Rank Ranking

by Don Boudreaux on August 23, 2007

in Health, Myths and Fallacies

John Stossel of ABC News writes a regular column.  Every one is worth reading.  His most recent column exposes some of the flaws in those now-celebrated rankings that purport to find that medical care in the U.S. is inferior to that in countries such as France, Morocco, and Cyprus.

Here’s a chunk of Stossel’s column:

So what’s wrong with the WHO and Commonwealth Fund studies? Let me count the ways.

The
WHO judged a country’s quality of health on life expectancy. But that’s
a lousy measure of a health-care system. Many things that cause
premature death have nothing do with medical care. We have far more
fatal transportation accidents than other countries. That’s not a
health-care problem.

Similarly,
our homicide rate is 10 times higher than in the U.K., eight times
higher than in France, and five times greater than in Canada.

When you
adjust for these "fatal injury" rates, U.S. life expectancy is actually
higher than in nearly every other industrialized nation.

Diet and lack of exercise also bring down average life expectancy.

Another
reason the U.S. didn’t score high in the WHO rankings is that we are
less socialistic than other nations. What has that got to do with the
quality of health care? For the authors of the study, it’s crucial. The
WHO judged countries not on the absolute quality of health care, but on
how "fairly" health care of any quality is "distributed." The problem
here is obvious. By that criterion, a country with high-quality care
overall but "unequal distribution" would rank below a country with
lower quality care but equal distribution.

It’s when this so-called "fairness," a highly subjective standard, is factored in that the U.S. scores go south.

The U.S.
ranking is influenced heavily by the number of people — 45 million —
without medical insurance. As I reported in previous columns, our
government aggravates that problem by making insurance artificially
expensive with, for example, mandates for coverage that many people
would not choose and forbidding us to buy policies from companies in
another state.

Even with
these interventions, the 45 million figure is misleading. Thirty-seven
percent of that group live in households making more than $50,000 a
year, says the U.S. Census Bureau. Nineteen percent are in households
making more than $75,000 a year; 20 percent are not citizens, and 33
percent are eligible for existing government programs but are not
enrolled.

(HT Sandy Baillie)

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  • Eric

    I've really grown to appreciate Stossel's work over the last year, year and a half. His most recent book, Myths, Lies, and Downright Stupidity is fantastic.

  • ...i'll add him, along with Walter Williams and Thomas Sowell, as my regular reads on JWR.

  • "...and 33 percent are eligible for existing government programs but are not enrolled."


    How many people in countries with universal healthcare wait too long to go to the doctor until it's too late?

  • Mark

    "How many people in countries with universal healthcare wait too long to go to the doctor until it's too late?"


    But that isn't a question about the health care system. THe real question, in evaluating health care systems is, "How many people in countries with universal health care were forced to wait to long to see a doctor or specialist, to see receive diagnostic procedure, and then to receive treatment?"


    If you look at actual, micro-economic health care statistics you will see that the United States still has the best health care syste. The survival rates for almost all types of cancer, are much higher in the United States because in this system the patient is diagnosed and treated much faster, and the treatments and drug therapies are much more effective.


    Also, the United States has much higher rates of procedures like knee and hip replacements, and other quality of life improving procedures.


    Our health care system is more expensive because it is more effective. Americans have more money to spend than Europeans and Canadiens, and the fact that we choose to spend in on extending and improving the quality of our lives through high technology health care delivered almost immediately is not surprising.

  • The Albatross

    A fine article, but I also recently heard from a friend of mine who is dean of a medical school that the US numbers are being skewed by rising infant mortality, which is being driven by increased use of fertility treatments and improved prenatal care, which are causing more marginal fetuses to carry to term. Funny how too much healthcare can drive up mortality rates.

  • Henri Hein

    John Stossel rocks.

  • Albatross,


    A commenter on my blog (and this blog, I believe) also noted that U.S. infant mortality statistics include premature births that don't survive, whereas the rest of the world counts premie deaths as "still-born," which aren't included in infant mortality or longevity stats. I haven't independently verified this, but my commenters are very smart and honest folks, so I'm inclined to believe it.

  • Dick King

    http://tinyurl.com/2np9gb is the WHO report everyone is talking about.


    Note that two of the seven criteria are:


    Fairness of financial contribution:


    and


    Distribution of Financing:


    .


    Isn't it interesting that a study that purports to measure the effectiveness of the nations' health care systems [or at least that's portrayed that way] gives out 2/7 of its points based on how socialized the system is?


    -dk


  • Lee Kelly

    Dick King,


    I assume you actually mean:


    "Isn't it interesting that a study that purports to measure the effectiveness of the nations' health care systems [or at least that's portrayed that way] gives out 2/7 of its points based on how coercive the system is?"


    There is nothing social about "socialisation," it's just a euphamism to conceal and divert.


