WP: CBO says health care repeal would deepen deficit

[PeterMP]

With regards to your first point you are right that current preventive care methods need to be changed A study by Dr. Patricia Stone et. al. summarized it best when it stated that "One of the issues is that strategies that target preventive services at populations with high prevalence have lower cost-utility ratios than strategies applied. This is congruent with previous researchers’ findings that prevention interventions targeted at especially high-risk persons offer higher gains in life expectancy than prevention interventions for average-risk populations." One of the things that needs to occur is to have more of a focus and understanding of how to correctly carry out preventive measures and many feel that this is not going to occur under our system since preventive care has not proven to be a priority. Another study found that "Patients with diabetes or chttp://www.extremeskins.com/showthread.php?342960-WP-CBO-says-health-care-repeal-would-deepen-deficit/page6ardiovascular disease who are uninsured prior to gaining Medicare coverage need more costly and intensive care over subsequent years than if they have been previously insured" and this has been attributed to their lack of preventive care.

I agree with most of what you've said here, but changing our preventative care methods is not going to be easy.

Look at what happened with mammograms on this board based on a simple suggestion by the government that it might be good to have women talk to their doctors about getting mammograms and actually use some of the information we have on breast cancer to make decisions rather than a random age:

http://www.extremeskins.com/showthread.php?308596-Breast-exam-guidelines-now-call-for-less-testing

Doctors may be a small driver of health care costs but what I was stressing is that our prices for everything are higher and that is a serious reason that our health care costs are so high. There is a great study called "It's the Prices Sutpid" that summed up this issue best and if you would like I could email it to you.

Our costs directly of doctors is higher because their expenses are higher than in most other countries, but it isn't at all clear to me that the REAL costs of doctors are actually that much greater in the US than in other countries or it is simply accounting issues.

And medical school costs in this country are going up faster than inflation, even at state run Universities. In France, those costs are hidden because they are paid by the government and not even counted as medical costs in their budget.

The Japanese do not force companies to sell them the MRIs for less money. What they do is they set a price they are willing to buy them for. Then what happens is simple market economics. The MRI companies have decided to start competing for these health care dollars by creating machines that cost less. This means that they may not have all the same bells and whistles as some MRI machines you see in the US but they are effective and do the job.

Okay, force is not the right word, but nobody really believes the difference in our costs and their costs is only related to the more simplistic machines as the piece I linked states.

Companies can recover manufacturing costs plus a small profit based on the price that the Japanese government has instituted so companies sell the MRI machines. Essentially, the same is true for medical technology/drugs in any government run medical care system.

The question is are those controlled prices doing what we need to continue R&D and investment long term for there to be more advancements. By governmentally limiting costs, are we negatively affecting innovation?

http://www.fas.org/ota/reports/9336.pdf

"Over a longer span of time, economic returns

to the pharmaceutical industry as whole

exceeded returns to corporations in other

industries by about 2 to 3 percentage

points per year from 1976 to 1987, after

adjusting for differences in risk among

industries. A risk-adjusted difference of

this magnitude is sufficient to induce

substantial new investment"

2-3% isn't that much and since 1987 (and even through the period they were doing their analysis), globally there have been greater efforts to control the costs of medical care, including drugs and technologies.

Are we now below the point (or will we soon get there) that profits from the medical industry no longer are competitive with other investments mechanisms when risk accounted for?

(This is from a more recent study:

"For R&D-intensive industries, such

as pharmaceuticals, that omission can significantly overstate

profitability. Adjusted for the value of its R&D

assets, the drug industry’s actual profitability still appears

to be somewhat higher than the average for all U.S.

industries, but not two to three times higher, as standard

measures of profitability indicate.")

(And the costs of producing new drugs have gone up as compared to the time frame analyzed in the earlier study:

"Total spending on health-related research and development

by the drug industry and the federal government

has tripled since 1990 in real terms. However, the number

of innovative new drugs approved by the Food and

Drug Administration each year has not shown a comparable

upward trend. NME approvals shot up for a few

years in the mid-1990s and then fell again; on the whole,

such approvals have consistently ranged between about

20 and 30 per year. Measured by the number of drugs

approved per dollar of R&D, the innovative performance

of the drug industry appears to have declined."

http://www.cbo.gov/ftpdocs/76xx/doc7615/10-02-DrugR-D.pdf

(I've discussed the reason behind this before related to changes in technology that actually made discovering drugs easier leading to some new low hanging fruit, and the essentially industry wide error of investing in combinatorial chemistry.)

If this "new" costs of developing drugs is the "real" cost, then the 2-3% discussed in the older piece is now gone IF it actually still existed given the government controls GLOBALLY put in since the analysis range of the older piece.

[shk75]

Is the spending lower because of teh recassion? Or is it because of companies readjusting their policies to cost more but cover less like Boeing and AARP insurance did just saying it had teh lowest increase in 50 years means nothing. You have to look at the whole picture

This is due in part to three things:

1. people lost their jobs and this their insurance which led to less doctors visits, hospital admissions, etc.

2. people were more reluctant to pay out of pocket expenses

3. it did still increase though largely in part to the vast increase in Medicaid subscribers and an increased use of prescription drugs

[PeterMP]

This is due in part to three things:

1. people lost their jobs and this their insurance which led to less doctors visits, hospital admissions, etc.

