201. elliot803 - Aug. 3, 1999 - 4:03 PM PT
ranheim:
Most health care experts don't seem to agree with you, since such comparisons are common in the literature on health care reform.
202. ranheim - Aug. 3, 1999 - 5:03 PM PT
I know they don't agree.
Actual experience on the "firing line" excludes one from the category of "expert" when there are bureaucrats present. They KNOW!
203. elliot803 - Aug. 3, 1999 - 5:21 PM PT
ranheim:
I think you will find that most of the people who have done serious research on health care policy and published their findings in reputable journals are M.D.s or others with recognized professional expertise in the field.
204. ranheim - Aug. 3, 1999 - 7:50 PM PT
You, very likely, know more than do I on this subject. Health care policy is a political topic. I have never heard such a discussion between doctors in the recent past. As students, when we knew it all, we had some very un-informed "discussions".
The only policy expert that I have seen on TV (I don't bother reading) is male : Euwe Rhinehardt (that is phonetic spelling from a faulty memory; Ivy League?). I thought he was "pie in the sky" and turned him off.
If it is policy - in health - you wish to discuss, I am the last one you wish to speak with.
I am to the right of Ghengis Khan : I see very little wrong with fee for service. It has been complicated by the government and insurance companies.
Personally, the only health insurance I own is a private policy with the highest deductible that the company allows me. As a self employed individual, I cannot deduct the premium at tax time. Thank God! I have never made a claim on that policy since 1972. Luck!
205. bubbaette - Aug. 4, 1999 - 7:47 AM PT
Insuarance is essentially gambling in my view. When I was in grad school I took the bet that I wouldn't have medical bills above the $210 a month it would take to purchase my health insurance. That gamble paid off. I suspect that most younger and middle age adults would find that they'd come out ahead banking the premiums.
I was fortunate enough not to have a serious accident, a trouble pregnancy, or disease. The medical care I did receive cost more overall than if I'd had insurance because my health care providers and pharmacy have volume-services deals with insurance companies that a sole patient doesn't have. Moreover, their "reasonable and customary" charges that are paid by non-insured patients tend to be inflated because docs know that they'll only get a percentage of reasonable and customary for insured patients -- whether medicare or private.
I'm not an attorney, but I've always wondered about the "price-fixing" aspects of health care charges.
206. Ronski - Aug. 4, 1999 - 9:17 AM PT
Unfortunately, I don't have time to talk today, but should have tomorrow. I do want to say that the real problem with health care in the U.S. is the health status of the inner city poor and other minorities. Health care indices in the Western world are very similar from nation to nation. Health care status for middle class Americans, however, is better than health care status than that of most Europeans regardless of class, and certainly better than that of the Japanese. What brings American averages down are indices for American minorities. Infant mortality among blacks (though declining) is three times infant mortality among whites. One of the most serious problems in public health was the lack of access to health care in inner cities. This is being alleviated through a variety of ways (including the rapidly expanding number of physicians and the growing use of nurse-practitioners and physicians assistants as licensed providers).
But one thing remains as a serious obstacle: a lingering cultural bias against seeking health care among the poor and, more importantly, making the changes in life style necessary to cause that access to care to be of any good. It drives some advocates for the poor nuts to hear this said, but probably the biggest problem in American public health is the continuing lack of compliance to treatment regimens and healthful habits by the poor. It is, therefore, important to continue the current focus on educating the poor to take advantage of the health care that is available to them from medical centers, charitable organizations, and public health clinics. The most fertile area for improvement is with pre-natal care. Many poor women respond very well to educational outreach when it is explained to them how pre-natal care is for the good of the baby. But socialized medicine is not a solution to this problem.
207. Ronski - Aug. 4, 1999 - 9:22 AM PT
Re: Message #205 --
That is exactly what insurance is, gambling. But it can also be said that not having insurance is gambling with your life.
And "price fixing" or some version of it is an inevitable occurrence in a third-party payer system, in other words, in the kind of health care we have had as a nation since about 1950.
208. elliot803 - Aug. 4, 1999 - 9:44 AM PT
Ronski:
"Health care status for middle class Americans, however, is better than health care status than that of most Europeans regardless of class, and certainly better than that of the Japanese."
I find this highly unlikely, for comparisons between equivalent "classes" in the respective populations. The statistics I have seen show that Europeans and Japanese score higher than Americans on health indices for all socioeconomic levels. And this despite the fact that the U.S. spends substantially more per capita on health care than Europe or Japan.
"What brings American averages down are indices for American minorities. Infant mortality among blacks (though declining) is three times infant mortality among whites."
Blacks only comprise about 12% of the U.S. population, so even a much higher rate of infant mortality amoung blacks does not affect the overall national rate very much. Yet the national rate is substantially higher than that of other countries.
"But one thing remains as a serious obstacle: a lingering cultural bias against seeking health care among the poor and, more importantly, making the changes in life style necessary to cause that access to care to be of any good."
No, it's not "cultural bias" it's the fact that many poor Americans DO NOT HAVE HEALTH CARE COVERAGE. Even where state and federal programs do exist, the coverage they provide is often so limited, and the eligibility requirements so convoluted, that many poor people who are covered under such programs do not know they are covered or do not know what coverage they have. In Britain ANYONE can go to any health care facility and know that they will receive medical care without being given some huge bill for it. That's the crucial difference.
209. elliot803 - Aug. 4, 1999 - 9:48 AM PT
Ronski:
"But socialized medicine is not a solution to this problem."
You keep using this phrase "socialized medicine." What does it mean? Do you mean universal coverage? Or do you mean a single (government) payer? Or do you mean a system in which both health care funding and delivery and directly controlled by the central government? Or what? Is Britain's NHS "socialized medicine?" Canada's Medicare system? France's mandatory insurance system? Japan's?
210. elliot803 - Aug. 4, 1999 - 10:04 AM PT
If voluntary private health insurance or fee-for-service is superior to mandated universal coverage, why has every industrial democracy in the world except the U.S. abandoned the former in favor of the latter? And why have none of these countries gone back to a voluntary private scheme? And why isn't there even any significant political movement in any of these countries for abandoning universal coverage? And why is the U.S. moving in the same direction (albeit slowly)? And why is Medicare--the U.S. government's program of "socialized medicine" for the elderly--one of the most popular government programs?
211. Ronski - Aug. 4, 1999 - 10:36 AM PT
elliot,
Very good questions. And they deserve more of a reply than I have time for right now, but suffice it to say for the meanwhile that universal health care grew out of several things: an extension of the very legitimate role of government to ensure the public health by controlling easily communicable diseases (the Typhoid Mary syndrome); and the vast appeal of collectivism in the middle part of this century, basically sold to the masses as the promise that they will get something for nothing.
