Healthcare & rationing

MSimon · Post by **MSimon** » Sun Aug 30, 2009 5:06 am

from the NPR link:

This is how Japan keeps cost so low. The Japanese Health Ministry tightly controls the price of health care down to the smallest detail. Every two years, the health care industry and the health ministry negotiate a fixed price for every procedure and every drug.

I don't think there is anyone smart enough to do that for a heterogeneous population spread out as it is in the USA. Hayek (Road to Serfdom) says it is impossible to do for one. And then there is the kin selection problem in the USA.

http://en.wikipedia.org/wiki/Kin_selection

We are not a genetic country in any sense. This changes the calculation of the amount of socialism that will work. If you judge by the current political unrest I think we are close to the American limit.

TallDave · Post by **TallDave** » Sun Aug 30, 2009 6:21 am

I'll link this again since you obviously didn't read it last time:

http://www.npr.org/templates/story/stor ... d=89626309

I'm not sure why you think I didn't read it.

You keep going on about MRI machines as if it is some kind of conclusive proof of superiority.

It's one of the factors that explain why we have better outcomes.

That article there, which is based in fact, says Japan enjoys 2x the actual scans per capita as the U.S. I think that's a more relevant metric, don't you?

What? No. They do more MRIs because they HAVE more MRIs. Electronics are cheap in Japan.

So that's nice for Japan, and I'm sure it helps a lot, as does the fact their doctors are willing to work for far less than doctors in the U.S. or Europe. I'm not sure how anyone is supposed to make that paradigm work outside of Japan, though.

http://news.bbc.co.uk/2/hi/health/7510121.stm

There is a huge variation in cancer survival rates across the world, a global study shows.

The US, Australia, Canada, France and Japan had the highest five-year survival rates, while Algeria had the worst, Lancet Oncology reported.
Spending on health care was a major factor, the study of 31 countries said.
...
Professor Coleman said some of the differences could be attributed to variations in "access to diagnostic and treatment services".

"This, of course, is associated with the amount of investment in technology such as CT scanners."

Every two years, the health care industry and the health ministry negotiate a fixed price for every procedure and every drug.

Again, this is a classic free rider problem. We pay for R&D, no one else does. If we stop paying there's no more R&D. As with our defense of Europe, the cost to us of not doing so is such that we accept getting screwed by all the other countries, who "negotiate" with the power of the state behind them to get prices that don't cover R&D.

http://en.wikipedia.org/wiki/Free_rider_problem

This is like a group of people who discover they can board a train and avoid paying the fare by threatening the conductor. Soon more and more people are doing it. Eventually only a few wealthy, principled people are paying the entire cost for the train.

Guess what happens to the train if they stop paying too?

But they like having the train, and they can afford it, so they keep paying.

vankirkc · Post by **vankirkc** » Sun Aug 30, 2009 7:13 am

http://news.bbc.co.uk/2/hi/health/7510121.stm

1) Three of the five top cancer survival rate countries listed in that reference are 'socialist'. Not exactly a strong support for your case.

2) I doubt the U.S. figures count individuals who, due to lack of means, are unable to receive long term treatment for their cancer. If such people were included it would undoubtably reduce the survival rates substantially.

Skipjack · Post by **Skipjack** » Sun Aug 30, 2009 12:26 pm

Yes you should ask why though? It's typically because the US is focused on the pursuit of Research and Development as compared to most other countries.

Gblaze, you failed to quote (and maybe also read) the entire paragraph to that quote. Here it is again:

Our country has 8 million inhabitants, yours has 300 million. Naturally you have more Nobel laureates and you contribute a higher percentage to the worlds medical science.

Let me rephrase it, to make it more clear:
It is natural that a population of 8 million does not produce as many Nobel Laureates as a population of 300 million. Comprende?

If we were to adopt some form of social medicine this would be drastically changed and we would literally become much like Europe, as some would say, "past our glory days" and others would call "has-been's"

I cant follow that logic, sorry.

All due respect, 9 months isn't much. My wife is also from the US. That is just one view of 300 million, you'll need some than that to get a good understanding of what life is like here.

How many months have you spent in Austria? In Germany? Any other country than the US?
It is not just my wife. I have lots of friends in the US as well, that think the same. Everyone in her family has the same opinion also.

Do you give an 80-year-old a new kidney?

That depends. With the available kidneys being the limiting factor here (as I have said a few times already, but I have been ignored), it is more reasonable to give that to someone who has a higher chance of actually surviving the procedure. You know at the age of 80 every surgery is a high risk. If it is more likely that the patient will die on the table, because he is to weak, it does not make sense to "waste" a perfectly good kidney on him. My grandmother has lung cancer. She is 90. At her age (and in he condition), chemotherapy would kill her before the cancer does.

