Democracy - We had a good run

[Lark the Sisterman]

Judging by this thread, democracy has indeed run its course.

Let the Illuminati rule, I say. They're doing it anyway and that way they wouldn't have to be so sly and hush-hush about it.

[ljkeane]

That's only true if you assume that other systems actually deliver that exact same or superior product for less money. There are so many variables and metrics that the judgment as to whether they are actually delivering equivalent services is more subjective than objective. There's a good argument, for example, that the U.S. essentially subsidizes the rest of the world in terms of medical advances.

I'd like to see some evidence of that beyond some vague hand waving. Most developed economies invest significantly in medical research. The analysis I've seen of the extra costs of the US system almost all points to the waste in the system being the major reason for the higher costs.

There are numerous measures that rank many healthcare systems higher than the US system for a significantly lower cost, the superior product that the US system is providing doesn't seem to be immediately obvious to most observers.

[TrackerNeil]

Why does it have to be the system that is broken, why not the people themselves? Look, when we talk about health care reform we aren't talk about reforming actual health care so much as reforming health insurance. So for most Americans you aren't talking about anything that is going to change the kind of care that they receive when they visit a doctor. Also when you talk about health statistics like life expectancy and infant mortality your talking about more than just health care your talking about wellness which is more comprehensive term. That would cover not only health care but also things like diet, exercise, cleanliness and over all stress levels. The death of a guy by heart attack who was 50 lbs overweight, who stopped going to the doctor because his doctor kept telling him to put down the jelly doughnuts and beer, and who collapsed while chasing an ice cream truck, the longest run he has had in years, isn't going to tell you anything about our health care system. Is it possible that the above statistics have more to do with the fact that we are as a people fat and lazy and we are getting fatter by the day. If you wanted to compare health care systems you would do a study of the actual care recieved at an American health care provider and compare it what you would receive some place else. This link has a list of countries ranked by life expectancy. Japan has the highest at 82.6 and the U. S. is 38th with a life expectancy of 78.2. This link is an article BMI and obesity. Japan has the lowest with only 3.2 percent of the population with a BMI over 30. The United States has the highest with 30.6 percent of the population with a BMI over 30. This article discusses the changes of in BMI in the 40 year period from 1960 to 2002. The average Amercan's BMI. It has gone from 25 to 28. Given the impact obesity, poor diet and lack of exercise have on so many disease such heart disease, diabetes, to cancer, it may be that our health care system is doing a heroic job just to keep our 78.2.

AndyP, even if I grant you that Americans are unhealthy slobs who demand too much of their doctors, you really haven't addressed the fundamental dysfunction of our current system; i.e., it leaves millions unable to get coverage and, by implication, care. Timothy Noah of Slate writes pretty eloquently about how health insurance companies apply strict standards to those who apply for coverage, leaving lots of people - basically healthy people - out in the cold.

Look, I'm not going to try to convince you or anyone else that the current system isn't working very well. Most Americans know it is and those who don't aren't going to be convinced. But to confuse the problems of health insurance with the health of Americans is IMO intellectually sloppy.

[Aemon Stark]

That's only true if you assume that other systems actually deliver that exact same or superior product for less money. There are so many variables and metrics that the judgment as to whether they are actually delivering equivalent services is more subjective than objective. There's a good argument, for example, that the U.S. essentially subsidizes the rest of the world in terms of medical advances.

You have quite the talent for offering arguments with little to no substance or supporting points, which are nonetheless dressed up with lots of jargon terms like "variables" and "metrics". The US does not subsidize the world in terms of anything, much less medical advances. Clinical trials are conducted globally and - wouldn't ya know it - we actually do research too. The US is only a world leader when it comes to spending money on administration, something on the order of 30% of total costs. Overhead takes up about 3% of Canadian public spending. Now *that* is efficiency.

[Noontidal]

You have quite the talent for offering arguments with little to no substance or supporting points, which are nonetheless dressed up with lots of jargon terms like "variables" and "metrics". The US does not subsidize the world in terms of anything, much less medical advances. Clinical trials are conducted globally and - wouldn't ya know it - we actually do research too. The US is only a world leader when it comes to spending money on administration, something on the order of 30% of total costs. Overhead takes up about 3% of Canadian public spending. Now *that* is efficiency.

Ok, I found some numbers: http://www.medicalnewstoday.com/articles/127893.php I am guessing that merely accounts for government spending, private donations from the US are typically even more significantly higher than other countries, but I can't find the numbers on that. Here's another link http://content.healthaffairs.org/cgi/content/full/23/3/10 From this link I get the impression that the issue with the US' healthcare may rest in their ability to pay. As in, there are plenty of individuals that can pay more, therefore it is expected that everyone pay more, which naturally nudges out those in lower income brackets.

