Health Care systems

[Broomstick]

And I'm going to bow out of this argument entirely - my mother was hospitalized on Friday and I need my energy to deal with that rather than some jackass with his head up his ass. He can talk all he wants about how great the US system is - me, I get to spend time with the family trying to figure out how to pay the co-pays this time. AND battling the docs who want to keep doing stuff mom doesn't want. Because that's a lot of the US problem right there - yes, technology is great, but not when it's overused. The average sprained ankle does NOT need an MRI. As just one example.

Speaking of MRI's, interesting statistic - there are more MRI machines in the city of Pittsburgh than in the entire nation of Canada. Brought to you by the Journal of the American College of Radiology, thank you very much. Which means either Canada has way to few - or Pittsburgh, not to mention the rest of the US, has way too many.

[Edi]

Sucks to hear that, Broomstick.

I hope your mother recovers quickly and that everything turns out as well as possible.

Edi

[Broomstick]

Thank you for the good wishes. Given her state of health, any illness is serious at this point, and it doesn't help that my father seems to be ill as well, although not as seriously. I don't know if I'll be making a trip to Michigan to help out or not - it depends on how she's doing tonight or tomorrow morning.

But if I disappear from the board for a bit, you'll know why.

[Crown]

All the best for your mother Broomstick.

[tharkûn]

my mother was hospitalized on Friday and I need my energy to deal with that

Best of luck Broom, hope she pulls through without problems.

Speaking of MRI's, interesting statistic - there are more MRI machines in the city of Pittsburgh than in the entire nation of Canada. Brought to you by the Journal of the American College of Radiology, thank you very much. Which means either Canada has way to few - or Pittsburgh, not to mention the rest of the US, has way too many.

Either that or there happens to be a major MRI research center in Pittsburgh, I know of several major MRI groups out of Carnegie Mellon, but hey what's another ancedote

KC:

So...I ask again, what seperates the police and healthcare so widely in your mind that one is essential to the public good and the other is best left in the hands of those with a profit motive?

At the risk of being longwinded:

I hold that government's best function is that of regulator, ergo if one wishes to enforce regulation there should be some agent of enforcement. Enter the police. The police provide a basic level of security and they act as part of the enforcement mechanism of government edict. Without some type of law enforcement, even if it is only the old shire reeve concept, the ability of the government to act as regulator of the free market cannot exist.

In addition to the above most police departments don't behave in either monopsonistic nor monopolostic fashion.

CT:

Tharkun, would you respond as to how a system that is actually a hybrid of free-market and socialized healthcare would be inferior to an all free-market system?

It depends on how it is run. Currently the US has such a hybrid - Medicare and Medicaid - and it is abysmal. Medicare is about the most assbackwards healthcare policy on the planet; there is a literal ton of rules and regulations governing it. A better model would get the government out of attempts to delineate specifics of care, and into subsidizing the costs of those who cannot afford them.

Argueably Canada itself has a hybrid system with public payment, and private supply.

ggs:

I think it is actually closer to utterly ignoring the private insurance part while stating "teh big government is bad" over and over again.

Canadian private health insurance exists to cover those services and treatments delisted in the 80's (early 90's?) or that were never covered to begin with. Most notably prescription drug costs, eye care, dental work, and private hospital rooms. Quantifying its effect is rather haphazard as the rules governing it vary dramaticly by province, as a general rule most provinces have rules that end up preventing physcians from working in both the private and public sectors as well as raising costs.



The big problem I'm having here is that the only evidence I'm hearing about the superiority of socialized medicine boils down to:
1. We pay less.
2. We live longer.

Paying less ... well price leveraging, wage differentials, standardization, and reduced technological outlays will do that.

Living longer ... all I keep seeing is people saying that take these countries here, compare to the US overthere, and we will ignore all the other differences and conclude that it is the healthcare system that makes the difference. From my point of view I look at the differences that existed in life expectancy in 1960 or 1930 and find that even before various healthcare systems diverged those differentials existed.

For instance Canadian life expectancy at birth has been longer than American for decades. It male life expectancy at birth in 1930 - was 3.3% longer, 1940 - 3.5%, 1950 - 3.1%, 1960 - 2.6%, 1970 - 3.3%, 1980 - 2.8%, 1990 - 2.6%, 2000 - 2.2%.

I simply cannot see how those you on the other side of the debate can tell me with straight faces that something as complicated as life expectancy or infant mortality can simply be attributed differences in healthcare. Particularly given that many of these differences existed prior to socialization of healthcare.

[Patrick Degan]

I simply cannot see how those you on the other side of the debate can tell me with straight faces that something as complicated as life expectancy or infant mortality can simply be attributed differences in healthcare. Particularly given that many of these differences existed prior to socialization of healthcare.

