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About that "World's Best Healthcare System" the U.S. is supposed to have...

BigTreeDeac said:
Gotcha, misinterpreted your point a bit. You are correct that certain ethnicities have increased incidence rates of various genetic disorders. However this is because a vast majority of genetic disorders are recessive meaning both alleles must have the altered gene in order to get disease. The isolated (and resulting inbred) nature of certain populations results in the increased risk. As you outbreed, you lower that risk because fewer and fewer individuals end up carrying the disease allele which results in fewer and fewer homozygous recessive individuals. This obviously doesn't apply to dominant genetic disorders but they are a minor fraction of total diseases. So on average, the more heterogeneous a population is the lower the rates of these types of diseases.

I will grant you it can be difficult to compare health outcomes between countries that have vastly different population/genetic dynamics. However if one was to seek to determine if heterogeneity positively or negatively impacted disease occurrence and health outcomes, there would be far more support (history/dogmas of genetics, research, case studies, etc) supporting the notion that increased heterogeneity positively impacts it. Much tougher sell the other way.
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Yeah, I get what you are saying with respect to a particular disease. But if you take all diseases, across all ethnicities, and combine them all (or at least many) in one place, that would seemingly create a much higher amount of possible permutations of disorders for that country's healthcare system to deal with that impact other afflcitions (i.e. does someone with Sickle Cell have a different heart disease or cancer treatment/outcome than someone without?). Whereas if you are dealing with a homogeneous population with a relatively limited number of genetic disorders, then your treatment/outcome is going to be relatively consistent even though you may have higher concetrations of a handful of particular disorders, because there are less variables in play.
 
And I am making the same general point about nutrition. If you have a Japanese citizen who has grown up eating a traditional Japanese diet, then you know genreally what has gone into it. Obviously no two people eat the same thing, but you can generally extraplate it over a population. But if you take an American citizen who has grown up eating an American diet, you have really no idea what is in it, because what is an American diet? So it is hard enough to remove the variables as to other Americans, but then trying to compare that American population's health history/treatment/outcomes with other countries as to a particular disease or diseases, and attempting to explain away that nutrition variable is just a complete crapshoot when looking at it from the perspective of what the respective health care systems are having to address in their starting point for care.
 
TownieDeac said:
No, my understanding is that the opposite is true. Outbreeding (via sexual/epidemiological heterogeneity) fosters genetic diversity, which is good for population health. I don't think there's any epidemiological evidence to suggest that ethnic or genetic or phenotypic homogeneity has an effect on outcomes.
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You're kind of making my point for me. I'm talking about the impact of that genetic diversity on the afflictions that actually affect life span, like heart diease, cancer, etc (not the genetic makeup itself). That diversity is the starting point from which the health care system has to address the affliction. If you are a doctor facing a new American patient with heart disease or cancer, you're dealing with that built-in diversity and not knowing exactly how that particular body is going to react to the treatment. In a more homogeneous society, you have a much more consistent idea of the effects of the treatment.
 
Agreed, but we're not there yet. Which is why, IMO, it is dumb to just say "France treats cancer better than the US because a bar graph says so." We have no way to reliably know at this time.
 
Many people have looked at the Medicare efficiency numbers and tried to bend them around to make private insurance look better. I posted an article earlier in this thread by a private insurance advocate and he was only able to bend the numbers to get Medicare to about 8% admin and bend the private numbers down to get theirs to 17%, and then try to explain how good it is for consumers that the private insurers are spending that overhead on "process improvement" (i.e., claim avoidance). The Cato article posted manages to bend them even further - but Cato is no way a neutral observer here, they are a libertarian/very conservative think tank with a strong political pressure arm, funded in large part by the Kochs. In order to bend those numbers, they go and pull all kinds of other government agency spending into Medicare and then put a multiple on the spending by counting the alleged inefficiency of tax collection and its impact on the economy, etc. etc. The ol' kitchen sink approach - discredit government at all costs!

