Tuesday, September 08, 2009

The Most Expensive Health Care System in the World


 
The USA has the most expensive health care system in the world. They're number 1 by a long shot.

But does the USA have the "best" health care system in the world? Is it going to change?

Change doesn't look promising. Apparently it's a lot easier to make up campaign slogans about change than it is to actually deliver.




[Hat Tip: Genomicron]

20 comments :

  1. telmiIt all depends on what "best" means. "Best" in terms of life expectancy--no. "Best" in terms of cost effectiveness--no. "Best" for those of us who have great group (socialized medicine) health insurance--yes. "Best" political health care system that health care lobbyists can buy??--many Americans think this is the case.

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  2. "Apparently it's a lot easier to make up campaign slogans about change than it is to actually deliver."

    Barack has enough trouble right now convincing parents that "Work hard and stay in school" isn't some coded message designed to turn their schoolchildren into Socialist/Nazi/Muslim hordes. Trying to get through to people who scream "No socialized medicine!" and "Keep your hands off my Medicare!" all in one breath is a bit more difficult.

    Just coincidentally, this roughly coincides with the ascendancy of plutocrat-owned "news" media in the USA.

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  3. Carl Bajema says,

    "Best" for those of us who have great group (socialized medicine) health insurance--yes

    Why do you think the American health care system is better than Switzerland's or Japan's?

    Is there any objective evidence to support such a claim?

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  4. Larry - it may be a good idea to re-resd Carl's response.

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  5. I think the republicans are playing this one really well (for their benefit at least). National Health systems rapidly become critically important factors in the lives of many people and they will resist changing this system once its in place. If this goes through in the US there is an extreme problem for the republicans in that old people may become dependent on the new system (as they tend to be everywhere else in the west). The danger of the republicans changing it back may be enough to lost them significant votes in future elections. In a way the situation is not unlike Thatchers privitization of the housing market, which resulted in nearly a generation of Tory rule in the UK as people were dependent on the new system and didnt want Labour to change it back (and thus ruin the inflated house price market).

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  6. Good news - I finally have an appointment for my minor knee surgery in Kitchener - October 28. Free -- but I'll have to pay the $500 roundtrip cost from my sabbatical location myself.

    That's only 8 months after I first started having severe pain and only 5 months after it was diagnosed as a cartilage tear!

    In the US I would have been operated on months ago.

    But, by all means, continue to criticize the flawed American system without acknowledging that the Canadian system is also flawed.

    You can ration with cost, or you can ration with delay. I don't think one is morally superior to the other.

    Limping along here in Boston...

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  7. Define "minor surgery"...? No pre- and post-operative imaging? No anesthesia? No surgeon? No operating venue? No rehab afterwards?

    The only thing minor about it is a) you won't die if you don't get it right away, and b) you probably won't die on the operating table either, and c) it might take the surgeon 30 minutes to fix instead of hours.

    The resources that go into your "minor surgery" aren't that different from the resources that go into "major surgery". The value of self-righteous whining notwithstanding, it's really hard to see the validity of your complaint that others have been prioritized higher than you.

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  8. Anonymous completely misses the point.

    He thinks a system where people are forced to wait 8 months for minor surgery is morally superior to a system where people can get this surgery in two or three weeks.

    That is the point, not my "whining".

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  9. My wife's GP/PCP recommended her a thyroid exam after her annual physical in late 2007. By hte time we got an appointment with the endocrinologist (3 months waiting list) I had been laid off and was hanging on to my ex-employer's health plan during the time-in-lieu of layoff notice period. Since I was not going to have employer subsidized health insurance at my new job, and my wife anyway had none at her's we had an agonizing choice. Do we take the appointment with the endoc and sign up for a new self-paid plan - the "low" deductible kind - in which case it would be my wife's last meeting with the endoc as the new plan would not cover "pre-existing" conditions. Or do we go ahead and with the pre-existing condition so that the new insurer does not retrospectively cancel our policy in the not too distant future? So we took the plunge, my wife saw the endoc - on the last day of my old employer paid plan - and waited for another 7 months till she could sign up a for an employer paid plan with her employer. She saw the endoc again for a detailed check and prescription late in December/08. The world's best healthcare!

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  10. He thinks a system where people are forced to wait 8 months for minor surgery is morally superior to a system where people can get this surgery in two or three weeks.

