RufusTFirefly

The bulk of the difference in life expectancies among developed nations is not medical care, but lifestyle.

And the USA is pretty comparable with many European countries; e.g., USA estimated 2005 = 77.71; Denmark 77.62; Ireland 77.56; Portugal 77.53; European Union countries 78.30; Finland 78.35; UK 78.38; Belgium 78.62; Germany 78.65.

We aren't looking at massive differences here, though there are some like Andorra at 83.51.

JJ5

And guess what it was in the USA in 1905. 47 years

We aren't doing so bad.

flanneruk

"The bulk of the difference in life expectancies among developed nations is not medical care, but lifestyle."

And the evidence for this is...?

The only facts we know (as opposed to assert) are straightforward. America spends almost twice as much per head on healthcare as Britain, and gets slightly worse results. And far worse results than Japan.

As far as I'm aware there is no other area of human activity in which American productivity is half Britain's. Americans, collectively, are in denial about this extraordinary national incompetence.

smueller

The evidence is common sense. Obesity, diet, tobacco usage, genetics, etc. play a substantial role in life expectancy. Even the most aggressive sophisticated health care system imaginable cannot save some people from themselves.

The Vancouver-based Fraser Institute publishes an annual report on Canadian health care. Some of their statistics are relevant to this thread. Nationwide, the median wait for an MRI is 12.6 weeks, a CAT scan is 5.2 weeks, and an ultrasound is 3.1 weeks. Three months is a long time to wait if your doctor thinks you have a brain tumor. More disturbingly, the combined wait time from initial GP consultation to final treatment for the most common life threatening conditions has nearly doubled in the past decade. The system is clearly faltering under the weight of excess demand.

Canada has 3.9 MRI machines per million people, which extrapolates to less than 130 for the entire country. About five or six years ago, I read that the state of Ohio had more MRI machines than the entire United Kingdom.

Most Americans are willing to provide health care for those that truly cannot afford it (Medicaid and Medicare are not controversial programs). Most of the debate is centered on identifying low-income families that clearly can't afford it from those that simply don't want to buy it. I have relatives that faithfully buy cigarettes and lottery tickets, but won't buy health insurance.

Unlike Canadians, who seem unwilling to take a critical look at their system, most Americans agree that we have a ways to go with our health care system, we just can't agree on the solution (government provided, employer mandate, etc.). The mere fact that the majority of Americans are unwilling to forfeit their current plan for a one-size-fits-all government plan, even if it's "free," testifies to the fact that the current system serves the bulk of Americans quite well.

Even those Americans that have absolutely no coverage are not denied treatment. The greatest risk they face is bankruptcy, not death.

flanneruk

smueller:

British obesity, tobacco use, and genes are virtually indistinguishable from America's. But we live slightly longer for half the healthcare cost. All those MRI machines in Ohio do virtually nothing to prolong Ohian lives. They simply make Ohian doctors less liable to lawsuits than Britain's, and give Ohians the delusion they're doing something there's no evidence for in the outcome data.

All these boys' toys are just ways of subsidising tech companies unless they can be shown to improve health. And there's not a scrap of evidence Ohio's MRI machines do that.

bettyk

Is affordable healthcare a RIGHT? Is it guaranteed in the Constitution? Are we MORALLY obligated to provide healthcare to people who eat until they become so obese they develop diabetes, heart disease, etc? Or to people who, in spite of years of warnings, continue to smoke and develop lung disease, cancer, etc? Or people who engage in risky sexual behavior and develop HIV?

Are we obligated to pay 50% or more of our earned income in taxes so everybody, including illegal aliens, can have the best healthcare available?

Do I have the answers? No. I grew up poor and without insurance. My mother died of cancer and was treated for free at MD Anderson Hospital, one of the best cancer hospitals in the country.

I have always had good coverage thru my employer for years and now I'm covered under my husband's insurance. I've been on both sides and I still don't know how we, as a nation, could afford to pay to cover everybody.

soccr

A big cost in US medical care is the amount of time devoted to dealing with the Medusa monster of insurance bureaucracy -- and that's also why insurance costs are so high: between 35 and 40 cents on the dollar paid to private insurance companies, depending on how you do the accounting. Instead of one bureaucracy, providers have to deal with many, many -- each one designed mainly to sustain itself and, as an afterthought, pay for health care claims it can't get out of paying. Then there are the costs of exec salaries, extreme-measure technology, and legal CYA costs.