2. people were more reluctant to pay out of pocket expenses

3. it did still increase though largely in part to the vast increase in Medicaid subscribers and an increased use of prescription drugs

As I pointed out to JMS, the real costs of ALL drugs has been slowing for several years before the recession as many drugs come off of patents and generics take their place.

[shk75]

As I pointed out to JMS, the real costs of ALL drugs has been slowing for several years before the recession as many drugs come off of patents and generics take their place.

Well generics plays a large role and is a reason why many other nations spend less per prescription than the US. Many OECD nations require that the generic be purchased if it is available and this has helped curb costs. However growth in prescription drug costs was more rapid in 2009 than 2008 which stumped health care people a little but because it was assumed that lower insurance coverage rates and more unemployment would not lead to an increase in pharmaceutical purchases.

---------- Post added January-10th-2011 at 10:17 AM ----------

I agree with most of what you've said here, but changing our preventative care methods is not going to be easy.

Look at what happened with mammograms on this board based on a simple suggestion by the government that it might be good to have women talk to their doctors about getting mammograms and actually use some of the information we have on breast cancer to make decisions rather than a random age:

http://www.extremeskins.com/showthread.php?308596-Breast-exam-guidelines-now-call-for-less-testing

Our costs directly of doctors is higher because their expenses are higher than in most other countries, but it isn't at all clear to me that the REAL costs of doctors are actually that much greater in the US than in other countries or it is simply accounting issues.

And medical school costs in this country are going up faster than inflation, even at state run Universities. In France, those costs are hidden because they are paid by the government and not even counted as medical costs in their budget.

Okay, force is not the right word, but nobody really believes the difference in our costs and their costs is only related to the more simplistic machines as the piece I linked states.

Companies can recover manufacturing costs plus a small profit based on the price that the Japanese government has instituted so companies sell the MRI machines. Essentially, the same is true for medical technology/drugs in any government run medical care system.

The question is are those controlled prices doing what we need to continue R&D and investment long term for there to be more advancements. By governmentally limiting costs, are we negatively affecting innovation?

http://www.fas.org/ota/reports/9336.pdf

"Over a longer span of time, economic returns

to the pharmaceutical industry as whole

exceeded returns to corporations in other

industries by about 2 to 3 percentage

points per year from 1976 to 1987, after

adjusting for differences in risk among

industries. A risk-adjusted difference of

this magnitude is sufficient to induce

substantial new investment"

2-3% isn't that much and since 1987 (and even through the period they were doing their analysis), globally there have been greater efforts to control the costs of medical care, including drugs and technologies.

Are we now below the point (or will we soon get there) that profits from the medical industry no longer are competitive with other investments mechanisms when risk accounted for?

(This is from a more recent study:

"For R&D-intensive industries, such

as pharmaceuticals, that omission can significantly overstate

profitability. Adjusted for the value of its R&D

assets, the drug industry’s actual profitability still appears

to be somewhat higher than the average for all U.S.

industries, but not two to three times higher, as standard

measures of profitability indicate.")

(And the costs of producing new drugs have gone up as compared to the time frame analyzed in the earlier study:

"Total spending on health-related research and development

by the drug industry and the federal government

has tripled since 1990 in real terms. However, the number

of innovative new drugs approved by the Food and

Drug Administration each year has not shown a comparable

upward trend. NME approvals shot up for a few

years in the mid-1990s and then fell again; on the whole,

such approvals have consistently ranged between about

20 and 30 per year. Measured by the number of drugs

approved per dollar of R&D, the innovative performance

of the drug industry appears to have declined."

http://www.cbo.gov/ftpdocs/76xx/doc7615/10-02-DrugR-D.pdf

(I've discussed the reason behind this before related to changes in technology that actually made discovering drugs easier leading to some new low hanging fruit, and the essentially industry wide error of investing in combinatorial chemistry.)

If this "new" costs of developing drugs is the "real" cost, then the 2-3% discussed in the older piece is now gone IF it actually still existed given the government controls GLOBALLY put in since the analysis range of the older piece.

It is true that real costs of doctors are not significantly higher in the US which is why like I said does not really play a role in our escalating costs but when combined with all other expenses like higher costs for MRIs, invasive procedures, emergency care, prescription drugs, everything these little percentages add up and play a huge role.

Your point about R&D is a fair one and another hot topic in the field. Many feel that other nation's health care costs are not truly accurate since they depend on the US for so much R&D. They argue that the US actually subsidizes these systems because as you know R&D is extremely expensive and so OECD nations let us do the research and then they benefit once it is complete. These same people think that a universal system in the US would hurt advancement in technology. My response to these people is that I think companies in the US would adapt to the new regulations and I do not think there will be a real difference (in other words the benefit of having all people insured and covered will outweigh the possible losses in R&D). However, not all feel this way and there is not definitive proof for either side.

[JMS]

Well generics plays a large role and is a reason why many other nations spend less per prescription than the US. Many OECD nations require that the generic be purchased if it is available and this has helped curb costs. However growth in prescription drug costs was more rapid in 2009 than 2008 which stumped health care people a little but because it was assumed that lower insurance coverage rates and more unemployment would not lead to an increase in pharmaceutical purchases.

