EPTAnyhow, let's get on with the thread:
Foucault wrote:
At the same time I can see the obvious positives with universal healthcare, BUT the big question that many people don't seem to understand is whether or not the government should provide healthcare. Why should that be the government’s responsibility? Do we want to live in a society where our government takes care of us like children? No thanks.
At the same time I can see the obvious positives with universal healthcare, BUT the big question that many people don't seem to understand is whether or not the government should provide healthcare. Why should that be the government’s responsibility? Do we want to live in a society where our government takes care of us like children? No thanks.
This is a common argumentative approach of opponents of government: make some allusions to whatever part of the government they're criticising as being the "nanny state" and then concluding that it is therefore bad without actually making any objective appraisal of the system. This is essentially just an ad hominem fallacy against government. It also displays massive ignorance as anybody who has real experience with government run healthcare will point out that it doesn't even remotely resemble treating people like children (at least no more so than any insurance company). As I will show further in this post (and what has been posted before in an article given by ghrur), the reality is that governments do provide vastly more efficient and effective healthcare than any private system and that most people stand to benefit immensely from such a system.
Aegraen wrote:
No. See, you get this misleading crap from people who are trying to paint an ideological picture.
No. See, you get this misleading crap from people who are trying to paint an ideological picture.
I love the way Aegraen responds to academic publications citing figures by decrying them as "misleading crap" without ever actually addressing the facts presented in the publication. This is a well known and commonly used logical fallacy called poisoning the well. You'll see this a lot from idiots decrying government healthcare programmes when confronted with actual facts and figures since they can't actually make a an honest rebuttal to the evidence that's presented to them.
Aegraen continues:
The current US Healthcare system, is an amalgamation of Private and Government. Medicare and Medicaid, SCHIP (Which ironically covers people until their 32...wait? Is a 32 y/o a child? Our congresscritters are insane) puts a huge strain not only on the Federal, State and every health clinic, hospital, etc. because it pays for roughly half of the price of the costs. So, where do the clinics, hospitals, etc. recoup this money? You.
The current US Healthcare system, is an amalgamation of Private and Government. Medicare and Medicaid, SCHIP (Which ironically covers people until their 32...wait? Is a 32 y/o a child? Our congresscritters are insane) puts a huge strain not only on the Federal, State and every health clinic, hospital, etc. because it pays for roughly half of the price of the costs. So, where do the clinics, hospitals, etc. recoup this money? You.
This is another common tactic of opponents of government run healthcare when they're confronted with the fact that the US system is vastly more expensive than healthcare in other countries (for generally far worse outcomes). They try to portray their system as a combination of government and private run systems and it's the fault of the government that healthcare is so expensive, not the poor innocent private insurers, pharmaceutical companies, etc. They use this as a springboard to go back to attacking government programmes and as usual, provide no real evidence to support their position.
Looking at the actual overhead costs between Canada and the US found here. we can see that the US incurs three times the overhead costs of Canada per capita. Examining the reasons for this, we find...
The New England Journal of Medicine wrote:
A system with multiple insurers is also intrinsically costlier than a single-payer system. For insurers it means multiple duplicative claims-processing facilities and smaller insured groups, both of which increase overhead. Fragmentation also raises costs for providers who must deal with multiple insurance products — at least 755 in Seattle alone — forcing them to determine applicants’ eligibility and to keep track of the various copayments, referral networks, and approval requirements. Canadian physicians send virtually all bills to a single insurer. A multiplicity of insurers also precludes paying hospitals a lump-sum, global budget. Under a global-budget system, hospitals and government authorities negotiate an annual budget based on past budgets, clinical performance, and projected changes in services and input costs. Hospitals receive periodic lump-sum payments (e.g. 1/12 of the annual amount each month).
The existence of global budgets in Canada has eliminated most billing and minimized internal cost accounting, since charges do not need to be attributed to individual patients and insurers. Yet fragmentation itself cannot explain the upswing in administrative costs in the United States since 1969, when costs resembled those in Canada. This growth coincided with the expansion of managed care and market-based competition, which fostered the adoption of complex accounting and auditing practices long standard in the business world.
A system with multiple insurers is also intrinsically costlier than a single-payer system. For insurers it means multiple duplicative claims-processing facilities and smaller insured groups, both of which increase overhead. Fragmentation also raises costs for providers who must deal with multiple insurance products — at least 755 in Seattle alone — forcing them to determine applicants’ eligibility and to keep track of the various copayments, referral networks, and approval requirements. Canadian physicians send virtually all bills to a single insurer. A multiplicity of insurers also precludes paying hospitals a lump-sum, global budget. Under a global-budget system, hospitals and government authorities negotiate an annual budget based on past budgets, clinical performance, and projected changes in services and input costs. Hospitals receive periodic lump-sum payments (e.g. 1/12 of the annual amount each month).