As for thinking our healthcare costs are inflated by those horribly immoral people being punished by God with their deserved diseases, #1 that ain't what costs so much (see above), #2 what an awful approach to deciding who deserves health care and #3 if you think they're expensive now, wait'll you see what happens if treatment/help is delayed or incompetent.

kswl

" I have relatives that faithfully buy cigarettes and lottery tickets, but won't buy health insurance."

Perhaps we should have lottery-funded healthcare.

kswl

Joanne28, our deductible is $4,900 per year, which is what we pay before the insurance pays a penny. For that coverage we are charged $450 per month. (No prescription coverage at all.)

AllisonK

BTW -- if you want to read the article I quoted, it is online at http://www.opinionjournal.com/editor...l?id=110007011

bettyk

Allison, thanks for the article. Sounds alot like what has happened to gasoline and other commodities. Once you start tacking on all the state mandated additives dictated by the environmentalists, etc., the price and availability of gasoline is negatively impacted. Seems like with healthcare, you should be able to choose coverage tailored for your needs and not some politician or special interest group.

AllisonK

I'm not sure what happened to my post -- perhaps it was deleted because I had copied a chunk of text from the article from yesterday's Wall Street Journal editorial page (at the link I specified above)? Anyway, you can read the article if you want. I think it pertains to our discussion here because part of the reason that health care is so expensive to Americans is that we are obliged by our state health insurance commissoners to pay in our premiums for many special interest services (things like coverage for wigs, acupuncture, massage therapy, etc) which many (most?) people would choose not to pay for. Since health insurance is regulated on a state-by-state basis, people in some states pay a reasonable amount, while others pay perhaps 10 times that reasonable amount (New Jersey is notoriously bad, as is New York; Missouri is good).

The other thing I wrote about was my experience with the Canadian Medical Services Plan. I lived in Vancouver, BC for four years ('98-'02) and found that it was probably too easy for me to abuse the services of my family doctor in that I would go in for every little ache and pain simply because I could get a doctor's reassurance without it costing me anything. I'm sure the same happens here in the U.S. for people who have a simple co-pay. Also, I had an intestinal disorder that my GP tried to treat and was unsuccessful but reluctant to refer me to a gastroenterologist. I became so desperate for help that I sought out a naturopath at my own expense (and discovered he was a quack) before my doctor would agree to the referral. As an American who is used to having control over what medical doctor I see and when, I found this to be frustrating. I also wanted to be under the care of a dermatologist but my GP would not go for it. So I found a loophole that allowed me to see a dermatologist for cosmetic reasons. Apparently cosmetic procedures fall outside the scope of MSP?? I didn't need a referral.

Another problem in Canada was that often some portion of the medical community was on strike (e.g., x-ray technitions, nurses, etc) and during the strikes medical treatment at the hospitals was limited.

I do have to say that the amount I paid in the Canadian MSP was minimal -- around $56 CAD a month after the rates went up!!! I was on a student visa so I did not get a good indicator as to how much tax Canadian workers were paying for me to have this low payment. I also saw a physiotherapist regularly for only $25 a session.

I believe that the Canadian system has changed in the past few years and less is covered under the basic MSP plan.

Matrexx

I came accross this article about a government review of the Greek health care system. We haven't heard from anyone with experience in Greece, so I thought I'd post it.

http://www.ekathimerini.com/4dcgi/_w.../07/2005_59042

RufusTFirefly

One of the big costs in the US system is paying for treatments that aren't covered in many socialized systems; e.g., quality of life treatments for people with chronic debiliating conditions like MS; organ transplants and renal dialysis for the elderly; etc.

In many socialized systems, these people just suffer if they can't pay out of pocket for treatment--or they are drugged to relieve pain. It is not considered cost-effective to treat such cases as they are unbelievably expensive to treat--and they are probably right about that, but... .

kleeblatt

My experience in Switzerland is:

1. Health insurance is paid by each person and not by your employer. You can choose your own doctors (with exceptions).

2. Accident insurance is paid by your employer.

3. Dental insurance is paid by each person and not by your employer.

Maternity stay: Normal births are allowed to stay 5 days in the hospital.
C-sections are allowed to stay 10 days.

