Can someone explain the health care 'crisis' to me?

[Richard Tanner]

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How many people do you know who would choose bypass surgery over a vegan diet

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Believe it or not, this question has never come up in conversation. Even if it had, a sampling of my friends wouldn't be a particularly scientific study.

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What would you choose?

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No idea. Quality of life v. expectancy is a big question here. If I'm 65 and they say I have 5 years to live, eh, might as well live well. If I'm 40 and they give me the same 5 years, then it's a harder call.

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Pretty much everyone I know would give the vegan diet a shot

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Cool.

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given that so many people (1/500 Americans per year) are making the counterintuitive choice, it seems clear to me that people are not aware of the dietary option.

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Ignoring the fact that you've already assumed what comes "naturally" in this spot, the fact that they make that choice isn't proof that they're being misled/not informed. It's possible that people who've treated their bodies with reckless abandon their entire lives really just don't care.

Cody

[tolbiny]

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The US system is closer to free market than the Canadian/European single payer systems, which work better.

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Bill,
I'm going to mix numbers a little here, and i'll note where, this is for which numbers were easiest to find. And I didn't dick around with exchange rates which may change things (as of today the Canadian dollar is at 0.93 US dollars so they shouldn't be drastically off).

For fiscal year 2005-2006 Canada spent

Elderly, 28.992 (all numbers in billions)
Employment insurance 14.4
childrens benefits 9.2
health 27.225

For a total of 79.82 billion.

The US spent
SS 544.8
medicare 345.7
medicaid 268
UE and welfare 359.5

total 1518 billion

Using the US population at 302 million, and GDP at 12.98 trillion and canada at 33 million and gdp of 1.105 trillion you get

US $5026.50 per person and 11.7% of GDP spent on these programs
Canada $2418.70 per person, and 7.22% of GDP.

So would you like to reconsider your statement that the US is somehow more freemarket than Canada?

[Bill Haywood]

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So would you like to reconsider your statement that the US is somehow more freemarket than Canada?

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The research is much appreciated, but I'm not following your conclusion at all.

Canada has single payer, but has better health care for half as much money. The US is closer to a free market because private or no insurance is a large portion of the system.

How could US medicine be LESS free market than Canada?

[bkholdem]

I"m sure I like and respect doctors much more than the average person since I was very ill as a child and doctor's have literally saved my life but lets keep things in perspective here 60 years ago doctors didn't really have much of anything to say about smoking and diet and exercise were much less frequently a topic of conversation in doctors offices prior to managed care.

Doctors are human and doctors are economic actors just like everyone else. They range from selfish to selfless widely just like most other professions.

[hmkpoker]

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Besides, my post had nothing to do with how to care for others, just a commentary about which people he cares for.

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If I may make an analogy of sorts...

Let us say that there is a plane with ten passengers, none of whom know each other. It crashes over an island in the ocean. Luckily none of the passengers die, and manage to get to shore.

To survive, they form a social tribe; members give what they can and take what they need.

It happens, unfortunately, that one of the members is morbidly obese. His caloric requirements are much higher than everyone else's, and he has to eat the food of four people to survive. Because he is so out of shape, he cannot do manual labor, and thusly cannot contribute to the society. He snores loudly at night, and smells terrible. No one likes him.

Call it cruel if you wish, but this person is nothing short of a drain on social resources. Without him, the remaining majority have much more food, and fewer externalized problems that they have to fix. Exiling him from the community would quite literally do the most good for the most people. Isn't that the point?

Do you realize how much cheaper health coverage would be in a free market? It would be available more cheaply and of better quality to all but the bottom few centiles. Socialism asks an overwhelming majority to give up their freedom, wealth and prosperity, just so the neediest few at the very, very bottom can continue to drain society of its resources. Let these unfortunate few be selected against, and the rest of us can live wonderful lives.

How can we ever live in a free, prosperous world is our primary political objective is to protect those who create a net drain on society?

[bkholdem]

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Oh, and real quick, "prolonging life" is a really bad metric, IMO. It is definitely the traditional one, and I think that is a significant failing and hurdle for the advancement of medical treatment. I, for one, am completely uninterested in prolonging anyones life. What I am interested in is alleviating suffering and improving quality of life, AS DEFINED BY THE PATIENT. A lot of times, this means living longer, but ALL the times, this means living better.

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If I may derail for a minute:

If a patient comes to you and requests some viagra prn's to enance their marriage and some modafinil prns to enhance their economic situation and some ativan prns to manage stress do you pull out your script pad and start writing because this would be in line with as defined by the patient.

as far as i am concerned doctors should do this barring any particular contraindication but my perception is that this would not be the routine course of action, in particual for the ativan.

and what about beta blocker prn's for anyone who wants them for any kind of public speaking? do you start writing freely upon request?

what say you doc?

[bkholdem]

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Oh, and real quick, "prolonging life" is a really bad metric, IMO. It is definitely the traditional one, and I think that is a significant failing and hurdle for the advancement of medical treatment. I, for one, am completely uninterested in prolonging anyones life. What I am interested in is alleviating suffering and improving quality of life, AS DEFINED BY THE PATIENT. A lot of times, this means living longer, but ALL the times, this means living better.

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Of course. As long as the cardiologist lays out the dietary option and talks about it's possible benefit, then it's fine if the patient rejects it. But there's no way most cardiologists talk about going on a strict vegan diet to patients with advanced heart disease.

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I just can't see how you can say that. I don't know that many cardiologists, and I haven't seen them interact with patients, so I can't really speak to the issue from experience. I would just say it seems very unlikely you are correct.

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Do you think that doctors are somehow immune from being economic actors?

[hmkpoker]

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The US system is closer to free market than the Canadian/European single payer systems, which work better.

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Are you willing to contend that any of the proposed free-marketizing plans for American health care (eliminating the War on Drugs, cutting Medicare/aid, reducing government regulations on what insurance companies have to include in their plans, reforming the tort system) will somehow make American health care more expensive to the insured?

Most Americans pay for Medicare, both through taxes and indirect costs. They get nothing for it back. Remove the program and they get cheaper health care at no cost to quality. Most people benefit substantially. QED.

[bkholdem]

Is it irresponsible for a real estate agent to extoll the benefits of investing in real estate to the exclusion of other investments? Is it irresponsible for the soccer coach to recommend soccer as physical exercise?

Doctor's are going to self preserve first. They are economic actors second. They may or may not have your best interests at heart and may or may not sublimate their own economic gain for your benefit. Some do and some don't (to varying degree's).

[tolbiny]

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Canada has single payer, but has better health care for half as much money. The US is closer to a free market because private or no insurance is a large portion of the system.


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In the US a large portion of the population don't qualify for any of the benefits listed. Not one- they are having X% of their income confiscated and in return they get nothing. In fact they get worse than nothing since that money is getting put into the medical system on behalf of others which means they must compete against their own money. This allows health providers to raise their rates well above what the market would bear since the government doesn't have any real interest in negotiating better deals. There isn't some magic land where "private" insurance rates are unaffected by public spending.