:doh: The reason why foreign nations pay less for perscription drugs than the united states have nothing to do with generics. American drug companies sell their products in countries like Canada for 0.50$ on the dollar. Not generics. Name brand american drugs are sold by American drug companies for that price. Why? Because it's profitable to sell those drugs for that price internationally. Why are they so expensive here? Because it's more profitable to charge American citizens twice as much and we don't have any legislative protections against it. Least we didn't.

AMERICANS like to think that their health care is the best in world: certainly better than socialised Canada’s or weird and wonderful Mexico’s. But as drug prices in America have climbed and fewer people are covered by health insurance (18.4% of the non-elderly population had no insurance in 1998, up from 14.8% ten years earlier) patients have become aware that Canada and Mexico can sometimes provide the same drugs at half the price. So, clutching their prescriptions, they are crossing the northern and southern borders by the busload. The savings, they find, are worth the tripuote

http://www.economist.com/node/334131

Here is the deal. The US healthcare system has been systematically stripped of competition because back in the 40's and 50's the case was made that competition was too expeneive and because of specialization in healthcare services the free market system was not suited for healthcare delivery. Which is why no industrialized country on earth uses the free market to deliver healthcare. Without competition prices were allowed to find their own level. Healthcare moved from consuming 4% of GDP in the 1970's to about 17.6% of GDP in 2009.

http://www.finfacts.ie/irishfinancenews/article_1021355.shtml

This basically brain dead approach to healthcare has meant the highest prices in the world for Ameircan consumers. This is for drugs, hospital care, and insurance. The height of this farse was expereneced during the Bush Jr administration when he actually outlawed American citizens from being able to import american drugs from foreign socializt healthcare delivery systems where those drugs could be purchased so much cheaper. This was done solely to protect drug company profits.

The reason why healthcare companies charge so much more here, is solely due to the fact they can and it's profitable to do so. There is no force on earth that would get them to sell their products in foreign nations at a loss; yet they do sell their products there; the same products they sell here; for significantly cheaper. the only explaination is they are doing so because it's profitable to do so.

Currently the abuses of the drug companies and hospital companies are not on the table; only the insurance companies. Why? Because the US pharmaceuticals and healthcare delivery companies negotiated reforms with the federal government at the beginning of this process. That's why the focus of this entire healthcare fight has been the insurance companies.

[shk75]

:doh: The reason why foreign nations pay less for perscription drugs than the united states have nothing to do with generics. American drug companies sell their products in countries like Canada for 0.50$ on the dollar. Not generics. Name brand american drugs are sold by American drug companies for that price. Why? Because it's profitable to sell those drugs for that price internationally. Why are they so expensive here? Because it's more profitable to charge American citizens twice as much and we don't have any legislative protections against it. Least we didn't.

Here is the deal. The US healthcare system has been systematically stripped of competition because back in the 40's and 50's the case was made that competition was too expeneive. Without competition prices were allowed to find their own level. Domesically this has meant the highest prices in the world for ameircan consumers. This is for drugs, hospital care, and insurance. The height of this farse was expereneced during the Bush Jr administration when he actually outlawed American citizens from being able to import american drugs from foreign socializt countries where they could be purchased so much cheaper. This was done solely to protect drug company profits.

The reason why healthcare companies charge so much more here, is solely due to the fact they can and it's profitable to do so. There is no force on earth that would get them to sell their products in foreign nations at a loss; yet they do sell their products there; the same products they sell here; for significantly cheaper. the only explaination is they are doing so because it's profitable to do so.

Well when I referenced generics I was responding to PeterMP specifically when he was talking about drug costs in other nations. If you look at that posts it also references drug prices and as you can see I state that our costs for prescription drugs are higher in the US than other nations. This is tied in to what I was telling Peter earlier with regards to Japan and MRI machines. When you have one person who sets the prices, like in other nations, it is easier to control costs. Even in the US the same drug can have 50 different prices depending on the insurance, plan, etc. What you are referencing is the fact that we do not have a price-setter here and that is why I stated that the difference in prices is perhaps the largest driver of our increased costs.

[NavyDave]

Part of Obamacare included extending the patents on profitable drugs to prevent avoidable generic types which I totally disagree with allowing them to do. Competition across state lines, etc should be part of the GOP repeal as well as TEA Party Caucus mandating generic drugs on patents that would have expired pre Obamacare as well as investigating price gouging.

[shk75]

Part of Obamacare included extending the patents on profitable drugs to prevent avoidable generic types which I totally disagree with allowing them to do. Competition across state lines, etc should be part of the GOP repeal as well as TEA Party Caucus mandating generic drugs on patents that would have expired pre Obamacare.

Well a lot of the time big pharmaceutical firms get a bad reputation but to play devil's advocate the process to develop a drug is extremely costly. Many times the one approved drug has to pay for the 10-20 failed drugs. There is usually an estimated ten-year window in which drugs recoup lost investment. What these firms state is that if generics are allowed to enter the market before this ten year period big Pharma will lose money on their investments and no longer be able to develop new drugs.

