Piling On the NHS

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More on the glorious, flawless British National Health Service. As you-know-who recently said, Britons that the patronize the public system get top-notch care and a free Pimms Cup with every visit: "Now, the British system is really government-owned, in the sense that the government owns and runs the hospitals, the government employs the doctors. And so, they work for the government, so it's very much a government-owned and -run and -controlled program in Britain. And again, you know, everything is free. And you see the hospitals in the film. People are very happy with it."

Except, the Telegraph reports, those diagnosed with cancer:

Cancer survival rates in Britain are among the lowest in Europe, according to the most comprehensive analysis of the issue yet produced.

England is on a par with Poland despite the NHS spending three times more on health care.

Survival rates are based on the number of patients who are alive five years after diagnosis and researchers found that, for women, England was the fifth worst in a league of 22 countries. Scotland came bottom. Cancer experts blamed late diagnosis and long waiting lists.

In total, 52.7pc of women survived for five years after being diagnosed between 2000 and 2002. Only Ireland, Northern Ireland, Scotland, the Czech Republic and Poland did worse. Just 44.8pc of men survived, putting England in the bottom seven countries.

Full story here.

Also from the Telegraph: nurses face joblessness by NHS budget squeeze; the elderly are "becoming increasingly disabled because of a lack of basic care to help them look after their feet"; list of hospitals threatened with closure in budget cutbacks; and NHS dentists are often more expensive than their private counterparts.

NEXT: Hurricane Harbingers

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  1. I admit this has been a long time ago…but I knew a woman who had a heart attack in London and when presented with the best of NHS chose to book a flight home to the good old US to be treated. This despite being advised that there was a very real risk of her death on the flight back.

    Course George Harrison did the same thing looking for cancer treatment during the furor over Hillary Care.

    [awwwww shadddup and go drink yer wine old man, this is the 21st century]

  2. I’d be curious to see how much of the difference can be attributed to cultural factors.

  3. I remember when I was living in England a couple of years ago there was a rash of stories on the BBC about how people in northern England were basically forced to pull their own teeth since the NHS basically had a monoply on dentistry and had cut back on the numbers of dentists available for each region to save money (in some areas one NHS dentist was responsible for servicing 5 or 6 towns), so the people couldn’t get appointments. The government finally opened up dental care to private industry after a big outcry…it’s unsurprising that the private sector is offering better care.

  4. As an American who has been treated by the NHS, I can tell you that it is fucking horrible.

    I had one NHS doctor say to me with a sneer “I don’t know what your American doctor is going to do, but I wouldn’t operate on your foot.” This was a foot expert telling me he wouldn’t fix my shattered heel (5 pieces) which would leave me a clubfoot and an inch or two shorter in one leg–essentially crippled. Mainly because foot operations can be dangerous if they become infected. I almost slugged him from my bed.

    So I went home to NYC and had the guy who fixes the feet and ankles of the New York Giants fix my foot. My (gasp, horror) private insurance paid for it, and he did a wonderful job.

    Fuck the NHS.

  5. It’s too bad the “Figures from France are not available,” since the French system of private practitioners and universal insurance coverage is much closer to the modified-single-payer system most Americans support.

    And because the French system regularly leads the world in health outcomes.

    Sorry, Michael. I know that must have a big blow to you, not to be able to provide the most comprehensive and relevant data, regardless of its policy implications.

  6. Because this post was clearly about France and how wonderful it is. Maybe you could respond to the actual data being presented instead of saying that it doesn’t matter because France’s healthcare system pwns, which, correct me if I’m wrong, isn’t the subject of the post.

  7. Joe has a good point.

    I tried Googling to find the overall 5 year cancer survival rates in France and I could not find the data.

    I found lots of UK articles saying how much better the French system was compared to the UK system, but I could not find the raw numbers anywhere.

    You would think since the have a superior system, they would brag about the numbers.

  8. Just an FYI — the general consensus on universal health care (in theory and in practice) is that the British system is a good example of “How Not to Do it”.

    Canadian and French systems are considerably better, although I suspect the UK system would undoubtably be considered far superior from the point of view of the 50 million US citizens who don’t have insurance at all.

  9. Wait a minute, England has a government run health-care thingy too?

    Wow, they do things differently in other countries, that’s for sure.

  10. Remember, it’s that “access” that’s better in England… oh, and Cuba too, not quality.

  11. UK system would undoubtably be considered far superior from the point of view of the 50 million US citizens who don’t have insurance at all.

    1: Who are these 50 million citizens?

    2: There are a whole lot of uninsured U.S. Citizens in our hospitals and clinics, right now, as I speak, getting free healthcare.

  12. Survival rates are based on the number of patients who are alive five years after diagnosis

    Well that certainly sounds like a number of convenience.

    First off, my brother-in-law was diagnosed with bone marrow cancer (age 53) and was given 6 years to live. He died 6 years later from bone marrow cancer (age 59). That counts as a “survival” for this chart.

    On the other hand, if he had lived under NHS he probably would have put off going to the doctor for a few more years and would have been diagnosed at age 58. If he lived to 59, that would not have counted as a survival.

    In other words, I think national health care sucks too but this data doesn’t tell us anything.

  13. Canadian and French systems are considerably better, although I suspect the UK system would undoubtably be considered far superior from the point of view of the 50 million US citizens who don’t have insurance at all.

    Cant speak for the French, but trust me the Canadian system is defintely defintely not the bright star in the sky.

  14. Canadian and French systems are considerably better

    No private doctors at all (Canada) is better than Britain’s? At least the latter has Harley Street and the like. Also, the population of the UK is about twice Canada’s.

    And I gather the French system works rather like traditional indemnity insurance, with reimbursements? What if you can’t afford to front that kind of argent in the first place?

  15. I believe there are higher rates of smoking in Europe than the United States. Could this impact their cancer survival rates?

  16. I don’t understand that while the US leads fairly substantially in five year cancer survival rates yet it is pretty far down the list in life expectancy vs. EU countries. (Some of the top EU countries UN World Population Report listed on Wiki: Iceland 81.8, Switzerland 81.7, Sweden 80.9, Itay 80.5, and Norway 80.2 versus the US 78.2)

    Do we have more heart related deaths than these countries? Is it for other reasons like HIV/AIDS or accidents, etc.? We’re more likely to survive cancer but a higher percent of Americans get it?

  17. it is pretty far down the list in life expectancy vs. EU countries

    Are life expectancy figures based on the median, or the mean?

  18. Do we have more heart related deaths than these countries? Is it for other reasons like HIV/AIDS or accidents, etc.?

    From what I’ve read, it’s how the other countries measure/count infant mortality.

  19. “Canadian and French systems are considerably better”

    But still far below US standards. Why do Canadians come to the US for health care they would have to wait for there?

  20. I suspect the UK system would undoubtably be considered far superior from the point of view of the 50 million US citizens who don’t have insurance at all.

    Right, because, you know no insurance = absolutely no health care.

    Or not. I know that I, as a young man flush with cash but sans insurance, can walk into a drugstore and treat whatever run of the mill ailment. I also pay cash for my regular dental check-ups, which nets me a discount.

    So, yeah, I have plenty of “health care” without having insurance.

  21. Paul, do you wait until you get sick enough to go to the emergency room to get your medical care?

    Gee, why not?

  22. eoj,

    How about I write whatever the hell I want, and treat your bitching with the respect it deserves?

  23. Russ 2000,

    There are actual differences in infant mortality as well, that some have tried to explain away as entirely the result of counting differences, but can’t.

    If you read about this issue, you’ll find that the types of situations that are counted differently are a tiny fraction of all births.

  24. “it is pretty far down the list in life expectancy vs. EU countries”

    It has nothing to do with the qaulity of health care in those countries. It’s more a result of genetic factors and diet.

  25. Paul, do you wait until you get sick enough to go to the emergency room to get your medical care?

    Myth #1: Poor U.S. Citizens only get emergency healthcare.

    Fact: Wrong.

    Yes, there is a process, yes, the initial setup may be beauracratic– and yes, it may need reform. Yes, there may be uneducated poor people that aren’t aware of services available to them, leading them to be underinsured. But once in the system, you have healthcare, including but not limited to preventative care.

  26. The most interesting thing in this is the male/female difference. Without looking at every country pairing (since they are in different orders) it appears at a quick glance that female survival rates are higher everywhere, except the US. We truly kick ass in male survival rates. Anyone know the reason for this? Is it some macho European refusal to see the doctor? The endless propaganda to get checked for Prostate Cancer we have in the US? Anyone have any idea?

  27. I have read elsewhere that the US infant mortality data underperforms relative to other western countries owing to our aggressive treatment of very premature babies, many of whom would have been considered nonviable and ultimately had become “stillbirth/miscarriage” statistics in other countries.

  28. Well that certainly sounds like a number of convenience. [regarding 5 years]

    Not really. 5 years is the point where the Kaplan-Meier survival curves level off for most cancers, and the patient can be considered to be in long-term remission. There are exceptions, of courrse. Melanoma patients must be followed for 20 years, and breast cancer can never truly be considered cured.

