Blue Dog Democrats

[RobMoney$]

Originally Posted by saz

no, doctors aren't forced to do anything. canada isn't a communist country.

no, just socialist

[saz]

and damn proud to be living in a social democracy

[Documad]

So you can't go to any doctor you want. Thanks for clarifying.

[saz]

Originally Posted by Documad

So you can't go to any doctor you want. Thanks for clarifying.

no i can go see any doctor i want.

[Documad]

Originally Posted by saz

no i can go see any doctor i want.

You mean if you pay him or her yourself and if the doctor accepts you as a patient? I'm really confused about how it works. If doctors retained freedom of choice then I assume that some doctors don't accept patients on the government plan. And how does it work if everyone on the government plan wants to go to the same doctor? On a basic economic level, how does it work if the best doctor can't charge more? Or does your plan just cover a certain percentage or a certain amount and you cover everything over that so that there can still be price competition?

When I had family living in the UK they couldn't get to the doctor they wanted and they couldn't get the procedure they wanted so they paid a private doctor. It was so fucked up. I have no idea how Canada does it though.

[Schmeltz]

So far I haven't really seen anything approaching a cogent argument in favour of the current American health care system, which seems to me badly deficient in many ways. Read the transcript or watch the video for an inside look at how for-profit health insurance actually works in the USA. All I can say is that I'm very, very glad not to live under that kind of corporate tyranny. In fact I don't understand why anybody would choose a private corporation, which is accountable to nobody but its investors, over a government-subsidized plan, governments being accountable directly to their citizens and voters.

Originally Posted by Documad

So you can't go to any doctor you want. Thanks for clarifying.

I'm kind of confused by this. What point are you trying to make here? I would think it obvious to anyone that there are practical difficulties in giving every single person access to every single doctor, but nobody in this thread has suggested that, anywhere.

Moreover I think saz makes a good point - when it comes to costs and what Americans might have to give up in order to provide affordable health care to their own people, the Military-Industrial Complex has an awful lot of potential. Even at only 4% of its GDP the USA spends almost as much on defense as the rest of the world put together. It's very bemusing to see people get all rankled at the thought of their hard-earned money being spent on the health and welfare of their friends and neighbours, while they seem quite complacent at the thought of their hard-earned money being spent to bomb the shit out of poor brown people on the other side of the world.

Originally Posted by RobMoney$

no, just socialist

What a bunch of crap, Canada's as capitalist as anywhere else. Confine your one-liners to topics about which you might know something.

[DroppinScience]

Originally Posted by Schmeltz

What a bunch of crap, Canada's as capitalist as anywhere else. Confine your one-liners to topics about which you might know something.

That would imply he could post only in "Beastie General."

[RobMoney$]

Originally Posted by DroppinScience

That would imply he could post only in "Beastie General."

Ahahhaaah

ahaaaaa

ah


brilliant comment on the issue at hand. You're so much more intelligent than me.

[RobMoney$]

BTW, I already hate the term "blue dogs"



...like nails on a chalkboard.

[DroppinScience]

Canadian health care hardly a Marxism threat

[RobMoney$]

Originally Posted by Schmeltz

So far I haven't really seen anything approaching a cogent argument in favour of the current American health care system, which seems to me badly deficient in many ways. Read the transcript or watch the video for an inside look at how for-profit health insurance actually works in the USA.


Confine your one-liners to topics about which you might know something.

So you claim that no one's really making a compelling argument for the current system, and then you post a link to a completely slanted "Democracy Now" article to support your position?
That's a riot.

So where's your compelling argument against the current system?
I hope you don't consider posting a link to someone else's article to be YOU making a compelling argument?

My mind is 100% open.
Tell me why I should be for this nationalization of healthcare.

I'll be happy to respond with my argument against it.

[Schmeltz]

Originally Posted by Documad

You mean if you pay him or her yourself and if the doctor accepts you as a patient? I'm really confused about how it works. If doctors retained freedom of choice then I assume that some doctors don't accept patients on the government plan. And how does it work if everyone on the government plan wants to go to the same doctor? On a basic economic level, how does it work if the best doctor can't charge more? Or does your plan just cover a certain percentage or a certain amount and you cover everything over that so that there can still be price competition?

