Health Care systems

[Patrick Degan]

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

He's making the claim, therefore that puts the burden of proof on him to support his argument.

[tharkûn]

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.

I'm not dismissing it. For the umpteenth time I deplore the gap between being covered by Medicaid and being able to afford insurance - you know the people who "just slip through the cracks". I have stated repetively what I think is a decent way to close the cracks. Just because there is a problem with the current US system, it does not follow that the ONLY solution is socialization.

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

In marginal cases, perhaps. Obviously the benifits follow a law of diminished return, hence why I said the money spent on drug advertising is either slightly benificial or a wash. I am categoricly not saying that it is the only, best, or efficient way to do this, just that it is THE way it happened in the US and the results were benificial.

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.

Funny your parliament said much of the same thing when they dropped cost-plus pricing. The British admitted it flat out as a reason why they went to salaried physicians. Regular checkups are cost effective, unlimited "free" checkups are not. Every country in the world has some type of mechanism for rationing care. In the US and several other countries market incentives are used, in most countries - including the US - regulation is used.

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"?

No I said that socialized medicine tends to be slower to invest in new technologies as well as having less capital infrastructure. Not suprisingly the article stated exactly that - Canada was less likely to use the advanced techniques and had invested significantly in capital infrastructure which resulted in a 17% higher mortality hazard.

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?

The entire advertising tangent came when someone, I think Broom, talked about drug advertisement as wasteful. I replied that it did have some public health benifit - increasing public awareness - and said that it looks like the money spent is a wash or slightly benificial. Never have I suggested that public health policies in Canada should be ignored; to be abundently clear they SHOULD be included.

The "baseline health" predominately refers to health risks. Things like OBESITY, DRUG USE, VIOLENCE, EXERCISE, CULTURE, RELIGIOUS PRACTICE, etc.

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?

Canadian infant mortality has been lower since the stastics were recorded. . In other words the disparity has been there since long before Canada offered free pre-ntal care.

I also didn't want to get into yet another long winded explanation of stastistics going into why for political purposes (religious right) the US reports as live births what most other countries call "still births"; suffice it to say if you ignore the number of infant dead in the first hour use infant mortality falls 20%. American infant mortality stastics are skewed by overreporting of live births due to politics. All of this is laid out in Pediatrics by Dr. Wegman.

Yes free socialized prenatal care may have advantages over private and charitable prenatal care availible in the US, however like all the other indicators you need to do some actual friggen research and make sure your counting methodologies are identical (they aren't), and look at remove confounding factors - like say the greater percentage of the American population that is adverse to aborting fetuses that have no chance at viability.

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.

Fine find some corrected stastics which only take into account the hazards you feel are not a direct consequence of private healthcare. Show me the stastics you think are best corrected and we can work from there.

[Surlethe]

Why the hell do you persist in this? You've consistently been getting your ass handed to you for the past seven pages.

Look, to save you the trouble, I'll sum up your argument:

"Socialist healthcare is bad because it leads to inefficient outcomes; free market healthcare is good because it optimizes efficiency."

What is the definition of efficiency? It is the distribution of scarce resources based on willingness to pay.

When will you get this through your skull? Everyone has been telling you for the past 8 pages: WE DO NOT WANT EFFICIENCY IN A HEALTHCARE SYSTEM!!

Efficiency is based on willingness to pay, which presumes possession of money. However, in a healthcare system, the people who need healthcare the most are the people who can least afford to pay for it. This renders the definition of "efficient" meaningless in establishing whether a healthcare system is good or bad.

Why do you think the US healthcare system consistently costs more per capita, and still allows millions to fall through the cracks, than the socialized systems of nations like Canada? Because it, like you, is pursuing the moronic ideal of an efficient healthcare market, when in reality an efficient healthcare market is a very, very bad thing.

A pure--or close to pure--free market system is thus incapable of dealing with healthcare, for the very reason the invisible hand moves market outcomes to maximize efficiency. What is the opposite of a free market? A socialized market. To anyone with a brain, it follows immediately that, in order to get a good--not efficient--healthcare system, we ought to move toward socialization, rather than toward a free market.

[tharkûn]

Why the hell do you persist in this? You've consistently been getting your ass handed to you for the past seven pages.

Perverse curiosity.

"Socialist healthcare is bad because it leads to inefficient outcomes; free market healthcare is good because it optimizes efficiency."

What is the definition of efficiency? It is the distribution of scarce resources based on willingness to pay.

Efficiency is not defined by distribution. The most general definition is a measure of the inputs relative to the outcomes. In health economics you have Pareto, KH, X, and Allocative efficiency. Pareto efficiency occurs when no change can be made that improves the lot of one individual without impairing that of another. KH is similar to Pareto except it allows losses by one individual to be offset by gains of another. X is a brute force calculation of what technology and business can do in a completely competitive market. Allocative is defined to be the level/type of production most benificial to society.

Socialized systems can be hideously inefficient, numerous third world systems blighted by graft, waste, and stupidity come to mind.

Efficiency is based on willingness to pay, which presumes possession of money. However, in a healthcare system, the people who need healthcare the most are the people who can least afford to pay for it. This renders the definition of "efficient" meaningless in establishing whether a healthcare system is good or bad.

No it means you know nothing about economic efficiency. Efficiency measures the outcomes of how you expend your resources - manhours, minerals, land, etc. If you spend 200 manhours, all the minerals in a tractor, and an acre of land to feed 300 people it is less efficient than spending the same to feed 600. Socialized countries CONSTANTLY try to improve efficiency. That is why Canada left cost plus pricing, that is why the UK went to salaried physicians, that is Germany has copays.

