Calling all US residents and citizens.

[gator]

Sources for these statistics? Plus there's so many 'illegal Mexicans' cos the US stole 1/3 of Mexico in the 19th Century. Manifest destiny and all.

so u r a dude, who believes in historical retribution and not in present laws, borders and sovereignity eh? then where do we start? u know there are plenty of starting points, but none justify...

[gator]

I live in more than one county (moving around like a desi ninja) plus I don't mind paying for my friend's ass getting fixed :D

ur intentions are appreciable...

[chunky_lafanga]

Btw I meant country and not county :hysterical:

[maggot_brain]

huh? those are the people who will be paying insurance for everyone instead of their own families....

The NHS is funded from taxes here, and isn't most income tax for example proportional to your income? I don't know how the tax system works in the US. Even if you're on the dole here you get free treatment.

[maggot_brain]

so u r a dude, who believes in historical retribution and not in present laws, borders and sovereignity eh? then where do we start? u know there are plenty of starting points, but none justify...

No. What I am saying is that parts of the United States are in some ways natural extensions of Latin America due to their high Latino populations. So what if Mexicans are coming in? What are you going to do stand on the border with an M16 like some losers do? Anyways, illegal immigration is less of a crime than an illegal war. Human beings have always migrated THROUGHOUT history. The US economy would probably collapse if Mexicans weren't doing all the jobs the Americans didn't want to do.

[gator]

No. What I am saying is that parts of the United States are in some ways natural extensions of Latin America due to their high Latino populations. So what if Mexicans are coming in? What are you going to do stand on the border with an M16 like some losers do? Anyways' date=' illegal immigration is less of a crime than an illegal war. Human beings have always migrated THROUGHOUT history. The US economy would probably collapse if Mexicans weren't doing all the jobs the Americans didn't want to do.[/quote'] i dont want to go into details here.... but there have been enuf studies done to show tht they are more of a drain on the economy than what has been portrayed... especially a country with socialist schemes like social security and medicare suffer heavily with the influx of so many illegals who dont pay any taxes.... i think, u r arguing for the heck of arguing when u say illegal immigration does not harm any country... or u r too naive... oh btw, the mexican have their own problem of illegals from nicargua.... and yes, they are standing with M16s on their border.... u should first float ur theory to them... infact, there should be more latino latino, brother-brother shyte....

[Dhondy]