    Dude, what does the average wait time work out to when you factor in the people who never get the surgery because they can't afford it? I'm guessing it's longer than 8 months.

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  11. Chris -

    It's your claim, how about you provide the data instead of just "guessing"?

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  12. How much different is a Washington bureaucrat from an insurance claims clerk?

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  13. Actually Jeffrey, you're the one making unsubstantiated claims about wait times. I'm just out of school, with no supplementary coverage and enough debt already. Are you telling me that if I was in the US I would only wait 2-3 weeks for minor knee surgery if I needed it?

    According to the US Census Bureau (via Factcheck.org) around 46 million people under the age of 65 don't have health insurance.

    My point, since you missed it, is that by excluding the people who won't be treated at all because they lack insurance or other means your figures are misleading. Without those numbers you too are "just guessing".

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  14. Jeffrey Shallit asks, "It's your claim, [that some people never the surgery because they can't afford it], how about you provide the data instead of just "guessing"?

    Sure, you provide the data yourself, fool. Instead of whining in pain limping around for 8 months waiting for the Canadian heath care system to fix you for free, why didn't you just pay the cash to get the surgery immediately while you were in Boston? Because you can't afford it!

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  15. Well, Jeffrey, if anybody had mentioned the Canadian system in glowing terms before you, perhaps you would have a point in taking others to task for ignoring its flaws. However, you were the first to bring up the Canadian system, in the usual knee-jerk (ha) response to criticism of the US system - "But the Canadian system has long waits".

    This was a post about the US system, and how it has been shown to have higher cost and poorer outcomes than assorted other healthcare systems in the developed world. Nobody said the Canadian system was perfect or morally superior. So who were you arguing with - or were you just clouding the argument?

    And since you ask for data - from the Commonwealth Fund: "One–half of adults with health problems in the U.S. said they did not see a doctor when sick, did not get recommended treatment, or did not fill a prescription because of cost." This same organization, note, finds Canada is the only country worse than the US in terms of wait times overall (of 6 countries sampled). There's plenty of room for slamming both!

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  16. However, you were the first to bring up the Canadian system, in the usual knee-jerk (ha) response to criticism of the US system - "But the Canadian system has long waits".

    Let's view my response in the context of Larry's blog. Anyone following this blog knows that it's a theme of Larry's that the Canadian system is superior, both morally and in terms of outcomes, to the US system.

    Criticizing the Canadian system because it has long waits is not "knee-jerk"; it is a simple fact. I don't oppose health-care reform in the US, but I think those that advocate single-payer have a responsibility to acknowledge that it can result in longer wait times.

    why didn't you just pay the cash to get the surgery immediately while you were in Boston? Because you can't afford it!

    Wrong - guess again.

    Are you telling me that if I was in the US I would only wait 2-3 weeks for minor knee surgery if I needed it?

    Yes, if you can pay for it.

    Actually Jeffrey, you're the one making unsubstantiated claims about wait times.

    No, my claim is not unsubstantiated. I have had both major and minor knee surgery in the past in the US, and wait times were exactly what I said.

    There's plenty of room for slamming both!

    Exactly my point. The Canadian system is superior for chronic diseases that are easily managed with family doctor supervision, such as asthma, and for acute life-threatening cases. But it is not superior for painful, but not life-threatening, conditions.

    Although I entered the Canadian system thinking it would be superior to the American system (and argued with American physician friends exactly that), my 19-year experience with the Canadian system has been, overall, much more negative than with the American system.

    And I also have had the experience that most Canadians are unable to acknowledge the flaws in their system and argue rationally about it. Instead, they respond with personal insults.

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  17. "Hi:

    Two things

    1) I’d like your permission to (re)print your article on ‘Torchwood’for our website

    2) I was hoping we could use your ‘scribing’ talent for our website.

    The Best Shows Youre Not Watching (dot) com [all one word]
    ‘Torchwood’one of our featured shows. We’re hoping to round up a few people who can occasionally contribute perspective (via an article/blog) on the shows – maybe a recent episode, future direction, plot shortcomings etc.

    What’s in it for you?
    Primarily a larger audience back channeled to your blog. We don’t pay but the site has a lot of promise and we're pretty excited about getting it off the ground. Let me know what you think.

