[RobMoney$]

Originally Posted by Schmeltz

That's a crock of shit and you know it. But in the first place, that's not an article, it's an interview, with a well-placed insider in the corporate American insurance system. His arguments against the system your country uses are extremely well-founded in view of his position. Perhaps you should do yourself a favour and read more than the headline, difficult though that might be for you.

Second, the reason you should be for this "nationalization" of health care, which doesn't seem to be at all what the bill before Congress is proposing, is the fact that it would give the many millions of your countrymen who currently have no access to affordable health care a shot at enjoying the same privileges available to most of the rest of the Western world. I can understand why you might not like the Obama administration's proposals as to how to deal with this problem, as they do seem at least somewhat flawed, and not just because of the increase in federal spending they would necessarily entail. But I cannot for the life of me imagine why you would argue in favour of retaining your country's current, wholly inadequate system of health care provision. It sucks. It is terrible.

To be honest, your statement about no one putting forth a cogent argument against a nationalized plan got to me, considering you hadn't really put forth a solid argument yourself supporting it.
I've spent the better part of this evening researching and I'm more convinced than ever now.

Americans spend more money each year on health care, in both absolute terms ($6,350 per person) and as a percentage of GDP (15.2%), than anyone else in the world. (OK, the Marshall Islands spend 15.4% of their GDP on health care, but that's only $294 per person.)
European countries spend an average of $1,652 per person on health care each year, or 8.6% of GDP.

Yet the US ranks behind most European countries, and in fact, behind about three-fourths of all developed countries in life expectancy.

It's not surprising that we have so little to show (in terms of health) for all of our extravagant spending on health care. As it turns out, once certain basic health care needs are met, there's no correlation between additional spending on health care, on the one hand, and improved health, on the other. Marginal spending on health care tends to be either useless or worse than useless. We could maintain similar life expectancy and quality of life if we slashed our medical care in half.

Here's my argument.

1. In the U.S., more spending on health care does not mean better health.








From this article in The New Yorker:

McAllen is in Hidalgo County, which has the lowest household income in the country ... McAllen has another distinction, too: it is one of the most expensive health-care markets in the country. ... In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average. The income per capita is twelve thousand dollars. ...

El Paso County, eight hundred miles up the border, has essentially the same demographics. ... Yet in 2006 Medicare expenditures ... in El Paso were $7,504 per enrollee - half as much as in McAllen. ... There’s no evidence that the treatments and technologies available at McAllen are better than those found elsewhere in the country. ... Nor does the care given in McAllen stand out for its quality. ... The primary cause of McAllen’s extreme costs was, very simply, the across-the-board overuse of medicine. ...

In a 2003 study, ... Elliott Fisher, examined the treatment received by a million elderly Americans diagnosed with colon or rectal cancer, a hip fracture, or a heart attack. They found that patients in higher-spending regions received sixty per cent more care than elsewhere. ... Yet they did no better than other patients, whether this was measured in terms of survival, their ability to function, or satisfaction with the care they received. If anything, they seemed to do worse. ...

And from a 2003 article in the Washington Monthly:

Where specialists are abundant, they find elders to treat--and Medicare pays, spending, for example, $50,000 more per patient in Miami than Minneapolis, as my colleague Shannon Brownlee recently wrote in The Atlantic. But according to John Wennberg of Dartmouth Medical School, elder persons living in regions where the use of specialists is high have no greater life expectancy than their counterparts in regions where it is low.

The reference to Miami and Minneapolis comes from this study:

In Miami, average inpatient Medicare spending on people in their last six months of life was about double Medicare spending in Minneapolis; average ICU days were nearly four times higher. What are the implications of such differences for the efficiency of health care? In this paper, we used Medicare claims data to document the extent of these variations across 306 hospital referral regions in the U.S. We did not find strong evidence that the spending differences were due to underlying variation in health levels across regions. Nor did we find evidence of any benefits from higher spending levels; regional survival rates following acute conditions like AMI (heart attacks), stroke, and gastrointestinal bleeding were not correlated with more intensive health care spending. ... In sum, our results suggest that ... regions providing more intensive care are not gaining net health benefits over regions providing less care ... .

