Welfare in the US

[Wonkish1]

Well as you close down the local hospitals those healthcare consumers don't just disappear. They then move to getting serviced at the major hospitals.

'Healthcare consumers'? Christ. And that was without a hint of irony, I presume? Lord...

Anyways, that's the whole point. The entire and uttermost totality of the point. Because, you see, the quality of treatment from both specialist and non-specialist staff tends to improve when there is a major concentration of specialists. Hospitals, in that respect, are like Universities. And like Universities, you also want some serious teaching and research going on as well. A better atmosphere in general, and better care for the patients.

Oh, and if someone is advocating increasing the importance of specialist care within a system, then it is reasonable (and also logical) to assume that this person supports training and employing more specialists. It is possible that this hypothetical individual is bemused at the fact that he feels the need to point this out, it being so blindingly obvious.

Naturally this hypothetical individual would not dignify the rest of your post with a response and would be most unlikely to take any bait from from that general direction.

Consumers of healthcare is the correct term when your referring to it on a macro level(think about it when you buy a drug your not a patient you are a consumer). Its an economics term. When your talking about those that see a doctor or something like that they become "patients". I'm just trying to use accurate lingo here.


Quality of healthcare doesn't necessarily go up as you centralize it. Actually in a lot of cases(if not most) the opposite occurs. Centralization gets you scale efficiency, but also gives you bureaucratic inefficiency. This is a problem that plagues big companies today and how they handle these issues matters a lot.


You would be surprised by the amount of people that I come across that think all you need to do is force doctors to see more patients and the demand will be met while not taking into account that they don't have enough time. Your entire national dental system appears to be the poster child of that idiot thinking. How many NHS patients does a dentist need to see a day now in order break even these days? 600?


So your now "not dignifying the rest of my post with a response"? I don't think you can argue that  I am acting in bad faith here. As you can tell at least in the case of Marston and I we are having a nice back and forth on healthcare and we aren't stomping our feet at each other like this. So is you saying that have more to do with the fact that you just don't like participating in a discussion with me or can you actually point to things that are bothersome or not fair?

[Wonkish1]

It is certainly one of the reasons for the problem of late diagnosis though. Another issue with cancer statistics here, of course, is the fact that many cancer patients are elderly and there has always been an assumption here (and this was the case long before 1948) that there's not much point adding a few extra years to a life that was likely to end soon anyway. My own Grandad chose to fade slowly out to increasing doses of morphine rather than risk surgery that would have extended his life by a couple of years at the cost of what was left of his quality of life.

You just hit on a point that is huge.  Americans are only brave when they are dropping bombs on innocent women and children half way around the world.  When it comes time for them to face the reaper they wet their pants.  I've seen it time and time again.

You check out some of these amazing new cancer wonder drugs and you will see something like this... Spend six figures and come in for us to dump poison into your veins every few weeks and you may live a whopping six months longer!  If the government refuses to participate in this farce right wingers start screaming "Death Panel!"

You want to decrease ludicrous health care expenditures in America?  Then grow a pair and face death with some dignity and stop these pointless ludicrous expenditures.  And lose weight for Heaven's sake.

So you have never heard of remission before then have you? Its quite common in the US for people who are diagnosed initially with cancer to live decades beyond that point.

Also, who really is the "die quickly" party then, there Link!

[Wonkish1]

Well as you close down the local hospitals those healthcare consumers don't just disappear. They then move to getting serviced at the major hospitals.

'Healthcare consumers'? Christ. And that was without a hint of irony, I presume? Lord...

Yup. I'm sure he was serious.  That's the way they talk about healthcare here in America.  It's be so cheapened.  You would think instead of saving lives doctors were selling widgets.  They think healthcare is some open air bazaar where patients, oops, I mean "healthcare consumers" just wander around the free market making wise well informed decisions and doctors, oops, I mean "providers" are at their beck and call.  I love that term "providers."  It's pretty cool that in America these right wingers have f'ed up the health care system so much we can refer to doctors and call girls with the same name.

Link, Healthcare consumers are the correct term because its all encompassing. Only people that see doctors are patients. People aren't patients of drugs. People aren't patients of health coaches. People aren't patients of nutritionists. And the list goes on.

Just because you don't know the lingo doesn't mean that its my fault.

