. Day.

Doctor: 'Hello Mark. What can I do for you today?'

Mark: 'Well Doc, you can make my wang as big as gravitationally possible.'

Doctor: 'Sure thing. Pull down those panse and lets get busy'.

|5.26.06 @ 12:16PM|#

3. In Britain, how prevalent are procedures to correct non-life threatening conditions? For instance, hip replacement surgery. In my office of 100 people, two of these operations resulted in our insurance payments shooting through the roof.

Funny you mention that. My HR director told me that if we eliminate the gastric bypass option from our corporate insurance policy, our rates would plummet. She didn't say how much, it is significant just the same, but considering how many people took this option n the past 5 years, zero, it's obvious we've been overpaying the whole time and contributing to the situation for just such a wobbly conclusion as in this study.

|5.26.06 @ 12:18PM|#

Yeah, Mark, we'll see how long your healthcare costs are lower than ours, if that procedure's not strictly rationed!

|5.26.06 @ 12:23PM|#

Carrick and Isaac prove the old saying - when you have no argument, resort to accusations and pointless qualifications!

Oh, is questioning the truth of statements made in support of an argument not a valid mode of discussion?

Like this gem:

The Brits and the rest of the first world prolong life just as much as we do and the proof is in the longevity.

As the article made plain the life expectancy of Americans who reach age 65 is longer than equivalent Brits. The trivial difference in life expectancies is due to the higher rates of auto accidents and homicides. Although you referred to that difference it is not relevant to this thread since as Garth pointed out the study under discussion dealt with older well-to-do white inhabitants of each country (people who are much less likely to be victims of homicide or auto accidents).

And Bob is a dickhead because he accuses Bailey of trying to prove that our free-market health-care system (it took a long time to post this since I had to stop the uncontrollable laughter that resulted from just typimg that) was superior to Britain's socialized one. If he had read the article he would have known that was not the point. Talk about an asshole living in his own fucking echo chamber. Of course, I was stupid in that one regard. I should have simply ignored the troll.

|5.26.06 @ 12:30PM|#

Oh come on, now, Jamie. It's good for us to be reminded that there are other views -- it keeps us mentally sharp to consider their arguments on the rare occasion that they come up with something more coherent than "that's stupid!"

The exercise of thinking through what they're saying, finding the inevitable logical flaws, and describing those flaws clearly makes us better able to discuss these issues with people who can be reasoned with.

|5.26.06 @ 12:32PM|#

I just read an interesting article about end of life issues. The jist was that we need more hospice and less high cost fancy schmancy institutional care. I think this gets to a big part of our cost problem - the break up of the family in America. In most Old World countries, the families tend to stick together more - and right up til the end. What to do? Well, it's a cultural problem, obviously, but there's an economic/political aspect to this as well. Perhaps if our government wortked harder to secure the interests of families over the interests of the wealthy, we would see less end of life cost burden on the system.

JMJ

Russ Feingold (D-Wis)|5.26.06 @ 12:32PM|#

Ralphie: I don't how it compares with England but I've seen estimates that as much as 40% of our medical expenses are on people in their last year of life.

RCD: . . . high end-of-life care costs, which people want, nay, insist on, do not translate into longer life expectancy.

I don't think you libers have thought about which way stuf like this cuts in the larger debate. here is what I mean:

JMJ comes around once in a while to ask what the value add is from the US health insurance system, that is what the benefits are that justify the enormous cost of the insurance administration and fund allocation system itself. However, you may feel abot Jersey, it is a good question and one that a good liber should be able to answer if they want any kind of cred outside the reservation.

The most common answer to Jersey's query is to say that the health insurance system has to work hard to calculate premiums based on perceived risks and actuarial science. In this way, we make sure that the people who are getting the med care are the same, probabilistically as the ones paying for the medical care. Okay, fair answer maybe, if true.

Now we have ralphie and RCD and the rest say that the costs are hugely concentrated in the last year of life. We also know probabilistically speaking that the last year of life is going to be somewhere in the 75 to 90th year range. You don't have to be an actuarial scientist to realize that old people should therefore be paying gigantic premiums, orders of magnitude above what younger people pay. Roghly speaking, and if we take Ralphie's guess as true, 40% of the total premiums should be coming from the 75 to 90 set.

