Let's talk healthcare

[iNow]

You're good at pulling up graphs...show me some numbers that support your assertion that "pregnant women lose their babies for lack of healthcare". PLEASE. Just so you can live up to your own standards when I make assertions based on a seeming assumption.

The argument is not how you framed it. I said that infant mortality is almost certainly related to pregnant women lacking access to healthcare. Please confirm for me that you do not disagree with this point.

 

I then said that the numbers of uninsured (or underinsured) pregnant women is probably quite high. I did a guess-timate and suggested thousands to hundreds of thousands. I will support that now.

 

According to this site, there are approximately 6 million pregnancies in the US every year: http://www.americanpregnancy.org/main/statistics.html

 

According to this site (which references the ACOG report), 13% of pregnant women are uninsured: http://www.wsws.org/articles/2009/jun2009/wome-j02.shtml

 

 

So, when we do the math, and calculate 13% of 6,000,000, we obtain a number of 780,000.

 

 

That means I under estimated... There are nearly 800 thousand uninsured pregnant women EVERY YEAR in the United States. My argument is that this plays a fairly significant role in infant mortality. The logic seems self-evident to me. If you have a valid reason to doubt that a lack of access to care from doctors, and a lack of access to medication, and tests, and all of the other wonders of modern medicine does NOT cause more babies to die... Then I'd truly love to hear it.

[JustinW]

Does that study refer only to private health care or is medicaid included? Because if it's not, and I saw nothing that indicated it was, this can more than make up for it. http://statehealthfacts.org/comparemaptable.jsp?ind=222&cat=4

[iNow]

Does that study refer only to private health care or is medicaid included?

This is a good question, but given how low the income must be for a person to qualify for Medicaid, there is still going to be a few hundred thousand pregnant women not protected by it.

 

According to this site, we can assume that there are approximately 700,000 medicaid covered births each year. So, even if I FULLY concede the benefit of the doubt to you, and we adjust the numbers according to your question, that still leaves 80,000 women EVERY YEAR who are trying to go through pregnancy with zero coverage, zero care, zero doctor involvement, zero prescription coverage, and almost certainly poor nutrition and living conditions.

 

So, I will ask you again... Are you seriously suggesting that this lack of access to healthcare for almost 100,000 pregnant women every year will not be a major contributor to the higher infant mortality rate in the United States?

[JustinW]

I'd be lying if I said you didn't have a point, if we DID assume these numbers were correct, but I have a feeling we're missing something here though I'm not quite sure what it is yet.

 

The fact of the matter is that we do spend a lot on healthcare. Can we figure out how to spend less while remaining at the forefront of innovation and quality? I think we can.

 

Can we figure a way to make coverage more accessible to those who fall into the gap of too much/not enough income? I think we can.

 

BUT, I don't feel that it's necessary to copy a fundamentaly different system, that has it's own flaws, in order to do so. I also don't feel that we need to put policies in place that will make our problems worse in order to establish a reason for making this change. And I above all don't feel that this issue should be turned over to bureaucracies that have hardly ever had good track records at anything else they do. From that, we can only expect quality and efficiency to go down, especially because the older it gets the more it becomes a self preservation of the organization rather than a means to provide a service. But you may have some differing thoughts on the matter.

[iNow]

I think even one pregnant woman without access to healthcare is one too many. I think the same logic should apply to all people, even those not carrying a child. Healthcare in my mind is a moral imperative, not a privilege for the rich and well-to-do. Treating it as a business necessitates inefficiencies. Companies must make money and increase shareholder value. That is their modus operandi. They make their money by raising premiums and decreasing paid claims. Taken to it's logical extreme, insurance companies would charge the highest premiums possible and never pay out on a single claim. It's anethema to what "healthcare" should be, which is a focus on improved health and well-being, and access to care when we get sick. We often get sick through no fault of our own, and I am frankly disgusted by having to have these same arguments with people over and over again.

 

It's a moral imperative.

It makes more sense financially to cover everyone.

The collective freedom of our people will be enhanced by covering them with universal care, not restricted.

Even one pregnant woman without access to medical care is one too many, let alone 100,000 or 800,000, or any number in between.

[John Cuthber]

Justin,

I see you have realised that "The infant mortality rate correlates very strongly with and is among the best predictors of state failure."

(That's a quote from one of the pages you cite.)

 

Do you accept that this is the reason why I chose it?

I presume you don't plan to argue against your own evidence so, there's no doubt that a poor inant mortality rate makes the US look bad

 

However I'm puzzled by some of their assertions- for example they say

" For example, in Germany and Austria, fetal weight must reach one pound to be counted as a live birth"

Which is very odd. those countries don't use the pound as a unit of weight.