[Wonkish1]

Yes it does some of that thanks to the insurance industry taking a 5% cut + cut over fighting whether or not something is covered in the plan. The real reason is that wages in the healthcare industry are higher in US than nearly everywhere. I suspect covering the entire population under current average standard would probably increase the healthcare spending by about 10% in the us, because of elimination of bureacracy and savings due to preventative care in other areas(not necessary healthcare, but worker productivity etc(of course to do something like this you would have to mandate flu shots which would piss off about 10% of US population majorly)).
I thought that we are talking about "expensive" aka "non-mainstream" cancer that's currently not covered in the UK and the like(first world single-payer). I don't know why are we even having this discussion though, it's just an epic strawman drawing contest, since I suspect neither of us is in the healthcare industry and can break down the cancers by type/price to treat/average survival rate after treatment before writing the posts. Last part would be a yes, based on other governmental agencies and how emotional people will get if it's not that way.

Missed this one yesterday.

Insurance companies "taking a cut" doesn't have anything to do with expensive cancer treatments since they are expensive on the *provider side* not the *insurance side* of the equation. Also insurance company profit *margins* are very low relative to other industries. If their profits were wiped out you would see a change in premium cost of a couple measly percent a year. Its really a non issue. Also some are non profit or mutuals anyway who don't have shareholders and they don't have any difference in pricing. The liberal notion peddled by some politicians that our system is expensive because of high health insurance profits is an outright lie that their stupid followers believe.

Wages among primary care physicians have been falling and falling fast. They are now at risk of slowing down the number of people entering medicine because of sheer size of student loan debt, large number of non income producing years in school, and the lower income payoff for doing it. I can assure you that the incomes of healthcare professionals is a lot smaller factor than you would think it is.

Preventative care among the insured, medicaid, medicare, and VA is already top notch and getting better(even the ObamaCare can easily derail that with community rating) because in the US unlike the rest of the world we can incentivize people to engage in it by doing things like lowering their deductibles, co-pays, or even premiums.

Practically every form of cancer is expensive. The more common cancers in places like Britain have much worse outcomes because of the constraints they have placed on supply. The less common cancers(or other illnesses) either aren't covered at all in Britain or they have so little supply that you will likely never be treated. Some of these rare cancers and illnesses can have very good outcomes prolonging peoples lives for 5, 10, even 20 years or more. Just because they are rare and expensive doesn't mean that they are synonymous with death.

The country would bankrupt itself in less than 2 years if it approved every single treatment in a government run system. It would be mathematically impossible.

[Marston]

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Agreed.

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I was more aiming towards the fact that if you reside in a rural area, a network model wouldn't likely be of much use because most network HMO's contract with large group practices that are in traditionally located in large metropolitan area's.

I think you're trying to surgically remove HMO's from the larger context of managed care and unfairly single out and link them to non-native healthcare systems. You see, pretty much 99% of employer-based health plans operate under a managed care type of system. They pretty much all have taken "a bureaucratic approach to limiting expensive treatment". You're more prone to be aware of the Gatekeeping method traditionally used in HMO's because it requires the patient to be proactive in seeking out referrals by the primary care physician in order to gain access to higher levels of medical services.

Don't be fooled, however! Other types of managed care certainly use bureaucratic approaches that are on par or even more "intrusive" than your traditional HMO Gatekeeping method. Look at prospective utilization review, for one. Under this method, the enrollee or provider (depending on the plan and/or case) must call the plan administrators for precertification, that is, approval before certain services are provided. Most of these plans use clinical guidelines to determine the appropriateness of care.

There's also concurrent utilization reviews and retrospective utilization reviews that are widely used in managed care plans outside of HMO's. The point I'm trying to make is that managed care is bureaucratic in nature. And given that managed care has basically taken over employer-based health insurance, I would argue that it's not receiving the amount of backlash that you may think or want to think it has. Hell, I could even make a case that Medicare, which still operates mainly under the traditional fee-for-service reimbursement method, is actually less bureaucratic than your every-day managed care plan in terms of utilization review.   

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Really? I mean, Really?

So you're saying I don't have to worry too much about a proven disparity in health outcomes between, say, an average community hospital and a highly-ranked teaching hospital system like the University of Michigan? Let me tell you, if I had the ability to choose, I would take Michigan every time over the hospital that is located not 10 minutes away from me. I'm not going to argue that the NHS is perfect. But it's inappropriate to discount the fact that they've made great progress in updating their hospitals and outpatient centers since the 1990's. Also, if you're judging the quality of their "product" by way of outcome, I'm unsure how you come to your conclusion.