The existence of global budgets in Canada has eliminated most billing and minimized internal cost accounting, since charges do not need to be attributed to individual patients and insurers. Yet fragmentation itself cannot explain the upswing in administrative costs in the United States since 1969, when costs resembled those in Canada. This growth coincided with the expansion of managed care and market-based competition, which fostered the adoption of complex accounting and auditing practices long standard in the business world.
It's also good that you mention SCHIP because the programme represents a reduction in healthcare costs in the system.
The article wrote:
People who disenroll from Medicaid or SCHIP programs as a result of programmatic changes are not likely to replace public program insurance with private commercial insurance, because it is unlikely that people who live near the poverty level will be able to afford the premiums that are associated with private commercial health insurance.
[...]
Most states make programmatic changes in their Medicaid/SCHIP programs in an effort to decrease their costs for these programs. However, this study demonstrates that programmatic changes that result in disenrollment actually increase the total health care costs for the community. Most of the health care costs for the uninsured are paid by federal and state governments through Medicare and Medicaid in the form of disproportionate share hospital adjustments and indirect medical education payments in addition to other federal programs, such as funding for community health centers and the Maternal and Child Health Bureau. Indeed, federal and state funds have been estimated to cover 87% of the total costs of uncompensated care.11 Potential savings from programmatic changes in Medicaid/SCHIP also are offset by increased Medicaid medically needy spending, increased tax subsidies to private insurance, and increased costs that are associated with uncompensated care.2 In a previous analysis of Medicaid disenrollment in an agricultural community, we concluded that 10% disenrollment would increase the number of uninsured children by 21% and increase the community’s health care costs as a result of a shift in sites of care from less expensive ambulatory office sites to more expensive [emergency department]s and increased hospitalizations.
People who disenroll from Medicaid or SCHIP programs as a result of programmatic changes are not likely to replace public program insurance with private commercial insurance, because it is unlikely that people who live near the poverty level will be able to afford the premiums that are associated with private commercial health insurance.
[...]
Most states make programmatic changes in their Medicaid/SCHIP programs in an effort to decrease their costs for these programs. However, this study demonstrates that programmatic changes that result in disenrollment actually increase the total health care costs for the community. Most of the health care costs for the uninsured are paid by federal and state governments through Medicare and Medicaid in the form of disproportionate share hospital adjustments and indirect medical education payments in addition to other federal programs, such as funding for community health centers and the Maternal and Child Health Bureau. Indeed, federal and state funds have been estimated to cover 87% of the total costs of uncompensated care.11 Potential savings from programmatic changes in Medicaid/SCHIP also are offset by increased Medicaid medically needy spending, increased tax subsidies to private insurance, and increased costs that are associated with uncompensated care.2 In a previous analysis of Medicaid disenrollment in an agricultural community, we concluded that 10% disenrollment would increase the number of uninsured children by 21% and increase the community’s health care costs as a result of a shift in sites of care from less expensive ambulatory office sites to more expensive [emergency department]s and increased hospitalizations.
Then there is also the issue of medical advertising in the US (which obviously incur greater costs to the system), but I'll get back to that a little later.
Aegraen continues
Secondly, the average American is among the top .05% wealthiest people in the world, so of course it's going to be 'expensive' in comparison to outside the US.
Secondly, the average American is among the top .05% wealthiest people in the world, so of course it's going to be 'expensive' in comparison to outside the US.
Bwahahahaha! Are you honestly suggesting that the average American is enormously wealthy compared to the average Canadian? According to the World Health Organisation, the US spent 15.3% of its GDP on healthcare in 2006. Canada only spent 10.0%. So as can be seen when taking relative GDP into account, the US system isn't just more expensive, it's massively more expensive.
The U.S. hands down has the greatest doctors, nurses, surgeons, specialists, you name it, practitioners and technology and availability in the world.
You know, I'm going to agree that healthcare in the US is great. But this is a lot like saying Steve Jobs' mansion is one of the best houses in the world. While we're all sure that it's fantastic, there's just no way on Earth you can afford it. Same goes for healthcare. Having the best experts in the world available means nothing if people are denied access because they simply can't afford it. Speaking of Steve Jobs, we can see how this works out in practice.
You want to know how you cut down costs? You remove government impediment in the market. Quite frankly, I can't remember a time when government intervention into a market didn't result in disaster.
Probably because you have the long-term memory rivalling that of an amoeba, but I digress...
