Universal Health Care

[JayTee]

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However, full privitization (and therefore competition) of fire services would be either more costly or less effective than regulated fire services.

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Why do you say that? I'm generally interested in your reasoning.

[The Truth]

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Editted to remove pointless snarky comment.

So the United States, in aggregate, spends more dollars per capita on health care? So what?

I notice the graph shows dollars spent on health care per capita, rather than the fraction of per capita production spent on health care. Adjusting for this produces a number that is much more in line with the nearest countries, although US spending is still the highest at about 11%, with the nearest other country being germany at 9%. Hence total US health care spending is only of order 20-25% higher than Germany, rather than the misleading 50% above the nearest country (Switzerland) indicated by the original graph.

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No matter how you try to slice it, the US spends WAYYYY more on health care (for worse results).

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But even this number is deceptive. It is an elementary thought experiment to decide what the implications of this logic is: If a government wants to spend it's countries health care dollars more "efficiently", all it has to do is nationalize the health care system, and then not spend anything on health care at all. What an astonishingly low sum to spend on health care! Surely such a health care system is a marvel to be emulated. Any country can look more "efficient" under this criteria by simply spending less on the health care of their citizens.


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This is just silly. We would be fine with the US spending tons tons more on healthcare if the US healthcare system yielded better results. It is appalling that we spend this much and end up getting worse care on average.


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This is most blatantly the case in the UK, where the socialized health care system is an ongoing national unnatural disaster of shortages, wait lists, rationing, and simple non-treatment.


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And they still manage better results than the US freeish market system. (mostly because the waitlists etc are on nonessential surgeries.

One of the best single indicators of a countrys health was developed by the WHO; called "healthy life expectancy." This measure represents the number of years that a child born now can expect to live in good health (i.e; total life expectancy minus years of illness adjusted for quality of life). This is good for the US because we get elective procedures done quickly. By this measure the a child born in the US today can expect to live the equivalent of about 69.3 healthy years of life, while children born in the other 22 industralized nations can expect an average 2.5 additional years ("overdosed amercia" by john abramson or search around and find the WHO study) .


Every way we try to slice the data, the US healthcare system just does not preform very well.

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Americans can spend a higher fraction of their income on health care because health care is largely a luxury good. As real income increases relative to higher priority goods like food, clothing, shelter, energy, etc., more "discretionary" income is available for less critical things like entertainment and healthcare. America with it's high per capita average income will have of course see a higher than average fraction of that income dedicated to these things. Should we conclude that our theater industry is "inefficient" because American's spend a much high fraction of their income on movies than any other country in the world?


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Yeah, and there is 1 thing that all the extra money we spend on health care is buying us. (this where it starts to click together.)

The US provides the best SERVICE to patients in the world. A WHO study that evaluated seven nonmedical aspects of health care like prompt attnetion, quality of amenities, autonomy, confidentiality etc the us was a clear 1st place.

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Furthermore, these kinds of international comparisons are useless in the absence of incredibly high end regression analysis with a tremendous amount of data, since they violate ceteris paribus, i.e. all else is not equal. Even in that case the results are always open to interpretation. Americans are the fattest people in the world, as everyone likes to tell us. We voluntarily choose to be so, but the cost is in poorer average health, poorer average health that must be paid for by increased health care spending, so we spend more.


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Contrary to common wisdom, the poor ranking of the US cannot be attributed to our rates of smoking, drinking, or consumtion of red meat. America ranks in the better have of industralized nations on those measures, and we have the 3rd lowest cholesterol.

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Altogether I am reminded of the ridiculous claims that health care is better in Cuba in the United States because infant mortality is lower, without regard to the fact that neonatal care in the United States is so superior that high-risk pregnancies that simply become miscarriages in other countries become premature births in the United States, thus leading to elevated infant mortality rates.


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The US ranks a lowly 24 among 39 developed countries on infant mortality. There is, however, a problem with international comparisons of infant mortality. Resuscitation is more likely to be attempted on extremely premature babies on in the US than many other countries. The extremely premature babies on whom resuscitation is unsuccessful are then counted as infant deaths, whereas they would be counted as fetal deathes if no attempt at resuscitation had been made. A way around this problem is to look at mortality rates after only a week of life. On that measure the US position improves only from 24 to 20.

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Lastly, I find it laughable that the authors of the study neglect to tell us that the reasons that healthcare goods and services and administrative costs are rising so fast is because of the cost of regulatory compliance and administration imposed by government, a large part of which non-profit and government run hospitals are exempted from.


[/ QUOTE ]

And the non-profit hotpitals are doing no better than their for profit brothers.



