Health Care systems

[Thinkmarble]

Hiho Hiho, quote mining I go.

Quoting the OECD policy brief (Beware PDF file) on private insurance.

Whatever the role played in a health system, private insurance has added to total health expenditure

and

While private insurance is often viewed as a tool to enhance efficiency, the evidence shows, it has made only a small contribution so far

It may be worth to point out that health care cost per capita in purchasing power parity dollars with research cost excluded is still twice as high in the USA as in nearly any other country.
Source for that is again the OECD, by the way of Crooked Timber

[Patrick Degan]

Crooked Timber

The figure doesn’t show it, but it’s worth noting that despite not having a national health system, U.S. public expenditure on health in the 1990s was higher in terms of GDP than in Ireland, Switzerland, Spain, Austria, Japan, Australia and Britain.

It’s easy to see that mainstream debate about health care in the U.S. happens inside a self-contained bubble, and that one of its main conservative tropes —the inevitable expense and inefficiency of some kind of universal health care system— is wholly divorced from the data.

[The Guid]

I don't trust the private sector to provide me with enriching art - because it doesn't bring a profit. So I do not trust it with my health - because I might not be profitable.

Everyone has a right to healthcare.

[tharkûn]

Hiho Hiho, quote mining I go.

With bloody ruts of context cuts, hiho, hiho, hiho.

Whatever the role played in a health system, private insurance has added to total health expenditure

Why? Welll let's check the rest of the paragraph.

Private insurers tend to have less bargaining power over price and quality of care as compared with with public systems, particularly single payer ones.

You mean a monopsony can use price leverage to depress market prices in reciprocal manner that a monopoly can inflate them? Wow that's a real surprise Of course when you use that leverage, you breed monopoly and less investment tends to be forth coming to bring new products to market as well as reducing costs so the rest of the world can afford them.

While private insurance is often viewed as a tool to enhance efficiency, the evidence shows, it has made only a small contribution so far

Furthermore in several OECD countries insurers have had few incentives to manage care cost effectively, due to a combination of desire not to restrict individual choice, providers' resistence, and the cost of implementing such action

Of course in the OECD study the Netherlands and Germany are considered the second and third most penetrated markets for private insurance; which is a rather bloody large caveat considering the large (in comparison to America) underlying public health systems and in general limiting private insurance coverage to the wealthy ... of course in the Netherlands there are also regulations prohibiting insurance from exceeding the performance of the public sector

My own quote mining from your source:

Private health insurance has enhanced consumer choice and the responsiveness of health systems in many OECD countries. First, the opportunity to buy private health insurance in itself offers consumers an additional level of choice with respect to financing health-care services and providers on an out-of-pocket basis. Second, private health insurance has improved individuals' choice over health providers and timing of care in most countries with duplicate markets - although the scope of this added choice depends upong the freedom of choice already existing within public systems. Third, most private health insurance markets offer a wide array of products to consumers, allowing them to tailor their risk and product preferences.

In general your source is taking a poll of private insurance as it exists throughout OECD countries. This goes from extremely limited coverage, for instance only of copays to full coverage of all medical care. It runs the gamit from a de facto rich man's tax to a premium service to reduce load on public resources to full coverage of the majority of the population.

It may be worth to point out that health care cost per capita in purchasing power parity dollars with research cost excluded is still twice as high in the USA as in nearly any other country.

Which OECD data set is this drawn from? In one they don't discount the the price disparities that result when companies sell to monopsonies on a per unit cost basis and to the US on a total cost basis.

I don't trust the private sector to provide me with enriching art - because it doesn't bring a profit. So I do not trust it with my health - because I might not be profitable.

Generally speaking, the survival rates in socialized medicine are lower. When you risk adjust outcomes to remove demographic differences it tends to show better rates of survival if you have newer technology and more capital expenditures; things which tend to be disfavored in socialized medicine.

That companies can make a living sueing other companies and clients for implementing an algorithm which they bought the rights too 2-3 mergers & selloffs ago a good thing makes me want to weep for the world.

Companies can make a living sueing fast food resterauntes when obese people tank their health. The problems of the American sue frenzy are far deeper than IP.

In any event better IP means more incentive to invest in making newer, better healthcare treatments possible; rather than investing outside of IP - like say in popular music, real estate development, or more cheap made in China plastic crap.

Yes there are some bad points in patent law that allow the bloody obvious to be patented, however if you weaken patent law you also impede the free flow of information. Rather than patent IP and provide the information on the patent to the rest of the world for free, companies can, do, and will opt for using trade secrets when they show better cost effectiveness. Rather than encouraging companies to release their data for limited monopoly; you'd encourage them to hoard it for perpetual monopoly?

[Patrick Degan]

Yes, Tharkun, quoting out-of-context is a bad thing. Perhaps you should stop doing it.

Here's a longer extract from the .pdf file you cherry-picked your quotes from which provides a much better view of what "context" actually is:

But an abundance of product choices can make it harder for higher-risk patients to find cover, to the extent it results in segregation of the market by risk level. To avoid the problem of vulnerable groups being priced out of the private insurance market, as has occurred in some OECD countries, some policymakers have limited the scope for insurers' flexibility and innovation. For example, they have regulated the minimum benefits that insurers must cover, required insurance products to be standardised, or limited the extent to which insurers can refuse cover and rate premiums on the basis of individual risk.


DOES PRIVATE HEALTH INSURANCE PROMOTE HIGH-QUALITY CARE?

Private health insurance has had only a minimal impact on the quality of care in most OECD countries, since private insurers have not usually engaged in significant efforts to influence the quality of the services they finance. The lack of effort is due to a combination of factors, ranging from lack of regulatory and financial incentives for insurers, to a desire not to restrict individual choice, as well as resistance from health-care providers to the introduction of a new source of influence on decisions over appropriateness of care.

The United States has been the only OECD country where some private insurers, known as managed care plans, have been substantially involved in efforts to influence some aspects of care delivery. Despite indications of some effectiveness, the overall evidence of the impact of quality of care is mixed; such plans do not appear to have fundamentally changed critical processes. Payment incentives that do not consistently reward plans' or employers' efforts to improve quality and inadequate quality-measurement and reporting systems, explain the still small and non-systemic impact of private health insurance on quality improvements in the United States.


HAS IT HELPED RELIEVE COST PRESSURES?

Policymakers often look to private health insurance markets as an alternative or additional source of finding for publicly financed health systems, especially when these budgets are stretched to capacity. Yet health systems in OECD countries continue to be predominantly financed from public sources, which account, on average, for 72% of total health expenditure, compared to 6.3% for private health insurance and 19% for out-of-pocket payments. Only in the United States does private health insurance exceed a third of total health expenditure, at 35%, while it goes above 10% only in the Netherlands, Canada, France, Germany, and Switzerland.