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You didn't.

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What I was trying to get at, in simple terms, is that if everyone is insured, we don't have the healthcare professionals in place to service the universally insured population.

You can comfort yourself all you want by claiming the U.S. has universal access (I suppose in some perverse way it does). Only about 30 states have high risk pools set-up. The ACA set up a national high-risk pool but the 80:20 coinsurance and the 125%-150% premiums above market averages severely limit the number of applicants with the ability to pay.

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I don't know. Please enlighten me.

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So, would it be safe to assume that you would perhaps prefer Singapore's system to our own?

As for play-or-pay, employers would have to provide health insurance for their employees or pay into a public health insurance program. If the employer chooses to pay, financing is through a payroll tax paid by the employer and the employee, very similar to the way Medicare and Social Security are currently handled through payroll deductions. Because the employer-based system is already in place, it would be the least disruptive to the current system, obviously.

[Wonkish1]

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Agreed.

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I was more aiming towards the fact that if you reside in a rural area, a network model wouldn't likely be of much use because most network HMO's contract with large group practices that are in traditionally located in large metropolitan area's.

I think you're trying to surgically remove HMO's from the larger context of managed care and unfairly single out and link them to non-native healthcare systems. You see, pretty much 99% of employer-based health plans operate under a managed care type of system. They pretty much all have taken "a bureaucratic approach to limiting expensive treatment". You're more prone to be aware of the Gatekeeping method traditionally used in HMO's because it requires the patient to be proactive in seeking out referrals by the primary care physician in order to gain access to higher levels of medical services.

Don't be fooled, however! Other types of managed care certainly use bureaucratic approaches that are on par or even more "intrusive" than your traditional HMO Gatekeeping method. Look at prospective utilization review, for one. Under this method, the enrollee or provider (depending on the plan and/or case) must call the plan administrators for precertification, that is, approval before certain services are provided. Most of these plans use clinical guidelines to determine the appropriateness of care.

There's also concurrent utilization reviews and retrospective utilization reviews that are widely used in managed care plans outside of HMO's. The point I'm trying to make is that managed care is bureaucratic in nature. And given that managed care has basically taken over employer-based health insurance, I would argue that it's not receiving the amount of backlash that you may think or want to think it has. Hell, I could even make a case that Medicare, which still operates mainly under the traditional fee-for-service reimbursement method, is actually less bureaucratic than your every-day managed care plan in terms of utilization review.    

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Really? I mean, Really?

So you're saying I don't have to worry too much about a proven disparity in health outcomes between, say, an average community hospital and a highly-ranked teaching hospital system like the University of Michigan? Let me tell you, if I had the ability to choose, I would take Michigan every time over the hospital that is located not 10 minutes away from me. I'm not going to argue that the NHS is perfect. But it's inappropriate to discount the fact that they've made great progress in updating their hospitals and outpatient centers since the 1990's. Also, if you're judging the quality of their "product" by way of outcome, I'm unsure how you come to your conclusion.

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You didn't.

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What I was trying to get at, in simple terms, is that if everyone is insured, we don't have the healthcare professionals in place to service the universally insured population.

You can comfort yourself all you want by claiming the U.S. has universal access (I suppose in some perverse way it does). Only about 30 states have high risk pools set-up. The ACA set up a national high-risk pool but the 80:20 coinsurance and the 125%-150% premiums above market averages severely limit the number of applicants with the ability to pay.

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I don't know. Please enlighten me.

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So, would it be safe to assume that you would perhaps prefer Singapore's system to our own?

As for play-or-pay, employers would have to provide health insurance for their employees or pay into a public health insurance program. If the employer chooses to pay, financing is through a payroll tax paid by the employer and the employee, very similar to the way Medicare and Social Security are currently handled through payroll deductions. Because the employer-based system is already in place, it would be the least disruptive to the current system, obviously.

Staff HMOs are the plans that have the *most* managed care deployed on them in general, and in comparison to major medical, HDHP(of which has next to 0) its by a massive margin.

The example you gave of prospective utilization review is just gate keeping where an administrator performs the gate keeping instead of a primary doctor.

Since the largest growth market in insurance today is HDHP how could you possibly say that "managed care" has taken over employer provided health insurance today?

Go ahead and make your case that Medicare is less bureaucratic doesn't mean I'm going to agree with it.