    If healthcare were really socialised (by individuals freely choosing collective action), then you would not need to enforce it.


    Regards,

    Lee

  • The Albatross

    M.Hodak,


    It would appear that you and your commentators are correct. Although I would like to find some data comparing the use of fertility drugs and services in different countries (all these people having underwight quintuplets cannot be good for infant mortality). Anyway, from our friends at Wikipedia:


    "The exclusion of any high-risk infants from the denominator or numerator in reported IMRs can be problematic for comparisons. The United States counts many infant births as live which other countries do not and therefore usually appears to have a much higher rate of infant mortality than similar countries. The US counts an infant exhibiting any sign of life as alive, no matter the month of gestation or the size, but other countries differ in these practices. For example, in Germany and Austria, fetal weight must reach one pound to be counted as a live birth, while in some other countries, including Switzerland, the baby must be at least 12 inches long. Both Belgium and France report babies as born lifeless if they are less than 26 weeks' gestation."


    The full article:


    http://health.usnews.com/usnews/health/articles/060924/2healy.htm

  • Mark,


    I think you misunderstood me. I meant to say that health decisions are personal and there's no limit to gov paternalism: even if access is universal some people will not take advantage of it, just like that third of uninsured that don't take advantage of existing programs. So we should castigate the socialized european governments for not forcing a minimum of healthcare on everyone (sarcasm on), like force everyone to get a colonoscopy. In fact, in the USSR some people were forced to get mental health care.

  • Mark

    No problem. I believe I understood you but I was trying to carry it to a different point.


    "So we should castigate the socialized european governments for not forcing a minimum of healthcare on everyone (sarcasm on), like force everyone to get a colonoscopy"


    Actually, I would support such a program.


    My proposal would be for the government to create a voucher program for age specific medical treatment. For example, for young children this voucher would cover childhood checkups and vaccinations. For older people it would cover mammagrams or prostate exams.


    The vouchers would cover full or partial costs for these procedures for people up to 200% of the poverty line. Further, the treatment covered by these vouchers would essentialy be mandatory in that to be eligible for government health care programs like Medicaid or Medicare, or other state programs, the person would have to get these preventative cares.


    I would expect such a program could be run for less than $10 billion per year, both state and federal money, and that the overall cost savings would more than cover this cost.

  • vidyohs

    Mark,

    "Our health care system is more expensive because it is more effective."


    This is not precisely the whole truth, lord but I wish that it were.


    Socialist meddling in health care is the prime reason we have such expensive health care today. Please understand that when I say socialist meddling in the health care system I am talking about the fringe arena as well as direct health care. By the "fringe arena" I am talking about the scum bag lawyers that circle the health care system trolling for and snagging people who have the slightest complaint or suspect grounds for a lawsuit. Talk to any doctor about the cost of his insurance and you will be totally shocked if you have never done this before.


    Now obviously in order to afford that insurance, he has to do what? Charge more of course.


    Compound that by the vast numbers of people who, after health care was virtually mandated by a socialist congress in response to bribing by labor unions, once having obtained health insurance ceased totally to examine the bills in order to see what the provider was charging, and you have a recipe for disaster and high prices.


    An asprin $12? How could that possibly be or withstand the examination and challenge by the patient who cared?


    We did it to ourselves and the high fees of the medical providers are not just because they are good.


    That they are good, no excellent, is beyond question in my opinion.


    The tactic, very clearly spelled out in international communism, is to create havoc in all societies so bad that the people cry out for government salvation. They have done it in the education system, the health care system, the markets, no, virtiually no area of our society has not felt the destruction of the application of socialist tactics.


    I am involved in the legal system and the health care system in a tangental sort of fashion. I see the scum bag lawyers at work, up close and personal, and I am constantly in and out of our hospitals and clincs. The USA has the finest health care facilities and personel in the world. Now in any system there will be a bad apple. The larger the system the larger the number of bad apples, but God forbid that I would get sick and need profession medical help in another country.


    It is ironic that my wife and I have as best friends, dedicated socialists. About a year ago they sat at my dining table and asserted emphatically that the USA had the 26th worst health care system in the world!

    It amazed me that Chuck would say such a thing because I taught him my business and he had by then acheived a good measure of succes and income from it, so I know that he is as involved as I am and can see as well as I can.


    I didn't vigorously argue the point at the time because I felt I needed to do some research and see what the hell they were basing their claims on. (BTW the female is from England is a RN though she doesn't practice anymore.)


    The next day I went to the internet and did some searching of international statistics and the only, I repeat the ONLY, thing I could find was what Stossel found. By the standards of WHO the USA was 26th in Health care "delivery", not quality, "delivery".


    So, the statement 26th 'worst' was totally wrong as the word 'worst' is a word quantifying quality unless explained further in such a manner as: 26th worst in health care delivery.