Repeal of these systems is not on the horizon because people are understandably reluctant to give up something that they think they are getting for free. A recent poll (Fox) indicated that 50 % of Americans think the U.S. Government has money that did not come from the taxpayers, which shows the abiding ignorance abroad in the land on the simplest of economic matters. In Europe, people these days aren't any savvier.
Nevertheless, Europe, Canada and Japan have, in the past few years, been cutting back on the health care services they had promised through their nationalized plans. They can no longer afford them.
I do not think we should move in the opposite direction Europe is travelling. We shouldn't make the mistakes they made in the first place. We would eventually only have to cut back the way they are doing. Just as we did with welfare.
212. elliot803 - Aug. 4, 1999 - 10:51 AM PT
Ronski:
"Very good questions. And they deserve more of a reply than I have time for right now, but suffice it to say for the meanwhile that universal health care grew out of several things: an extension of the very legitimate role of government to ensure the public health by controlling easily communicable diseases (the Typhoid Mary syndrome); and the vast appeal of collectivism in the middle part of this century, basically sold to the masses as the promise that they will get something for nothing."
Well, if this embrace of "collectivism" was a mistake, why have these countries not reversed themselves? Britain adopted the NHS in 1944. Canada started Medicare in (I believe) 1972. Other countries have had mandatory univeral coverage for similar lengths of time. And NOT A SINGLE ONE has decided to go back to a voluntary private scheme. Doesn't that fact represent OVERWHELMING evidence of the superiority of their systems over the American one? Sometimes, in some places, voters act in haste or poor judgement and do something that is against their best interests, but when every single advanced democracy in the world except one embraces universal coverage, and none of them show the remotest sign of abandoning it after decades of experience with it, that's rather compelling evidence that it's a better way to organize the provision of medical services than the alternative.
"Repeal of these systems is not on the horizon because people are understandably reluctant to give up something that they think they are getting for free."
They don't "think they're getting it for free." It's paid for by taxes. People know this. Your argument, as libertarian arguments so often are, is anti-democratic to the core. What you're saying is that the people are incapable of deciding what is in their best interests.
213. Ronski - Aug. 4, 1999 - 11:04 AM PT
Anti-libertarian? Heaven forfend!
People are capable of making decisions based on the information they have. If half the public thinks it is getting something for nothing, the public schools have perhaps played a role here, another example of intrusion into the natural scheme of things by the state, in this case for the furtherance of the state.
But people are not entirely stupid, either. The economic lower half of the population pays considerably less in taxes than the upper half. For people who are less productive, soaking the rich is, regrettably, an attractive option, given that so many people no longer accept the notion that they do not have a right to that which is not their own.
214. elliot803 - Aug. 4, 1999 - 11:24 AM PT
Ronski:
"Anti-libertarian? Heaven forfend!"
No, I said "anti-democratic"--meaning the idea that people are incapable of deciding what is best for themselves.
"People are capable of making decisions based on the information they have. If half the public thinks it is getting something for nothing, the public schools have perhaps played a role here, another example of intrusion into the natural scheme of things by the state, in this case for the furtherance of the state."
So is it your claim that the only reason for the existence of public schooling in all advanced democracies, and the existence of mandatory universal health coverage in all except one, is that the people in all of these countries have been DUPED (and for periods of DECADES)? Or are you saying that voters are just naturally unable or unwilling to acquire the information they need to make the proper decision? Do you know that saying by Lincoln about the limits on fooling the people?
If you really believe that democracy is so fundamentally corrupt that every single advanced democratic government in the world has fooled its people for so long in such a basic way about such important issues as health and education, or so fundamentally flawed that people simply cannot make the right choices for themselves on these matters, why do you support it at all? How do you ever expect the "right" choices (i.e. the ones you favor) on health care and education to prevail under such a flawed form of government?
215. PsychProf - Aug. 4, 1999 - 11:45 AM PT
As I see it, most want superior health care and first rate coverage for "cheap prices"...this can't happen unless personel/industries are underpaid, or tax dollars subsidize the expenses. Choose your poison. Choose your price.
216. Ronski - Aug. 4, 1999 - 2:12 PM PT
elliot,
I can't answer all your questions right now, but I will say that I do not believe that democracy is corrupt, only corruptable, and even then amenable to being repaired.
That said, I believe that there is a tendency in democracies for people to vote themselves access to the public treasury and to other people's money (see the Athenian republic), and that vigilance is the price of liberty, effeciency, and morality.
217. elliot803 - Aug. 4, 1999 - 2:33 PM PT
Ronski:
The basic idea of democracy is self-government. That is, decisions about what the government should and should not do for the people are best made by the people themselves. If the people decide that the government should guarantee access to comprehensive health care for all citizens (i.e., mandatory universal coverage), who are you to say that they are wrong? I'm not saying that voters don't sometimes make the wrong choices, choices that they later come to regret and reverse. Of course that sometimes happens. But when EVERY mature democracy in the world decides that government-backed universal coverage is the way to go, and gives no indication of reversing that decision after decades of experience with it, it's wildly implausible for you to claim that all these people in all these countries for all these years on a such a basic matter have been just been fooled into doing something that is against their better interests. The desirability of mandated universal coverage over voluntary private insurance is pretty much as close to being a settled issue as anything can ever be in a democracy.
218. ranheim - Aug. 4, 1999 - 3:01 PM PT
I think most of you know that I have no use for democracy. This country was founded as a republic. That I believe in. A democracy is a "mobacracy" - and that quotes many of the founding fathers. The problem with democracy in my view is that it takes only 50% of voters PLUS 1 to force their will on the remainder; no matter what their decision is. That system is not for me. Take Switzerland for example : if the canton one lives in votes for (you put in your selection) and you don't like it, move to the canton next door. That is not possible in the USA. I have to obey those nine (9) lawyers in Washington, D.C. that wear high school graduation gowns. (The Supreme Court).
Getting back to medicine. Someone who knows more history than I may care to look into this. Seems to me that WW II had a great deal to do with the current state of medicine; both the practice of medicine and the way the government of that country manages same. Up to sulfa (mid 30s) and penicillin (late 30s) doctors did a lot of holding of hands; very little practice of medicine. Antibiotics had an immediate effect on war wounds. After the war, it had the same positive effect on chilhood health and allowed surgeons to be more agressive in all the surgical sub-specialties. (Because the doctor could now treat infections - prior to the war, he could not.) As the European world was so much rubble at the end of the war (plus all of Europe was broke), did this condition lead to a collective answer for the delivery of medicine? While in the relatively unscathed USA, an entirely different system evolved. I don't know enough history to say whether this a possibility - or not.