Bottom line: A universal system like the NHS is OK for primary care, but does not do as well as the US system for specialized care. Mike Moore will not tell you this, of course. He will also not tell you that the "per capita spending in US is highest" argument is specious. Who is spending the money? It does not imply high govt spending or out-of-pocket spending. It implies high medical expenses, over 50% of which are reimbursements by insurance companies. He will never tell you that most US employers will pay group insurance premiums for their employees. And of course, he will not even let you sniff the fact that US cancer survival rates are the best in the world. And such care costs money. Read this: http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2003/09/07/nhs07.xml Second, 47 million people not having health insurance is another Mike Moore red herring. A large number of those choose not to have it, but will spend on expensive cars, shoes and clothes (Anecdotal evidence - just the kind that Mike Moore made a film with). I chose to go without health insurance for a while because I was arrogant. But I was fortunate that nothing happened. I could easily have afforded the premium by making small sacrifices to my lifestyle. Third, the movie as well as other media outlets say the US has higher infant mortality rates than other developed countries. What they don't tell you is that the standard for "live" births is inconsistent. For example, the US counts any baby with a heartbeat as a "live birth." Other countries (Norway, Switzerland etc.) count only babies that meet certain length and weight criteria as a live-birth. When you account for that, it is all a wash. Of course, one cannot accuse Mike Moore of possessing the intellectual acumen to dig deep into the statistics for the real answer: http://www.nationalcenter.org/NPA547ComparativeHealth.html They also say the life expectancy in the US is lower. Another specious, intellectually lazy argument: http://blogs.wsj.com/numbersguy/does-the-us-lead-in-life-expectancy-223/ See, it is easy for a film-maker to propagandize. Moore never claimed he was documenting "fact." We just assume it, and the damage is done. Finally, a universal (single-payer) healthcare system will result in higher taxes. I am not willing to shell out 45% of my income for a huge HMO that is run by bureaucrats (which is what NHS is, or any govt single payer insurance system in the US would be). Another poster said "elderly care is abysmal in the US." It may be true. But it is not like elderly care is not a crisis in other parts of the world, which have universal healthcare: http://www.guardian.co.uk/society/2006/mar/26/longtermcare.politics The clinchers for me were these 4 unrelated anecdotes: (a) when my sister (an NHS doctor) asked me how come my daughter was already seeing a specialist pediatrician (2 days after she was born). To me, it is just an expectation that my baby will be seen by a specialist from day one - I expect more from my healthcare system (b) when my niece (the daughter of 2 NHS doctors) had to wait weeks for an allergy test; here, you can get it next week. In the US: © My colleague's daughter was diagnosed with leukemia. She was admitted to the hospital immediately, and put on chemotherapy within hours of diagnosis. She went into remission in 3 days, and was discharged. And we just have a low-cost teacher's insurance policy (d) A friend of mine (a grad student with a small University insurance plan) was diagnosed with testicular cancer. Went into outpatient surgery the next day. Out in a few hours - recuperating at home now. I would rather have my money in my pocket. I would rather pay out-of-pocket for primary care (you could negotiate with your doctor for good OOP charges), and have "catastrophic" insurance plans with high deductibles. I will not go to the doctor for every sneeze and sniffle. AS far as I am concerned, it comes down to this: do we want a system that delivers high quality care to most of its population, or one that delivers mediocre care to all its citizens? I'll go for the former. In other words, I'll take my chances in the US, thank you very much. This is not to say that there are no problems with the US system. There are, but the government (the biggest HMO behemoth of all) will only compound them. How is this for irony: "Germany, Sweden and Australia are now establishing free-market alternatives in an attempt to alleviate problems caused by their nationalized health care systems. Indeed, these countries are learning that the best course for provision of quality health care is not more patient power rather than more government power." From here: http://usgovinfo.about.com/od/medicarehealthinsurance/i/nathealthins_2.htm