Your now talking about health outcomes. I was talking about hospital caused infections due to poor conditions and inferior service. Of course people are going to the place that produces the best outcomes. I'm just saying that if they end up being brought to emergency in any old local hospital in the US they have a lot less to worry about in hospital caused infections relative to a place like the UK. I would probably choose Intermountain as my hospital of choice for an expensive procedure that fell under my deductible(I have HDHP) and it would much more depend on the problem if it was a very expensive procedure over my deductible.


So it appears you agree that the issue isn't access-availability its access-affordability? That makes a difference when your talking about things like community rating that then address a problem that isn't even there and make other problems much, much worse. I agree that there are access affordability issues that need to be dealt with. I do not agree that there are access availability issues outside of maybe illegal immigrants.


Costs skyrocketed. Its the ultimate test to determine whether or not our system is more like the government systems of Europe or more of a market based one. In a market, as supply increases costs fall. In government systems if you increase supply costs rise. It also illustrates the very key point that "skin in the game" matters a lot. With most costs coming from someone else they just utilize the extra supply and the costs are bore onto the system itself and not on those that are using it.


While there are key things I don't like about the Singapore system, taking the bad with the good I would easily take that one over our own. There's is more private based than ours and everybody is insured.


While not exactly what I thought you meant by "play or pay" I thought it was going to be pretty close to what you said. And the answer is no I don't support that. I don't even agree that employer provided is an ideal system. I prefer insurance being purchased on the individual level, and I'm sure you understand some of things that would entail.

[Link]

It is certainly one of the reasons for the problem of late diagnosis though. Another issue with cancer statistics here, of course, is the fact that many cancer patients are elderly and there has always been an assumption here (and this was the case long before 1948) that there's not much point adding a few extra years to a life that was likely to end soon anyway. My own Grandad chose to fade slowly out to increasing doses of morphine rather than risk surgery that would have extended his life by a couple of years at the cost of what was left of his quality of life.

You just hit on a point that is huge.  Americans are only brave when they are dropping bombs on innocent women and children half way around the world.  When it comes time for them to face the reaper they wet their pants.  I've seen it time and time again.

You check out some of these amazing new cancer wonder drugs and you will see something like this... Spend six figures and come in for us to dump poison into your veins every few weeks and you may live a whopping six months longer!  If the government refuses to participate in this farce right wingers start screaming "Death Panel!"

You want to decrease ludicrous health care expenditures in America?  Then grow a pair and face death with some dignity and stop these pointless ludicrous expenditures.  And lose weight for Heaven's sake.

So you have never heard of remission before then have you? Its quite common in the US for people who are diagnosed initially with cancer to live decades beyond that point.

Also, who really is the "die quickly" party then, there Link!

You think the majority of people diagnosed with pancreatic cancer are alive a decade later?



This is why healthcare "consumers" make poor and unrealistic choices in regards to their healthcare.  Thank you for illustrating my point in such grand fashion Wonkish.  Cost benefit ratio Wonkish.  Look into it.

[Link]

My own Grandad chose to fade slowly out to increasing doses of morphine rather than risk surgery that would have extended his life by a couple of years at the cost of what was left of his quality of life.

You check out some of these amazing new cancer wonder drugs and you will see something like this... Spend six figures and come in for us to dump poison into your veins every few weeks and you may live a whopping six months longer!  If the government refuses to participate in this farce right wingers start screaming "Death Panel!"

So you have never heard of remission before then have you? Its quite common in the US for people who are diagnosed initially with cancer to live decades beyond that point.

Also, who really is the "die quickly" party then, there Link!

The ignorance on the right is astonishing.  The truly amazing part though is they are so confident in their ignorance.  You really think these types of blowhards can make intelligent decisions about our national healthcare delivery system?

[Filuwaúrdjan]

As I've established above, people choosing to pay or not pay by themselves is not rationing.

Not everyone has access to the same amount of money (obviously). Therefore a market-based healthcare system essentially rations healthcare based on the ability (and often the perceived ability) to pay. Alternatively, it could be stated that what is rationed under such a system is actually choice (oh, irony). Healthcare, of course, is not actually a product so any use of the word 'ration' is a little on the dodgy side, but it will have to do.

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Market mechanisms is just a piece of jargon that I like. The meaning is obvious. Exclusion should also be obvious; if large numbers of people are effectively excluded from access (either by - inevitably poorly informed as most people are utterly ignorant of medical matters - choice or by economic circumstance) to the roughly the same level of healthcare as the bulk of the population, then it obviously becomes easier to supply certain things to the majority.