219. elliot803 - Aug. 4, 1999 - 3:36 PM PT
ranheim:
What proposals do you have for improving American republican democracy? Your post implies that you would abolish the Supreme Court (which raises the question of who would then have the final authority on issues of constitutional interpretation). You also don't seem to understand the Swiss system. Yes, the country is divided into semi-autonomous cantons, which are analagous to U.S. States, but they are subordinate to the Swiss federal government, just as the States are in the U.S. But this is all off topic anyway and should probably go to the U.S. Politics thread.
220. ranheim - Aug. 4, 1999 - 4:05 PM PT
I cannot intelligently discuss policy matters. As an M.D., I was all science and math. I do read a good deal of history; but, no political science or sociology. Plus, I have lived 60+ years and one has to learn something - if even by osmosis.
Off thread I know - but, recently (past 2 years) didn't the "federal" government (is it in Bonn?) pass a tax? And the cantons voted it down - and in a huge hurry. I don't have a clue as to how the central capitol splits power with the seperate cantons. But, the cantons prevailed.
221. tmachine - Aug. 4, 1999 - 9:22 PM PT
I've had to read through this thread rather hastily, but I'm sure I won't be the only person to point out that the chief single drawback of being a voluntary paying consumer of medical care, in terms of the market, is that--unlike other areas of the market where consumers exercise judgment about the best way to spend their money--in medical care the consumer has no (or usually very little) idea about how to spend the money. Doctors or hospitals or technicians or insurance companies tell us what they think has to be done and what it costs. We have to rely on, at best, a second opinion. This is an inescapable reality. So our "consumer" judgment is largely meaningless.
This is frequently exacerbated by the fact that we often have to consume medical care under circumstances where we have NO control at all. Last January my son was bullied at his public high school in the Bronx, knocked down exceedingly hard onto packed snow in the playground during a snowstorm. The school nurse called me at work to say he was in a lot of pain and could I come and get him to take him to the emergency room or a doctor. We live on the other side of New York City from the school and I knew it would be terrible and take far too long to take my son home on the subway if he was hurt, so I had to take the subway myself back to Brooklyn to get our car (my husband was unavailable). When I picked up the car 40 minutes later I phoned the nurse, who said Sam was so miserable she had called an ambulance and sent him with someone from the school to the local hospital, Montefiore, which is about ten blocks from the school. I drove to the hospital, waited with Sam, saw him through examination and X-ray, waited for results (happily, bad bruises only, no broken ribs or injured spleen), talked to the resident, and drove Sam home. He was at the hospital for about five hours.
222. tmachine - Aug. 4, 1999 - 9:24 PM PT
We didn't have his insurance card with us, but I told the hospital what the HMO was (Aetna/USHealthcare) and they gave us a preliminary bill.
To cut a long story short, after I had submitted a letter with the bill to the insurance company, it took me and my husband about ten hours of explaining and/or yelling to get the hospital (who were mostly fairly friendly and cooperative) and the insurance company speaking to each other sufficiently to get the latter to pay the former (about $400 or $500 total). Much later we suddenly received a $330 bill from the NYC fire department for their ambulance services. with more phone calls, we got them to submit it to Aetna/USHC. A couple of days ago we got another bill from the fire department for about $120. Apparently Aetna/USHC had determined that they were only liable for two-thirds of the ambulance bill. When my husband phoned yet again to point out that sticking us with an emergency bill for an expense over which we had absolutely no control was a bit much, Aetna/USHC suddenly decided that in fact they would pay for another $85 or so, leaving us with a kind of copay of about $35. We wait to see whether this will in fact happen (seven months after the actual incident, of course).
I retail this long story mainly to point out that as a middle-class, theoretically insured health care customer, I have had unbelievable amounts of hassle, evasion and trouble with my insurer, in the kind of situation where I have no means of deciding how, or whether or not, to spend my health care dollars differently. Obviously with a kid who's not bleeding or otherwise seriously injured, it would have made an awful lot more sense to take him to the hospital in a taxi, for $5, instead of a fire department ambulance for $330. Equally obviously, in the circumstances nobody could make that decision. We were stuck.
223. tmachine - Aug. 4, 1999 - 9:26 PM PT
Apart from having to pay whatever balances the insurance company didn't pay, my husband and I probably spent at least ten of our own working hours (which I would estimate at $100 an hour) haranguing the insurance company workers on the phone, so $1000 of our time was added to our monthly family premium of almost $700.
I would definitely take an emergency room ambulance trip and visit in National Health Service Britain (where I grew up) over this experience. And I don't think paying for it out-of-pocket because it's not a catastrophe is the answer either. At $800 or $900 a time, it wouldn't take more than one or two of such incidents or accidents (which are the most likely kind of hospital visits when you have three kids) to start landing one in serious financial trouble.
224. CalGal - Aug. 4, 1999 - 10:55 PM PT
Actually, I believe that catastrophic coverage of the *real* sort--not the HMO variety--does include ambulance and hospital fees. At least it does on Blue Cross. IOW, the hassle you experienced was HMO hassle, not insurance hassle per se.
To me, in reading your story, my first reaction is that I would have killed that damn nurse for calling an ambulance. You told her you'd be on your way. Calling an ambulance and going to an emergency room is what cost you all that money--and he had to wait at least as long as it took you to show up, so there really wasn't any difference in *where* he waited. And I imagine the nurse's office was more comfortable than the emergency room. So I probably would have submitted any bills to the school and at the very least given them some serious shit.
Too many people are operating under the mindset that the medical costs are going to be paid by someone else. (I'm not referring to you, but the school).
So in some cases, it would be a true emergency. In other cases, the school procedures would be changed to deal with the fact that they can't go around ordering ambulances unless the situation is an emergency.
And in some cases, it would be a bad medical year and the money would be forked out--and deducted at tax time.
I'm glad your son is okay, and I hope the bullies were punished.
225. ranheim - Aug. 5, 1999 - 5:26 AM PT
#221
I know nothing about car repair. After nearly 40 years in medicine I am still marveling at how well the human body works; and when "sick", repairs itself. Seems to me that machines - all of them - give more trouble than does the body.
I feel as lost taking my car for repair as you do going to a doctor or hospital. (I am that odd male : I have never liked an automobile/or trying to be Mr. FixIt). Life in the USA seems to have become as sub-specialized as is medicine. Just look at TV ads (isn't that a degrading thought?) : there is an ad to change your oil; there is an ad to change you muffler; there is yet another ad for your tires; for your transmission; and on and on.