That ain't happening folks and that means that the insurance system fails on its own terms as a mechanism for fair allocation of costs. The system does keep some poor person from running off with my premium payments, but instead it means that some rich-enuf-to-afford-insurance geezer in the oncology ward is splitting my premiums with the eager, and sometimes successful, investments team at the healthcare co.

You know, I don't mind so much doing some charity tru the government mechanism of socialized medicine as I do here in Canada, but goddamn if my charity is going to the insurance co's and their rich, white, old, dying, insistent clientele.

Timothy|5.26.06 @ 12:39PM|#

I've got a loverly bunch of coconuts, deele dee dee, there they are all standing in a row.

|5.26.06 @ 12:43PM|#

RF, my understanding (which is very imperfect) is that the health insurance field for folks over 65 is very messy indeed, due to the intrusion of Medicare into the system.

In life insurance (which I know just a bit more about), you can sign up for a long-term contract that stipulates that you'll pay a fixed amount that does not vary over the life of the policy. In the beginning, you're paying more than is required for actuarial stasis; in the end, less. Mightn't a similar dynamic be at work here?

|5.26.06 @ 12:47PM|#

I actually think JMJ has a point about the diminishing importance of family ties in the U.S. having some effect on things. It's not really something that is easy to measure, of course. Though his point on hospice might be a little strong, because I've been quite impressed with hospice organizations here from my own experience.

Russ Feingold (D-Wis)|5.26.06 @ 12:54PM|#

In life insurance (which I know just a bit more about), you can sign up for a long-term contract that stipulates that you'll pay a fixed amount that does not vary over the life of the policy. In the beginning, you're paying more than is required for actuarial stasis; in the end, less. Mightn't a similar dynamic be at work here?

No because health insurance does not offer fixed rate lifetime plans. If it did, I would have gotten one a long time ago. With the life insurance you are actuarially prepaying for your contractual right to a "cheap" policy when you are old. The is no similar quid pro quo in the health insurance game, at least none that I ever saw.

|5.26.06 @ 12:58PM|#

Good point, RS. It is hard to defend health "insurance" -- but to say that A is bad does not prove that B is good.

|5.26.06 @ 1:26PM|#

It is hard to defend health "insurance"...

of course the main reason it is hard to defend health "insurance" is that various state and federal mandates have changed it from a means of pooling medical risks into a means of pooling medical costs. But I suspect that's part of what you were driving at.

The Kids|5.26.06 @ 1:28PM|#

Good point, RS. It is hard to defend health "insurance" -- but to say that A is bad does not prove that B is good.

No, it just means we need to start sticking it to the geezers. The insurance company is more regulated than most industries because it has long been understood that insurance companies need to be large and can't accomodate the numerous small businesses needed for true capitalism and true competition. Accordingly, it may be time to start enforcing decent actuarial practice by reg. Stick'em up, Geez, you been getting a free ride and now it is time to pay the piper. Outlaw the AARP!

|5.26.06 @ 1:42PM|#

Perhaps if our government wortked harder to secure the interests of families over the interests of the wealthy, we would see less end of life cost burden on the system.

JMJ

Our government??? Our government will change our cultural values?
Is there ever an end to what the government is supposed to do for you?
Could you once in a while start thinking about how you should arrange your life?

|5.26.06 @ 2:02PM|#

NM, my point (you left out the contextual reference) was that the gov't could use it's powers over trade and commerce and taxation to help direct greater wealth opportunities to those who need it. Everything is cultural, NM.

PL, I think you misconstrued me - I love the hospice system. Did wonders for my grandmother. We need more of it - much much more.

JMJ

grylliade|5.26.06 @ 2:09PM|#

The jist was that we need more hospice and less high cost fancy schmancy institutional care.

Um, I believe that should be "gist." But I might be wrong; after all, I once worked at Wal-Mart, so I'm dum as a rok. U shud luk it up b4 u trust me.

|5.26.06 @ 2:15PM|#

...to help direct greater wealth opportunities to those who need it...

Dumbass.

That's exactly what the capitalist system does. Of course, those "needy" folk have to actually get off their dead asses and do something to get at that wealth... but that's clearly beyond your ken.

Fucking dumbass Marxist.

|5.26.06 @ 2:25PM|#

Nice write up Ron B. Maia S also covered this at Stats the other day.

|5.26.06 @ 2:41PM|#

Clean Hands, you wouldn't know a Marxist from your own ass.