The rest of your post looks like general free market is better than goverment stuff (which I agree with for the most part.)


The problem with the health care system is not that the free market is broken. It isn't even goverment intervention. I believe that goverment intervention has raised the cost of health care to some degree, but not nearly enough to cause this "crisis." To be honest, "administrative costs and the cost of regulatory compliance" aren't a big deal when compared with the more dramatic things goverment has done (wage control + tax breaks for health insurance causing employers to be the primary gateway for people to become insured.)


Anyway, I got off topic. The goverment hasn't helped, but the goverment isn't the problem. The consumers are the problem. The free market is reacting to consumer demands. The consumers don't demand better healthcare (they don't know what better helathcare is in the firstplace). Consumers often identify more treatment with better treatment. Consumers want nicer hosptial rooms and to be treated better. The consumer wants the newest arthritis medication they saw on tv (despite the fact that it is no better than the old one that costs 1/10th the price) So, the consumer gets these things.

The money doesn't go toward education the public on what makes them healtheir, the money goes towards making them believe vioxx is the answer. So, people demand that their insurace company give them vioxx or they'll change insurance companies.


So, do we need daddy to come in and tell us what is best for us? Do we want daddy to make healthcare cheaper and more effecient? Oy vey, i wish we (consumers) could as a group see the long term. It would make things easier.


If you want any of my sources, let me know.

[Copernicus]

However, full privitization (and therefore competition) of fire services would be either more costly or less effective than regulated fire services.

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Why do you say that? I'm generally interested in your reasoning.

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I don't know firefighting well at all, but just looking at it from a general business perspective:

First there are the basic inefficiencies of competition including marketing, competition for employees driving up wages, redundant corporate administrative staffs, redundant training staffs (or the costs of a secondary training system if "fire fighter schools" were to develop as a result of privatization).

There are additonal equipment and real estate costs. Each competing company in a given coverage area needs a complete firehouse and at least one full engine, one EMT van (if thats part of their responsilities), and whatever other equipment is needed. If the municipal company is fully equipped at a certain level, at the very least when you divide their coverage into smaller companies there is the potential for "fractional equipment" that has to be rounded up to 1 whole piece. The rounded up portions represent redundant costs.

A competitor also face critical mass issues as it grows. One client in an area needs a full engine, full staff on every shift, etc. That group can accomodate n clients. When they reach n+1 clients they need to staff up a full engine, staff etc. The centralized municipal company doesnt face that problem as often as several smaller companies because their jurisdiction is relatively constant and slow growing. There is the reverse problem when a client is lost to a competitor company. An engine and staff may be completely unneccessary as the client base drops below the existing equipment and staff base by 1 client. While you can layoff staff, that isnt conducive to morale in a business that is very stressful to start with, and equipment cant be bought and sold that flexibly.

Then there are issues of access to fire hydrants, water supplies etc. First in to a market will presumably purchase these from the municipality, but the second player in will have to pay for access to that infrastructure (if mandated by law, so we've violated the totally "free" market requirement, but we'll let that slide since its a minimal violation) or build its own if the first in doesnt allow access.

Then youve got legal costs. Totally private firms will have tremendous exposure to law suits (or equivalent insurance costs) in the event they fail to respond or effectively put out a fire. Municipalities have much more limited exposure by law and by psychology...you're much less likely to sue your neighbor the fire chief who you know is doing a good job than you are the faceless CEO of the company you happen to sign up with.

There may also be more intangible issues. Will someone be as likely to become a volunteer at a for-profit fire company as he would the local municipal company protecting his community? I would expect some, and possibly significant fall off in the number of volunteers, which have to be replaced by paid personnel.

Im sure there are other areas of cost redudancies, as I said I dont know the business that well.

[CallMeIshmael]

Copernicus,

can you reconcile "The countries that provide socialized health care are evidence that it isn't true, since they are either extremely expensive, lower quality or both. " with observations in the thread that both the US health care system costs more and performs pooer than many socialized countries?

ie, stuff along the lines of "According to a 2000 study of the World Health Organization, publicly funded systems of industrial nations spend less on health care, both as a percentage of their GDP and per capita, and enjoy superior population-based health care outcomes"

Which is backed up through data. Im curious if you are able to cite your comment.

[CallMeIshmael]

You can try to discretit the data all you want, but, from objective observation, it appears that countries with socialized medicine do a better job at providing health care, on average, than a free market system in the US.


Something that I havent seen mentioned in this thread, (though I havent read it all) is that idea that the US might be in a very different position than these other countries.