  29. It could be that certain types of cancers which are more difficult to treat are more common in other nations. The figures by themselves are probably a pretty good proxy but they leave a lot to be desire.

  30. Also, note to self, dont get cancer in Slovenia.

  31. “There are actual differences in infant mortality as well, that some have tried to explain away as entirely the result of counting differences, but can’t.”

    The reason why the infant mortality rate is larger in the US is because we do everything in our power to save premies. If a baby dies before his or her 1st birthday, it adds to the number of infant deaths. In countries with socialized medicine, a premie is more likely to be aborted for cost saving purposes.

  32. Myth #2: somebody made a comment about poor U.S. citizens ONLY getting emergency health care.

    Here let me try: British citizens ONLY get crappy health care.

    BTW, the number of excess deaths due to inadquate health care access in the U.S. is estimated at 14,000 per annum.

  33. “It could be that certain types of cancers which are more difficult to treat are more common in other nations.”

    You’re only guessing, Syloson. Do you have any data to back that up?

  34. While I am sure that the USA, my homeland, is number one in everything and has the best system for everything, I find these broad based crosscountry comparisons difficult to swallow. How are these statistics gathered? How are they validated? Is someone dying of colon cancer with lung metastasis counted as a colon case or a lung case?
    Too many variables from nation to nation to make much of a case for anything.
    Nevertheless, I know that America is number one.

  35. “BTW, the number of excess deaths due to inadquate health care access in the U.S. is estimated at 14,000 per annum.”

    Better to give those uninsured tax breaks for insurance than to put the whole country under socialized medicine and have the bad results they have in other countries with socialized medicine such as long waiting lists for diagnostic tests and operations resulting in deaths while waiting and deaths because the ailment wasn’t diagnosed in time.

  36. joe, your smugness and condescension seem to be at an all-time high today (not just on this thread). Maybe you could tone that down a bit so people can more easily digest the substantive points you’re trying to make.

  37. Considering the number of people who get driven into bankruptcy due to medical costs I really really wonder about that “poor people get health care FREE!” You mean, aside from getting nagged for 15 years about paying the costs of the emergency room, getting hassled by collection agencies, and have your credit score collapse? Some freedom!

  38. Rattlesnake Jake,

    No. Its just a question that comes to mind when looking at the data. Is there anything wrong with that?

  39. Myth #2: somebody made a comment about poor U.S. citizens ONLY getting emergency health care.

    Bait and switch joe. You implied this in the suggestion that uninsured people have to get their healthcare in the E.R.

    Your response to me: Paul, do you wait until you get sick enough to go to the emergency room to get your medical care?

    You can wiggle all you want, it’s not working, and we’re not buying.

    BTW, the number of excess deaths due to inadquate health care access in the U.S. is estimated at 14,000 per annum.

    So what? What’s the rate, joe? We live in a country of 300 million people. You’re beginning to swing wildly, joe.

    This entire country is awash in free medical care for poor or uninsured, joe.

  40. One of the reasons that the French figures might not be able available is due to their fairly strict privacy laws re: an individual’s health care. That’s just a guess though.

  41. it is pretty far down the list in life expectancy vs. EU countries

    I thought of two more that may be pertinent – firearm related and obesity related.

  42. How are these statistics gathered? How are they validated? Is someone dying of colon cancer with lung metastasis counted as a colon case or a lung case?
    Too many variables from nation to nation to make much of a case for anything.
    Nevertheless, I know that America is number one.

    Case in point, the repeatedly debunked “infant mortality rate”. What counts as “infant mortality” in one country is way different from what counts in another. Some countries call it a “do over” if the baby is born under a certain ceiling and dies within several hours– even days in some cases. Body: tossed out with medical waste.

    The U.S. counts every child that lives after delivery– even if only for a few minutes.

  43. Rattlesnake Jake,

    Most of the uninsured – and an even greater % of those uninsured unwillingly – don’t pay enough income tax to cover the cost of insuring their families.

    But I agree, having the govenrment help people with the cost of insurance is better than turning the provision of health care services into a job for the government, like paving the roads.

    Cutting checks is something the government does well. Providing services in a manner that meets customer demands is not.T

    his is pretty much a settled question among most Americans – the outstanding question is how best to help people afford the insurance.

  44. I thought of two more that may be pertinent – firearm related and obesity related.

    I was thinking automobile deaths. We use cars far more in this country than they do in Europe, where theres plenty of mass transit.

    What I would like to see is life expectancy for those who reach 60 compared between countries. That takes out things like infant mortality, firearms, and most car accidents. This would make it a better indication of health care quality.

  45. Actually, if I had such an illness I’d probably get treated in India or Thailand at one of the brand new, state of the art private hospitals there. Great physicians, surgeons, etc. and quite cheap from what I understand.

  46. firearm related and obesity related.

    de stijl:

    Firearms: Suicide or murder?

    Obesity: Obesity related or obesity caused? I weigh around 175 pounds. I’m over six feet tall. I’m not obese by any stretch of the imagination. Yet I very well may die of something “obesity related.” If I kick off from a heart attack when I’m 75, was that obesity related? Or maybe smoking related? Hint: I don’t smoke either.

    The old joke: If a man living on a desert island and never smokes a single cigarette, but he dies of a heart attack, could you record his death as being “smoking related”?

  47. Cutting checks is something the government does well.

    Having heard some recent “funny” stories from my Mom related to Social Security, I disagree.

  48. You implied this in the suggestion that uninsured people have to get their healthcare in the E.R.

    No, I didn’t, Paul. My implication was about “too much,” and you mis-stated it as “only,” in order to make the point easier to rebut.

    This entire country is awash in free medical care for poor or uninsured, joe.

    There are systems in place – ones that you oppose. They are, obviously, not large enough to provide universal coverage, and are cobbled together in an inefficient manner.

    What is the rate?

    Quite a bit higher than it would be if poor people were receiving adequate medical care.

  49. Most of the uninsured – and an even greater % of those uninsured unwillingly – don’t pay enough income tax to cover the cost of insuring their families.

    Of course they don’t. But they can probably still get insurance. See: https://www.wship.org/Default.asp

  50. Does anyone have rates of excess death from crappy-ass healthcare for western countries with socialized medicine?

  51. Firearms: Suicide or murder?

    Both.

    Obesity: Obesity related or obesity caused?

    I was thinking of diabetes actually.

  52. “And because the French system regularly leads the world in health outcomes.”

    The reason why the UN rates the French system so high is due to cost savings and egalitarian considerations. These are important issues to the UN, but of more importance to me are less waiting time, better quality care, better research and development – all areas where the US excells.

  53. No, I didn’t, Paul. My implication was about “too much,” and you mis-stated it as “only,” in order to make the point easier to rebut.

    It was a terrifically weak implication, but now that you’ve clarified, fair enough…

    There are systems in place – ones that you oppose.

    What the f…?! You know nothing about which systems I oppose. Some I do oppose, some I don’t. Some need reform, some don’t. Some I oppose purely for reasons of liberty and social control:

    Suggestion: If you start paying for people’s healthcare, someone’s going to complain that others ain’t livin’ right.

    Response: No, that’ll never happen. We just want to make sure that everyone has access to healthcare.

    Result: We’re banning [fill in the blank] because people aren’t making healthy choices, and it’s costing the public money.

    What is the rate?

    Quite a bit higher than it would be if poor people were receiving adequate medical care.

    I think I have my answer.

  54. World Population Report listed on Wiki: Iceland 81.8, Switzerland 81.7, Sweden 80.9, Itay 80.5, and Norway 80.2

    Insert joke about no one in these countries working for a living.

  55. With regards to Norway, it is flush with oil money, thus the government can buy just about anything without raising taxes.

  56. Thank the HMOs for our cancer survival rates.

    Early detection is among the more important factors in cancer survival, and the HMOs pioneered offering testing for that.

    In the days of yore, you couldn’t get a test like that paid for unless you had some kind of justifying symptom. …what do you mean I can’t get a mammogram unless I have a lump?

    The HMOs didn’t want to have to treat you long term, testing for everybody was less expensive than treatment for the few, so in terms of cancer survival, the HMOs were way ahead of traditional care for a long time.

    Any headway that’s been made for Medicare patients in terms of preventative care and early detection was a product of that statistical embarrassment.

  57. “What I would like to see is life expectancy for those who reach 60 compared between countries. That takes out things like infant mortality, firearms, and most car accidents. This would make it a better indication of health care quality.”

    I have seen figures that corrected for accidents and murders and the life expectancy rates come out pretty close to the same. Also, Japanese pay much more out of pocket for their health care and their life expectancy is higher than any country with “free care”. It’s due to their diet and genetics.

  58. So Jake, when the pols say we are the “only industrialized country” without government heatlh care, they aren’t counting Japan?

  59. Sure, joe. I’m sure that’s easier than admitting that gubmint-run healthcare is less than spectacular in the UK. By the way, you’re a smug, arrogant know-it-all son of a bitch.

  60. And Jake, don’t white Americans at least have similar genes to Europeans? Whats the life expectancy for white Americans vs. Europeans?