Gry - I apologize for that prior remark. Though said in sarcastic jest, it was mean and I should never have said it. I'm sorry. I've had my share of menial work in my life. I had no place to talk.

JMJ

|5.26.06 @ 2:59PM|#

RF,

I think the answer to your question is that we do not actually have a free market health care system. While critics will typical say, look at the flaws of our free market enterprise and compare it to the socialized system of Western European countries, the truth is we both have partially private/social systems. We just vary in the amount.

Why aren't premiums on young folks very low, and old folks really high? Because insurance is a regualted industry and the regulators would never allow such a thing to happen. Any actuary could do that analysis for you, but our system does not allow the rational outcome to occur.

Insurance companies do not exist in a pure free-market system, their actions are tightly constrained by the government in virtually aspect (how much they charge, what they can invest in, who they can cover, etc...).

This likely a highly sub-optimal point as young workers (like myself) pay high premiums for care we don't currently need, and older folks consume much more healthcare then they could afford absent the re-distribution young to old.

|5.26.06 @ 3:01PM|#

Gee, JMJ, I love you, too.

Let's see: Marx held in his classic formulation that capital should flow "from each according to his ability, to each according to his need."

You've spoken in the past for the "from" side of this cant; today's statement covers the "to" side pretty neatly.

So, to break down my refrain:

"Fucking" - purely editorial, ad hominem and mean. But heartfelt.
"dumbass" - a statement of observed fact.
"Marxist" - see above discussion of Marxism and your adherance to it.

Dave W.|5.26.06 @ 3:12PM|#

Why aren't premiums on young folks very low, and old folks really high? Because insurance is a regualted industry and the regulators would never allow such a thing to happen. Any actuary could do that analysis for you, but our system does not allow the rational outcome to occur.

I suspect this is untrue. Does anybody have any links on this point?

More to the point: if the value add of the insurance company is to fairly distribute payments based on actuarial risk, BUT the gov't regulations prevent this from actually happening in the way that LannyC believes, then what is the value add of the insurance system. JMJ's dreaded question comes right back like a persistent yeast infection.

|5.26.06 @ 3:25PM|#

One clear example of this phenomemon was the rates for home fire insurance in San Diego. As the city grew it expanded into areas typically believed to be likely to incur significant fire risks.

The natural response of the insurance companies was to charge very high rates for homeowners insurance (which usually includes fire damage protection). These high rates were seen as deeply unfair, and they insurers were not allowed to charge them.

Given that insurers could not charge these higher rates to those in dangerous areas, they did the next best thing. They raised overall rates by a bit and essentially all of their other customers were subsidizing the dangerous San Diego residents.

While this is certainly not the "optimal" solution, it could be a reasonable sub-optimal solution.

|5.26.06 @ 3:28PM|#

What on earth did I say to provoke such attacks?

|5.26.06 @ 3:33PM|#

But I do agree, if you impose enough regulations and conditions you will essentially have nationalized the insurance industry.

Then there is no point in even claiming there is any private element to the system.

|5.26.06 @ 3:33PM|#

While this is certainly not the "optimal" solution, it could be a reasonable sub-optimal solution.

It might seem reasonable to the person in living in the subsidized fire zone, but sounds pretty unreasonable to those living in safer areas who already find living in San Diego to be expensive enough without paying for the guys living in fire-prone areas.

If you MUST live in a fire zone, at least have the sense to build your house out of something fireproof like concrete, for Chrissake.

Dave W.|5.26.06 @ 3:46PM|#

I understand that, Lanny, having been a San Diego homeowner for a bit. I don't think health insurance works the same way.

At any rate, I am calling in this thread for regulations that demand that insurance companies *follow* the actuarial data rigorously, which is the opposite of what happened with the fire insurance in San Diego.

|5.26.06 @ 3:58PM|#

Dave,

Creating a framework for insurance firms to follow the actuarial data makes a lot of sense. The problem with a set of regulations surrounding that, is it is really quite difficult to figure out what that a fair rate should be.

In a prior job I worked as a banker for some insurance companies and looked at the tables they use to calculate life insurance rates. One immediate problem that arises is that historical data is not really a great guide for future expenses.

Most specifically in life insurance, if you looked at anybody's mortality risk from historical data, you were almost certainly going to overestimate their chance of death. Since life expectancy's have been steadily rising any strict historical analysis will be incorrect.

Similarily, if you look at medical costs, you are likely to underestimate costs as real world medical expenses have been steadily increasing.