Perhaps it's better to look at the source the refer to

" A good source for the most recent IMRs as well as under 5 mortality rates (U5MR) is the UNICEF publication 'The State of the World's Children"

With a little digging around you will find that the US still does badly compared to Europe on under-5 mortallity rates here

http://www.unicef.org/rightsite/sowc/statistics.php

 

Where you can also find what the page you quote describes as some of the best data.

Guess what.

The USA still comes out as doing badly and they still spend more money on healthcare.

 

Even the webpage you linked to shows you are wrong.

Why are you trying to defend the indefensible?

 

"Quote

Better health care leads to fewer premature babies- more or less by the definition of "better" and "health".

Show me something that can back up that statement. "

 

OK, no problem.

You said it yourself.

To be specific, you said "low birth-weight infants have had a growing chance of survival, due to growing medical advancement. "

Now it's obvious that premature infants have low birth weights and you accept that progress in medicine is improving their chances- but their chances are measured not just wrt how thing used to be but also compared to babies whose birth weight isn't low.

 

So what you have said is that (low birth weight i.e.) premature infants have a lower chance of survival (though medical research is trying to address that disparity).

 

What I'm saying is that "a lower chance of survival" is not "better health" so anything that reduces the rate of premature babies (with their lower chance of survival) imporoves the net health.

To be simplistic, it's healthier for babies to stay in the womb.

More premature babies means fewer are staying there so that's bad for them.

I really cannot understand why we need to explain this to you.

 

 

"Countries that are behind in that area will have more abortions due to the fact that the odds of saving the child are lower."

And once again, I ask how?

How do you know in advance "this baby will be born prematurely and so be at risk of ill health or death so I will abort it"?

By the time it's premature it's obviously too late for an abortion.

 

"And again you're missing my point."

Possibly, but you are missing the evidence.

A higher abortion rate is not a good thing.

 

In response to "speaking of economics, I'll ask you the same question. What's wrong with this? http://politicalcalc...ate-part-1.html"

the simple answer is "plenty"

They choose to use a different model explicitly because it doesn't fit t the data as well as the usual simple correlation.

"We can see from this chart that the linear regression no longer does such a good job in describing the relationship "

 

They also rather miss the point of their own graph.

As they say "Our next chart takes our first chart showing the 2005 OECD Nations' Health Care Expenditures per Capita vs GDP (PPP) per Capita, and simply adds some fifty data points for the individual U.S. states "

And, if you look, practically every state in the US is above the line through the rest of the data.

Now their claim was that because the US is very big, it isn't fair to compare it against the smaller countries.

That's not a valid argument anyway, but if you swallow it you still find that each state in the US- just like the US as a whole, spends a disproportionate amount on healthcare.

Plotting each state is an invalid experiment because they are all strongly related to one another- they all have the same federal laws and government for example. So, in effect it's like putting the USA on the chart lots of times and then saying that a line through the states' point goes through the most points. It's true but it's deceitful.

 

They also say " The economic "law" of diminishing marginal utility suggests that there is a limit to how much additional benefit an individual or a population may receive from additional spending for health care."

Nowm, the law of diminishing returns is fine, as far as it goes but it's not a mathematical law. It's a statement of how the value of things tends to fall if you already have lots of them.

My first chocolate bar of the day is much nicer than my tenth.

But there's a different approach to healthcare. The first dollar you spend improving my health will probably achieve more than the second , and the thrid will probably achieve even less.

But here's the kicker.

No matter how you spend I will still die. I will always really really want that last dollar in a desperate attempt to stay alive

It's an infinite sink for money so you never get close to "we have spent enough on that" in absolute terms.

The "law" of diminishing returns doesn't fit healthcare expenditure.

Now I have no doubt that the people who drew up that website knew perfectly well what they were doing.

They were telling lies.

It's quite a long and complex page and I really don't have time to rubbish each part of it in turn.

I might come back to it when I get bored but in the meantime:

 

trust me- you can't trust it.

 

 

 

"It is founded on the basis that, as you pointed out the US certainly hasthe medical knowledge to offer better treatment to many of it's citizens.

Since the US is reasonably democratic, the people have chosen not to.

 

How so?"

 

You failed to copy the important bit of what I wrote.

 

The full quote is

""That's an unfounded, disinginous statement if I've ever heard one."

It is founded on the basis that, as you pointed out the US certainly has the medical knowledge to offer better treatment to many of it's citizens.

Since the US is reasonably democratic, the people have chosen not to.

 

What problems do you have with the foundation of my statement?"

Now answer the question.

 

 

"show me some numbers that support your assertion that "pregnant women lose their babies for lack of healthcare". "

Why, you already accepted it.