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But that's nonsense. There isn't an infinite supply of surgeons, doctors, nurses and other staff. There isn't an infinite supply of equipment. There isn't an infinite supply of drugs (and certainly not of very expensive ones). And so on and so forth. And there never actually can be; there is no long-term in healthcare. All that matters is what is available now, not what might be available in twenty years time.

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I'm not really trying to prove anything. All I'm doing is pointing out certain things that are known to have an impact on cancer statistics here. What you want to do with that information is up to you, of course.

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Have you ever tried thinking critically? Try it and run that paragraph back to yourself.

Anyway, I don't think I have ever denied that Americans with means have access to top notch healthcare. Who would? That's not the problem, from my perspective. As I wrote earlier, it is question of determining winners and losers.

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I'm sure that they have, but the rates are (from what I know) much higher...

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Franz Kafka was a man.

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In other words, very little...

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There are actually multiple answers to that, but the main one would be the point I've been going on about endlessly; access to the best quality treatment irrespective of class or medical history. This turned out to be absolutely necessary a couple of years ago, but there would be no chance of my American doppelgänger (if he even reached that point or was even born; neither are all that likely) being so lucky. There are, as I wrote earlier, winners and losers in every system. And maybe the personal is political, after all.

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Whether something is or is not a political issue (top five? I don't remember that, for all the tabloid trolling) does not determine whether it is or is not a problem. Hospital infections might not be a political issue in the U.S (which is hardly surprising as, unlike Britain, the People do not own the hospitals and the State is not responsible for running them) but they are most certainly a problem, much as they are everywhere else.

[Wonkish1]

You think the majority of people diagnosed with pancreatic cancer are alive a decade later?



This is why healthcare "consumers" make poor and unrealistic choices in regards to their healthcare.  Thank you for illustrating my point in such grand fashion Wonkish.  Cost benefit ratio Wonkish.  Look into it.

HAHAHAHA, you picked one type of cancer. I mean how do you not expect to be laughed at!

[Wonkish1]

The ignorance on the right is astonishing.  The truly amazing part though is they are so confident in their ignorance.  You really think these types of blowhards can make intelligent decisions about our national healthcare delivery system?

Link I hope to God that someone as stupid as you never, ever gets the power to make a decision anybody else is dependent upon.

[LastVoter]

Why don't you post your own examples?

[Wonkish1]

As I've established above, people choosing to pay or not pay by themselves is not rationing.

Not everyone has access to the same amount of money (obviously). Therefore a market-based healthcare system essentially rations healthcare based on the ability (and often the perceived ability) to pay. Alternatively, it could be stated that what is rationed under such a system is actually choice (oh, irony). Healthcare, of course, is not actually a product so any use of the word 'ration' is a little on the dodgy side, but it will have to do.

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Market mechanisms is just a piece of jargon that I like. The meaning is obvious. Exclusion should also be obvious; if large numbers of people are effectively excluded from access (either by - inevitably poorly informed as most people are utterly ignorant of medical matters - choice or by economic circumstance) to the roughly the same level of healthcare as the bulk of the population, then it obviously becomes easier to supply certain things to the majority.

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But that's nonsense. There isn't an infinite supply of surgeons, doctors, nurses and other staff. There isn't an infinite supply of equipment. There isn't an infinite supply of drugs (and certainly not of very expensive ones). And so on and so forth. And there never actually can be; there is no long-term in healthcare. All that matters is what is available now, not what might be available in twenty years time.

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I'm not really trying to prove anything. All I'm doing is pointing out certain things that are known to have an impact on cancer statistics here. What you want to do with that information is up to you, of course.

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Have you ever tried thinking critically? Try it and run that paragraph back to yourself.

Anyway, I don't think I have ever denied that Americans with means have access to top notch healthcare. Who would? That's not the problem, from my perspective. As I wrote earlier, it is question of determining winners and losers.

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I'm sure that they have, but the rates are (from what I know) much higher...

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Franz Kafka was a man.

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In other words, very little...

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There are actually multiple answers to that, but the main one would be the point I've been going on about endlessly; access to the best quality treatment irrespective of class or medical history. This turned out to be absolutely necessary a couple of years ago, but there would be no chance of my American doppelgänger (if he even reached that point or was even born; neither are all that likely) being so lucky. There are, as I wrote earlier, winners and losers in every system. And maybe the personal is political, after all.