Put aside the question of Medicare vs. US private insurers for a moment and just look at the raw GDP numbers of peer states with single-payer systems. They are all spending much lower percentages of total GDP and per capita amounts on healthcare, and almost all of them actually spend a smaller percentage of their total government outlays on healthcare than the US! http://www.oecd.org/unitedstates/Briefing-Note-USA-2013.pdf

However, the overall level of health spending in the United States is so high that public (i.e. government)
spending on health per capita is still greater than in all other OECD countries, except Norway and the
Netherlands. Public spending on health in the United States has been growing more rapidly than private
spending since 1990, largely due to expansions in coverage.
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What this tells me is that Medicare is operating within a badly flawed system. Medicare could do a better job, sure, but it is still doing a better job of cost containment than private insurers, and if it were allowed to negotiate drug pricing (like Euro single payers do) it could do even better. http://www.usatoday.com/story/opinion/2014/04/20/medicare-part-d-prescription-drug-prices-negotiate-editorials-debates/7943745/ Do you think maybe the reason Medicare is not as efficient as it could be has something to do with all the lobbyists in DC representing people that have a vested interest in keeping Medicare inefficient, making sure it pays high prices for drugs and medical devices, and maximizing doctor and hospital income?

To conclude:
1. The overall US private and public insurance healthcare system is drastically under performing the world on cost-effectiveness. There can be no question about this.
2. Arguably, health outcomes in many of these countries are significantly better than the US. Certainly, none of them are significantly underperforming the US. Quibble about McDonald's all you want, all you are doing is trying to find some excuse to justify your ideological unwillingness to face up to the science. Nobody has yet taken me up on my offer to post a link to any source, credible or otherwise, countering the studies I have posted.
3. All the other competitors in the contest are running some form of government single payer system.

How on earth can anyone conclude that best way to control healthcare costs is to do the OPPOSITE of what everyone else is doing? If the US private insurance system is so efficient and so good at cost containment and is spending all that overhead to improve its product and help the insureds (and seriously, give me a break, really?) why are all those inefficient government bureaucracies around the world beating the pants off our system?

I used to believe in the libertarian, free the market concepts on healthcare and I thought the McCain plan was good in 2008. That was before I learned just how serious the gap is between the US system and the single payer systems around the world. The more I learn about it, the more convinced I am that the only way to get health spending under control and deliver quality care to all Americans is some kind of single-payer system.
 
Deacon923 said:
Many people have looked at the Medicare efficiency numbers and tried to bend them around to make private insurance look better. I posted an article earlier in this thread by a private insurance advocate and he was only able to bend the numbers to get Medicare to about 8% admin and bend the private numbers down to get theirs to 17%, and then try to explain how good it is for consumers that the private insurers are spending that overhead on "process improvement" (i.e., claim avoidance). The Cato article posted manages to bend them even further - but Cato is no way a neutral observer here, they are a libertarian/very conservative think tank with a strong political pressure arm, funded in large part by the Kochs. In order to bend those numbers, they go and pull all kinds of other government agency spending into Medicare and then put a multiple on the spending by counting the alleged inefficiency of tax collection and its impact on the economy, etc. etc. The ol' kitchen sink approach - discredit government at all costs!

Put aside the question of Medicare vs. US private insurers for a moment and just look at the raw GDP numbers of peer states with single-payer systems. They are all spending much lower percentages of total GDP and per capita amounts on healthcare, and almost all of them actually spend a smaller percentage of their total government outlays on healthcare than the US! http://www.oecd.org/unitedstates/Briefing-Note-USA-2013.pdf



What this tells me is that Medicare is operating within a badly flawed system. Medicare could do a better job, sure, but it is still doing a better job of cost containment than private insurers, and if it were allowed to negotiate drug pricing (like Euro single payers do) it could do even better. http://www.usatoday.com/story/opinion/2014/04/20/medicare-part-d-prescription-drug-prices-negotiate-editorials-debates/7943745/ Do you think maybe the reason Medicare is not as efficient as it could be has something to do with all the lobbyists in DC representing people that have a vested interest in keeping Medicare inefficient, making sure it pays high prices for drugs and medical devices, and maximizing doctor and hospital income?

