American Politics: the Lost Generation

[Former Lord of Winterfell]

80% of the determining factors of the score for responsiveness basically measure how pleasant an environment is provided for the patient, not actual healthcare.

"Amenities", which included "cleanliness, space, and hospital food" only accounted for 15% of the ratings. By contrast, 20% of the rating was on "prompt attention" alone. 5% was on patient choice of provider or facility, 16.7% was on patient autonomy in terms of making decisions. Access to social support network, which I think can fairly be considered part of care, was another 10%. Respect for patient dignity was 16.7%

Or, like I said, there's the other data I posted discussing cancer survival, or being No. 1 in life expectancy when you exclude traffic fatalities in homicides, or the links above regarding high wait times for surgery and MRI in Canada. And of course, considering that there is a wider disparity in terms of care received in the U.S. based on income, all those logically rankings would be lowered for people without insurance or care, and raised for those who do.

[TerraPrime]

I'd like to see the average 5-year survival rate for cancers in the U.S. once we figure in the 20 to 40 million people who receive no health care. I wonder what the average wait time will look like once we add those people into the data?

[ljkeane]

"Amenities", which included "cleanliness, space, and hospital food" only accounted for 15% of the ratings. By contrast, 20% of the rating was on "prompt attention" alone. 5% was on patient choice of provider or facility, 16.7% was on patient autonomy in terms of making decisions. Access to social support network, which I think can fairly be considered part of care, was another 10%. Respect for patient dignity was 16.7%

I think all of the factors apart from prompt attention (which is not individually shown) are extremely debateable as measures of the actual quality of healthcare received, as the WHO definition says they certainly don't measure how the system responds to health needs. The WHO responsiveness ranking a very flimsy basis for saying that the quality of medical care you would receive in the US is higher than in Canada, which is what you used it for.

[The Progressive]

Didn't we rehash all this already?

I'm sure last time it was over international comparision of infant-mortality rates .......... and FLOW et al were trashing the very same WHO report that is being touted here by FLOW et al.

[Aemon Stark]

Stego said Palin went to Canada for free health care. Guess I shouldn't have listened to him....

I have no idea if Palin's story is even true, let alone accurate.

Thanks for the advice, but no, I think I'll keep mentioning it. In a survey biased to downgrade the overall U.S. ranking, they couldn't help by rank the U.S. first in the only category that directly measured health care itself. But feel free to disagree -- I won't lose any sleep over it.

Unfortunately for your argument, there's nothing in the survey that indicates that responsiveness in the US was significantly different from other top-ranked countries (Switzerland, Luxembourg, Denmark, Germany, Japan, and Canada), all of which fell in the same distribution (3-38). On the other hand, the US ranked below countries like Bangladesh, India, and Iraq on "fairness in financial contribution". Make what you will of that.

Canadians waited longer than ever before (18.3 weeks) for non-emergency surgery in 2007, despite a multi-billion-dollar effort by government to speed up medical care, according to a report released yesterday by Canada's Fraser Institute. Highlights of the report include:

I don't know where the Fraser Institute is getting its numbers, but it's worth noting that it's our equivalent of the Cato Institute. Not to be trusted. If you want to see some actual wait times data, please see here. There are seven MRIs in Nova Scotia in the public system and one private one that I know of (though I've heard rumours of its pending insolvency). If it's urgent, you'll get it. If it's of marginal value to the diagnosis, you will wait. And, I suppose if you have more money to blow, you can pay out of pocket.

I understand exactly what you mean. What I'm talking about are laws in the States that mandate coverage for acupuncture, chiropractic, mental health, etc., etc., etc. Insurance companies are not permitted to offer coverages that exclude such things, which necessarily drives up costs.

The result of those mandates is that insurance companies balance those additional coverage obligations by raising co-pays, deductibles, and/or premiums for the other "medically necessary" aspects of coverage.

Mental health must be covered under anything "comprehensive". Get rid of the rest and change the laws rather than complaining about the difficulty of doing it.