Probably because the statistics support the argument. I know that's a concept you can't seem to wrap your tiny mind around, but there it is.

[Darth Wong]

I simply cannot see how those you on the other side of the debate can tell me with straight faces that something as complicated as life expectancy or infant mortality can simply be attributed differences in healthcare.

Give that you yourself declared that drug company advertising is part of the health-care system (a definition which would also include the kind of government outreach, free pre-natal care, and public-education campaigns that are typical to a more socialized country), this statement is downright hilarious. I guess "health-care system" only has a narrow definition when you're talking about socialized systems, but an incredibly broad definition that includes Viagra and Paxil TV commercials when you're talking about the US, right?

[tharkûn]

Give that you yourself declared that drug company advertising is part of the health-care system (a definition which would also include the kind of government outreach, free pre-natal care, and public-education campaigns that are typical to a more socialized country), this statement is downright hilarious.

I fail to see why some advertisements which have shown in peer reviewed journals to increase treatment of underreported conditions would not be part of the healthcare system. Public-education, pre-natal care like oh say WIC, etc. would likewise be included.

I guess "health-care system" only has a narrow definition when you're talking about socialized systems, but an incredibly broad definition that includes Viagra and Paxil TV commercials when you're talking about the US, right?

Paxil I'm unsure of. Viagra commericials appear to save lives. Impotence is a warning sign of several conditions and getting treatment for impotence tends to lead to treatment of related problems. Even if we just look at the men who opt for more heart conscious lifestyles simply so their physicians will give them Viagra, there is measurable benifit from such advertisements.

All told drug advertising appears to be slightly benificial or a wash.

But tell me Mike is your entire arguement safely summed up in "We live longer" and "we pay less"? Or do you have some better data that gets rid of all the other variables at play?

[Patrick Degan]

But tell me Mike is your entire arguement safely summed up in "We live longer" and "we pay less"? Or do you have some better data that gets rid of all the other variables at play?

You've degenerated to mere trolling, Tharkie. The data supporting the conclusion has been posted in this very thread along with the sources. But I suppose you're going to argue that the availability of healthcare is somehow not involved in lower infant mortality and longevity.

[Darth Wong]

Bwahahaha, I just got a new sig quote!

[SirNitram]

Viagra.. Commercials...

What the flaming fuck? Seriously, has someone put acid in Tharkun's meals?

[muse]

Bwahahaha, I just got a new sig quote!

I'm sure it's saved the sex lives of many impotent men, and possibly prevented a handful of suicides due to said impotence.

[Xon]

But tell me Mike is your entire arguement safely summed up in "We live longer" and "we pay less"?

What other standards are you going to judge a healthsystem by!

Especially when they have presented rediciously amounts of data for proof.

[tharkûn]

I'm sure it's saved the sex lives of many impotent men, and possibly prevented a handful of suicides due to said impotence.

Either that or when men were stampeding to their doctors to get this drug their doctors wisely screened them for diabetes, coronary artery disease, hypertension, depression, kidney diseases, etc. Erectile dysfunction is a symptom of other more serious conditions. When men go seeking treatment so they can have sex, many are diagnosised with underlying conditions - like diabetes. Early detection of these underlying conditions means that treatment starts sooner and mortality rates go down. I am of course ignoring the off-label uses of sildenafil citrate which show some postive health incomes in double blind clinical trials.

Viagra advertising is helpful in that ubiquitious numbers of men who otherwise never would have told a doctor of this symptom are doing so. In ye good old days men did not tell their physicians they were suffering from erectile dysfunction, this lead to later diagnosis of a whole host of conditions, some of them quite lethal. Getting men to actually go to the doctor and talk about erectile problems was a major improvement in early diagnosis of underlying conditions and hence treatment.

Is advertisement the only or best way to do this? No. Does it appear to be 'working'? Yes.

Bwahahaha, I just got a new sig quote!

I cannot claim original authorship, that would belong to the keynote speaker at industry conference back in 2001 or 2002. I hope you enjoy mocking peer reviewed science.

[Darth Wong]

I cannot claim original authorship, that would belong to the keynote speaker at industry conference back in 2001 or 2002. I hope you enjoy mocking peer reviewed science.

Oh puh-lease, an "industry conference" is to real scientific peer review as politics is to real administration. The pharmaceutical industry has increasingly demonstrated its lack of standards in testing in recent years with multiple drugs being recalled for serious side-effects, which is no fucking surprise when all of the "peers" are being paid by the very people whose claims they're supposed to be investigating.