To conclude:
1. The overall US private and public insurance healthcare system is drastically under performing the world on cost-effectiveness. There can be no question about this.
2. Arguably, health outcomes in many of these countries are significantly better than the US. Certainly, none of them are significantly underperforming the US. Quibble about McDonald's all you want, all you are doing is trying to find some excuse to justify your ideological unwillingness to face up to the science. Nobody has yet taken me up on my offer to post a link to any source, credible or otherwise, countering the studies I have posted.
3. All the other competitors in the contest are running some form of government single payer system.

How on earth can anyone conclude that best way to control healthcare costs is to do the OPPOSITE of what everyone else is doing? If the US private insurance system is so efficient and so good at cost containment and is spending all that overhead to improve its product and help the insureds (and seriously, give me a break, really?) why are all those inefficient government bureaucracies around the world beating the pants off our system?

I used to believe in the libertarian, free the market concepts on healthcare and I thought the McCain plan was good in 2008. That was before I learned just how serious the gap is between the US system and the single payer systems around the world. The more I learn about it, the more convinced I am that the only way to get health spending under control and deliver quality care to all Americans is some kind of single-payer system.
Click to expand...

where the fuck is lectro?
 
Deacon923 said:
Many people have looked at the Medicare efficiency numbers and tried to bend them around to make private insurance look better. I posted an article earlier in this thread by a private insurance advocate and he was only able to bend the numbers to get Medicare to about 8% admin and bend the private numbers down to get theirs to 17%, and then try to explain how good it is for consumers that the private insurers are spending that overhead on "process improvement" (i.e., claim avoidance). The Cato article posted manages to bend them even further - but Cato is no way a neutral observer here, they are a libertarian/very conservative think tank with a strong political pressure arm, funded in large part by the Kochs. In order to bend those numbers, they go and pull all kinds of other government agency spending into Medicare and then put a multiple on the spending by counting the alleged inefficiency of tax collection and its impact on the economy, etc. etc. The ol' kitchen sink approach - discredit government at all costs!

Put aside the question of Medicare vs. US private insurers for a moment and just look at the raw GDP numbers of peer states with single-payer systems. They are all spending much lower percentages of total GDP and per capita amounts on healthcare, and almost all of them actually spend a smaller percentage of their total government outlays on healthcare than the US! http://www.oecd.org/unitedstates/Briefing-Note-USA-2013.pdf



What this tells me is that Medicare is operating within a badly flawed system. Medicare could do a better job, sure, but it is still doing a better job of cost containment than private insurers, and if it were allowed to negotiate drug pricing (like Euro single payers do) it could do even better. http://www.usatoday.com/story/opinion/2014/04/20/medicare-part-d-prescription-drug-prices-negotiate-editorials-debates/7943745/ Do you think maybe the reason Medicare is not as efficient as it could be has something to do with all the lobbyists in DC representing people that have a vested interest in keeping Medicare inefficient, making sure it pays high prices for drugs and medical devices, and maximizing doctor and hospital income?

To conclude:
1. The overall US private and public insurance healthcare system is drastically under performing the world on cost-effectiveness. There can be no question about this.
2. Arguably, health outcomes in many of these countries are significantly better than the US. Certainly, none of them are significantly underperforming the US. Quibble about McDonald's all you want, all you are doing is trying to find some excuse to justify your ideological unwillingness to face up to the science. Nobody has yet taken me up on my offer to post a link to any source, credible or otherwise, countering the studies I have posted.
3. All the other competitors in the contest are running some form of government single payer system.