You said that medical advances enable fewer women to have premature babies and that premature babies are more likely to die.Since women without healthcare don't get to take advantage of those advances, more of them lose their babies.

 

You are arguing against yourself again.

[john5746]

I'd be lying if I said you didn't have a point, if we DID assume these numbers were correct, but I have a feeling we're missing something here though I'm not quite sure what it is yet.

 

The facts seem to be really irritating you, sorry it bugs you so.

 

If you also compare states, you will see similar results.

 

 

 

States like Mississippi, with higher numbers of poor people, poorly educated, less access to healthcare and more income disparity have worse quality of life than states like Massachusetts.

 

americashealthrankings

 

TED TALKS

 

Even if the US adopted the best system, we still wouldn't have top tier results. I think we would have to improve income and educational disparities to really get near the top.

[jeskill]

BUT, I don't feel that it's necessary to copy a fundamentaly different system, that has it's own flaws, in order to do so. I also don't feel that we need to put policies in place that will make our problems worse in order to establish a reason for making this change. And I above all don't feel that this issue should be turned over to bureaucracies that have hardly ever had good track records at anything else they do. From that, we can only expect quality and efficiency to go down, especially because the older it gets the more it becomes a self preservation of the organization rather than a means to provide a service. But you may have some differing thoughts on the matter.

 

You don't need to copy Canada's system -- there are a lot of good two-tier healthcare possibilities that have both universal health care and private care for those who wish to pay top dollar. It should be noted, however, that if your concern is that a government bureaucracy will decrease quality and efficiency, it should be noted that the US's health care system spends A LOT of money on bureaucracy, especially when you compare it to Canada:

 

From the New England Journal of Medicine:

In 1999, health administration costs totaled at least $294.3 billion in the United States, or $1,059 per capita, as compared with $307 per capita in Canada. After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada. Canada's national health insurance program had overhead of 1.3 percent; the overhead among Canada's private insurers was higher than that in the United States (13.2 percent vs. 11.7 percent). Providers' administrative costs were far lower in Canada.

A universal health care system, even if it were administered by the state governments rather than the federal government, would likely decrease a significant proportion of the bureaucratic costs because you'd be dealing with one pool instead of multiple.

[JustinW]

iNow,

 

I think even one pregnant woman without access to healthcare is one too many. I think the same logic should apply to all people, even those not carrying a child. Healthcare in my mind is a moral imperative, not a privilege for the rich and well-to-do.

And when do people's responsibility for their own lives come into play? How far are to go to insure that people have no responsibility for their own well being?

 

Treating it as a business necessitates inefficiencies.

Like government bureaucracies doesn't? Let's provide a new arena so now they get to play politics with our healthcare at an even scarier level than they do already. Doesn't sound that morally acceptable to me.

 

Companies must make money and increase shareholder value. That is their modus operandi. They make their money by raising premiums and decreasing paid claims.

And we have put a policy into effect that gives them no choice. That is until every employer dumps their employees into the government plan because it will now cost them less to do so. It's a nice setup if you ask me. Once the majority of Americans have been dumped into the government plan, there will no longer be any excuse not to fully turn it over to government.

 

We often get sick through no fault of our own, and I am frankly disgusted by having to have these same arguments with people over and over again.

I would get used to it if I were you. Any time there is something to argue about, you can bet someone like me will come along and argue about it.

 

The collective freedom of our people will be enhanced by covering them with universal care, not restricted.

Collective freedom huh?

 

 

John,

 

I see you have realised that "The infant mortality rate correlates very strongly with and is among the best predictors of state failure."

(That's a quote from one of the pages you cite.)

 

Do you accept that this is the reason why I chose it?

I presume you don't plan to argue against your own evidence so, there's no doubt that a poor inant mortality rate makes the US look bad

No, I said that iNow might have a point "IF" we can assume the numbers are accurate. I still believe that the reasons I gave play just as much of a role in infant mortality as do the reasons that iNow gave.

 

 

Perhaps it's better to look at the source the refer to

" A good source for the most recent IMRs as well as under 5 mortality rates (U5MR) is the UNICEF publication 'The State of the World's Children"

With a little digging around you will find that the US still does badly compared to Europe on under-5 mortallity rates here

http://www.unicef.or.../statistics.php

 

And does this source give you the reporting criteria? I couldn't find it.

 

The USA still comes out as doing badly and they still spend more money on healthcare.

So? We also make more money. Generally speaking the more you make the more you spend. http://en.wikipedia.org/wiki/List_of_countries_by_per_capita_personal_income

 

 

OK, no problem.

You said it yourself.