Did you not see the statins statistics? We get better heart disease care too.

Mhmmm, the pescy statins. I am taking those too. Sortis to be precise. Statins are meant to reduce the amount of tryglycerides and cholesterol in your blood. Now, once your cholesterol levels have been adjusted and you keep a well ballanced diet (as you should and a good doctor will recommend that to you), you will not need to take those anymore. They do have lots of side effects, you know. You do need some cholesterol actually and Statins dont discriminate between LDL and HDL. I cant wait for the day when I wont have to take them anymore, actually. So a good doctor will take the patient of these meds as soon as possible. Of course in the US this decision is more profit driven, so doctors might feel contempt to keep a patient on these meds longer than necessary.
It might be further worth noting, that the so often quoted dietary and lifestyle differences might affect the need for these statins as well. I also think that the US has more heart desease and obese patients with elevated cholesterol levels. This I am not sure about though. So I am saying "might" and "think". I would have to check up the precise statistics here and compare them and then draw conclusions. That takes time and my time is precious.

TallDave · Post by **TallDave** » Sun Aug 30, 2009 5:32 pm

1) Three of the five top cancer survival rate countries listed in that reference are 'socialist'. Not exactly a strong support for your case.

Uh, no. Given that we're virtually the only non-socialist health system in the industrialized world, the fact we're on top argues strongly that capitalist health care creates better outcomes. This is especially true since at 300 million we're the largest country in the sample, meaning we can't benefit from some quirk involving a small culture. And the socialist countries are free riders, as I've pointed out above.

2) I doubt the U.S. figures count individuals who, due to lack of means, are unable to receive long term treatment for their cancer. If such people were included it would undoubtably reduce the survival rates substantially.

I don't see any reason they wouldn't be counted, and people can borrow money to pay for such care anyway. And are you also assuming we don't include people in socialist countries where the state has determined it is not cost-effective to treat them?

TallDave · Post by **TallDave** » Sun Aug 30, 2009 5:40 pm

It is natural that a population of 8 million does not produce as many Nobel Laureates as a population of 300 million. Comprende?

And why does Europe as a whole, with its greater-than-U.S. population, produce far fewer Nobels/innovations? Socialism is the answer.

With the available kidneys being the limiting factor here (

I suspect specialist availability is another limiting factor. Socialized systems always have longer wait times for specialist care.

If it is more likely that the patient will die on the table, because he is to weak, it does not make sense to "waste" a perfectly good kidney on him.

Exactly, it's marginal. In the U.S., we have much greater resources, so we are more likely to attempt transplants, artifical hip replacements, etc.

Skipjack · Post by **Skipjack** » Sun Aug 30, 2009 6:40 pm

Hello Mr Tall! I have told you, nummerous times now, that you can not take Europe as a whole and compare it with the US. A large part of Europe is poorer and less developed. As I mentioned it would be as if you would put the US together with Mexico.
Why dont you get that into your head?
Also, I have no idea why the larger population of the US, which has much more natural resources than Europe and much more land (and that is one reason why you are richer) would have any negative effect on its healthcare. If any it would be beneficial because the odd cases dont affect statistics as badly as they do in countries with a smaller sample size.

PS: I find it quite amusing how you are dodging avoiding and/or simply lying your way out of some arguments.

gblaze42 · Post by **gblaze42** » Sun Aug 30, 2009 7:19 pm

Gblaze, you failed to quote (and maybe also read) the entire paragraph to that quote. Here it is again:

Our country has 8 million inhabitants, yours has 300 million. Naturally you have more Nobel laureates and you contribute a higher percentage to the worlds medical science.
Let me rephrase it, to make it more clear:
It is natural that a population of 8 million does not produce as many Nobel Laureates as a population of 300 million. Comprende?

*Sigh* yes I understand, please understand that has nothing to do with size of population, since most of the Nobel laureates migrate to the US from other countries and become citizens.
It does have everything to do with the way the US spends on R&D.

How many months have you spent in Austria? In Germany? Any other country than the US?
It is not just my wife. I have lots of friends in the US as well, that think the same. Everyone in her family has the same opinion also.

I tend to travel quiet a bit to many countries. I'll be in the UK next month in fact. Do you actually seek out people who don't agree with you? (besides this forum)

Quote:
If we were to adopt some form of social medicine this would be drastically changed and we would literally become much like Europe, as some would say, "past our glory days" and others would call "has-been's"

I cant follow that logic, sorry.

Ok, I'll word it like this, if the US were to move towards socialized medicine we would loose all the competitiveness and the best of the US and become like Europe, a has-been country as countries of Europe are past their prime in being a world leader. Better?