    Anyway just to keep our relationship interesting I nailed them on it the next time we got together, and they did a "muirgeo" (which is what all socialist do) they sputtered and back pedaled and tried to dodge but in the end they had to admit that they had made misleading statements.


    Stossel is dead on, the USA has no superior in health care personel or facilities. And, if we could get government out of it we could reduce the costs dramatically with just that action.


    Re-educate the people to act responsibly and not only pay cash for their health care but examine the bill the same way they would when they go to the grocery store and that would bring down the other factor of high costs.


    For dental care, I canceled out dental "insurance" and went to my dentist and told him, "look we have known each other for some years now. I will pay you cash for your treatments just as I have been doing under my old dental plan, but I am canceling my dental plan. Do we have a deal?"


    He said, "certainly. that arrangement costs me nothing and I still don't have to deal with the BS paperwork."


  • Plac Ebo

    What a relief! John Stossel has eased my guilt. I can sleep tonight knowing that we still have the best health care system in the world. And, even more important, that our system of health care, large parts of which are driven by the pursuit of corporate profits, dovetails with the goal of quality accessible healthcare for all. Now all I have to do is convince a stubborn relative of these truths. I'll just give her a copy of Stossel's article when she complains about her pre-existing kidney disease that makes it impossible for her to get insurance. And how she is afraid to have her children tested for this disease because if they test positive it will make it impossible for them to get insurance. And then when she gets all smart and tells me that we spend a higher percentage of GDP on health care of any country (USA 16%, France & Germany about 11% are second highest); that we have 8 million uninsured children, and millions more under-insured; that we have more operations per capita than any other developed country, and that 12,000 per year die from unnecessary operations; and that we have a system that encourages drugging, over-testing and operating rather than preventing disease. Yeah, Stossel's article ought to silence her.





  • Plac Ebo

    Mark said:


    ... I am talking about the scum bag lawyers that circle the health care system ...

    ======================


    If doctors would do a better job of weeding out their incompetent members there would not be as much fodder for the legal profession which coincidentally does not do a very good job of weeding out their incompetent members.

  • Plac Ebo

    Correction: I attributed a quoted passage to Mark and it should have been to vidyohs. My apologies.

  • Now all I have to do is convince a stubborn relative of these truths.


    She could move to Canada, or France even.

  • Mark

    "An asprin $12?"


    Well, what we have in the current health care financing is actually fixed cost accounting. Therefore, teh $12 charge for an aspiring is nothing but a budgetary allocation of variable and fixed costs, and is essentially a meaningless number.


    I agree that more market forces need to be employed for health care. Consumers need more choices, in fact, they need a vast array of choices because there are so many unique health care consumer characteristics.


    When I talk about this I laugh when the sinlge payer advocates claim we already have choices (because they believe having choices is a bad thing because the consumer CANNOT decide these matters for themselves, but need smart people to make the decisions for them). The fact that the choices are actually the choices your EMPLOYER made, based on the criteria of what was best for your employer does not seem to register with them.


    "Fixing" the health care crisis without ruining what we have is in my opinion easier than most people believe. I am a free market economist, but it is clear that government needs to be involved.


    Here is my "solution".


    1. Eliminate the tax preference for employer based health care insurance.


    2. Replace that with a tax deduction and credit system. High income people would get a deduction and lower income people would get a credit that would have refundablility.


    3. Individuals would then purchase their own health care insurance from the private marketplace. THe value of this for the consumers is that they would be able to get the services they require, the risk premium they seek, and the insurance policy would be completely "portable" because it is no longer tied to employment which changes from time to time.


    The health care insurance market would have to be deregulated to allow this portablily across states/regions and all government regulations regarding the coverage would be eliminated. The consumer now determines exactly what they want.


    4. Governments would create a non-profit health insurance company that would act as an insurer of last resort. The premiums for this coverage would be subsidized by a tax on insurance premiums and health care providers.


    These subsidies would act as an overall risk pooling across all insurance coverages.


    5. Government would create "reinsurance" for individuals with chronic illnesses like asthma or diabetes. This reinsurance would cover the medical costs of chronic disease, allowing these individuals to qualify for health insurance are "regular" rates. The "reinsurance" would be completely paid or highly subsidized up to a level of incomes of 200-300% of median income.


    6. The government would create the age specific preventative medical vouchers. Although I am sceptical of some of the claims of the cost savings of "preventative" medicine age specific procedures and diagnostics would prevent certain illnesses and diseases from becoming worse and in the end I would have to believe that it would save at least as much as is spent on such care.


    I also believe that if people know that they will get such checkups they will feel better about their health. I think that people hear all of the negatives and think "I can't afford to go to the doctor" and this makes them not go even though there are ways of getting medical treatment even if you cannot pay.


    7. The problem of the poor uninsured is a medical care delivery problem. All of these costs are borne by the health care system, which means in the end either the taxpayers or insurance premiums pays for the care.