To be specific, you said "low birth-weight infants have had a growing chance of survival, due to growing medical advancement. "

Now it's obvious that premature infants have low birth weights and you accept that progress in medicine is improving their chances- but their chances are measured not just wrt how thing used to be but also compared to babies whose birth weight isn't low.

Do you normally take people's words out of context to support your arguments? I said that refering to new technology and new procedures that give at-risk pregnancies more of a chance to survive.

 

 

They also rather miss the point of their own graph.

As they say "Our next chart takes our first chart showing the 2005 OECD Nations' Health Care Expenditures per Capita vs GDP (PPP) per Capita, and simply adds some fifty data points for the individual U.S. states "

And, if you look, practically every state in the US is above the line through the rest of the data.

Now their claim was that because the US is very big, it isn't fair to compare it against the smaller countries.

That's not a valid argument anyway, but if you swallow it you still find that each state in the US- just like the US as a whole, spends a disproportionate amount on healthcare.

Plotting each state is an invalid experiment because they are all strongly related to one another- they all have the same federal laws and government for example. So, in effect it's like putting the USA on the chart lots of times and then saying that a line through the states' point goes through the most points. It's true but it's deceitful.

The state indications over the first graph were amounts of GDP (PPP) on average, NOT health expendatures per GDP.

 

trust me- you can't trust it.

 

I usually don't.

 

It is founded on the basis that, as you pointed out the US certainly has the medical knowledge to offer better treatment to many of it's citizens.

Are you saying that we don't? To say that a doctor doesn't do everything technologically possible for his patient needs a little more backing than just saying it.

 

You said that medical advances enable fewer women to have premature babies and that premature babies are more likely to die.Since women without healthcare don't get to take advantage of those advances, more of them lose their babies.

 

That's not what I said. I said that medical avances allow more at-risk pregnancies come to be born for hopes in a saving of it's life. It seems that you're twisting my words around to look like they have different meanings.

 

john5746,

 

The facts seem to be really irritating you, sorry it bugs you so.

I don't think we were talking about FACTS. It was an assumption that the numbers were true, in which I also stated that I had a feeling that something was missing.

 

Even if the US adopted the best system, we still wouldn't have top tier results. I think we would have to improve income and educational disparities to really get near the top.

Let's let the government dictate that too. Yeah

[iNow]

And when do people's responsibility for their own lives come into play? How far are to go to insure that people have no responsibility for their own well being?

Interesting questions to ponder, but frankly irrelevant in this context. I'm talking about healthcare, and I stand firm in my position that it should not be limited to those with wealth and restricted from those who do not.

 

 

Like government bureaucracies doesn't? Let's provide a new arena so now they get to play politics with our healthcare at an even scarier level than they do already. Doesn't sound that morally acceptable to me.

They already do. It's called Medicare, the elderly love it, and it's actually cheaper than private insurance (it's managed to keep the growth of costs lower).

 

http://krugman.blogs.nytimes.com/2011/06/12/medicare-versus-private-insurance-the-data/

 

... and also here:

 

http://krugman.blogs.nytimes.com/2011/06/12/its-the-health-care-costs-stupid/

 

 

 

 

Yay, go us! U.S.A! U.S.A! U.S.A!

 

I would get used to it if I were you. Any time there is something to argue about, you can bet someone like me will come along and argue about it.

It's not an "argument" when one side ignores all the data, argues from a purely ideological position, and prioritizes "what I feel in my gut" over what the facts say.

 

Just sayin'.

 

Collective freedom huh?

Since you seem to have missed my point, let me elaborate. In aggregate, the overall freedom in our country will increase if more people have healthcare access. Right now, millions and millions of people lack access to care and their freedom is hence quite limited and restricted. Overall, by providing them with care we increase the overall "collective" freedom in our country, even if a small handful of people are upset because they no longer get to choose whether they are covered under BlueCross, Aetna, or not covered at all.

[John Cuthber]

"Do you accept that this is the reason why I chose it?

No, I said that iNow might have a point "IF" we can assume the numbers are accurate. I still believe that the reasons I gave play just as much of a role in infant mortality as do the reasons that iNow gave."

Justin, stop calling me a liar.

No matter what someone else said, I told you quite clearly what I think and why.

[JustinW]

iNow,

 

Interesting questions to ponder, but frankly irrelevant in this context.

I think the question is completely relevant to the context of the conversation. People used to be responsible for providing the means to pay for their family's as well as their own healthcare. Just over the past century it has become a matter for someone else to provide it. Just something else that some feel they're entitled to.

 

 

They already do. It's called Medicare, the elderly love it, and it's actually cheaper than private insurance (it's managed to keep the growth of costs lower).

