American Politics: the Lost Generation

[snake]

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.

Seeing as how you brought up Canadian health care I looked for some comparisons and I found that in a joint Canadian/US survey done in 2003 Canadian health car was on par with US health care for those who have insurance and much better than those in the US without insurance.

Link.

The summary,

Americans in the lowest income groups are much more likely than their Canadian counterparts to be in fair or poor health, according to a study comparing health status and access to health care services between the two nations.

The study was based on the Joint Canada/United States Survey of Health, a unique population health survey conducted jointly by Statistics Canada and the US National Center for Health Statistics of the US Centers for Disease Control and Prevention between November 2002 and June 2003.

The study, published recently in the journal Health Affairs, found that almost one-third (31%) of Americans with the lowest incomes reported fair or poor health, compared with 23% among their Canadian counterparts.

At the other end of the income spectrum, there were no differences in health status between Canadians and Americans in the highest income group.

In terms of access to health care services, the situation for Canadians was more like that of insured Americans. Canadians and insured affluent Americans were similar regarding their access to physicians, including access to a regular medical doctor. However, Canadians experienced fewer unmet health care needs overall.

You can find the study from the site I linked.

[Swordfish]

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).

And some people do not have insurance, and do not need healthcare.

In fact, that makes up a pretty large percentage of those numbers you quoted.

Odd that you left out mentioning the largest subset of that group here, yes?

[Former Lord of Winterfell]

Seeing as how you brought up Canadian health care I looked for some comparisons and I found that in a joint Canadian/US survey done in 2003 Canadian health car was on par with US health care for those who have insurance and much better than those in the US without insurance.

Link.

The summary,

You can find the study from the site I linked.

I followed the links, and it appears that even the survey authors attribute a significant part of the results to factors such as obesity and smoking. There's a difference between health and health care, because poor health can result from a whole host of factors in addition to available care. The survey you linked also reported this:

About 13% of Americans reported that they had experienced an unmet health care need in the year prior to the survey, compared with 11% of Canadians. The difference is attributable to a much higher rate among uninsured Americans, 40% of whom reported an unmet need. There was no difference, however, in the proportion who reported unmet health care needs between Canadians and Americans with health care insurance (10%). The top reasons for unmet health care needs differed in the two countries. Waiting too long was most often reported in Canada, while costs were reported in the United States.

and this:

On the whole, Americans were more likely to be "very satisfied" with their health care services, while Canadians were more likely to be "somewhat satisfied," even when compared with insured Americans.

About 42% of Americans reported that the quality of their health care services in general was excellent, compared with 39% of Canadians. However, Canadians were more likely to report that the quality was only "fair." These differences remained when Canadians were compared with insured Americans.

Of course, the results are just a survey of individual opinions rather than objective measurements such as wait times and survival rates from various diseases, so I'm not sure how much weight you want to give to that.

Both the list, the David Brin blog, and the Kristof article all said that the U.S. essentially subsidizes medical research for the rest of the world -- it's part of what we're paying for with our higher prices. Does anyone have any comment on that?

[TerraPrime]

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.

None of those I dispute.

My point is that these health statistics are like counting which school has the fastest track-and-field record by counting only the track and fiend athletes in one school while counting everyone in the other school. The "average wait time" is only meaningful for those who have a wait time. It's pointless for those without insurance and/or health care.

So yes, in America, you win, if you can afford adequate care. Now that the cheerleading segment of our program is over, can we get back to addressing some real issues?

[Mad Monkey]

Basically, that last entire page of arguing was over the suggestion that people who have access to high-quality health care enjoy high-quality health care, right? Is that something that even sounded controversial?

[Lord Mord]

FLoW,

Do people understand that our current laws do not permit private insurers to offer this type of minimal coverage? Insurers are required by various state laws to cover various conditions, which means that these type of catastrophic, condition-limited policies are illegal. I can't quite understand why its immoral to repeal laws requiring those coverages, yet we'd endorse a government system that excludes the very same things.

I don't know if "we'd" endorse it. I think that I might.

My reasoning is that I'd rather everyone were automatically covered for preventive care, than that anyone had to do without anything at all.