Some excellent points there, Prof, and the articles in The Telegraph and Guardian are certainly in resonance with some of my own observations as a NHS employee. However, I'm afraid you ignore more than you highlight. As a physician, I have some understanding of the way the US sysrem works, particularly as somebody who earned the right to work there by passing all the relevant exams, but turned down offers of residency back in 1997 to stay in the UK. I'll be honest and admit that I didn't know all the stuff I write below when I made that decision, but in retrospect, I am glad I did. I am afraid, the whole argument that the US healthcare system somehow costs the taxpayer less money falls down on its face when you look at the figures. Costs per capita are about twice the average for the OECD group of nations. Mortality statistics, despite the ones quoted by you in The Telegraph, lag behind most other wealthy countries and even for the insured population, clinical outcomes and patient satisfaction are pretty average. You say that you'd prefer the US system to subscribing to a giant HMO, i.e. the government. Well, the US government's true share amounted to 9.7% of GDP in 2005, and about 60.5% of the total health spending. It's sobering to realize that this exceeds the per capia government health spending in every country except Norway, Switzerland and Luxembourg. (Share of government spending in the UK and Canada was 7.2% & 6.9% respectively). Guess what, you, the taxpayer, are paying all that moolah. On top of your health insurance premiums. Some history would offer some perspective here for those who don't know the US health system. Until 1965, US employers offered private health cover, but the folks who needed care most, i.e. the elderly, the disabled, or the poverty-stricken, were mostly uninsured and forced to rely on badly run government institutions or charity. In 1965, Congress established Medicare, the social insurance programe for the elderly. It was a dream come true for private companies, who now account for 15% of US acute care hospitals. Similarly, for profit dialysis firms rushed in after the government made everyone with ESRD eligible under Medicare in 1972. The HMOs came in in the 1970s against a background of soaring costs, on the face of it, to promote market efficiency and patient choice.The government gave the elderly the choice to remain under Medicare or register with one of the HMOs, with incentives such as free glasses. However, the HMOs were pretty clever. They recognized that most patients use little care- around 22% of the elderly don't use medical care at all, while a small fraction- the very ill, use up the lion's share of care. Thus, windfall profits were to be had by cherry picking- recruit healthier than average old people into the scheme, and return the sick ones, with the hefty medical bills to Medicare. Only one party was ever going to benefit from this arrangement. Thus, campaigns by HMO executives to recruit the healthy elderly included carrots such as health club memberships, complemenrary dinners at venues and times that would rule out the frail, ill ones and ads painted at the bottom of swimming pools. HMOs also used financial sticks to encourage doctors to drive out sick patients back to Medicare. Primary Care physicians would have their own fees deducted for referrals to specialists, for example. When all else failed, and a HMO would find itself saddled with too many ill patients, they would simply close shop in that area and return all the ill ones to Medicare. By the 1980s, private HMO's selective enrolment of healthy elderly people had raised annual Medicare costs by $2 billion. Yet, despite this, HMOs couldn't compete with Medicare. The administrative burden of such HMOs is around 15%, and dwarfs the 3% in traditional Medicare. The cost of caring for the 8 million who have switched to the HMOs is 12% above the cost for corresponding patients who stayed with Medicare. Thus, a scheme meant to bring in market efficiency, has evolved into a multi-billion dollar subsidy for the private HMOs. Their massive financial power is a politcal roadblock for future reforms. It's not just the HMOs, however, who are responsible for the waste. Costs for private insurance that govt purchases for public employees, has risen much faster than Medicare's. Investor owned dialysis centres have 9% higher mortality than non profit centres. Investor owned hospitals, which actually obtain most of their funds from private coffers, have a 2% higher death rate and 19% higher costs than non-profit hospitals. Investor owned hospitals spend less money on nurses, and far more on managers than non profit ones. Ironically, the one government administered programme that was derided as a failure of non-profit policies, has turned out to be a major success story- the Veteran's Health Admonistration system. It has recently emerged as a leader in quality improvement and IT. It offers more equitable care, of higher quality, at a comparable or lower cost than private alternatives. Here are some more figures: the proportion of admin costs for health has risen fully 50% in the last 30 years and now stands at 31% of total outlay for health, nearly twice that in Canada. Dunno if Moore covered this, but HCA- the biggest private provider in the US, deliberately submitted inflated bills, and expenses to the govt, structured deals such that Medicare picked up the cost of corporate expenses, and paid doctors in return for patient referrals. When the HCA CEO resigned in the face of fraud investigations into the company, he left with $324 million in company stock. Tenet's CEO exercised stock options of more than $111 million shortly before resigning under pressure in 2003. The head of HealthSouth, who provide rehab care, made $112 million in 2002, the year before he was indicted on fraud (and cleared). Four years later he was convicted on unrelated bribery charges. Walk into an emergency department in the US- what do you see? In the last 10 years alone, 425 EDs- frequented by the ill and uninsured- have closed. Overcrowded EDs turn away an ambulance every minute, on average. Not a pretty story. Standards of care may be higher in the US, but that's not because of private healthcare. The US healthcare is much more technology driven, and probably more evidence based than in Europe, certainly the UK, always has been. Your acquaintances with leukaemia, etc may have been seen expeditiously in the US, but even in the UK,which only comes 11th in the world health league, cancer patients have to be seen within a maximum 2 weeks from the time that they a are referred. Many countries in Europe have even shorter waits. If I get time, I'll write about the shortcomings in the NHS. It has many faults, but so does the US system, which you failed to address in your post. (Most of the data here is from an article by Woolhandler and Himmelstein in the 1 December 2007 issue of the BMJ).

[Anakin]

It's amazing how stats can be manipulated to portray a view however wrong it is. US doesn't have a decent health care system no matter how anyone tries to twist facts. And by decent I mean for average people, not the millionaires or congressmen.