[JMS]

Is the spending lower because of teh recassion? Or is it because of companies readjusting their policies to cost more but cover less like Boeing and AARP insurance did just saying it had teh lowest increase in 50 years means nothing. You have to look at the whole picture

Spending isn't lower. The increase in spending is at a 50 year low. Healthcare costs in this country have been growing at 3x the rate of inflation for decades. Which is why healthcare consumed 4% of GDP in the 1970's and nearly 18% of GDP in 2009.

The point isn't that Obamacare which only partially took effect in 2010 had such a dramatic effect on healthcare's spiraling out of control costs. The point was to refute another poster who claimed healthcare costs had gone up because of Obamacare.

[PeterMP]

Part of Obamacare included extending the patents on profitable drugs to prevent avoidable generic types which I totally disagree with allowing them to do. Competition across state lines, etc should be part of the GOP repeal as well as TEA Party Caucus mandating generic drugs on patents that would have expired pre Obamacare as well as investigating price gouging.

I'm pretty sure this isn't true. I don't think there is anything in the law regarding patents.

Obama has even talked about reducing the length of patents:

"President Obama has proposed changing the length of time patents covering pharmaceuticals are enforceable. His proposal is to change the patent term from 20 years to 7 years. According to Medical News Today, it takes 8 years on average for a new drug to receive FDA approval. Thus, the President’s proposal is to essentially eliminate patent protection for drugs. If this proposal is implemented, the net result will be to kill innovation in the pharmaceutical industry. This will increase the long term cost of medical care. Medicines are inexpensive medical treatment compared to surgical techniques, the main alternative. "

(A very slanted piece, but the general facts are correct, I believe.)

http://hallingblog.com/2009/08/13/obama-%E2%80%93-change-pharmaceutical-patent-term-to-7-years/

I tend to favor shorter patent periods and more protection for companies that follow the rules with respect to approval and post-market studies and safety and less regulation of prices.

(Okay, the new law is 12 years of exclusivity for biologics, which aren't JUST drugs and aren't what the main drug market is now, and this isn't completely out of line with the existing 20 year patent on pharmaceuticals.)

[JMS]

Well when I referenced generics I was responding to PeterMP specifically when he was talking about drug costs in other nations. If you look at that posts it also references drug prices and as you can see I state that our costs for prescription drugs are higher in the US than other nations. This is tied in to what I was telling Peter earlier with regards to Japan and MRI machines. When you have one person who sets the prices, like in other nations, it is easier to control costs. Even in the US the same drug can have 50 different prices depending on the insurance, plan, etc. What you are referencing is the fact that we do not have a price-setter here and that is why I stated that the difference in prices is perhaps the largest driver of our increased costs.

Yes you are talking about buying in bulk. A large group of citizens who know they will need so many doses of a certain drug negotiationing for that drug as a bulk as the verterans administration does. As all other American organizations including medicare and medicade were bared from doing by federal law passed by Bush in 2006.

The nation's top health official said yesterday that the government should not negotiate Medicare drug prices, a position that sets the stage for an early confrontation with the incoming Democratic Congress.

http://www.washingtonpost.com/wp-dyn/content/article/2006/11/13/AR2006111301356.html

---------- Post added January-10th-2011 at 11:14 AM ----------

I'm pretty sure this isn't true. I don't think there is anything in the law regarding patents.

Obama has even talked about reducing the length of patents:

"President Obama has proposed changing the length of time patents covering pharmaceuticals are enforceable. His proposal is to change the patent term from 20 years to 7 years. According to Medical News Today, it takes 8 years on average for a new drug to receive FDA approval. Thus, the President’s proposal is to essentially eliminate patent protection for drugs. If this proposal is implemented, the net result will be to kill innovation in the pharmaceutical industry. This will increase the long term cost of medical care. Medicines are inexpensive medical treatment compared to surgical techniques, the main alternative. "

(A very slanted piece, but the general facts are correct, I believe.)

http://hallingblog.com/2009/08/13/obama-%E2%80%93-change-pharmaceutical-patent-term-to-7-years/

I tend to favor shorter patent periods and more protection for companies that follow the rules with respect to approval and post-market studies and safety and less regulation of prices.

I agree with you that Obama hasn't really touched patents for drug companies. Probable won't either. Just trying to tackle the insurance leg of the healthcare trust nearly sank his presidency. Drug companies settled up with Obama before the healthcare debate. They agreed to give back the 80 billion Bush gifted to them in 2006. They also agreed not to make a big stink when Americans were given back their ability to bargen collectively for drugs; and then their is the importation of drugs from foreign contries by private Americans for there personal use which became legal again under Obamacare..

The drug companies agreed not to fight these things on the eve of healthcare reform, in exchange for assurances Obama would not seak harsher reforms. The 80 billion Obama got from the insurance companies went into his budget for the larger Obamacare package.

Obama gives powerful drug lobby a seat at healthcare table

The pharmaceutical industry, once condemned by the president as a source of healthcare problems, has become a White House partner.

Reporting from Washington — As a candidate for president, Barack Obama lambasted drug companies and the influence they wielded in Washington. He even ran a television ad targeting the industry's chief lobbyist, former Louisiana congressman Billy Tauzin, and the role Tauzin played in preventing Medicare from negotiating for lower drug prices.

Since the election, Tauzin has morphed into the president's partner. He has been invited to the White House half a dozen times in recent months. There, he says, he eventually secured an agreement that the administration wouldn't try to overturn the very Medicare drug policy that Obama had criticized on the campaign trail.

