Comparative Performance of American Health Care
baraka
Posts: 1,268
I came across this article in one of my subscriptions and found it interesting.
http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=482678&#doc482678
Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries. This report—an update to two earlier editions—includes data from surveys of patients, as well as information from primary care physicians about their medical practices and views of their countries' health systems. Compared with five other nations—Australia, Canada, Germany, New Zealand, the United Kingdom—the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives. The U.S. is the only country in the study without universal health insurance coverage, partly accounting for its poor performance on access, equity, and health outcomes. The inclusion of physician survey data also shows the U.S. lagging in adoption of information technology and use of nurses to improve care coordination for the chronically ill.
Executive Summary
The U.S. health system is the most expensive in the world, but comparative analyses consistently show the United States underperforms relative to other countries on most dimensions of performance. This report, which includes information from primary care physicians about their medical practices and views of their countries' health systems, confirms the patient survey findings discussed in previous editions of Mirror, Mirror. It also includes information on health care outcomes that were featured in the U.S. health system scorecard issued by the Commonwealth Fund Commission on a High Performance Health System.
Among the six nations studied—Australia, Canada, Germany, New Zealand, the United Kingdom, and the United States—the U.S. ranks last, as it did in the 2006 and 2004 editions of Mirror, Mirror. Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last on dimensions of access, patient safety, efficiency, and equity. The 2007 edition includes data from the six countries and incorporates patients' and physicians' survey results on care experiences and ratings on various dimensions of care.
The most notable way the U.S. differs from other countries is the absence of universal health insurance coverage. Other nations ensure the accessibility of care through universal health insurance systems and through better ties between patients and the physician practices that serve as their long-term "medical home." It is not surprising, therefore, that the U.S. substantially underperforms other countries on measures of access to care and equity in health care between populations with above-average and below average incomes.
With the inclusion of physician survey data in the analysis, it is also apparent that the U.S. is lagging in adoption of information technology and national policies that promote quality improvement. The U.S. can learn from what physicians and patients have to say about practices that can lead to better management of chronic conditions and better coordination of care. Information systems in countries like Germany, New Zealand, and the U.K. enhance the ability of physicians to monitor chronic conditions and medication use. These countries also routinely employ non-physician clinicians such as nurses to assist with managing patients with chronic diseases.
The area where the U.S. health care system performs best is preventive care, an area that has been monitored closely for over a decade by managed care plans. Nonetheless, the U.S. scores particularly poorly on its ability to promote healthy lives, and on the provision of care that is safe and coordinated, as well as accessible, efficient, and equitable.
For all countries, responses indicate room for improvement. Yet, the other five countries spend considerably less on health care per person and as a percent of gross domestic product than does the United States. These findings indicate that, from the perspectives of both physicians and patients, the U.S. health care system could do much better in achieving better value for the nation's substantial investment in health.
Key Findings
Quality: The indicators of quality were grouped into four categories: right (or effective) care, safe care, coordinated care, and patient-centered care. Compared with the other five countries, the U.S. fares best on provision and receipt of preventive care, a dimension of "right care." However, its low scores on chronic care management and safe, coordinated, and patient-centered care pull its overall quality score down. Other countries are further along than the U.S. in using information technology and a team approach to manage chronic conditions and coordinate care. Information systems in countries like Germany, New Zealand, and the U.K. enhance the ability of physicians to identify and monitor patients with chronic conditions. Such systems also make it easy for physicians to print out medication lists, including those prescribed by other physicians. Nurses help patients manage their chronic diseases, with those services financed by governmental programs.
Access: Not surprising—given the absence of universal coverage—people in the U.S. go without needed health care because of cost more often than people do in the other countries. Americans were the most likely to say they had access problems related to cost, but if insured, patients in the U.S. have rapid access to specialized health care services. In other countries, like the U.K and Canada, patients have little to no financial burden, but experience long wait times for such specialized services. The U.S. and Canada rank lowest on the prompt accessibility of appointments with physicians, with patients more likely to report waiting six or more days for an appointment when needing care. Germany scores well on patients' perceptions of access to care on nights and weekends and on the ability of primary care practices to make arrangements for patients to receive care when the office is closed. Overall, Germany ranks first on access.
