American economic dominance

[dabrockster]

I do remember increased wait times after ACA.

I also remember individuals between the ages of 18-26 were very much against the mandatory requirement to pay for insurance. I remember this being a big sticking point of it being a mandate and not free or available to anyone who wants it and those who opt out didn’t have to pay.

one item that I think that has been great was the ability to keep our children on our health insurance plans longer that before and the inability for insurance plans unable to deny treatments for specific health conditions.

[Bo Diddley]

There is plenty of data that supports it.

one reason I think this is the case is people in countries with universal healthcare (even if it is shitty) get more access to routine healthcare.


I really think Obama care helped a ton and something more along the lines of strengthening that program rather fully socialised medicine.

I do remember increased wait times after ACA.

[frank ryan]

I ran the universal healthcare question through the AI at work, and it tried to tell me the UK had better mortality outcomes than the US, using an under age 75 treatable mortality rate that it called the gold standard used by health economists. It also indicated that peers had better outcomes than both of us. I think that illustrates how misleading statistics are.

I asked it to play devils advocate and provide counter points. Interesting exercise. Among other things, it points out that the US excels at cancer treatment and subsidizes the rest of the world with medical R&D.

I asked it to summarize what it was saying:

There is plenty of data that supports it.

one reason I think this is the case is people in countries with universal healthcare (even if it is shitty) get more access to routine healthcare.


I really think Obama care helped a ton and something more along the lines of strengthening that program rather fully socialised medicine.

[Bo Diddley]

I ran the universal healthcare question through the AI at work, and it tried to tell me the UK had better mortality outcomes than the US, using an under age 75 treatable mortality rate that it called the gold standard used by health economists. It also indicated that peers had better outcomes than both of us. I think that illustrates how misleading statistics are.

I asked it to play devils advocate and provide counter points. Interesting exercise. Among other things, it points out that the US excels at cancer treatment and subsidizes the rest of the world with medical R&D.

I asked it to summarize what it was saying:

Comparing the UK’s universal healthcare to the US system reveals a tragic paradox. The UK’s NHS "kills by delay." While everyone gets free care, severe bottlenecks mean patients wait months for treatment. When we control for age and baseline health, researchers estimate 14,000 to 16,600 people die annually in the UK strictly due to extreme 12+ hour emergency room delays, while delayed cancer treatments (where a mere 4-week wait increases mortality risk by up to 13%) claim thousands more. Meanwhile, the US "kills by exclusion." Controlled cohort studies show that 26,000 to 45,000 working-age Americans die annually strictly because they lack health insurance and cannot access timely care.
To compare them directly, health economists use "Treatable Mortality" (deaths under age 75 from conditions that should be 100% curable with timely care). By this metric, the US performs significantly worse: 95 preventable deaths per 100,000 people compared to the UK's 71. This indicates that even when controlling for age and population size, the US system's financial barriers (uninsurance, high deductibles, and insurance denials) ultimately prove deadlier than the UK's rationing by time.

However, the "devil's advocate" counter-argument is highly compelling. The US is heavily penalized by this metric because it has a much sicker baseline population struggling with higher rates of obesity, diabetes, and substance abuse before they ever step into a clinic. But once you are actually diagnosed with a complex, lethal disease like cancer, the US system outshines the UK. For example, the 5-year breast cancer survival rate is over 90% in the US compared to roughly 85% in the UK, because the US system scans faster, bypasses waiting lists, and deploys advanced therapeutics immediately.

[Bo Diddley]

I've thought about this for a bit, and I really believe the health care debate is more of a philosophical rather than a practical one for most people. The fundamental issue is whether or not a country believes health care is a human right or not. For those governments that believe it is, some form of universal heath care is mandatory. Funding questions flow from that premise, including rationing however you want to define it. For those who see it as more of a privilege to live with the availability of 'top-notch' health care, governments can and will decrease funding for health care social nets. There is an implicit compromise that as long as excellent health care is available to most people, there will be those who get left behind.

Spoiler alert: realities in both types of government fall short of their ideals. In this day and age an American on disability who is developing pneumonia will choose not to go to the hospital because they can't afford it (real current story from an acquaintance!). Whole swaths of specialty care can opt out of seeing medicare or medicaid patients. And there is no denying that the quality of health care many people get is dependent on their income or lack thereof. And I don't think it's debatable that most Americans are OK with those realities. Whether it triggers some brain stem reflex of individual freedom or a the pros outweigh the cons for many, a complete transition to socialized medicine is a non-starter. If health care expenses continue to get more prohibitive, that may change.