When I had family living in the UK they couldn't get to the doctor they wanted and they couldn't get the procedure they wanted so they paid a private doctor. It was so fucked up. I have no idea how Canada does it though.

Well, it's somewhat complicated to explain, but Wikipedia has all the answers. The thing to keep in mind is that health care in Canada falls under provincial, and not federal, jurisdiction (although the feds do provide some of the funding). Every province is required by federal law to cover all medically necessary care, but outside those legally defined boundaries - for things like eye care or dental care or cosmetic surgery - there are wide variations from province to province. This is why most Canadians either pay cash for eye and dental care, or get employer-sponsored insurance to cover it.

With that in mind, you could sum up the Canadian health care system as publically funded, but privately delivered. The vast majority of doctors are private practitioners who bill the provincial health authorities for their compensation on a fee-for-service basis; the money for this comes from general provincial revenues (ie taxation) and federal transfer payments. So it would seem to me that Canadian doctors have just as much leeway to choose their patients or charge for their services as doctors anywhere else; the difference is the Canadian single-payer system - the provincial governments assume the burden of payment, rather than the individual patients themselves. It's quite different from in the UK where the entire service is fully nationalized at the federal level.

I can illustrate these things with my personal experience, which I've described in another thread - when I dislocated my shoulder for the third time, I went to a practitioner who was extremely off-putting and didn't want to treat me until I injured it for a fourth time. I said fuck this and went to another practitioner, whom I'd seen before, who put me on the operating table two weeks later, for the same low price of zero dollars. You see, doctors do have latitude to exercise their discretion in choosing whether to treat patients, and patients do have latitude in choosing their practitioners. But the key point is that it's free. And so far as price competition - well, first of all that's not the be-all and end-all of human relations. But if patients gravitate to the better practitioners, these then have more opportunities to bill the province for services rendered, and will thus make more money. I'm sure it's not as simple as that, but the point is Canada isn't some kind of mini-USSR where the doctors are all standing next to the patients in circular bread lines.

[Documad]

Originally Posted by Schmeltz

Well, it's somewhat complicated to explain, but Wikipedia has all the answers. The thing to keep in mind is that health care in Canada falls under provincial, and not federal, jurisdiction (although the feds do provide some of the funding). Every province is required by federal law to cover all medically necessary care, but outside those legally defined boundaries - for things like eye care or dental care or cosmetic surgery - there are wide variations from province to province. This is why most Canadians either pay cash for eye and dental care, or get employer-sponsored insurance to cover it.

With that in mind, you could sum up the Canadian health care system as publically funded, but privately delivered. The vast majority of doctors are private practitioners who bill the provincial health authorities for their compensation on a fee-for-service basis; the money for this comes from general provincial revenues (ie taxation) and federal transfer payments. So it would seem to me that Canadian doctors have just as much leeway to choose their patients or charge for their services as doctors anywhere else; the difference is the Canadian single-payer system - the provincial governments assume the burden of payment, rather than the individual patients themselves. It's quite different from in the UK where the entire service is fully nationalized at the federal level.

I can illustrate these things with my personal experience, which I've described in another thread - when I dislocated my shoulder for the third time, I went to a practitioner who was extremely off-putting and didn't want to treat me until I injured it for a fourth time. I said fuck this and went to another practitioner, whom I'd seen before, who put me on the operating table two weeks later, for the same low price of zero dollars. You see, doctors do have latitude to exercise their discretion in choosing whether to treat patients, and patients do have latitude in choosing their practitioners. But the key point is that it's free. And so far as price competition - well, first of all that's not the be-all and end-all of human relations. But if patients gravitate to the better practitioners, these then have more opportunities to bill the province for services rendered, and will thus make more money. I'm sure it's not as simple as that, but the point is Canada isn't some kind of mini-USSR where the doctors are all standing next to the patients in circular bread lines.

Thanks for explaining it in a way that I can understand.

[Schmeltz]

Originally Posted by RobMoney$

My mind is 100% open.

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.

[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.

[Schmeltz]

Originally Posted by RobMoney$

To be honest, your statement about no one putting forth a cogent argument against a nationalized plan got to me

I said no such thing. What I said was that nobody had put forth a cogent argument in favour of the current system. With comprehension problems like this, it's no wonder you won't read the interview I linked to.

