danon

"Lies, damned lies, and statistics"

Although this discussion has been informative and interesting, neither side will"win" the argument and "convert" anyone by presenting statistics, personal or family experiences
or various cases in the media.
The difference (simply put) is: philosophical.

ira

Hey, we hit 500.

I thought we would be shut off at 200.

sjj

This is my parting shot at smueller, who stated that there must be some kind of inverse relation between infant mortality and income level in countries with universal medical insurance. He's right, in part. The authors of the study I cited define "gap" as the difference between infant mortalities in high income and low income neighborhoods during the two periods covered in their study. This following is a direct quote from the article:

First, after controlling for births, Manhattan was the only city with a statistically significant association (at the 5% level) between infant mortality rate and income (or deprivation) indicator in both periods. Second, the magnitude of the infant mortality rate gap was dramatically greater in Manhattan than in any of the other cities. In Manhattan, we estimated that the low-income neighborhoods had an infant mortality rate approximately 2.5 times that of the rest of the city. In the other 3 cities, in contrast, we estimated that the infant mortality rate of the low-income (or high-deprivation) neighborhoods was never greater than approximately1.25 times that of the rest of the city in either period.

danon is right. The differences between the camps are philosophical, and further discussion based on evidence is useless.

robjame

smueller - reread what you wrote.

<<If the WHO gave greater weight to cancer survival rates or availability of the newest drugs, the US would move up in the rankings.>>
I recall our son playing T-ball at age 7 and saying, “We would have had more homeruns if there had only been two bases”.

…cause there is a whole lot more two good healthcare than these two things.

(Need I add if you can’t get diagnosed or afford to buy the drugs, it doesn’t really matter.)

<<Because the WHO is not "unbiased," it has a strong bias toward nations that provide universal coverage.>>
And why do you think that is smueller?

WHO's assessment system was based on five indicators: overall level of population health; health inequalities (or disparities) within the population; overall level of health system responsiveness (a combination of patient satisfaction and how well the system acts); distribution of responsiveness within the population (how well people of varying economic status find that they are served by the health system); and the distribution of the health system's financial burden within the population (who pays the costs).
And what do the foremost leaders in the areas of health in the world think makes up Good Health?
Overall Level of Health: A good health system, above all, contributes to good health. To assess overall population health and thus to judge how well the objective of good health is being achieved, WHO has chosen to use the measure of disability- adjusted life expectancy (DALE). This has the advantage of being directly comparable to life expectancy and is readily compared across populations. The report provides estimates for all countries of disability- adjusted life expectancy. DALE is estimated to equal or exceed 70 years in 24 countries, and 60 years in over half the Member States of WHO. At the other extreme are 32 countries where disability- adjusted life expectancy is estimated to be less than 40 years. Many of these are countries characterised by major epidemics of HIV/ AIDS, among other causes.

basingstoke2

>The difference (simply put) is: philosophical.<

True - that is, for those who have found their philosophy. Then, there are the others, the undecided waiting to be swayed.

robjame

I sense you are right sjj and this will be my parting shot.

Maybe it is philosophical…

When smueller quoted “Access to a waiting list is not access to healthcare."
and
“Just because you are on a list or have a card in your wallet does not mean that you [Canadians] will promptly receive high-quality healthcare.”

I realized that he is right. .. and I accept that.
Sure I might be triaged, but my right to access is no more or less than any other citizen. If you believe in universal healthcare, you must accept that.
Do Americans not believe this?
Is there a belief that if you can afford it, you should be able to gain better, quicker access?
Is this the class system of the 21st century?
“Let them eat cake” seems almost tame.

SamH

Thanks sjj. So if I understand correctly, some country's health plan depends on employers to supply much of the cost via employee benefits as we do here. Then thru taxation of some type others get to be covered.

What would be the motivation for employers to provide these benefits if the government would make insurance available if they dont?

ira

>The difference (simply put) is: philosophical.<

You could well be right, danon, but what philosophy requires that people pay more to get less?

Hi Sam,

The European VAT rates run 17-19%. The VAT is used to fund more than health care.