Efficiency: On indicators of efficiency, the U.S. ranks last among the six countries, with the U.K. and New Zealand ranking first and second, respectively. The U.S. has poor performance on measures of national health expenditures and administrative costs as well as on measures of the use of information technology and multidisciplinary teams. Also, of sicker respondents who visited the emergency room, those in Germany and New Zealand are less likely to have done so for a condition that could have been treated by a regular doctor, had one been available.
Equity: The U.S. ranks a clear last on all measures of equity. Americans with below-average incomes were much more likely than their counterparts in other countries to report not visiting a physician when sick, not getting a recommended test, treatment or follow-up care, not filling a prescription, or not seeing a dentist when needed because of costs. On each of these indicators, more than two-fifths of lower-income adults in the U.S. said they went without needed care because of costs in the past year.
Healthy lives: The U.S. ranks last overall with poor scores on all three indicators of healthy lives. The U.S. and U.K. had much higher death rates in 1998 from conditions amenable to medical care—with rates 25 to 50 percent higher than Canada and Australia. Overall, Australia ranks highest on healthy lives, scoring first or second on all of the indicators.
Summary and Implications
Findings in this report confirm many of the findings from the earlier two editions of Mirror, Mirror. The U.S. ranks last of six nations overall. As in the earlier editions, the U.S. ranks last on indicators of patient safety, efficiency, and equity. New Zealand, Australia, and the U.K. continue to demonstrate superior performance, with Germany joining their ranks of top performers. The U.S. is first on preventive care, and second only to Germany on waiting times for specialist care and non-emergency surgical care, but weak on access to needed services and ability to obtain prompt attention from physicians.
Any attempt to assess the relative performance of countries has inherent limitations. These rankings summarize evidence on measures of high performance based on national mortality data and the perceptions and experiences of patients and physicians. They do not capture important dimensions of effectiveness or efficiency that might be obtained from medical records or administrative data. Patients' and physicians' assessments might be affected by their experiences and expectations, which could differ by country and culture.
The findings indicate room for improvement across all of the countries, especially in the U.S. If the health care system is to perform according to patients' expectations, the nation will need to remove financial barriers to care and improve the delivery of care. Disparities in terms of access to services signal the need to expand insurance to cover the uninsured and to ensure that all Americans have an accessible medical home. The U.S. must also accelerate its efforts to adopt health information technology and ensure an integrated medical record and information system that is accessible to providers and patients.
While many U.S. hospitals and health systems are dedicated to improving the process of care to achieve better safety and quality, the U.S. can also learn from innovations in other countries—including public reporting of quality data, payment systems that reward high-quality care, and a team approach to management of chronic conditions. Based on these patient and physician reports, the U.S. could improve the delivery, coordination, and equity of the health care system by drawing from best practices both within the U.S. and around the world.
http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=482678&#doc482678
Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries. This report—an update to two earlier editions—includes data from surveys of patients, as well as information from primary care physicians about their medical practices and views of their countries' health systems. Compared with five other nations—Australia, Canada, Germany, New Zealand, the United Kingdom—the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives. The U.S. is the only country in the study without universal health insurance coverage, partly accounting for its poor performance on access, equity, and health outcomes. The inclusion of physician survey data also shows the U.S. lagging in adoption of information technology and use of nurses to improve care coordination for the chronically ill.
Executive Summary
The U.S. health system is the most expensive in the world, but comparative analyses consistently show the United States underperforms relative to other countries on most dimensions of performance. This report, which includes information from primary care physicians about their medical practices and views of their countries' health systems, confirms the patient survey findings discussed in previous editions of Mirror, Mirror. It also includes information on health care outcomes that were featured in the U.S. health system scorecard issued by the Commonwealth Fund Commission on a High Performance Health System.