Dental: It's a relatively new thing here. People are just learning to get their teeth cleaned once a year. We have lots of US Dental Hygenists here because lack of our own hygenists.

Schools pay for one free check up a year for your child.

Switzerland's prescribed medicine is more expensive than Germany's. The manufacturers (mostly Swiss) say they need the money to cover their research costs.

We don't sue our doctors yet when they make a mistake. We accept it as a risk taken, although this may change in the future.

julies

Thanks to all of you who took the time to reply. After hearing from all of you who live other places than the US, I am more firmly convinced than ever that the US needs major reform. However, for those of us who are used to fairly easy access to specialists and tests some of the examples from Canada do sound rather scary. These are the anecdotes that probably will stop any type of meaningful reform in the US.

Smueller's reference to the Fraser Inst. study and the typical waits for MRI, CAT etc. was disheartening. The Canadian example of a 2 1/2 year wait for an ultrasound is also incredible as is the 6 month wait for an opthamologist (unless perhaps this is a very very specialized person). The unequipped public ambulances in Italy are also scary.

Overall, however, I think that the rest of you who live outside of the US are very lucky that you live places where there are sane and sensible policies in place. One big problem in the US is that there are the haves and the have-nots as far as healthcare. Most people who have good insurance through their employer are satisfied with the status quo. They are not interested in rocking the boat unless they lose coverage, have to pick up the whole cost themselves or have the wake-up call when a family member has to go uninsured.

JJ5

Or when we personally see a green card holder with a chronic disease receive approximately 2 to 3 million dollars worth of U.of C. cutting edge care over a 5 year period, while not putting a cent back into the system. And when she lived in her original home country she had gotten no care beyond a baseline diagnosis (Philipines).

These instances are ongoing while American citizens go without minimal emergency care in some non-life threatening situations, or are deferred / refused and sent to hospitals for the non-paying patient. I have seen crying mothers writing a check for a cast that they know is going to bounce.

I would not want to deny anyone care, but where is the justice or appropriateness of allocation of funds in the above system. There isn't any.

We have a joke here in IL about Stroger having his heart attack and rerouting himself to Northwestern; in other words, HE did not go to the county hospital that was named after him.

These things need to be changed, as does the entire system which eats upon the spoils of suing for malpractice. Doubt if insurance companies or lawyers will let that happen.

AllisonK

Julies,

In the U.S., at least part of the reason that employers are able to offer reasonably priced medical coverage to their employees is that health insurance arrangements of large and mid-size companies that are self-insured are exempt from state regulation, while individual policies must conform to them. The Health Care Choice Act would let people buy insurance across state boundaries and thus give them the option to choose a vendor from a state that has fewer regulations.

Of course, there are many other problems with our system which need addressing, but this one simple thing, if enacted into law, should help people who bear the burden of a broken system and those who have simply foregone health coverage altogether because of its outrageous cost.

A good research article can be found at: http://www.heritage.org/Research/HealthCare/wm803.cfm

Allison

Barbara

Actually, what the Health Care Choice Act would do is make it more difficult for many Americans, mostly older and sicker people, to obtain health insurance. The insurance regulations which many states have are to protect the consumer.

This Act would allow insurance companies to sell their policies from one of the states which have few regulations, so many areas of coverage now included in most health insurance policies would disappear. The following could be included in this group mammograms, cervical cancer screening,prostate cancer screening.

There is nothing in this Act which requires insurance companies to reduce the cost to the consumer,and as consumers have you ever known them to do that voluntarily? So, the net result would be less coverage for the same amount of money, or even more.

Please look into this proposal very carefully.

http://www.familiesusa.org/site/Page...are_Choice_Act

AllisonK

Barbara,

You don't seriously think that people would choose a policy that does not provide cancer screening, do you?

What states currently have such deficient regulations that its residents are saddled with such poor health insurance? Are the people in Iowa or Wyoming worse off than those in New Jersey or New York? Are they currently being denied cancer screening or diabetes coverage? Are people in these states risking their lives with inadequate coverage? I don't buy this "race to the bottom" argument at all. Instead, I see that larger pools will be created and less regulation will be involved, both driving the cost of health coverage down.

Allison