All efficient means is that you have a good cost/benifit return.

Why do you think the US healthcare system consistently costs more per capita, and still allows millions to fall through the cracks, than the socialized systems of nations like Canada?

It purchases more QALYs, and as each successive QALY follows exponential price increases the average cost goes up. The cost of labor in the rest of the world is less. Much of the world leverages off of marginal costs rather than full costs ...

The nuts and the bolts of are Americans die younger without medical intervention, higher rates of obesity, more violence, more stress ... it all kills. In order to give the average American a lifespan 98% of an non-American simply takes more medical intervention and more costly medical intervention at that.

Because it, like you, is pursuing the moronic ideal of an efficient healthcare market, when in reality an efficient healthcare market is a very, very bad thing.

Oh please the British explicitly stated they were looking for efficient healthcare. Hell they pegged the value directly at 30,000 pounds per QALY above which it would not be efficient for the public sector to pick up the tab.

A pure--or close to pure--free market system is thus incapable of dealing with healthcare, for the very reason the invisible hand moves market outcomes to maximize efficiency. What is the opposite of a free market? A socialized market. To anyone with a brain, it follows immediately that, in order to get a good--not efficient--healthcare system, we ought to move toward socialization, rather than toward a free market.

Every government on the planet undergoes cost benifit analysis of healthcare in order to deliver efficient care. That is why there are restrictions on specialist care, real wage freezes for medical professional.

The problem with an Ayn Rand type healthcare market is people would get priced out of the market. The problem with completely socialized medicine is that you have price ceilings above which it is impossible to offer universal care. The problem with pricing out the poor can be dealt with subsidization of the poor, establishing floor pricing at which the government pays, etc. ... none of which require full socialization of medicine - and most governments are leary of full socialization in any event.

When I look at efficiency I'm looking at how much is being paid (both internalized and externalized) vs how many lives are saved (that would have otherwise have been lost without this specific decision being made this way). I find nothing henious about optimizing that. Frankly I find it harder to continance the low level of healthcare spending in the rest of the world; if socialized medicine IS so much more efficient than the only reason NOT to spend US levels on healthcare and getting even MORE QALYs is because something is more important than saving lives.

[Darth Wong]

Frankly I find it harder to continance the low level of healthcare spending in the rest of the world; if socialized medicine IS so much more efficient

The numbers show that it is.

than the only reason NOT to spend US levels on healthcare and getting even MORE QALYs is because something is more important than saving lives.

Sure, like improving the "baseline health" that you want to deliberately ignore by "correcting" for it in all of your arguments. Lots of things you would dismiss as "social programs" rather than "health-care spending" start coming into play once you discuss government strategies for improving baseline health, such as education and community programs etc. But in your mind, even though you think drug company advertising is a perfectly legitimate part of the US health-care system, all of those things in a country with better social programs are red-herrings, right?

At the end of the day, Americans spend a shitload of money on health-care and still get sicker and die earlier than everyone else in the wealthy western nations. You concoct all manner of rhetorical chicanery to explain this away such as classifying "baseline health" as a red-herring, but nobody is buying it. At this point it's rather obvious that you intend to "win" this debate through sheer endurance.

[tharkûn]

The numbers show that it is.

Where is the peer reviewed publication?

Sure, like improving the "baseline health" that you want to deliberately ignore by "correcting" for it in all of your arguments.

I'm wondering what government program is going to change population genetics, considering that is a major player in baseline. I'm wondering what is going to change cultural practice, religious observence, obesity, etc.

Of course you do realize that you just admitted that your healthcare system's performance is based in part off expenditures not included in healthcare budgets and hence all claims of "we spend less" would then need to be completely re-evaluated? Right?

You concoct all manner of rhetorical chicanery to explain this away such as classifying "baseline health" as a red-herring, but nobody is buying it. At this point it's rather obvious that you intend to "win" this debate through sheer endurance.

I'm just waiting for you to meet a basic scientific burden of proof. You are intelligent enough to know that some characteristics should be normalized when comparing outcomes. Genetics comes to mind in a big way. You disagree about what characteristics should be normalized out, fine, cite the peer reviewed paper that normalizes out whichever characteristics YOU THINK ARE LEGITIMATE and then when can go from there. You and I both know that when you a multitude of independent variables in play you need to do some stastics or controls to get experiments down to one variable; so provide some disaggregated numbers, controlled numbers, or baseline corrected numbers. Exclude any studies whose premise you think is unfair, just start by citing ONE peer reivewed paper that gets rid of those independent variables you deem legitimate to toss.

Or do we have to go through yet another round where you refuse to make any attempt to prove causality in a scientific manner?

[Patrick Degan]

I'm wondering what government program is going to change population genetics, considering that is a major player in baseline. I'm wondering what is going to change cultural practice, religious observence, obesity, etc.

Didn't I predict it folks? Only Tharkie would attempt to argue that somehow, someway, healthcare access has nothing to do with greater longevity and lower infant mortality.

[Darth Wong]

The numbers show that it is.

Where is the peer reviewed publication?

You cannot perform basic math without an authority to appeal to?

Sure, like improving the "baseline health" that you want to deliberately ignore by "correcting" for it in all of your arguments.

I'm wondering what government program is going to change population genetics, considering that is a major player in baseline. I'm wondering what is going to change cultural practice, religious observence, obesity, etc.

Oh wow, I guess Canadians are genetically superior to Americans now? That's really cool. Not supported by anything I've heard, but really cool. I guess I should be proud. And yes, in fact, a stronger public education system, smaller disparities between rich and poor, and better social programs do affect cultural factors such as religious observance and obesity etc.