Among the six nations studied—Australia, Canada, Germany, New Zealand, the United Kingdom, and the United States—the U.S. ranks last, as it did in the 2006 and 2004 editions of Mirror, Mirror. Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last on dimensions of access, patient safety, efficiency, and equity. The 2007 edition includes data from the six countries and incorporates patients' and physicians' survey results on care experiences and ratings on various dimensions of care.
The most notable way the U.S. differs from other countries is the absence of universal health insurance coverage. Other nations ensure the accessibility of care through universal health insurance systems and through better ties between patients and the physician practices that serve as their long-term "medical home." It is not surprising, therefore, that the U.S. substantially underperforms other countries on measures of access to care and equity in health care between populations with above-average and below average incomes.
With the inclusion of physician survey data in the analysis, it is also apparent that the U.S. is lagging in adoption of information technology and national policies that promote quality improvement. The U.S. can learn from what physicians and patients have to say about practices that can lead to better management of chronic conditions and better coordination of care. Information systems in countries like Germany, New Zealand, and the U.K. enhance the ability of physicians to monitor chronic conditions and medication use. These countries also routinely employ non-physician clinicians such as nurses to assist with managing patients with chronic diseases.
The area where the U.S. health care system performs best is preventive care, an area that has been monitored closely for over a decade by managed care plans. Nonetheless, the U.S. scores particularly poorly on its ability to promote healthy lives, and on the provision of care that is safe and coordinated, as well as accessible, efficient, and equitable.
For all countries, responses indicate room for improvement. Yet, the other five countries spend considerably less on health care per person and as a percent of gross domestic product than does the United States. These findings indicate that, from the perspectives of both physicians and patients, the U.S. health care system could do much better in achieving better value for the nation's substantial investment in health.
Key Findings
Quality: The indicators of quality were grouped into four categories: right (or effective) care, safe care, coordinated care, and patient-centered care. Compared with the other five countries, the U.S. fares best on provision and receipt of preventive care, a dimension of "right care." However, its low scores on chronic care management and safe, coordinated, and patient-centered care pull its overall quality score down. Other countries are further along than the U.S. in using information technology and a team approach to manage chronic conditions and coordinate care. Information systems in countries like Germany, New Zealand, and the U.K. enhance the ability of physicians to identify and monitor patients with chronic conditions. Such systems also make it easy for physicians to print out medication lists, including those prescribed by other physicians. Nurses help patients manage their chronic diseases, with those services financed by governmental programs.
Access: Not surprising—given the absence of universal coverage—people in the U.S. go without needed health care because of cost more often than people do in the other countries. Americans were the most likely to say they had access problems related to cost, but if insured, patients in the U.S. have rapid access to specialized health care services. In other countries, like the U.K and Canada, patients have little to no financial burden, but experience long wait times for such specialized services. The U.S. and Canada rank lowest on the prompt accessibility of appointments with physicians, with patients more likely to report waiting six or more days for an appointment when needing care. Germany scores well on patients' perceptions of access to care on nights and weekends and on the ability of primary care practices to make arrangements for patients to receive care when the office is closed. Overall, Germany ranks first on access.
Efficiency: On indicators of efficiency, the U.S. ranks last among the six countries, with the U.K. and New Zealand ranking first and second, respectively. The U.S. has poor performance on measures of national health expenditures and administrative costs as well as on measures of the use of information technology and multidisciplinary teams. Also, of sicker respondents who visited the emergency room, those in Germany and New Zealand are less likely to have done so for a condition that could have been treated by a regular doctor, had one been available.
Equity: The U.S. ranks a clear last on all measures of equity. Americans with below-average incomes were much more likely than their counterparts in other countries to report not visiting a physician when sick, not getting a recommended test, treatment or follow-up care, not filling a prescription, or not seeing a dentist when needed because of costs. On each of these indicators, more than two-fifths of lower-income adults in the U.S. said they went without needed care because of costs in the past year.
Healthy lives: The U.S. ranks last overall with poor scores on all three indicators of healthy lives. The U.S. and U.K. had much higher death rates in 1998 from conditions amenable to medical care—with rates 25 to 50 percent higher than Canada and Australia. Overall, Australia ranks highest on healthy lives, scoring first or second on all of the indicators.