There are different schemes for funding health care in different countries. Details are in the long thread above.

hanl

"The European VAT rates run 17-19%"

21% in Belgium

But the healthcare here is excellent!!

sjj

SamH,
You've summarized my point accurately. Re your question, in many implementations of this type of plan employers have to pay a sum of money for every employee they don't insure, and this money goes into the pot to subsidize the purchase of private insurance. In addition, employers would probably continue to offer medical benefits as a recruitment tool.

tomboy

Basingstoke2 wrote: Diabetic amputations are less than 10/10,000 in Canada and some European countries compared to 56/10,000 in the US.

Couldn't that also mean there are more diabetics per 10,000 in the US? Knowing that overweight is a contributing factor, I'd find that a high incidence of diabetes/10,000 would lead to a high incidence of diabetic amputations/10,000. I know it's anecdotal, but I'll bet the number of morbidly obese per 10,000 is a LOT higher in the US than almost anywhere else (despite the use of trans fats in pizzas and not in croque monsieurs).

thursdaysd

smueller writes: ""I still don't think the small geographic area covered by the SEER registries an adequate substitute for figures for the whole of the US." The same paragraph that you cited continues - "The SEER population tends to be somewhat more urban and has a higher proportion of foreign-born persons than the general US population." If the statistics are skewed, this suggests that they would be biased in an unflattering manner. Funny how you left that part out."

Actually, I would expect that health care is better in cities than in rural areas. Funny that you have not responded to the quote from the original article that "mortality rates provide crucial evidence of progress against cancer, but they are not easy to interpret in terms of the effectiveness of cancer care".

But I agree that this is a philosophical difference. Either you think it is acceptable that people living in your country will die unnecessarily because they cannot afford health care, or you do not. In this context I note that the "compassionate conservative" currently running the US is trying to prevent government funded health care being extended to more children than at present.

smueller

I suspect that basingstoke's numbers are per 10,000 diabetics, otherwise the numbers would seem awfully high for either part of the world.

basingstoke2

Yes sm, that is per 10,000 diabetics. Sorry for not being clear. The numbers are from a recent Annals of Internal Medicine.

Geordie

I haven't read all of the points so this point may already of been made.

If employers in the US are footing the bill for their employees medical insurance then surely their premiums will go up if they have a large number unhealthy employees.

Therefore, things like genetic testing could be used to identify potential medical conditions. People having to report on personal and family illnesses when applying for jobs and obese people being rejected before they've even said a word in the interview.

It doesn't sound very healthy to me

Geordie

Sarvowinner

<<Comparing a heatwave to a Category 5 hurricane is apples and oranges. Heatwaves don't make roads impassible, take down power grids, etc. Also, how many of the Chicago heatwave deaths 17 years ago occurred in hospitals?>>

But why in a six month period begiing six months after the hurricane was the mortality rate in New Orleans so much higher than 3 years prior?

<<In 2003, we averaged 924 deaths per month according to death notices. In contrast, for the first six months in 2006, New Orleans averaged 1,317 death notices per month. This means that approximately 7,902 citizens expired in the first six months of 2006, as compared to approximately 5,544 in the first six months in 2003.>>

Surely, a decent health care system could be implemented in a first world country six months after the fact. These figure are even worse when you consider the population in NO had fallen from 450k m to 230K.

As of March 2007, <<Since the storm and floods, only four of the eight hospitals in the parish have reopened, all at decreased capacity. The City’s Health Department, which employed more than 200 health professionals, lost more than 60 percent of its staff and closed eight of its 13 clinics. >>

rex

While I am no longer chagrined at the persistence of this thread, I remain surprised that it has been allowed to stay here as a considerable bandwidth consumer, given its very tangential relation to Europe travel.

The discussions (largely quite civil) are indeed related to differences among countries in North America and Europe (with a lesser comparison to countries on other continents) in the matter of the the sociology, economics, politics and policy-making approaches to medical care funding. But many discussions of US v. Europe differences in "sociology, economics, politics and policy-making" get deleted from this forum.

