Intersting read on Nationalized Healthcare

[Brainfade]

offered with no comments. http://www.ibdeditorials.com/IBDArticles.aspx?id=299282509335931

[Dhondy]

Yes, interesting read, although it tells us what we already knew. Do you ever get tired of presenting one sided arguments, Cricaddict?:winky: Look, there are some home truths that one needs to recognise, and which brook no argument, because they are common sense stuff. The first is that in a developed country, health care, funded through private money, will always trump a system that's funded through statutory funds in clinical efficacy, and speed of access. Hence, that poor woman in Canada would have had faster access, and a better clinical outcome, had she lived in the States....and had insurance. Secondly, a totally government funded system will beat a privately funded system on equity and universality of access. These are the founding principles of the national health systems in the UK and Canada, founded by Aneurine Bevan and Castonguay respectively. Thirdly, administrative costs and overheads will always be higher in a privately funded system. The US spends double the money that Canada does on administration (32% v 16%) as a proportion of total healthcare outlay. Even if you look within the US, governmemt funded schemes such as Medicare and Medicaid consume a miniscule proportion- less than 2%, on administration. There is no doubt therefore that taxation funded schemes are more efficient. Fourthly, dissatisfaction among end users is inevitable, whatever system you use. Derek Wanless, a banker in the UK, who wrote a report on the NHS in 2001, once famously said, "Unhappiness with health systems remains a constant , regardless of the funding system, and how much money is spent". Similarly, money spent does not equate with satisfaction. The most quoted report on comparative national health indices is by the Commonwealth Fund, a private foundation based in the US. Their report showed that despite the money spent, overall satisfaction with the health system is the lowest in US among seven industrialised countries. Canada came second. You don't have to look too far for the reasons. The US healthcare system is proportionally the most expensive in the world, spending $6400 per capita, to around $3200 in most other industrialised countries- exactly double. If you have employer sponsored insurance in the US, you'd shell out nearly $11,000 per year- this is far more than any other country in the world. So does all that money equate into better care? And here comes the incriminating final point. The Commonwealth fund looked at the healthcare systems in six countries and judged them on five criteria- healthy lives, quality of care, access, efficiency and equity. You'd think the US would score highest in quality of care, wouldn't you, for all the money it spends. It did- on just one of the four sub-criteria, which was right care. In the three other quality indices- safe care, coordinated care and patient centred care, it came near the bottom. The Brits will be astonished to know that their favourite punching bag, the National Health Service in the UK, was ranked first ahead of Germany in second, NZ & Australia at joint third, Canada at fifth, with the USA ending up with the wooden spoon. What's more, Britain topped the world league in quality of care, efficiency and equity. Are the tabloids listening? Individual cases such as the one your article illustrates will always paint tax funded systems such as those in Canada in poor light because of the rationing that exists of necessity in such countries, the sheer scale of funds available to insurance funded punters in the US, particularly for expensive illnesses such as cancer, and the speed of access that such money buys. But when it comes to caring for the masses, looking after the greater good, the needy in the society, the 10 or 20% who need that care most and are often the ones who can afford to insure themselves the least, there is no comparison between the two systems. Here's an article I commend to you. Access is free. It's a sobering read. http://www.annals.org/cgi/reprint/148/1/55.pdf

[Brainfade]

OK, now you've gone and done it. Here I am at work, trying to write a report, and you couldn't find a better time to post this reply? Now I have to stay up all night to get my report done, because I'd rather argue with you now.

Yes' date=' interesting read, although it tells us what we already knew.[/quote'] My only point of interest was the opinion of the founder of the Canadian healthcare system. When someone of that stature acknowledges that what he built is broken, one pays attention. FWIW, I put no stock in the article's anecdotes.

Do you ever get tired of presenting one sided arguments, Cricaddict?:winky:

