Universal Health Care

[Copernicus]

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sorry, I really dont understand your point here

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you said that the statistical reports dont reflect people who are not treated. However, the same can be said about people whose insurance doesnt cover treatments. <font color="red"> which, once again, is such a small number it wouldnt even find its way into the statistics had they been treated </font>


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coverages for necessary surgery in the US are essentially all inclusive

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Well, "essentially" is obviously a red flag here. And of course, you can assert this just as well as I can assert "all Canadians get access to necessary surgery"

But, I know a friend from school whose mother didnt get a surgery because it wasnt covered. (it wasnt a complete necessity, some back pain thing). Am I now to conclude that this isnt 'atypical'? <font color="red"> it depends on the coverages she elected. It may or may not be atypical for her given coverage. I cost and design employer provided health benefits. There are very few if any policies written that exclude any sort of necessary surgery. Also, audits of health insurers claims payments consistently show much higher instances of overpayments and payments for non-covered events than payments denied for covered events, and the latter are always corrected. Your friends situation may have been the result of alternate procedures that were determined to be medically equivalent or superior, or her proposed treatment was considered experimental.</font>


No, because I think its poor reasoning to judge complex situations based on a few anecdotes. But, I dont think you've presented any clear evidence to show that the problems of non-access in Canada are any more severe than they are in the US. <font color="red">Since there are virtually no problems of non-access in the US any access problems in Canada are by definition more sever than the US. Access is one of the most credible statistics, since it is relatively discrete and easy to measure. As noted in someone elses post the US is rated first in access. </font>



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It is ONE of the most expensive, and provides health care among the best in the world. There arent enough valid statistics to differentiate among the highest n in costs, or the top k in quality. The US is clearly in both of those (limited) groups.

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when you said "The countries that provide socialized health care are evidence that it isn't true, since they are either extremely expensive, lower quality or both" you seemed to find ways to do some rough rankings.

What countries have medical care that cost more than in the US, and yet is of poorer quality?

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As I already said, the statistics are insufficient to draw conclusions such as absolute rankings of either cost or quality. My statement, perhaps not expressed as clearly as this, is that within the ranges of the credibility of the statistics that do exist there will be some countries whose upper bound on cost estimates and lower bound on quality estimates will exceed/fall short of the potential ranges of US statistics. That does not imply that you can pick which ones actually do exceed/fall short.

As stated before, one broad indicator of quality is life expectancy from 5 years old excluding the cohort that died violent deaths, and the US ranks number 1.

[CallMeIshmael]

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Since there are virtually no problems of non-access in the US

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"low-income US residents reported more problems obtaining care than their peers in 4 other English-speaking countries
(Australia, Canada, New Zealand, and the United Kingdom); and that quality-of-care ratings were similar in the 5 countries"

"A peer-reviewed comparison study of health care access in the two countries published in 2006 concluded that U.S. residents are one third less likely to have a regular medical doctor, one fourth more likely to have unmet health care needs, and are more than twice as likely to forgo needed medicines"

http://www.pnhp.org/canadastudy/CanadaUSStudy.pdf


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My statement, perhaps not expressed as clearly as this, is that within the ranges of the credibility of the statistics that do exist there will be some countries whose upper bound on cost estimates and lower bound on quality estimates will exceed/fall short of the potential ranges of US statistics.

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OK, so, you claim that these countries show that socialized medicine is exceedingly more costly, lower quality, or both, but have nothing to back it up, or even a country in mind. Got it.

Or, perhaps, giving you a tad more leeway, you made a claim (ie that 1 or more of these countries exist) based simply on the fact that, under the guidelines you provide for disproving the claim, it cannot be shown that, with 100% certainty, the country doesnt exist. Which is obviously a great argument.

God exists!

No he doesnt

Then why cant you disprove it!!!!!!

[allintime333]

so say you are poor and get cancer in the US you wouldnt be able to see a doctor but every other industal country you would see that doctor. I bet if we stop spending all the money on a dumb war we could find a way to make this work.

[lehighguy]

Life expectancy and infant mortality are based on a number of factors, the healthcare system only being one of them. If I transplanted the US healthcare system to Japan it would probably rank one of the best in the world in these categorize because they eat and live well in that culture.