I think I have had more than sufficient opportunity to express my unorthodox views on several of those issues.

So, I will follow one of the other angles presented here in the last few days, and share this item from the NYTimes on diabetes, obesity and causally-related mortality and morbidity. While not as rigorous in providing evidence for its assertions as say Lancet... or the NEJM.. I believe that it is reasonably accurate, balanced and will be eye-opening to many readers here.

Some mythbusters:

1. Most obese Americans are not diabetic, and never become diabetic, casting important questions on the relationship between obesity and diabetes.

2. Although acute weight loss in obese diabetics achieves short term improvements, no dietary changes in diabetics have ever been shown to have much impact on longevity, and in particular diabetes-related cardiovascular disease, which is by far the leading cause of diabetes-related deaths.

3. Similarly, rigorous blood glucose testing and "good" blood glucose control have hardly been shown to improve any outcome measure in diabetes.

4. By contrast, cholesterol-lowering and blood pressure control can dramatically reduce cardiovascular morbidity and mortality in diabetics. Yet, the vast majority of diabetics are intensely focused on blood glucose control, and as few as 20% even know the importance of hyperlipidemia treatment or hypertension management.

http://www.nytimes.com/2007/08/20/he...0diabetes.html

So, yes, Americans (especially from ages 5 to 20) are "eating themselves into" ("finding themselves in"?) an oversized epidemic of diabetes, and this may indeed produce a sea change of morbidity, premature deaths and increased medical care for decades to come. The cause(s), possible public health solutions and medical care policy-making implications make for a far murkier picture than you might suppose.

More answers (need to) lie on future horizons, and may come from research in unexpected corners.

http://news.yahoo.com/s/hsn/20070821...lpdriveobesity

kerouac

I was away for 5 days, so I had to just quickly skim through the last 150 or so additions to this thread.

My quick read left two things in my mind:

1. Cancer recovery rates in the U.S. are better than in other countries. But how much cancer does each country have and what part of the body? (We all know that Australia is #1 for skin cancer.) This might have significant bearing on the treatment and recovery statistics.

2. Regarding the 15,000 deaths in France in 2003, Italy admitted last year that its deaths were grossly underestimated for that period, and it had more than 15,000 deaths. This certainly doesn't get either country off the hook, but it absolutely shows what a killer heat wave that was. I do recall from reading statistics about it that the country that suffered the most deaths per capita from the heat wave was.... ultra rich tiny Luxembourg. (It has also been pointed out that death rates plummeted in the affected countries for the rest of 2003, as so many of the weaker subjects had died already, but they probably would have died in 2003 anyway. This was the case of one of my great aunts -- age 94 -- who was one of the French 15000.)

wyostiv

Some info on the health care system in Germany--not sure if it's been updated recently.

You must be in the public health scheme if your income is below about 48,000 euros a year--otherwise it's optional. It costs you and your employer about 15% of your gross salary--up to a maximum of about 600 euros per month. There are copayments and deductables you have to pay when you get treatment or prescriptions; e.g., 28 euros a day for hospital stays, up to 10 euros for prescriptions, etc.

You also must be in the long-term nursing care plan that costs about 1.7% of your gross salary.

Recently they've cut back on dental care and some other reimbursements. More cuts are anticipated.

You can get private insurance for increased dental coverage, service from private doctors/hospitals, and for vision products. Some medical providers do not accept public health scheme patients.

logos999

>otherwise it's optional
It's optional for self employed people and freelancers too. No matter what the income is.
>maximum of about 600 euros per month
Paid 50/50 by you and the employer.
freelancer/self empl. pay 100%
>copayments and deductables you have to pay when you get treatment
Only for not generally accepted treatements. There's a long list of what is covered, although it may take longer for new treatments to get on that list .
>Recently they've cut back on dental care.
No, only has been discussed. All dental treatments (surgery) are included if needed. However only in the standard form. Dentures will cost you at least 40% of their price, 60% are covered by the system. The work of the dentist is included in the insurance.
>Some medical providers do not accept public health scheme patients.
Illegal, you can sue them if you have proof.