[Brainfade]

Doc, I thank you for replying. I will be honest - I was anxiously awaiting your reply (you being the resident doctor) to my initial post. Let me state my sources first: I have depended on websites like the American Association of Physicians and Surgeons and links therein, and on numbers that I obtained from the US Census website. I also accessed the BMJ opinion paper (from Himmelstein’s group), whose data and interpretations you have quoted profusely. Finally, being a skeptic, I went back to the original statistical study (http://www.cmaj.ca/cgi/reprint/166/11/1399?ijkey=94b978e3341e9ea02331c04a9079f3f7a5bd754b), on which Himmelstein’s opinion paper is based: Now that I have tried to do my homework, here we go: While I am well aware of the flaws in the American system, I chose to highlight the good with the sole purpose of debunking Mike Moore’s myths. My position: “The US healthcare system is flawed, but not because and Mike Moore says so.†First of all, Moore twists infant mortality and life expectancy data without looking closer at the apples-to-oranges comparisons. At best, it’s a mistake; at worst, it’s deliberate. But, he’s a filmmaker. What’s worse is that Himmelstein (a Harvard professor) buys into these flawed statistics, too. I was aghast, to say the least. I wanted our posters to understand the following: (a) Different countries use different methods to calculate births. Countries are supposed to count any infant showing any sign of life as a "live birth." The United States follows that guideline, but Switzerland does not count any infant born measuring less than 12 inches as a birth; France and Belgium do not count any infant born prior to 26 weeks as a live birth (WOW; in their opinion, a child that is not 6 months old is not a live child at all, so if it dies, it is not counted as “infant mortality.â€) In short, many other nations exclude many high-risk infants from their infant mortality statistics, making their infant mortality numbers look better than they really are. The statistical twisting of which Anakin speaks is actually Mike Moore’s M.O., not the other way around. MAIN SOURCE: http://www.nationalcenter.org/NPA547ComparativeHealth.html (b) In the case of life expectancy, factors like ethnicity and life choices (obesity, smoking, alcohol abuse) are greater factors than the presence of a universal healthcare system. In other words, healthcare = treatment of the sick (and it is not only the sick who die), which does not always translate into higher life expectancy. Regardless, the data that you showed with regard to government spending (9.7 % of US GDP vs. 7 % for UK) only reinforce my point: More per capita government spending on healthcare does not lead to better life expectancy. Thus, other factors likely strongly affect this statistic. Response to some specific points in your post: (1) US Government’s healthcare spending and taxes: As alluded, I pay approximately 8% of my gross income as Medicare and Medicaid tax (in addition to healthcare premiums). And the result? A government system that does not work. How can I expect the US Government to do a better job of managing healthcare with more of my tax money? (2) Investor-owned hospitals vs. non-profit hospitals: First of all, the non-profit hospitals that Himmelstein references are not government hospitals. Rather, they are PRIVATE non-profits like the Harvards and Yales and Columbias. They are funded by charitable trusts and donations as well as patient fees, and offer top-notch care. Extrapolating those results to make a case for government-controlled healthcare is disingenuous. So, there goes the “government healthcare works†theory. Himmelstein asks “Is private really better?†My answer is a resounding YES, based on his own opinion paper where he talks about private, non-profits. As usual, the devil is in the details. The original researchers (Devereaux et al., CMAJ 166, 1399) state their reasoning for the worse performance of for-profits: “In addition to generating profits, private for-profit institutions must pay taxes and may contend with cost pressures associated with large reimbursement packages for senior administrators that private not-for-profit institutions do not face.†Notice the ugly “tax†word again? (3) HMOs: As you stated, HMOs are government-mandated, government-subsidized, out-of-control agencies, and need to go. I completely agree. My contention is that TRUE free market norms have been violated, and entrepreneurs offering better healthcare plans are allowed to function freely. Why? Because the government intervened. Furthermore, the "administrative costs" of private health insurance verses government plans such as Medicare and other countries is also very misleading- they do not include the cost of collecting premiums in those statistics. Should the cost of the IRS in collecting payroll medicare taxes be included? The absurdly low "administrative overhead" used by many to state the "efficiency" of Medicare fails to take into account the administrative overhead of the local carriers, which is considerable. (4) The VA hospitals: I cannot rebut this point. I read another excellent article on the VHA and their success. Here it is: http://www.washingtonmonthly.com/features/2005/0501.longman.html (5) The turnaround time for cancer patients: With all due respect, Doc, my scenario was remission in 2 days. Yours was “seen in 2 weeks.†I rest my case. Regardless, the US has higher rates of survival from severe conditions: http://www.freemarketcure.com/whynotgovhc.php Another number that is bandied about is that there are 47 million uninsureds in the US. Let’s take a look: I checked the US Census data numbers. They have an Excel sheet that I downloaded (can pass it on if you are interested). Out of the 47 million uninsured, 17 million make more than $50,000 a year (more than what I make). These are people who can afford to pay their premiums but choose not to do so. They are the ones probably choosing fancier cars and swankier homes (things that I have been accused of on this thread J). Should I pay for them? Furthermore, 11 million are illegal immigrants. Should I pay for them (besides what I am already paying anyway)? That leaves 19 million uninsured (~ 5 % of the population). Something needs to be done for them, but should it involve the government? It appears that PRIVATE, NON-PROFIT HEALTHCARE is the way to go. With a government-run system, there will be too much government interference in my choices of doctor, treatment and care (the problem will just shift from HMO to government). So, my position in brief: Stop Medicare and Medicaid; invest those tax dollars to subsidize private non-profits or expanding VA-like facilities. and in making health insurance premiums tax-exempt or at least tax-deductible. Allow patients TRUE free market choices for health insurance. (Did not address in this post): Tort reform. Ridiculous medical malpractice laws plague our doctors, who are forced to pass the costs on to patients/insurance companies. Fixing this is an imperative. I will be interested in hearing about your opinion on the drawbacks of the NHS.