    Preventative vouchers may help reduce some of the uninsured costs, as people would be able to get earlier diasnosis of illnesses before they become worse and the system has to pick up extensive expenses.


    Therefore, I see very little reason why individuals under a certain income level are simply not just given an "insurance" card.


    I agree that such a step could potentially increase demand because suddenly the coverage is "free", but I would argue that this increase in demand would be minimal because their care already is "free".


    What would change is that these newly "insured" people would be able to get primary care, rather than emergency care which has much higher costs (the reason is that emergency care must be staffed to a variable level of cares, primary care can be staffed to cares that come in by appointment).


    8. I am sure there are really smart people who understand the logistics of Medicaid, Medicare, and state insurance premiums that could identify savings of $40-80 billion or more, and these people need to be turned loose in the system and whatever changes they find need to be implemented.


    9. Institute Tort reform. The most simple way of making this change is to require lawsuits to actually show malpractice. Regardless of what modern American juries, John Edwards, and the rest of the trial lawyers believe, malpractice is not the fact that something bad happened. For there to be malpractice the practitioner must perform the service in a non-standard method. Unfortunately this standard is not often met when juries award major awards.


    Secondly, and this needs to be a change for all tort cases not just medical ones, punitive damages needs to be limited and criminalized.


    THe concept of "hit them in the wallet because that is where it hurts" is meaningless when all of these damage awards are simply passed back onto the consumer. The fact that to avoid malpractice doctors perform redundant and unnecessary testing makes the "punitive damage" award multiple fast for all consumers.


    Instead of this, send people to jail and prohibit them from practicing again.

  • muirgeo


    "We have far more fatal transportation accidents than other countries. That's not a health-care problem.


    Similarly, our homicide rate is 10 times higher than in the U.K., eight times higher than in France, and five times greater than in Canada."

    Stossal


    Wow great to know that indeed we are getting a good deal out of our 16% of GDP health care industry.


    But what to do about all the murders and car wrecks?

  • The Albatross

    "She could move to Canada, or France even."


    She probably will not have to. As Stossel points out in the article 33 percent of the uninsured are eligible for some sort of state sponsored medical assistance but fail to enroll. Many states provide subsidized pools for people with high risk or pre-existing conditons.


    Also, if we want to play anecdote, then may I relate the tale of my English grandfather and how the British National Health Service will not treat his cancer. Somehow the thought of him "taking one for the team" does not make me sleep very well at night.

  • muirgeo

    http://www40.statcan.ca/l01/cst01/health30a.htm




    http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54...>



    Browse some facts my good Libertarian friends. In a Libertarian society if you are as bad a shopper for your goods as you are for the facts those Economic Royalist will have you selling your soul for their well packaged snake oil....I would worry a lot for many of you in such a world.




    You accepted Stossal with out question. Good marketing sells people what they think they want and think they need. Many of you want what Stossal's selling. It comes in such a neat package. Did anyone stop to think to ask him where he did the calculations on which he based his claims about mortality adjustments. Well I will send him a query.


    Some basics


    Age adjusted death rates per 100,000


    U.S.A. Oh, Canada

    Renal failure 14 8.3


    Neoplasms 190 174


    heart disease 232 127


    Accidents 37 25


    Murder 5.6 1.7


    Flu/pneumonia 20 13


    Anyone want to bet Stossal pulled those "numbers" out of his colonoscope???

  • T L Holaday

    Nice find, muirgeo. The accidents and homicides account for just fourteen of the one hundred forty four excess U.S. deaths.


    Looks like Boudreaux has been hoaxed.

  • Below something I wrote in my Voice and Noise, 2006, and that though it has nothing to do with health illustrates the type of rating flaws that might haunt us


    “A short while ago, A. T. Kearney/Foreign Policy published their Globalization Index (Foreign Policy, March/April 2004), which assigns points to countries by measuring the number of Internet users, hosts, and secure servers—without even considering the contents transmitted online or through other media. In July of 2004, one of the many lists of favorite Web hits ranked Paris Hilton as No. 1, Howard Stern as No. 50,, and in between—besides the Bible, diets, marihuana, and beheadings in Iraq—nothing that could be even remotely related to any type of useful learning.


    Who is more global, a family in a rich country with 10 televisions for 10 local sitcoms or a family in a poor country with only one TV on which they watch foreign programming? Who is more global, a family from a rich country that visits Paris or a family from a poor country with loved ones working abroad on whose remittances they depend for survival? Clearly, the index developers need to go back to the drawing board.”

  • macquechoux

    Colonoscope? Hoaxed?