Which has problems of it's own, not to mention that seniors have to have private insurance just to get the coverage they need.

http://www.seniorcor...-with-medicare/

 

 

It's not an "argument" when one side ignores all the data, argues from a purely ideological position, and prioritizes "what I feel in my gut" over what the facts say.

It's great that someone can call it facts when information can be provided that dispute the reasoning and integrity of the so called "facts" that have been provided. I have never claimed that any information that I have provided are FACTS, because I know that anything can, and probably will, be disputed. Someone provides numbers, and if I can list the reasons that those numbers are inaccurate or at least cannot be a basis for arguement, then that is why I would disagree about them being FACTS.

 

Since you seem to have missed my point, let me elaborate. In aggregate, the overall freedom in our country will increase if more people have healthcare access. Right now, millions and millions of people lack access to care and their freedom is hence quite limited and restricted.

Are you talking about people's mobility? The freedom to move around? Or the freedom to enjoy other aspects of life without having to burden themselves with responsibilty to provide for themselves?

 

Overall, by providing them with care we increase the overall "collective" freedom in our country, even if a small handful of people are upset because they no longer get to choose whether they are covered under BlueCross, Aetna, or not covered at all.

I think you nailed it with what I have bolded in your statement. So we are trading freedom for security? And that's okay? How far will we let a government go to protect us from ourselves? It seems that I have picked the proper signature for the times huh? And yes this arguement is as much ideological as it is a factual one. People can have opinions that combine the two, and there is no reason they shouldn't.

 

John,

 

Justin, stop calling me a liar.

No matter what someone else said, I told you quite clearly what I think and why.

Okay that is the reason you posted the links. So? I quite clearly told you why I think you were wrong in using that information as a basis for your arguements. You said you listed that information because YOU THOUGHT it was indisputable. I then gave reasons as to why it WAS disputable for arguing the matter of healthcare quality.

Okay you thought it was indisputable fact, ( however it's NOT in the context of the arguement).

I retract my statement about not believing your reasons for posting it. Good enough?

 

Now, for Pete's sake, let's quit beating a dead horse and move on.

Edited March 26, 2012 by JustinW

[iNow]

I think you nailed it with what I have bolded in your statement. So we are trading freedom for security? And that's okay? How far will we let a government go to protect us from ourselves?

I'm pretty sure I explained this earlier. Your freedom "not to be insured" is actually no such thing. What it really is best described as is "your freedom to mooch off the rest of us." Yes, that is a freedom I am quite happy to restrict.

 

We ALL need access to healthcare at some point in our lives. If you "choose" not to get coverage, then you receive care by law and it increases costs for the rest of us. Healthcare cannot be treated as a commodity like you would with a dishwasher or a vehicle, where you can "choose" not to purchase or use one, yet that's what your entire position requires... As if a) people have perfect access to information on what to choose, b) people know precisely when or how much care they will need, and c) people can choose not to need healthcare. It's ludicrous on its face, and yet it serves as the foundation for your entire argument.

 

Further, as I stated above, I'm talking about healthcare specifically, not "how far the government should go to protect us from ourselves." That is so far beyond the scope of this discussion that it is little more than a red herring. It's as if I said, "I'm trying to decide between a Toyota and a Nissan," and you then try to hijack the conversation into "let's talk about whether or not ground transportation or rail should be the best method of goods shipment."

 

Also, FWIW... I never claimed Medicare was perfect, so your criticisms miss the mark a bit. I simply claimed that it's better than private insurance across many different domains and metrics, not the least of which is cost control and availability of coverage to large swaths of people.

[Phi for All]

People used to be responsible for providing the means to pay for their family's as well as their own healthcare. Just over the past century it has become a matter for someone else to provide it. Just something else that some feel they're entitled to.

People used to be responsible for providing the overland route to travel by car from coast to coast. Just over the past half a century it was decided that we could pool national taxes and build the Interstate Highway System, shortening the time and expense for EVERYONE who travels. The measure passed because Americans felt they deserved it, it was much more efficient and it saved resources, not that they were entitled to it.

 

(Almost) everyone I know calls that progress.

[JustinW]

iNow,

 

I'm pretty sure I explained this earlier. Your freedom "not to be insured" is actually no such thing. What it really is best described as is "your freedom to mooch off the rest of us." Yes, that is a freedom I am quite happy to restrict.

And this really only applies to those who aren't living up to their responsibilities to provide for themselves. The same people that will get the benifit from such a healthcare system.

 

 

We ALL need access to healthcare at some point in our lives.

And when did THAT stop being an individual responsibility?