"The White House blessed it," Tauzin said.

Don't think they had to swallow much more than that.

buy the way... If you want to meet a real horses rear end; look up Tauzin and the role he played in Bush's reform of 2006 and what has occured to him since. Tauzin used to be in congress; but after he chapioned bush's 2006 900 billion dollar "reform"; Tarzin resigned from congress and became the drug companies man on the hill. Highest paid lobiest for the healthcare industry.

[PeterMP]

The other thing that really should be pointed out that I didn't see in either of these threads is that in every western country that I know about, prior to the recession, health care costs have also been increasing faster than inflation. So it isn't just adopt the policies of country X and problem fixed, but adopt those policies and pretty much imediately start looking for a long term fix to the problem.

Because of all of those countries are also looking to modify their systems.

[shk75]

The other thing that really should be pointed out that I didn't see in either of these threads is that in every western country that I know about, prior to the recession, health care costs have also been increasing faster than inflation. So it isn't just adopt the policies of country X and problem fixed, but adopt those policies and pretty much imediately start looking for a long term fix to the problem.

Because of all of those countries are also looking to modify their systems.

I touched on that in the other thread when I stated that all countries are struggling with increasing costs, but what makes the US unique is that our costs are increasing at a faster rate and at the same time we have worse outcomes.

There is something called the Universal Laws of Health Care Systems:

1. No matter how good the health care is people will complain about it

2. No matter how much is spent on health care doctors and hospitals will argue it is not enough

3. The last reform always failed

When I was doing research in Europe I was shocked at how true this is. In every country rising costs are the headline and there are constant proposals for reform. This was most evident in Britain where it seemed like everyday there was another headline about health care in the UK and its failures. However, what is interesting is when people are polled in these countries, they are much happier with their system then we are here.

[PeterMP]

I touched on that in the other thread when I stated that all countries are struggling with increasing costs, but what makes the US unique is that our costs are increasing at a faster rate and at the same time we have worse outcomes.

There is something called the Universal Laws of Health Care Systems:

1. No matter how good the health care is people will complain about it

2. No matter how much is spent on health care doctors and hospitals will argue it is not enough

3. The last reform always failed

When I was doing research in Europe I was shocked at how true this is. In every country rising costs are the headline and there are constant proposals for reform. This was most evident in Britain where it seemed like everyday there was another headline about health care in the UK and its failures. However, what is interesting is when people are polled in these countries, they are much happier with their system then we are here.

Well, measures of health out come are tricky and have been discussed here several times. The big one that JMS likes to cite is the WHO measure, which includes as part of its scoring system "fairness" so is immediately biased towards giving ones that give a legal requirement to cover everybody better scores so even if you had two countries that had the same exact data in terms of life expectencies, illness rates, survival rates for major life ending illnesses, "real" costs, etc. they'd score the one with a government mandate to cover everybody better. This method always seemed a bit biased to me.

The other issue is societal issues. One easy way to look at this is look at deaths by accident. According to the WHO data, we lead Europeans in deaths by accidents. We also lead in deaths by preventable diseases, like AIDS, and we lead in the number of people that have AIDS.

I'm not saying our system is really good and certainly not saying that it is economically effecient, but a lot of people out there (e.g. Michael Moore) paint our real results as being much worse than they really are.

I don't want to get in a discussion on this topic. Everything I have to say on it is linked in or actually in this thread:

http://www.extremeskins.com/showthread.php?302648-Mises-A-Free-Market-Guide-to-Fixing-Healthcare

With respect to government run health care, I guess my biggest thing is long term, I don't believe the government will tell people "no, that procedure/drug is too expensive.", and they certainly won't raise taxes to cover the expenses.

[shk75]

Well, measures of health out come are tricky and have been discussed here several times. The big one that JMS likes to cite is the WHO measure, which includes as part of its scoring system "fairness" so is immediately biased towards giving ones that give a legal requirement to cover everybody better scores so even if you had two countries that had the same exact data in terms of life expectencies, illness rates, survival rates for major life ending illnesses, "real" costs, etc. they'd score the one with a government mandate to cover everybody better. This method always seemed a bit biased to me.

The other issue is societal issues. One easy way to look at this is look at deaths by accident. According to the WHO data, we lead Europeans in deaths by accidents. We also lead in deaths by preventable diseases, like AIDS, and we lead in the number of people that have AIDS.

I'm not saying our system is really good and certainly not saying that it is economically effecient, but a lot of people out there (e.g. Michael Moore) paint our real results as being much worse than they really are.

I don't want to get in a discussion on this topic. Everything I have to say on it is linked in or actually in this thread:

http://www.extremeskins.com/showthread.php?302648-Mises-A-Free-Market-Guide-to-Fixing-Healthcare

The WHO ranking system, while not perfect, is still considered by most to be the best study in terms of health care systems and their effectiveness. The ranking system is composed of many different factors, fairness being one of them, but even when that factor is removed the US still ranks low. Also there is no debate on health outcomes since they do not involve fairness. Here are the facts on our outcomes:

The US ranked last among curing people from preventable deaths in a study evaluating the system of 19 OECD nations. The amount of people who die from curable diseases was almost double that in nations like Japan, France, and Spain.

