Feel free...

Cheers. As I drove home, I decided to open up a new thread, but now you've done the hard work, I don't have to!

thanks Brad ... I needed a couple of laughs.

In answer to this post : viewtopic.php?p=11886#p11886

Archduke Russell John wrote:

freeman2 wrote:It seems to me if you're going to blame the government for being the cause of high health
costs without commensurate health care benefits, then you should be able to explain how other western countries are able to deliver health care at a cheaper cost to everyone

Because they run them as significant deficits.

This is actually irrelevant. The US can hardly lecture anyone on deficits, and the point is that the cost of running government healthcare in countries in Europe is much lower, regardless of whether it's paid in full by taxes or there's a shortfall. Not every country is running a deficit to speak of anyway - Norway usually has a surplus.

Archduke Russell John wrote:

freeman2 wrote:Iwhile at the same time doing better than we do with regard to the overall health of their people (life expectancy, infant mortality, etc.)

Because they don't actually. They use different methods to calculate those figures. For example, in the U.S. we consider any birth where the baby breathes a live birth for infant mortality figures. Much of Europe will only consider it a live birth if the baby survives X number of hours and weighed X lbs at birth.

By ‘Much of Europe’, how much do mean? Most EU members? Half of them?

According to this CDC paper, http://www.cdc.gov/nchs/data/databriefs/db23.htm, (see table 1) of the 19 European nations they got comparisons with, 13 use the same WHO standard for recording a live birth as the USA. Norway’s is slightly different, but the CDC say that the effect is virtually the same, as they only omit births under 12 weeks gestation, and a miniscule proportion of those would be live births. Of the remainder, only one (Czech Republic) applies a rule using hours of survival (they count all births over 500g [1lb2oz] and any under 500g where the baby lives for at least 24 hours). The others (France, Ireland, Poland, Netherlands) use birth weight (all 500g) and/or gestational period (usually 22wks).

Fair enough on that, but this next sentence is the real howler:

Archduke Russell John wrote:If you recalculate using the same methodologies, the U.S. numbers jump to the top of the list.

I’m afraid you have been misinformed. If you only compare the USA to the other EU countries listed, the US position moves from being 19th out of 20 to being 13th out of 14 – the only EU nation in that study worse than the US is Slovakia (both based on figure 1).

If you ignore all births before 22 weeks, the USA comes in at 17 out of 20, and still twice as high as Sweden and Norway (figure 2).

So, for clarity, you do not ‘jump to the top of the list’. You move up a notch or so, but are still near the bottom.

Now, what the CDC suggests is the main cause of the difference is not the different definitions used, but that the USA has a higher rate of premature births than European nations. Of course, premature birth is itself a health issue and the causes for that can be manifold - more under-18 and over-35 pregnancies? Poorer health to begin with? A different area of study, for sure, and worthy of some attention. But it’s not explained away by methodological differences.

So, the CDC conclude:

The United States compares favorably with Europe in the survival of infants born preterm. Infant mortality rates for preterm infants are lower in the United States than in most European countries. However, infant mortality rates for infants born at 37 weeks of gestation or more are generally higher in the United States than in European countries.

Right, now we’ve looked at the comforting American Exceptionalist canard that different methodologies not only explain the US’s poor performance but actually stop it from being the best, I’d like to ask a little more about these ‘different methods’:

Freeman listed another factor – life expectancy. In what way is the US method of measuring this different from everywhere else?

Which other measures that the USA is falling down on are measured in a significantly different way?

Because as far as I can see, we pretty much are comparing oranges with oranges on these. 5-year survival/mortality rates for diagnosed conditions are based on the same definition. Prevalance rates of conditions will be the same measure. Life expectancy is based on observed age at death and ages of people still alive.

And, assuming you can actually provide us with these differences, how much of an impact do you think they actually have on the USA’s comparative performance.

If you have information otherwise (and this time, perhaps a source would help), please furnish it., so that we can test your assertions.

In response to this: viewtopic.php?p=11930#p11930

Ray Jay wrote:

rickyp wrote:ray

This is a huge part of our economy, so I don't think it can be easily explained, but one thing that you have to look at is how much money the US spends on elderly health care towards the final stages.

This is not unique to the US.

What is your source for saying that the extent of these expenditures is not unique to the US? I do know that a huge % of medicare spending is for the last year of life. Do you have a source that compares that end of life spending for other countries?[/quote]

In the UK we also spend a very large proportion on geriatric and end-of-life care. Oddly, it’s not just Americans who rage against the dying of the light.

More than 40 per cent of the NHS budget is currently spent on people aged over 65.

– 2006 source http://www.guardian.co.uk/society/2006/ ... e.politics

Older Americans account for over one third of all medical spending in this country -- approximately $300 billion a year for their share of the cost.

– 2001 source http://www.longtermcarelink.net/elderca ... issues.htm

I think that the two are comparable (the US article does not specify that 65 = ‘Older’ but goes on to talk about the average costs of a 65-yr-old patient compared to a 40-yr-old).

And on 'last-year-of-life'?