Summary and Implications
Findings in this report confirm many of the findings from the earlier two editions of Mirror, Mirror. The U.S. ranks last of six nations overall. As in the earlier editions, the U.S. ranks last on indicators of patient safety, efficiency, and equity. New Zealand, Australia, and the U.K. continue to demonstrate superior performance, with Germany joining their ranks of top performers. The U.S. is first on preventive care, and second only to Germany on waiting times for specialist care and non-emergency surgical care, but weak on access to needed services and ability to obtain prompt attention from physicians.
Any attempt to assess the relative performance of countries has inherent limitations. These rankings summarize evidence on measures of high performance based on national mortality data and the perceptions and experiences of patients and physicians. They do not capture important dimensions of effectiveness or efficiency that might be obtained from medical records or administrative data. Patients' and physicians' assessments might be affected by their experiences and expectations, which could differ by country and culture.
The findings indicate room for improvement across all of the countries, especially in the U.S. If the health care system is to perform according to patients' expectations, the nation will need to remove financial barriers to care and improve the delivery of care. Disparities in terms of access to services signal the need to expand insurance to cover the uninsured and to ensure that all Americans have an accessible medical home. The U.S. must also accelerate its efforts to adopt health information technology and ensure an integrated medical record and information system that is accessible to providers and patients.
While many U.S. hospitals and health systems are dedicated to improving the process of care to achieve better safety and quality, the U.S. can also learn from innovations in other countries—including public reporting of quality data, payment systems that reward high-quality care, and a team approach to management of chronic conditions. Based on these patient and physician reports, the U.S. could improve the delivery, coordination, and equity of the health care system by drawing from best practices both within the U.S. and around the world.
The greatest obstacle to discovery is not ignorance,
but the illusion of knowledge.
~Daniel Boorstin
Only a life lived for others is worth living.
~Albert Einstein
but the illusion of knowledge.
~Daniel Boorstin
Only a life lived for others is worth living.
~Albert Einstein
Post edited by Unknown User on
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Comments
Forty six million uninsured. Another 75 million UNDER-insured.
One significant health problem accounts for the highest cause of personal bankruptcy.
Let's look at the 'for profit' heath insurance industry. What is their goal? To provide maximum profit to shareholders. How is this done? By denying policies to those with risk factors, pre-existing health conditions and shafting the elderly. It is done by purposefully denying claims, by delaying payments and by cutting off policyholders after they file claims.
but the illusion of knowledge.
~Daniel Boorstin
Only a life lived for others is worth living.
~Albert Einstein
What "worries" you about this?
Is this surprising? Homes and cars account for most of the rest. Why is a product's association with bankruptcy negative?
This is duplicitous. Profit for the "health insurance industry" certainly requires ensuring that less money goes out than comes in. But at the same time, no one has insurance in order to be either denied care or for the sake of having something called insurance. The industry, in order to survive in the first place, must provide a valuable service since people have the choice not to buy it in the first place.
Silly me. :rolleyes: Do I really need to answer this one for you, ffg? I think you know me well enough to answer that one for yourself.
We've covered this ground before. No, with our current system, it certainly is not a surprise. I understand you look at health care as a luxury for the privileged few, but I don't see it that way.
You see, there are really no choices. That's the problem. And my point was to show that even those that can afford health care get denied time and time again. I could go into detail about my personal experience if you like.
but the illusion of knowledge.
~Daniel Boorstin
Only a life lived for others is worth living.
~Albert Einstein
Emergency rooms in most metropolitan areas are in a crisis. Even those not in high crime areas are experiencing overcrowding. When my father went into congestive heart failure, he had to be diverted from an overcrowded hospital ER that was only 2 miles away, to one that was 12 miles away.
One of the big problems is that people with no insurance use the ER as a first resort for care. Many of these people could be treated in urgent care centers, but urgent care facilities require insurance.