 

As if a) people have perfect access to information on what to choose, b) people know precisely when or how much care they will need, and c) people can choose not to need healthcare. It's ludicrous on its face, and yet it serves as the foundation for your entire argument.

My arguement on this point is ,yes, it is a persons individual responsibility to provide this for themselves. Since when did we have to treat the majority of our population like children? If someone doesn't take responsibility for themselves, let them suffer the consequences. That may seem harsh, but I don't believe in pampering a grown adult. And I don't believe my government should mandate that I provide for them. Us middle class Americans have a hard enough job of providing for our own as it is.

 

Further, as I stated above, I'm talking about healthcare specifically, not "how far the government should go to protect us from ourselves." That is so far beyond the scope of this discussion that it is little more than a red herring. It's as if I said, "I'm trying to decide between a Toyota and a Nissan," and you then try to hijack the conversation into "let's talk about whether or not ground transportation or rail should be the best method of goods shipment."

 

Since the arguement is getting the government involved in doing just that, "protecting us from ourselves" or "doing this for our own good", I believe it is relevant to the specifics of the subject.

 

 

Also, FWIW... I never claimed Medicare was perfect, so your criticisms miss the mark a bit. I simply claimed that it's better than private insurance across many different domains and metrics, not the least of which is cost control and availability of coverage to large swaths of people.

And my point is that it's so good, you still have to include a PRIVATE insurance to get the coverage you need. Goes to show how much "better" it is.

 

Phi,

 

People used to be responsible for providing the overland route to travel by car from coast to coast. Just over the past half a century it was decided that we could pool national taxes and build the Interstate Highway System, shortening the time and expense for EVERYONE who travels. The measure passed because Americans felt they deserved it, it was much more efficient and it saved resources, not that they were entitled to it.

Efficiency and quality of a universal system is still one of the fundamental debating topics of the arguement. Not to mention that the government doesn't mandate that you use the highway system or how you use the highway system(barring certain circumstances). It's not like their taking away the option not to drive, or the option to drive on smaller streets. So the analogy doesn't quite fit. Edited March 26, 2012 by JustinW

[doG]

There seems to be one thing missing in all of the comparisons of U.S. healthcare compared with other nations, medical litigation and the associated insurance cost it causes. Malpractice litigation is probably higher in the U.S. than any other nation because the U.S. court system is viewed as a lottery by many as a source of free money

 

Some research will show that actual malpractice awards as a percentage of total medical costs are actually quite low but that doesn't show the whole picture. In reality a U.S. hospital has to carry some type of liability or malpractice insurance on nearly everything they use in the course of patient care in order to limit their exposure to malpractice litigation. This cost must obviously be passed on as it is with any profitable business. They can't have facial tissues on hand for patients without liability insurance to protect them from the one lawsuit that might occur because some patient alleges they were allergic to the Kleenex.. The exorbitant insurance that must be carried by practitioners and their facilities directly drives the cost of U.S. healthcare artificially high compared with other countries that have limits on tort cases.

 

It is not uncommon in the U.S. to see certain geographic areas facing shortages or emergency room physicians because the malpractice insurance is high enough that doctors in the area are not willing to work for the difference between what they can charge and what they must pay for malpractice insurance. I was personally affected for about 3 weeks in South Florida one year when an increase in malpractice insurance rates left all the ERs in South Florida without any doctors at all. Some anomaly had caused rates to temporarily jump higher that many physicians annual income until the state insurance commissioner stepped in. Doctors literally could not afford to practice there in the meantime unless they did so without insurance.

 

This is also part of a largely overlooked relationship that affects practitioners and their patients alike. Practitioners end up having to charge patients more and more to cover the cost of increasing malpractice insurance that they pass on to the patient and patients end up having to pay higher and higher health insurance premiums to their insurers to cover the higher cost of health care that was inflated from increased malpractice insurance on the doctors side of the equation. Insurance companies are collecting at both ends but it's not their fault, it's the fault of the U.S. judicial system which carries the threat of exorbitant awards in liability cases. Until this is fixed I don't think the U.S. will ever have a system comparable with other nations.

[John Cuthber]

"Now, for Pete's sake, let's quit beating a dead horse and move on. "

You mean the one where the US pays roughly twice as much for healthcare but doesn't get a better service?

That's the biggest dead horse here.

The numbers show it to be true.

Even the web page you cited agrees that things like infant mortality (with all it's problems) and under 5 year mortality (which addresses those problems to some extent) are widely used and broadly accepted by, for example the WHO as measures of "fitness for purpose".

It's difficult to argue against average lifespan as an indicator of good healthcare (even if a right-wing think tank disagrees).

There's no question that the US pays more.

You seem to accept it when you say "So? We also make more money. Generally speaking the more you make the more you spend.".