    I'm not sure what accident rates and murder rates have to do with the quality of health care but try sinking your teeth into these numbers posted at Carpe Diem:


    http://bp0.blogger.com/_otfwl2zc6Qc/Rs4F8De87cI/AAAAAAAACGY/nO2cIX5nrE8/s1600-h/cancer.bmp




    Better yet goggle the survival rates for breast & prostate cancer as compared with your favorite universal care country vs. the US.

  • Plac Ebo

    macquechoux, please define "survival rate." My impression is that it is more of a marketing phrase that measures how long someone can be kept alive than it is an accurate beat-cancer-quality-of-life-measure.

  • John Pertz

    I think that socialized medicine advocates have some questions that they need to answer. If you believe that nationalization of the health care industry is a SOCIALLY OPTIMAL idea then I would like some answers to my questions.


    1. If health care innovation is a global public good and if the evidence shows that market oriented health care systems produce the bulk of the world's public goods within the sector then why do you believe that nationalization is an appropriate reform?


    2. Do you believe that Europeans have equal access to high end U.S style health care. Im talking about M.D Anderson type of care.


    3. Do you believe that there are factors which weigh negatively on the infant mortality and average life expectancy rates, which are not pertinent to health care?


    4. If you answer yes to question 3 then do you believe that using those statistics is an appropriate metric for comparing health care outcomes across countries in the industrialized world?

  • muirgeo

    Let me just quickly say between pateints, I don't think you have to nationalize health care. Actually I'm against that. But I still think if you nationalize the payor and allow market systems to compete for those single payor dollars we will save lots of money and lots of lives. Likewise American business can be freed of their health car overhead.


    $4,000 dollars a person in Canada and $7,000 here in the US of A. Who wants a $3,000 dolar raise out of the pockets of useless insurance CEO's and paper pushers. ME!

  • Murgo

    To John P.


    1: Yes, already much innovation comes from our public universities nd via NIH grants.


    2: Yes..in general.


    3: Yes, but I don't think all the differences in outcome and cost are explained away by these factors alone.


    4: Yes they are the best we have. When some one wants to throw away the baby with the bath water...especially with regards to complicated things like health statistics and global warming you can be sure it's likely because they don't like the implications of the evidence and NOT because they are statistical obsessive compulsives.

  • The Albatross

    U.S.A. Oh, Canada

    Renal failure 14 8.3


    Neoplasms 190 174


    heart disease 232 127


    Accidents 37 25


    Murder 5.6 1.7


    Flu/pneumonia 20 13


    Thanks for the numbers, but I believe they make Stossel's point. Outsiders look at these numbers and blame America's healthcare system or the 45 million uninsured. Stossel makes the very valid point that these differences might be due to cultural or demographic differences. Sure he mentions murder and accidents, but he also brings up obesity, diet, and lack of exercise. Needless to say, even if you do not agree, it is a valid point and certainly comes nowhere near to snake oil or rectal content.

  • Floccina

    Muirgeo although I think Stossel’s stats are wrong.

    If you are able to handle some ugly and unfortunate truth look at this study:


    http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030260


    You need to include race in your figures. Asians evidently live longer in the USA than in Asia, blacks live longer in the USA than just about anywhere else in the world. Surprisingly enough Hispanic Americans have lower infant mortality than white Americans and blacks have much, much higher (I believe that blacks also have higher multiple births). Compare North Dakota (mostly Norwegians) with Norway and amazingly the homicide rates and the death rates are very similar. We can win the infant mortality race by allowing more Mexicans immigrate and the life expectancy race by allowing more Chinese to immigrate. This is sad but seems to be true.

    We do spend more in healthcare and get little for it, but we do get something.

  • Floccina

    T L Holaday wrote:

    "Nice find, muirgeo. The accidents and homicides account for just fourteen of the one hundred forty four excess U.S. deaths.


    Looks like Boudreaux has been hoaxed."


    But if they are mainly to young people they can take off more years of life than say cancer. BTW Italians are alchoholics less than Germans maybe that is why they come out on top.

  • Python

    Muirgeo,


    Are you suggesting that the higher number of US citizens that die of heart disease compared to Canadians is due to our health care system?


    Please be specific as to why.


    Your buddy, Python.

  • The Albatross

    According to the CIA World Factbook the death rate in Canada is 7.86/1,000 and 8.26/1,000 in the US. (I'm not a mathematician, so I am just going to assume that in order to convert this into per 100,000 we just multiply by 100.) This leaves us with death rates of 826 and 786 per 100,000. So in order to explain the difference we need to find 40 people per 100,000. If roughly 4/100,000 more Americans are murdered and an extra 12/100,000 die in accidents, then that would explain 16 of the needed 40 (or 40 percent of the difference), which would indicate that these measurements are important. Sorry, I had to do this on the fly, and encourage the checking of my math.