    Thanks

    ReplyDelete
  18. "Hi:

    Two things

    1) I’d like your permission to (re)print your article on ‘Charlie Rose’for our website

    2) I was hoping we could use your ‘scribing’ talent for our website.

    The Best Shows Youre Not Watching (dot) com [all one word]
    ‘Charlie Rose’one of our featured shows. We’re hoping to round up a few people who can occasionally contribute perspective (via an article/blog) on the shows – maybe a recent episode, future direction, plot shortcomings etc.

    What’s in it for you?
    Primarily a larger audience back channeled to your blog. We don’t pay but the site has a lot of promise and we're pretty excited about getting it off the ground. Let me know what you think.

    Thanks

    ReplyDelete
  19. "But it is not superior for painful, but not life-threatening, conditions."

    1. I'm a U.S. citizen living in the USA who spent several months of each year from 1989-1994 working in Edmonton and Calgary.

    2. I acknowledge the long wait times for many conditions **diagnosed** to be non-life-threatening in Canada. I remember an Edmonton friend's husband waiting months for shoulder surgery. OTOH they had very little money, and might not have been able to afford the surgery at all in the U.S.

    3. I've had twisted ankles treated in Canada and the U.S. The Canadian treatment was more thorough (a nurse put an Ace bandage on my ankle and made sure I knew how to do the wrap myself before I left vs. a doctor telling me to go buy an Ace bandage and put it on), faster (45 minutes for admission, X-ray, consultation, bandaging and payment, vs. several hours waiting, filling out insurance forms, X-ray and consultation) and much, much cheaper than in the U.S. ($60 paid at discharge after a minute or two to determine the fee for a non-citizen, vs. hundreds of dollars after receiving multiple medical bills from hospital, doctor and radiologist and hassling with insurer over a period of months).

    4. In the company where I work, only "high deductible" medical coverage is offered, meaning anyone with a family must spend thousands of dollars of their own money before insurance begins to pay 80% of the bill, and more thousands before catastrophic full coverage kicks in. (There are also maximums for some benefits, so coverage occupies a band between uncovered levels.) A couple of years ago, one of my co-workers had a terrible cough and great difficulty breathing. Her manager was literally begging her to go to the doctor, but she refused because she was a single parent on a low salary who wanted to save money to send her only child to college (which costs at least tens of thousands of dollars here, more typically hundreds of thousands - that's a discussion for another time). It could have been something serious (luckily for everyone, it wasn't, and her son is in college today), but this woman was not even willing to get a diagnosis because of the potential costs.

    The plural of anecdotes, of course, is not data, so here's a data point: Health care costs are involved in more than 60% of U.S. bankruptcies.

    So I'll certainly grant that the U.S. system can provide care more quickly in particular situations such as the one you happened to face, assuming that the U.S. care can be afforded. However, I'm not ready to grant that this amounts to moral equivalence between the Canadian system and one that makes it difficult or impossible to get care even in some cases of relatively urgent need.

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  20. Jeffrey,

    While you report waiting for about 8 months for minor knee surgery, Ontario Health reports an average waiting time of 98 days for Priority 4 cases in hospitals the Kitchener area. Against a target of 182 days, 86% of 10,473 Priority 4 cases have been completed within target and 90% have been completed within 215 days. The department defines Priority 4 as follows

    # Minimal pain; disability does not threaten role and independence
    # Disease progression is minimal.

    These are decisions made by doctors and not bureaucrats - public or private. In the US it is private bureaucrats who decide what care one gets. Even the much vaunted emergency care option amounts to little, as if one isn't at a county run hospital, there is little more than palliative care, while the hospital tries best how to dump the patient at the doorstep of the nearest county hospital, or draw from public funding to treat the patient. There is an entire industry of companies that offer this service insurance companies and hospitals - deseivingly called "revenue augumentation and enhancement" A system like Canada's that treats people regardless of their ability to pay is morally superior to one that rations coverage by pricing.

    There is an interesting series on Dr. Mano Singham's blog here http://preview.tinyurl.com/nnxa7o about his experience ordering a colonoscopy. Mano heads the University Center for Innovation in Teaching and Education at Case Western Reserve University, and also faculty adviser to university's Campus Freethought Alliance

    ReplyDelete