Of course you do realize that you just admitted that your healthcare system's performance is based in part off expenditures not included in healthcare budgets and hence all claims of "we spend less" would then need to be completely re-evaluated? Right?

Nice attempt to change the subject, you lying fucktard. You claimed that Canada's low health-care expenditures must mean that we don't give a shit about people dying because the other expenditures in our societies apparently have nothing to do with public health at all. That argument is false, and the way you tried to change it after the fact in order to blunt the rebuttal is just as dishonest as all of your other bullfuckery in this thread.

fine, cite the peer reviewed paper that normalizes out whichever characteristics YOU THINK ARE LEGITIMATE and then when can go from there.

I'm waiting for you to cite a peer-reviewed paper to explain away the infant mortality deficit. You're the one who beats so hard on that "peer review" drum, yet you haven't provided a shred of evidence to back up your dismissal of the figures.

[Darth Wong]

I'm wondering what government program is going to change population genetics, considering that is a major player in baseline. I'm wondering what is going to change cultural practice, religious observence, obesity, etc.

Didn't I predict it folks? Only Tharkie would attempt to argue that somehow, someway, healthcare access has nothing to do with greater longevity and lower infant mortality.

It's even better than that; he's trying to argue that we Canadians are genetically superior to you Americans, thus explaining our longevity. Until now, I had no idea that we Canucks were the Master Race.

[Zor]

I'm wondering what government program is going to change population genetics, considering that is a major player in baseline. I'm wondering what is going to change cultural practice, religious observence, obesity, etc.

Didn't I predict it folks? Only Tharkie would attempt to argue that somehow, someway, healthcare access has nothing to do with greater longevity and lower infant mortality.

It's even better than that; he's trying to argue that we Canadians are genetically superior to you Americans, thus explaining our longevity. Until now, I had no idea that we Canucks were the Master Race.

Glory to the Race! May we always rule over American Serfs!

Zor

[Dahak]

That is why Canada left cost plus pricing, that is why the UK went to salaried physicians, that is Germany has copays.

Copay is just a tiny thing...
You pay a maximum of 10€ per prescribed medicine/drug if you're above 18 years, for a total of 2% of your annual income (less if you're chronically ill).

[Surlethe]

Perverse curiosity.

Curious about what? Seeing if you can win by endurance?

Efficiency is not defined by distribution. The most general definition is a measure of the inputs relative to the outcomes. In health economics you have Pareto, KH, X, and Allocative efficiency. Pareto efficiency occurs when no change can be made that improves the lot of one individual without impairing that of another. KH is similar to Pareto except it allows losses by one individual to be offset by gains of another. X is a brute force calculation of what technology and business can do in a completely competitive market. Allocative is defined to be the level/type of production most benificial to society.

You just said the same thing I did in a different way. Efficiency is defined by distribution. Efficiency is:

The property of a resource allocation of maximizing the total surplus received by all members of society.

In other words, the way resources are distributed which maximizes the total surplus in the market. The total surplus is, of course, the consumer surplus plus the producer surplus--and the consumer surplus is:

Consumer surplus [is] the amount buyers are willing to pay (emphasis mine) for a good, minus the amount they actually pay for it ... [It] measures the benefit that buyers receive from a good as the buyers themselves perceive it. (emphasis not mine).

The other types of efficiency listed are red herrings and have nothing to do with my point: that a pure market efficiency is a bad thing because people who are unable to pay are SOL.

Socialized systems can be hideously inefficient, numerous third world systems blighted by graft, waste, and stupidity come to mind.

And, on the other hand, socialized systems can be as efficient as possible while still ensuring blanket medical treatment.

Efficiency is based on willingness to pay, which presumes possession of money. However, in a healthcare system, the people who need healthcare the most are the people who can least afford to pay for it. This renders the definition of "efficient" meaningless in establishing whether a healthcare system is good or bad.

No it means you know nothing about economic efficiency. Efficiency measures the outcomes of how you expend your resources - <snip example>. Socialized countries CONSTANTLY try to improve efficiency. That is why Canada left cost plus pricing, that is why the UK went to salaried physicians, that is Germany has copays.

Of course they're trying to improve efficiency -- efficiency is a good thing, as long as you're not screwing people over.

All efficient means is that you have a good cost/benifit return.

No shit, Sherlock. Efficient means you have a good cost/benefit return where the benefit is measured by the buyer's willingness to pay. This, of course, totally ignores the ability to pay, which means if you're poor, you're fucked.

The nuts and the bolts of are Americans die younger without medical intervention, higher rates of obesity, more violence, more stress ... it all kills. In order to give the average American a lifespan 98% of an non-American simply takes more medical intervention and more costly medical intervention at that.

Why do you think Americans die younger? Is it because of those factors, or might it be because the fucking healthcare system is fucking broken?

Oh please the British explicitly stated they were looking for efficient healthcare. Hell they pegged the value directly at 30,000 pounds per QALY above which it would not be efficient for the public sector to pick up the tab.

Sure. Let's see a reference for this.

Either way, the British are looking for efficiency within a socialized healthcare system, not looking to dump socialism for law-of-the-jungle healthcare.

Every government on the planet undergoes cost benifit analysis of healthcare in order to deliver efficient care. That is why there are restrictions on specialist care, real wage freezes for medical professional.

Really? Governments do cost-benefit analyses?

The problem with an Ayn Rand type healthcare market is people would get priced out of the market. The problem with completely socialized medicine is that you have price ceilings above which it is impossible to offer universal care. The problem with pricing out the poor can be dealt with subsidization of the poor, establishing floor pricing at which the government pays, etc. ... none of which require full socialization of medicine - and most governments are leary of full socialization in any event.