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Whether something is or is not a political issue (top five? I don't remember that, for all the tabloid trolling) does not determine whether it is or is not a problem. Hospital infections might not be a political issue in the U.S (which is hardly surprising as, unlike Britain, the People do not own the hospitals and the State is not responsible for running them) but they are most certainly a problem, much as they are everywhere else.

Again you apparently don't understand what the word rationing means.


You sure about that? In markets as supply increases, costs come down not up! If the poor were apart of a market based system in healthcare aggregate costs will fall, but I wouldn't even come close to calling the US system a "market based system".


Where did I say that there is infinite supply of healthcare? There is a huge difference between not finite and infinite, I mean I could give you a link to an online dictionary if you want so you don't make mistakes like that. There is not the same amount of doctors in the US than even a month from now. Some retire, some new get in, etc. The supply is ever changing. And in a market system the supply will grow to the amount of demand. In a market system demand isn't infinite because only so many choose to pay(and no I'm not talking about a system without insurance--but one where insurance takes on its more catastrophic roll).


We got into discussions of quality of healthcare between the US and the UK. The UK controlling the supply of expensive treatment was brought up. A discussion ensued about how cancer treatment and how you thought that worse statistics in the UK was caused by social norms, but you failed to show any that were very different than the US and could account for the disparity. Now your acting like the reason why cancer treatment was to just talk about the UK and not the differences.


That paragraph makes perfect sense. The vast majority of our public has access to an amazing amount of healthcare supply, testing, etc. and they get great outcomes. A small minority of our public(for a host of reasons) don't have access to that and get treated in emergency care when they situation becomes noticeable. Both develop illnesses. Clearly the lack of early detection and great outcomes for that small minority would put a drag on our aggregate statistics by a pretty large margin. And still we kick you @$$ in aggregate health outcomes of specific illnesses.


I think you don't understand how our system works. The vast majority of the country have access to great healthcare(not just wealthy). **The poor, elderly, disabled, and children of the poor all have access to great healthcare.** And then there is a group of people that only have access to emergency care because they don't have health insurance and aren't enrolled in a government program. Do you want me to list the types of reasons people fall in that category?


What do you mean by rates?


Oops!! I quickly glanced at the Wikipedia entry for some reason came out thinking it was a chick. Guess that is what happens when you only look at something for like 30 seconds and being distracted by other things.


Clearly my friend I've spent a lot of time studying this stuff. Or maybe you can point to me a book that encompasses everything about a healthcare system in its pages. Otherwise we are forced to piece it together from numerous sources.


Well what medically happened? What was your situation that your situation that leads you to think that you wouldn't have lived in the US? And how is it different in the UK?


They are not as big of a problem here relative to how bad they are in the UK. Not even close!

[Wonkish1]

Why don't you post your own examples?

Of what?

[Gustaf]

The case for government-run healthcare, apart from the simple equality point, tends to be either assymmetric information or some kind of ideological valuation of peoples' discount rates as being too high.

[Link]

You think the majority of people diagnosed with pancreatic cancer are alive a decade later?



This is why healthcare "consumers" make poor and unrealistic choices in regards to their healthcare.  Thank you for illustrating my point in such grand fashion Wonkish.  Cost benefit ratio Wonkish.  Look into it.

HAHAHAHA, you picked one type of cancer. I mean how do you not expect to be laughed at!

You've heard of lung cancer, right?  It's not exactly what you would call a cherry picked rare type of cancer.  Let's look at the numbers...



Esophageal Cancer...



Remeber that vaccine that Perry mandated in Texas.  Yes, the one the lunatic right wing skewered him for.  It helps to prevent esophageal cancer.  So instead of vaccinating the population against this type of cancer we will just wait until they get it and spend six figures in a vain attempt to try and cure them.

All three cancers listed are in the top ten cancers that kill.  Lung cancer is the number one killer.  Still laughing?  It does not make sense to withhold treatment for cancers you can cure or at least get a good 5 year and 10 year survival rate.  Cancer is not a monolithic disease.  It simply does not make sense to spend billions treating every type of cancer for the entire population over 65.  You must pick what kind of cancer it makes sense to treat and you must also pick what stage of cancer is reasonable to treat.

[Link]

Why don't you post your own examples?

Of what?