[Former Lord of Winterfell]

I'd like to see the average 5-year survival rate for cancers in the U.S. once we figure in the 20 to 40 million people who receive no health care. I wonder what the average wait time will look like once we add those people into the data?

First things first: do you have any evidence to support the claim that 20 to 40 million people receive no health care?

I don't know where the Fraser Institute is getting its numbers, but it's worth noting that it's our equivalent of the Cato Institute.

Do you have a different source with different number? Good luck, because as I mentioned, feel free to google it. And I provided an number of other links that you, curiously, failed to address. The canadaonline link actually linked directly to the government websites.

If you want to see some actual wait times data, please see here.

I checked out your link, but all it contained was a vague promise by the government to improve wait times -- a curious bit of evidence to support your claim that wait times aren't a problem at all.

You may want to look at this list of 10 facts about American health care, with references. Actually, you probably don't, but that's okay.

http://www.ncpa.org/pub/ba649

David Brin, a pretty good SF author and lefty who strongly favors reform, sums it up fairly. Worth a read, because he points to the advantages and disadvantages of the various systems.

http://davidbrin.blogspot.com/2009_06_01_archive.html

I don't have a problem with the argument that other systems provide a more even distribution of health care that benefits people in the lower end of the economic spectrum. What bugs me is the messianiac conviction that there isn't a single virtue to the American system at all -- we apparently do nothing of significance better than any of the comparables. As Brin sanely points out, he is suspicious of zero-sum games.

[The Progressive]

You may want to look at this list of 10 facts about American health care, with references. Actually, you probably don't, but that's okay.

http://www.ncpa.org/pub/ba649

Lol, I like how they used

14] Nicholas D. Kristof, "Franklin Delano Obama," New York Times, February 28, 2009. Available at http://www.nytimes.com/2009/03/01/opinion/01Kristof.html.

along with the Federation of Pharmaceutical Industries and Associations abd the Cato Institute as references.

[Aemon Stark]

I don't know where the Fraser Institute is getting its numbers, but it's worth noting that it's our equivalent of the Cato Institute.

Do you have a different source with different number? Good luck, because as I mentioned, feel free to google it. And I provided an number of other links that you, curiously, failed to address. The canadaonline link actually linked directly to the government websites.

The other links merely repeated numbers taken from that same Fraser Institute study. That people wait sometimes is not in question - that this contributes to much more than occasional inconvenience is certainly debatable.

I checked out your link, but all it contained was a vague promise by the government to improve wait times -- a curious bit of evidence to support your claim that wait times aren't a problem at all.

Did you not see the link on the page that said "wait times data"? Look again. Nor did I say they're not a problem, but said problem has more to do with excessive patient expectations than any kind of increased morbidity or mortality due to waiting.

You may want to look at this list of 10 facts about American health care, with references. Actually, you probably don't, but that's okay.

http://www.ncpa.org/pub/ba649

David Brin, a pretty good SF author and lefty who strongly favors reform, sums it up fairly. Worth a read, because he points to the advantages and disadvantages of the various systems.

http://davidbrin.blogspot.com/2009_06_01_archive.html

I don't have a problem with the argument that other systems provide a more even distribution of health care that benefits people in the lower end of the economic spectrum. What bugs me is the messianiac conviction that there isn't a single virtue to the American system at all -- we apparently do nothing of significance better than any of the comparables. As Brin sanely points out, he is suspicious of zero-sum games.

I'm certain you've posted that former link before or someone else has. Either way, it's using sources garnered from ideological think tanks and newspaper articles, along with a selective and rather short list of actual peer-reviewed articles. The stats are out-of-date in many cases too, not that it much matters, since more MRIs also applies more MRI use regardless of the value of doing so.

[Former Lord of Winterfell]

The other links merely repeated numbers taken from that same Fraser Institute study. That people wait sometimes is not in question - that this contributes to much more than occasional inconvenience is certainly debatable.

The links go directly to the government websites, as a I pointed out above.

Did you not see the link on the page that said "wait times data"? Look again. Nor did I say they're not a problem,

Have you no shame, sir? Because your exact statement was:

If you need an MRI, you don't wait.