False dilemma. Note I was pointing out we must move toward socialization, not socialize completely. Learn to read.

When I look at efficiency I'm looking at how much is being paid (both internalized and externalized) vs how many lives are saved (that would have otherwise have been lost without this specific decision being made this way). I find nothing henious about optimizing that.

You find nothing heinous about screwing people over because they can't pay?

Frankly I find it harder to continance the low level of healthcare spending in the rest of the world; if socialized medicine IS so much more efficient than the only reason NOT to spend US levels on healthcare and getting even MORE QALYs is because something is more important than saving lives.

And that's your problem. You completely fail to see my point: in that regard, EFFICIENCY IS BAD!!! Socialized medicine is not more economically efficient than free-market healthcare. It just saves more lives, which is why it is better.

[Stark]

Copay is just a tiny thing...
You pay a maximum of 10€ per prescribed medicine/drug if you're above 18 years, for a total of 2% of your annual income (less if you're chronically ill).

Oh shush Dahak: you don't know ANYTHING about European healthcare. Tharkun is the expert, remember?

[tharkûn]

You cannot perform basic math without an authority to appeal to?

Call the presses U of M can officially disband their entire school of public health, no need to do real scientific analysis, every can be answered by simple math

Dollars in Canada are not the same as dollars in the US you need to adjust for wage differences and price differentials. That is but one example of why simple math is BS. It is frigging bad medical practice, as in your ass can be sued, to only use "basic math" to back up medical claims.

Oh wow, I guess Canadians are genetically superior to Americans now?

Fact Canadians have lower incidence of sickle cell allele. Fact Canadians have a lower frequency of Tay-Sach's disease.

Bluntly America began with some some nasty genetic subpopulation and has had far less gentic comingling. All those years of limited gene pools in the hills of Appalachia? Yeah we all know what inbreeding does for genetic health Likewise prohibiting marriage among racial minorities in small areas of the south artificially contracted gene pools. In breeding (multiple cousin marriages) were a fact of life for hundreds of years in isolated communities in the US, it would be amaizing if there weren't less inbreeding and genetic amplification in Canada.

That's really cool. Not supported by anything I've heard, but really cool.

You've never heard of those small communities where nowhere immigrated and they bred within a small population for generations?

And yes, in fact, a stronger public education system, smaller disparities between rich and poor, and better social programs do affect cultural factors such as religious observance and obesity etc.

Okay, so then you conceed that in order to make an accurate comparison of cost effectiveness all the expenditure figures need to revised upward to include the cost of these efforts?

Fine you have other legitimate expenses you are spending the money on besides healthcare, how does this impact the cost effectiveness, considering these things aren't reported in your healthcare budgets?

I'm waiting for you to cite a peer-reviewed paper to explain away the infant mortality deficit.

NOT MY BURDEN OF PROOF. You claimed the infant mortality difference is indicative of superior healthcare, fine prove it. You might start by showing that the reporting of stastistics is the same in both countries, it isn't. You might then look at the likelihood of mothers to belong to elevated risk groups - age, genetics, drug use, etc. And then after you've gotten rid of all the other variances besides healthcare, then you could make a causal claim.

It's even better than that; he's trying to argue that we Canadians are genetically superior to you Americans, thus explaining our longevity. Until now, I had no idea that we Canucks were the Master Race.

You had far less baggage about maintaining racial purity, you had far fewer isolated communities, and I know of numerous genetic conditions tied to the slave trade that never flourished in Canada.

Is that the whole story? Of course not. However whenever you are looking at two geneticly different subpopulations you need to take genetic differences into account. Most commonly places like Japan, Iceland, Greenland, Nepal, etc. have screwy genetics that you cannot ignore. Another common factor is non-random marriage. Ashkenazi Jews are notorious for having unusual genes, as are numerous other religious sects that forbid intermarriage. You cannot simply blithly ignore genetic differences if you are doing real science. You either normalize your two samples - random and big is a good thing, or you control them having equal genetic representation (if an allele is present in 2% of one studied population you want it to be present in 2% of the other studied populations).

That's why Broom is correct that the Japanese have the best breast cancer survival rates, but wrong that it necessarily comes from treatment. Women of complete Japanese descent have better genes in this regard.

Sur:

Curious about what? Seeing if you can win by endurance?

Curios how many excuses Mike will make for not getting peer reviewed data.

You just said the same thing I did in a different way

BS. You defined it as relative to what people are willing to pay. Economics doesn't actually require any form of payment to exist to work. Even in a completely command economy (think North Korea only more so) you still have scarcity of goods and you still can use inputs inefficiently - like say burnding wheat for heat while eating wood pulp for food. No money is required to be inefficient.

Consumer surplus [is] the amount buyers are willing to pay (emphasis mine) for a good, minus the amount they actually pay for it ... [It] measures the benefit that buyers receive from a good as the buyers themselves perceive it. (emphasis not mine).

What is in the "..."?

The other types of efficiency listed are red herrings and have nothing to do with my point: that a pure market efficiency is a bad thing because people who are unable to pay are SOL.

Your point was that I beleive that efficiency should be optimized, hence whatever definition of efficiency you prefer is IRRELEVENT. When you are talking about my position we get to use my definitions.

And, on the other hand, socialized systems can be as efficient as possible while still ensuring blanket medical treatment.

Some socialized systems will be more efficient than some non-socialized systems. I hold that socialized systems tend to be less efficient - they tend to delay capital investment, invest less in R&D, and take longer to implement vital new technologies.