  61. The reason why the UN rates the French system so high is due to cost savings and egalitarian considerations. These are important issues to the UN, but of more importance to me are less waiting time, better quality care, better research and development – all areas where the US excells.

    Wait! Hold the phone! HOLD THE PHONE!
    You mean to tell me that different people value different things? We don’t ALL value cost savings and egalitarian considerations the same way the UN does? Holy Bejeeses!

    I wish there was some healthcare system where you could choose your providers based on things that mattered to you, and pay for it accordingly…

  62. “Remember, it’s that “access” that’s better in England… oh, and Cuba too, not quality.”

    Indeed it is. And with Cuba, there is no reason to question those statistics. And those surveys, the ridiculous WHO survey being the best example, that claim access to healthcare in Cuba is better than that in the US, there is no reason to disbelieve those either.
    As we all know, every statistic put forth by the Castro government is fact-checked by Cuba’s vast independent media. They leave us no reason to even suspect that Cuba’s pronouncements concerning its healthcare system are actually propaganda from a murderous dictatorship to be consumed and regurgitated by gullible Americans like joe. You know, the same joe who actually claimed in another thread that his posts on this message board are free of ideology and only seek to present the facts. I laughed for an hour over that bullshit.

  63. Another question would be at age are folks in the U.S. likely to get cancer vs. these other nations? If say in Sweden folks don’t get cancer until on average ten years later than Americans do that would of course explain part of the difference.

  64. Early detection is among the more important factors in cancer survival

    Except that, if you take ‘survival’ to mean, ‘lives for 5 years’, maybe all early detection has really done is move the calendar back.

    IOW, early detection doesn’t mean that more people are being cured. It just means what it means — it might have no actual implications at all for real, long-term survival.

  65. In countries with socialized medicine, a premie is more likely to be aborted for cost saving purposes.

    Ding! Rattlesnake gets a cookie.

    We’ve got indigent teenagers with 24 week premies in the NICU receiving hundreds of thousands worth of medical care.

    Insurance: None.
    Free prenatal care availability: 100%
    Prenatal care actually used: 0%
    Patient emotional investment in their own healthcare: Nearly none.
    Teenager: Outside on cell phone text messaging friends, making plans for the weekend while baby sits in platic bubble.
    Medical staff: on phone with CPS

    ooooh the stories I could tell.

  66. “Quite a bit higher than it would be if poor people were receiving adequate medical care”

    Yeah, kind of like the adequate medical care they are receiving by waiting in line for months to see a doctor. That is some damn fine care.
    Of course by now, the French are probably experts in providing medical care to the poor. When one considers they have the highest unemployment rate in western Europe, they must be getting quite a bit of experience. By all means, let us emulate them.

  67. Paul,

    One of things that was certain to happen if universal health care was adopted was the elimination of medical privacy.

    Except that, in France, medical privacy is so much stricter than our own that the data for cancer survival rates was unavailable, apparently.

    I’m not saying the side-effects you mention aren’t worth thinking about, only that the assertion that they are inevitable and insurmountable shouldn’t be taken at face value.

    And no, I’m not terribly interested in doing your homework for you. Information about inadquate medical access in easily found on the web. If your position on this issue requires that you, somehow, manage not to know that tens of millions of Americans don’t hae access to the medical care they need, then you’ve obviously put quite a bit of effort into not knowing that.

  68. Wow, “glorious, flawless British National Health Service” – that’s a straw man the size of the Statue of Liberty. If there’s someone who thinks that the NHS, or Canada’s Medicare systems are glorious and perfect, I’d love to meet them. But let’s not get caught up in such rhetorical inanity.

    The absence of France and Canada in the stats are curious omissions. France is often cited as the exemplar of health care while Canada is more similar in culture and lifestyle to the US than any other country in the world. Data from these two countries would be quite interesting.

    The UK results do seem shockingly bad. However, look at Sweden or Iceland, which presumably have socialized systems as well. Clearly it’s possible to come close to American cancer survival rates in socialist hellholes like Scandanavia.

    Given that there’s been much discussion above on being uninsured, I’m curious about something. What the hell do you do in the US if you’re uninsured and get cancer? (I’m genuinely curious, I’m Canadian and I have no idea). I assume an ER is off the table because from their POV, it’s not an emergency. You’re obviously not going to get insured at that point. Are you screwed, doomed to a painful death? Will someone treat you for free?

  69. This conversation had to turn abortion eventually I suppose.

    Anyway, I would note that many European nations have far more restrictions (at least formally) on abortion than is true of the U.S.


  70. Anyway, I would note that many European nations have far more restrictions (at least formally) on abortion than is true of the U.S.

    IIRC its outlawed in Germany by their constitution.

  71. ramster,

    You can apply to Medicaid I think. Also, there are a number private organizations that help out both children and adults who have cancer.

  72. Am i the only one who noticed this Only in the USA Cancer Survivor rates in Men are more than Women

  73. eoj | August 21, 2007, 2:42pm | #

    Sure, joe. I’m sure that’s easier than admitting that gubmint-run healthcare is less than spectacular in the UK.

    joe | August 21, 2007, 1:27pm | #

    It’s too bad the “Figures from France are not available,” since the French system of private practitioners and universal insurance coverage is much closer to the modified-single-payer system most Americans support.

    In England, you can’t read basic English, either.

    Are my positions really so invulnerable that people have to make up weaker ones to attribute to me? The evidence suggests so.

  74. Chavez-boy,

    *Kiss-kiss*

    How many of YOU have your own groupies?

  75. It used to be very simple. You were poor, you got ill, you died. Bloody NHS just exacerbates the poverty.

  76. “the outstanding question is how best to help people afford the insurance.”

    One way is to make the insurance less expensive. We could do this by giving tax incentives for catastrophic policies and move away from policies that insure every minor office visit. If people paid more for minor medical expenses out of pocket, the competition of shopping around for lower price medical care would bring costs down and make medical expenses more affordable for more people. Vouchers could be given to the poor, including elderly poor. The poor could use those vouchers to shop around for better priced care, which they would do if they could cash in the remainder of what was left on their vouchers at the end of the year and spend on whatever they wanted. Means testing should be used for bringing down Medicare costs. Medicare will go broke if we don’t do something about it. There are plenty of wealthy elderly whom I’m paying taxes to support who are perfectly able to provide for their own medical needs.

  77. The obsession with the tiny % of problematic births ignores a rather signifcant factor: inadequate of absent prenatal care is a major contributing factor towards premature births and other neo-natal medical problems.

    Sure, we spend hundreds of thousands of dollars per premie, rather than a couple grand for prenatal care. This is rational?

  78. “In countries with socialized medicine, a premie is more likely to be aborted for cost saving purposes.”

    And this another reason surveys that try to rank healthcare quality are absolutely useless. These countries abort these fetuses and then do not have to consider them when determining the rate of infant mortality. The US leads the world in the delivery and care of premies. Obviously the mortality rate amongst this group will be quite high, leading to ridiculous claims that Cuba, amongst others, has a lower infant mortality rate than the US. Of course none of this would matter if the healthcare debate was not full of imbecilic jackasses who actually believe that bullshit.

  79. We’re banning [fill in the blank] because people aren’t making healthy choices, and it’s costing the public money.

    This was a point I brought up sometime in another health thread. But I don’t think they’ll ban it. They’ll just ban it for YOU. Since your sodium intake was too high last month, once you try to buy a bag of potato chips, the debit machine won’t complete the transaction. It’ll only work if you buy carrot sticks and health pellets. You going to try to get around that by paying cash? Fine, we’ll ban the use of cash. For everyone.

    Ridiculous, you say? What WON’T we do in the name of public health?

  80. Sure, we spend hundreds of thousands of dollars per premie, rather than a couple grand for prenatal care. This is rational?”

    I challenge you to produce numbers demonstrating how little you claim we spend on prenatal care.

  81. Rattlesnake Jake,

    There are serious problems with assuming that the purchase of health care functions according to the market dynamics you describe.

  82. Oopsie, forgot to close that tag. The first paragraph should have been the only one.

    joe, can I borrow that HTML book when you’re done?

  83. Chavez-boy manages to be absolutely certain the all comparative studies of medical systems is worthless, and to be equally certain that the American system is vastly superior to all others.

    That’s quite a trick.

  84. Jeebus, Thuggie, we spend an enormous amount on pre-natal care. Did you really not realize that I was talking about a specific sub-set of the population?

    I see a lot of people play dumb on these threads. Don’t worry, Hugo, I’m not going to accuse you of that.

  85. joe,

    I dont think Jake is far off, if any. We do know that cash only GPs charge less than those that take insurance, so it seems that Jake has at least some evidence in his favor.

  86. “Chavez-boy manages to be absolutely certain the all comparative studies of medical systems is worthless, and to be equally certain that the American system is vastly superior to all others”

    Nowhere ever have I written that the US system is vastly superior to every other country. I challenge you to find one passage where I have written that. You can say what you want about my arguments, but I am content with the knowledge I am not stupid enough to believe the outlandish propaganda concerning the Cuban health care system; that will forever mark you as a gullible jackass.