Winky aside, I have always recognized that the current system of care in the US has significant problems (my replies to you and KR in pre-historic threads). I have acknowledged from the outset that the US system lacks in good primary care, while trumping the rest of the world in advanced/specialized care. Where I beg to differ is on what can be done to solve the problems. It is true that a majority of my early posts on this topic appeared to be "in defense of the US system." In reality, I am trying to fight the fact that the ills of the system have been grossly exaggerated by the likes of Michael Moore using data based based on erroneous comparisons - I even pointed those errors out here. That well-educated folks far more intelligent than I am can fall for such propaganda is unfathomable. Secondly, I made it a point to read the opinion papers that you posted; I acknowledged some of the conclusions, but poked holes in the data that were shown in those opinion papers (months ago; was it a Lancet paper?) after digging deeper into the original data published in the research articles (and misrepresented in the opinion paper). My conversations with numerous doctors here have led me to recognize that the trouble of the US system stem not from lack of government regulation, but too much regulation as it is. Some examples: (a) HMOs were government-mandated, payment systems are based on government-mandated Medicare rates, (b) high administrative costs imposed on practitioners due to required government paperwork, and most of all, © high medical malpractice insurance rates are based on government-backed decisions on medical malpractice cases. All these costs are passed on to the consumer, explaining the $6400 vs. $3200 statistic. I believe that eliminating these costs is central to solving the healthcare problem and contend that the best means to this end is to get the government out of the business of healthcare. You have yourself acknowledged that a privately-funded system results in better advanced/specialized care. I fear that this will be diluted by a government-managed system. The question is: Is there a middle ground? Maybe the opinion paper you posted has the answer. Believe me, I will read it - but, I will also dig into the data on which the opinion is based. And 6 months from now, I may reply :winky:

[Dhondy]

I believe that eliminating these costs is central to solving the healthcare problem and contend that the best means to this end is to get the government out of the business of healthcare

That is just madness, about on par with you being at work on a Sunday. Can you give even a single example of anywhere in the world that this has worked? Take the government out of healthcare, and all hell will break lose. Do I really have to spell it out for you?

[Guest dada_rocks]

My limited understanding of issue goes llike this Private controlled: money making the ultimate objective not answerable to anyone but fast service low wait time etc.. No acess if u can't afford it.. For instance my brother-in-law can get appointment with any specialist within a week in USA but here in Canada I have to wait upto an year depenidng on emergency quotient of the medical issue involved. We both can afford insurance and we both have them. Someone who can't afford insurance still gets treated in Canada but in USA they have no such luck. Govt controlled: Universal access but then wait time comes in picture. Just because u have money u can't get ahead in the line. Powers to be answerable to voters. Here everybody gets the treatment in same queue rish and poor alike... Inefficient system upto a large extent. Both have their pros and cons but I certainly won't recommend total private or govt control ..

[Brainfade]

That is just madness, about on par with you being at work on a Sunday. Can you give even a single example of anywhere in the world that this has worked? Take the government out of healthcare, and all hell will break lose. Do I really have to spell it out for you?

I said "take the government out of the business of healthcare" not "take the government out of healthcare." There is a big difference. The role of the government should be to create and enforce laws that regulate the process enough to keep hell from breaking lose. It is not to mandate prices, choices and treatment options. That is what the HMOs and Medicare do now, and it is an abject failure ridden with bureaucratic roadblocks. Such decision-making should be left to the doctors - you are the experts. An example of where it has worked - there are probably none. But then again, has any modern government made a good-faith effort to implement free-market medicine the right way? I doubt it, although Stockholm may be getting it right: http://www.ncpa.org/pub/ba/ba369/ More importantly, the US healthcare system may have been functioning well in a free-market world before the government decided to butt in. More reading for the good doctor: http://www.fee.org/publications/the-freeman/article.asp?aid=4305 I'd appreciate an honest evaluation of the above articles, if you have time.

[cybervickey]

My limited understanding of issue goes llike this Private controlled: money making the ultimate objective not answerable to anyone but fast service low wait time etc.. No acess if u can't afford it.. For instance my brother-in-law can get appointment with any specialist within a week in USA but here in Canada I have to wait upto an year depenidng on emergency quotient of the medical issue involved. We both can afford insurance and we both have them. Someone who can't afford insurance still gets treated in Canada but in USA they have no such luck. Govt controlled: Universal access but then wait time comes in picture. Just because u have money u can't get ahead in the line. Powers to be answerable to voters. Here everybody gets the treatment in same queue rish and poor alike... Inefficient system upto a large extent. Both have their pros and cons but I certainly won't recommend total private or govt control ..

explained very nicely !didnt know that Canada had universal health care,doe sit count for dental as well ?how about if you wanna get braces and all ?

[Guest dada_rocks]

No.. for dentals you will have to have insurance.

[fineleg]

My limited understanding of issue goes llike this Private controlled: money making the ultimate objective not answerable to anyone but fast service low wait time etc.. No acess if u can't afford it.. For instance my brother-in-law can get appointment with any specialist within a week in USA but here in Canada I have to wait upto an year depenidng on emergency quotient of the medical issue involved. We both can afford insurance and we both have them. Someone who can't afford insurance still gets treated in Canada but in USA they have no such luck. Govt controlled: Universal access but then wait time comes in picture. Just because u have money u can't get ahead in the line. Powers to be answerable to voters. Here everybody gets the treatment in same queue rish and poor alike... Inefficient system upto a large extent. Both have their pros and cons but I certainly won't recommend total private or govt control ..