Whatever the role played in a health system, private health insurance has added to total health expenditure. Most OECD countries apply less government control over private sector activities and prices, compared to public programmes and providers. Private insurers tend to have less bargaining power over the price and quantity of care as compared with public systems, particularly single-payer ones. Countries that have multiple sources of primary coverage, including those with significant private health insurance market size, tend to be those with the highest total health spending levels per capita, such as the United States, Switzerland, Germany, and France.



HAS PRIVATE INSURANCE SHIFTED COST FROM PUBLIC SYSTEMS?

There are a number of reasons why private health insurance has not significantly reduced public financing burdens. For one thing, people with private insurance often continue to rely upon publicly financed hospital services in duplicate markets. Privately financed hospitals have often focussed on a limited range of elective services, leaving the responsibility for more expensive services or populations to public programmes.

Second, in OECD countries that have restricted eligibility for public insurance to lower-income and vulnerable groups, leaving the rest to buy primary private health insurance (the United States, the Netherlands, Germany), public spending on health as a percentage of GDP is not lower than that of many countries that provide universal public coverage. This can be partly explained by the concentration of healthcare cost among a small fraction of the population that is generally publicly insured —such as the elderly, chronically ill, and long-term disabled.

Third, de-listing of services from public coverage, another strategy to shift cost onto the private sector, has generally remained confined to less expensive services, which may be paid for out-of-pocket or through supplementary private health insurance plans.

In some cases, private health insurance has actually added to public expenditure on health or public costs generally. Where private health insurance covers cost sharing on public coverage systems, as in France, the resulting increases in use of services raise the cost of publicly financed health systems. In addition, countries that grant significant public subsidies to private health insurance, as Australia and the United States, have seen a reduction in government revenue or an increase in public cost.



DOES PRIVATE HEALTH INSURANCE MAKE HEALTH SYSTEMS MORE EFFICIENT?

While private health insurance is often viewed as a tool to enhance efficiency, the evidence shows it has made only a small contribution so far. Several reasons explain this performance. Insurers need to sustain high administrative costs in order to attract and retain clients, provide them with a diversity of insurance plans, and negotiate multiple contractual relationships with providers. Furthermore, in several OECD countries, insurers have had few incentives to manage care cost-effectively, due to a combination of desire not to restrict individual choice, providers' resistance, and the cost of implementing such action.

Difficulties in extracting efficiency improvements from private health insurance markets can also come from the way in which insurers compete. In several OECD countries, insurers are confronted with limited competitive pressures as there is little consumer mobility across insurers. It is attractive for insurers to employ cost-shifting and selection of risk as a means of insurer competition and protection against adverse selection, rather than improving the cost-effectiveness of care provided to clients. Finally, the lack of "vibrant" price and quality competition among providers inhibits forces in insurance markets, for example if providers exercise dominant market power, leading them to demand high prices for health services and shielding them from insurers' pressure to improve quality or cost-effectiveness of care.

Pages 4-7 of the OECD Policy Brief, which says in part in the introductory section on page 1:

Private health insurance can help governments attain health system performance goals, but can also put them at risk. The effect depends, in part, on the role of private health insurance in terms of market size and function with respect to public systems. In countries where private health insurance plays a prominent role, it can be credited with injecting resources into health systems and helping to make them more responsive. However, it has also given rise to considerable equity and cost-control challenges in most of those same countries.

—which, by any intelligent and honest reading of the passage and the entire report, is discussing how private insurance can supplement public healthcare programmes.

[Darth Wong]

Examples of biological advances made without a corporate profit motive:

• The discovery of antibiotics
• The discovery of vaccination
• Germ theory
• Pasteurization
• DNA
• Evolution

I dunno, that sounds fairly impressive considering there's supposedly no incentive to do any research without big corporations taking your money.

[tharkûn]

Examples of biological advances made without a corporate profit motive:

* The discovery of antibiotics
* The discovery of vaccination
* Germ theory
* Pasteurization
* DNA
* Evolution


I dunno, that sounds fairly impressive considering there's supposedly no incentive to do any research without big corporations taking your money.

Black white fallacy. I'm not saying there is NO incentive to do R&D, I'm saying there is LESS incentive.

In any event you KNOW there is a world of difference between proof of concept and mass production. Take vaccination, the first crude vaccinations (historicly known as varioliation) were discovered centuries ago in China. In 1796 Jenner finally made it with a mortality rate lower than 2%. It wasn't until the early 20th century that a reliable, effective, and moderately safe vaccine was being mass produced and an eradication campaign could be waged, not surprisingly private investment helped make this possible.

Likewise with antibiotics. We all know Alexander Fleming discovered penicillin in 1928, what most people don't know that until 1939 it wasn't mass produced (to all the bio majors, yes I'm aware of Duchesne). It took the extreme demands of WWII to drop the per dose price from $20 in 1940 to $.55 in 1943. Why was that? Because the government (American or British) were not willing to drop the money into R&D and the modern pharma industry didn't exist. THAT type of research is what you pretty much need corporate money for these days; without a massive injection of capital you don't go from proof-of-concept to mass produced product. Not surpisingly the mass production itself was done by private companies.

Lastly I think we should look at a retrospective of DNA. Who built the automated DNA sequencers that let us read DNA wholesale? Private industry. Who mass produces PCR so you can use miniscule DNA? Private industry. The resources needed to go from concept to useable product dwarf the ones needed to get the concept as a general rule. Who took the restriction enzymes from laboratory concept to mass produced tool? Private industry. Who took the tools and mass produced insulin and a crap load of other chemicals? Private industry.

In N&P there is a thread devoted Hilleman. Argueably he is the most influential and productive vaccinologist in history. He beat Salk to polio but was unable to grab the headlines due to regulatory concerns by Merck. However with Merck's backing he went on to tackle measles, mumps, and Hep-B. All this came at a private company after he had done some pioneering work at Walter Reed. The private sector was more willing to devote resources to his work than Uncle Sam ever would have.

Acadamia does better general research than industry, generally speaking, but if you want to bring a product to the masses it takes either massive government support - normally defense department backing up the wazoo - or oodles of investment from the private sector.

Oh and on Germ Theory, Pasteurization, and the etc. ... Pasteur was working in a winery as an industrial problem solver. The resources he used were provided by industry to a large degree who wanted to know how to prevent lactic acid production in fermentation (besides his university was dedicated to practical research to benifit the economy). Not only did Pasteur invent the field of microbiology and a handful of chemical fields ... he also is responsible for a universalis increase in the quality of alcoholic beverages.