  • Murgo

    According to my source;


    http://www40.statcan.ca/l01/cst01/health30a.htm


    The death rate in Canada is 579.1/100,000

  • The Albatross

    Yeah well, I don't know either, which is why I start every semester with Thomas Sowell's chapter "By the Numbers" in Vision of the Annointed. It is a great way for students to see how people try and lie to them through the use of statistics. This way students earn a hearty disrespect for everything they read and their professor.

    Frankly, do I know why the CIA and Canadian numbers differ. However, as an economist who is also a lawyer I will attempt to apply the law of evidence. If the Canadian number was higher than the CIA number, then I would accept it as a statement against interest. However, as the number is much lower, and the evidence suggests that Canada (as well as many other nations) employs tactics that would tend to underestimate its death rate, then I am more inclined to believe the CIA--it is, after all, considered the gold standard in some matters and (with presumably bigger fish to fry) really does not have a dog in the fight between the single payer and whatever the hell the American system is. At the end of the day, I do not know, but, considering my experience in government, I would somewhat discount that provided by statcan. I could be wrong, but the trusty factbook doth not indicate where its facts come from--presumably not from Stossel's rectum.

  • Mesa Econoguy

    No, there aren’t 40 million uninsured. It’s more like 20-30 million:


    http://www.cbo.gov/ftpdoc.cfm?index=4210&type=0&sequence=0


    The US healthcare system is the best in the world. Period. Better doctors, better/more accessible delivery, better research and development, better perfusion, better administration, better response time, better trained professionals (just not enough), better overall in virtually every single measurable metric.


  • Mesa Econoguy

    “The commonly cited estimate of 40 million uninsured comes from the Census Bureau's Current Population Survey (CPS). Based on a large nationally representative sample, the CPS has been collecting data on health insurance status since 1980.


    Although the CPS is intended to measure the number of people who lack health coverage for a whole year, its estimate more closely approximates the number of people who are uninsured at a specific point in time during the year. Data from three federally sponsored national surveys--the Survey of Income and Program Participation (SIPP), the Medical Expenditure Panel Survey (MEPS), and the National Health Interview Survey (NHIS)--yield estimates of the number of uninsured at a particular point in time that are very similar to the CPS estimate of about 40 million (see Summary Figure 1). In contrast, data from SIPP and MEPS indicate that 21 million to 31 million people are uninsured for an entire year. “


  • brotio

    "My impression is that it is more of a marketing phrase that measures how long someone can be kept alive than it is an accurate beat-cancer-quality-of-life-measure."

    Plac Ebo


    Plac Ebo, Here's one anecdote for survival rate definition: My grandmother was diagnosed with breast cancer over twenty years ago. She's 86 years old now, walks three to five miles-a-day, drives, keeps a garden, and basically does anything she wants and can afford. A pretty high quality-of-life, wouldn't you say?

  • The US healthcare system is the best in the world. Period. Better doctors, better/more accessible delivery, better research and development, better perfusion, better administration, better response time, better trained professionals (just not enough), better overall in virtually every single measurable metric.


    It's certainly not the best healthcare system by "every single measurable metric." What I think is more accurate to say is that the product delivered by this system is better -- but the system itself creaky, inefficient, and in need of reform. The libertarian pro status quo folks are (no doubt unintentionally) aping the rigid, blinders-on stance of their left wing opponents in the pro single payer camp. Both approaches are flawed.


    While the actual product delivered by the US healthcare system is very often the best in the world, that system is nonetheless subject to pressures and difficulties that are far less severe and even non-existent in other rich world healthcare systems. Generally speaking, in those other systems, people don't get denied coverage for preexisting conditions, but in the US this is a serious issue. As is the related problem of job lock. Moreover, in the US, a significant portion of the population lacks medical insurance at any given time; depending on whose statistics you cite that number is anywhere from 7% to 15% of the public. In the rest of the rich world that number approaches zero. In the US, administrative expenses -- such as the money devoted to finding out which people ought not be offered an insurance policy -- are a tremendous drain of resources. Again, these numbers have consistently been shown to be much lower in other rich countries. And here in the US, medical expenses are a significant driver of personal bankruptcy and financial ruin. Again, this simply isn't the case elsewhere. And by "other" systems we're not necessarily talking about evil socialist schemes. France, Australia and Switzerland, to give a few examples, embrace a wide degree of private sector participation in healthcare, and yet manage to avoid the pitfalls of the US model. And their systems deliver results broadly in line with the American experience. For a lot less money.


    I agree with many of the posters here about the numerous advantages America consumers enjoy because of the heavy participation of non-governmental actors in the delivery of healthcare. I also strongly agree with the notion, that, in any efforts to enact reform, we should refrain from throwing out the private sector baby with the bathwater. But nonetheless it's time to change the bathwater.

  • vidyohs

    Muirgeo


    This says everything about the quality of your thought.


    "Let me just quickly say between pateints, I don't think you have to nationalize health care. Actually I'm against that. But I still think if you nationalize the payor and allow market systems to compete for those single payor dollars we will save lots of money and lots of lives. Likewise American business can be freed of their health car overhead."