  87. And no, I’m not terribly interested in doing your homework for you. Information about inadquate medical access in easily found on the web.

    I’ll tell you what, joe, you back up your assertions, and I’ll back up mine. That number was your assertion, and you provided no relation, no relativity, no comparable statistics. And you made the worst statistical blunder of all: you provided a whole number– and then suggested that it’s worse here than anywhere else. I’m not asking you to do my homework, mine is done. You need to do your homework.

    If your position on this issue requires that you, somehow, manage not to know that tens of millions of Americans don’t hae access to the medical care they need,

    I don’t have the sports cars I need, joe. What does it mean in the big picture? Britons and Canadians complain they don’t have the healthcare they need, yet you repeatedly defend those systems as “superior”. You’re on the ropes on this subject, and you know it. I’ve worked in and around the healthcare industry for around 20 years now. I have an very good knowledge of who uses clinical, emergency, in-patient and out-patient services. I know where the money is coming from. I know who is paying, and I know who’s not paying. The one liner assertions about healthcare “access”, the bait and switch, the conflation of statistics, the hit-and-run utterances of whole numbers sans context to suggest something is ‘worse’ don’t fly here.

    inadequate of absent prenatal care is a major contributing factor towards premature births and other neo-natal medical problems.

    Sure, we spend hundreds of thousands of dollars per premie, rather than a couple grand for prenatal care. This is rational?

    Wrong again, joe. Wrong, wrong, wrong.

    http://www.metrokc.gov/health/famplan/fsprenatal.htm

    “First Steps” insurance pays for your prenatal care including prescriptions and childbirth classes. It also covers medical, vision, and dental visits that are not part of your pregnancy or delivery. If you haven’t picked a doctor or want to find out about other resources in your community – like WIC or maternity support services – call the family planning clinic (link) nearest you for a maternity screening appointment. Dental care is important during pregnancy and most dental clinics are very busy – call for an appointment as soon as you can. If you need help finding a dentist, or have questions about what your medical coupon pays for, contact your local public health center or CSO.

    For god’s sakes joe, here in Washington you can get free prenatal if you’re an illegal immigrant. There was even an initiative to try to block that.*

    *= I have no idea what the success of the initiative was.

  88. robc,

    There is a good book called “Sick” that goes deeply into this issue. I’ll just note that the people currently paying for their health care with cash, and the treatments they pay for that way, are not entirely representative of the whole market.

  89. Nowhere ever have I written that the US system is vastly superior to every other country.

    No, you’ve written that every other country has a health care system vastly inferior to the US.

    That you don’t understand…aw, fuck it.

    Shush, thug, the grownups are trying to talk.

  90. Paul,

    You don’t need a sports car at all. People actually do need medical care. That’s why people don’t call for universal sports cars.

    I no longer care about your level of ignorance on the subject, because you’ve clearly cultivated it for the purpose of defending the ideology that causes you to think that sports cars are the equivalent of health care.

    BTW, it’s nice that there are hoops one can jump through. Thank you, liberals. It still isn’t the same thing as a universal sytem.

    I don’t come here to convince libertarians of anything. I come here to learn from libertarians, when they have something to teach me. Simply saying nuh-uh to widely availably, widely-understood knowledge doesn’t accomplish that.

  91. joe,

    Duh. You notice I did say GPs, right? Some of the stories Ive seen are that some of the people paying cash have insurance, its just easier to pay cash for basic doctors visits than to deal with the insurance companies.

    Referring back to a previous thread, have you figured out how MSAs actually work yet?

  92. Not to pile on, but:

    “First Steps” insurance continues to pay for your medical care for 60 days after your baby is born – this includes your 6 week post-partum check, birth control, dental, and vision visits[…]

    60 days after your baby is born, your “First Steps” insurance will be replaced with “Family Planning Only” insurance. DSHS will mail a “Family Planning Only” coupon to the address you gave them when you applied for “First Steps” insurance. This important insurance covers you for 10 more months and pays for birth control clinic visits and your birth control supplies[…]

    IMPORTANT – Your coupon will help pay for rides to your doctor visits. Call 1 (800) 923-7433 for information or to ask for a ride.

    So, let’s sum up here. Poor? Prenatal care: free. Postnatal care: free. Dental and vision: free. Rides to the doctor: Subsidized and provided.

    Basically, joe, we’ve got a ruthless, capitalistic, evil healthcare system that is on its knees, begging for tired, poor, huddled masses to get into the system so we can start showering them with free healthcare. These are the systems that you admit exist, claim I don’t support, then later suggest (with vague language) that don’t exist or are inadequate.

    It’s lunchtime, I’m heading out to club some baby seals, and block access to our clinics with my SUV. I’ll leave the thread to the rest of you.

  93. joe –
    for someone who gets very upset whenever people assume you’re in favor of/against a certain position, you certainly have committed the same offense several times this thread.
    chill out, seriously

  94. “No, you’ve written that every other country has a health care system vastly inferior to the US”

    Nope, never written that anywhere either, moron. Nice try. However, I expected better from you, what with your master’s degree and all. As we all know, the 2 years or less it takes to get those degrees imbue one with omnipotence.

    You should quit trying to even argue about health care joe. On how many separate occassions do you have to have your mistakes pointed out to you before you finally admit you have no fucking clue what you are talking about? I have been arguing with you about this for months, stretching all the way back to when you erroneously claimed that only those with a life-threatening illness could be treated at the ER. I should have known then how ignorant you were concerning healthcare in this country. But then you actually went and did something that no one else on this board was even close to stupid or gullible enough to do: you swallowed everything whole the Castro government had to say about its healthcare system. I believe the term for people like you is “useful idiot”. I personally find the term to be too charitable in relation to you because you are fucking useless.

  95. In joe vs. Paul,

    Game, set and match to Paul.

  96. So Chavez is a thug, just curious here — who do you believe has a superior health-care system to the US ?

  97. Better to give those uninsured tax breaks for insurance…

    How come no one offers this as a solution to the lack of health insurance for the working poor?

    On April 15th, allow the previous year’s premiums to be deducted.

    IIRC, you don’t actually owe any federal taxes until you make around $30k, so all of the premiums will be refunded to you by Uncle Sam.

  98. I think the whole concept of health-care “systems” is wrong. Proper health care would involve an individual patient and an individual insurance company and an individual doctor and an individual hospital (and etc). The quality would be as good as the sum of the parts. No “system” necessary.

    As soon as we start talking about “systems” we are conceeding the concept of a central controlling organization.

  99. “Some of the stories Ive seen are that some of the people paying cash have insurance, its just easier to pay cash for basic doctors visits than to deal with the insurance companies.”

    There are some clinics that don’t take insurance. They charge less money for services because they don’t have to hassle with all the paper work. This is what is good about our country. We have lots of options as opposed to the “one size fits all” in the socialized medicine countries. The free market responds to people’s needs. It is when government gets involved, including in our country, when we have problems. So often, the government has to come up with a solution to a problem that they themselves have caused.

  100. Holy shit, joe, you are really in rare form today. Did you get up today deciding to reinforce every idea people had that 1) you are an insufferable smug jackass, and 2) that you act just like the stereotypical idea of an asshole elitist condescending liberal?

    You are getting pwned by people who clearly know far more than you on this subject; you can’t bring yourself to even be skeptical about Cuban claims; and you just keep digging.

    Sometimes you are funny, sometimes reasonable, sometimes make good points.

    Not on this thread.

  101. Episiarch,

    I’m glad I stopped actively watching the conversation.

  102. Rattlesnake Jake –
    too bad they’ll probably make it illegal for places to not accept insurance. I can’t think of a good reason for it, which means that it’s almost inevitable.

  103. “Better to give those uninsured tax breaks for insurance…”

    “How come no one offers this as a solution to the lack of health insurance for the working poor?”

    Giuliani has such a solution. If the 14,000,000 uninsured is the problem, why not make it easier for them to get the insurance as opposed to putting the whole system on a ruinous socialized medicine system. The reason ofcourse is that big government politicians like Hillary think only the government can resolve problems. It’s better to give patients more power to shop around and bring down costs. Tort reform is another way to bring down medical prices, but that’s another area where Hillary and her kind stand in the way. They’re more concerned about helping their lawyer friends than they are about making medical care more affordable for the little guy.

  104. Anyway, the numbers by themselves leave something to do be desired. They are helpful but I’d like to see more flesh there.

  105. Syloson,

    It became sort of fascinating to me, watching joe flame out like this. I’ve seen it before; he has a problem admitting being wrong and on certain issues, especially those he is most invested in (this being one of them), he just will not back down no matter how much he is getting his ass kicked.

    However, it is a good indication of his objectivity on particular subjects.

  106. Paul,

    It is good that there is a public health insurance system available for that segment of the population. There are no doubt people who take advantage of it.

    I would like to see more of that sort of thing, becasue there continue to be signifant numbers of people with unmet needs.

    Not sure where the baby seals bit comes from.

  107. Episiarch,

    I don’t give a crap about your widdle feelings.

    I haven’t written a word about Cuban health care.