Come on Mike you and I both know it takes a crapload more knowledge than the proof of concept of a combustion engine to bring about the Model T, let alone the Mustang. In economic terms the bulk of R&D cost is in the scale up, not the basic science. Virtually all the methods of production employed in the lab are totally cost ineffective for mass production - if not downright physically impossible (for instance when some of the new anti-retrovirals were first synthesized in micro batches the reactions used liberated enough heat to boil a 55 gallon drum of water if scaled directly up; surface area to volume tends to kill the easy batch reactions). Basic research requires a large investment to bring to mass production and ramp up; the disconnect between proof of concept and product is hellishly wider than in the 1930's and getting wider.

But what the hell, you are not pulling an idiotic black/white fallacy and ignoring the issue scale to boot, right?

[Broomstick]

Low-income patients just don't get good care; this is not a secret. And things like expensive co-pays and deductibles only encourages people to avoid using medical care unless they have self-diagnosed it to be serious; what do you not understand about this?

"Expensive copays" exist in order to affect patient choice. On drugs they are almost solely to switch a patient to cheaper generics, and are a bloody effective tool for saving money without compromising care.

Ah, yes, the abundant supply of medications under the American system...

My parents are on Medicaid with a Blue Cross supplement, which is as good as it gets for senior citizens these days. They even have a drug benefit. They use generics. The use mail-order to bring the price down either further.

My mother's monthly drug bill, even with all the "cost-savings" involved, it still $800+ out of pocket. In other words, more than they spend on food in a month. Almost as much as they spend on housing. Again, how are poor, unemployed, disabled people supposed to pay these things?

My parents are lucky - in addition to social security my father has a good pension that hasn't been taken away yet. They actually can afford to pay these bills.

I suppose you could say they brought it on themselves, they should have taken better care of themselves - except my mother has a genetic form of heart disease that frequnetly kills by 40 or 45 - that's she's still alive at 75 is a testament to just how fit and healthy she's been over her lifetime. I suppose you could say they should have invested in a 401(k) - except they didn't exist until about 5 years before my parents retired, which is not much time to build up a nest egg.

Gee, maybe we should just tell people life is too expensive, just fuck off and die?

You know, tharkun, your attitude that "well, if you get sick declare bankrupcty and be destitute for awhile" just plain sucks. You know why? Because it's not like that everywhere. When something's unavoidable it's a hell of a lot easier to accept, but the brutal fact is that in Europe or Canada or Australia a middle-class family with a member suffering catastrophic illness or accident is NOT left bankrupt. There is still money to live in a decent neighborhood in housing that isn't falling apart, there is still money to send children to college, there is still money left to retire on at the end of life, there is still an inheritance left for descendants. Only in the US are those things routinely wiped out, and only in the US is this seen as somehow good.

It's a fucking lack of compassion is what it is.

[Darth Wong]

This, as far as I can tell, is Tharkun's argument:

1. The presence of a government insurer somehow eliminates the profit motive from private drug companies. Don't ask me how or why; I just say it's so, therefore it's so.
2. Government-subsidized research would be a bad thing, because private companies are better innovators than government-funded university researchers. Don't ask me to prove this statement; I just say it's so, therefore it's so.
3. When faced with examples of HUGE innovations produced through means other than the corporate profit motive, I will simply retort that corporations used those innovations and exploited them for profit. I'm not sure how this supports my claim in point #2, but hopefully nobody will notice.
4. When faced with logical reasons for corporate profit motive to be a poor sole driver for research (namely the fact that they will tend to devote dollars only toward commercial "sure thing" research such as copycat drugs and "lifestyle" drugs rather than something which might benefit humanity but carries greater financial risk), simply ignore those reasons and carry on stating that government-subsidized research is a bad thing. Cite communism as proof, totally ignoring the history of government-subsidized university research in capitalist countries. Also ignore the history of questionable and fraudulent corporate testing of their own products.
5. The fact that the US produces most of the world's drugs proves all of the above claims about the evils of government-subsidized medical R&D. Never mind the fact that the sheer amount of money being poured into this system would obviously tend to generate this situation regardless.
6. When discussing health outcomes between the US and Canada, any metric in which the US does better should be touted and exaggerated, totally disregarding the fact that not everyone in the US has access to that system or can even pay the co-pays and deductibles required in order to use it. Any metric in which Canada does better should be ignored.
7. Waiting times are the bane of socialized health-care. Much better to simply kick millions of people out of the system so that those who remain get shorter waiting times. Whenever someone points out that wait times in socialized systems are determined by medical urgency rather than financial means, simply repeat previous point and act as though wait times are constant.
8. Bankruptcy is a perfectly acceptable solution to the problem of middle-class people who can't afford health-care.
9. Middle-class people who avoid or delay expensive medical care because of its great cost are stupid and deserve to die, so they shouldn't factor into any health-care discussion. They should have chosen bankruptcy which, as stated before, is a perfectly acceptable health-care solution.

And that is apparently the health-care ideal in Tharkun-world.

[tharkûn]

Ahh Broomstick another anecdote that somehow disproves a general rule

My mother's monthly drug bill, even with all the "cost-savings" involved, it still $800+ out of pocket. In other words, more than they spend on food in a month. Almost as much as they spend on housing. Again, how are poor, unemployed, disabled people supposed to pay these things?

Medicaid has 1 dollar copays; and those can be waived if the patient is completely indigent. In other words you mother pays a miniscule fraction of the true cost of her medecine because she can afford it.

You know, tharkun, your attitude that "well, if you get sick declare bankrupcty and be destitute for awhile" just plain sucks. You know why? Because it's not like that everywhere. When something's unavoidable it's a hell of a lot easier to accept, but the brutal fact is that in Europe or Canada or Australia a middle-class family with a member suffering catastrophic illness or accident is NOT left bankrupt. There is still money to live in a decent neighborhood in housing that isn't falling apart, there is still money to send children to college, there is still money left to retire on at the end of life, there is still an inheritance left for descendants. Only in the US are those things routinely wiped out, and only in the US is this seen as somehow good.

Yes in Britain thousands of women die. Even in Australia which has the 2nd or 3rd (it is close to Canada) survival rates more women die of breast at greater hazard than the US. Thank you but while you remain fixated on the economic hardships and declare that socialization is the only solution; I remain fixated on the dead bodies.

1. The presence of a government insurer somehow eliminates the profit motive from private drug companies. Don't ask me how or why; I just say it's so, therefore it's so.

MONOPSONY. When you have a single buyer in the market they leverage prices down, which means a lower profit margin. Lower profit margins mean less investment. Less investment means more time between proof-of-concept and mass production. That means MORE DEAD PEOPLE.

2. Government-subsidized research would be a bad thing, because private companies are better innovators than government-funded university researchers. Don't ask me to prove this statement; I just say it's so, therefore it's so.