This study from the US contains a lot on the costs of healthcare in the year leading up to death (and comparisons with people in the same age groups who do not die) https://www.cms.gov/ActuarialStudies/do ... f_Life.pdf

People who died cost about 30% (it was going up from 26.5% in 1994 to 28.8% in 1999, so let's extrapolate that it's now about 33%) of the total cost for people over 65

On end-of-life costs, this paper looks across the world and notices the same phenomenon - that costs escalate rapidly the nearer a person is to death - in the USA, UK, Netherlands... Population Ageing and Health Care Expenditure

This report on the NHS shows that the costs for cancer patients (27% deaths) to the NHS and social care amount to £1.8bn (equivalent to about $3.5bn at the time)

Here's one from Scotland: http://isd.scot.nhs.uk/isd/files/ptd1.pdf which looks at the costs incurred by the NHS at the time close to death. From that I'm going to estimate that the 73% of deaths that are not cancer will in total cost about double that of the cancer deaths, taking the cost to about $10.5bn

That's about 1 eighth of the quoted costs to Medicare ($88bn [url]according to doing the sum from this[/url]in the USA. which is an odd correlation with the 10:1 ratio of total heathcare spending between the USA and UK. Seems to me that we spend about the same proportion as you do.

So, the high cost of end-of-life care is not unique to the USA. I doubt very much that it's confined to the USA and UK. Of course, some of the studies also suggest that age itself is less a worry in terms of escalating costs in the future than the effect of actual end-of-life costs.

Anyone got any more myths that we can bust?

Ray Jay wrote:thanks Brad ... I needed a couple of laughs.

Glad to be of service. It is a gift...

According to this source, health care spending for the elderly was 36% of US health care expenditures in 2002. http://www.ahrq.gov/research/ria19/expendria.htm

13% of the US population is over 65. 16% of the UK population is over 65.

http://www.data360.org/dsg.aspx?Data_Set_Group_Id=466

So, if you adjust the US number by 16/13rds, the 36% goes to 44.3%. That is a 2002 #, so it is probably low.

Since the US spends more than the UK on health care (we are all agreeing on that), the US overspending is even more acute amongst the elderly. I don't think you've busted me on this one.

Ray Jay wrote:According to this source, health care spending for the elderly was 36% of US health care expenditures in 2002. http://www.ahrq.gov/research/ria19/expendria.htm

13% of the US population is over 65. 16% of the UK population is over 65.

http://www.data360.org/dsg.aspx?Data_Set_Group_Id=466

So, if you adjust the US number by 16/13rds, the 36% goes to 44.3%. That is a 2002 #, so it is probably low.

And the first link says that 'more than 40%' of the NHS budget is spent on the over-65s as of about 2006 (although that data could be old).

'over 40%' is not too far off of '44.3%' is it? We can quibble that maybe it's up to 10% higher. But your health system costs about 50-75% more than ours does overall (depending on whether you measure per capita or proportion of GDP).

Since the US spends more than the UK on health care (we are all agreeing on that), the US overspending is even more acute amongst the elderly. I don't think you've busted me on this one.

I've shown that we spend about the same as a proportion of our health spending on the elderly (over 65s) and on last-year-of-life.

Which suggests that it's not these that are actually dragging your spending up, but something else. If you are spending about 10x the amount as we are on 5x the population generally, and you are also spending about 10x the amount as we are on about 4x the elderly population, and you are also spending about 10x the amount on end-of-life care as we are, then what is it that makes you so different?

You would therefore be spending about 10x the amount on people under 65 as we are. And about 10x per head on people who are not within a year of death.

So where's the big difference, RJ? One that accounts for a large amount of the 5% extra on GDP that you spend which we do not.

For the specifics on end of life, I couldn't trace your argument, perhaps because one link was inadvertently not provided. I'll have to look at the rest in more detail when I have time.

http://www.nao.org.uk/publications/0708 ... _care.aspx

Here's the missed link. Point 4 lower down contains the datum: "We estimate that the annual cost to NHS and social care services of providing care to cancer patients in the 12 months prior to death (27 per cent of deaths) is £1.8 billion."

From the Economics forum about Solyndra...

Archduke Russell John wrote:
Well no. First I would tell them to use the current system of medicaid as it is set up. Which is to ask the hospital to apply to medicaid to cover them.

Barring that, I would say no have the hospital treat them but explain to the patient they will be responsible to pay for all cost incurred in treatment if they do not have insurance. Then it would be up to the person to ask what the costs would be.

Danivon wrote:
Sounds all very proper. Does the same apply if they present in an unconscious state? What if they unhelpfully die before being able to be presented with the bill?

Oh, and an additional:

What if they present with the symptoms of a treatable yet virulent communicable disease and can't pay? Do you turn them away and just treat the (insured) people who end up catching it from them? Surely if individual health is not a government responsibility, public health is?

Danivon,
Thank you for the extreme cases, surely you can see that there are people who show up with minor issues? But to answer your very uncommon issues...