That doesn't let countries with some form of socialized medicine off the hook. Someone on my curling team had heart bypass surgery a year ago, yet there aren't enough specialists here for him to get routine follow-up. And it took him a long time just to get a primary care provider after moving here. If health care is a right, there will be a constant fight about adequate funding, which in the future will only get worse as it gets more expensive. As I've said before living in a rural area on an island presents a government constant headaches to fund health care, but once the decision is made that it is a basic human right, you're kind of stuck with that. But since universal health care plays so much into the Canadian ideal many here accept real deficiencies. If adequate health care coverage becomes a problem for more here, that may change.

I'm still not sure how I feel about universal health coverage. The UK system should give anyone pause. Still, I have heard other European countries do a better job. I'm just not connected to people to get that firsthand feedback like I am to people in the UK.

On the other hand, I have seen how my own kids have struggled with paying for insurance. Here in the US, health care is still rationed, but there seems to be a divide between those who can afford it and those who can't. Even if they have health insurance, it might only serve as a catastrophic cap of sorts. As a soldier, I am probably the most privileged. I haven't paid a dime for health care for many years.

I wonder if looking at it in supply/demand terms is helpful. Is healthcare zero sum? How much more can we increase resources?

[dabrockster]

FDS

FHVS

[Jeff Lebowski]

I've thought about this for a bit, and I really believe the health care debate is more of a philosophical rather than a practical one for most people. The fundamental issue is whether or not a country believes health care is a human right or not. For those governments that believe it is, some form of universal heath care is mandatory. Funding questions flow from that premise, including rationing however you want to define it. For those who see it as more of a privilege to live with the availability of 'top-notch' health care, governments can and will decrease funding for health care social nets. There is an implicit compromise that as long as excellent health care is available to most people, there will be those who get left behind.

Spoiler alert: realities in both types of government fall short of their ideals. In this day and age an American on disability who is developing pneumonia will choose not to go to the hospital because they can't afford it (real current story from an acquaintance!). Whole swaths of specialty care can opt out of seeing medicare or medicaid patients. And there is no denying that the quality of health care many people get is dependent on their income or lack thereof. And I don't think it's debatable that most Americans are OK with those realities. Whether it triggers some brain stem reflex of individual freedom or a the pros outweigh the cons for many, a complete transition to socialized medicine is a non-starter. If health care expenses continue to get more prohibitive, that may change.

That doesn't let countries with some form of socialized medicine off the hook. Someone on my curling team had heart bypass surgery a year ago, yet there aren't enough specialists here for him to get routine follow-up. And it took him a long time just to get a primary care provider after moving here. If health care is a right, there will be a constant fight about adequate funding, which in the future will only get worse as it gets more expensive. As I've said before living in a rural area on an island presents a government constant headaches to fund health care, but once the decision is made that it is a basic human right, you're kind of stuck with that. But since universal health care plays so much into the Canadian ideal many here accept real deficiencies. If adequate health care coverage becomes a problem for more here, that may change.

Thank you for that honest and thoughtful response.

Yes, it is a matter of tradeoffs either way. And as medical costs get higher, that doesn't mean that single-payer necessarily works better. High costs in single payer are precisely what leads to rationing and shortages. Well, that is a big part of it anyway.

The fact of the matter is, the US is a hybrid system. Medicare/medicaid/government paying doctors to serve in remote areas/etc.

[Northwestcoug]

I've thought about this for a bit, and I really believe the health care debate is more of a philosophical rather than a practical one for most people. The fundamental issue is whether or not a country believes health care is a human right or not. For those governments that believe it is, some form of universal heath care is mandatory. Funding questions flow from that premise, including rationing however you want to define it. For those who see it as more of a privilege to live with the availability of 'top-notch' health care, governments can and will decrease funding for health care social nets. There is an implicit compromise that as long as excellent health care is available to most people, there will be those who get left behind.

Spoiler alert: realities in both types of government fall short of their ideals. In this day and age an American on disability who is developing pneumonia will choose not to go to the hospital because they can't afford it (real current story from an acquaintance!). Whole swaths of specialty care can opt out of seeing medicare or medicaid patients. And there is no denying that the quality of health care many people get is dependent on their income or lack thereof. And I don't think it's debatable that most Americans are OK with those realities. Whether it triggers some brain stem reflex of individual freedom or a the pros outweigh the cons for many, a complete transition to socialized medicine is a non-starter. If health care expenses continue to get more prohibitive, that may change.

That doesn't let countries with some form of socialized medicine off the hook. Someone on my curling team had heart bypass surgery a year ago, yet there aren't enough specialists here for him to get routine follow-up. And it took him a long time just to get a primary care provider after moving here. If health care is a right, there will be a constant fight about adequate funding, which in the future will only get worse as it gets more expensive. As I've said before living in a rural area on an island presents a government constant headaches to fund health care, but once the decision is made that it is a basic human right, you're kind of stuck with that. But since universal health care plays so much into the Canadian ideal many here accept real deficiencies. If adequate health care coverage becomes a problem for more here, that may change.