Insurance executives aren't stupid, but when they set rates then need to make a guess as to the future path of mortality or health costs. But since it is definitely a guess, I don't think anyone could say for sure what someone's true cost is going to be. Especially with the constant creation of new, expensive life prolonging medicines and technologies.

|5.26.06 @ 4:06PM|#

Actually, it seems pretty self-evident to me that healthcare costs rise as a result of having someone else always pay the bill.

I was without health "insurance" for several years; my consumption of healthcare services was pretty minimal during that time. As soon as I got "insurance" again, it seemed more reasonable to go in for relatively minor issues that I might have left at watchful waiting otherwise. Human nature.

Another thing that makes healthcare more expensive is the cost of liability insurance that providers must carry - ambulance-chasing lawyers add literally billions of dollars of direct expense to the system every year. Hell, every month.

Loser-pays or damage limits might help with this part of the problem, though I also find the idea of simply hanging all of the lawyers somewhat attractive, as well. :-)

Dave W.|5.26.06 @ 4:56PM|#

Medical malpractice happens. When it touches you or your family come back here and cry for yourt lost innocence.

|5.26.06 @ 5:05PM|#

Of course it happens. Didn't deny that. But the tort bar has long since given up the pursuit of justice for the pursuit of cash.

$26,000,000,000 in malpractice liability costs in 2003. It seems unlikely to me that there was $26 billion worth of actual damage done... except by the lawyers.

Dave W.|5.26.06 @ 5:20PM|#

$26,000,000,000 in malpractice liability costs in 2003. It seems unlikely to me that there was $26 billion worth of actual damage done.

why do you doubt that? Do you have any idea was spent on US healthcare as a whole? Can you intuit these numbers somehow?

|5.26.06 @ 5:32PM|#

Are you actually saying that malpractice litigation isn't out of hand?

You must be one of the ambulance-chasers...

Dave W.|5.26.06 @ 5:35PM|#

Thou sayest.

|5.26.06 @ 5:39PM|#

So, do you channel dead babies? Or do you just hire class-action plaintiffs?

What's your particular racket?

Dave W.|5.26.06 @ 5:46PM|#

I patented the concept of the zero value add entity several years ago and I am suing the bastids 4 all they got.

|5.26.06 @ 5:54PM|#

Are you actually saying that malpractice litigation isn't out of hand?

Clean Hands, you can't take anything he says seriously - he is obviously a self-interested shill for lawyers.

|5.27.06 @ 6:52AM|#

Are you actually saying that malpractice litigation isn't out of hand?

More serious response (than u deserve):

I don't know if it is or it isn't. I recently had a person with your exact attitude about medical malpractice plaintiffs' lawyers feel me out to see if she had a malpractice claim (I told her I didn't think so). What is up with that? Is she falling for the anti-John Edwards hype she dittoes -- thinking that the courts really do consider every adverse outcome to be a malpractice? Or, alternatively, was she thinking that her case was real malpractice, as opposed to all the fake malpractice she routinely decries? Another story: last night a friend of mine went into the hospital for what may or may not be Fenn-phenn caused heart problems. Now that is not malpractice, but it is a similar cost to the system. So, I don't know about you, Clean Hands, but I am touched by these malpractice questions personally, even though I have never done personal injury law or anything remotely similar. And when I say "touched by these questions" I mean both cases that make you feel for the patient and cases that make you feel for the doctor. And cases where I don't know what to think.

What I do know is that the damages and injuries caused by malpractice are a real problem. I also know the legal system has its own injustices and unfair results, just like the healthcare system. What the malpractice system does, in effect, is set a standard as to how carefully doctors have to practice and how carefully drugmakers have to test before charging us, the public, for the benefit of their healing powers. I understand that we can't hold doctors to a perfect standard, but if all mistakes are forgiveable, then there will be lots and lots of mistakes. Cost pressures will see to that. It is probably fruitless to argue about the conduct of the bad doctors (a minority I am sure, and a minority I have never encountered in my life as a patient) because, to a large extent, you really have to be there and know all the circumstances to understand in your heart that a doctor has crossed the line from harried to ruthless. Since we don't have an opportunity to tour some hospitals together and talk to families of the paying customers of the medical system, think for a second about PhenFen. How many people died from this combination of diet drugs? I tried to look it up, but the number of fatalities is not readily available. Was it 2? About as many as the Unabomber killed? As many as McVeigh got? Katrina? 9/11? More? Lots more? How is my friend in the hospital going to pull through? Do her problems really have anything to do with Phen Fen or not? I have no idea about any of these things.