Unconscious: Treat as medical professional says to mitigate emergency (if any), wait for family/friends to identify; transfer to charity facility barring other support.
Virulent communicable disease: Treat as medical professional says to mitigate emergency (if any), wait for family/friends to identify; transfer to charity facility barring other support. Are you advocating detention against the will of the patient? At the Court's discretion, I would agree.

What is your viewpoint on a person coming to the ER with a cold? Is it the responsibility of the taxpayer to ensure treatment of something as innocuous as the common cold? Perhaps a bad case of post-nasal drip? If you bring worst case scenarios, I will bring the egregious instances of abuse.

I agree that an ER should treat the immediate emergency situations if the patient has no means of support (based upon the ER's triage determination), and I have said such. Surely you do not advocate the treatment of a non-paying person for the common cold, do you?

RAy

Don't you have to ask yourself why Obama didn't reform the tort system as part of his health care initiative? Would it be fair to say that he was beholden to the legal profession for contributions? He basically chose the legal profession over dealing with our large deficits.

Obama has disappointed in many ways. But its a tough town Washington.
Torte reform in Texas hasn't lead to lower insurance costs or lower over all medical costs there ... So perhaps the "cost of defensive medicine" rationale has been proven partly wrong.
It may be that the use of over subscribing tests is as much a part of directing tests that in themselves are a profit centre, and also a part of doing business the usual way.

bbauska

Surely you do not advocate the treatment of a non-paying person for the common cold, do you?

Ah, so this is what a mindless drone is?

In real life, every person who comes into an emergency ward takes up time. You can't be certain its a common cold until someone is seen and diagnosed. And thats an expense.
every solution for the uninsured and indigent involves tax payers ultimately paying for their care. People who refuse to carry health insurance and get treatment beyond their means to pay are also depending on the system to subsidize their care as well.
As soon as there is a mandate to guarantee treatment, there is a a socialization of the cost of some who are treated. (thats what medicaide is...)
And as long as there is a public health angle to consider, the taxpayer is again on the hook.

Who benefits most from the status quo in the US health system?

bbauska wrote: Thank you for the extreme cases, surely you can see that there are people who show up with minor issues?

Of course I do. But the extreme cases are the ones that are most likely to need medical attention quickly, and where not acting can have serious repercussions.

In fact, the name 'Emergency Room' is a clue as to the kind of cases that it is set up to deal with, is it not?

But to answer your very uncommon issues...

Unconscious: Treat as medical professional says to mitigate emergency (if any), wait for family/friends to identify; transfer to charity facility barring other support.

And if no charity exists or is able to deal with it? Who pays for the treatment up to transfer if there's no family - the charity? Is there some way to ensure that there are enough charities to go around to cover all this, or is it based on whose prepared to set them up and pay into them?

Virulent communicable disease: Treat as medical professional says to mitigate emergency (if any), wait for family/friends to identify; transfer to charity facility barring other support.

As before, it seems that you differ from ARJ. He's the one who had earlier suggested that the government have nothing to do with healthcare. Those who accept some, exigent, services at least have put some thought into the considerations involved.

Are you advocating detention against the will of the patient? At the Court's discretion, I would agree.[/quote]I'm not 'advocating' anything, I'm asking about the limits of public healthcare that you and your fellow conservatives are comfortable with setting.

What is your viewpoint on a person coming to the ER with a cold? Is it the responsibility of the taxpayer to ensure treatment of something as innocuous as the common cold? Perhaps a bad case of post-nasal drip? If you bring worst case scenarios, I will bring the egregious instances of abuse.

Quite simply, they should be sent away regardless of whether they can pay or not - hospitals are not places for people with just a cold, let alone the ER dept. The ER is for real emergencies.

I agree that an ER should treat the immediate emergency situations if the patient has no means of support (based upon the ER's triage determination), and I have said such.

It was ARJ who was saying that the government should not have a part in health. It seems that you and I agree that there is a case.

What I find interesting is the idea that 'means of support' comes into the triage situation. Won't this add a delay even for those who are covered, as doctors and administrators try to find out if they are?

Surely you do not advocate the treatment of a non-paying person for the common cold, do you?

[/quote]As I've already said, I don't advocate treatment of any person for the common cold at an ER. That's not what they are for. If someone has a cold they should:

a) treat the symptoms with mild over-the-counter drugs
b) stay at home as much as possible (ideally, to avoid infecting others), keep warm and drink plenty of fluids
c) if it persists, or symptoms worsen, go to a GP ('family doctor') so they can check for a secondat infection or if it's more than a cold.

Of course, I think that the GP should be publicly funded too, but even so, they would usually not go out just for the common cold or want people to clog up their waiting rooms spreading rhinitus viruses around.

Comprendé?

rickyp wrote:Torte reform in Texas hasn't lead to lower insurance costs or lower over all medical costs there ... So perhaps the "cost of defensive medicine" rationale has been proven partly wrong.

Or perhaps defensive medicine is not simply a response to legal liability fears. I can think of three reasons why it may be more common that have nothing to do with torts:

1) The patients want a battery of tests run because they think that's the best way to diagnose
2) the doctor prefers to run loads of tests than to rely on their own skills and time to diagnose
3) profit motive on running loads of tests