Dada Rocks, Are u saying in Canada the wait times are very high for medical care (if it is not "urgent", but still something you want to take care of quickly per your own choice)? Even if you afford and buy insurance, this is the case!? Whoa! I was not aware of this, and in that respect US may be better. However - I still feel even in US, the wait time to get appointments are not as good as India - in India, I can easily get quicker appointments from doctors - same day or within 2-3 days time, not like after "10-15 days". But, that maybe because we do have some doc contacts in India - maybe, but in general I feel it is LOT easier to get appointments quicker in India.

[Brainfade]

Another interesting read http://news.bbc.co.uk/2/hi/health/7476074.stm Now, from the other side of the debate. Key quote: 82% of Brits are proud of the NHS! Hmm, Dr. Dhondy .. maybe you're on to something ... :-)!

[Dhondy]

http://news.bbc.co.uk/2/hi/health/7476074.stm Now, from the other side of the debate. Key quote: 82% of Brits are proud of the NHS! Hmm, Dr. Dhondy .. maybe you're on to something ... :-)!

Don't worry. In true British fashion, we'll mend a system that's not broke and make it worse. A juinior Health minister, actually a well known surgeon called Ara Darzi, has today published a report on the NHS to coincide with its 60th anniversary, which recommends giving patients ever more choice, including the ability to ditch their current GPs, building polyclinics in London and the rest of the UK that would compete with existing primary care providers and lead to duplication of efforts, and in general reinvent the wheel and pour taxpayers money down the drain. I am beginning to think you have a vested interest in all this, Prof.:D Are you just an academic studying the system, or a shareholder in one of those disgustingly rich health insurance companies?

[THX_1138]

sheer numbers mate... when you distribute risk over a larger sample space with low risk members, expected cost of insurance is lower... actuarial science 101. a government funded, universal healthcare beats private healthcare provided by multitude of smaller, private agencies; both in cost and universality of coverage.

[Guest dada_rocks]

Dada Rocks, Are u saying in Canada the wait times are very high for medical care (if it is not "urgent", but still something you want to take care of quickly per your own choice)? Even if you afford and buy insurance, this is the case!? Whoa! I was not aware of this, and in that respect US may be better. However - I still feel even in US, the wait time to get appointments are not as good as India - in India, I can easily get quicker appointments from doctors - same day or within 2-3 days time, not like after "10-15 days". But, that maybe because we do have some doc contacts in India - maybe, but in general I feel it is LOT easier to get appointments quicker in India.

yes it's long for instance my wife got her dermatalogist appointment after an year.. if it's sthg urgent they do try to expedite it but still it's long .. In india u most probably belong in upper crust.. Heck i can call for instance top physician/surgeon in muzaffarpur patna and might get appointment same day but for general gentry wait times in their clinics are at least two months.. So things are not any better for majority of folks in india either..

[fineleg]

yes it's long for instance my wife got her dermatalogist appointment after an year.. if it's sthg urgent they do try to expedite it but still it's long .. In india u most probably belong in upper crust.. Heck i can call for instance top physician/surgeon in muzaffarpur patna and might get appointment same day but for general gentry wait times in their clinics are at least two months.. So things are not any better for majority of folks in india either..

Actually, even for majority of folks in India, I think they can see a doctor far quicker than they can see one in USA or Canada etc.

[Guest dada_rocks]

Doctor meaning MBBS sitting on every street corner yes they can; but if u need an appointment with some specialists then uwill have to wait if not well-connected and well-loaded..

[Dhondy]

yes it's long for instance my wife got her dermatalogist appointment after an year.. if it's sthg urgent they do try to expedite it but still it's long .. In india u most probably belong in upper crust.. Heck i can call for instance top physician/surgeon in muzaffarpur patna and might get appointment same day but for general gentry wait times in their clinics are at least two months.. So things are not any better for majority of folks in india either..

Dada, we used to be like that in the UK until 2001. After that, the government poured a huge amount of money into the NHS, got more doctors, equipment, etc and increased capacity. Now, waiting times are very short. From the point of referral from primary care, a majority of patients would probably have completed treatment by 18 weeks, which is the government target.