This is another common tactic of opponents of government run or regulated healthcare. Pretend the rest of the world doesn't exist outside of the US or try to pretend that the problems faced by these countries are far worse than what they realistically are. If you compare actual health metrics between nations, we see that countries with strong government run or regulated system significantly outperform the US. Take life expectancy or infant mortality statistics from the CIA World Factbook. The US rates 50th and 45th in the world respectively in these statistics. Seriously? Resulting in disaster?
Not only that, most Americans are HAPPY with their current healthcare.
I'm sure the countless Americans that see the word "DENIED" printed in nice friendly big red letters on their medical insurance claim forms share your feelings on US healthcare. But of course, they don't represent "most Americans", especially in your small world not having to deal with any major medical problems. It's easy to make problems disappear if you're willing to ignore statistics and generally don't pay much attention to the problem.
And lol at the retarded video. But it does illustrate a common tactic of those that try to denounce the Canadian healthcare system and government run healthcare in general: pretend the issue is much worse that what it realistically is, and not compare it to what would happen in the US.
In the video itself, they make a big issue of waits for trivial issues when (and they actually show this on the video) Canada uses triage and prioritises people on the basis of medical necessity. Given that the guy claimed he hurt his wrist but didn't seem so concerned to wait it out and actually get it checked out, I would venture a guess that his condition was not that critical (if he wasn't just faking). If he had honestly thought he had broken his wrist, do you seriously think he would have left? But even if we consider the wait times this moron harps on about, we have to realise that the US spends significatly more money on healthcare and removes 1/6 of its population as uninsured and countless other "denied" claims from the queues. If Canada were to implement policies to achieve such effect, I'm sure its healthcare system would resemble a fucking five-star hotel. Similar thing goes for a blood test. I’ve never heard of someone in urgent need of a cholesterol test that was already experiencing heart problems. Again, this is a common approach from those that argue that universal healthcare is a bad thing. It makes you wonder how long the guy would have to wait if he needed to get his wrist checked or his blood tested and was one of the unfortunate many that don't have health insurance. Want to take a guess how long he's going to wait in the US?
They also try the dishonest tactic of trying to find people in the street who have had bad experiences with heathcare in Canada, which I'm sure, never happens in the US. This is why statistics are important when trying to measure the actual quality of care rather than picking and choosing anecdotes. The presenter claims that there millions of horror stories, but never relies on proper statistics because the statistics tell a different story.
They dishonestly represent healthcare spending as a function of taxation rather than look at actual statistics on healthcare expenditures which I gave earlier, provided by WHO. These statistics are readily available and not too difficult to find (at least no more than statistics on taxation) for Quebec Canada so it's clear he's just being dishonest to distort the issue. (Oh, and he's fucking lying about the rates of taxation in Quebec but I guess he didn't think anybody would check that.)
Oh, and they outright lie about privitisation of healthcare in Canada. There are private clinic in Canada but most of them are just sub-contractors to the government, i.e. you go to one, but the government is still picking up the tab. So yeah, real US style privitisation going on there...
The next section is just a worthless red herring on comparing the prices of selected items between the US and Canada.
He finally closes with a load of BS about how hybrid systems don't work without actually looking at healthcare systems which are hybrid and do work, like in Finland where I can see private and public doctors and yet we enjoy better healthcare (check CIA World Factbook) at lower relative cost (a whopping 8.2% of GDP).
In short, these guys are idiots and dishonest shits... Much like Aegraen, actually... But the saddest part is that Aegraen honestly believes that this video actually presents greater academic value than a peer-reviewed paper published by a university. Seriously, according to Aegraen, this video which contains the wonderful claim "Math is for suckers," after performing some oh-so-complicated multiplication (at around the 18 minute make) should honestly been taken more seriously than a university publication. Well, now we at least understand how the presenter has formed his opinion; his IQ is actually less than his shoe size.
Anyhow moving on...
Ecael wrote
I don't know, the US suffers from one particular problem that we don't see in European countries in terms of its size. A more suitable comparison would probably be China or Russia, considering they are some of the few countries that can really match US in terms of both population and size.
I don't know, the US suffers from one particular problem that we don't see in European countries in terms of its size. A more suitable comparison would probably be China or Russia, considering they are some of the few countries that can really match US in terms of both population and size.