Socialized systems exist because GOVERNMENTS beleived them to be more EFFIICIENT than otherwise providing free medical care for those who cannot afford it and having a private system for those who can. There are exception to this, notably the Netherlands.

Of course they're trying to improve efficiency -- efficiency is a good thing, as long as you're not screwing people over.

In other news water is wet

Efficient means you have a good cost/benefit return where the benefit is measured by the buyer's willingness to pay.

Oh please. You can do cost/benifit returns at any level. The Canadian government routinely does them to see what benefit Canadian citizens get in return for what cost Canadian citizens pay. I hold that at a global level socialization tends to be less efficient; this takes into account differences in wages, prices, regulation, externalized costs, etc.

Why do you think Americans die younger? Is it because of those factors,

Yes. Americans have been dying younger for DECADES. I pulled the data from 1930 to present for the US vs Canada and the Canadians have lived longer long before socialized medicine came on the scene. Given that the effect, Americans die younger, preceeds alleged cause, socialized medicine, I would rather keep the laws of physics than say that Americans die younger because they lack socialized healthcare.

SOMETHING was different in 1930 and it wasn't socialized medicine. Therefore until I see peer reviewed data showing causation I'm going to assume whatever the hell made Canadians live longer in 1930 is still present.

Sure. Let's see a reference for this.

Certainly:

Devlin N., Towse A. Cost Effectiveness Thresholds: Economic and Ethical Issues. 2002.
London King's Fund/Office for Health Economics.

Either way, the British are looking for efficiency within a socialized healthcare system, not looking to dump socialism for law-of-the-jungle healthcare.

Really? That's funny because neither am I. I advocate government subsidization of insurance premiums for those who cannot otherwise afford them. In other words everyone gets health insurance, the poor don't pay for it, the working poor get scaled benifits, and those who can so afford pay premiums in a regulated market.

Why the hell is assumed that everyone who opposed socialized medicine is automaticly an advocate of Ayn Rand capitalism? Is your brain that worthless?

Really? Governments do cost-benefit analyses?

Yes because they value efficiency. Particularly Pareto and Allocative efficiency.

You find nothing heinous about screwing people over because they can't pay?

Read the damn thread first. I support subsidization for those who can't pay. You know if the cost of your insurance premium, food, shelter, clothing, and other necessities of life is greater than your income then the government writes a check to pick up the difference (actually I'm more generous than that, but I don't want to go through this AGAIN).

And that's your problem. You completely fail to see my point: in that regard, EFFICIENCY IS BAD!!! Socialized medicine is not more economically efficient than free-market healthcare. It just saves more lives, which is why it is better.

I'm still waiting for the proof of that. Comparing life expectancies isn't enough - those are too heavily weighted by average age of the population and gender distribution. Comparing life expectancy at birth is better, but that still ignores issues like genetics, obesity, religious observance, cultural practice, etc.

So at this point you have one of two choices you can:
use normalized or controlled data, something no one in this thread seems to be willing to post.

opt for Mike's strategy and claim that all, or at least most, of those factors are the product of things like differing education systems, income redistribution, public awareness campaigns, etc. Therefore one can leave them in the stastistics as de facto dependent variables. The problem here is that it suddenly means all the expenditure data as reported by the government is worthless so any cost effectiveness (saving the most lives for the same amount expenditures - public and private) measures done using the official figures is no longer valid.

If you want to be the first one in thread to provide peer reviewed data showing that with "fairly" normalized data shows socialized medicine saving more lives, then I'm glady await your reference.

[Patrick Degan]

So at this point you have one of two choices you can:
use normalized or controlled data, something no one in this thread seems to be willing to post.

opt for Mike's strategy and claim that all, or at least most, of those factors are the product of things like differing education systems, income redistribution, public awareness campaigns, etc. Therefore one can leave them in the stastistics as de facto dependent variables. The problem here is that it suddenly means all the expenditure data as reported by the government is worthless so any cost effectiveness (saving the most lives for the same amount expenditures - public and private) measures done using the official figures is no longer valid.

Actually, it seems the choices are either to acknowledge the data which has demonstrated quite graphically that the U.S. healthcare system delivers far less bang for the buck than its social-based competitors in the EU and the other OECD countries, or simply be bamboozled by Tharkie's endless handwaving bullshit.

[Surlethe]

BS. You defined it as relative to what people are willing to pay. Economics doesn't actually require any form of payment to exist to work. Even in a completely command economy (think North Korea only more so) you still have scarcity of goods and you still can use inputs inefficiently - like say burnding wheat for heat while eating wood pulp for food. No money is required to be inefficient.

Take the quote in context, asshole.

You just said the same thing I did in a different way. Efficiency is defined by distribution.

Why the fuck do you think we're not talking about a command economy? Because in a free market, distribution, demand drives distribution. We're talking about why the U.S. health care system sucks dick because it is attempting to maximize economic efficiency, which is total cost-benefit analysis, rather than saving lives.

What is in the "..."?

Consumer surplus, the amount that buyers are willing to pay for a good minus the amount they actually pay for it, measures the benefit that buyers receive from a good as the buyers themselves perceive it (emphasis not mine).

Your point was that I beleive that efficiency should be optimized, hence whatever definition of efficiency you prefer is IRRELEVENT. When you are talking about my position we get to use my definitions.

It doesn't fucking matter. Let's take a look at your alternate definitions.

Pareto efficiency occurs when no change can be made that improves the lot of one individual without impairing that of another. KH is similar to Pareto except it allows losses by one individual to be offset by gains of another. X is a brute force calculation of what technology and business can do in a completely competitive market. Allocative is defined to be the level/type of production most benificial to society.