[Copernicus]

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Since there are virtually no problems of non-access in the US

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"low-income US residents reported more problems obtaining care than their peers in 4 other English-speaking countries
(Australia, Canada, New Zealand, and the United Kingdom); and that quality-of-care ratings were similar in the 5 countries" <font color="red">is the methodology in the link? i'll look later </font>

"A peer-reviewed comparison study of health care access in the two countries published in 2006 concluded that U.S. residents are one third less likely to have a regular medical doctor, one fourth more likely to have unmet health care needs, and are more than twice as likely to forgo needed medicines" <font color="red">these reflect voluntary actions more than the system itself.. I dont have a regular doctor, I go to specialists when I need them, and an occasional visit to an Immediate Care center that has rotating staff. The quality of care is quite sufficient, but I would be in that statistic of "not having a regular doctor". Many people stop and start their meds, not because they dont have the ability to get them, but because they think they no longer need them or because they are too lazy or cheap to go back to the doctor to get refills, including tests if necessary. this is a perfect example of how statistics can be used to lead one to erroneous conclusions</font>

http://www.pnhp.org/canadastudy/CanadaUSStudy.pdf


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My statement, perhaps not expressed as clearly as this, is that within the ranges of the credibility of the statistics that do exist there will be some countries whose upper bound on cost estimates and lower bound on quality estimates will exceed/fall short of the potential ranges of US statistics.

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OK, so, you claim that these countries show that socialized medicine is exceedingly more costly, lower quality, or both, but have nothing to back it up, or even a country in mind. Got it.

Or, perhaps, giving you a tad more leeway, you made a claim (ie that 1 or more of these countries exist) based simply on the fact that, under the guidelines you provide for disproving the claim, it cannot be shown that, with 100% certainty, the country doesnt exist. Which is obviously a great argument.

God exists!

No he doesnt

Then why cant you disprove it!!!!!!

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<font color="red"> no, you dont get it, and I dont know any more effective ways to try and help you get it. If you don't understand statistical studies vis a vis the credibility of the underlying data (whether through inconsistent reporting and collection, categories that are too broad and capture too many effects, then there isnt much I can do. I will just state it very simply and clearly...there are no studies that I have seen that are rigorous enough to accurately assign ordinal ranks to either costs or quality. At best you can put ranges on them.</font>

Yes, as I expected there are some biases in the methodology and reliance on subjective information. The US statistics include a signficant number of "uninsured". Since the decision to purchase and the level of coverage purchased is primarily voluntary, the statistics related to the uninsured population are given too much weight. If their methodology excluded those who had access to insurance but declined, most of the statistics would be indistinguishable or reverse their order.

Also, look at Table 4, the multi-variate analysis. Those statistics that are objective have such wide confidence intervals that the differences in the relative probabilities are insiginificant. Subjective questions like perceived quality are totally meaningless, because it is so broad and the responders have little basis for comparison. Also, when one perceives his medical care as "free" because its buried in his taxes, his expectations are lower and satisfaction ratings higher.

The one category that stands out is those who claim they didnt get meds because of cost. That is very high even for a question that is reasonably discrete. However, if you go back to the basic data that difference is entirely attributable to the uninsured. One would expect that someone who opted to save a few dollars and not buy insurance would also perceive the cost of medications as too high and not buy them. There is also the underlying subsidy of Canadian Rx by the US due to the artificial price caps imposed by Canadian law contributing to the difference.

In short, the methodology of this study, while more rigorous than many, has significant gaps and biases. It also reaches subjective conclusions that are unsupported by the objective data, even accepting the biases in the data.

[Jetboy2]

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"It seems reasonable to suspect that government might be able to administer some particular industry better than private business due to differences of structure and incentive."

It may seem reasonable... but can you give us an example?

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An example is the Rural Electrification Program.

[CallMeIshmael]

the link provided gives methods


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I go to specialists when I need them, and an occasional visit to an Immediate Care center that has rotating staff. The quality of care is quite sufficient, but I would be in that statistic of "not having a regular doctor".

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I believe access to the same doctor is something often looked at as a positive; since its not unthinkable that a situation arises where the treatment provided by someone with a great deal of familiarity would be preferable to that of someone with no information beyond a chart. But, I admit, I wouldnt consider this a great point.