So I suppose you're technically correct. You didn't say that wait times weren't a problem. You just said there weren't any wait times. Oh, and because you can't get an MRI in the first place unless a physician says you need one, the claim that there are people on the wait list who don't need an MRI is false on its face.

but said problem has more to do with excessive patient expectations than any kind of increased morbidity or mortality due to waiting.

Yeah, those damn patients not wanting to wait a year for surgery, or 6 months for an MRI that their doctor already has determined was necessary. Well, since the latter point regarding mortality is purely conjecture on your part, I'll just stick with the data that shows extremely long wait times. I mean, I suppose having to wait a year for a hip replacement won't actually kill you; it may just mean that you're miserable and in pain, so you may have a point from a certain perspective.

I'm certain you've posted that former link before or someone else has. Either way, it's using sources garnered from ideological think tanks and newspaper articles, along with a selective and rather short list of actual peer-reviewed articles. The stats are out-of-date in many cases too, not that it much matters, since more MRIs also applies more MRI use regardless of the value of doing so.

Guess you ignored the citations to the Nobel website, U.S. Dept. of Health and Human Services, OECD, the U.K.'s Department of Health, etc. Just because a think-tank is ideological doesn't mean that objective facts it reports are inaccurate. And generally, when that happens, think tanks from the other end of the spectrum jump all over the error. So where is you opposing view?

I also like your claim that the peer-reviewed articles were "selective", especially given that you haven't read them. I think people can just click on the link themselves, look at the data and references for themselves, and decide for themselves whether the books look cooked. But a whole lot of those peer-reviewed articles weren't even American, so good luck convincing everyone they're all biased.

And yes, Nicholas Kristof is just a writer. But he's a highly respected, two-time Pulitzer Prize winner who strongly supports what Obama is doing in the realm of health care, if you'd bothered to follow the link and actually read what he wrote. He's hardly the type of guy who would invent facts that go against his thesis of reform, especially without adequately researching them. He's just honest enough to admit that the facts are not completely one-sided. You're not.

But for all that, you haven't produced any alternative statistics that disprove the ones in that acrticle. None. Essentially, you've been presented with facts that don't match your completely one-sided view of the issue, and rather than integrating them into a more balanced picture, you simply reject them out of hand. Because if they don't match your preconceptions, they must be false.

[Former Lord of Winterfell]

Lol, I like how they used

along with the Federation of Pharmaceutical Industries and Associations abd the Cato Institute as references.

You don't have any clue who Kristof is, do you? Did you confuse him with Bill Kristol, per chance?

[The Progressive]

I think the more pertinent issue is that the article you linked to used an op-ed piece as reference for a factual claim.

Hilarious.

[ThinkerX]

I'm getting a certain vibe from your posts, so just so I'm clear whether or not it's correct: Are you inclined, even if you had a bit more income, to forgo getting insurance in the case of serious illness or impairment?

That is fairly accurate, yes.

[Former Lord of Winterfell]

I think the more pertinent issue is that the article you linked to used an op-ed piece as reference for a factual claim.

Hilarious.

Presumably because Pulitzer Prize winners for the NYT would have their shit jumped in a moment if they published facts that turned out bogus. Eh, and to think I actually took you off ignore.

[The Progressive]

The issue isn't the credibility of the NY Times editorial desk. However, this concerns intellectual dilligent and integrity, a subject you might not be familiar with, so I'll explain it in more details so that the whining can stop.

Now it is quite usual for editorial pieces to throw out facts and figures along with their spin on those facts and figures. Sometimes, they would as least be honest enough to make a passing remark about the actual study or database where they got those data or number from. So presumably a serious, non-opinionated article, when making a factual claim such as the one you linked to, would actually do enough dilligent research to look up the studies mentioned in whatever opinion pieces, and then reference the primary source itself ........ because hey, that op-ed piece might not be entirely honest with whatever data or statistics they mentioned.