Possibly the lawyers would like a word, but, my feeling is that "laymen" will always choose an ambulance over a taxi due to the possibility of a law suit. A patient of mine had a heart attack. A "clot buster" was given locally and then he was put on a HELICOPTER for the 1+ hour trip to Houston (his choice for further evaluation). As he was in stable condition, nothing was done in Houston for apporximately 12 hours. I asked "Why the helicopter?" And his reply was "My wife wanted to drive me; but, they refused to permit this! They insisted on a helicopter." A word of advice for you non-medical people - sign out "ama" (against medical advice). Then do what you deem appropriate! As a physician, I am NEVER asked about transportation from point to point; that is the purview of either nurses or administrative types.
226. bubbaette - Aug. 5, 1999 - 5:45 AM PT
Ranheim
My darlin is a mechanic, and I expect he gets the same sort of thing that Docs get in social situations -- comparative strangers wanting him to diagnose their vehicles and do repairs on the spot. Not too long ago, hubby was in the dentist's chair when the office water pump went out. The dentist wanted him to low crawl the building and repair the pump as if it were the most natural thing in the world.
But unlike Docs, most anybody can call himself a mechanic. There are a number of "mechanics" working in repair shops that don't know a carburator from a radiator, but are willing to charge you by the hour and sell you parts you don't need.
227. tmachine - Aug. 5, 1999 - 7:56 AM PT
Calgal--to let the nurse off the hook a little: (1) Sam was really in pain, and at that point we had no way of knowing whether he had done some real damage, e.g., to his spleen. (2) It was the middle of the worst snowstorm we had in NYC all winter, so for all she knew I'd have a tough time getting there. (3) legally, she HAD to call an ambulance--anything else and she and the school would be liable if it went wrong. (4) the New York City school system is one of the biggest bureaucracies in the country. do you have any idea what trying to take it to court would be like or how long it would be before we saw any money? frankly, taking it on would be the only thing that could make arguing with insurance companies seem easier. (5) the school did a pretty thorough investigation, and the chief bully, among other things, had to apologize publicly to my son.
ranheim: see (3) above re taking the taxi. I personally would have picked the taxi without hesitation; but much of the point of the story I told stems from the fact that the decision about the ambulance had to be made WITHOUT my involvement. I'm the kid's mother; I could have decided what to do; but I was in transit and unavailable to be asked. So the nurse had to pick the legally safe way.
Also, when it comes to cars I can at least read Consumer Reports to check up on the reliability and repair records of different brands. When you're going to the emergency room there isn't even that level of knowledge.
228. HardyHarHar - Aug. 5, 1999 - 10:27 AM PT
elliot803 - Aug. 3, 1999 - 3:25 PM PT
Hardy:
"But you are making the mistake of assuming that you have selected the proper indices for evaluating the overall quality of health care."
I'm using the ones health care experts use. Presumably, they have a better idea of which indices are the best measure of the general quality of health care than you do."
How come? What makes this study a monolith? Who are "they" and what makes "their" opinions (as expressed in their study design) important at all?
Elliot803, just because someone publishes something doesn't mean a) they know much about what they're studying, b) they don't have an agenda, c) they have good methodology, d) they know what they're doing. Further, because the authors thought that certain indices were of significance is itself meaningless. What was their study rationale, or were they just grinding out another "me-too" study?
So, lets look at one of their indices for health: Infant Mortality.
Its useless to discuss infant mortality without breaking the numbers into stratified rates:
Standardized Mortality Rates,
Age Specific Mortality Rates,
Proportional Infant Mortality and the
Proportional Mortality Ratio
Further, everyone has their own neonatal scoring system for assessing sickness and health, one is CRIB (clinical risk index for babies) which is scores for:
Birthweight
Gestational age
Max & Min. fraction of inspired oxygen
Max. base excess during first 12 hours
Presence of congenital malformations
Also, what were the study centers? Are they tertiary referral hospitals? Secondary? Are these cesarean deliveries? What are the stratifications for mothers who made pre-natal visits? Mothers who didn't? Mothers whose pregnancies were planned? Mothers whose weren't? Did they stratify by education level? Income? Race?
229. HardyHarHar - Aug. 5, 1999 - 10:27 AM PT
Did the authors do small area analysis of the regions within countries? (there is significant variability within regions of the US alone, in the methods and treatment.)
Oh, and since we're talking health insurance here: what was the payor mix in this study? Did the authors pool patient populations that had government insurance and private insurance? And the people who were uninsured?
"Perhaps you ought to stick to peer-review journals rather than Scientific American?"
"Well, the Scientific American piece is based on peer-reviewed health care research. Since you have presented nothing at all in the way of substantive support for your own claims, your criticism seems misplaced."
What is it based on? Where did it first appear, then, and when? Who were the peers that reviewed it?
Basically, the study you cited is meaningless without the other pieces of information. And, as an indicator for the overall quality of health care in the US, it isn't even relevant.
"All they've evaluated is the quality of access to care."
Sophistry. If you can't get access to care, then the quality of that care doesn't matter."
BULLSHT, just because you can't get a table at the best restaurant in NYC doesn't mean they don't have the best food.
230. HardyHarHar - Aug. 5, 1999 - 10:28 AM PT
"197. elliot803 - Aug. 3, 1999 - 3:31 PM PT
Hardy:
"If you compared the quality of life adjusted years for Americans with health insurance to the quality of life adjusted years for Germans with health insurance, you'd be singing a different tune."
Well, if you select a subset of the American population that receives the best care and compare it with the average or typical European, you may find that the American group receives better care, but that doesn't tell you much about the overall quality of the respective countries' health care systems, because you're not comparing like with like. You seem to be saying that because *some* Americans may receive better care than most Germans, the American system is superior overall, and that just strikes me as nonsensical."
It's all about subsets, that is all that matters!
If Germany, or some other country, has a national insurance scheme, you have to stratify in order to compare the various populations. There is no comparison between such disparate groups.
I'm saying that Americans with private insurance have better access to health services, and that the health services they have access to are superior, to what the German citizen with private - and - government, insurance have. This goes for other countries (Britain, Canada, France.)
231. HardyHarHar - Aug. 5, 1999 - 10:28 AM PT
Elliot803:
"Well, if this embrace of "collectivism" was a mistake, why have these countries not reversed themselves? Britain adopted the NHS in 1944."