TallDave · Post by **TallDave** » Sun Aug 30, 2009 7:23 pm

A large part of Europe is poorer and less developed.

And why is that, despite many more centuries of Western civilization? Oh, right -- socialism. Eastern Europe is still recovering from a wasted half-century of anti-capitalism.

And you wonder why we're skeptical of socializing a fifth of our economy.

As I mentioned it would be as if you would put the US together with Mexico.

I'm not including Turkey in Europe, which would make it much worse. Hell, we can throw out Eastern Europe if you want, and it's still not even close.

Also, I have no idea why the larger population of the US, which has much more natural resources than Europe and much more land (and that is one reason why you are richer)

Oh please, the resource argument died last century. Russia has more land and more resources. Japan has little of either, as with S Korea, yet they dominate their region economically.

Did you know in the 1950s North Korea had a larger GDP than S Korea? Today S Korea's economy is ten times larger. Capitalism vs socialism again.

would have any negative effect on its healthcare. If any it would be beneficial because the odd cases dont affect statistics as badly as they do in countries with a smaller sample size.

Again, you're not following. If I pulled out, say, Minnesota, one could argue that was one small state with special characteristics, like Norway with its oil wealth has a distorted PPP GDP per capita.

We could (and arguably should) rank every U.S. state individually along with European countries, which are much closer in size to our states. What you would see then is that the top rankings are dominated by U.S. states.

gblaze42 · Post by **gblaze42** » Sun Aug 30, 2009 7:33 pm

Skipjack wrote:Hello Mr Tall! I have told you, nummerous times now, that you can not take Europe as a whole and compare it with the US. A large part of Europe is poorer and less developed. As I mentioned it would be as if you would put the US together with Mexico.
Why dont you get that into your head?
Also, I have no idea why the larger population of the US, which has much more natural resources than Europe and much more land (and that is one reason why you are richer) would have any negative effect on its healthcare. If any it would be beneficial because the odd cases don't affect statistics as badly as they do in countries with a smaller sample size.

PS: I find it quite amusing how you are dodging avoiding and/or simply lying your way out of some arguments.

You don't seem to understand, theirs what's called the European Union, a supernational community of European countries. The one that allows you to actually to compete, some what, with the US. That's what most statistics are based on. So really he isn't dodging anything, but you don't seem to understand the area in which you live that well.

Skipjack · Post by **Skipjack** » Sun Aug 30, 2009 7:35 pm

Do you actually seek out people who don't agree with you?

Huh? I am sorry, I cant follow.
I stayed out of this discussion here until the pile of bull spread in it blew my valves.

Look, my problem is simple:
I want to to move to the US. I love the US. Dont get me wrong. I do agree that socialism is bad... I do however not agree with an anarchic capotalism. Anyway, my problem is that when I move to the US I will be denied health insurance by all private insurance carriers. So I am arguing that I would like an alternative. The only alternative that I can (potentially) see happen is Obamas plan for public healthcare. However, maybe you can bring me someone who would provide me with healthinsurance.

Skipjack · Post by **Skipjack** » Sun Aug 30, 2009 7:39 pm

The European Union includes a lot of countries that are way behind Austria and Germany in all aspects. I would have never let them in, but it was ultimately not my decision. You know there is a US that is constantly begging to let Turkey in. Oh hell, I sure hope not. We already have waaaay to many of them in my country. They cause nothing but trouble and Erdogan is an islamofascist.
The differences between EU- member countries are bigger than the differences between US states.

gblaze42 · Post by **gblaze42** » Sun Aug 30, 2009 7:49 pm

Skipjack wrote: I do however not agree with an anarchic capotalism. Anyway, my problem is that when I move to the US I will be denied health insurance by all private insurance carriers. So I am arguing that I would like an alternative. The only alternative that I can (potentially) see happen is Obamas plan for public healthcare. However, maybe you can bring me someone who would provide me with health insurance.

Well I like capitalism, we wouldn't have the scientific advancements we have today without it.

There are always ways. It depends on your circumstances.

Check this out;
http://www.immigrationhealth.com/planb.htm

Skipjack · Post by **Skipjack** » Sun Aug 30, 2009 7:57 pm

Would they take someone with who had a heart attack?
I am only 34 years old, but I had one 3 months ago.
That is my problem...

Skipjack · Post by **Skipjack** » Sun Aug 30, 2009 8:07 pm

Hey, I would even be happy if the US passed a law that limits the cost for health insurance and that does not allow insurance companies to deny insurance to an applicant. That would at least give people like me a chance and it would still not be "socialized" or whatever you guys are sooooo affraid of (to the point of being ridiculous).