This is another common tactic seen in the healthcare debate: that the US geography is somehow special that it doesn't permit healthcare to run as efficiently as in other countries. The funny thing, is that if you compare the population density of the US (31 people/km^2) to Sweden (20 people/km^2), Australia (2.8 people/km^2) or Canada (3.2 people/km^2) we see that it really doesn't make much of an excuse. Actually, it makes more sense when you consider the factors more carefully. If you have a private for-profit system you won't see many clinics operating in places which don't have a high enough population density to make the profitable, there is simply little to no incentive for doctors to set up clinics there. If healthcare is covered by the government however, the government can set up clinics in more remote areas and operate them at a loss because these clinics can be subsidised by taxpayers in other parts of the country. This is simply not possible without some government involvement.
gchan wrote:
For costs, Europeans always tout that it's a feasible model, etc etc etc. Problem is we are picking up YOUR tab of the health costs. Your governments negotiate in bulk with insurance companies, pharmaceuticals, biotech companies to get below market rates which make it affordable over there. Where do you think these companies make up the lost revenue from EU markets? We pay for it. It's one of the primary reasons why our coverage is so much more expensive than you. If you don't believe me, take a look at the financials of the largest transnational pharmaceutical companies and biotech companies in the world. They all have a disclosure separating out US/international revenues and costs, and the US pays 3-10 times more than the rest of the world combined. This is particularly disturbing considering that almost all the technology is produced in the US and Singapore, which should mean we pay less than everybody else (logistically).
For costs, Europeans always tout that it's a feasible model, etc etc etc. Problem is we are picking up YOUR tab of the health costs. Your governments negotiate in bulk with insurance companies, pharmaceuticals, biotech companies to get below market rates which make it affordable over there. Where do you think these companies make up the lost revenue from EU markets? We pay for it. It's one of the primary reasons why our coverage is so much more expensive than you. If you don't believe me, take a look at the financials of the largest transnational pharmaceutical companies and biotech companies in the world. They all have a disclosure separating out US/international revenues and costs, and the US pays 3-10 times more than the rest of the world combined. This is particularly disturbing considering that almost all the technology is produced in the US and Singapore, which should mean we pay less than everybody else (logistically).
Nonsense! Why the hell would American companies even operate in Europe if they had to do so at a loss? And what the fuck do American health insurance companies have to do with European healthcare? Do you even understand the concept behind a single-payer system?
But it's a good thing you bring this up, let's take a look at how pharmaceutical companies spend their money, shall we?
The Public Library of Science wrote:
From this new estimate, it appears that pharmaceutical companies spend almost twice as much on promotion as they do on R&D. These numbers clearly show how promotion predominates over R&D in the pharmaceutical industry, contrary to the industry's claim.
From this new estimate, it appears that pharmaceutical companies spend almost twice as much on promotion as they do on R&D. These numbers clearly show how promotion predominates over R&D in the pharmaceutical industry, contrary to the industry's claim.
According to the estimates given in the article, big pharma spend $57.5 million on marketing compared to $31.5 million on R&D. You know those Paxil and Viagra commercials you see on TV? That's your healthcare expenditures hard at work. And this ignores the issue of lifestyle and me-too drugs developed by these pharmaceuticals which also represent considerable waste in the system.
And while it is true that the US manufactures more medical equipment and drugs than other countries, this is more of a function of its size than any inherent efficiency in the system. And don't forget my earlier point about higher overhead costs in the US as compared to Canada. Fact is, the reasons why your medical costs are so high is that your system is massively inefficient and these companies are gouging you in their pricing.
The alternative to this system where the US pays for the rest of the world's health care is a system where, like the EU countries, the US government negotiates in bulk against the insurance/biotech/pharmaceutical companies. But that would dry up all their potential profits and you would be looking at a virtual stagnation of private industry medical advancement...which would mean that the US government would have to also pick up the tab for all medical research.
Yes... Like in Japan (Warning: video) where they have heavy regulation of their health care to force costs down. How do the companies adapt and avoid? They find ways to make their equipment more effecient and cost-effective. Guess what? Even with heavy regulation, providers of medical equipment and pharmaceuticals are still profitable. They're just not obscenely profitable.
Oh by the way, you do realise that there are enormous amounts of research performed by universities, which isn't necessarily done for profit at all, but I guess they don't count, right?
If you think this is a good idea, look at history in the last 30 years. Governmental research is useful as a theoretical backbone (as in first developing the idea for a technology), but by and large, it's the private industry that makes the theoritical technology useful/applicable. And this is excluding the fact that with reduced US profits, the non-developed countries would suffer by a lack of investment from these transnational corporations.
This is again, unsupportable nonsense. Again, a common argument against government funded healthcare systems but there's absolutely no evidence supporting this. I've already demonstrated where these big corporations spend a sizeable portion of their profits. We can also see plenty of research is done outside of these massive corporations.
Quick list of major medical discoveries that were performed without a profit motive:
Vaccinations
Antibiotics
Germ theory
DNA
This isn’t the last 30 years but that’s already incredibly impressive work without any profit motive whatsoever. For something more recent there's the Sick Kid's hospital in Toronto which is one of the best treatment and research facilities in the world for children. It’s also not in the US and not done for profit.