Pareto efficiency: in other words, when the system is at the ethically highest possible point, i.e. where the U.S. healthcare system is not, and close to where Canada's is.

KH efficiency: if someone else wants what you've got, you're shit out of luck, because the "goodness" of the system is zero-sum.

X efficiency: free market, law of the jungle efficiency.

Allocative efficiency: if you're going to die, make sure you do it for the state, to increase allocative efficiency. Big Brother needs you!

Red herrings because using KH, X, and Allocative as indicators is obviously immoral (if you think allocative efficiency is an indicator of how well a healthcare system is working, you're morally bankrupt).

Pareto is where each individual is getting his optimum treatment: the end result of a socialist healthcare system. If you advocate this, you're in no position to argue against socializing medicine.

Some socialized systems will be more efficient than some non-socialized systems. I hold that socialized systems tend to be less efficient - they tend to delay capital investment, invest less in R&D, and take longer to implement vital new technologies.

That's because they're not busy screwing over people who can't pay--in other words, they allocate resources based on need, rather than on ability/willingness to pay.

Socialized systems exist because GOVERNMENTS beleived them to be more EFFIICIENT than otherwise providing free medical care for those who cannot afford it and having a private system for those who can. There are exception to this, notably the Netherlands.

No, socialized systems exist because governments believed them to be better suited for giving the entire public access to affordable health care, as opposed to determining access by ability to pay.

Oh please. You can do cost/benifit returns at any level. The Canadian government routinely does them to see what benefit Canadian citizens get in return for what cost Canadian citizens pay. I hold that at a global level socialization tends to be less efficient; this takes into account differences in wages, prices, regulation, externalized costs, etc.

In a free market, cost-benefit analysis still boils down to willingness to pay. Thus, it ought to come as no surprise that socialization is less efficient: it doesn't allocate resources based on willingness -- hence, as I must keep pointing out, ability -- to pay.

Yes. Americans have been dying younger for DECADES. I pulled the data from 1930 to present for the US vs Canada and the Canadians have lived longer long before socialized medicine came on the scene. Given that the effect, Americans die younger, preceeds alleged cause, socialized medicine, I would rather keep the laws of physics than say that Americans die younger because they lack socialized healthcare

SOMETHING was different in 1930 and it wasn't socialized medicine. Therefore until I see peer reviewed data showing causation I'm going to assume whatever the hell made Canadians live longer in 1930 is still present.

Hmm. What could have been different in the 1930s? Could it have been a ... Great Depression?

Really? That's funny because neither am I. I advocate government subsidization of insurance premiums for those who cannot otherwise afford them. In other words everyone gets health insurance, the poor don't pay for it, the working poor get scaled benifits, and those who can so afford pay premiums in a regulated market.

Why the hell is assumed that everyone who opposed socialized medicine is automaticly an advocate of Ayn Rand capitalism? Is your brain that worthless?

Because, moron, you advocated it. Hasn't it occurred to you that health care is a rival good? Here are some quotes which you stated earlier in the thread:

Yes I know the balance is saving lives. And like all novel medical procedures survival rates take a while to get up to baseline. As long as it is full and open disclosure for the donor about the real risks the medical 'professionals' can stuff it up their ass. Is some one else is willing to take a risk with a benificial expectation value it IS ethical.

When a patient cannot afford basic subsistence and medical bills some type of social safety net is required in a civilized world. The problem comes in rationing. Even if the full US GDP were devoted to treatment I could bankrupt the system with benifical but not cost effective treatments. At some point somebody has to make the hard choice of when is a life simply too costly to save.

Yes because they value efficiency. Particularly Pareto and Allocative efficiency.

And anyone who isn't a shitheaded moron can see valuing Pareto efficiency leads to a socialist system, and Allocative efficiency is immoral.

Read the damn thread first. I support subsidization for those who can't pay. You know if the cost of your insurance premium, food, shelter, clothing, and other necessities of life is greater than your income then the government writes a check to pick up the difference (actually I'm more generous than that, but I don't want to go through this AGAIN).

See above. It looks like you actually don't -- beyond a certain point, if they cost the state too much, you evidently feel it's all right pull the plug. Yep, really moral.

I'm still waiting for the proof of that. Comparing life expectancies isn't enough - those are too heavily weighted by average age of the population and gender distribution. Comparing life expectancy at birth is better, but that still ignores issues like genetics, obesity, religious observance, cultural practice, etc.

Read the damn thread before you ask for any more.

So at this point you have one of two choices you can:
use normalized or controlled data, something no one in this thread seems to be willing to post.

opt for Mike's strategy and claim that all, or at least most, of those factors are the product of things like differing education systems, income redistribution, public awareness campaigns, etc. Therefore one can leave them in the stastistics as de facto dependent variables. The problem here is that it suddenly means all the expenditure data as reported by the government is worthless so any cost effectiveness (saving the most lives for the same amount expenditures - public and private) measures done using the official figures is no longer valid.

If you want to be the first one in thread to provide peer reviewed data showing that with "fairly" normalized data shows socialized medicine saving more lives, then I'm glady await your reference.

Let me say it again: read. the. fucking. thread. Look at the information, and... but oh, wait; you've got that beautiful Wall of Ignorance (tm) up, don't you?
The data posted so far has demonstrated the U.S. healthcare system is inferior in virtually every way to the Canadian one. How hard is it for you to accept defeat?

It's even better than that; he's trying to argue that we Canadians are genetically superior to you Americans, thus explaining our longevity. Until now, I had no idea that we Canucks were the Master Race.

We bow to our masters of the North!

[tharkûn]

Take the quote in context, asshole.

Oh right you can't even say what context is needed and how I was wrong.