Take Canada, for example. If Canada never spent another dollar on attempting to discover medical advances again, they'd be OK, because the US does it for them. So, even if you decrease the incentive to advance medical technology in Canada (Im assuming we all agree that socializing a market decreases incentives), it doesnt really matter as much, since a foreign market is still pushing forward, and allowing them to use the advances.

However, you need *someone* to be the frontrunner. If America - the country to whom the world looks for advances - went socialized, it might have a very different effect than when Canada went socialized.

[Borodog]

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You can try to discretit the data all you want, but, from objective observation, it appears that countries with socialized medicine do a better job at providing health care, on average, than a free market system in the US.

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We don't have a free market health care system in the US. And it's not even close. In fact, the health care and health care insurance industries are two of the most heavily regulated industries in the entire economy, and have been increasingly so for going on 4 decades. Unsurprisingly, prices and dissatisfaction in these industries have continually increased relative to the general price level and real wages, while over the same period prices and dissatisfaction in much less heavily intervened in industries have fallen relative to real wages.

There are two particular areas of medical care which are in fact relatively free of much regulation (although there is some, occupational licensure and such): plastic surgery and veterinary care. Strangely enough, prices and dissatisfaction in these fields have fallen relative to real wages. However, this trend is flattening out as the level of intervention in those two markets is starting to increase as well.

[ConstantineX]

[ QUOTE ]
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Editted to remove pointless snarky comment.

So the United States, in aggregate, spends more dollars per capita on health care? So what?

I notice the graph shows dollars spent on health care per capita, rather than the fraction of per capita production spent on health care. Adjusting for this produces a number that is much more in line with the nearest countries, although US spending is still the highest at about 11%, with the nearest other country being germany at 9%. Hence total US health care spending is only of order 20-25% higher than Germany, rather than the misleading 50% above the nearest country (Switzerland) indicated by the original graph.

[/ QUOTE ]

No matter how you try to slice it, the US spends WAYYYY more on health care (for worse results).

[ QUOTE ]

But even this number is deceptive. It is an elementary thought experiment to decide what the implications of this logic is: If a government wants to spend it's countries health care dollars more "efficiently", all it has to do is nationalize the health care system, and then not spend anything on health care at all. What an astonishingly low sum to spend on health care! Surely such a health care system is a marvel to be emulated. Any country can look more "efficient" under this criteria by simply spending less on the health care of their citizens.


[/ QUOTE ]

This is just silly. We would be fine with the US spending tons tons more on healthcare if the US healthcare system yielded better results. It is appalling that we spend this much and end up getting worse care on average.


[ QUOTE ]

This is most blatantly the case in the UK, where the socialized health care system is an ongoing national unnatural disaster of shortages, wait lists, rationing, and simple non-treatment.


[/ QUOTE ]

And they still manage better results than the US freeish market system. (mostly because the waitlists etc are on nonessential surgeries.

One of the best single indicators of a countrys health was developed by the WHO; called "healthy life expectancy." This measure represents the number of years that a child born now can expect to live in good health (i.e; total life expectancy minus years of illness adjusted for quality of life). This is good for the US because we get elective procedures done quickly. By this measure the a child born in the US today can expect to live the equivalent of about 69.3 healthy years of life, while children born in the other 22 industralized nations can expect an average 2.5 additional years ("overdosed amercia" by john abramson or search around and find the WHO study) .


Every way we try to slice the data, the US healthcare system just does not preform very well.

[ QUOTE ]

Americans can spend a higher fraction of their income on health care because health care is largely a luxury good. As real income increases relative to higher priority goods like food, clothing, shelter, energy, etc., more "discretionary" income is available for less critical things like entertainment and healthcare. America with it's high per capita average income will have of course see a higher than average fraction of that income dedicated to these things. Should we conclude that our theater industry is "inefficient" because American's spend a much high fraction of their income on movies than any other country in the world?


[/ QUOTE ]

Yeah, and there is 1 thing that all the extra money we spend on health care is buying us. (this where it starts to click together.)

The US provides the best SERVICE to patients in the world. A WHO study that evaluated seven nonmedical aspects of health care like prompt attnetion, quality of amenities, autonomy, confidentiality etc the us was a clear 1st place.

[ QUOTE ]

Furthermore, these kinds of international comparisons are useless in the absence of incredibly high end regression analysis with a tremendous amount of data, since they violate ceteris paribus, i.e. all else is not equal. Even in that case the results are always open to interpretation. Americans are the fattest people in the world, as everyone likes to tell us. We voluntarily choose to be so, but the cost is in poorer average health, poorer average health that must be paid for by increased health care spending, so we spend more.