Americans with asthma die earlier than those in other OECD nations, except for Britain.

Americans with diabetes die younger than any citizens of an OECD nations.

Americans with kidney diseases have far worse outcomes than OECD nations.

Deaths from from surgical mishaps is higher than any OECD nation.

The US was last in life healthy life expectancy after age 60 among 23 OECD nations.

America is last in infant mortality among a study of 23 OECD nations.

I could go on and on. These are not cherry picked statistics, there are many more like this and they have nothing to do with WHO's fairness ranking. These are real outcomes and the US is last or close to last in all of them.

[JMS]

The other thing that really should be pointed out that I didn't see in either of these threads is that in every western country that I know about, prior to the recession, health care costs have also been increasing faster than inflation. So it isn't just adopt the policies of country X and problem fixed, but adopt those policies and pretty much imediately start looking for a long term fix to the problem.

That strikes me as disengenuous. The US healthcare costs are going up faster than any other country and we already pay nearly twice as much as the next comparable country. Likewise it's not true that most western countries have shared our history of decades of tripple the level of inflation increases in healthcare costs.

The bottom line is that it was only 4 decades ago that US Healthcare was considered the gold standard, or nearly so. We started out way ahead of all of these other countries; and where they inovated and reformed; we stagnated and relaxed. Leading to the situation we have today; where we have one of hte most expensive and least sucessful healthcare systems in the industrialized world. Not to mention unfair.

Because of all of those countries are also looking to modify their systems.

Which is a little bit like saying the redskins and pats both modified their defensive schemes last year thus they are comparable. We will just assume all other things are equal. Hell we had a major 900 billion dollar healthcare reform bill in 2006; and we had to revisit healthcare again in 2009. Don't think that's common place for the rest of the industrialized world. We have arguable one of the worst healthcare delivery systems in the world. We have went from a habitual #1 in the world to 37th by the UN affiliated US organized and funded World Health Organizations rankings. There is no comparison between ourselves and France, Italy, Germany, or Japan. No positive comparison can be made anyway.

[PeterMP]

The WHO ranking system, while not perfect, is still considered by most to be the best study in terms of health care systems and their effectiveness. The ranking system is composed of many different factors, fairness being one of them, but even when that factor is removed the US still ranks low. Also there is no debate on health outcomes since they do not involve fairness. Here are the facts on our outcomes:

The US ranked last among curing people from preventable deaths in a study evaluating the system of 19 OECD nations. The amount of people who die from curable diseases was almost double that in nations like Japan, France, and Spain.

Americans with asthma die earlier than those in other OECD nations, except for Britain.

Americans with diabetes die younger than any citizens of an OECD nations.

Americans with kidney diseases have far worse outcomes than OECD nations.

Deaths from from surgical mishaps is higher than any OECD nation.

The US was last in life healthy life expectancy after age 60 among 23 OECD nations.

America is last in infant mortality among a study of 23 OECD nations.

I could go on and on. These are not cherry picked statistics, there are many more like this and they have nothing to do with WHO's fairness ranking. These are real outcomes and the US is last or close to last in all of them.

All of which I'd expect from a country that is also first in death's by accidents (i.e. Americans with asthma are more likely to have an "accident" that kill them and so have a lower life expectency (and nobody seriously believes that we have poorer care related to accident survival. Our emergency care is generally very highly though of)).

Let's see what the OECD thinks:

"There is no simple way of saying whether this is true; the Box on quality of care below provides a very short summary of what we

4 know, which can be reduced to the statement that ‘in some areas, US health care is very good; in others it is

not.’"

According to their box, we are best in breast cancer survival. We are second best, in colon cancer survival. Then there is the other side. We are first (or last depending on how you want to state it), in complications related to diabetes and asthma.

http://www.oecd.org/dataoecd/5/34/43800977.pdf

Of course, a large part of diabetes out comes is personal decision making.

So to a large extent I would argue that your statistics are cherry picked. You managed to pick all of the places we do poorly and none of the cases we do well and completely ignore the point I made about societal issues.

[JMS]

All of which I'd expect from a country that is also first in death's by accidents (i.e. Americans with asthma are more likely to have an "accident" that kill them and so have a lower life expectency (and nobody seriously believes that we have poorer care related to accident survival. Our emergency care is generally very highly though of)).

Yes Americans are genetically more predisposed to accidents. Thus we should expect younger deaths out of our healthcare systems :doh:. Reminds me of Burgolds argument. Americans should be happy with our healthcare system ranked between Cuba and Costa Rica; because Americans in inherantly less healthy than other humans... :doh:

Face it pete; we have horrible healthcare delivery system in this country. It's what happens when you relax all your market compeditive mechanisms and then hoodwink the people into not imposing legislative restraints upon the reasoning it will interfere with a fictitious free market which doesn't exist.

Of course, a large part of diabetes out comes is personal decision making.

:doh: So we are natually unhealthy, naturally accident prone; and now we are inherantly poor decision makers too? Damned you make it sound like Americans should be very thankful we rank one rung ahead of cuba in healthcare delivery even though cuba pays about 1/200th of what we do per capita while covering every man woman and child in their country.