Government subsidized research would be a horrid thing - if that was the bulk of your research budget. Trusting a centralized planner to forecast the R&D field accurately is proven loser. I have no problem with government being one investor among many, because you know competition is GOOD thing.

The differences between basic academic research and commercial practical research should not be lost on you. Any respectable engineer should know that what you can do in a small batch quantities is not going to be all that applicable to scaled up continious flow production.

When faced with examples of HUGE innovations produced through means other than the corporate profit motive, I will simply retort that corporations used those innovations and exploited them for profit. I'm not sure how this supports my claim in point #2, but hopefully nobody will notice.

How many LIVES did Fleming save? Close to ZERO, it wasn't until Moyer and Florey did the scale up work that clinical trials could be run in 1943. Without Moyer and Florey's research, vastly more expensive than Fleming's, penicillin wouldn't have been saving Millions of lives a year. Mass production is a necessary step in saving lives, and tends to be the gratuitiously MORE EXPENSIVE step in the proces.

When faced with logical reasons for corporate profit motive to be a poor sole driver for research (namely the fact that they will tend to devote dollars only toward commercial "sure thing" research such as copycat drugs and "lifestyle" drugs rather than something which might benefit humanity but carries greater financial risk), simply ignore those reasons and carry on stating that government-subsidized research is a bad thing. Cite communism as proof, totally ignoring the history of government-subsidized university research in capitalist countries. Also ignore the history of questionable and fraudulent corporate testing of their own products.

They don't. Corporate research developed the mumps vaccine, the measels vaccine, and I beleive Reubella - none of which were copycat nor lifestyle. Likewise corporate research is still hammering away at HIV vaccinations, anti-cancer research, and even SCIDS treatments - all of which are obscenely high risk categories.

Quit with the BS strawmanning. I don't think some government research is a bad thing. I think it is LESS EFFECTIVE at mass production and scale up - which tends to be more expensive than basic research, notably because history is ubiquitious with examples.

5.The fact that the US produces most of the world's drugs proves all of the above claims about the evils of government-subsidized medical R&D. Never mind the fact that the sheer amount of money being poured into this system would obviously tend to generate this situation regardless.

No it wouldn't. Over HALF the market is the US. The US is neither pouring in double the money nor manpower of the rest of the world combined.

When discussing health outcomes between the US and Canada, any metric in which the US does better should be touted and exaggerated, totally disregarding the fact that not everyone in the US has access to that system or can even pay the co-pays and deductibles required in order to use it. Any metric in which Canada does better should be ignored.

Any metric should be hazard adjusted, like Canadian peer reviewed journals do when they want they best science Failures in the US system exist, which is why I propose corrections, of course Mike can stubbornly maintain that the only solution is socialization and single payer.

7. Waiting times are the bane of socialized health-care. Much better to simply kick millions of people out of the system so that those who remain get shorter waiting times. Whenever someone points out that wait times in socialized systems are determined by medical urgency rather than financial means, simply repeat previous point and act as though wait times are constant.

Waiting times kill people, even with effective triage. Rather than allow unequal care and have lower waiting times for EVERYONE, we must maintain egalitarian access. When line jumpers pay premium there is more money going into the system for more capacity, even in socialized countries this logic holds and supplemental private care is used to reduce waiting times and hence mortality.

8. Bankruptcy is a perfectly acceptable solution to the problem of middle-class people who can't afford health-care.

Bankruptcy requires one to sell their first born into slavery, prostitute their body for money, and results in people dying earlier

9. Middle-class people who avoid or delay expensive medical care because of its great cost are stupid and deserve to die, so they shouldn't factor into any health-care discussion. They should have chosen bankruptcy which, as stated before, is a perfectly acceptable health-care solution.

Middle-class people should have some disincentive from abusing the system, which countless peer reviewed studies have documented. Surprisingly middle class survival rates in the US are higher than elsewhere in the world. Rather than allow a market orientated system to exist, we should line the middle class against the wall and shoot a few of them as dead people are superior to the market.

Do you have anything to add to the debate Mike that isn't a gratuitious strawman?

[Patrick Degan]

Government subsidized research would be a horrid thing - if that was the bulk of your research budget. Trusting a centralized planner to forecast the R&D field accurately is proven loser.

As the appalling failure of the Manhattan Project demonstrated, presumably...

[The Guid]

http://news.bbc.co.uk/1/hi/health/4062067.stm

[Einhander Sn0m4n]

http://news.bbc.co.uk/1/hi/health/4062067.stm

Ok, so this proves the biased nature of the analyst. Kudos to the Beeb for not kowtowing and sucking corporate dick!

US analyst awards NHS top marks
The NHS is set to be the world's best healthcare system - according to a US health expert.

Professor Donald Berwick of the Institute for Healthcare Improvement made the claim in the journal Quality in Safety and Healthcare.

Compared with the US, he said the UK had done more to improve measures such as safety and effectiveness.

But a spokesman for the King's Fund, an independent think-tank, said Professor Berwick's analysis was "superficial".

"This seems to be a little superficial in its analysis of the NHS" -John Appleby, King's Fund

In his analysis, Professor Berwick said the US and UK healthcare systems faced similar problems, including improving safety and reducing medical errors, making care more effective and efficient, ensuring care focuses on patients rather than diseases or numbers, reducing waits, and offering everyone the same access to treatment.

But he said that, if asked to bet on which country will succeed in resolving them, "my money will be on the UK".

His verdict came in advance of the latest report of the NHS's performance from its chief executive Sir Nigel Crisp, due out on Friday.

'A behemoth system'

Professor Berwick praised the Labour government, and Prime Minister Tony Blair in particular, for the recent NHS Modernisation Plan - which saw the percentage of GDP spent on the health service rise from 6.5% to closer to the EU average of 8.5% - and the introduction of National Service Frameworks.

He wrote: "The modernisation process sought to establish accountabilities, structures, resources and schedules in the NHS that no-one at all is in a position to establish in the pluralistic, chaotic, leaderless US system."

However, he admitted that this rosy vision was not universally shared.

"No-one is thoroughly happy in the UK with the NHS modernisation programme to date; it has stumbled occasionally, as any project of that level of ambition must.

"But no honest observer can fail to credit the process with immense productive change, headed for real measurable success in a behemoth system that could easily seem unchangeable."

He said the biggest difference between the UK and US was "simple".

"The UK has people in charge of its health care - people with the clear duty and much of the authority to take on the challenge of changing the system as a whole."

"When it comes to health care as a nation, the US is leaderless," he said.

'Refreshing'

But Professor Berwick said there were three key areas in which the NHS had to improve.

He said the UK healthcare system was too fragmented, he says, with acute care and primary care providers still appearing to distrust each other and often working in different, and uncomplementary, ways.