[/ QUOTE ]

Contrary to common wisdom, the poor ranking of the US cannot be attributed to our rates of smoking, drinking, or consumtion of red meat. America ranks in the better have of industralized nations on those measures, and we have the 3rd lowest cholesterol.

[ QUOTE ]

Altogether I am reminded of the ridiculous claims that health care is better in Cuba in the United States because infant mortality is lower, without regard to the fact that neonatal care in the United States is so superior that high-risk pregnancies that simply become miscarriages in other countries become premature births in the United States, thus leading to elevated infant mortality rates.


[/ QUOTE ]

The US ranks a lowly 24 among 39 developed countries on infant mortality. There is, however, a problem with international comparisons of infant mortality. Resuscitation is more likely to be attempted on extremely premature babies on in the US than many other countries. The extremely premature babies on whom resuscitation is unsuccessful are then counted as infant deaths, whereas they would be counted as fetal deathes if no attempt at resuscitation had been made. A way around this problem is to look at mortality rates after only a week of life. On that measure the US position improves only from 24 to 20.

[ QUOTE ]

Lastly, I find it laughable that the authors of the study neglect to tell us that the reasons that healthcare goods and services and administrative costs are rising so fast is because of the cost of regulatory compliance and administration imposed by government, a large part of which non-profit and government run hospitals are exempted from.


[/ QUOTE ]

And the non-profit hotpitals are doing no better than their for profit brothers.



The rest of your post looks like general free market is better than goverment stuff (which I agree with for the most part.)


The problem with the health care system is not that the free market is broken. It isn't even goverment intervention. I believe that goverment intervention has raised the cost of health care to some degree, but not nearly enough to cause this "crisis." To be honest, "administrative costs and the cost of regulatory compliance" aren't a big deal when compared with the more dramatic things goverment has done (wage control + tax breaks for health insurance causing employers to be the primary gateway for people to become insured.)


Anyway, I got off topic. The goverment hasn't helped, but the goverment isn't the problem. The consumers are the problem. The free market is reacting to consumer demands. The consumers don't demand better healthcare (they don't know what better helathcare is in the firstplace). Consumers often identify more treatment with better treatment. Consumers want nicer hosptial rooms and to be treated better. The consumer wants the newest arthritis medication they saw on tv (despite the fact that it is no better than the old one that costs 1/10th the price) So, the consumer gets these things.

The money doesn't go toward education the public on what makes them healtheir, the money goes towards making them believe vioxx is the answer. So, people demand that their insurace company give them vioxx or they'll change insurance companies.


So, do we need daddy to come in and tell us what is best for us? Do we want daddy to make healthcare cheaper and more effecient? Oy vey, i wish we (consumers) could as a group see the long term. It would make things easier.


If you want any of my sources, let me know.

[/ QUOTE ]

Great post.

Some economists think that it's because employer-provided medical care is subsidized, meaning that there's a disconnect between who pays and the treatment received. Perhaps if patients could purchase out of mental "disposal income", rather than indulge in health care through a debit from their payroll check, they would make better choices about efficient treatment.

I think much the same problem exists with colleges, especially elite ones. Some of the major urban hospitals are more like luxury hotels than treatment centers.

[Borodog]

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No matter how you try to slice it, the US spends WAYYYY more on health care (for worse results).

[/ QUOTE ]

And a fat guy is going to spend way more on health care than a skinny guy, for worse results.

Until you can understand that these sorts of comparisons between things that are not otherwise equal are worse than meaningless, they are outright intentionally deceptive, in the absence of in depth logical anaylsis, your opinions will be formed by gut feelings, whims, emotions, whomever you hear spout something first or most forcefully, etc. In otherwords, not on reason and real facts informed by reason.

The rest of your post is great.

[pvn]

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No matter how you try to slice it, the US spends WAYYYY more on health care (for worse results).

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This is a fallacy that arises from aggregation.

The people who are consuming the most $$$ worth of health care and the people who are getting "worse results" are not the same people. The dollars are not spent equally, and the results are not equally distributed.

People don't come to the US to spend the most $$$ and get substandard results.

[mosdef]

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Until you can understand that these sorts of comparisons between things that are not otherwise equal are worse than meaningless, they are outright intentionally deceptive

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However, isn't it useful to try to develop aggregate comparisons that are meaningful? In other words, if you can account for differences in the population to come up with apples-to-apples health care aggregate expenditure costs wouldn't that be useful information? Particularly when one is trying to debunk "ends justifies the means" arguments. If you can show that the "ends" aren't even better, then you don't even have to argue that the means are evil.