I wonder why Americans are so unhealthy, accident prone and poor decision makers in 2010; when in 1970 we had had the best healthcare system in the wourld for decades.

I've got another explaination. We have a poor healthcare system which basically is expensive an ineffective. The rest of the world has just been more agressive in reforming and improving their systems and we've fallen behind.

[shk75]

All of which I'd expect from a country that is also first in death's by accidents (i.e. Americans with asthma are more likely to have an "accident" that kill them and so have a lower life expectency (and nobody seriously believes that we have poorer care related to accident survival. Our emergency care is generally very highly though of)).

Let's see what the OECD thinks:

"There is no simple way of saying whether this is true; the Box on quality of care below provides a very short summary of what we

4 know, which can be reduced to the statement that ‘in some areas, US health care is very good; in others it is

not.’"

According to their box, we are best in breast cancer survival. We are second best, in colon cancer survival. Then there is the other side. We are first (or last depending on how you want to state it), in complications related to diabetes and asthma.

http://www.oecd.org/dataoecd/5/34/43800977.pdf

Of course, a large part of diabetes out comes is personal decision making.

So to a large extent I would argue that your statistics are cherry picked. You managed to pick all of the places we do poorly and none of the cases we do well and completely ignore the point I made about societal issues.

There is NOBODY who would argue that we have better outcomes. Your argument is not accurate because you are talking about people who RECEIVE care. Here is a quote from the article you sourced:

"Overall, health outcomes are below average in the United States, but this is due, at least in part, to factors outside the health system. The United States stands out as performing very well in the area of cancer care,

achieving higher rates of screening and survival from different types of cancer than most other OECD countries. At the same time, many other countries, such as the United Kingdom and Canada, are doing much

better than the United States in providing good primary care to their population, thereby reducing the need for costly hospital care for chronic conditions such as asthma or complications from diabetes which should normally be managed outside hospitals."

This article is talking about medical care and outcome from procedures. It clearly states that our outcomes are below average, and why is that? They state that is it due to "factors outside the health system." What are these factors? The 50 million uninsured people who do not have access to, as they state, "providing good primary care to their population, thereby reducing the need for costly hospital care for chronic conditions such as asthma or complications from diabetes which should normally be managed outside hospitals." Nobody in this thread is arguing that the quality of our CARE is blow average. The point is that the quality of care does not matter when almost 20% of the population does not have access to it. That is what is driving our poor outcomes, our system itself and not the care provided by it.

[PeterMP]

There is NOBODY who would argue that we have better outcomes. Your argument is not accurate because you are talking about people who RECEIVE care. Here is a quote from the article you sourced:

"Overall, health outcomes are below average in the United States, but this is due, at least in part, to factors outside the health system. The United States stands out as performing very well in the area of cancer care,

achieving higher rates of screening and survival from different types of cancer than most other OECD countries. At the same time, many other countries, such as the United Kingdom and Canada, are doing much

better than the United States in providing good primary care to their population, thereby reducing the need for costly hospital care for chronic conditions such as asthma or complications from diabetes which should normally be managed outside hospitals."

This article is talking about medical care and outcome from procedures. It clearly states that our outcomes are below average, and why is that? They state that is it due to "factors outside the health system." What are these factors? The 50 million uninsured people who do not have access to, as they state, "providing good primary care to their population, thereby reducing the need for costly hospital care for chronic conditions such as asthma or complications from diabetes which should normally be managed outside hospitals." Nobody in this thread is arguing that the quality of our CARE is blow average. The point is that the quality of care does not matter when almost 20% of the population does not have access to it. That is what is driving our poor outcomes, our system itself and not the care provided by it.

I'll point out the statistics on cancer ARE NOT just the people that are covered by insurance. If you look at the total population of people, we do well for cancer recovery. We also do well for things like recovery from stroke.

Outside factors from the health care system include various societal issues beyond whether people are covered by insurance, including life style choices.

We've already been over the idea that providing more primary care, as we currently do it, won't significantly lower costs.

[PeterMP]

Yes Americans are genetically more predisposed to accidents. Thus we should expect younger deaths out of our healthcare systems :doh:. Reminds me of Burgolds argument. Americans should be happy with our healthcare system ranked between Cuba and Costa Rica; because Americans in inherantly less healthy than other humans... :doh:

Face it pete; we have horrible healthcare delivery system in this country. It's what happens when you relax all your market compeditive mechanisms and then hoodwink the people into not imposing legislative restraints upon the reasoning it will interfere with a fictitious free market which doesn't exist.

:doh: So we are natually unhealthy, naturally accident prone; and now we are inherantly poor decision makers too? Damned you make it sound like Americans should be very thankful we rank one rung ahead of cuba in healthcare delivery even though cuba pays about 1/200th of what we do per capita while covering every man woman and child in their country.

I wonder why Americans are so unhealthy, accident prone and poor decision makers in 2010; when in 1970 we had had the best healthcare system in the wourld for decades.

I've got another explaination. We have a poor healthcare system which basically is expensive an ineffective. The rest of the world has just been more agressive in reforming and improving their systems and we've fallen behind.

More people die from homicides in this country than any other OECD country, and that is based on long term statistics and has nothing to do with our medical care.

[JMS]

I'll point out the statistics on cancer ARE NOT just the people that are covered by insurance. If you look at the total population of people, we do well for cancer recovery. We also do well for things like recovery from stroke.