Professor Berwick also said the doctor-patient relationship was un-balanced, with patients "trained too well" to defer to the clinician. He said the service needed to be far more patient-centred.

The training and education of health professionals also needed to be altered to encourage clinicians to accept change, he said.

John Appleby, chief economist at the King's Fund, said: "This article seems to be a little superficial in its analysis of the NHS."

He said the commentary was not based on hard facts, and a World Health Organization evaluation of healthcare systems in 2000 placed France top - and the UK 18th.

Mr Appleby added: "It's true that the NHS does have a leader, but that doesn't mean it is a given that the right policies in place.

"There are potential problems with a couple of the main government policies of patient choice and a new way of paying hospitals, which both carry considerable risks and which aren't certain to give a better NHS for everybody."

And Shadow Health Secretary Andrew Lansley said: "Dr Berwick¿s report is at odds with reality: spending on hospitals has increased by almost 28% but activity has increased by only 5%."

He added: "One million people are still on waiting lists and 5,000 people die from hospital superbugs every year

But Dr Michael Dixon. chairman of the NHS Alliance, said: "This analysis is absolutely spot-on. It is refreshing to hear it."
Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/1/hi/h ... 062067.stm

Published: 2004/12/02 15:20:46 GMT

© BBC MMV

[Xon]

He added: "One million people are still on waiting lists and 5,000 people die from hospital superbugs every year

Talk about a red herring. So Hospital superbugs are suddenly a fault of who ever is paying the bills?

Talk about shifting goal posts

[Prozac the Robert]

Talk about a red herring. So Hospital superbugs are suddenly a fault of who ever is paying the bills?

Talk about shifting goal posts

The tories have been goin on about this for a while now. One of their adverts is a a big poster with "how hard can it be to keep a hospital clean" scrawled on it. It's absolutely pathetic.

[Einhander Sn0m4n]

Talk about a red herring. So Hospital superbugs are suddenly a fault of who ever is paying the bills?

Talk about shifting goal posts

The tories have been goin on about this for a while now. One of their adverts is a a big poster with "how hard can it be to keep a hospital clean" scrawled on it. It's absolutely pathetic.

Where's that study that found strong links between hospital superbugs and abuse of antibiotics by agribusiness? I Googled but can't seem to find it...

EDIT: GOT IT, Dead to Rights too!

[Darth Wong]

Ahh Broomstick another anecdote that somehow disproves a general rule

Hey numb-nuts, for the umpteenth time, you haven't established the "general rule" in the first place, except to state it as an axiom. You consistently quote snippets of articles out of context in order to suggest that there is some yawning gap in patient care between Canada and the US when they say no such thing, you consistently insist that the reason the US produces more R&D is privatization instead of sheer size and cash flow, and you act as though both claims are accepted when they are not.

I remain fixated on the dead bodies.

Which are more numerous in the US: a fact that you try to handwave away by blaming the victims and categorizing them so that they don't count.

1. The presence of a government insurer somehow eliminates the profit motive from private drug companies. Don't ask me how or why; I just say it's so, therefore it's so.

MONOPSONY. When you have a single buyer in the market they leverage prices down, which means a lower profit margin. Lower profit margins mean less investment. Less investment means more time between proof-of-concept and mass production. That means MORE DEAD PEOPLE.

You are a FUCKING LIAR. SEVERAL TIMES I have already pointed out that the Canadian government does not buy drugs for people, you fucking asshole. I'm tired of repeatedly pointing this out and then hearing you repeat your goddamned lies as if I never wrote it.

2. Government-subsidized research would be a bad thing, because private companies are better innovators than government-funded university researchers. Don't ask me to prove this statement; I just say it's so, therefore it's so.

Government subsidized research would be a horrid thing - if that was the bulk of your research budget. Trusting a centralized planner to forecast the R&D field accurately is proven loser. I have no problem with government being one investor among many, because you know competition is GOOD thing.

Yet again you state your assumption as fact.

The differences between basic academic research and commercial practical research should not be lost on you. Any respectable engineer should know that what you can do in a small batch quantities is not going to be all that applicable to scaled up continious flow production.

And production scaling disproves the utility of government-funded university research ... how?

When faced with examples of HUGE innovations produced through means other than the corporate profit motive, I will simply retort that corporations used those innovations and exploited them for profit. I'm not sure how this supports my claim in point #2, but hopefully nobody will notice.

How many LIVES did Fleming save? Close to ZERO, it wasn't until Moyer and Florey did the scale up work that clinical trials could be run in 1943. Without Moyer and Florey's research, vastly more expensive than Fleming's, penicillin wouldn't have been saving Millions of lives a year. Mass production is a necessary step in saving lives, and tends to be the gratuitiously MORE EXPENSIVE step in the proces.

Irrelevant. The R&D was done by Fleming. The fact that you need a corporation to mass-produce it doesn't change that fact. If I invent something but I need a company to mass-produce it, does that mean I didn't invent it?

When faced with logical reasons for corporate profit motive to be a poor sole driver for research (namely the fact that they will tend to devote dollars only toward commercial "sure thing" research such as copycat drugs and "lifestyle" drugs rather than something which might benefit humanity but carries greater financial risk), simply ignore those reasons and carry on stating that government-subsidized research is a bad thing. Cite communism as proof, totally ignoring the history of government-subsidized university research in capitalist countries. Also ignore the history of questionable and fraudulent corporate testing of their own products.

They don't. Corporate research developed the mumps vaccine, the measels vaccine, and I beleive Reubella - none of which were copycat nor lifestyle. Likewise corporate research is still hammering away at HIV vaccinations, anti-cancer research, and even SCIDS treatments - all of which are obscenely high risk categories.

Oops- anecdotes to disprove the general rule! See, I can dismiss claims using your rhetorical trick too!

Quit with the BS strawmanning. I don't think some government research is a bad thing. I think it is LESS EFFECTIVE at mass production and scale up - which tends to be more expensive than basic research, notably because history is ubiquitious with examples.

Research has NOTHING TO DO WITH MASS PRODUCTION. Your sophistry grows tiresome.

5.The fact that the US produces most of the world's drugs proves all of the above claims about the evils of government-subsidized medical R&D. Never mind the fact that the sheer amount of money being poured into this system would obviously tend to generate this situation regardless.

No it wouldn't. Over HALF the market is the US. The US is neither pouring in double the money nor manpower of the rest of the world combined.

How does that disprove the fact that massive sums of money are poured into the system in the US?

When discussing health outcomes between the US and Canada, any metric in which the US does better should be touted and exaggerated, totally disregarding the fact that not everyone in the US has access to that system or can even pay the co-pays and deductibles required in order to use it. Any metric in which Canada does better should be ignored.