Emergency room crisis just form a google search:
http://www.google.com/search?hl=en&q=emergency+room+crisis&btnG=Google+Search
but the illusion of knowledge.
~Daniel Boorstin
Only a life lived for others is worth living.
~Albert Einstein
So true, so true. I know this from my experience working as an EMT.
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I know enough to think that you would be concerned that 44 million people have no health insurance. What I'm wondering is why that is a source of worry. I don't know the answer to that question.
"Priveleged few"? If 44 million Americans have no insurance, then 240 million American do. Furthermore, in your "44 million" number are people who are already eligible for free insurance. And nearly half of that population will have insurance in the next six months, replaced by new people who lose their insurance.
"There are really no choices"??? Then what good are these figures? What could we possibly do with them without choices?
Certainly insurance providers deny care all the time. I'd never disagree with that or even question it as fact. But they also approve and provide care all the time. Do health insurance providers have some kind of obligation to never deny services?
The insurance industry has essentially made it impossible to get by without insurance and I hate that.
Of course Hospitals can't turn anyone away so those without insurance are actually cause all those other costs to be higher and those without generally go without preventative care and end up going to the emergency room for everything but that's just another part of the issue.
Honestly, like withholding, I'd love to see insurance as well as taxation move away from the employer. I believe if people knew exactly what they were paying for services they would demand more competitive pricing.
Ideally, I wish health insurance was only for the most expensive medical needs like surgeries, emergencies and the like, I shouldn't have to see if a guy is in my insurance network to go get a prescription filled for a runny nose.
Co pay is ridiculous, it's about like asking people how much they make and they tell you how much they take home. 20 or 40 dollars for a doctor visit are set as such so they don't piss people off about how much the doctor visit costs, between insurance and physicans and the working of the system by this or that individual, it's just a big mess. Converting that mess to some kind of national healthcare system isn't going to cure it, in fact, it probably just makes it even more messy and expensive. Because then, you're just looking at a blank check and no ownership of any shred of a budget. It will get treated like public schools, public transit and other public goods, shitty, lousy, and pissed on. In the end it will be another vote buying project for politicians, only truely working on the eve of elections to be pimped out as a look what I did for humantity....
I'm not sure what you're asking me here. Are you asking me why I care about those that are uninsured? Maybe it is a more 'human' issue for me than you, because I work in the field and I actually look these people in the eye. I've seen the fear a parent has for their child. I've seen middle class families that were insured go bankrupt due to a serious illness. I empathize with these people.
And what about those in the middle class, the ones that don't qualify for this 'free' insurance? Or the ones simply denied insurance. Not sure what your point is here.
Again, I'm not sure what you are getting at with your question. If you feel our current system is just fine, just debate that opinion with links to facts to back up your claims. Or if you have ideas for reform, present those. Whenever this topic is mentioned, you spend a lot of time questioning the motives of those interested in reform instead of contributing to the discussion with ideas or facts.
but the illusion of knowledge.
~Daniel Boorstin
Only a life lived for others is worth living.
~Albert Einstein
That's very cool, but not necessarily what I'm asking. I'm asking specifically what you are "worried" about? Are you worried about something happening to these people, or are you worried about something else entirely as part of this "44 million" number?
First, my point was that "priveleged few" is misleading language. It's not "priveleged few". It's the vast majority. There are an "underpriveleged few".
Now, certainly there are many people, including many in the middle class, that don't have insurance. Some of those people certainly could buy insurance if they choose to, but some simply cannot afford it or, as you say, are actively denied coverage. So, my point is that to group all these people together in one number is not necessarily a good idea since their situations are often fundamentally different. I would have been included in this number a few years ago, yet I certainly wouldn't have wanted someone speaking for me or using me as a justification for something I wouldn't have agreed with.
All this begs the question: whose responsibility is it to provide health care to these people, and does such a responsibility even exist? And in order to answer that question, it's important understand who these people are and why they don't have insurance to begin with.
I don't think our current system is "fine". I think the system is over-bureaucratized and overpriced relative to its value.