Exactly.

[Filuwaúrdjan]

Again you apparently don't understand what the word rationing means.

...

Let's try this again. We cannot all have access to the sort of medical treatment that we might ideally want and/or need at the very moment that we happen to want/or need it. Yes? Therefore, some way must be found to distribute treatment amongst the people that want it. And rationing will do just fine as a word to describe that process; it isn't ideal, but it captures the fundamental problem and so also captures the fundamental point. And this fundamental point is also the point at which the politics of healthcare are at their clearest; is the right to equality of access more important than the right to buy immediate access?

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The point is that it is stupid to think of anything other than the immediate when thinking about healthcare. At any one moment, the supply of the things needed in order to treat a particular group of possible patients is finite.

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No, all I was doing was pointing out the commonly accepted reasons for problems such as late diagnosis (I wouldn't feel comfortable going much further as this is very much not my area). On the one specific issue, well, perhaps everything is exactly the same in all places when it comes to social embarrassment over bodily functions, but that's unlikely as that kind of thing is never really uniform. It is certainly the case that immigrants working in the health service (and there are a vast number of them) are often surprised at the complicated web of euphemisms used by (especially older) patients and some NHS trusts actually run classes to help deal with the issue.

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Not in any great detail, no. I think that I have a better idea of how it works than you have about the NHS though. It's like talking to the bastard child of a dog-eared Friedmanite economics textbook and lurid headlines from the Mail and the Express.

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Well I am glad to learn that the good people of the Mississippi Delta and Central Appalachia have easy access to great healthcare. I had heard otherwise, you see.

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The number of people taking them up, obviously. I suppose one reason for that would be that it's sort-of needed in any system based around insurance.

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There aren't the words.

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I'm not about to post personal medical details in a public forum.

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Are you making things up again? Because you've got a bit of an unfortunate habit of doing that. The statistics on this subject are beyond unreliable, but you can get hold of them within a couple of seconds thanks to the marvels of the internet.

[Dr. Cynic]

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I had to have an emergency surgery a couple of years ago that if I hadn't have had, I would've died. I make almost, but not quite $175,000 a year. (Not quite as much at that time). I was almost bankrupted by the cost staying alive.

Some system.

[Torie]

The degree of price elasticity of the supply of medical services is a big issue, and one that bedevils policy makers. It's a problem because of the relatively high barriers to entry.

[Wonkish1]

You've heard of lung cancer, right?  It's not exactly what you would call a cherry picked rare type of cancer.  Let's look at the numbers...



Esophageal Cancer...



Remeber that vaccine that Perry mandated in Texas.  Yes, the one the lunatic right wing skewered him for.  It helps to prevent esophageal cancer.  So instead of vaccinating the population against this type of cancer we will just wait until they get it and spend six figures in a vain attempt to try and cure them.

All three cancers listed are in the top ten cancers that kill.  Lung cancer is the number one killer.  Still laughing?  It does not make sense to withhold treatment for cancers you can cure or at least get a good 5 year and 10 year survival rate.  Cancer is not a monolithic disease.  It simply does not make sense to spend billions treating every type of cancer for the entire population over 65.  You must pick what kind of cancer it makes sense to treat and you must also pick what stage of cancer is reasonable to treat.

How about Breast Cancer, Testicular Cancer, Brain Cancer, Lymphoma, Liver Cancer, Colon Cancer, Prostate Cancer the list goes on and on and on.

But I guess cancer really is just "synonymous with death". Tell that to Herman Cain and Rudy Guiliani as just 2 high profile public officials that are cancer survivors.

Link you must be a glutton for punishment.

[Wonkish1]

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I had to have an emergency surgery a couple of years ago that if I hadn't have had, I would've died. I make almost, but not quite $175,000 a year. (Not quite as much at that time). I was almost bankrupted by the cost staying alive.

Some system.

Why was that? What kind of policy do you have?

[Wonkish1]

Again you apparently don't understand what the word rationing means.

...

Let's try this again. We cannot all have access to the sort of medical treatment that we might ideally want and/or need at the very moment that we happen to want/or need it. Yes? Therefore, some way must be found to distribute treatment amongst the people that want it. And rationing will do just fine as a word to describe that process; it isn't ideal, but it captures the fundamental problem and so also captures the fundamental point. And this fundamental point is also the point at which the politics of healthcare are at their clearest; is the right to equality of access more important than the right to buy immediate access?