  108. “How come no one offers this as a solution to the lack of health insurance for the working poor?”

    Becasue the working poor’s income tax bill isn’t enough to cover health insurance.

  109. Episiarch,

    That you could find it remotely believable that no one is denied health care in this country just demonstrates your lack of knowledge and objectivity.

    That I don’t care to bang my head against the door and prove what is already widely understood by all who don’t actively strive to be ignorant does not reflect a lack of knowledge on my part.

  110. joe, don’t pull your strawman bullshit with me. I wasn’t part of this discussion other than offering a personal experience.

    I will make this as crystal clear as I can: you are acting like an asshole on this thread. Your attitude is corrosive. Your defensiveness is off the charts.

    This is not meant to be an insult. It is meant to alert you to this and maybe bring you back to earth.

  111. Episiarch,

    I’ll be the first to admit that I am quite ignorant when it comes to health care economics, etc. I will make one tentative claim: healthcare in the “West” is likely better than anywhere else on the planet.

  112. Anyway, it seems to me a lot of what a healthcare system will look like will depend on what a society values. I’ve always gotten the impression that Americans are far more freaked out by cancer than other nationalities, so we may get better outcomes because of that, On the other hand a society which values say “prevention” might have fewer deaths due to say diabetes or some such.

  113. Joe, I don’t believe you understand what I was proposing.

    As I said in my previous comment, IIRC, you don’t actually owe any federal income tax until you start making around $30k.

    For the working poor, presumably those making less the $30k per year, when they filed their 1040s, they would deduct their premiums from the total amount of tax they owed, so if they owed $100 to Uncle Sam, and they had $3000 in insurance premiums for the previous year, they would get $2900 in a refund.

  114. “How come no one offers this as a solution to the lack of health insurance for the working poor?”

    “Becasue the working poor’s income tax bill isn’t enough to cover health insurance.”

    Giuliani has. joe, have you not heard of negative income tax?

  115. How many of the US patients are covered by medicare?

    Without knowing medicare/non-medicare results for the USA, I don’t really find this information useful.

  116. “There are serious problems with assuming that the purchase of health care functions according to the market dynamics you describe.”

    The only time it wouldn’t would be in cases of emergencies when you didn’t have time to shop around. Otherwise, medical services would operate just like any other service. If people shopped around for the best prices, doctors, clinics, and hospitals would have the incentive to come down on their prices. One thing that currently stands in the way is that doctors aren’t allowed to advertise because of AMA regulations against advertising which are obviously intended to keep prices and therefore doctors’ incomes up.

  117. July 1, 1966 Medicare began. 19 million enrolled
    2004: 42 million enrolled in part A and/or B (5 million in Medicare Advantage, part C).

    35 million and change are 65 or order. 6 million and change are non elderly disabled and end stage renal disease patients.

    Part A benefit payments in 2004 was about $168 billion.

    Medicare Part A (“Hospital Insurance”, HI) includes

    Inpatient care coverage, requiring an initial deductible payment, plus copayments for all hospital days following day 60 withina benefit period

    Skilled nursing facility (SNF) care only if it’s within 30 days of a hospitalization of three or more days and certified as medically necessary

    Home Health Agency (HHA) care, including care provided by home health aide

    Hospice, which is provided to terminally ill persons with a life expectancy of six months or less and who elect to forgo standard Medicare benefits and receive only hospice care

    Part B, SMI (Supplementary Medical Insurance) benefits are available to almost all resident citizens 65 and over. It’s optional and requires a monthly premium. Part B covers:

    MD/Surg services (hospital and non hospital settings)

    Some covered services furnished by chiropractors, podiatrists, dentists and optometrists

    Services in an emergency room or outpatient clinic, including same-day surgery and ambulence services.

    (lab tests, e rays, diagnostics, etc not supplied in part A are supplied in Part B).

    In 2004, Part B provided benefits of $135 billion to 39 million people (33 million aged 65 or over; 6 million disabled)

  118. FWIW:

    Kaiser Family Foundation’s report on Medicaid and the Uninsured (PDF) hier

    their take on the issue.

  119. “Of course by now, the French are probably experts in providing medical care to the poor. When one considers they have the highest unemployment rate in western Europe, they must be getting quite a bit of experience. By all means, let us emulate them.”

    A big reason for the chronically high 10% unemployment rates in Western Europe is because the high taxes, made high largely due to socialized medicine, are draining the private sector. Do we really want to bring that here? The American public needs to be informed about these things before we go down that ruinous road.

  120. That’s a good tactic, joe- just grab something you said earlier in the thread and insists it says what I said you won’t say.

    Every single thread on H&R that illustrates some absurdity about government-run healthcare is met with your curled upper lip and righteous indignation. Nothing more.

  121. Cutting checks is something the government does well. Providing services in a manner that meets customer demands is not.This is pretty much a settled question among most Americans

    Yeah, joe, “most Americans” are statists and have closed their minds to the possibility that the government robbing people and giving those ill-gotten gains to people who haven’t earned it isn’t “doing something well”. Majority rule doesn’t necessarily make something right, efficient, or better. Thinking this is a “settled question” in the minds of most Americans doesn’t mean it actually is settled — it means most Americans are wrong and haven’t had the epiphany yet that they are allowing wrong, counterproductive, immoral stuff to happen.

    I mean this in the nicest way, of course. 😉

  122. “And Jake, don’t white Americans at least have similar genes to Europeans? Whats the life expectancy for white Americans vs. Europeans?”

    What about our large minority population that Europeans don’t have? Blacks have a lower comparative life span that skewers our figures lower.

  123. haha, “skewers”….

  124. Morat says:

    Canadian and French systems are considerably better, although I suspect the UK system would undoubtably be considered far superior from the point of view of the 50 million US citizens who don’t have insurance at all.

    It appears that only the uninsured die from cancer in America.

  125. Did I read upthread that non-insured people paying cash pay less for a medical treatment than if they are insured?

    Not in my experience, it hasn’t been. Maybe if I can find a goddamn clinic that refuses to accept insurance at all and cuts down on the paperwork, but at every stinkin’ hospital I’ve been to for tests it’s the uninsured paying cash that pays the top rate.

    Medical costs in the US are nuts. I just ended up paying over $80 for a simple dental cleaning and check-up, no X-rays. And that’s AFTER the discount from BCBS. If I hadn’t had it, the whole thing would have cost over $100. For a friggin’ dental cleaning.

    How much I would have paid in Japan? 2000 yen or so.

    Would it really be all that bad if we could at least get a group of physicians/clinics/insurers together and work to have standard check-ups be cheap, cheap, cheap? This is crazy.

  126. Late to the party.

    1) Sheesh!

    2) Tax breaks are useless. I think Giuliani proposes an “exemption” which reduces taxable income and is therefore useless. A tax credit would be different. Of course, a tax credit would likely get pissed away on food or shoes for the kids or something.

    3) If you’re poor enough, there are programs. If you’re well off or have a good job you have insurance. In between it’s not pretty; you don’t qualify for the program and you can’t afford insurance, even if you can get it.

    4) Medical providers often charge the uninsured MORE than the insured. Really. The bargaining power of a big health plan seems to bring the price down.

    5) I don’t know enough about the original article to respond, but if the issue is screening, then maybe if cancer treatment isn’t all that effective early detection translates to “survived” and late detection translates to “died” when the course of the disease wasn’t all that different. By the way, I’m in favor of screening and early treatment.

    6) Joe, don’t sweat the dypeptics. You make some good points. Maybe not always right, but some good points. This is a nest of ideologues.

    7) Whoever asked — if you have cancer and don’t have insurance (and don’t qualify for a poverty program ), you’re screwed.

  127. “A big reason for the chronically high 10% unemployment rates in Western Europe is because the high taxes, made high largely due to socialized medicine, are draining the private sector. Do we really want to bring that here? The American public needs to be informed about these things before we go down that ruinous road.”

    Rattlesnake Jake, quite likely some truth there. OTOH, medical insurance is a drag directly on our industry, affecting their global competiveness. Of course, medical benefits are getting to be less common. Also, I suspect that wanting to hang on to the insurance keeps some people at jobs that they should leave. I suspect that uncoupling health care from employment would help the economy (but no, just leaving everyone to fend for themselves isn’t it).

  128. Giuliani proposes a $15,000 “exclusion”, whatever that is. Sounds like an exemption, which sounds useless to me.

  129. “There are a whole lot of uninsured U.S. Citizens in our hospitals and clinics, right now, as I speak, getting free healthcare.” I hear this all the time on this H&R, and I call bullshit. Those who criticize private health care and want more of a government role point out that under our system many would be uninsured. THose who worship at the market reply “but the government has programs to take care of them.” Do you guys who make this point see how wrong it is? You’re saying “yeah, the government already plugs the holes in our preferred system, so that shows the government sucks and the private system rules!” Please try again!

  130. Of course our socialist empire will sap some incentive, but there will be plenty of people working in our private market programs. You see the humor from my post above I hope…

    BTW-I found this on France’s five year survival rates:
    “France had the highest five-year survival rate for all cancers (apart from non-melanoma skin cancer): 71% for women and 53% for men.”