First, I have posted what I believe should be done in pretty much every thread on this topic that I've participated in. Here is a summary I posted elsewhere:
- The United States government and state/local governments should make any corporation or individual serving in any health care related function completely tax-exempt.
- State government control of the insurance industry should be completely repealed. In many states, basic insurance rates would drop 50-60% if they were not forced to cover by the states services like IVF and other high-cost, low-used, services.
- Silly medical malpractice suits should be effectively outlawed by establishing precedent around willful negligence, barring patients from suing doctors and hospitals who simply make accidental mistakes.
- American consumers need to reconsider their involvements in the market as well. Employer-sponsered insurance plans have contributed to a "free healthcare" psychology, and as such consumer demand for healthcare has skyrocketed, thereby increasing prices. Consumers need to recognize that health care costs are increasing in large part becaose of their increased demands.
- American workers should continue to demand healthcare from their employers, and treat guaranteed insurance packages just like they treat their wages; refuse to work for an employer who will not provide some form of health insurance in exchange for labor. Consumers should also refuse to exchange with corporations that do not provide health insurance to their workers.
- Americans in general need to live healthier lives. The better we eat, exercise and live, the less of these services we'll need in the first place. Government's job is to protect us from the bad choices of others, not to erase the consequences of our bad choices on ourselves.
- Corporate strangleholds in certain sectors of the health care market need to be removed. Consumers need to reward providers focused on providing quality services as opposed to those focused on empire-building, profit maximization, or legal monopoly holdings. The recognition that competition will produce lower costs and further advances is paramount.
Now, I'm wondering why I'm being accused of questioning motives here. Is that a bad thing? Everytime this subject comes up, people approach it with numerous underlying premises including the premise stating that someone's health care is another's duty. The study posted seems to be partly built around that premise.
I truly believe the biggest part of the problem is the health INSURANCE industry. They price-fix so that competition is eliminated and their own product (insurance) becomes a necessity.
If I had been given all the health insurance premiums that have been paid for so far by my employers and myself and put them into some interest bearing account...AND if doctors could set their own prices to compete for my business, I would not need insurance at all except for catastrophic cases.
...are those who've helped us.
Right 'round the corner could be bigger than ourselves.
It's like pulling teeth with you sometimes!
but the illusion of knowledge.
~Daniel Boorstin
Only a life lived for others is worth living.
~Albert Einstein
Why? Premises come before conclusions, baraka.
You have absolutely nothing to apologize to me for.
"Our"??? And you wonder why I start with premise....
Everyone has a reasonable opportunity, IMO. For every cause of the uninsured, you'll find a person who overcame that very same cause to get insurance or healthcare. You're going to have to decide what "reasonable" actually means to you.
See, here's the thing baraka -- you really can't get to proposal until you do philosophy. If you want to know the overarching problem with the "system" in general, there is it...bad premises. I'm sorry if I harp on it.
I still don't understand your question and I'm not sure how to make myself any clearer. Yes, I worry about the health of the uninsured, esp the children.
Let's look at these 40 million uninsured. When they get critically ill, they have a right, by law, to go to the nearest emergency room and the hospital has to to take care of them. So, really there is somewhat of an universal catastrophic insurance policy in place. But this is an extremely inefficient way to provide health care, because the uninsured individual waits until they are in a crisis, which means very expensive care. Why can't we have policies that are affordable for these people? It might actually be cheaper for all of us.
Who are the uninsured? Well, your right that there are many variables here, but overall they are the working class in America, the people who make this country so great. We owe it to them morally to have affordable and available health insurance. I know you won't like this answer since you come from a more materialistic/objectivist perspective. I realize that resources are limited and that the obligations of citizens to help one another are not infinite. I'm not looking for a 'forced altruism' approach. I'm looking for a realistic approach that benefits all (that's a bit optimistic, I know) or most.
I'm still 'milling' over your suggestions here. I'll agree with your 4th point about the perception of 'free' health care. Those of us with employer-type insurance are a bit insulated from the 'real' cost of our care. And I agree it doesn't entitle one to everything under the sun. However, I would also suggest that the increased costs are due to much more than what you suggested. Our system is a very complicated one. A lot of health insurance premiums did not keep pace with inflation. Also, our aging population has increased. Those are two examples that come to mind.