[Brainfade]

It's amazing how stats can be manipulated to portray a view however wrong it is. US doesn't have a decent health care system no matter how anyone tries to twist facts. And by decent I mean for average people' date=' not the millionaires or congressmen.[/quote'] Anakin, in this case, it is propagandists like Mike Moore who have twisted statistics. Please see my tiresome response to Dhondy. The US healthcare system is far better than "decent." This is especially true in the case of specialized medicine. No doubt, there are problems related to universal access to primary care. My contention is that they cannot be solved by decreasing the quality of specialized care - which is exactly what will happen by getting the government to run it. What we need is a true free-market solution to health insurance, and true tort reform, both of which we do not have today (addressed in my tiresome post). BTW, I am an average guy, who wishes he was a millionaire but not a congressman.

[Brainfade]

You do that already Gator. You just dont realize it. Look at it this way. Say I sold you my house for 250 K. I would tell you that you have to actually pay me 275 K, the delta(25 K) that I would need to cover litigation fees in case you are unhappy with the house and for whatever reason decide to sue me. Would you agree to paying extra 25K? No way. Try looking at the balanced sheet of a top Pharma company. You will see an Entry called - Sundry Expenses. This is the expenses that is borne by the company when it manufactures a lousy product and gets sued left right and center, paying for settlements etc. This Sundry Expense does NOT come out of the Profit incurred by the company. Why? Because that will bring the profit down(and hence less bonus for executives and less dividents for shareholders). It is put as an "Expense", a cost towards the Medicine. What this means is if you buy a X medicine you are paying a certain percentage towards the Expenses of the company. The same theory works with Insurance companies too. No matter how much New Orleans gets devastated or Florida or whatever, the Insurance companies have set themselves in such a way that they still make profits. Heck California, inspite of all those natural disasters, keeps getting new Insurance companies every few weeks. And all these scamsters pick money from your pocket when you are not looking. The problem with US health system has a lot to do with these Pharma companies and Insurance companies. If they stop looting people the health cost will come down drastically on their own. xxx

Not to mention lawyers. Medical malpractice costs are ridiculously high.

[yoda]

US System is broken. There are no two ways about it. Primary care is basically non-existent. You can't even get treated for fever. They will ask you dump yourself in a mound of ice bags if the temp gets to 104 and 105. Too much money goes to the middle men and administrators. I like the Indian system. Pay yourself for cheap primary care. No appts necessary. Just get a facking token and see a doc in a few hours at the most. Insure yourself for major expenses.