    That’s “highest” for European years, but if the years ar comparable we can compare them to the US figures given above: 62.9 for women (lower) and 66.3 for men (higher). So women in France have about a 8% point higher suvival rate while the men have abut a 13% lower survival rate. In this area it seems we’ve got France beat.

  131. So what kind of healthcare systems do the rest of the countries have besides the US and the UK?

    Use the table to mock the NHS, which most healthcare-interested people already know has problems. But it doesn’t do much for a libertarian’s argument for US-style healthcare when the other countries score about as high but certainly pay much less and cover a higher percentage of citizens.

  132. Mr.Nice wrote: “That’s “highest” for European years, but if the years ar comparable we can compare them to the US figures given above: 62.9 for women (lower) and 66.3 for men (higher). So women in France have about a 8% point higher suvival rate while the men have abut a 13% lower survival rate. In this area it seems we’ve got France beat.”

    Only if you don’t take spending and coverage into account.

  133. I come here to learn from libertarians, when they have something to teach me.

    Since libertarians clearly have nothing to teach you on this subject — you haven’t granted the truth of a single thing they’ve said, and their premises go against the plain facts you say are commonly available to anyone sincerely searching — what the heck are you still doing commenting on this thread?

  134. “There are a whole lot of uninsured U.S. Citizens in our hospitals and clinics, right now, as I speak, getting free healthcare.” I hear this all the time on this H&R, and I call bullshit. Those who criticize private health care and want more of a government role point out that under our system many would be uninsured. THose who worship at the market reply “but the government has programs to take care of them.” Do you guys who make this point see how wrong it is? You’re saying “yeah, the government already plugs the holes in our preferred system, so that shows the government sucks and the private system rules!” Please try again!”

    You have used this same bogus line of argument on me before, and in order to do so you had to totally misrepresent my arguments. Several people here (it seems I have to add you to that list) have tried to claim that individuals without insurance get no access to health care at all, none, nada, 0%. This is bullshit. A very large amount of individuals receive non-emergent care via hospital ERs whether you call bullshit or not. This issue of access is the crux of the entire debate and you get it wrong. This is the same reason joe can immediately be discounted when arguing health care.
    Furthermore, I do not recall anyone ever claiming that the government should have absolutely no role at all in health care. It seems you are rebutting an argument no one made. Calling for a limited government role does not contradict one’s criticism of nationalized health care, no matter what tortured logic you employ.

  135. “Paul, do you wait until you get sick enough to go to the emergency room to get your medical care?”

    Jesus Christ this is getting old. There is no level of sickness that one must reach before he can receive care at an ER. Hospital ER’s are required to see you no matter how sick you are, period. Why do I have to tell the same people this over and over and over again, only to have them still not get it. If you do not understand this point and why it is important, you do not belong on a thread discussing health care. Instead you should immediately see a doctor, go to an ER if necessary, and get your mental deficiency diagnosed.

  136. Shush, thug, the grownups are trying to talk.

    Talk to yourself often, joe?

  137. “I haven’t written a word about Cuban health care”

    I hope you mean only in this thread. Because if you mean other threads you are a liar, plain and simple. What’s next, are you gonna claim you didn’t apologize for Chavez’s shuddering of the opposition TV station?

    “That you could find it remotely believable that no one is denied health care in this country just demonstrates your lack of knowledge and objectivity.”

    No one ever claimed 100% access to health care. And even if they did it is no more ludicrous than your seeming belief that in other countries there is in fact 100% access to care.

  138. Furthermore, I do not recall anyone ever claiming that the government should have absolutely no role at all in health care. It seems you are rebutting an argument no one made.

    Chavez is a thug: The government should have absolutely no role at all in health care (or education, or …).

    Sorry to undercut your argument, CIAT, but some of us here don’t like even small amounts of socialism.

  139. I apologize for my misrepresentation of your arguments. However, I believe government needs to have a role if only to certify worker qualifications or to ensure that minimal safety standards are met, etc.
    In many, if not most states, licensure boards perform a lot of those more “menial” duties, but they are still backed by force of law. I guess you could call them quasi-governmental entities.

  140. “The reason why the UN rates the French system so high is due to cost savings and egalitarian considerations. These are important issues to the UN, but of more importance to me are less waiting time, better quality care, better research and development – all areas where the US excells.”

    Amen to that. Very well said. The only egalitarianism in socialized systems is equal representation on a waiting list.

  141. One of my above posts that contained only a quote from joe was meant to also contain a quote from Mr. Nice Guy. I apologize if this caused confusion.

  142. Could somebody double-check my math, I seem to show France having a 67% cancer survival rate overall, but it’s entirely possible that I did the maths incorrectly.

    I used http://ist.inserm.fr/basisrapports/cancer-pronostic/synthese.pdf as my source material.

    That said, even if my math is wrong, I’m left curious about Australia, Females, the causes of the diseases, the ages of those who died, etc.

    After all, if I lived in a country where smoking was prevalent, I’d expect a high incidence of lung cancer to drive down my overall 5-year survival rates. I’d also expect my 5-year survival rates to decrease if I lived in a country with high lifespans, as more of those affected would be in the age group where survival is least likely.

    In short, I don’t think this article is sufficient evidence to come to any conclusions, especially given that cancer survivorship is usually closely linked to the availability of health care at early stages.

    That said, it is likely sufficient to incite confirmation bias from idealogues.

  143. “Furthermore, I do not recall anyone ever claiming that the government should have absolutely no role at all in health care. It seems you are rebutting an argument no one made. Calling for a limited government role does not contradict one’s criticism of nationalized health care, no matter what tortured logic you employ.”
    So yes or no Chavez, is it correct for government to take care of the many people who come to hospitals but who cannot pay because they are uninsured? You count on those progams for your arguments, so do you approve of them, at least in theory? Government has some job to do, right?
    Since you ask, will you move past MANY posters here on H&R and concede that a purely private system will leave many people with no access (a purely private system of COURSE means no laws mandating hospitals to see ANYONE, that is of course government coercion)?
    So in your opinion the gov. has crucial role to play, to pay for the uninsured?
    If the government can pay for that lazy drunk bum down the street to get emergency care, why not for me, who actually pays into taxes (and probably pays for him)?
    “Amen to that. Very well said. The only egalitarianism in socialized systems is equal representation on a waiting list.” Again, thank god there are no waiting lists in our system, where, say, uninsured people are turned down (and if they are not turned down it is not due to your blessed private system but to our gracious government, right?).

  144. “Jesus Christ this is getting old. There is no level of sickness that one must reach before he can receive care at an ER. Hospital ER’s are required to see you no matter how sick you are, period. Why do I have to tell the same people this over and over and over again, only to have them still not get it. If you do not understand this point and why it is important, you do not belong on a thread discussing health care.”
    The government uses its coercion to make sure that people who cannot pay are not turned out on the streets. Do you think this is a good idea that you will support and defend against the likes of jh, whom you fold faster than a laundery mat on Tues., or not? Please answer Chaves. If you think the private system is inherently better, then stop extolling what the gov. does to get help to those who fall w/in the gaps. Fence sitting can be hard on one’s ass…

  145. Beyond that, I find many of the posts in here to be misinformed at best. Such ignorance reached it’s peak when Paul wrote:

    This entire country is awash in free medical care for poor or uninsured, joe.

    This is a statement that could have only been written by somebody who has never been poor, or sick and uninsured.

    It’s almost comic to hear people complaining about relatively minor problems in British and Canadian systems as though they are catastrophic, and then turning around and claiming that the United States is “awash” with health care for the poor and uninsured.

    I understand that some of you simply don’t care about people who have had unfortunate lives for whatever reason, and that’s your right. But please just state outright that you don’t give a fig about poor people, instead of making absurdist claims that the poor have good health care.

  146. Once upon a time in America, back in the bad old days after the big war, the government didn’t help people get medical care. Doctor visits were cheap and insurance was cheap (although most people didn’t need it).

    But then, one day Long Blow Job decided that poor people were being neglected and Ta Dah, forty years later, you have to take a second on your house to pay for an office visit and nobody can afford health insurance.

    The ONLY thing that has changed? Well, shit howdy, it’s government guaranteeing that we all get decent medical care.

    Poor people used to be able to afford medical care. Now, nobody can.

  147. It’s almost comic to hear people complaining about relatively minor problems in British and Canadian systems as though they are catastrophic

    Right, cancer survival, such a trivial measure of a health care system.

    But I definitely agree that things would be much easier if the health care debate were about who cared more.

  148. “It’s almost comic to hear people complaining about relatively minor problems in British and Canadian systems as though they are catastrophic”

    Such as people waiting on long lists for diagnostic tests and operations and end up dieing before they can get that operation or their condition becoming inoperable before they are diagnosed.

  149. Life expectancy is a theoretical calculation that predict the length of life of a child born today. Numerous factors play into the overall life expectancy, such as deaths from accidents, crimes etc. The big factor is perintatal death rates. Only the US uses the strict WHO defination af live births and considers any births that shows evidence of life as a live births. Therefore, the US perinatal death rates are calculated higher than those of other countries. This issue of definition of life also impacts life expectancy and artifically suppresses the US values. Taken these differences into consideration, the US in fact has one of the highest life expectancies.