But, you seem to think you do know, Clean Hands. People who want your sympathy feed you the $26 billion number as an annual cost of malpractice to the system. You have decided that this is mostly litigious lawyers and jackpot juries, instead of customers getting their mony back because the mechanic made a horrible mess. I believe I know how someone like a Clean Hands comes by this intuition that all the cash transfers are bogus. The people who want his sympathy feed him media articles about every large verdict that seems unfair. They do not report much about families who clearly deserved a malpractice refund, but did not manage to get one for whatever reason. So, in a given year, Clean Hands hears about tens of millions of dollars worth of verdicts that seem unfair and he is awed into the sympathy that his media filter wanted.

Now let's pull it apart. Put those tens of millions of dollars up aganst the $26 billion spent by the system on malpractice in a given year. Its nothing. Its one tenth of one percent of the malpractice pie, these unfair verdicts that so shock'n'awe. Don't forget the patients who suffer and never sue or collect anything. These unfair verdicts also need to be somehow balanced against the fact that insurance companies are no pussies and can often manage to avoid liability they should fairly incur. Now to really lay on the doubt that we don't even know how much the $26 billion malpractice pie (including its indeterminate unfair and non-unfair portions) is compared to the total expenditures on healthcare. Is this $26 billion half of the healthcare dollars? 10%? One tenth of one percent?

That is the long answer. The short answer is that I don't know if the medical malpractice is out of control or in control. I am always puzzled by how you are supposed to take it on faith around these parts that malpractice and torts generally are bad or are incompatible with a free market. These torts are why we can trust our doctor or medicine or cosmetic surgeon or lawyer or gun or car as much as we do. If we trusted these products less, we would be less willing to engage in these commercial transactions as a society and that is bad for free markets in the long run.

Even if I were convinced that malpractice were out of control, I wouldn't want the reforms to be a simple hammer for insurance companies to beat down all comers, righteously aggrrieved and malingering alike. Cause that is what the damage caps are. Instead, reforms should be aimed at making the system more fair, making sure that anyone who is needlessly maimed at the hands of an outrageously careless doctor gets their due, while the familiar rogues gallery of faux wannabes stays away, far away, from the courthouse. Maybe the US should do what the UK does, whatever that is. I don't hear them complaining, but maybe I missed it. What did they do about the thalidomide babies over there? Can anybody sue for malpractice at all? Do UK doctors worry about malpractice? Why or why not?
Another more moderate proposal would be to crank down the price control on what contingency attorneys can charge. I think most states allow 33% or even 40%. If that gets cranked down to 20% or 25%, then I would guess that contingency attorneys would take more care in deciding which suits to bring -- they would get more risk-averse. This is a reform that could help select out the meritorious suits instead of merely jiggering the economics to crush all the suits.

Gotta go -- heard siren . . .

|5.27.06 @ 11:40AM|#

Bob wrote: What on earth did I say to provoke such attacks?

I think it was this insult:

"Jesus, Jersey, you wandered into the wrong temple. Saying the stuff you're saying is like taking a pee in the middle of a High Mass. What do you think this is, some sort of debating club? Tua culpa, tua culpa, tua culpa. Now pipe down so I can hear the sacred chanting and the organ music."

People who generally view civil societal and market approaches to social problems as 'generally' superior to legislative approaches are sometimes characterized by people like you in these insulting terms. You romanticize the State, reflexively reaching for the legislative wand at the first sight of trouble, and then turn around and accuse us of the very religious and magical thinking you are guilty of. Sacred chanting? In your temple it goes like this: "Oh great and all powerful state, giver of life, please solve all of our problems with a new wave of the legislative wand."

But I'm glad people like Jersey come to debate. I only wish he would back up his points instead of just relying on childish, playground taunts like "You're stupid...no, no, you are....oh, yeah, you are...well, you're stupidest, okay?"

|5.27.06 @ 12:26PM|#

Gotta go -- heard siren . . .

OK, that's funny!

|5.27.06 @ 2:29PM|#

More serious response (than u deserve):

Geez, save your breath. Anything an attorney says on the issue should be viewed very skeptically at best. You'd think someone who is so quick to question other's self-serving motives would know that and save us the trouble of having to ignore him.