Any metric should be hazard adjusted, like Canadian peer reviewed journals do when they want they best science Failures in the US system exist, which is why I propose corrections, of course Mike can stubbornly maintain that the only solution is socialization and single payer.

That is the only solution to the behaviour of insurance company behaviour, dipshit. You haven't even TRIED to produce an alternate solution; you simply try to change the subject to drug companies and FUCKING LIE about your completely false claim that individuals don't buy drugs for themselves under the Canadian system. You quite obviously know JACK SHIT about how the Canadian system works, yet you pontificate at length about it, blithely ignoring corrections from people who have used it.

7. Waiting times are the bane of socialized health-care. Much better to simply kick millions of people out of the system so that those who remain get shorter waiting times. Whenever someone points out that wait times in socialized systems are determined by medical urgency rather than financial means, simply repeat previous point and act as though wait times are constant.

Waiting times kill people, even with effective triage. Rather than allow unequal care and have lower waiting times for EVERYONE, we must maintain egalitarian access. When line jumpers pay premium there is more money going into the system for more capacity, even in socialized countries this logic holds and supplemental private care is used to reduce waiting times and hence mortality.

In short, if you're poor, you don't deserve the same health care as rich people. That way, rich people can get better health care. I get it.

8. Bankruptcy is a perfectly acceptable solution to the problem of middle-class people who can't afford health-care.

Bankruptcy requires one to sell their first born into slavery, prostitute their body for money, and results in people dying earlier

Mockery does not disprove the point. You feel that bankruptcy is a perfectly acceptable solution to the problem of middle-class people who can't afford health-care.

9. Middle-class people who avoid or delay expensive medical care because of its great cost are stupid and deserve to die, so they shouldn't factor into any health-care discussion. They should have chosen bankruptcy which, as stated before, is a perfectly acceptable health-care solution.

Middle-class people should have some disincentive from abusing the system, which countless peer reviewed studies have documented.

So "some disincentive" means "make it so that the co-pays and deductibles make health-care unaffordable unless they have self-diagnosed it to be an emergency worthy of financial hardship?"

Surprisingly middle class survival rates in the US are higher than elsewhere in the world.

That would depend on how you define "middle class", wouldn't it? People whose companies pay for good insurance have good health-care. Those who don't are fucked, and you figure it's better that way, right? After all, you believe in the superiority of "unequal care".

Do you have anything to add to the debate Mike that isn't a gratuitious strawman?

You have completely failed to show that any of my criticisms are strawmen. All you do is take the same thing I say and try to repackage it in a positive-sounding way. That, and your insistence on LYING about Canadian drug policies, is the entirety of your argument.

[Illuminatus Primus]

Government subsidized research would be a horrid thing - if that was the bulk of your research budget. Trusting a centralized planner to forecast the R&D field accurately is proven loser.

As the appalling failure of the Manhattan Project demonstrated, presumably...

I may agree with you on most of your strategy, but contrasting a major defense project prodded along with enormous geopolitical possibilities during wartime and possessing the single-handed ability to utterly obliterate industrialized, modern opponents with financing all aspects of medical science is an incredibly inappropriate analogy.

Not to mention it fails to account for politicization, especially considering the U.S. political climate.

Imagine some of the medical science that the Reagan Administration would have fucked with by fiat, or the current one, for that matter. I'm not sure the morning-after pill would EVER have been developed, and you can be all manner of safe abortion techniques and contraceptives would go on the back burner.

[Patrick Degan]

Government subsidized research would be a horrid thing - if that was the bulk of your research budget. Trusting a centralized planner to forecast the R&D field accurately is proven loser.

As the appalling failure of the Manhattan Project demonstrated, presumably...

I may agree with you on most of your strategy, but contrasting a major defense project prodded along with enormous geopolitical possibilities during wartime and possessing the single-handed ability to utterly obliterate industrialized, modern opponents with financing all aspects of medical science is an incredibly inappropriate analogy.

Granting the differences in both politics and priorities of the two efforts. The point of the observation was to demonstrate how idiotic Tharkun's blanket-assertion a priori that Government Research = Horrid Inefficency actually is.

[tharkûn]

Hey numb-nuts, for the umpteenth time, you haven't established the "general rule" in the first place, except to state it as an axiom. You consistently quote snippets of articles out of context in order to suggest that there is some yawning gap in patient care between Canada and the US when they say no such thing, you consistently insist that the reason the US produces more R&D is privatization instead of sheer size and cash flow, and you act as though both claims are accepted when they are not.

I consistently quote the numbers, when you didn't like my quotes and tried to BS about one of them I gratuitiously quoted the full body of the article which showed exactly what originally stated: Canadian heart patients were less likely to survive, as the body count showed, and they were healthier on average than their American counterparts. The reason American care was better was more access to newer and better treatments. Rather than have you BS about the semantics of quotes I've just been quoting the raw numbers. If you think the numbers are wrong, provide your own. Maybe even use comparative data from the same decade or *gasp* a peer reviewed journal

I further went on to cite the actual causes of death which Americans suffer disproportionately from Canadians - Circulatory diseases, homicide, accidents, and diabetes. If American healthcare is really so much worse - why isn't infection, cancer, organ failure, etc. up there?

Which are more numerous in the US: a fact that you try to handwave away by blaming the victims and categorizing them so that they don't count.

You claim more bodies, show em. If you can find a peer reviewed journal that shows a higher baseline adjusted mortality rate in the US than the rest of the G7, I will concede. And just so there is absolutely no weasal room by baseline adjustment I mean a study wherein the risk factors above and beyond medical care; like obesity, climate, activity level, demographics, etc.; are stasticly normalized.

I have already pointed out that the Canadian government does not buy drugs for people

And I have pointed out SEVERAL TIMES that I am talking about MONOPSONY, given that I've also stated Canada ISN'T A MONOPOSONY, I would hope you could put two and two togethor and conclude I'm talking about OTHER COUNTRIES. As nice as the Great White North is, and by the numbers it looks like it has the 2nd best healthcare in the world, it is not the sum total of socialized medicine. Canada has a single PAYER healthcare sytem, it is not a single BUYER system.

Yet again you state your assumption as fact.

Maybe because it HAS BEEN TRIED AND FAILED?

What exactly is your required burden of proof here?

And production scaling disproves the utility of government-funded university research ... how?

Government-funded university research is a fraction of the cost. It costs an order of magnitude more money to scale up than to do the basic research. The basic research for Lipitor was few hundred thousands dollars, the cost to bring it to market was around 600 million. Do the math, the big cost is not the basic research done in the 1920's.

Irrelevant. The R&D was done by Fleming. The fact that you need a corporation to mass-produce it doesn't change that fact. If I invent something but I need a company to mass-produce it, does that mean I didn't invent it?