Which is true enough, but an odd point of view.

If you want to buy some bread, do you look round to see what shop will offer it to you for the highest price?

Remember, we are not talking about paying a premium for a better product like getting nicer bread or having it delivered, it's a worse product that you buy- yet you seem happy to pay more for it.

 

So, it seems to me that by continuing to try to argue, you are flogging a dead horse.

[JustinW]

doG,

 

You've made a good point. One that I've failed to mention, but haven't overlooked completely. I know tort reform had a big impact here in Texas.

 

John,

 

You mean the one where the US pays roughly twice as much for healthcare but doesn't get a better service?

That's the biggest dead horse here.

The numbers show it to be true.

 

Even the web page you cited agrees that things like infant mortality (with all it's problems) and under 5 year mortality (which addresses those problems to some extent) are widely used and broadly accepted by, for example the WHO as measures of "fitness for purpose".

Yes and I've also cited reasons that they are wrong to compare systems using those numbers. Not to mention that the WHO have been labeled as biased due to the fact that their studies give bad marks for countries that have fee-paying treatment and rate countries by comparison with THEIR EXPECTED performance rather than objectively comparing quality of care.

 

There's no question that the US pays more.

You seem to accept it when you say "So? We also make more money. Generally speaking the more you make the more you spend.".

Which is true enough, but an odd point of view.

Sure I accept the fact that we could do a lot to cut down on spending. A good way to start is with tort reform such as doG brought up above. I never thought that spending shouldn't be adressed. It's just in the way that we are thinking about adressing it that I have a problem with.

 

 

If you want to buy some bread, do you look round to see what shop will offer it to you for the highest price?

No, but I buy a better quality.

 

Remember, we are not talking about paying a premium for a better product like getting nicer bread or having it delivered, it's a worse product that you buy- yet you seem happy to pay more for it.

Sure we are.

 

So we can look forward to healthcare being added to this list http://www.publicintegrity.org/investigations/broken_government/articles/full_list/ or do you think they'll suddenly get better at what they do?

[Phi for All]

I know tort reform had a big impact here in Texas.

You should start another thread about tort reform. I'd love to tell you why that's something else the corporate world has been salivating over lately. And why it's complete and utter bullshit.

 

As to tort reform as it relates to healthcare, litigation costs and malpractice insurance only account for between 1 to 1.5 percent of total medical costs, according to insurance industry consultants Towers Perrin. It is not even close to being a major driver of high healthcare costs.

 

You also shouldn't use Texas to support your arguments here. Your lack of regulations keep your insurance costs very high, you have the highest number of minimum wage workers in the US, you have the highest number of uninsured people in the US, and you rank #1 in adults without high school diplomas in the US. I'm sure you're different Justin, but it's easier to pull wool over the eyes of those who don't know any better.

 

Edit: Rick Perry's Texas tort reform only helped reduce doctor's malpractice insurance. So far, insurance for the patients hasn't gone down, so who did Rick Perry really help? Your insurance costs are higher than national average, despite having tort reform for the last nine years. What kind of big impact are you talking about?

 

http://wendellpotter.com/2011/09/the-mythical-benefits-of-tort-reform-in-texas/

[doG]

As to tort reform as it relates to healthcare, litigation costs and malpractice insurance only account for between 1 to 1.5 percent of total medical costs, according to insurance industry consultants Towers Perrin. It is not even close to being a major driver of high healthcare costs.

You link says the same thing I said above, i.e. "the cost of medical malpractice claims and litigation is so small a part of national health care expenditures..." and says nothing of the malpractice insurance or indirect liability insurance that was the point of my post. Medical malpractice insurance rates and rates for liabilities insurance on goods used for health care have risen significantly through the years. It is not the actual payouts that become a significant part of health care costs, it is the quantity of insurance required to protect providers.

 

According to a report from the GAO, "For example, the largest

writer of medical malpractice insurance in Florida increased premium rates for general surgeons in Dade County by approximately 75 percent from 1999 to 2002, while the largest insurer in Minnesota increased premium rates for the same specialty by about 2 percent over the same period. The resulting 2002 premium rate quoted by the insurer in Florida was $174,300 a year, more than 17 times the $10,140 premium rate quoted by the insurer in Minnesota."

 

This does not reflect any actual payouts to litigants, simply the costs that a physician, like any other business, must pass on to the customer. I personally lived through doctors quitting their emergency room practice because the cost of malpractice insurance put them out of business. I remember surgeons in West Virginia walking out on their jobs for the same reason. These doctors simply could not charge enough to pay for the insurance rate increases they faced at the time. Yes, many of these instances have happened in the near past or the distant past but the lingering rise in health cares costs effects us today.