  150. The uninsured in the U.S. do have access to excellent healthcare. My friend’s daughter is uninsured and received excellent cancer treatment (for free from a teaching hospital) and is now cancer free.

  151. ” I suspect the UK system would undoubtably be considered far superior from the point of view of the 50 million US citizens who don’t have insurance at all. ”

    Not just no, but HELL no. I pay out of pocket for all my medical and dental expenses, but I get some of the best treatment in the world and get it fast. Sure beats waiting 6 months for some bloated tax-funded bureaucracy to provide it.

  152. Don’t forget re: life expectancy, the US murder rate. Most homicides kill people in their 20’s, which has a disproportionate effect on life expectancy.

    If you look at what HEALTH CARE, not what crime does to people, look at post-65 life expectancy. Here the US is third, after Japan and Switzerland, IIRC. Setting aside Japan as unique (diet, etc), the Swiss have a private-insurance based system that consumes 11-12% of GDP, less than the US, but more than the UK/Germany,etc.

    D

  153. “If you look at what HEALTH CARE, not what crime does to people, look at post-65 life expectancy. Here the US is third, after Japan and Switzerland, IIRC.”

    It should also be pointed out that Japan’s system is not a “free” system paid for by taxes. Japanese pay a lot more than Americans in out of pocket expenses for premiums and co-payments.

  154. “Once upon a time in America, back in the bad old days after the big war, the government didn’t help people get medical care. Doctor visits were cheap and insurance was cheap (although most people didn’t need it).”

    Doctor visits were cheap, but then again, the doctor couldn’t do all that much.

    “But then, one day Long Blow Job decided that poor people were being neglected and Ta Dah, forty years later, you have to take a second on your house to pay for an office visit and nobody can afford health insurance.

    The ONLY thing that has changed? Well, shit howdy, it’s government guaranteeing that we all get decent medical care.”

    No, it’s that all this new diagnostic and treatment advances that are available. They cost. Don’t get me wrong, I’m really glad to have them, but they cost.

    And besides, government doesn’t guarantee that we all get decent medical care. Most of it is provided by employer provided insurance. If you’re old enough or poor enough, there are programs. If you’re in between, oh well.

  155. The 50 million number is the number of people who at least once, in the yeat measured, passed at a midnight uninsured.

    Liars on the left use this statistic as if it meant something completely different.

  156. “Considering the number of people who get driven into bankruptcy due to medical costs I really really wonder about that “poor people get health care FREE!””

    The study you are basing your view of the world on was a peice of propaganda worth only lining bird cages with.

    It counted ‘gambling debt’ as a medical expense. It counted losing your job to alcholism as a medical expense. It counted illegal drug abuse as a medical expense.

    And it listed as the cause of bankruptsy, anyone who had at least $1000 worth of medical expenses over the course of two years. So, if you had $30000 in credit card debt, a morgage on a home, and lost your job because of a drinking problem, so long as you had $1000 worth of medical expenses – even ones that you’d paid off – it counted the cause of bankruptsy as ‘medical’. Furthermore, the authors of the study refused to release the amounts of bankruptsy debt carried. So we have no idea what percentage of there claims involved what we might call extraordinary medical expenses (say greater than 15% of your person income in a single year).

    In other words, the authors reached for everything that they could to inflate the numbers for the purposes of thier headline grabber, and then buried the actual data so that it would be difficult to question thier methods. Nonetheless, what you can see of thier data paints a very different picture than what they claim about the data.

  157. I was poor and uninsured for most of my life. Now that I have health insurance, I haven’t a clue what to do with it. I was raised different. Doctors were for when you were dying, and then you went and found the best most expensive one you could because the cheap ones might kill you before they cured you.

    But, all of my experiences with the American medical system have been extraordinarily positive with very few exceptions. I have no complaints whatsoever with the quality of the care or with the structure and even willingness of the system to help you out if you are too poor to pay. You get free care from all sorts of sources – doctors will discount thier services, hospitals will waive fees and help you with payment plans, the government will step in to pay, charities are available.

    There are problems with the system, and I have lots of ideas how to make it better, but none of them involve adopting European style medical systems. In most cases, there simply isn’t a good correspondence between the challenges over here, and the challenges in some European oil state (like Norway), or a small country (like Sweden, Switzerland, or Denmark), and a very expansive, cosmopolitan, high immigration, high risk nation like the US. We need our own solutions, and they certainly don’t involve turning over our medical system to the bozos in FEMA/Congress/etc.

  158. Heh, socialism fails again.

    I find it very unlikely a significant enough number of U.S. citizens are involuntarily going without medical care in the U.S. to the extent that the toll exceeds, per-capita, the excess deaths of citizens being forced to wait for medical care or given substandard care in socialized systems. This data says the uninsured’s plight is not dragging U.S. cancer survivability down even to European levels — and cancer is expensive to treat.

    It’s not just that U.S. hospitals treat everyone who shows up needing care, or that states have their own systems of funding medical care for the poor; there are also all kinds of medical charities, formal and informal, a product of American-style capitalism’s enormous private wealth. These are not hard to come by; in a rural area I lived in for a while, there was a family or ne’er-do-wells notorious for fundraising almost every year for supposedly desperately-needed kidneys or livers.

    I’d be interested to see France’s numbers, but I’d be even more interested in seeing Japan’s.

    After all, if I lived in a country where smoking was prevalent, I’d expect a high incidence of lung cancer to drive down my overall 5-year survival rates.

    Not really. The prevalence of smoking affects the size of the sample (the prevalence of cancer); it doesn’t affect the rate of survival once they have cancer, unless you’re arguing the people with cancer are more likely to continue smoking (against physicians’ advice, one would assume) in one country than another.

    In this area it seems we’ve got France beat.”

    Only if you don’t take spending and coverage into account.

    Well, if we’re achieving higher survival rates with less coverage that suggests universal coverage may not be desirable. Overspending is a problem, but it’s largely a function of the quasi-socialist nature of private insurance, which ensures doctors and patients are both insulated from cost decisions; a true socialised system will either dictate costs, destroying quality as in Britain, or (more likely) exacerbate the problem by further insulating patients and doctors from costs. Also, we’re considerably wealthier than nearly all other major countries — we spend more than anyone else on most other stuff too.

  159. “And besides, government doesn’t guarantee that we all get decent medical care. Most of it is provided by employer provided insurance. If you’re old enough or poor enough, there are programs. If you’re in between, oh well.”

    Let’s help those that are in between, rather than bringing socialized medicine for all. Those who don’t have insurance and can’t afford them could get a tax break to purchase a good catastrophic policy.

  160. Rattlesnake Jake said:
    “Let’s help those that are in between, rather than bringing socialized medicine for all. Those who don’t have insurance and can’t afford them could get a tax break to purchase a good catastrophic policy.

    Jake, we might be able to negotiate. A tax credit (not deduction) and access to a group plan (for rates and availability) would go a long way.

    I still think I see trouble on the horizon with the employment benefit approach, since more employment is coming without medical benes, but, yes, your suggestion is something that could be worked with.

  161. Beyond that, I find many of the posts in here to be misinformed at best. Such ignorance reached it’s peak when Paul wrote:

    This entire country is awash in free medical care for poor or uninsured, joe.

    This is a statement that could have only been written by somebody who has never been poor, or sick and uninsured.

    Kevin, read my posts where I link to all the free healthcare you can get. Until then, shut up.

  162. Yes, by all means let’s go to a system like Great Britain. Then all of you can have the experience I had when “treated” there, which led to the loss of the central vision in my right eye at age 41, because they don’t bother to run fluorescent dye angiograms there when people have blurred sight.

    Had I been in the US, they’d have run one at the cost of several hundred dollars, and I’d have been treated with the newest laser therapy and BE ABLE TO F*CKING SEE FOR THE NEXT 40+ YEARS.

    And I assume you’ve all seen the recent article about the woman in the UK who was forced to GIVE BIRTH IN A TOILET, aided only by her mother, because no one would help her, since she was in the wrong ward or the wrong nurse was on duty or some g*ddamn thing.

    Or the article about the rampant hospital-acquired infection rates in the public UK hospitals versus the zero rate-of-infection in the private hospitals.

    Or how a neonatal unit in a Montana town of 55,000 had to handle the birth of quads of a Canadian mother, because the ENTIRE COUNTRY OF CANADA (30,000,000 people) didn’t have the facilities.

    You can take your public medical care and shove it sideways. Idiots.

  163. “Or the article about the rampant hospital-acquired infection rates in the public UK hospitals versus the zero rate-of-infection in the private hospitals.”

    What is the percentage, Chester?