I found one study that states that private medicine has been growing rapidly in Great Britian, a trend the author says indicates dissatisfaction with the National Health Service (NHS). Spivak (Wall St J [Midwest Ed] 1979 Aug 21;59(216):14) notes that even when free medical treatment is available, citizens will pay for a private room, quicker treatment, and the chance to choose their own physicians and hospitals. Membership in private health plans has increased 15 fold since the inception of NHS. These plans are adding over 100,000 members a year so that the private sector now accounts for about $550 million, or 2-3% of Britian's annual outlay on medical care. The author attributes this trend to three factors: (1) private medicine is now generating enough capital to finance a substantial expansion of its own facilities; (2) deterioration in NHS; and (3) the low price of private health plans.
So, which is it? It the British NHS superior? Or just another example of a lame British insitution kept alive past its usefulness?
And this, from (CMAJ 1996 Feb 1;154(3):378-81) :
"Health care: public, private or both? In Great Britain, about 13% of the population is covered by private health insurance, and everyone else is served by the public health care system known as the National Health Service, or NHS. Caroline Richmond, who examined the impact of private medical practice in Britain, says people become private patients for one compelling reason: to avoid the NHS's notoriously long waiting lists for surgery. According to Professor Alan Maynard, a health care researcher, the mainstays of the private sector are the "three h's" --hips, hernias and hemorrhoids--
232. HardyHarHar - Aug. 5, 1999 - 10:29 AM PT
along with some elective surgery, particularly in gynecology and opthalmology. Another small sector focuses on fertility regulation and cosmetic surgery. Although the levels are not monitored closely, physician consultants are not permitted to earn more than 10% of their income from private practice."
Or this tidbit, from (Aust Health Rev 1995;18(1):28-42):
"In April 1991 the reforms of the United Kingdom National Health Service (NHS) established an internal market, separating the roles of purchaser and provider, established new provider organisations (NHS trusts) and initiated the general practice fundholding scheme, where practices of a given minimum size could opt to manage their own budget. This paper reviews the experience so far and outlines recent developments. It concludes that it is difficult to assess whether, overall, the benefits of the reforms outweigh the costs. This is primarily because of a failure to undertake formal evaluation, either before the reforms were implemented, or since they have been implemented. Also, there have been a number of other changes over the same period, including an increase in funding of the NHS. However, two impacts can be identified. Firstly, there has been a shift in the balance of power from secondary to primary care. Secondly, there has been a growing realisation that very little is known about the costs and effectiveness of health care interventions, whether provided within a market-based system or not.
In other words, the NHS you hold up as a model isn't even the thing you thought it was, anymore and researchers in the know readily admit that they don't have a firm grasp of the systems effectiveness to begin with.
233. HardyHarHar - Aug. 5, 1999 - 10:33 AM PT
The long and short of it is this:
How good a health system is depends on what is important to "you."
To me, availability of surgery, when you need it, and the most advanceed techniques and materials are what matter to me.
My wife is pregnant at the moment so yeah, infant mortality does matter but I view the health of a baby (unless genetic or environmental sequalae are at play) as more a funciton of the health-habits of the parents than the health of the system.
234. HardyHarHar - Aug. 5, 1999 - 10:33 AM PT
Off for the weekend....
235. CalGal - Aug. 5, 1999 - 3:10 PM PT
TMachine,
Understood about the nurse; I shall absolve her. Also understood about the bureaucracy. I'm now aiming my sites at the bullies' parents.
Still, I think the point is that these issues can be resolved procedurally in many cases, leaving the occasional "ouch" bill when nothing was wrong but you had to pay.
Making medical decisions is *always* going to be on us, the consumers. We don't have as much ability now because the proliferation of HMOs have changed the landscape. And back before HMOs, the tendency was to blithely let the doctors do they wanted, regardless of the cost. Which is what caused employers, fed up with the high costs, to seek out HMOs.
It will probably be tough for some people to have to make their medical decisions. There will probably be insurance policies and health care offerings that spring up to spare these people the need to do so, were we to move to The CalGal Plan.
236. msgreer - Aug. 8, 1999 - 10:14 AM PT
Floria doctors who have "shady backgrounds" are about to get dragged into the sunlight, thanks to commendable efforts under way at the state Department of Health.
This month, the department began mailing out fingerprinting cards to 60,000 physicians, podiatrists, osteopaths and chirpractors under a new state law. The cards will enable the state to conduct national background checks to determine if doctors have criminal records elsewhere.
237. msgreer - Aug. 8, 1999 - 10:19 AM PT
cont.
With this month's mailing, fingerprintining will become a regular part opf the licensing process for doctors. Previously,doctors were required to report criminal convictions themselves - a system that, in several high-profile cases, allowed people with "checkered pasts" to move to the Sunshine State and resume practicing medicine.
The Department of Health also is posting information about doctors on the Internet. (www.doh.state.fl.us/mqa; click on "Practioner Profiling" and follow the directions.) Patients can lookup a doctor's address, educational background and professional training
238. msgreer - Aug. 8, 1999 - 10:23 AM PT
cont.
as welll as records of disciplinary action and criminal convictions, if any.
The listing is not complete yet, but, if state health officials follow through on their pledge to make it comprehensive,the site will become a valuable tool for consumers statewide. Officials say the records are added to and updated daily.
Florida is believed to be one of only two states to launch fingerprinting and profiling projects. Massachusetts ls similar programs.
It unfortunate that these efforts have become necessary, but - given the rapid growth of the health-care industry in Florida and recurring accounts of fraud and abuse it's imperative for state officials to take steps to protect patients from doctors who have something to hide.
239. msgreer - Aug. 8, 1999 - 10:29 AM PT
WELL... being a medical advocate i have no problem with this.
EXCEPT how about extending this to nurses and aides and pulmonary techs and anyone who will come in contact with a consumer.
hell, their have been aids working in nursing homes in florida who have raped elderly men and women.
they have been psych techs would have brutally raped and or beaten the mentally challenged housed in our state's facilities.
and when some get off their ass and looks into these offenses these health care workers have
shady" backgrounds themselves. some are convicted criminals who have come to florida from other states.
i am a nurse and i say check everyone. it is not only doctors.
if florida really wants to protect the consumer they will take this fingerprinting and profiling a step further.
240. bubbaette - Aug. 9, 1999 - 5:04 AM PT
Ms. Greer
I've heard some horror stories about home health care nureses, too.
Virginia recently required that a health profession licensing web site for docs as well. I don't know whether it's up and running yet. But I believe it's limited to M.D.'s as well.
241. ranheim - Aug. 9, 1999 - 5:24 AM PT
I had not heard of finger-printing of M.D.s previously.