 

The closest analogy I can think of is the gasoline ratchet. Gasoline goes up and so do groceries because of the increased fuel charge. Gasoline goes down but the groceries don't. Gasoline goes up again and so do groceries. Gasoline goes back down but not the groceries. As the cycle replays over and over groceries ratchet higher and higher. The same thing happens every time the insurance industry gouges health care providers. Their services go up, never down. As a result the cost passed on to the end consumers spirals up forever. These then raises the cost of individual health care insurance.

 

Consider the total value in profits of the U.S. health insurance industry as a whole. That is doctor's and patient's premiums combined minus payouts. This is all money ultimately paid by the patient for health care since they must pay their own premiums plus those passed on by the doctors. Every single dollar of it is part of the bottom line of U.S. health care costs. If it wasn't then none of those insurance companies would be making any profits, they'd be losing money.

[iNow]

There seems to be one thing missing in all of the comparisons of U.S. healthcare compared with other nations, medical litigation and the associated insurance cost it causes.

You brought up this same point in a similar discussion two and a half years ago, and the answer I shared with you then remains valid now. The risk of litigation only imparts a roughly 1 to 2% change in overall costs. By focusing on this issue in this way it's like you're trying to lose weight by switching from 99 cans of Coke per day to 98.

 

http://www.scienceforums.net/topic/43565-healthcare-compromise/page__view__findpost__p__515244

 

 

I said it in that thread and will say it again here. Tort reform is a good thing, we agree. However, it doesn't even come remotely close to impacting costs in the way that your post implies.

[doG]

You brought up this same point in a similar discussion two and a half years ago, and the answer I shared with you then remains valid now. The risk of litigation only imparts a roughly 1 to 2% change in overall costs. By focusing on this issue in this way it's like you're trying to lose weight by switching from 99 cans of Coke per day to 98.

 

http://www.scienceforums.net/topic/43565-healthcare-compromise/page__view__findpost__p__515244

 

 

I said it in that thread and will say it again here. Tort reform is a good thing, we agree. However, it doesn't even come remotely close to impacting costs in the way that your post implies.

It sounds like you're missing the point. I'm not talking about the risk of litigation but the cost of insurance to cover that risk. Are you really trying to say that a OB/GYN's average malpractice premium of $50,000-$200,000 a year is only 1-2% of their overall cost as a provider?

[iNow]

No, all of the references, however, show that defensive medicine and the insurance you cite is only a miniscule contributor to the healthcare costs under discussion.

[JohnB]

If it wasn't killing and bankrupting so many people threads like this would be funny.

 

Justin, you don't understand freedom at all. I'd love to be an employer in the US. So long as there was a good health plan I could treat my workers like the slaves they are. Nobody would leave as they are trapped by healthcare costs. In contrast in Australia I have to be polite and work with my employees, by having access to universal healthcare my people can tell me where to go and when without fear. Australians are free to choose who to work for, Americans are not. Any way you slice it we have freedoms that you don't.

 

As has been shown repeatedly in these health threads the US is paying at least twice as much per capita for healthcare and getting pretty ordinary results for the money. Your system doesn't need fixing, it needs changing. Honestly it's like watching someone arguing against buying a new car. The old one just needs a bit of fixing, and "Once we've replaced the engine, gearbox, differential, brakes, steering, interior and glasswork it'll be a great car". At some point you have to accept reality and buy a completely new car. The healthcare system you have id dying, put a bullet into it and put it out of your misery and go shopping for a new one.

 

As to the whole "individual responsibility" argument, what a joke. Civilised nations view Universal Healthcare as a given. Just like a fire brigade, ambulances, honest cops and an uncorrupted judiciary, these are the benefits of living in a civilised nation. We all pay a little bit in our taxes for the Firies, but very few of us will need them to put out a house fire. Why shouldn't avoiding house fires be "individual responsibility" as well?

 

Anybody arguing that a developed nation should not have some form of universal coverage should also be arguing against police, highways, firies and ambos on the same basis. And that is the final point. To argue against these things isn't to argue from a basis in fact or data but wholely and solely from an ideological perspective. As such this form of opinion is immune to all facts and data that conflict with its preformed view of the Universe and is roughly akin to a religious viewpoint.

 

Religion we discuss a few forums up, around here facts and data win.

[John Cuthber]

Re insurance you are all missing the point that, if the government underwrites healthcare it also underwrites the insurance. Since it has no shareholders it doesn't need to make a profit so it can be cheaper. Also it pools a larger group of risks which reduces it's costs.

 

 

Re the state of play for employers- I believe that may be why the UK government is trying to make our system more like the US one.