    That is as apt a display of socialist ignorance about free markets as I have ever seen.


    Oh no, you don't want to nationalize the health care system, you just want to nationalize how the exchange of goods and services are transacted!!!!! LOL!


    Wake up muirgeo. Free markets are about two individuals exhanging goods or services. Let's keep this so simply that even a socialist can understand it. I have gold and the doctor has care to provide. I contract the doctor to perform and reward him with an agreed upon part of my gold. That marketplace has two parts to be complete. If one part is taken out of the equation it is no longer free and whom-so-ever has the power to extract the part that is missing in actual fact controls the whole.


    So you don't government controlling how the doctors perform but you want to control how they are rewarded, so you're looking to extract one part of the market transaction from freedom and put it under dictation by faceless and nameless beauracrats.


    God that is brilliant!!!!!

  • vidyohs

    Plac Ebo,


    Posted by: Plac Ebo | Aug 23, 2007 10:48:12 PM

    "Now all I have to do is convince a stubborn relative of these truths. I'll just give her a copy of Stossel's article when she complains about her pre-existing kidney disease that makes it impossible for her to get insurance."


    How is your relative's inability to obtain insurance or pay for her health care a problem of the health care system?


    Specifically, how does it reduce the ability of any person or facility to provide excellent health care?


    I sympathize with your reltive's plight, but to place her problem in the lap of the health care system is incorrect.


    To imply not only is it the fault of the health care system but of the rest of us as well (which is what socialized medicine really is) is a denial of reality.


    If you're going to fault anything fault our education system for socializing you so that you forget individual personal responsibility.

  • Plac Ebo

    Repsonse to BROTIO: I am glad to hear that your grandmother has had 20+ years of quality living since her cancer diagnosis. Do you think that your grandmother is a typical example?

  • vidyohs

    Plac Ebo


    "If doctors would do a better job of weeding out their incompetent members there would not be as much fodder for the legal profession which coincidentally does not do a very good job of weeding out their incompetent members."


    Posted by: Plac Ebo | Aug 23, 2007 11:13:18 PM


    Sir,

    A question at a really good point. Thank you.


    Here is the dilemma that the socialist faithful face, and it applies to every facet of culture. It is also the reason I despise the socialist faithful and support the statement, "Thee is no such thing as a socialist intellectual or thinker."


    Here is the dilemma: How do you spend every moment of your day furthering the destruction of the standards developed over the thousands of years of human existence, standards that guided human interchange in a practical, reasonable, and rational manner, and not feel or suffer the effects of the disintergration, destruction, and dissolution that your work has brought?


    Answer: You can not. When a religion stupidly destroys everything that worked well and efficiently, then those religious believers have to live with the destruction just as do all others. That is why socialism is irrevocably stupid for humans to believe and practice.


    Since the beginning of the industrial revolution in this country socialist have been using every tool available, every ally possible, and spending every possible moment in education all with the dedicated goal of acheiving "equality of outcomes" in every human endeavor instead of the standard of "equality of opportunity". They aren't satisfied with the destruction of technical or mechanical standards, no the socialist went after all standards, including, or should I emphasize by saying 'especially', those of character and behavior.


    Before the onslaught of the socialist destruction it was possible for bad employees to be weeded out at the employer's discretion, no more. After many decades of ACLU action brought at the bequest of the communistic unions and socialist in general it not possible anymore for anyone to just fire someone and not face the very real threat of legal action brought by either the ACLU or one of the communisitic labor departments of the U.S. government.


    So there, Plac Ebo, is your short answer as to why it is so difficult for the very rare incompetent doctor to be weeded out by employers, and certainly doesn't even begin to address why incompetent and eveen criminal lawyers can't be weeded out. Lawyers and the BAR Associations are another story again of even more entrenched communistic policies. You see the results of the destruction of standards in every field, from simple receptionists to College professor's and titans of industry.


    Now if you want to talk about the actual percentage of incompetent doctors as opposed to what you "think" there is, then we can have another conversation altogether.


    I can not begin to tell you how many legal malpractice depositions I have taped, and frankly in that many hundreds I have only concluded twice from the testimony I saw and heard that there might be grounds for the lawsuit. Generally the lawsuit has been brought more as a lottery ticket is brought, as a dream of a financial jackpot not a genuine wrong.


    Does this mean that I believe that all doctors are Gods of perfection, absolutely not, no more than I believe that all auto mechanics are brilliant and technically competent.


    Now let me address one other facet of this argument. Since the socialists have effectively destroyed the standards of character and behavior of our forefathers that means the higher standrads of education have also been brought low, so low that many school graduates actually do not know how to think rationally.