How on earth can anyone conclude that best way to control healthcare costs is to do the OPPOSITE of what everyone else is doing? If the US private insurance system is so efficient and so good at cost containment and is spending all that overhead to improve its product and help the insureds (and seriously, give me a break, really?) why are all those inefficient government bureaucracies around the world beating the pants off our system?

I used to believe in the libertarian, free the market concepts on healthcare and I thought the McCain plan was good in 2008. That was before I learned just how serious the gap is between the US system and the single payer systems around the world. The more I learn about it, the more convinced I am that the only way to get health spending under control and deliver quality care to all Americans is some kind of single-payer system.
Click to expand...

I wont argue with the part of your conclusion on single payors ability to control cost/access though it has 0% chance of happening anytime soon in the US. Many single payer proponents underestimate (or ignore) the huge challenge it would be to overlay that system into the cultural & economic fabric of the american health system. And lets face it. The fed's track record here (ACA roll out, Medicaid, VA management, etc) is beyond horrible. One might argue we don't do government health care well (just like some parts of the world don't do democracy well). The american health care consumer is very different than in most other counties. Its just overly simplistic to argue single payor would work here since it "works there".

I also take exception to your point on the efficacy of the Medicare system vs private pay. Medicare is a major cause of the flawed US system, not just merely operating within its confines. I'm not sure how we can rationally say Medicare is doing a better job at controlling costs. As I've said before, Medicare sets reimbursement rates (unlike private payors who need to negotiate). But they have 0 track record controlling utilization. In fact, they've done the exact opposite (and one of the reasons we got Part C thought that has become a mess).

Govt could certainly negotiate lower drug costs (even though each Part D carrier negotiates today). But just as we've seen with Medicare doc reimbursement, we'd see more cost shifting to private pay. Just squeezing the balloon. And I for one feel like I've subsidized enough of the Part D market (i.e. Part D premiums are already 75%+ subsidized).
 
I just want to say that I am grateful for CH posting here. There is so much lack of knowledge yet posting bravado that it boggles the mind. It is like everyone is channeling their inner RJ. BTW, because a poll says a group of people are satisfied with medicare, does not make it a good product. It would be like saying prisoners LOVE yard time. That does not make jail a good place to be.
 
Sgt Hulka said:
I just want to say that I am grateful for CH posting here. There is so much lack of knowledge yet posting bravado that it boggles the mind. It is like everyone is channeling their inner RJ. BTW, because a poll says a group of people are satisfied with medicare, does not make it a good product. It would be like saying prisoners LOVE yard time. That does not make jail a good place to be.
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Who specifically is doing that?
 
I Don't care enough about this place anymore to go back through the 10 pages. but thanks for disseminating!

Have a great weekend!
 
Sgt Hulka said:
I Don't care enough about this place anymore to go back through the 10 pages. but thanks for disseminating!

Have a great weekend!
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Eh, you care enough to make the proclamation that the poster that you agree with must be right and anyone who disagrees with him is basically rjkarl. Great stuff!
 
CHDeac said:
I wont argue with the part of your conclusion on single payors ability to control cost/access though it has 0% chance of happening anytime soon in the US. Many single payer proponents underestimate (or ignore) the huge challenge it would be to overlay that system into the cultural & economic fabric of the american health system. And lets face it. The fed's track record here (ACA roll out, Medicaid, VA management, etc) is beyond horrible. One might argue we don't do government health care well (just like some parts of the world don't do democracy well). The american health care consumer is very different than in most other counties. Its just overly simplistic to argue single payor would work here since it "works there".

I also take exception to your point on the efficacy of the Medicare system vs private pay. Medicare is a major cause of the flawed US system, not just merely operating within its confines. I'm not sure how we can rationally say Medicare is doing a better job at controlling costs. As I've said before, Medicare sets reimbursement rates (unlike private payors who need to negotiate). But they have 0 track record controlling utilization. In fact, they've done the exact opposite (and one of the reasons we got Part C thought that has become a mess).