Much of what follows this seems to me largely irrelevant to the discussion. What's up for debate, as you've said yourself, is not the quality of care available in the USA, or how much medical establishments spend on caring for people. It's the fact that so many people cannot afford it. If people are incapable of paying for their own health care, or are left destitute in their effort to do so, or are denied care on the basis of inadequate medical coverage, then does it really matter how much unnecessary surgery is performed in a year? Health spending isn't the issue. Affordability by patients is the issue.

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.

Leaving aside the entirely spurious nature of this conclusion, would you like to show me where I have used the phrase "right to health care"? And anyway, it doesn't matter how much or whose money is spent on health care if tens of millions of people can't afford it either way. Which is what we're discussing.

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.

I dunno Rob, sounds an awful lot like big bad scary socialism to me. But actually if you read that interview I posted you'll see that a large part of the problem lies with insurance corporations who do exactly the same thing - exert every effort possible to deny paying out on the claims of their customers, while reaping billions in profits. That's the part of the system that needs changing.

[Schmeltz]

PS - Rob, you really should give credit where credit is due... that's not much to show for having spent most of the evening researching, is it?

[yeahwho]

Originally Posted by Schmeltz

So far I haven't really seen anything approaching a cogent argument in favour of the current American health care system, which seems to me badly deficient in many ways. Read the transcript or watch the video for an inside look at how for-profit health insurance actually works in the USA. All I can say is that I'm very, very glad not to live under that kind of corporate tyranny. In fact I don't understand why anybody would choose a private corporation, which is accountable to nobody but its investors, over a government-subsidized plan, governments being accountable directly to their citizens and voters.

That link parallels much of what my Mom who worked and retired from a major national insurance company has been saying all along to us kids. This is a business, your health, your families health and our Nations health.

Nothing personal America, it's just a business. When we bailout insurance giant AIG for $80 billion dollars just a few short months after denying underprivileged children a minuscule $5 billion so they could have health insurance, well it's nothing personal America, it's just business.

Fuck that business, I'll take socialized medicine, anything besides this nightmare.

[yeahwho]

Between saz and Schmeltz I'm completely in awe, first of all not only do you have excellent healthcare, the both of you have exceptional knowledge of how it works!

Bravo, not only has the healthcare cloak of confusion been lifted from both or your vocabularies, so has the myth "we're all gonna die waiting in line to see a doctor".

Jesus, when my sister had pertussis (whooping cough) she went to 3 of the top doctors on the west coast.... Her insurance covered 70% for two "un-preferred providers in Washington State and 50% for the out of state doctor. That's actually as good as it gets with most insurance when you go outside the policy writ

The public health facility down the block figured it out within minutes, just before she became critically ill. For free. They were extremely glad to see her and gave all of us in my family script to erythomyacin for free.

[b i o n i c]

this one's gonna rupture an artery in r$'s forehead

http://gothamist.com/2009/07/12/home...s_car_serv.php

Originally Posted by article

"Ricky Alardo, a homeless alcoholic nicknamed Ricky Ricardo" who "swigs cheap vodka by day at his favorite corner in Washington Heights, then calls an ambulance to chauffeur him to the hospital for a free meal and a warm place to sleep, courtesy of taxpayers who fund his Medicaid benefits." (More details here.) He calls 911 "four or five times a week," which works out to $300,000 a year—or $3.9 million over the 13 years he's been running the scam.

^ i wonder if anyone will forgo the classic predictable blame conclusions and realize what the real problem is here. ^

i bet objectivity is out to lunch somewhere getting high listening to calypso in his caddy

[DroppinScience]

Bill Moyers talks with health care professionals about Health Care Reform

Originally Posted by Bill Moyers

...[S]upporters who want to scrap the present system for fundamental change are staring glumly through the fog of war at a battlefield in total disarray. They fear that in the White House's desire to get a bill -- any bill -- passed by Congress, it will have been so compromised, so bent to favor the big interests, that it will be less Waterloo than water down, a steady diluting of what they'd hoped for, or America needs.

[RobMoney$]

In order to understand the President's approach to health care reform, it's important to understand the beliefs and policies of his advisers.

http://www.youtube.com/watch?v=5CHBv...layer_embedded