If it had been presented to us seniors in medical school as a part of becoming a LICENSED doctor (in addition to those 4 days of testing), I doubt that any of us would have had a second thought. (None of this had anything to do with successfuly graduating from my medical school. That was a seperate necessity!)
In that context, it is just a "hoop" that one must jump through.
242. allaneq - Aug. 9, 1999 - 5:14 PM PT
Existing Fraygrants;
We would like to invite you to try the new Fray, currently available in beta here. You should notice some significant changes, and we encourage you to read the FAQ available in the Fray Beta thread, if you have any questions. Over the long-term, Slate is working to provide a way let our readers provide feedback to the editors, and to build more of a sense of community among our readers. We hope that the newly redesigned Fray is a step in that direction.
You'll notice that the new Fray is structured around Slate itself, with a thread per department. After the beta is complete, you will be able to easily post feedback to an article, using a simple link at the bottom of each page. As the reader comment is added to each department's thread, we will select the best posts from each thread in the Fray and posting links to them at the bottom of the article itself, for other Slate readers to peruse and comment on. We have also made a Tech Support thread available here, and during the beta test, you can post your comments, complaints, or bug reports in our beta test thread, available here. Take a look around, test the waters, and let us know what you think.
Thanks,
Wes Miller
Program Manager
Slate Magazine
243. ChristinO - Aug. 10, 1999 - 11:16 AM PT
Sorry to interrupt, but with the death of the Fray I wanted to get this out there: I am now registered at both Suite101 and Salon's Table Talk as ChristinO.
You can reach me by e-mail at Cocuddehy@hotmail.com.
I will likely be changing my log-in ID and e-mail address but I'll let folks know before I do it.
I'll be around here until the bitter end to see everybody, but I look forward to romping with you all in other pastures in the near future and just wanted to let everyone know where I was.
244. allaneq - Aug. 10, 1999 - 4:00 PM PT
Greetings. A few quick notes/updates on the new Fray.
1:We're going to remove the host address in the new Fray this afternoon, and it should be reflected by tomorrow morning at the latest - so, you can post in complete privacy.
2:I'm looking into populating the username with your Slate login.
3:Several people have commented on the "delayed post" issue, and that the message which says it takes 2 minutes to show up.
This isn't technically true. It's actually 30 seconds. Why? Because the new Fray uses a very different (non-database based) architecture, so it should be more reliable under high server load, and faster.
Technical stuff out of the way...
First off, I apologize that the new Fray wasn't what you all had hoped for. The _last thing_ I had in mind while working on this feature was isolating/expunging our existing users. In fact, the primary goal was actually to get MORE interaction, and MORE of a community feeling going in the Fray. In fact, we wanted to have the beta _for_you_all_, and our hope was soliciting some great feedback _from_you_.
Secondly, our updates to/through our Tech support team should have been much better before the beta. I'll make sure that in the future, we keep Slate's reader community apprised of our goals and objectives as I can.
Tomorrow, I'll be creating a new general interest thread in the new Fray, which will be open discussion on any topic.
I'd really like to take this opportunity to invite you all to the new Fray, and tell you that I hope you will continue to participate in Slate's user forums. If you have concerns or issues, please post them in our beta feedback thread here - I WILL be watching for your feedback!
Thanks,
Wes Miller
Program Manager
Slate Magazine
245. ranheim - Aug. 11, 1999 - 3:52 PM PT
I thought that this thread had possibilities.
If the Fray can be saved, am I the only one who would like to see this discussion continued?
246. stamper - Aug. 11, 1999 - 9:25 PM PT
ranheim
you and i never spoke but i enjoyed reading your thought on the Educational Thread and think you had a lot of good things to say no matter what the topic.
247. msgreer - Aug. 12, 1999 - 4:42 AM PT
ranheim/hardy harhar
i have enjoyed your posts very much. i am very sad the fray is closing but feel very strongly about continuing a health care thread somewhere.
this is just too important not to get the information out.
i have never given specific advice to fraysters regarding their individual medical issues on this or any thread. i do not give medical advice over the fray.
but i think i helped jenerator and marsharme when they had an emergency situation awhile back.
i volunteer to discuss any issues with any fraysters after the fray goes out for good on the 23rd.
as i work everyday as a medical advocate/consultant perhaps i can be of help. if nothing else i can listen.
feel free to email me at msgreer@home if you want to discuss problems you or your family maybe having in the medical system.
i just want fellow frayster friends know this is an area that is near and dear to my heart.
i don't want to lose touch when it comes to the medical/insurance maze each of us goes through everyday.
remember i work as a medical advocate/consultant. if anyone has questions or concerns in this area please feel free to email me and we can discuss them
248. HardyHarHar - Aug. 12, 1999 - 9:45 AM PT
Yes, it was a fun little thread, I wish it were here to stay.
Salon has a lot of health-related discussions going on at the moment, perhaps we'll run into one another there?
249. msgreer - Aug. 12, 1999 - 10:29 AM PT
hardy harhar
perhaps we will.
250. Ronski - Aug. 12, 1999 - 12:11 PM PT
Health care is a major issue for me as well. Hope to see you folks again to discuss the subject in the near future. Kind regards to all.
251. elliot803 - Aug. 12, 1999 - 1:27 PM PT
Within 20 years at most, the U.S. will join the rest of the civilized world in having a system of comprehensive health care coverage, guaranteed for all Americans by the government.
252. Ronski - Aug. 12, 1999 - 1:31 PM PT
I think the U.S. will have returned to a fee-for-service system with much of the world joining us in that regard.
253. elliot803 - Aug. 12, 1999 - 1:55 PM PT
Ronski:
There isn't the slighest indication that any country with universal health coverage is going to abandon it and revert to a private fee system. There are strong indications that the pressure for comprehensive health care coverage for more and more Americans, and eventually for all Americans, will only increase.
254. Ronski - Aug. 12, 1999 - 2:04 PM PT
Of course there is such an indication. As posted here earlier, Europe is moving away from socialized medicine, not embracing it further, because they have seen it does not work very well.
255. elliot803 - Aug. 12, 1999 - 2:10 PM PT
Ronski:
That is nonsense. You need to read more closely. Some European governments are reforming their health care systems to increase efficiency, decrease waste, and so on, but none of them are considering eliminating the key characteristic that they all have in common and that distinguishes them from the U.S. system: UNIVERSAL COVERAGE.
If the British government, for example, tried to take away the right of every Briton to see a doctor or to receive medical treatment there would, quite literally, be rioting in the streets. Trust me on this. I know whereof I speak.