Because in a free market, distribution, demand drives distribution. We're talking about why the U.S. health care system sucks dick because it is attempting to maximize economic efficiency, which is total cost-benefit analysis, rather than saving lives.

No in free market economy demand and supply drive distribution. The current US system sucks because it has negative incentives at the low end of the scale, gaping holes above that, and then becomes the best system in the world for those higher up the economic ladder.

<snip useless babbling about efficiencies you don't understand>

Canada makes heavy use of allocative efficiency and pareto when doing their cost/benifits. The British NHS tends to use KH efficiency tests on Pareto analysis in theirs. Most US insurers like X and Medicaid tends to be Pareto. Every country on the planet uses some form of X efficiency when looking medical manfacturing.

You see none of these is inherently evil. You like Pareto efficiency, it is a special case of KH efficiency. KH in turn is allocative with a few more rules. X efficiency is a modification of thermodynamic efficiency. None of them are zero sum (for instance spending the healthcare budget on leeches and eye of newt would be inefficient under all definitions and changing to modern medical practice would be benificial for all persons).

Other fun things. There are MANY Pareto maximums, using that definition and the attendant methodology gives an amost infinite number of local maximums, fully socialized healthcare is not the only optimum. Indeed all and nothing distributions are Pareto efficient; avoiding that outcome is why Canada uses a KH test on Pareto methodology.

That's because they're not busy screwing over people who can't pay--in other words, they allocate resources based on need, rather than on ability/willingness to pay.

No that is because they make demand qausi infinite and are can then only work on the supply side of the equation to moderate price.

Right now women in the UK NEED better breast cancer screening - compared to either the US or Canada. They aren't getting it because the NHS hasn't been ponying up the money to increase early detection rates. In Canada cardiac infarction patients NEED more facilities to perform more aggressive and modern treatment - so their survival rates can increase at least 10% - the provinces haven't been building them (possibly because something else needs the funds more).

People truly need more healthcare than the world could possibly afford, somewhere you have to balance benifit against cost.

socialized systems exist because governments believed them to be better suited for giving the entire public access to affordable health care, as opposed to determining access by ability to pay.

If that were the case then you'd end up with every socialized country following the Netherlands's system. In reality there are dozens of different methods for socialization, from the Canadian model - which price leverages and socialized payment to the British model - which socialized some payments and most supply to hybrids like the Italian model - which socialized a floor function and allows superlative payment.

The UK socialized supply because they thought it would be more efficient. Canada didn't because they didn't think it would be more efficient. Right now the Canadians appear to have better outcomes backing their decision.

It is quite amusing that you hold these absolutes about socialized medicine, given that there are as many theories about how to provide socialized medicine as there are countries providing it.

In a free market, cost-benefit analysis still boils down to willingness to pay.

Only if one takes an Ayn Rand definition of free market. I go with Adam Smith.

hus, it ought to come as no surprise that socialization is less efficient: it doesn't allocate resources based on willingness -- hence, as I must keep pointing out, ability -- to pay.

Go read Equality and Efficiency: The Big Tradeoff by Okun. At a certain point more equility ends being counterproductive.

Frankly I wonder why you don't use your healthcare arguements in other vital goods. Like food distribution, housing, clothing, etc. What is the criterion for when you determine if ability to pay should matter?

Hmm. What could have been different in the 1930s? Could it have been a ... Great Depression?

Considering the trend continues into the 1940's and 1950's (Canada socialized healthcare in the 60's), I would hazard a guess as to no.

Because, moron, you advocated it. Hasn't it occurred to you that health care is a rival good?

It isn't. Parts of healthcare are rival by definition, others are not. Citing specific examples would require you to give a complete definition of what you consider a rival good to be.

My previous statements:
Yes I know the balance is saving lives. And like all novel medical procedures survival rates take a while to get up to baseline. As long as it is full and open disclosure for the donor about the real risks the medical 'professionals' can stuff it up their ass. Is some one else is willing to take a risk with a benificial expectation value it IS ethical.

I was talking about partial liver transplants in which the donor accepts a significant risk so the recipient greatly reduces the risk of death. If a person is fully informed and is willing to accept the risk of donating a portion of their liver, then who are we to say that they cannot risk their life to save the life of a person they care deeply about?

The only time such an operation could possibly be unethical would be if the risk to the donor was greater than the risk reduction to the recipient.

What in hell this has to do with advocating Ayn Rand capitalism is bloody beyond me. The surgery in question is currently being done throughout the world, in both socialized and non-socialized contexts.

When a patient cannot afford basic subsistence and medical bills some type of social safety net is required in a civilized world. The problem comes in rationing. Even if the full US GDP were devoted to treatment I could bankrupt the system with benifical but not cost effective treatments. At some point somebody has to make the hard choice of when is a life simply too costly to save.

Note the italics. I straight up advocate a social safety net, but somehow I'm pusing "law of the Jungle"? Please. There are many medical treatments that are benificial (increase life expectancy for the individual) but are not cost effective; i.e. doing brain scans with every headache because there might be a brain tumor. The benifit is low, but not zero; therefore at some point some mechanism has to step in and say this isn't efficient medicine and the public won't pay for it as part of the safety net. This happens all the time in socialized countries. Right now ISSYS has a dosimeter that allows for more efficient dosing of liquid medicines - fewer mistakes, less waste, and less infection; multiple European bean counters have turn it down because the cost of the dosimeter works out to around 70,000 USD per QALY.

and Allocative efficiency is immoral.

Tell that to those evil Canadians who like to use it when evaluating cost effectiveness.

It looks like you actually don't -- beyond a certain point, if they cost the state too much, you evidently feel it's all right pull the plug. Yep, really moral.