[tharkûn]

Oh puh-lease, an "industry conference" is to real scientific peer review as politics is to real administration.

Except when said conference is used to recap previously published work.

pharmaceutical industry has increasingly demonstrated its lack of standards in testing in recent years with multiple drugs being recalled for serious side-effects

Historicly about 2% of drugs get recalled after winning FDA approval, these days that number has been lower than in the past. That tended to happen because finding side effects is a laborious process and some don't show up until the patient population reaches into the millions. No sane drug company knowingly puts drugs on the market with these types of side effects. That is a proven money loser. Once the side effects become known, and they will, you are going to have hundreds of parasitic lawyers hammering you with class action lawsuits on behalf of everyone who ever took the drug. Most settlements in previous lawsuits have cost so much that the drugs were never profitable.


The current crop of drugs are being pulled because after increasing the sample size by a few orders of magnitude effects were seen that previously didn't make it out of background noise. Hiding the side effects last just long enough for one researcher anywhere in the world to run the patient stastics and look for increased morbidity/mortality correlations; in the modern world you CANNOT hide side effects even if you burn all incriminating data.

[Darth Wong]

Oh puh-lease, an "industry conference" is to real scientific peer review as politics is to real administration.

Except when said conference is used to recap previously published work.

Like what? This idiotic notion that Viagra ads save lives by getting people to get checkups at the doctor? As if this gives your system an advantage over one which accomplishes the same thing far more effectively by making doctor visits free for everyone? And this notion comes from the same fucktard who said that a good health-care system needs to have a disincentive for poor people to go to the doctor too often?

I love the way you try to have your cake and eat it too. If you're going to use the incredibly oblique logic that anything which might get people to go to the doctor is by definition a lifesaver by virtue of simply getting him in that office for a checkup, then you should also accept the logic that making it difficult for poor people to go to the doctor must be costing human lives.

But oh no, I wouldn't expect anything remotely resembling consistency from you. It's become quite obvious that you will say any goddamned thing that comes to mind if you think it will save your knee-jerk apologist position.

[HemlockGrey]

I'm sure there's a few people out there who would have killed themselves if not for Viagra.

[tharkûn]

Like what? This idiotic notion that Viagra ads save lives by getting people to get checkups at the doctor?

The idea that American males previously simply wouldn't tell their doctors that they HAD erectile problems. Persistent impotence is a warning flag for many more serious coniditions. Simply getting American males, with all the assorted cultural sexual baggage, to discuss it with their doctor meant that there is now a better chance to catch things before other, more serious symptoms show up.

As if this gives your system an advantage over one which accomplishes the same thing far more effectively by making doctor visits free for everyone?

It doesn't. The money spent on viagra ads is more or less a WASH. If men are willing to pay out of pocket for a doctor's visit they otherwise wouldn't, I really don't see the negative impact.

The problem with free doctors visist is that you have divorced demand from price. Fine how did your government deal with it? Last I heard Ontario had simply using price controls on the supply side to de facto ration doctors' hours.

a good health-care system needs to have a disincentive for poor people to go to the doctor too often?

Canada has them as well, they just go at it from the otherside of the equation. The whole point of going off cost plus payments was to create a disincentive for providers to overtreat.

I love the way you try to have your cake and eat it too. If you're going to use the incredibly oblique logic that anything which might get people to go to the doctor is by definition a lifesaver by virtue of simply getting him in that office for a checkup

It is not just about getting them to the doctor's office. It is about getting them to admit to a clear symptom which correlates well with more serious conditions. The first tangible sign of hypertension in an older male might well be erectile dysfunction. Ideally this wouldn't be an issue, men would be full, honest, and frank with their doctors without a little blue pill; however given all the crap that infests American sexuality something is needed.

I'm not toting this as some miracle wonder policy, merely that the benifits offset the disadvantages. Drug advertising isn't particularly henious nor particularly brilliant. In some cases it wastes money, in some cases it saves lives.

But oh no, I wouldn't expect anything remotely resembling consistency from you.

That's okay I've come to expect you to ignore questions, misquote articles, and ignore hard data from peer reviewed sources.

Do you have anything besides "we live longer" or "we pay less"? Can you cite any hazard adjusted data to support your point?

[SirNitram]

Do you have anything besides "we live longer" or "we pay less"?

What else matters when it comes down to Healthcare? This is a serious question. Both are objective benefits that directly link to the purpose of healthcare.

[tharkûn]

What else matters when it comes down to Healthcare? This is a serious question. Both are objective benefits that directly link to the purpose of healthcare.

The short answer:
Because these are complex issues.