It can't really be argued that the US doesn't spend the lion's share (as it were) on healthcare, research and whatnot. Although it should be noted, as important as healthcare is, it really is not particularly important for a vast majority of individual and is no more than an insignificant drop in a bucket of life expectancies. I have also heard (discussed on cspan in fact) that the US spends 2x or more on many drugs made in the US compared to various other countries such as Canada. In total, the US spends around 7900usd per capita on healthcare, which is nearly double that of the second biggest spender (either Canada or Germany). The research cost I linked would account for 116.67usd per capita, assuming the other link reflects an accurate divvying of funds there are certainly more funds being accounted for in the 7900usd and I cannot make a good assessment or verdict without all the relevent numbers.

[The Iceman of the North]

What do you mean "lion share", Noon? According to your link, the US is responsible for 21.8% of health research, while the US GDP is around 24% of the world GDP.

[Swordfish]

We've all heard this argument many times before, but when you look at statistics like life expectancy and infant mortality rates (objective metrics),

Except those are not objective metrics, particularly infant mortality, and even if they were, they're hardly comprehensive.

There is plenty of information out there about why infant mortality rates are not a good indicator of the quality of healthcare.

[Night Watchman]

There is plenty of information out there about why infant mortality rates are not a good indicator of the quality of healthcare.

Really? It strikes me that a country with a better health care system would have a lower Infant Mortality rate than a country with a worse health care system.

[Noontidal]

Really? It strikes me that a country with a better health care system would have a lower Infant Mortality rate than a country with a worse health care system.

Then it strikes you incorrectly. This is yet another area wherein lifestyle has the greatest influence while medical healthcare might actually have a negative impact. Hospital births are necessary for only a tiny fraction, and there are some midwives that consider the hospital environment to be one that induces a need for said environment.

What do you mean "lion share"

As I said, that does not include private donations which are typically much greater. Also the other link provides a breakdown in how the 7900usd per capita is spent. Although, even if we go with the $35b figure as the hypothetical only figure - sure it would hurt if any individual country dropped its official contribution, but if the US dropped it's funding it would be royally fucked.

However, in reality, that $35b appears to be merely a drop in the bucket. Assuming numbers have not changed significantly , the US' actual contribution is somewhere around $711b after subtracting administrative costs, profits, etc.

[Shryke]

Then it strikes you incorrectly. This is yet another area wherein lifestyle has the greatest influence while medical healthcare might actually have a negative impact. Hospital births are necessary for only a tiny fraction, and there are some midwives that consider the hospital environment to be one that induces a need for said environment.

Yeah, bullshit. Medical care will not negatively impact natal health and/or care.

The type of care received can, however, impact the statistics based on how said statistics are taken.

[Former Lord of Winterfell]

Please elaborate on this. I'm not following you. Yeah, I get that employer-based issues restrict choices...that's part of why I want to end it.

If people with more significant medical issues gravitate towards more comprehensive plans, their claims will drive up premiums in those plans and people in better health who have fewer claims will shift to other, lower-benefit plans that the less healthy avoid. The result will be a tiered system with little sharing of the risk. Healthy people will be in low benefit, low premium plans, and the less healthy will be paying a ton. The disparity will obviously get worse if you eliminate caps and ban exclusion of preexisting conditions.

In terms of the role of elected representatives, it makes sense for them to exercise independent judgment if the wishes of their constituents can't be heard either due to limited communications, as in earlier days of the republic, or when legislating becomes a full-time job and citizens can't possibly stay up to speed on every piece of legislation, like now. But IF it is a sufficiently significant issue that most people are involved and have an opinion, ignoring the opinions of constituents seems a lot more difficult to justify.

We fully respect the legitimacy of voters' opinions when they vote someone out of office if they disagree with their vote on an issue. Why are their opinions any less legitimate before the representative actually votes on the issue?

[Swordfish]

Really? It strikes me that a country with a better health care system would have a lower Infant Mortality rate than a country with a worse health care system.

Then it strikes you incorrectly. As I said, there's plenty of information out there about why you've been struck incorrectly, if you're really curious.

This is a great example of 'common sense' logic not necessarily being accurate, with a dash of confirmation bias thrown in for good measure.

[Noontidal]

Yeah, bullshit. Medical care will not negatively impact natal health and/or care.

That is neither an argument nor refutement. Nor does it address what I put forth. From what I have read, all one can really have without being a professional (midwife)is an even-keel dispite on this matter. I personally, would say that common sense combinded with a historical perspective supports the stance that birth is only rarely a medical procedure. You may disagree, but that's as far as it goes.