What is the alternative? If by pulling the plug you could afford to save 4 lives that would otherwise be lost? Absolutely. It comes down to the question, "What would be done with the resources they are consuming if we pull the plug"? How much are willing to spend to keep a 100 year old person alive? 1 million per annum? 10 million per annum? 1 billion per annum? At some point the resources that must be invested to keep one man from dying have to come at the expense of many of other men.

I support a floor function that has a basic garuntee and allows people to purchase additional healthcare above and beyond the basic amount if they so chose.

Read the damn thread before you ask for any more.

I've read the damn thread. The only life expectancy stastics presented have come straight from the basic aggregate stastics, they are not sufficient to establish causation.

Look at the information, and... Banging my head but oh, wait; you've got that beautiful Wall of Ignorance (tm) up, don't you?

WHAT information? That Canada has a longer life expectancy than the US? If that is the measure of good healthcare then we can piss on the American, Canadian, British, French, and German healthcare systems ... and all hail the wonder of Japanese healthcare.

Oh wait there are other things we need to look at which show Canadian healthcare to superior to Japan ... the same things we need to look at with the US.

The data posted so far has demonstrated the U.S. healthcare system is inferior in virtually every way to the Canadian one. How hard is it for you to accept defeat?

I have already established what I require, proper scientific data from a peer reviewed source. I'm not going to accept public policy changes on data I would laugh at in a clinical trial.

[Patrick Degan]

The data posted so far has demonstrated the U.S. healthcare system is inferior in virtually every way to the Canadian one. How hard is it for you to accept defeat?

I have already established what I require, proper scientific data from a peer reviewed source. I'm not going to accept public policy changes on data I would laugh at in a clinical trial.

Performance statistics are performance statistics whether you choose to acknowledge them or not; it's not as if this is down to a theory that needs testing but a demonstrated measure over a given period of time. So stop trying to constantly Move the Goalposts if you don't mind.

[Surlethe]

Oh right you can't even say what context is needed and how I was wrong.

You were attacking my definition of efficiency for defining solely as "relative to what people are willing to pay", and leaving out allocation, when in the very next sentence I included the fact that efficiency is defined by distribution.

The current US system sucks because it has negative incentives at the low end of the scale, gaping holes above that, and then becomes the best system in the world for those higher up the economic ladder.

Those discrepencies? Because a free market drives the system, rather than a social health system. And that is why the U.S. system sucks.

<snip bullshit red herrings about efficiencies>

I don't know why I followed those up. They have nothing to do with the argument. The argument is about how and why the U.S. gets its ass kicked by every other socialized nation's healthcare system. Data has been presented. You have ignored it. A priori reasoning has been presented. You have ignored it in favor of pursuing irrelevancies.

If that were the case then you'd end up with every socialized country following the Netherlands's system. In reality there are dozens of different methods for socialization, from the Canadian model - which price leverages and socialized payment to the British model - which socialized some payments and most supply to hybrids like the Italian model - which socialized a floor function and allows superlative payment.

I said nothing about methods. I was talking about results. Learn to read, imbecile.

It is quite amusing that you hold these absolutes about socialized medicine, given that there are as many theories about how to provide socialized medicine as there are countries providing it.

Man of straw.

In a free market, cost-benefit analysis still boils down to willingness to pay.

Only if one takes an Ayn Rand definition of free market. I go with Adam Smith.

You might make more sense if you had a grasp of my argument. Obviously, you don't.

[/list]

[tharkûn]

You were attacking my definition of efficiency for defining solely as "relative to what people are willing to pay", and leaving out allocation, when in the very next sentence I included the fact that efficiency is defined by distribution.

Efficiency in its most basic form is comparison between input and output. In physics a perfectly efficient engine loses zero energy to waste heat - all the input energy becomes output work. There is nothing inherent to efficiency that comes down to willingness to pay. Yes there are measures that use that methodology, however they use WTP as their metric, I on the other hand use QALY and DALY metrics because I don't agree with the WTP system.

Those discrepencies? Because a free market drives the system, rather than a social health system. And that is why the U.S. system sucks.

Those discrepancies exist because the US congress appears to have piss all for ability to design a compotent healthcare system. Instead they have crafted a healthcare plan that leaves a wide gaping hole and the major benificiaries of social healthcare in the US tend to be among the richest members of society.

You advocate telling the morons who designed much of the present crap - here go expand on the 100,000 pages of regulations you've already written and run healthcare for everyone else. I, on the other hand, would like some signs of basic compotency from the government that would run socialized healthcare before they become the first and final arbitrators.

I said nothing about methods. I was talking about results. Learn to read, imbecile.

It is obvious you don't know jack about healthcare economics, the actual methodologies involved, or the math behind them. With the exception of X efficiency all the other efficiencies have multiple optimimums - hence why you can see dozens of different healthcare systems in the world.

I don't know why I followed those up.

Because you want to sound like you have something intelligent to say, rather than simply "me tooing" the points Mike has already raised.

You might make more sense if you had a grasp of my argument. Obviously, you don't.

Wonderful I don't grasp it, but you can't even be bothered to point out which specifics I'm getting wrong.

As far as I can tell you ranted about how my liking of efficiency was evil. I point out four different measures of efficiency in use in healthcare economics and you decide to BS about those. As far as I can tell your entire "argument" is to strawman my position as some type of Objectivist scheme and rant about how immoral that is. To whit you haven't provided any data to back up your point and when pressed to do so you merely point at the rest of the thread. Me too with a twist of strawman. Please feel free to respond with yet another post free of any useful data, orginal points, or actual content.