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Many people stop and start their meds, not because they dont have the ability to get them, but because they think they no longer need them or because they are too lazy or cheap to go back to the doctor to get refills, including tests if necessary. this is a perfect example of how statistics can be used to lead one to erroneous conclusions

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here, however, you're wrong.

This is a COMPARISON between two groups. So, even IF we assume that people who forgo medicine do so because they dont think its working, it is not necessarily relevant, because people in BOTH countries will do this. Perhaps Americans stop taking medicine they should; but, that doesnt mean canadians are not just as able to do so.

In your post, you stated reasons being cost or laziness. Laziness is a GOOD reason; if americans are, on average, lazier than canadians, then that would be a reason for the difference that isnt a product of the health care system. But, I doubt laziness amounts to much of a difference here.

However, too cheap is a terrible reason. If monetary reasons prevent people from getting access to medicince in America that they would have access to in Canada, and the medicine is called "needed medicine" that is an advantage for the Canadian system.


Also, you seem to have ignored 'more likely to have unmet health care needs'



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no, you dont get it, and I dont know any more effective ways to try and help you get it. If you don't understand statistical studies vis a vis the credibility of the underlying data (whether through inconsistent reporting and collection, categories that are too broad and capture too many effects, then there isnt much I can do. I will just state it very simply and clearly...there are no studies that I have seen that are rigorous enough to accurately assign ordinal ranks to either costs or quality. At best you can put ranges on them.

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No, you dont get it.

You said "The countries that provide socialized health care are evidence that it isn't true, since they are either extremely expensive, lower quality or both. "


When, what you meant to say was "given the range of data, we cannot be 100% sure that a country does not exist that has socialized medicine, both costs more, and has poorer quality care than america"

But you didnt. You made a sensational statement that you have no ability to backup.


Beyond that, you are clinging the the assumption that not only are all reports about cost of health care in different countries possibly wrong, but that they are GROSSLY wrong, and that the errors made terribly overestimate the cost of healthcare in the US or underestimate that cost in just about every other country in the world.


While I do understand that there is some chance the above is true, if you cant see that its an unlikely parlay, then I dont know what I can do. Its one thing to suggest that a methodology isnt 100% perfect. Its another to suggest a conclusion that has been reached many times, using different (though still admitedly imperfect) methodologies, that that not only agree but agree BY A LOT, are completely wrong, without having any evidence to back the claim, other than "the methodology might have made some errors"

[Copernicus]

See my analysis of the study methodolgy in the edited post.

I apologize for not being able to explain statistical credibility at a level you can understand, but you still don't get it.

We are talking about statistics that I work with every day in my job. I know the flaws in the studies and the ways these studies can be biased, either intentionally or innocently. This one appears to be innocent, unless the decision not to exclude the voluntarily uninsured was a concious one.

[CallMeIshmael]

OK,

1. why arent there studies that show socialized countries with higher HC costs than america?

2. "The countries that provide socialized health care are evidence that it isn't true, since they are either extremely expensive, lower quality or both"


this says NOTHING of ranges. It says countries with socialized medicine must either 1) have poorer quality 2) cost exceedingly more or 3) both. These are absolute statements.

IF you think this statement doesnt go COMPLETELY against this new philosophy of "well, we cant know for sure because, the data just inst there" you're silly.

[Copernicus]

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OK,

1. why arent there studies that show socialized countries with higher HC costs than america?

2. "The countries that provide socialized health care are evidence that it isn't true, since they are either extremely expensive, lower quality or both"


this says NOTHING of ranges. It says countries with socialized medicine must either 1) have poorer quality 2) cost exceedingly more or 3) both. These are absolute statements.

IF you think this statement doesnt go COMPLETELY against this new philosophy of "well, we cant know for sure because, the data just inst there" you're silly.

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It doesnt, and Im obviously incapable of explaining why to you. The study you posted, which attempt to rank just 2 countries, should show clearly enough that the statistics used, which arent atypical from WHO studies, render such quality rankings meaningless.

As far as cost in socialized systems, with costs buried in tax policy, an apples to apples comparison of what is included in costs is impossible. Per capita spending has at least two major problems...the definition of "spending" (eg is the cost of a private hospital room really medical spending or is it travel and entertainment?) , and the exclusion of elective unnecessary care in the non-socialized systems that isnt covered (and often purchased in the US btw) under the socialized system and never accounted for.