Before adopting a government system of new entitlements, doesn't it make sense to see if private companies for whom taxpayers aren't on the hook can address the problem first?

If insurance companies were on the hook to establish a revenue stream for covering the uninsured on the basic plan (as Aemon described it), a stream which, for this particular purpose, was subject to inspection and regulation and penalties by the government ... and if they could provide the basic plan to paying customers for no (or very little) more than it would cost the average taxpayer ... then I'd consider letting the private sector do it, sure.

[Former Lord of Winterfell]

None of those I dispute.

:bang:

The "average wait time" is only meaningful for those who have a wait time. It's pointless for those without insurance and/or health care.

Agreed.

So yes, in America, you win, if you can afford adequate care. Now that the cheerleading segment of our program is over, can we get back to addressing some real issues?

Do whatever you want. But maybe you'd like to discuss the data relating to medical innovations.

Basically, that last entire page of arguing was over the suggestion that people who have access to high-quality health care enjoy high-quality health care, right? Is that something that even sounded controversial?

I didn't think so, but I guess I was wrong.

[TerraPrime]

Do whatever you want. But maybe you'd like to discuss the data relating to medical innovations.

That seems plain.

If their assessment is true, and I'm not sure that I buy that it is, then it's unfair for the Americans to shoulder the lion's share of the cost that sustains medical innovations.

I'm also okay with a slowing-down on research investment by the pharmaceuticals, if that will mean offering health care to all citizens.

[Former Lord of Winterfell]

FLoW,

I completely understand that point.

Er, I think you may have described the President's plan, but then, who knows?

I guess my preferred approach would be to first permit private insurers to offer those more stripped-down plans covering preventative care and other medical conditions, at least on a catastrophic basis, and then see where that left us in terms of the numbers of uninsured.

Obviously, I think HSA's could perhaps work to reduce costs as well. Interesting stuff happening with them in Indiana, that's for sure.

http://online.wsj.com/article/SB10001424052748704231304575091600470293066.html

[Former Lord of Winterfell]

That seems plain.

If their assessment is true, and I'm not sure that I buy that it is, then it's unfair for the Americans to shoulder the lion's share of the cost that sustains medical innovations.

It isn't. Any ideas how to force them to share it, though? I can't think of any, but someone else might.

I'm also okay with a slowing-down on research investment by the pharmaceuticals, if that will mean offering health care to all citizens.

Ack! Okay, my point all along is that there are two sides to this. Yes, our system may provide very good care for the people who have insurance, and the most medical advances. On the other hand, its expensive as hell and some people aren't covered. I can completely understand someone claiming that this combination is less moral than a more egalitarian system.

Oh, by the way, I've been asked a few times about "free market" ideas for bringing down costs. Based on a few things I've read, I'm wondering if we should perhaps end the stranglehold the AMA has on medical schools, which essentially creates an artificial doctor shortage. Don't know enough about it to have a fully formed opinion yet, but it might be a decent issue to explore.

[Mad Monkey]

Is part of the reason that there is a "doctor shortage" is because medical students are discouraged from becoming relatively low-paid general practitioners by the crushing financial cost of medical school? I've heard that before but I don't have any hard numbers right at hand.

[Former Lord of Winterfell]

Is part of the reason that there is a "doctor shortage" is because medical students are discouraged from becoming relatively low-paid general practitioners by the crushing financial cost of medical school? I've heard that before but I don't have any hard numbers right at hand.

I read something recently where the AMA pressures medical schools to limit the number of medical students. Of course, that not only reduces the supply of doctors, but enables those schools to jack up fees. That means more loans to be paid off, etc. I thought I read that there's something Congress does to discourage medical schools from expanding enrollment, but I can't remember exactly what that was. Just tossing this out there in case in rings a bell for someone else.

[ljkeane]

Both the list, the David Brin blog, and the Kristof article all said that the U.S. essentially subsidizes medical research for the rest of the world -- it's part of what we're paying for with our higher prices. Does anyone have any comment on that?

Do you have any statistics on how much of the difference in healthcare spending in the US is due to medical research?