Govt could certainly negotiate lower drug costs (even though each Part D carrier negotiates today). But just as we've seen with Medicare doc reimbursement, we'd see more cost shifting to private pay. Just squeezing the balloon. And I for one feel like I've subsidized enough of the Part D market (i.e. Part D premiums are already 75%+ subsidized).
Click to expand...

Canada's health system was exactly the same as ours until about 1980. The issue is political will and special interest capture of US policymakers, not cultural and economic differences.

No system is perfect and every system has to make sense in its own cultural context. But the system we have now is manifestly broken. Obamacare doubles down on a broken system. Going the other direction, to a more "free market" system, doesn't make sense for two macro reasons: (1) the opposite approach works better in every comparable nation, and (2) there is no reason to believe that anything remotely close to a well-functioning market can work in the healthcare context. The goods are all credence goods, there is an unbridgeable information chasm between seller and buyer, and the goods themselves are often unaffordable by even the wealthiest consumers.

The rest of your post is your opinion. I have asked, and I renew the invitation, for you to post some links to good material backing up your opinion. I am genuinely interested in learning more about Medicare and healthcare policy overall. We're 10 pages in, and almost no one has posted a link to back up anything they've opined on. In any case, I would not advocate for expanding Medicare as currently structured to all Americans. I would advocate for taking the best ideas from the rest of the OECD, who have operated very successful laboratories for us the last 50 years, and structuring a new system that makes sense.
 
There is no doubt that patient satisfaction metrics in the US system are quite problematic. My brother, an ER doc, has a lot of stories about patient satisfaction scores being skewed by whether or not he is willing to dole out pain meds to drug seekers. Nonetheless I think there is an apples and oranges problem here. US patient satisfaction studies happen in an environment of heavy drug marketing and fee for service treatment. Other countries vary, but generally speaking drug marketing and incentives for overtreatment are quite different in other OECD countries. I don't discount the problems with patient satisfaction numbers; it's just one of several metrics that all add up to a pretty compelling case that a single-payer type system is superior to the US system, when compared across multiple countries with different variations on the theme of healthcare as a public good.
 
Sgt Hulka said:
I just want to say that I am grateful for CH posting here. There is so much lack of knowledge yet posting bravado that it boggles the mind. It is like everyone is channeling their inner RJ. BTW, because a poll says a group of people are satisfied with medicare, does not make it a good product. It would be like saying prisoners LOVE yard time. That does not make jail a good place to be.
Click to expand...

But a poll almost certainly reveals that the redsk*ns mascot is not offensive. #knowyourmethodology
 
Deacon923 said:
Canada's health system was exactly the same as ours until about 1980. The issue is political will and special interest capture of US policymakers, not cultural and economic differences.

No system is perfect and every system has to make sense in its own cultural context. But the system we have now is manifestly broken. Obamacare doubles down on a broken system. Going the other direction, to a more "free market" system, doesn't make sense for two macro reasons: (1) the opposite approach works better in every comparable nation, and (2) there is no reason to believe that anything remotely close to a well-functioning market can work in the healthcare context. The goods are all credence goods, there is an unbridgeable information chasm between seller and buyer, and the goods themselves are often unaffordable by even the wealthiest consumers.

The rest of your post is your opinion. I have asked, and I renew the invitation, for you to post some links to good material backing up your opinion. I am genuinely interested in learning more about Medicare and healthcare policy overall. We're 10 pages in, and almost no one has posted a link to back up anything they've opined on. In any case, I would not advocate for expanding Medicare as currently structured to all Americans. I would advocate for taking the best ideas from the rest of the OECD, who have operated very successful laboratories for us the last 50 years, and structuring a new system that makes sense.
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Excellent post.
 