256. Ronski - Aug. 12, 1999 - 2:19 PM PT
elliot,
I did not say any nation is abandoning its system at the moment, so it is you who needs to read more closely. I said that these nations are moving away from the promises made to their peoples, and cutting back on the services provided (certainly not simply "reforming" them).
In another two decades, I suspect these systems will have just about collapsed entirely, though.
257. elliot803 - Aug. 12, 1999 - 2:26 PM PT
Ronski:
Give me an example of a country that you claim is "moving away" from universal coverage. Then provide evidence to support that claim.
And just to make it crystal clear: I'm NOT asking for evidence of internal reform or reorganization in the funding or delivery of services. I'm asking for evidence that the current guarantee of comprehensive coverage for all (or virtually all) people in that country will be rescinded. That is the fundamental difference between the U.S. system, and the system in every other industrial democracy.
258. elliot803 - Aug. 12, 1999 - 2:33 PM PT
Ronski:
"In another two decades, I suspect these systems will have just about collapsed entirely, though."
Well let's see: They produce a healthier population than the U.S. health care system does, for a much smaller amount of money, and the people they serve report higher levels of satisfaction than Americans do.
And yet, somehow, you think these systems are destined to collapse and be replaced with a system based on private fees.
Ronski, you live in a fantasy world. It's one thing to oppose existing policies and trends that are near-universal. It's another to pretend they don't exist. Take care that you don't truly go off the deep end.
259. Ronski - Aug. 12, 1999 - 2:50 PM PT
elliot,
Please join us at TT, and you can monitor my proximity to oblivion, though I must say I prefer this format to theirs.
Your post here ignores the heterogeneity of American society and the health problems related to inner-city status, though this was discussed earlier. When you compare Americans and Europeans of similar education and income, Americans are healthier, as HHH tried to explain to you.
The European system is beginning to crack, no matter what you think. People there will not forever wish to hand their destiny over to the state. They will, finally, grow up.
Why even the French may someday have a political system as good as their food, though they may be the last to do so.
260. elliot803 - Aug. 12, 1999 - 3:09 PM PT
Ronski:
"Your post here ignores the heterogeneity of American society and the health problems related to inner-city status, though this was discussed earlier. When you compare Americans and Europeans of similar education and income, Americans are healthier, as HHH tried to explain to you."
He didn't "explain it," he claimed it. I asked for substantiation, but he didn't respond. My understanding is that Europeans are healthier than Americans at all socioeconomic levels.
But the larger point is that the comparison is specious, anyway. So what if *some* Americans are healthier than *some* Europeans? Of course they are. It would be a miracle if the poorest of one industrialized democratic country were healthier than the richest of another. The important point is that, overall, people who live in countries that provide guaranteed, comprehensive health care coverage are healthier than Americans, live longer than Americans, and spend less money on health care than Americans.
I think you know that once universal coverage is established in America, it will never be eliminated. It'll become like Medicare is in Canada, the NHS is in Britain--enormously popular, so popular in fact that the idea of doing away with it would be unthinkable. You don't trust the people to decide what's best for themselves through the democratic process.
261. elliot803 - Aug. 12, 1999 - 3:13 PM PT
Ronski:
"The European system is beginning to crack, no matter what you think."
Well, you can keep saying this, but until you provide some serious evidence that it's actually a true statement (and some clarification of what "The European system is beginning to crack" is supposed to mean), it's just wishful thinking on your part, part of the reality distortion field that I suppose all libertarians need to create in order to convince themselves that their ideas actually have some non-zero probability of ever becoming public policy.
262. msgreer - Aug. 13, 1999 - 7:33 AM PT
elliot
i happen to agree with your posts regarding univeral health care coverage. 20 years away..that sounds right.
i have been working on the one payer system in the state i live in for 7 years. we have not been on the ballot yet but i am not giving up.
my sister also a nurse who live in california has been working on one payer system for 15 years or more. the initiative has been on the california ballot twice but failed both times. she continues her work.
i am quite use to fighting for equal health care for all.
i enjoyed reading your most recent posts.
263. Ronski - Aug. 13, 1999 - 7:40 AM PT
Canada is having serious problems with its health care system, and a currency that has gone from being worth more than the American counterpart to 2/3 of it.
Germany is reeling under the cost of its social welfare programs.
Britain had to bring back a simultaneous system of private health care.
And in this country, social security, once the third rail of American politics, is bound for a reform that will permit people to opt out.
In twenty years, I can easily see the socialist health programs of the West being no more, or a shell of their current selves.
264. elliot803 - Aug. 13, 1999 - 9:40 AM PT
Ronski:
You are talking nonsense. *Every* advanced democracy is having problems with its health care system because of the aging of its population and the advent of new treatments and technologies that put an ever-growing demand on resources. The fact is that other countries have been much more successful at controlling health care costs than the U.S. The recent slowdown in the increase of health care costs in the U.S. is attributable to the rise of managed care, which is more like the systems in other countries than it is like traditional American fee-for-service. Other countries cover more people for less money and provide a superior level of service. There is no, repeat NO, political movement in Canada, Britain, or any other country that I'm aware of to repeal their policy of government-guaranteed universal coverage. As I said, if any politician in Britain were foolish enough to attempt such a thing there would be riots. There are few rights Britons value more highly than the right to see a doctor and obtain medical treatment when they are sick.
265. HardyHarHar - Aug. 13, 1999 - 10:03 AM PT
Oh, God.
elliott,
I'm not all that interested in doing a bunch of research to prove to you what I already know. I will say this, however, the main sticking point (from my point of view) is that the indices you point to as you claim European superiority, are bunk. In other words, the bad science you offered as evidence isn't worth the good science it would take to debunk it.
Regardless, you seem set on ignoring the trends in Europe that include an increase in private insurance, the lengthening of waiting lists for non-trauma-related surgery and the overall decline in the strength of what you call "comprehensive" health care coverage. The British service has been revamped into a public and a private wing. Guess what, the private wing is in charge of the money. So, in effect, the service you claim is untouchable is already "touched."
266. elliot803 - Aug. 13, 1999 - 10:13 AM PT
Hardy:
"I'm not all that interested in doing a bunch of research to prove to you what I already know. I will say this, however, the main sticking point (from my point of view) is that the indices you point to as you claim European superiority, are bunk."
They're the ones used by health care experts. I somehow doubt you have a better understanding of the issue than they do.
"Regardless, you seem set on ignoring the trends in Europe that include an increase in private insurance, the lengthening of waiting lists for non-trauma-related surgery and the overall decline in the strength of what you call "comprehensive" health care coverage."