BS. The research was done by Fleming, and was a fluke of his lousy laboratory practice, the development was done by Moyer and Florey and without them penicillin would still have been too expensive to do clinicals for testing human safety. Indeed Fleming sat on his discovery until IG Farben came out with Prontosil and he thought to emulate their successful mass production and commericialization techniques.

Inventing something is the easiest step in the process. That gets you IP rights. Once there you need to do much development and normally a good bit of research to bring a product to market. The costs of invention opposed to mass production are MINISCULE.

Oops- anecdotes to disprove the general rule! See, I can dismiss claims using your rhetorical trick too!

Oh I'm sorry let me put it this way on average about 60% of the drugs in pharma pipelines target novel function, i.e. at one point the top end of Merck contained: a chemo mitigator, a novel function diabetic, an incremental anti-depressant, and vaccines for Herpes, rotavirus, and HPV. Granted I'm ignoring the companies outside of the top 20 when I state that figure and I'm not looking at data before 1995, but running the student T gives a nice bit of confidence.

Research has NOTHING TO DO WITH MASS PRODUCTION.

You are kidding me right? Where in hell do the billions of dollars pharma line items for scale up research go then? The first leg of the drug race is to synthesize something you can patent and show it might work. Then you have to start again from scratch and research/egineer a way to make it in clinicly useful quantities. Think of it this way, the first leg allows processes with unlimited thermal budgets, unlimited per unit costs, and has unrestricted methodoly play with. The second leg has limited thermal budgets, limited per unit costs, and drasticly limited methodolgy.

One has to useually research an entire new chemical/physical pathway to make the drug or device in question; often with no use of the orgininal pathway. It is atypical that the first method of production found for IP purposes is useful for mass production.

How does that disprove the fact that massive sums of money are poured into the system in the US?

Let's see the US spends less than half the money to be had and less than half the manpower to be had; hence when it accounts for more than half the market it is more efficient than the rest of the world.

In short, if you're poor, you don't deserve the same health care as rich people. That way, rich people can get better health care. I get it.

Deserve hasn't got a damn thing to do with it. I'm for the best health care for the most amount of people. You know UTILITARIANISM. Take queu jumping. It is not fair that rich people can jump the queu and have their surgeries done faster (and if nothing else they can go outside the country), however when they pay a premium to do so then there are more resources to ADD CAPACITY. This is EXACTLY why Britain, Australia, and a host of other countries allow for parrallel private healthcare. Likewise giving the rich access to medications, devices, and procedures which are not cost effective to give to the general public is a good thing - it puts more resources into the system to bring down prices.

I'd rather have an inequitious distribution of superior healthcare than an equitable distribution of inferior healthcare if it means saving more lives.

Mockery does not disprove the point. You feel that bankruptcy is a perfectly acceptable solution to the problem of middle-class people who can't afford health-care.

What are is so terrible about bankruptcy that is unacceptable for healthcare but is acceptable for acts of nature? To me there isn't a bloody difference if you go insolvent due to a healthcare bill or because a tornado thrashes your home and business.

Of course I am skeptical of any claims that large numbers of middle class Americans in otherwise fiscally sound positions are going broke due to healthcare.

So "some disincentive" means "make it so that the co-pays and deductibles make health-care unaffordable unless they have self-diagnosed it to be an emergency worthy of financial hardship?"

Do you have a mental deficiency that precludes you from discussing this subject without gross strawmanning? The typical copay is nowhere near the true cost of treatment, it has nothing to do with pricing services out of people's reach and everything to do with encouraging them to make good choices. For example the copay for a brand name drug can be as low as 2% of the real cost, the copay for the generic might be 3% of the full cost, yet the patient only sees a 25 vs 15 dollar copay and they are statisticly more likely to opt for the 15 dollar copay. In a related note copays for hospital services are small fraction of total costs, the goal is to get people to THINK before they use services. The idea is to discourage people from overusing healthcare just because they have NO cost for doing so.

That would depend on how you define "middle class", wouldn't it?

Fine give me a definition for middle class that you would typicly use and I will state if the stastics hold.

After all, you believe in the superiority of "unequal care".

Along with several governments with two tiered socialized medicine. The rich can opt for medical treatments which are not cost effective to implement in the general population. This adds resources to the system, brings down prices, and improves minimum standard of care. I do not approve of a system like the current US one where the floor for the minimum standard of care is so low and ass backwards. Unequal care, when done properly, raises the minimum standard of care.

You have completely failed to show that any of my criticisms are strawmen.

Right, keep telling yourself that

All you do is take the same thing I say and try to repackage it in a positive-sounding way

Funny because all you are doing is repackaging what I say in a negative-sounding way, along with blatently strawmanning positions.

That, and your insistence on LYING about Canadian drug policies, is the entirety of your argument.

Here's a clue. I'm talking about SOCIALIZED MEDICINE, in general. Canada is ATYPICAL. If you are specifically talking about Canadian healthcare, frigging say so. If I don't attach a country I'm most often talking about world healthcare in general or socialized medicine in general.

For instance, generally a single insurer is tantamount to a single buyer, Canada is an exception in this regard and hence the comment is not a statement about Canada.

When I'm talking specifically about Canadian health care I tend to use words like well: "Canada", "Canadian", "Canuck", "The Great White North", etc. If you don't see one of those words or phrases you might, just might, stop and pause before assuming I'm talking about Canada.

[Darth Wong]

I consistently quote the numbers, when you didn't like my quotes and tried to BS about one of them I gratuitiously quoted the full body of the article which showed exactly what originally stated

And which does not support your preferred conclusion. The study indicated that patient care was not an issue; the only issue was the aggressive use of revascularization in US hospitals. They obviously suggest that Canadian hospitals be more aggressive about the use of this procedure, however there is NO reason to believe that this aggressiveness has anything to do with privatization. As per http://eurheartj.oupjournals.org/cgi/reprint/22/18/1702 , there are similar distinctions between the UK and Germany even though both of them use socialized medicine. Not to mention the fact that you focus entirely on this single metric and ignore other glaring issues like infant mortality, as I mentioned before and as you simply handwaved away.

The reason American care was better was more access to newer and better treatments.

Wrong. They stated clearly that more aggressive use of the same invasive treatment, available on both sides of the border, was the determining factor. They cited a "conservative" mindset on the part of Canadian hospitals, not unavailability of advanced procedures.

Which are more numerous in the US: a fact that you try to handwave away by blaming the victims and categorizing them so that they don't count.

You claim more bodies, show em. If you can find a peer reviewed journal that shows a higher baseline adjusted mortality rate in the US than the rest of the G7, I will concede. And just so there is absolutely no weasal room by baseline adjustment I mean a study wherein the risk factors above and beyond medical care; like obesity, climate, activity level, demographics, etc.; are stasticly normalized.