I think you try to inject your inflexible philosophy in discussions where it is not needed. Presenting ideas on topic that are based on your philosophy is not my problem. Try to see the forest through the trees. You lose sight of the topic at hand by focusing on picking apart every single statement, trying to find a contradiction or a underlying motive.
but the illusion of knowledge.
~Daniel Boorstin
Only a life lived for others is worth living.
~Albert Einstein
Yeah, those that don't have access to group contracts (insurance usually offered by one's employer), where expected health care costs are averaged out over a large number of people ,pay more. That averaging allows the insurance company to offer health insurance at a lower cost than they would have to charge to an individual. Your pre-existing condition places you in a high risk category, much like how all other types of insurance works. But unlike the individual that drives recklessly, you have no control over your genetic predisposition for disease (or maybe your the unfortunate victim of a freak accident). So yes, it does not seem fair.
but the illusion of knowledge.
~Daniel Boorstin
Only a life lived for others is worth living.
~Albert Einstein
If only your premises were more clear.
Damn straight!
Are you not an American? Yes, 'our'! Splitting hairs and getting off topic.........
I know what it means to me. Reasonable, eh? Let's look at someone who makes about $25,000 (before taxes) a year. Can we really expect this person to be able to pay five to seven thousand dollars a year for a basic insurance policy? What about those with pre-existing conditions that can afford the policy, but are denied by the insurance companies?
I agree that in order to 'fix' something, you need to identify the problems. Is this what you mean?
but the illusion of knowledge.
~Daniel Boorstin
Only a life lived for others is worth living.
~Albert Einstein
Ok. If you worry about the "health of the uninsured", obviously that's a bigger issue than insurance or even health care (in terms of patient/provider dynamics), right? Even people with the best insurance or health care in the world can still be incredibly unhealthy.
Now, if children are of particular concern, wouldn't it make more sense to examine what a healthy child truly is? Focusing on "access to healthcare" seems sort of narrow in this context, particularly since very few children in this country have no access to healthcare. Of the roughly 8 million uninsured children in this country, 75% are already eligible for zero-cost health care. A large portion of the remaining 25% live in households that could easily afford insurance (> 300% poverty line). In effect, we end up with "only" about a million children whose parents have a good argument for having "no access to health care". But would we say that there are only one million unhealthy children in America?
It certainly would be cheaper, but not cheaper than removing the emergency room requirement to begin with. Thankfully, "cheaper" is not a standard we should go by when considering these issues. Obviously there is more to it than that.
What makes an "efficient" health care system? It stands to reason the most "efficient" health care system is the one that treats patients like they're part of an assembly line and simply pumps them full of whatever drugs happen to be believed as cure-alls that day. Is "efficiency" really what we should be shooting for here?
I'd argue that individual health is what we should be gauging these systems by. Not "cost". Not "equity". Not "access". Not "efficiency". Health. Now, Americans are certainly unhealthier than in many other nations, at least on most scales. But is that a function of the "healthcare system" alone? Of course not, since nations with almost no healthcare system to speak of can beat out both American capitalists and foreign socialists on a lot of scales.
:rolleyes:
Come on now. America is "great" because of lots of people who have insurance and lots of people who don't. America "sucks" sometimes because of people who have insurance and because of some people who don't. Trying to tie this issue to "what makes America great" is fine for idiotic politicians, but I think we can do better than that.
This is a better argument, but I still don't "owe" them shit. They're the working class? I pay the salaries they've accepted in part for what they make for me. If you want to play the altruism game, we can do that. I'll simply call them selfish for wanting insurance to begin with. I'll suggest that they should give up 20 years of life altruistically for their capitalist masters, or some such junk.