You constantly make factually incorrect statements. In Britain, waiting lists for elective procedures are going DOWN, not up. I am not aware of a trend towards private care in Europe (another one of your endless unsupported claims). Even if it's true that more people are buying supplementary private insurance, that does not alter the central fact that the Europe provides better care, for more people (all their people, in fact), at a lower cost, than does the U.S.
"The British service has been revamped into a public and a private wing. Guess what, the private wing is in charge of the money. So, in effect, the service you claim is untouchable is already "touched."
I don't know what this means. The NHS is today, as it has always been, funded by the government from general taxation. It provides comprehensive medical care to all people in Britain, guaranteed by the government.
267. Ronski - Aug. 13, 1999 - 2:00 PM PT
elliot,
The strains on socialized medicine are not coming from advances in technology alone, they are coming from the inherent inefficiencies of centralized control and universal government funding.
The cracks are there. It will take a couple of decades for the edifices to collapse, but collapse they will, as all cumbersome bureacracies eventually do.
268. elliot803 - Aug. 13, 1999 - 3:32 PM PT
Ronski:
"The strains on socialized medicine are not coming from advances in technology alone, they are coming from the inherent inefficiencies of centralized control and universal government funding."
No, this isn't true, either. The administrative and overhead costs of single-payer and centralized systems are much lower than those of the labyrinthine American patchwork of public and private coverage.
"The cracks are there. It will take a couple of decades for the edifices to collapse, but collapse they will, as all cumbersome bureacracies eventually do."
So, you keep saying. The only problem is, there is no empirical evidence to suggest that there is any truth to this claim at all. But keep clinging to the faith. It's all you have. And I'm sure when the U.S. finally joins the rest of the civilized world in providing guaranteed coverage for all its people, you'll continue to predict its imminent demise, rather than face up to the fact that it is just a better way to organize the provision of health care.
269. ranheim - Aug. 13, 1999 - 3:35 PM PT
These health care experts that elliot refers to - who are they?
I avoid Ivy League "EXPERTS". In medicine, they frequently speak/write about things as they WISH they were - not reality.
Don't mention the CDC in Atlanta. They speak with next year's budget in mind.
270. HardyHarHar - Aug. 13, 1999 - 4:30 PM PT
elliott,
I went out and found a small sample of the large number of papers that speak to the changes/health to/of the British system and I quoted them over a week ago. So, I really just don't see the point in this discussion.
And, for the 4th or 5th time, I don't consider the indices you cited, from a journal article that was reported, what, 3rd hand by you? which you found in a non-peer review journal, to be relevant to the overall quality of America's health care system. You do find these indices to be important - so be it. I don't give a fuck - got it? They're worthless!
What matters to me is obviously different, in fact, the way I see it, the very fact these were the measures chosen indicates that the authors couldn't find any important meaures in which the Europeans "won" so they had to stick to unimportant measures.
Finally, you still seem loath to understand the obvious: since Americans have a completely different system for paying for their health services, and there are so many differences between the various populations to be considered here, you simply can't do the type of study you keep citing. Its bullshit. Got it? If you want to arbitrarily choose some aspect of a health care system and inpregnate it with "all importance," then fine, but its totally arbitrary and meaningless the way it was reported by you, on behalf of the authors.
You keep accusing me of making claims and not supporing them, well I'm sorry but from my point of view you have yet to support any of your claims either. You cited one source from a non-peer-review journal, I cited three sources from peer-review journals. Whose backed-up their claims and who hasn't?
271. elliot803 - Aug. 13, 1999 - 4:48 PM PT
Hardy:
"I went out and found a small sample of the large number of papers that speak to the changes/health to/of the British system and I quoted them over a week ago."
Yes, and you're overlooking the teeny detail that absolutely none of them contained the slightest indication that Britain ever plans to abandon is guarantee of comprehensive health care for all its citizens. So they are completely irrelevant. No one is disputing that many countries are reforming their health care systems, just like the the U.S. is. But none of them, not Britain, not Canada, NONE, are backing away from universal government-guaranteed coverage, which is the characteristic that distinguishes all of them from the U.S. system. How many times do I have to repeat this before it sinks in?
272. HardyHarHar - Aug. 13, 1999 - 4:52 PM PT
Elliott,
They are backing away - not on purpose, and not as part of a planned programme, but as a natural course of the evolution of this business.
I think you know all too well that what Europeans will put up with would never stand in America. In Europe, people accept higher tax rates because they "trust" their governments and the services they receive. Not so here, its ingrained in us to resist taxes and government intervention. Well, even from a purely anecdotal sense, wouldn't you agree that younger Europeans are more like Americans than they are like older Europeans?
Regardless, I blew my fuse earlier and I apologize for cussing.
chow.
273. elliot803 - Aug. 13, 1999 - 4:52 PM PT
Hardy:
"And, for the 4th or 5th time, I don't consider the indices you cited, from a journal article that was reported, what, 3rd hand by you? which you found in a non-peer review journal, to be relevant to the overall quality of America's health care system."
That's okay, because your hopelessly biased opinion doesn't matter. What matters is the opinion of the experts, and of the general population of the countries involved.
"Finally, you still seem loath to understand the obvious: since Americans have a completely different system for paying for their health services, and there are so many differences between the various populations to be considered here, you simply can't do the type of study you keep citing."
You are the only person who seems to think the health care systems in different countries cannot meaningfully be compared. But as I said, your personal opinion is worthless. What matters is what people with recognized expertise in the field have concluded.
274. HardyHarHar - Aug. 13, 1999 - 4:53 PM PT
who are these experts? Where do they work?
275. elliot803 - Aug. 13, 1999 - 5:01 PM PT
Hardy:
"They are backing away - not on purpose, and not as part of a planned programme, but as a natural course of the evolution of this business."
Nonsense. Show me EVIDENCE that any of these countries are considering withdrawing universal, comprehensive health care coverage from their citizens. You cannot, because there is no such evidence. You're just making things up out of thin air. The material you quoted from earlier contains no such suggestion.
"I think you know all too well that what Europeans will put up with would never stand in America."
On the contrary, Americans are gradually moving towards what has been the norm in Europe for decades. A larger and larger proportion of the American population is being guaranteed health care coverage through the government. The next step will be the addition of prescription drug benefits for Medicare recipients. And the next major push, according to health care experts, will be to guarantee coverage for all American children. Wake up and smell the coffee!
"Well, even from a purely anecdotal sense, wouldn't you agree that younger Europeans are more like Americans than they are like older Europeans?"
No. But I do I think younger Americans are more like Europeans than are older Americans.