[Kalbear]

Then it strikes you incorrectly. As I said, there's plenty of information out there about why you've been struck incorrectly, if you're really curious.

Where? A google search found nothing at all that indicated that higher overall health care led to worse infant mortality rates.

[The Iceman of the North]

As I said, that does not include private donations which are typically much greater. Also the other link provides a breakdown in how the 7900usd per capita is spent. Although, even if we go with the $35b figure as the hypothetical only figure - sure it would hurt if any individual country dropped its official contribution, but if the US dropped it's funding it would be royally fucked.

However, in reality, that $35b appears to be merely a drop in the bucket. Assuming numbers have not changed significantly , the US' actual contribution is somewhere around $711b after subtracting administrative costs, profits, etc.

Where do you get that the figures in the first link doesn't contain private donations? Skimming over the text I didn't find anything about it.

As for the second link, again, I couldn't find what you claim to be there. All I found was a claim by a former former FDA Commissioner crying on the behalf of Big Pharma of the "unjust" system of known as free trade. Where did you get $7,900 per capita from?

[Swordfish]

Where? A google search found nothing at all that indicated that higher overall health care led to worse infant mortality rates.

Who has asserted that higher overall healthcare led to higher infant mortality rates?

Not me.

Seriously, if that's the way you read that conversation then I don't know what to tell you.

I'd go look for a link or two, but frankly, it isn't even really worth it. It's not going to change anyone's mind about UHC, and I'm not really in the mood for a link war today.

If you're legitimately interested in why infant mortality rates are not appropriate to compare levels of overall healthcare among nations, the information is readily available.

[Kalbear]

Okay, sword - I'm genuinely curious. Where have you found this information? Because I've never - not once - heard that there is no reasonable correlation between high qualities of health care and infant mortality rates.

And I'm still not finding it.

If you're still up for it and don't want a link war, please PM me a couple.

[The Dude]

Except those are not objective metrics, particularly infant mortality, and even if they were, they're hardly comprehensive.There is plenty of information out there about why infant mortality rates are not a good indicator of the quality of healthcare.

Care to share this information? I didn't say they were comprehensive, I was just providing examples.

Then it strikes you incorrectly. This is yet another area wherein lifestyle has the greatest influence while medical healthcare might actually have a negative impact. Hospital births are necessary for only a tiny fraction, and there are some midwives that consider the hospital environment to be one that induces a need for said environment.

From the info I saw, the biggest factors were pre-natal care and premature birth rates. These are areas where it becomes very difficult to separate the lifestyle and healthcare influences. It is most certainly both. To pretend that medical knowledge and care are somehow going to have an overall averse affect to healthy birth rates is preposterous.

Why does it have to be the system that is broken, why not the people themselves?

.....

Given the impact obesity, poor diet and lack of exercise have on so many disease such heart disease, diabetes, to cancer, it may be that our health care system is doing a heroic job just to keep our 78.2.

I'm fairly certain that it's both. So, I agree with you in part, but believe your answer to only be a half truth.

A very large responsibility of health care is education. That is up to the individual and the system. Why aren't we doing more to promote healthy lifestyles? Why are so many people waiting until they are sick and hospitalized before doing something about it?

Is part of the problem that they can't afford regular doctor visits? Is there something about our system that discourages this? Maybe something like "pre-existing conditions"?

[Noontidal]

Where do you get that the figures in the first link doesn't contain private donations? Skimming over the text I didn't find anything about it.

As for the second link, again, I couldn't find what you claim to be there. All I found was a claim by a former former FDA Commissioner crying on the behalf of Big Pharma of the "unjust" system of known as free trade. Where did you get $7,900 per capita from?

Here:

Together G7 countries were responsible for over 88% of all publicly funded health research

If I had good numbers for private expenditure on HC research I would use them, all I have is the World Almanac among other sources, telling me that the US spends 7900 per capita on healthcare(or according to wikip, 8047). Combining that with the small amount of information I've gleaned on how this money is divvyed up, the US spends somewhere between 200b - 800b on healthcare research.

[Noontidal]

From the info I saw, the biggest factors were pre-natal care and premature birth rates. These are areas where it becomes very difficult to separate the lifestyle and healthcare influences. It is most certainly both. To pretend that medical knowledge and care are somehow going to have an overall averse affect to healthy birth rates is preposterous.

I can recommend some books that address the subject, or specifically the negative impact hopsital births may have, it'd probably leave you undecided(would you like the book recommendations?). Even so, lifestyle is easily the more heavily weighted item when you consider the factors - age when giving birth, food, obesity, anorexia(or any eating disorder), smoking, drinking, exercize, fashion mood and freak accidents. There seems to be very little a hospital can do for an infant, an ultrasound is a tool for saving the life of the mother, not the infant.