[Jeff Lebowski]

Here we go again. Frankie whinning like a bitch that he is treated unfairly and misrepresented. Your beyond delusional and have no ability to see your own bias..

FDS

[dabrockster]

I am being honest. How about not making assumptions all the time and telling me what I mean. It's always negative and often misrepresented.

Here we go again. Frankie whinning like a bitch that he is treated unfairly and misrepresented. Your beyond delusional and have no ability to see your own bias..

[Jeff Lebowski]

(taps the sign)

Furthermore, with the mostly private health care system we have in the US, it is more expensive to the end user, but the efficiency, accessibility, and standard of care is very high. And the US pharmaceutical industry's innovation benefits the entire world. With single payer/socialized medicine, there is more equal access, but you have more rationing, longer wait times, higher taxes, and ultimately higher poverty levels and reduced standard of living overall due to the economic drag of the social safety net. If a country like Canada decides to go the single payer route, fine - knock yourself out. I can certainly respect the reasoning behind that choice. But please spare us the moralizing. Both systems have tradeoffs. If you think there aren't a significant number of deaths in a single payer system due to rationing and long wait times, you are a fool.

[Bo Diddley]

???

So you don't think the Royal College of Emergency Medicine accounted for such a fundamental distinction in their research? For the ER study, they specifically said "excessive waits".

Ditto for researchers from London School of Hygiene & Tropical Medicine and Oxford University and Blackburn with Darwen Borough Council. You don't think they were smart enough to make that distinction either?



Note the term "excess deaths".

And you seem to be ignoring this one, which is not related to waiting at all:

You're trying to draw me into an argument I never made. Of course NHS delays can cause excess deaths. I never disputed that.

What I objected to was the first number you cited and specifically held up against the estimate of US deaths due to lack of access to healthcare. Those are measuring different things, so comparing them directly doesn't support the conclusion you were drawing.

If after all this you still can't see the distinction, I don't know what else to tell you.

[Jeff Lebowski]

If they end up dying as a result of the wait, I agree they died because they lacked timely access to care. But the statistic you posted doesn't tell us that. It counts everyone who died while waiting, not everyone whose death was caused by waiting. Who knows how many would have died anyway?

The US estimate, as imperfect as it is, controls for confounding factors. The NHS figure is a raw count. Those are not equivalent measures.

???

So you don't think the Royal College of Emergency Medicine accounted for such a fundamental distinction in their research? For the ER study, they specifically said "excessive waits".

Ditto for researchers from London School of Hygiene & Tropical Medicine and Oxford University and Blackburn with Darwen Borough Council. You don't think they were smart enough to make that distinction either?

The report found there were 30,000 excess deaths in 2015 in England and Wales and that these were likely associated with NHS and social care cuts.

Note the term "excess deaths".

And you seem to be ignoring this one, which is not related to waiting at all:

One in six doctors have seen patients die because of rationing in NHS resources, according to a new survey.

More than half said they had seen patients suffer due to treatment rationing and two thirds said that they had been told not to prescribe certain drugs by their NHS trust, even though the results could be fatal.

[Jeff Lebowski]

The continued cherry picking does not help your argument which as pointed out is based on fallacious reasoning. If comparison is the method you prefer to utilize as a part of your overall methodology, and scale is only important in making deprecatory claims concerning rationing, why not compare other countries health care as well?

Because we both know that will only further undermine your unsupportable arguments.

As Diddly continues to correctly assert: you are equating two measures that are not equatable. In one of the links I provided which you have not addressed except with fallacious reasoning, it is estimated that as many as 24 million Americans don't even have health care. Circling back to the initial premise of this entire thread, and as supported by scientifically corroborated research, this could be addressed by better utilizing GDP (American economic dominance) to the benefit of all citizens.

How about that?

So the sources that confirm your bias are correct and rigorous, and the ones that prove you wrong are "fallacious reasoning"?

[tooblue]

1/3 the population of the US and yet far more deaths due to rationed healthcare. How about that?

The continued cherry picking does not help your argument which as pointed out is based on fallacious reasoning. If comparison is the method you prefer to utilize as a part of your overall methodology, and scale is only important in making deprecatory claims concerning rationing, why not compare other countries health care as well?

Because we both know that will only further undermine your unsupportable arguments.

As Diddly continues to correctly assert: you are equating two measures that are not equatable. In one of the links I provided which you have not addressed except with fallacious reasoning, it is estimated that as many as 24 million Americans don't even have health care. Circling back to the initial premise of this entire thread, and as supported by scientifically corroborated research, this could be addressed by better utilizing GDP (American economic dominance) to the benefit of all citizens.

How about that?