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The point is that it is stupid to think of anything other than the immediate when thinking about healthcare. At any one moment, the supply of the things needed in order to treat a particular group of possible patients is finite.

You must be logged in to read this quote.

No, all I was doing was pointing out the commonly accepted reasons for problems such as late diagnosis (I wouldn't feel comfortable going much further as this is very much not my area). On the one specific issue, well, perhaps everything is exactly the same in all places when it comes to social embarrassment over bodily functions, but that's unlikely as that kind of thing is never really uniform. It is certainly the case that immigrants working in the health service (and there are a vast number of them) are often surprised at the complicated web of euphemisms used by (especially older) patients and some NHS trusts actually run classes to help deal with the issue.

You must be logged in to read this quote.

...

You must be logged in to read this quote.

Not in any great detail, no. I think that I have a better idea of how it works than you have about the NHS though. It's like talking to the bastard child of a dog-eared Friedmanite economics textbook and lurid headlines from the Mail and the Express.

You must be logged in to read this quote.

Well I am glad to learn that the good people of the Mississippi Delta and Central Appalachia have easy access to great healthcare. I had heard otherwise, you see.

You must be logged in to read this quote.

The number of people taking them up, obviously. I suppose one reason for that would be that it's sort-of needed in any system based around insurance.

You must be logged in to read this quote.

There aren't the words.

You must be logged in to read this quote.

I'm not about to post personal medical details in a public forum.

You must be logged in to read this quote.

Are you making things up again? Because you've got a bit of an unfortunate habit of doing that. The statistics on this subject are beyond unreliable, but you can get hold of them within a couple of seconds thanks to the marvels of the internet.

What you are referring to is what kind of system do you use to handle scarcity? Its the first topic of your most basic econ class you'll take. That is a far cry from calling market a rationing mechanism and it wont "do fine just fine" describing that process.

And that values question is absolutely not the issue with healthcare because its a false dichotomy. The question that plagues healthcare is, "How do we get everybody in the system while doing the best to lower cost and increase quality, convenience, and choices." I mean do you disagree with that? Isn't that what you have come to expect for all of things you buy whether apartments, cars, food, etc.


Well if all you care about is what is currently available then we might as well just wash ourselves of this issue and go home because there is no way you can improve a system in a day it takes time for the changes to take hold.


Again you brought up social norms as a reason why there is bad outcomes caused by an elongated process for expensive illnesses in the UK. I said that many of those same social norms exist in the US and we have a much swifter process and better outcomes. I offered that it was because the UK has constricted the supply of many things in the process of treating these illnesses that produces later diagnosis and the elongated process. You didn't want to agree and then named something that is also a problem in the US. So yeah again, my answer is a real answer for the differences, yours isn't quite explaining those differences between the countries.


What have I said about your system that is incorrect?


What are you referring to in particular in regards to the Mississippi Delta and Central Appalachia? 3rd party payment(insurance/programs), quality, what?


You sure about that I have maybe had 2-3 times I actually went to a doctor purely for a physical in my entire life and I'm in my late 20s(yeah I know I'm bad). The primary driver of physicals for your first 30 years of age in the US is actually school sports. I just had my uncle sign off on the paperwork back then. That aside you do kind of get a very, very basic physical every time you show up to the hospital.


Okay fair enough and I completely understand. But that aside, do you think you would be dead in the US because of your or your parents economic situation? Any chance you could tell me how old you were when this event happened?


Well if there is no way that you will accept any data showing the problems of hospital caused infections in the UK then maybe everybody should just ignore it then.

[Link]

It simply does not make sense to spend billions treating every type of cancer for the entire population over 65.  You must pick what kind of cancer it makes sense to treat and you must also pick what stage of cancer is reasonable to treat.

But I guess cancer really is just "synonymous with death".

How you got that from that sentence I will never know.

I'm beginning to see how Sara Palin was so popular with certain people. "Death Panels!!!"

[Wonkish1]

Look in case folks aren't reading through all of Marston and I's discussions I am not going to be a defender of our system as a hole. There is a ton wrong with it. The costs are high, unnecessary healthcare utilization is at insane levels, lots of uninsured, more and more people are being priced out of the market, etc.

^^^ And this is only some of the problems.


But one thing I will defend is that in the US the quality side of the equation is WAY better than the European systems. And the problem with the European systems is supply being constricted to keep costs down and that affects all the people in them.