Finally, these observations are from a couple articles in the Annals of Internal Medicine:

1. The more inpatient-based and specialist-oriented pattern of practice observed in high-spending regions largely explains regional differences in Medicare spending. Neither quality of care nor access to care appear to be better for Medicare enrollees in higher-spending regions.

2. Medicare enrollees in higher-spending regions receive more care than those in lower-spending regions but do not have better health outcomes or satisfaction with care.

The biggest and most carefully controlled study on this topic was the RAND Health Insurance Experiment. The gist is that when people have to pay for medical care on their own, they buy substantially less of it than when a third party is paying. But they get the same results in terms of their health. The extra health care has no benefit.



2. Indeed, a great deal of spending on health care is completely useless.


From David H. Newman, M.D. at the NYT blog:

The practice of medicine contains countless examples of elegant medical theories that belie the best available evidence.

* Recent press reports detailing the dangers of cough syrup for children have noted that cough syrup doesn’t work. True: No cough remedies have ever been proven better than a placebo, either for adults or children. Yet their use is common.

* Patients with ear infections are more likely to be harmed by antibiotics than helped. While the pills may cause a small decrease in symptoms (for which ear drops work better), the infections typically recede within days regardless of treatment. The same is true for bronchitis, sinusitis, and sore throats. Unnecessary antibiotics are still given to more than one in seven Americans each year for these conditions alone, at a cost of more than $2 billion and tens of thousands of serious adverse medication effects requiring treatment.

* Back surgeries to relieve pain are, in the majority of cases, no better than nonsurgical treatment. Yet doctors perform 600,000 of these surgeries each year, at a cost of over $20 billion.

* More than a half million Americans per year undergo arthroscopic surgery to correct osteoarthritis of the knee, at a cost of $3 billion. Despite this, studies show the surgery to be no better than sham knee surgery, in which surgeons “pretend” to do surgery while the patient is under light anesthesia. It is also no better than much cheaper, and much less invasive, physical therapy.

More on knee surgeries to treat arthritis in this Washington Post article:

One of the most common surgical procedures performed in the United States — arthroscopy to treat arthritis in the knee — is useless. ... [The] findings are being published in today’s issue of the New England Journal of Medicine. ... The study marks the second time a major study has questioned the operations, which can cost about $5,000 and are done on hundreds of thousands of Americans each year.

All of this suggests that we could probably slash our health care spending in half without sacrificing our health.


3. Conclusion

A large fraction of the health insurance we purchase apparently doesn't do as much good as many people think it does. Our life expectancy has improved by about 30 years over the last century, but only about five of those years are due to improvements in medicine.
Most of it comes from better hygiene, better workplace safety, and better food inspections. (Most of the improvements from medicine involve vaccinations.)

Americans are spending twice as much on health care as most developed countries, but we still rank quite poorly in longevity.

A competitive health care market in the U.S. has put it at the head of the class in terms of innovation and customer satisfaction. Modern medicine has discovered all kinds of new treatments for diseases that nobody even knew existed a few decades ago. Cures (or preventative measures) focusing on such fancy new "diseases" as high cholesterol have been hugely profitable for pharmaceutical companies, but probably a waste of time and money for everybody else.

We'd probably have a similar life expectancy and quality of life if we weren't so enthusiastic about spending other people's money on health care.
Your "right to health care" would require some other person to give up a portion of their life or their property to either treat you, or to provide you with drugs or medical implements. The Constitution does not provide for another individual to be indentured to you in this manner.
Therefore, you have no "right" to health care.
Perhaps we should do something about the Wal-Marts and the Home Depots of the United States who continue to do everything they can to prevent offering their employees health insurance while they reap in billions in profits.
You know, legislation to actually help the poor working slobs instead of just throwing even more money that we don't have at the problem.