And thus you seek to eliminate the fact that millions of people in America themselves are "beyond medical care" by virtue of not being covered adequately, hence you are looking for excuses to weasel out of the whole fucking subject.

And I have pointed out SEVERAL TIMES that I am talking about MONOPSONY, given that I've also stated Canada ISN'T A MONOPOSONY, I would hope you could put two and two togethor and conclude I'm talking about OTHER COUNTRIES.

What a fucking bullshit artist. First you talk specifically about US vs Canada, then you quietly switch to anonymous strawman systems whenever convenient, and when you get caught, you say "but I wasn't talking about Canada, I was talking about my strawman!"

Inventing something is the easiest step in the process. That gets you IP rights. Once there you need to do much development and normally a good bit of research to bring a product to market. The costs of invention opposed to mass production are MINISCULE.

Hey dumb-shit, that would be what those generic drug manufacturers in Canada are for.

[

Research has NOTHING TO DO WITH MASS PRODUCTION.

You are kidding me right? Where in hell do the billions of dollars pharma line items for scale up research go then? The first leg of the drug race is to synthesize something you can patent and show it might work. Then you have to start again from scratch and research/egineer a way to make it in clinicly useful quantities. Think of it this way, the first leg allows processes with unlimited thermal budgets, unlimited per unit costs, and has unrestricted methodoly play with. The second leg has limited thermal budgets, limited per unit costs, and drasticly limited methodolgy.

You are confusing science and engineering. Once the scientists figure out the concept (which is the real hurdle), drug companies figure out how to make lots of it. Nobody is sitting around saying "who cares if we figure out how to cure AIDS, what matters is the mass-production facilities". That costs money but once the research is done, it is an easy cost to justify because you know the product works and you know you will have a market. You're just trying to justify your evasive bullshit.

How does that disprove the fact that massive sums of money are poured into the system in the US?

Let's see the US spends less than half the money to be had and less than half the manpower to be had; hence when it accounts for more than half the market it is more efficient than the rest of the world.

Or its citizens take too many drugs. The fact that the rest of the world (which is not a cohesive market) does not outperform the US hardly proves anything and you know it. If the rest of the world were a cohesive market with a single regulatory body, currency, etc. and spending 14% of their collective GDP on healthcare, are you so sure that they would not produce more R&D than the US?

In short, if you're poor, you don't deserve the same health care as rich people. That way, rich people can get better health care. I get it.

Deserve hasn't got a damn thing to do with it. I'm for the best health care for the most amount of people. You know UTILITARIANISM.

Utilitarianism also has this little clause about trying to reduce undue suffering, and inflicting misery upon the unprivileged in order to make life easier for the privileged is not utilitarian. Not to mention the fact that your "disincentive" for poorer people to use medicine is not functionally different from simply denying them care, since both concepts produce the same result. I see you only employ utilitarianism when you find it convenient, and discard it otherwise.

I'd rather have an inequitious distribution of superior healthcare than an equitable distribution of inferior healthcare if it means saving more lives.

Infant mortality rates indicate that you might want to replace this with "saving more rich peoples' lives", since the totals certainly do not support your "help the rich, fuck the poor, the numbers will add up positive in the end" assertion on that score.

What are is so terrible about bankruptcy that is unacceptable for healthcare but is acceptable for acts of nature? To me there isn't a bloody difference if you go insolvent due to a healthcare bill or because a tornado thrashes your home and business.

There's a reason insurance is supposed to protect you against things like that. But as the bankruptcy statistics show, it does not. The ratio of bankruptcy claimants who had medical insurance is the same regardless of whether their bankruptcy was medically related; in other words, having insurance does not provide statistically meaningful protection against major medical bankruptcy. Small wonder, since major health problems tend to produce recurrent expenses (unlike the one-time expense of, say, a house fire), and insurance companies drop you the minute they detect that you are starting to generate recurrent expenses.

Of course I am skeptical of any claims that large numbers of middle class Americans in otherwise fiscally sound positions are going broke due to healthcare.

The point is not how many people it happens to; the point is that medical insurance does not show any statistically significant protection against it happening to them. Your scheme of "unequal care" visits an undue amount of misery upon its victims.

So "some disincentive" means "make it so that the co-pays and deductibles make health-care unaffordable unless they have self-diagnosed it to be an emergency worthy of financial hardship?"

Do you have a mental deficiency that precludes you from discussing this subject without gross strawmanning? The typical copay is nowhere near the true cost of treatment,

Nice strawmandering, fucktard. It doesn't have to be near the true cost of treatment; it only has to be high enough so that people of limited means will tend to avoid seeking health-care unless they have self-diagnosed the problem to be severe enough to risk financial hardship.

I do not approve of a system like the current US one where the floor for the minimum standard of care is so low and ass backwards.

Yet you still insist that we need hordes of costly and dishonest insurance middlemen between government and provider. Why?

Unequal care, when done properly, raises the minimum standard of care.

Sounds like "trickle-down medicine".

Here's a clue. I'm talking about SOCIALIZED MEDICINE, in general. Canada is ATYPICAL.

What difference does it make whether Canada is an "atypical" example of socialized medicine as long as it disproves your sweeping generalizations about how socialized medicine is always a bad idea, fucktard?

[Castor Troy]

I see that some are debating corporate and government research for medical technology and the like...why not just use both of them? Get the best of both worlds, you know?

[Darth Wong]

I see that some are debating corporate and government research for medical technology and the like...why not just use both of them? Get the best of both worlds, you know?

Fine idea. After all, private drug companies still exist in Canada and are certainly not prohibited from doing research. But certain people insist that government-funded R&D has been "tried and failed", so you would have to ask them why it's so damned bad.

[Illuminatus Primus]

Granting the differences in both politics and priorities of the two efforts. The point of the observation was to demonstrate how idiotic Tharkun's blanket-assertion a priori that Government Research = Horrid Inefficency actually is.

Anyone familiar with the U.S. Federal Government and the federal bureaucracy cannot help but instinctively cringe at such a level of responsibility being placed at the hands of government planners. This level of widescale planning and allocation is where I begin to feel that it is too complex and choatic to leave to simply government planning. I'm very uncomfortable with that. Government planning ought to help supplement major societal health problems and also rare diseases where there is some profit motive (as tharkun noted), but not enough to develop quickly.

[Darth Wong]

One other issue relating to government-funded R&D (which I think we should do more of in Canada) is R&D toward health issues where there is no conceivable profit motive at all. Dietary issues, for example. In many countries, diet and herbs are used in much the same way that drugs are here. Some of those beliefs and practices are bunk, some of them are not. But we have no way of knowing until someone does the research, and there is zero profit motive in such research because there is no patentable drug.