Outside factors from the health care system include various societal issues beyond whether people are covered by insurance.

We've already been over the idea that providing more primary care, as we currently do it, won't significantly lower costs.

I would argue that those "outside" factors aren't outside at all. It's part of our system that we deny care to millions of Americans. When we judge relative costs of systems; we do so on a per capita metric. Our system is the most costly in the world even when we spread out the costs across those who we exclude from coverage, per capita...

It's disengenous to include those uncovered people in the figure when you are calculating costs but then exclude them when you are calculating outcomes...

[PeterMP]

I would argue that those "outside" factors aren't outside at all. It's part of our system that we deny care to millions of Americans. When we judge relative costs of systems; we do so on a per capita metric. Our system is the most costly in the world even when we spread out the costs across those who we exclude from coverage, per capita...

I think you misunderstood my point about outside factors. I meant in terms of larger societal issues and personel decision making.

Yes, our health care system is easily the most expensive when you take into account everybody in the US and even the relative wealth of the US.

I'm not arguing that our health care system is good or economically effecient.

[shk75]

I'll point out the statistics on cancer ARE NOT just the people that are covered by insurance. If you look at the total population of people, we do well for cancer recovery. We also do well for things like recovery from stroke.

Outside factors from the health care system include various societal issues beyond whether people are covered by insurance.

We've already been over the idea that providing more primary care, as we currently do it, won't significantly lower costs.

Peter, please you are confusing the arguments. Outcomes do not refer to costs, they refer to health. If you would like to make the argument that providing more primary care does not improve the health of the population than go ahead, but you and I both know that is a foolish argument. Here is what is accepted by every single health care professional:

If you are rich and have good insurance and you do not live in a medical island, the current system works for you. We have some of the best doctors, trauma centers, hospitals, procedures in the world. If you can afford them you will be well taken care of. That is why people from universal systems in countries like France and Japan come to places like the Mayo Clinic and Cleveland Clinic.

If you are middle class you are often cared for pretty well unless you have a serious and debilitating chronic issue which in that case can go either way. You may receive good care and recover or you may have yoru claims denied and go bankrupt, like the other 700,000 Americans who file bankruptcy claims each year due to medical costs.

If you are extremely poor you will have access to medicaid (well not necessarily but that is another debate) but if you do not qualify or if states have cutback qualification standards you are pretty much screwed and if you are unlucky enough to get sick you will be in big trouble.

The point is we have a two tiered system. If you are rich you will most likely enjoy some of the best medical care in the world. If you are not it often comes down to one thing, luck. This is why all nations that have reformed their systems have first started with the ethical question of, do all people deserve access to high quality care. Those who say yes form universal systems, those who say no have systems like ours.

[JMS]

More people die from homicides in this country than any other OECD country, and that is based on long term statistics and has nothing to do with our medical care.

In a debate that's called introducing an unrelated (and in this case incorrect) fact into the discussion. You said we were more accident prone, and poor decision makers. Were you saying we were more accident prone because we were more likely to wonder in front of a bullet? If that's not the case then your incorrect homicide statistic is really irrelivent to my rebuttle to your original hypothesis.

Now as to your "statistic". It was true in the 1990's that America had the highest murder rate per capita in the world. It's not true in the 21 st century. In the 21st century we rank down at #24.

Murders (per capita) (most recent) by country

# 1 Colombia: 0.617847 per 1,000 people

# 2 South Africa: 0.496008 per 1,000 people

# 3 Jamaica: 0.324196 per 1,000 people

# 4 Venezuela: 0.316138 per 1,000 people

# 5 Russia: 0.201534 per 1,000 people

# 6 Mexico: 0.130213 per 1,000 people

# 7 Estonia: 0.107277 per 1,000 people

# 8 Latvia: 0.10393 per 1,000 people

# 9 Lithuania: 0.102863 per 1,000 people

# 10 Belarus: 0.0983495 per 1,000 people

# 11 Ukraine: 0.094006 per 1,000 people

# 12 Papua New Guinea: 0.0838593 per 1,000 people

# 13 Kyrgyzstan: 0.0802565 per 1,000 people

# 14 Thailand: 0.0800798 per 1,000 people

# 15 Moldova: 0.0781145 per 1,000 people

# 16 Zimbabwe: 0.0749938 per 1,000 people

# 17 Seychelles: 0.0739025 per 1,000 people

# 18 Zambia: 0.070769 per 1,000 people

# 19 Costa Rica: 0.061006 per 1,000 people

# 20 Poland: 0.0562789 per 1,000 people

# 21 Georgia: 0.0511011 per 1,000 people

# 22 Uruguay: 0.045082 per 1,000 people

# 23 Bulgaria: 0.0445638 per 1,000 people

# 24 United States: 0.042802 per 1,000 people

# 25 Armenia: 0.0425746 per 1,000 people

# 26 India: 0.0344083 per 1,000 people

# 27 Yemen: 0.0336276 per 1,000 people

http://www.nationmaster.com/graph/cri_mur_percap-crime-murders-per-capita

you will note that both Columbia and Costa Rica have more murders per capita but still have better healthcare systems than we do in the United States as rated by the World health organization study.