A friend of mine recently had a serious medical problem that was initially treated with two inexpensive antibiotics. His initial problem got better, but he developed intractable nausea and vomiting. His doctor then switched him to one very expensive medication which worked well and did not cause nausea at all. A couple of weeks ago while we were together in a country with a single-payer system he developed a recurrence and we visited a local doctor who prescribed the two inexpensive medicines. That doctor did not know of and could not obtain for us the more expensive medicine with tolerable side effects. My friend, retired military, suffered awful nausea and vomiting for several days until we could find a US DOD facility where he secured the better medicine.

What struck me most about this incident is that were my friend a citizen of that country he probably would not even know that there was an alternative to constant nausea. He would think that he was getting high quality, efficient medical care. What you want when you are sick is many, many options. A free country is the best place to get the most options. Although our health care has been wrecked by Medicare and Medicaid, it is still better than the "single payer" BS.
 
tjcmd said:
A friend of mine recently had a serious medical problem that was initially treated with two inexpensive antibiotics. His initial problem got better, but he developed intractable nausea and vomiting. His doctor then switched him to one very expensive medication which worked well and did not cause nausea at all. A couple of weeks ago while we were together in a country with a single-payer system he developed a recurrence and we visited a local doctor who prescribed the two inexpensive medicines. That doctor did not know of and could not obtain for us the more expensive medicine with tolerable side effects. My friend, retired military, suffered awful nausea and vomiting for several days until we could find a US DOD facility where he secured the better medicine.

What struck me most about this incident is that were my friend a citizen of that country he probably would not even know that there was an alternative to constant nausea. He would think that he was getting high quality, efficient medical care. What you want when you are sick is many, many options. A free country is the best place to get the most options. Although our health care has been wrecked by Medicare and Medicaid, it is still better than the "single payer" BS.
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Sorry to hear your friend doesn't live in a state where medical marijuana is legal.
 
Deacon923 said:
There is no doubt that patient satisfaction metrics in the US system are quite problematic. My brother, an ER doc, has a lot of stories about patient satisfaction scores being skewed by whether or not he is willing to dole out pain meds to drug seekers. Nonetheless I think there is an apples and oranges problem here. US patient satisfaction studies happen in an environment of heavy drug marketing and fee for service treatment. Other countries vary, but generally speaking drug marketing and incentives for overtreatment are quite different in other OECD countries. I don't discount the problems with patient satisfaction numbers; it's just one of several metrics that all add up to a pretty compelling case that a single-payer type system is superior to the US system, when compared across multiple countries with different variations on the theme of healthcare as a public good.
Click to expand...

So to recap: patient satisfaction numbers are unreliable, we can't accurately account for genetic differences across countries, we can't accurately account for nutrition variation across countries, the government health care programs we already have are ripe with fraud and utilization issues, and nobody wants anybody making less than $100k/year to pay more for anything because we need to just stick it all on The Man, but we are supposed to accept that (a) despite being unable to account for these extremely important variables we are supposed to just accept that some websites indicating single-payer systems "work" better than ours (whatever that means) performed by admittedly biased groups hold any grain of truth or applicability; and (b) it is possible for us to implement an even remotely well-functioning single-payor system akin to a Euro model given our last attempt at healthcare reform has been nothing less than a complete shitshow despite anyone with an ounce of common sense knowing well in advance that it was going to be a complete shitshow. Sounds great to me!

Look, nobody says that our current system is well-functioning. It is a disaster. But at the same time, as Ch points out, single-payer is simply not going to work here for a variety of cultural, political, and economic reasons that simply do not exist in other countries. The best way for us to start to control healthcare costs is to shift our national focus to nutrition and exercise to reduce our need for health care in the first place so that it is focusing on the truly unpreventable and the end-of-life process, and to link the cost of treatment with the cause of the problems. As I've mentioned before, there are ways to work within our current system to do just that, which are significantly easier and more likely to succeed than trying an overhaul to a single payer system.
 
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