Now, if we want to talk about how to get them access to "affordable and available healthcare", we can do that. The costs of healthcare are out of control. I'm paying for 30 people's healthcare right now, and the bills for it just floor me whenever I see them. The costs of healthcare are functions of little more than supply and demand. And demand is at all time highs while supply is stagnating. Let's talk about getting more doctors out there. Let's talk about getting more competition into the pharma market. Let's talk about way to temper the demands of hypochondriacs and pill-poppers. Let's talk about getting people to live healthier lives to begin with.
Very much so. About 2 months ago I started publishing what I pay for my employee's healthcare on their pay stubs. Lots of people were shocked. Not so shocked that they did anything about it, of course, but shocked nonetheless
Definitely. First, health insurance premiums are not a function of inflation. They shouldn't be either. If car costs were a function of inflation, the Honda Civic would probably cost you about $60K, so inflation is not a good gauge for comparing prices. It assumes you're selling the same product with the same demand and the same supply, and that's a false comparison whether or not you're talking about cars or doctors.
Second, an aging population has much to do with demand. But that's an inescapable fact of population demographics. The aging populations in socialistic systems are arguably causing more damage to them then they even are here. But I don't think anyone really wants to propose killing off old people or force-breeding young taxpayers, so I'm not sure what we can actually do about this.
Sometimes, yes. But it's easy to turn these same claims around and toss their opposites right back at others.
If you need me to clarify a premise, demand clarity. If you want to ignore premise though, that's different.
Is it that simple baraka? Are there not reasons that person only makes $25k per year, or is that just blind, irrelevant happenstance? Furthermore, is an insurance company denial just wrong by default? I mean, let's say you're an insurance company and I'm a 55 year old man who smokes, drinks, eats fried chicken everyday and has already had 2 heart bypass surgeries. Should you have to cover me, knowning full well that there's a 99.9% chance that I'm going to cost you thousands of times more than you can legally collect in premiums?
Yes, in part. I also mean that you cannot ignore the nature of the solution you're proposing either. The most effective way to "fix" the healthcare system would be through violent eugenics, but good premises would invalidate that as a solution.
I haven't even read the rest of your post, but I'll start with this, as it goes off topic. I believe that health care is a kind of basic need. It responds to something that all of us experience. We experience either the threat of illness or the actuality of illness, and we respond on a very intimate and personal level to that when we see it in ourselves, but also in others. I personally deal with this everyday due to the nature of my profession. I believe health care should be a basic right and the opportunity should be there for all. I understand you feel health care is the individual's responsibility and it should be rationed by income and ability to pay. I feel that is is also the individual's responsibility to take initiative and manage one's health, but that's hard to do for some folks when there are no reasonable options. btw, I'd appreciate links to your statistics.
but the illusion of knowledge.
~Daniel Boorstin
Only a life lived for others is worth living.
~Albert Einstein
We can can be inventive as a nation, so I wouldn't worry about our system turning into a complete socialized health care system. Would you be in favor of a two-tiered system?
What about offer preventative care? Wait, you want to talk about premise? How about the false premise our current system is based on, that health care is a commodity like cars and that it should be distributed according to the ability to pay in the same way that consumer goods are. That's not what health care should be. Health care is a need; it's not a commodity, and it should be distributed according to need. The 'genius' of the marketplace will not take care of it.
Another problem is that our medical researchers, the pharmaceutical companies, the people who manufacture tests and treatments, etc are able to invent and develop new medical tests and treatments much faster than the general rate of the economy. I'm glad you at least see killing off old people is not an option.
but the illusion of knowledge.
~Daniel Boorstin
Only a life lived for others is worth living.
~Albert Einstein
Uh ok, I demand clarity! See my 'premise' above.
The reason is that the man's job only pays $25k a year. What are you getting at here?
And no, a denial is not wrong by default. But a lot of denials are 'wrong'. Your example of the unhealthy 55 year old man is not the case for all. I do feel the man in your example is responsible for his poor health and these factors should be considered. But then you have folks like sicnevol. He did not 'choose' his genetic predisposition.
:rolleyes:
but the illusion of knowledge.
~Daniel Boorstin
Only a life lived for others is worth living.
~Albert Einstein