    A for instance if I may: What rational human being forgets that he is the employer in a doctor patient relationship? The doctor attains skill and knowledge and markets them to potential customers. If you find yourself ill and you feel you need the doctor's services, you become his employer and he your employee. If he is incompetent then you'd be wise to fire him and find a more competent doctor. If you do not do so, then the result is on your head not his.


    How do you determine he is competent before you employ him, you ask? Well, how do you determine the new car you want is really a good deal.....you do your due diligence. If you don't then you deserve what you get.





  • T Sowell fan

    I don't understand why some people expect medical insurers to cover pre-existing conditions. Isn't that like expecting life insurers to pay retroactive death benefits? Teaching point: Understand the value of medical insurance and buy early. Your life and the welfare of those dependent upon you may depend on it. Or not. The choice is yours.


    Also, it would be interesting to know the percentage of people that don't have life insurance -- and why they don't. I expect that one of the main reasons is the same as for medical insurance: many people simply don't believe the costs are justified by the benefits received.

  • Python

    T Sowell fan,


    Some people are born with pre-existing conditions.

  • Plac Ebo

    Response to VIDYOHS: In your post (Aug 25, 2007 12:09:26 PM) you stated, "... It is also the reason I despise the socialist faithful and support the statement, 'Thee is no such thing as a socialist intellectual or thinker.' ..."


    In order to respond to you we'd better start at the beginning- way back in time when early man stopped hitting each other in the head with their clubs and decided it was beneficial to live together in harmony- relatively speaking. Why do you think communal living was preferable to a solitary existence? Was it just to have someone to grunt with over a fire? No, there was more to it than that. It was done to temper the harshness and brutality of going it alone against nature and other men. A group could better feed, clothe, shelter and defend themselves than could a loner. And, it was a real benefit when members were unable to care for themselves. For example, if one was suffering from a sabre tooth tiger bite, he would have a better chance of surviving because others would feed, clothe, shelter and defend him during his recovery.


    Fast forward to the present. Society has gotten more complicated. But, the overall goal is the same- to temper the harshness and brutality of the world in which we live. In short, when we live in society we take care of one another. The only question is to what degree. And that leads to my response that you "despise the socialist faithful." Until you abandon society, and go live alone in the woods, and live solely off the land, you too are a socialist. You may see a different role for government in society than I do, but you do see a need for government.

  • Plac Ebo

    Another response to VIDYOHS: I must say you have gone overboard with your socialist bashing. If what you say is true please explain how it is that the Scandinavian countries are among the most prosperous in the world? High standard of living; high quality of life; few, if any left behind, ... . How is that possible?


    You also blame the ACLU and communistic labor departments for the existence of the few incompetent doctors that you claim exist in our system. If you want to place blame you should start with the unbridled greed that permeates much of our capitalistic system. Unnecessary operations, unnecessary tests, ineffective and dangerous overprescribed drugs- done in the pursuit of more income and more profits. As for incompetent doctors, you are underestimating the severity of incompetence in the health system. For example, thousands die each year from unnecessary and botched operations, and thousands more from prescription errors. Capitalism and the free market may solve some of society's health care problems, but it introduces many additional ones.

  • Plac Ebo

    One more time to VIDYOHS: From your post (Aug 25, 2007 10:44:50 AM) you stated, "... How is your relative's inability to obtain insurance or pay for her health care a problem of the health care system? ... Specifically, how does it reduce the ability of any person or facility to provide excellent health care? ..."


    It is not a problem if the ONLY goal of our health care system is to provide excellent health care to those that can afford it. However, if you want our excellent health care to be available to all members of society then inability to obtain insurance is a big problem. Excellent health care doesn't mean much to a person who cannot afford it and doesn't have access to it. Indifference, or self-deception does not alter the fact that millions of Americans are suffering this fate.

  • Plac Ebo

    Response to T Sowell fan: You don't understand why some people expect medical insurers to cover pre-existing conditions. I don't either. The purpose of a corporation is to maximize shareholder value and that usually means to maximize profits! It's not to do charitable work. It's not to go on moral crusades. It's not to protect the environment. It's not to make sure that every citizen gets excellent health care. It's solely to maximize shareholder value.


    If you're an insurer and the rules allow you to refuse coverage for pre-existing conditions and doing so will maximize profits, then the insurer has a duty to deny such coverage. For any corporation, employee insurance is just like any other expense they need to control, and if possible eliminate. Furthermore, corporations must test the limits of every law and regulation in the pursuit of profits. A corporation does not have a duty to be a "good citizen" unless there are profits to be made from doing so. It's brutal, but that's the way capitalism works.


    Unregulated capitalism will not make quality health care accessible to all and improve our country's overall health. For the insurers, hospitals, doctors, and drug companies there are few incentives for prevention. The big profits are made in operating, testing and drugging a citizenry. For the employers the incentives are to cut health benefits. Less, not more, privatization is needed in the health care industry.

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