The long anser:

Canadians live longer. They have always lived longer, stastics prior to 1930 of course not being all that firm. Is it caused by having a 50% lower obesity rate or having socialized medicine? It is NOT enough to establish that Canadians live longer, you need to establish that they live longer because of socialized medicine. You can do this through normalizing the disaggragated stastics to get rid of differences in religion, obesity, climate, etc.; as of yet nobody appears to be willing to get these stastics. Instead all I keep seeing is the cia factbook repeated ad naseum.

Canadians pay less. Well first off Canadian labor is cheaper. Second off Canada price leverages off of marginal costs, not full real costs. Third Canada invests far less into capital expenditures - MRI machines, CAT scanners, new OR's, etc. In order to do a fair economic comparison you need to eliminate wage disparity, cost savings that are impossible if the US tries them, and examine the cost/benifit return on infrastructure. Fourth Canada has a better tort system, the cost of CYA in the US is far, far higher.

Those two questions would be more than sufficient to establish your case if the ceteris parabis assumption held; however it most dramaticly does not.

[Darth Servo]

Canadians live longer. They have always lived longer, stastics prior to 1930 of course not being all that firm. Is it caused by having a 50% lower obesity rate or having socialized medicine? It is NOT enough to establish that Canadians live longer, you need to establish that they live longer because of socialized medicine. You can do this through normalizing the disaggragated stastics to get rid of differences in religion, obesity, climate, etc.; as of yet nobody appears to be willing to get these stastics. Instead all I keep seeing is the cia factbook repeated ad naseum.

Of course its a complex issue but the fact that EVERYONE there gets health care compared to the US where many just slip through the cracks can NOT be dismissed as a contributing factor. But even IF it were irrelevant, none of this changes the fact that you don't have jack supporting YOUR side.

[Patrick Degan]

Canadians live longer. They have always lived longer, stastics prior to 1930 of course not being all that firm. Is it caused by having a 50% lower obesity rate or having socialized medicine? It is NOT enough to establish that Canadians live longer, you need to establish that they live longer because of socialized medicine. You can do this through normalizing the disaggragated stastics to get rid of differences in religion, obesity, climate, etc.; as of yet nobody appears to be willing to get these stastics. Instead all I keep seeing is the cia factbook repeated ad naseum.

Uh uh, asshole —YOU are the one trying to handwave away the fact of universal healthcare access as a major factor in the longevity and lower infant mortality of Canadians (about as moronic an argument as I've ever seen from anyone shy of Comical Axi) and YOU are the one trying to handwave away the statistics presented not only by the CIA Worldbook but also by multiple surveys of OECD countries. Why don't you try presenting the evidence which actually backs your position that healthcare access is a negligible factor in this matrix, or are you simply going to continue to be the dishonest chickenshit you've shown yourself to be several pages back in this thread?

[Illuminatus Primus]

You're asking him to prove it is not a factor? Isn't that a negative?

[Darth Wong]

The idea that American males previously simply wouldn't tell their doctors that they HAD erectile problems. Persistent impotence is a warning flag for many more serious coniditions. Simply getting American males, with all the assorted cultural sexual baggage, to discuss it with their doctor meant that there is now a better chance to catch things before other, more serious symptoms show up.

Do you think that if Viagra advertising on TV stopped, men with impotence problems would refuse to go to the doctor?

Canada has them as well, they just go at it from the otherside of the equation. The whole point of going off cost plus payments was to create a disincentive for providers to overtreat.

No, it was simply due to the fact that money isn't infinite. And characterizing regular doctor checkups as "overtreatment" is pathetically dishonest even for you.

That's okay I've come to expect you to ignore questions, misquote articles, and ignore hard data from peer reviewed sources.

This stone is being thrown from a glass house by the same fucktard who took a peer-reviewed article where they blamed conservative use of invasive procedures for the entire difference, even taking pains to note specifically that there were other no detectable differences in care whatsoever once you accounted for this single factor, and you creatively interpreted this to mean "it's caused by socialized health-care"?

Not to mention treating advertising as part of the solution in the US while ignoring the effect of stronger government public health policies in Canada on the "baseline health" index that you so proudly insist we "correct" for before comparing the two systems?

As I said, you're a dishonest little shit who will say anything to save your apologist position. And where is your answer to the point about free pre-natal care in Canada and the obvious effect that this should have on the huge infant mortality rate difference that you so casually dismiss?

Do you have anything besides "we live longer" or "we pay less"? Can you cite any hazard adjusted data to support your point?

Since many of the "hazards" you want to "correct" for have to do with inadequate availability of free care and targeted health education to the poor which happens to be one of the issues under discussion, I will take this as the dishonest bullfuckery that it is.