The fact that the US has some of the best universities in the world I suspect is more of a factor in it's contributions to medical research than the format of it's healthcare system. A quick look at the factors used in the NCPA article to show the US contribution to medical advances shows that the UK, which has probably one of the more socialised healthcare systems in the world, has provided around 25% of the innovations that the US has and more than that in Nobel laureates over the last 10 years. Considering the relative total spending on healthcare that seems disproportionately high.

[Mad Monkey]

I did some quick Googling when I saw your post:

this article talks about how the number of medical students has been increasing significantly over the past couple of years. It's from 2006 so it's a little outdated, but I'm sure that it hasn't changed that much over the last three years:

First-time enrollees in the 2006 entering class totaled almost 17,400, a 2.2 percent increase over last year.

The number of applications also increased for the fourth consecutive year. More than 39,000 individuals applied to attend medical school this fall, a 4.6 percent increase over last year's total of 37,373. The grade point averages and MCAT scores of this year's applicant pool were the highest in more than a decade.

However, I found something that matched up with your note about the AMA deliberately trying to shrink the amount of doctors

The predictions of a doctor shortage represent an abrupt about-face for the medical profession. For the past quarter-century, the American Medical Association and other industry groups have predicted a glut of doctors and worked to limit the number of new physicians. In 1994, the Journal of the American Medical Association predicted a surplus of 165,000 doctors by 2000.

That U.S.A. Today article implies though that the AMA has recently reversed its position:

Even the American Medical Association (AMA), the influential lobbying group for physicians, has abandoned its long-standing position that an "oversupply exists or is immediately expected."

This article also mentions what you said about Congress discouraging the amount of doctors produced. Basically, Medicare is not only responsible for what we all know it does for the elderly but it also funds medical residencies required for all doctors to start practicing in the U.S.

Congress controls the supply of physicians by how much federal funding it provides for medical residencies — the graduate training required of all doctors.

Medicare, which provides health care to the nation's seniors, also is the primary federal agency that controls the supply of doctors. It reimburses hospitals for the cost of training medical residents.

The government spends about $11 billion annually on 100,000 medical residents, or roughly $110,000 per resident. The number of residents has hovered at this level for the past decade, according to the Accreditation Council for Graduate Medical Education.

In 1997, to save money and prevent a doctor glut, Congress capped the number of residents that Medicare will pay for at about 80,000 a year. Another 20,000 residents are financed by the Veterans Administration and Medicaid, the state-federal health care program for the poor. Teaching hospitals pay for a small number of residents without government assistance.

I honestly didn't know about this. Even though attitudes are changing about the "doctor glut", Congress might be nervous about increasing expenditures at a time where a lot of people are becoming deficit hawks, even if it is necessary. The only way I can see this making any progress is if they remind everyone that the doctors that our aging baby boomer population needs have to be trained somehow...

[Shryke]

And some people do not have insurance, and do not need healthcare.

In fact, that makes up a pretty large percentage of those numbers you quoted.

Odd that you left out mentioning the largest subset of that group here, yes?

No, because those people only exist temporarily.

As people go on living, the chances of them not needing healthcare goes to zero. (Or close to zero if you count the people who never use the healthcare system and then die instantly)

Of course, those people have probably already received healthcare anyway, what with birth and all.

[Shryke]

Are the Doctor Shortages in question a universal or regional matter?

Cause the 2 are completely different animals.

[Mad Monkey]

Are the Doctor Shortages in question a universal or regional matter?

The article in question is talking about the United States as a whole. We have enough doctors now, but the problem basically that, because of that whole baby boom people, there are a bunch of people entering the time of their lives where they need a bunch of medical care and there aren't enough new doctors being produced in time to meet the new demand:

Bodiford experienced what many Americans may soon face: a shortage of physicians that makes it hard to find convenient, quality health care. The shortage will worsen as 79 million baby boomers reach retirement age and demand more medical care unless the nation starts producing more doctors, according to several new studies.

The country needs to train 3,000 to 10,000 more physicians a year — up from the current 25,000 — to meet the growing medical needs of an aging, wealthy nation, the studies say. Because it takes 10 years to train a doctor, the nation will have a shortage of 85,000 to 200,000 doctors in 2020 unless action is taken soon.