Shocking, I know. ;)

[TerraPrime]

First things first: do you have any evidence to support the claim that 20 to 40 million people receive no health care?

Total population of the U.S. is about 300 million. Approximately 15% are without health care. So, that is about 45 million. The estimate varies, depending on the criteria you use, and the stringency of reporting. The range of 20 to 40 is the accepted range, from what I've been reading.

Here are some links:

Wiki: http://en.wikipedia.org/wiki/Health_care_in_the_United_States

An op-ed piece that refutes the 46 million number: shortended to fit screen. I disagree with several points in this article when it comes to "counting" who doesn't have health care, but it is the lowest estimate I can find, so I am providing it for comparison.

How many people in the U.S. are without health care, in your understanding?

[Former Lord of Winterfell]

Total population of the U.S. is about 300 million. Approximately 15% are without health care. So, that is about 45 million. The estimate varies, depending on the criteria you use, and the stringency of reporting. The range of 20 to 40 is the accepted range, from what I've been reading.

Are you equating that people have no insurance with people not getting any care? There's a pretty big distinction there, particularly with respect to the statistical point you made in the original post.

How many people in the U.S. are without health care, in your understanding?

8. Maybe 9.

[TerraPrime]

Are you equating that people have no insurance with people not getting any care? There's a pretty big distinction there, particularly with respect to the statistical point you made in the original post.

I don't see how.

My point is that the data showing U.S. system working better are wrong, because they only count the people who can afford care.

What is the average wait time for an MRI in the U.S.? Indefinite.

Why?

For those who cannot afford an MRI, the wait is indefinite. (X + Indefinite)/Total = indefinite.

That was the point I was making.

The actual number of people without insurance is rather moot, in this context.

And I'm still waiting to learn about how Balanced Budget Amendment that can control the spending on entitlement programs can lead to lowered cost of health care in this country.

[Former Lord of Winterfell]

I don't see how.

I'm confused. Are you saying that all of the people who don't have health insurance don't get any healthcare, or not? Because when I asked you for where you got your numbers for how many people had no care, you cited me the number of uninsured. I'm just trying to find out if you think those two numbers are equal.

[TerraPrime]

I'm confused. Are you saying that all of the people who don't have health insurance don't get any healthcare, or not? Because when I asked you for where you got your numbers for how many people had no care, you cited me the number of uninsured. I'm just trying to find out if you think those two numbers are equal.

I already explained why, in the context of the point I was making, the precise number is irrelevant.

However, to follow the factual side of the argument, of course the number of uninsured and the number of people without health care are not the same. Partly, it will depend on how you define health care. In the second article I cited, for instance, the author cited the emergency care that people are entitled to as a form of health care. I disagree with that classification.

As far as insurance and care, I agree that the two are not the same. Some people have insurance, and still cannot get health care. Some people can get health care, but do not need to pay for insurance directly (people on Medicaid/Medicare, etc).

[Former Lord of Winterfell]

I already explained why, in the context of the point I was making, the precise number is irrelevant.

I couldn't disagree more. In fact, I think it makes my point even stronger. After I posted information about cancer survival rates, you said the following:

I'd like to see the average 5-year survival rate for cancers in the U.S. once we figure in the 20 to 40 million people who receive no health care. I wonder what the average wait time will look like once we add those people into the data?

The assumption implicit in that remark is that the data for the entire U.S. somehow excluded those 20-40 million people. But why would that be the case? As long as those people received any treatment at all, whether Medicare, Medicaid, or just an emergency room visit as they were dying, there's no reason to believe that their information wouldn't be included in those national statistics. Presumably, the uninsured/underinsured would get the least treatment, so their inclusion in those national statistics would drag the overall survival rates below what it would be if we just looked at people who actually had insurance.

And that backs up the point I was making -- that health care in the U.S. is wonderful if you can afford it. Heck, even if your assumption was correct, all that would mean is that the U.S. cancer survival rates for people who have insurance are the best in the world. Any inclusion of the uninsured/underinsured in the original statistics only makes that argument stronger because it raises the survival rate for those who have insurance.