  164. My friend is a drummer in a band that went up to Canada to do a show. While partying after the show he got a terrible nose bleed that wouldn’t stop. A fan of the show gave my friend his medical card, so my friend went to the hospital with this guy’s card & got free medical treatment – no questions asked… Imagine all the free health care we’d be giving out if we went to Communist Health care. Not to mention all the hypocondriacs we have in this country that would be going to the doctor for every little thing…

  165. The asshole factor starts when “my doctor” becomes “the medical industry,” quickly followed by “our national healthcare system.” Once that happens, we’re all assholes. It isn’t ours, it isn’t national (until we force it to be so), and it sure as hell is not a system.

    I just want to do business with my doctor. However the hell they do it in Europe? I don’t want that. Did “we” learn anything from “Our National Educational System” or “Our National Auto Industry” or “Our National Energy System”? I think “Our National Communists” are really having “our” way with this shit.

  166. IN REGARDS TO FREE CARE IN THE USA. MANY AREAS HAVE 6MONTHS TO A YEAR WAITING LIST FOR A FIRST APPT FOR CLINIC. ALSO, YOU CANNOT MEDICAID AND HAVE MORE THAN 2500 DOLLARS ASSESTS. THIS INCLUDES A HOME OR CAR. THIS WOULD TOTALLY PUT THE SCRUNCH ON ANYONE WHO IS TEMPORARY OUT OF WORK OR DISABLED AND WAITING FOR SSD (WHICH CAN TAKE YEARS TO GET.)
    SSD CAN ONLY BE COLLECTED 24 MONTHS AFTER BEING ON SOCIAL SECURITY DISABILITY. MANY WAIT 3-4 YEARS FOR THAT.
    REGARDING HOSPITAL EMERGENCY CARE:: THE MAJORITY OF MEDICAL CARE IS OUT PATIENT TREATMENTS AND PREVENTIVE. THEY ARE NEVER DONE IN THE ER. THEREFORE, MUCH CARE CANNOT BE ACCESSED BY MANY.
    AND HERE ARE SOME OTHER FACTS: OVER 50 PERCENT OF OUR BANKRUPTCIES ARE DUE TO MEDICAL BILLS. OUT OF THOSE, OVER 50 PERCENT HAD INSURANCE, WHAT DOES THIS MEAN? THAT THE INSURANCE FAILED THEM GREATLY!
    INSURANCE COMPANIES FORCE YOU TO STAY OR RESIDE IN ONE AREA. FOR INSTANCE. MANY WILL NOT COVER OUT OF YOUR ZONE. MANY LIKE TO SPEND MONTHS IN OTHER AREAS. THEY WOULD NOT BE COVERED BY MOST POLICIES TODAY. YEARS AGO, YOUR INSURANCE COVERED YOU ANYWHERE AND EVERYWHERE.
    YOUR INSURANCE ALSO WILL NOT COVER YOU OUT OF THE COUNTRY USUALLY.
    SENIORS AND DISABLED DO NOT GET DENTAL CARE OR OPTICAL. IF THEY CANNOT AFFORD IT, THEY CANNOT GO TO A DENTIST. TRY LIVING WITH SEVERE TOOTH PAIN! DENTAL CARE IS ALSO ESSENTIAL FOR THE GENERAL HEALTH OF THE BODY.
    THE UNINSURED USUALLY CANNOT AFFORD DENTAL CARE AND THEREFORE GET VERY LITTLE OR NONE
    THERE ARE COUNTRIES THAT HAVE BETTER ACCESSIBILTY THAN WE DO, NO DOUBT.
    HOWEVER, IF WE CAN GIVE THE WORLD 2.5 BILLION DOLLARS YEARLY FOR THEIR HEALTHCARE AND ALL THE OTHER BILLIONS WE GIVE AWAY. WE CAN MAKE A FAR BETTER HEALTHCARE SYSTEM HERE FOR ALL.
    OUR ECONOMY AND BUSINESS BASE HAS CHANGED FROM LARGE CORPS TO SMALL BUSINESS. THEY ARE THE LEAST LIKELY TO BE ABLE TO AFFORD INSURING EMPLOYEES. THIS PROBLEM WILL ONLY ESCALATE IN THE FUTURE. SOMETHING NEEDS TO BE DONE

  167. ramster | August 21, 2007, 2:49pm | #
    “Given that there’s been much discussion above on being uninsured, I’m curious about something. What the hell do you do in the US if you’re uninsured and get cancer? (I’m genuinely curious, I’m Canadian and I have no idea).”

    There are “Hill-Burton” hospitals in every major region that are federally funded and cannot turn patients away. There are also state cancer funds. I know. My mother has survived 12 years from breast and lung cancer thanks to them. Unbeknownst to me, she allowed her insurance to lapse in her 50’s after she lost her job at a large corporation that was downsizing and could not find a new one that would provide her health insurance.

  168. Can we just have CHRIS’s all caps rant deleted? Not only is it an eye sore, but its inaccurate to the point of being either deliberately counter-factual or the product of someone that needs to be on medication.

    But just some facts to counter that silliness because Europeans (not knowing any better) tend to take it for fact.

    1) The longest wait I’ve ever experienced to get into a clinic without an appointment was an hour and a half. The longest wait I’ve ever experienced to see a specialist was 4 weeks, and that only because it wasn’t a life threatening issue.
    2) Medicaid availability is based on income, not on total assets. I think the household income cut off point is somewhere around $35,000.
    3) SSD is a type of supplementary income – ei a form of welfare. While you can have a serious discussion about that, it wouldn’t be a discussion about the availability of health care.
    4) I’ve already previously debunked the ‘study’ that supposedly indicated that half of all bankruptsies are the result of medical bills. See my August 22, 2007, 1:06pm post.
    5) The problem most people have with insurance is that they don’t want insurance – they want something for nothing. The real problem with insurance is that it raises the total cost of health care. This is true whether the insurance is private or publicly funded. To see why this is true, simply note that the salaries of everyone involved in the health insurance industry (whether private employees or public ones) all other associated costs of running offices must be added to the total cost of health care in the country in question, and that this burden is then divided amongst all the users of the system. It’s fairly easy then to see that each insurance enrollment increases the cost of medical care incrementally, and therefore increases either the number of people now no longer able to afford it. The end result is a highly inefficient system and lots of inefficient entitlements to try to cover that. Add to that that any such system will attract corruption (especially if it is a public system, 20-30% of Medicaid costs are estimated to be fraudulent), and you end up with really expensive medical care. Consider the problem of dental insurance. An insurance seller, whether a private firm or a government (with the power to force you to pay for the insurance), takes in a certain amount of money, pays its costs, and then distributes the rest. In the case of dental insurance that covered reutine checkups, cleaning, and small repair – all of which has a very regular payout and payout period across the population – insurance quickly comes to resemble a loan. Although you are paying into the fund, the insurance company is taking a percentage of it, and then returning to you the remainder at the time of the care. The nasty truth about insurance is that on the aggregate, the total cost of the insurance ALWAYS exceeds the total cost of the care it provides. On aggregate, people would always be better off saving thier money to pay for thier own care, collecting interest on thier investments, and then paying for care, than they would be to pay for insurance. The reason that dental insurance is not offered, is that you can’t make money on it. And I’m glad that its not offered, because it would be a scam. The question then becomes, how do we pay for dentistry if not an insurance program? And that is an interesting question that completely escapes our ranter.
    5a) The best argument against voluntary insurance is that it is a market for lemons and thus unlikely to work according to the Adam Smith model of a functioning capitalist system. However, that is entirely above the head of anyone that writes in all caps with punctuation that at best can be called periodic.
    6) You have no idea how much I hate the phrase ‘something needs to be done’? More evil has been done in the name of ‘something needs to be done’, than any other vice of the human species.

  169. Medicaid requirement vary by household composition and state. Yes there are resource limits. Your house, 1 vehicle, and burial fund (possibly) are protected.

    Insurance doesn’t make sense for samllish routine predictable expenses. You need it for large unpredictable expenses. You’re right, the insurance industry is a major source of expense for the medical system. That’s why some people wouldn’t mind seeing it gone.

    Chris would do better to use mixed case, but don’t waste yer time bitchin about it.

  170. I’m Canadian and Canada has the BEST cancer treatment in the world!

    It is called “we’ll put you on the waiting list for treatment”

  171. Let me second celebrim’s point on Medicaid — my mother had cancer when I was in college, and she received Medicaid even though her and my dad were both employed. (Ironically, Medicaid is considered income for purposes of financial aid, so it prevented me from receiving aid and I ended up working full-time to pay my way through school).

  172. If some Canadians only had to wait 6 months for treatment for serious conditions they would be very happy.
    Those who can afford to, and who want prompt treatment, go South of the Border for excellent care.

  173. 1) Most of the cross-country studies intentionally over-emphasize equity over effectiveness.

    2) The U.S. is far superior to Canada in wait times, and to most Continental systems in delivering advanced diagnostic technologies and new drugs.

    3) The U.K. is unhealthy compared with the U.S.

    4) Despite real problems with universality in America, most coverage gaps are ephemeral and Medicare broader than believed; the commonly-touted bankruptcy statistic is significantly overstated.

    5) The “cure” for U.S. healthcare is more of the market — to correct the tax code’s unwise linkage between health insurance and employment — not more government.

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