But the production of new doctors has changed little since 1985. Today, new physicians roughly equal the number of doctors retiring. Within a decade, baby boom doctors licensed in the 1960s, 1970s and 1980s will retire in large numbers that will outstrip the 25,000 new doctors produced every year, Cooper says.

The effective number of physicians will fall even more, Cooper says, because doctors work shorter hours today. "The public expects good, innovative health care, but we're not producing enough physicians to provide it," Cooper says.

It doesn't look regional. While the northeast has the most doctors (according to the chart), it seems unrealistic to expect that to last forever if all those doctors who got their licenses back to 1960 are going to retire and not enough are being generated to replace them.

[Starkimus]

I do not have any data to back this up on hand, however from personal experience (spouse is a general practioner, and I knew alot of her collegues while in Med School as well as alot of practicing Family Docs as well), the number of Family Doctors is going down for a fairly simple economical reason:

1) Pay for Family Docs has generally decreased over time.

2) Cost for Med School has generally increased over time.

This does not in general apply to specialists. However, as malpractice insurance continues to rise for specialists, their numbers will most likely decrease. I remember a few years ago an article in the State newspaper reporting an alarming shortage of specialists in the Myrtle Beach area and cited the reason as...Doctors just could not make a living there anymore due to increased costs, and decreased pay.

The pay part of course comes down to Medicare and Medicade patients, and how many of those you have versus how many patients you have with Private Insurance. The cost part is in general tied to rising malpractive insurance costs as well as all the overhead necessary to deal with Medicare, Medicade, etc.

Another interesting story. I met an ER doc in Colorado this past week while skiing. His story was that he had been in the ER business for over 20 years but just got sick of all the headaches (basically insurance companies as well as Medicare and Medicade), and finally said to hell with it. So now, he practices on his own, and just does cash. You get a service, you pay cash, no insurance etc. He carries little malpractice insurance, and works out of his house. His bills are in general much lower than going to the hospital and of course he has little to no overhead. There are limits to what he can do as well of course. However, his story is that he makes more "take home" money now, with much less headaches. While this is in general not the norm, I can certainly see a larger portion of the Doctor population moving to this type of business if the current Health Care Reform goes through.

Hasta!

Stark Out!

[Security Squish]

Another interesting story. I met an ER doc in Colorado this past week while skiing. His story was that he had been in the ER business for over 20 years but just got sick of all the headaches (basically insurance companies as well as Medicare and Medicade), and finally said to hell with it. So now, he practices on his own, and just does cash. You get a service, you pay cash, no insurance etc. He carries little malpractice insurance, and works out of his house. His bills are in general much lower than going to the hospital and of course he has little to no overhead. There are limits to what he can do as well of course. However, his story is that he makes more "take home" money now, with much less headaches. While this is in general not the norm, I can certainly see a larger portion of the Doctor population moving to this type of business if the current Health Care Reform goes through.

Wait. This ER doc was in charge of billing, insurance, Medicare and being a doctor? That's very strange. All the ER docs I work with love that there is no buisness angle to their job, they just work. Insurance is also quite affordable becuase the work backs up their plans as long as they follow hospital policy. That must have been a rinky dink ER. Most of the time private practice is such a bitch because of all the extra administrative work that comes with it. Does this doc run his/her whole buisness, or have employees? I can't imagine it's less hassle or hours. Hospital ER docs might only make low 6 figures here, but they have cushy hours, never on call, and have no admin work, unless they take a director job, and that comes with more money. Strange story, maybe things are really different where you live.

[alguien]

Only in Texas...

The top conservative activist on the powerful Texas Board of Education, who rejects evolution and has pushed for a revisionist right-wing U.S. history curriculum, is on the way out, after a moderate candidate defeated him in a tight primary last week.

Lobbyist Thomas Ratliff edged out McLeroy 50.4%-49.6% in a GOP primary for the seat McLeroy has held since 1999.

-He [McLeroy] described his textbook evaluation process this way to the Washington Monthly: "The way I evaluate history textbooks is first I see how they cover Christianity and Israel. Then I see how they treat Ronald Reagan--he needs to get credit for saving the world from communism and for the good economy over the last twenty years because he lowered taxes."

At least he lost. Still, this guy was on a school board for 10 years?!? :stunned: