Canada Health care killed Richardson

[el jefe]

i think this argument is specious, jayb. canadian diets and habits aren't that different from ours and traumatic injuries (gunshot wounds, stabbings, etc -- homicides are usually the result of penetrating trauma) are considered a public health issue, so the comparison is still valid as a measure of the effectiveness of a health care delivery system. infant mortality is higher in the u.s. than canada as well -- do you think homicide rates matter as far as this is concerned? are u.s. infants more likely to smoke cigarettes? is canadian breast milk healthier than american? give me a break. we're talking about statistics based upon populations measured in the millions. you just don't want to believe the data because it doesn't support your ideology.

[JayB]

"And the rightwing mantra of "leave medicine to the doctors, not the gov't" - what utter bullshit - these are the same clowns who took over, raped, and all but destroyed our medical system in the '80s and '90s with 'managed care'. The republicans explicitly didn't want doctors making medical decisions - they manufactured a system which explicitly took decision-making out of doctor's hands and gave it to insurance companies."

 

let's use the complete statement if you are going to quote from it, jayb. seems to me that joseph is saying that rightwing shills used fear of guvmint bureaucrats restricting treatment options as a smokescreen to shift this power to corporate bureaucrats instead. try going to a specialist who is "outside" your hmo, ppo, or whatever and you'll find it isn't covered -- in other words, your treatment options are being limited. myself, i'd rather this decision be made by the government bureaucrats because i can, at least on some level, influence that decision by how i vote. corporate bureaucrats, on the other hand, have the best interests of the corporation in mind, not the public interest.

 

At least this is an honest answer - ultimately you want the government to ration care instead of corporations - and I certainly appreciate your candor on this point.

 

I personally don't want my care rationed by anyone, but I'm more comfortable with a system where the government regulates the private insurers and it's still possible to choose what kind of coverage I get, and who I buy it from.

 

While not quite on the same topic, it's impossible to get too far down this road without contemplating what effect a national healthcare monopoly with price controls, which inevitably lead to supply controls, will have on innovation. I think that this is an important consideration, since things that start off as expensive and rare have a tendency to become widespread and relatively cheap it they're significantly better than existing alternatives.

[billcoe]

Following up on what Jayb says is this fairly balanced web site:

http://healthcare-economist.com/2007/10/02/health-care-system-grudge-match-canada-vs-us/

 

"Health Care System Grudge Match: Canada vs. U.S.

 

October 2, 2007 in International Health Care Systems

 

Who has a better health care system: Canada or the U.S. Michael Moore would vote for Canada. Libertarians would side with the U.S. A new NBER working paper by June O’Neill and Dave O’Neill concludes that the two systems may produce more similar health outcomes than was previously believed.

 

History of the Canadian System

 

The paper reviews some of the major developments in the Canadian health care system during the last half century.

 

Since the late 1960s Canada essentially has had a universal health insurance system covering all services provided by physicians and hospitals. To implement universal coverage the federal and provincial governments took over full funding of both hospital and physician services, setting physician fees and hospital budgets. During the 70’s physicians, dissatisfied with the official fee amounts, chose to work outside the system and bill patients at higher amounts. But with the passage of the Canadian Health Act of 1984 Canada outlawed extra billing and became a rigid one-tier system which restricted the provision of any “core” services outside the public’s so-called “Medicare” system (Irvine, Ferguson and Cackett).

 

Since all hospital and physician services are free, demand surged in Canada leading to skyrocketing costs. This lead to government spending cuts in the 1990s; shortages and waiting lines resulted.

 

The condition for shortages was enhanced because of the provision in the 1984 Act that decreed that any service that the single payer provides, no matter how much in short supply it may be, cannot be privately insured or produced and sold in Canada. Relief came, however, in 2005 when the 1984 Act was struck down as unconstitutional by Canada’s highest court {Chaoulli v.Quebec (Attorney General), 2005, IS.C.R. 791, 2005 SCC 35}. A slim 4/3 majority ruled that the government’s argument—that allowing a private sector, would undermine their public system—was not supported by the actual experience of other countries (U.K., France and Germany) that had converted from single payer to dual systems.

 

Data

 

The authors’ main data set used is The Joint Canada/U.S. Survey of Health (JCUSH). Collected between the fall of 2002 and spring of 2003, this data set includes 3,505 Canadian and 5,183 American individuals.

 

Basic Statistics

U.S. Canada

Life Expectancy (Male) 74.8 77.4

Life Expectancy (Female) 80.1 82.4

Infant Mortality/1000 live births 6.8 5.3

Obesity Rate (Male) 31.1 17.0

Obesity Rate (Female) 32.2 19.0

HC spending as % of GDP (2005) 16.0% 10.4%

 

 

We can readily see that the U.S. has worse life expectancy, infant mortality rates, and obesity rates that Canada, yet pays more for for these relatively poorer outcomes. Canada is clearly better…right?

 

Investigating Infant Mortality

 

It turns out that once we condition on infant birthweight–a significant predictor of infant health–the U.S. has equivalent infant mortality rates. In fact U.S. infant mortality is lower for low-birthweight babies than Canadian infant mortality for low birthweight babies. Overall infant mortality, however, is higher in the U.S. because the incidence of babies with low birthweight is higher than in Canada. This may be due to demographic or epidemiological factors, or it may be the case that the U.S. is better at having a live birth for a low birthweight baby.

Birthweight Distribution Birthweight-specific Infant Mortality

 

U.S. Canada U.S. Canada

<1500 1.4 0.9 247.3 262.2

1500-1999 1.5 1.1 29.3 36.6

2000-2499 4.6 3.7 12.2 12.9

2500-2999 16.6 15.0 4.8 4.4

≥3000 75.9 78.9 2.1 2.0

 

<2500 7.5 5.7 60.4 58.0

 

 

Overall Mortality Differences

 

Why do Canadians live longer. One reason is due to the excess number of accidents and homicides in the U.S. compared to Canada. In fact 50%-85% of the mortality gap between American and Canadian adults in their twenties can be explained by the increased American accident/homicide rates. For people over 50, 30-50% of the difference in age-specific mortality rates can be attributed to the excess number of heart disease patients in the U.S. These heart disease findings are more likely driven by American lifestyle choices rather than the efficacy of the U.S. medical system.

 

Access to Care

 

Well, the medical efficiency of the two systems may not be so different but access to care must vary greatly, right? Canada has an egalitarian, socialist system while the U.S. relies (somewhat) on free-market capitalism to allocate medical services.

 

Below we see that Canada general has a lower disease incidence rate, but treatment rates are generally higher in the U.S. Further, these difference decrease even more if we only look at Caucasians in each country. The authors state “the composition of the non-white group differs by country—predominantly black in the U.S., but Asian in Canada; and racial differences in health outcomes may differ in the two countries.” See CensusScope for more details on the U.S. racial composition.

Canada U.S.

% with condition % gets treatment % with condition % gets treatment

All

Asthma 6.6 80.3 7.8 78.8

High blood pressure 8.8 84.1 13.1 88.3

Heart Disease 2.4 67.2 2.6 69.6

Angina 0.9 74.6 1.1 61.0

Whites Asthma 6.9 82.7 7.7 77.6

High blood pressure 9.1 83.2 12.5 87.3

Heart Disease 2.7 69.4 2.4 73.2

Angina 0.9 70.7 0.8 75.1

 

 

In Canada, the main reason for an unmet need was because the wait was too long or the treatment was unavailable. In the U.S., most people who do not receive treatment fail to do so because of cost considerations.

 

Preventive Services

 

Probably the most surprising discovery of the paper was that Americans partake in more preventive care than Canadians.

 

* Mammograms: 88.6% of American females 40-69 had ever had a mammogram compared to 72.3% of Canadians.

* PAP smear: 86.3% of American females 20-69 had a PAP smear in the last 3 years compared to 75.1% of Canadians.

* Prostate screening: 54.2% of American men 40-69 had ever had a PSA test compared to 16.4% of Canadians.

 

As an economist, I attributed this finding to moral hazard: Canadians know that if they would get a disease that their government will pay for their care. Thus, they may be less motivated to ask for preventive services. One of my medical school colleagues noted, however, that physician recommendations also play a large part in the amount of care given. Further, most patients strongly wish to avoid disease, not simply due to cost considerations, but because of the physical and mental impact the disease would have on their life.

 

Conclusion

 

American are less healthy than Canadians. What this paper finds, however, is that this is mainly due to the fact that the U.S. has a higher incidence of disease. It turns out that Americans may have slightly higher access to treatment than Canadians. The paper is not the most smoothly written piece I have read, but the data is revealing. The small-ish sample size of the JCUSH mean that the results should not be taken as definative. Since the data set uses the same survey for both countries, however, the authors present convincing evidence that this cross-country comparison is of a high quality.

 

* June E. O’Neill and Dave M. O’Neill (2008) “Health Status, Health Care and Inequality: Canada vs. the U.S.,” Forum for Health Economics & Policy: Vol. 10: Iss. 1 (Frontiers in Health Policy Research), Article 3.

* O’Neill JE; O’Neill DM (2007) “Health Status, Health Care and Inequality: Canada vs. the U.S.” NBER working paper #13429."

 

Could our system be improved. Damned straight. Like JH says there are a lot of costs and inefficiencies doing it this way. Would a Government version be an improvement....hmmm, based on what I see, probably could be, but it might not necessarily be as others point out the costs and inefficiencies of a government system, but the jury's is still out on that one. Certainly we've seen how well the gov't has handled social security. That would seem like an easier thing to manage to me.

 

 

[j_b]

More fear-mongering by the corporate media about "commie healthcare" while industry lobbyists and their toady politicians develop policy "reform" behind close doors. Canadians have among the longest life expectancy on the planet (3 years longer than americans on average) which certainly couldn't happen without a healthcare system benefitting the population.

 

 

If you are going to make a relevant comparison of the precise contribution that a healthcare system makes to longevity, you first have to make sure that you are measuring outcomes that are actually affected by what happens in clinics and hospitals, no?

 

Not only, because healthcare is also in large part about prevention and because what happens in hospitals is only valid for those who make it to the hospital. Although life expectancy isn't a precise gauge of healthcare system performance, it does give a better indication of how a given system serves it population than a detailed study of outcomes for a specific illness. Here is the last existing ranking of population health and healthcare system performance by the World Health Organization, Canada ranked at #30 and the US ranked at #37: http://www.photius.com/rankings/healthranks.html

[akhalteke]

ditto jefe. Bitch killed herself. No sense blaming anyone but her.

wow dude...you're an asshole...

 

...and your a midget. What's your point?

[JayB]

i think this argument is specious, jayb. canadian diets and habits aren't that different from ours and traumatic injuries (gunshot wounds, stabbings, etc -- homicides are usually the result of penetrating trauma) are considered a public health issue, so the comparison is still valid as a measure of the effectiveness of a health care delivery system. infant mortality is higher in the u.s. than canada as well -- do you think homicide rates matter as far as this is concerned? are u.s. infants more likely to smoke cigarettes? is canadian breast milk healthier than american? give me a break. we're talking about statistics based upon populations measured in the millions. you just don't want to believe the data because it doesn't support your ideology.

 

It may be that Canadian stabbing and gunshot victims are more likely to survive on average than they are in the US, and if you can find a study that provides good evidence to suggest that this is the case, then that would prove that the Canadian health system is better in this regard.

 

I'll have to disagree with you when you assert that the higher incidence of gunshot wounds, for example, means that our health-care delivery system is worse than Canada's.

 

With regards to infant mortality, if you can establish that the US and Canada have the same criteria for measuring infant mortality, and the US still figures worse than Canada or any other particular country - then they're doing a better job and we should figure out what specific changes we can institute based on the way that they care for pregnant women and infants. Most measures of infant mortality use the number of deaths between the ages of zero and 1 per 1000 *live births* to come up with an infant mortality figure. At the very least, I hope that you'd agree that if you're going to have an accurate comparison between two countries, you have to demonstrate that they use the same standards to determine what constitutes a live birth (see post below).

 

As a minor aside, I think that there *are* differences in the average age of pregnancy, the tendency to seek pre-natal care, etc between say - undocumented immigrants and the general population that have an effect on infant mortality in ways that are difficult (but not impossible) to counter and that do have a minor but real affect on mortality stats in ways that are largely absent in Canada. I also think that this is an issue that's larger than the health system, and we can have that discussion if you wish, but I still think that if your purpose is an accurate, intellectually honest comparison of healthcare in country A versus country B, you have to make an effort to account for things that the health system can, and cannot, reasonably do to save and prolong lives.

[Choada_Boy]

Clearly the most socialist countries in Europe (Scandinavia) have the best health care. Please forward this thread to Obama for societal reassignment.

[Choada_Boy]

 

Basic Statistics

U.S. Canada

 

Obesity Rate (Male) 31.1 17.0

Obesity Rate (Female) 32.2 19.0

 

 

Shocking. We must be the fattest fucks on the planet. And have you seen the size of their margarine tubs?

[JayB]

For El Jefe:

 

1: Paediatr Perinat Epidemiol. 2002 Jan;16(1):16-22.Click here to read Links

Registration artifacts in international comparisons of infant mortality.

Kramer MS, Platt RW, Yang H, Haglund B, Cnattingius S, Bergsjo P.

 

Department of Pediatrics, McGill University Faculty of Medicine, Montreal, Canada. michael.kramer@mcgill.ca

 

Large differences in infant mortality are reported among and within industrialised countries. We hypothesised that these differences are at least partly the result of intercountry differences in registration of infants near the borderline of viability (<750 g birthweight) and/or their classification as stillbirths vs. live births. We used the database of the International Collaborative Effort (ICE) on Perinatal and Infant Mortality to compare infant mortality rates and registration practices in Norway (n = 112484), Sweden (n = 215 908), Israeli Jews (n = 148123), Israeli non-Jews (n = 52 606), US Whites (n = 6 074 222) and US Blacks (n = 1328332). To avoid confounding by strong secular trends in these outcomes, we restricted our analysis to 1987-88, the most recent years for which data are available in the ICE database for all six groups. Compared with Norway (with an infant mortality rate of 8.5 per 1000), the crude relative risks [95% confidence intervals] were 0.75 [0.69,0.81] in Sweden, 0.97 [0.90,1.06] in Israeli Jews, 1.98 [1.81,2.17] in Israeli non-Jews, 0.95 [0.89,1.01] in US Whites and 2.05 [1.95,2.19] in US Blacks. For borderline-viable infants, fetal deaths varied twofold as a proportion of perinatal deaths, with Norway reporting the highest (83.9% for births <500 g and 61.8% for births 500-749 g) and US Blacks the lowest (40.3% and 37.6% respectively) proportions. Reported proportions of live births <500 g varied 50-fold from 0.6 and 0.7 per 10000 in Sweden and Israeli Jews and non-Jews to 9.1 and 33.8 per 10000 in US Whites and Blacks respectively. Reported proportions 500-749 g varied sevenfold from 7.5 per 10000 in Sweden to 16.2 and 55.4 in US Whites and Blacks respectively. After eliminating births <750 g, the relative risks (again with Norway as the reference) of infant mortality changed drastically for US Whites and Blacks: 0.82 [0.76,0.87] and 1.42 [1.33,1.53] respectively. The huge disparities in the ratio of fetal to infant deaths <750 g and in the proportion of live births <750 g among these developed countries probably result from differences in birth and death registration practices. International comparisons and rankings of infant mortality should be interpreted with caution.

[KaskadskyjKozak]

More fear-mongering by the corporate media about "commie healthcare" while industry lobbyists and their toady politicians develop policy "reform" behind close doors. Canadians have among the longest life expectancy on the planet (3 years longer than americans on average) which certainly couldn't happen without a healthcare system benefitting the population.

 

 

Canadian life expectancy has nothing to do with disparities in health care systems.

 

Once the Canucks catch up to our obesity levels (word is they are working hard to do so) you'll see that 3 year margin evaporate.

 

[prole]

 

Canadian life expectancy has nothing to do with disparities in health care systems.

 

Once the Canucks catch up to our obesity levels (word is they are working hard to do so) you'll see that 3 year margin evaporate.

 

Yay?

[DirtyHarry]

What we should do to solve our countries obesity problem and energy problem is put all the super obese people in camps where they can watch all the tivo and play all the video games and eat all the chicken wings they want for free (The Canadians can watch figure skating and curling). Then we gradually liposuction out their fat and make biodiesel with it. Essentially we harvest the lazy and obese for fuel. Two problems solved at once.

 

 

[Jim]

Then there is cost. The U.S. has the most expensive health care system in the world, speding $4,178 per capita, more that twice the OECD median of $1,783, without any appreciable results, and almost twice as much as Switzerland - which has a govenrment conrolled private system. Currently we're about 15% of GDP spending on health care predicted to go to near %19 by 2017. 20% of this is just on adminstrative costs because of multiple carriers and inefficies.

 

I'm not bent on a government system, but we need a sigle payer system. And we need universal coverage. There is no other industrialzed country where you could lose your home and go bankrupt because of medical costs.

[tvashtarkatena]

We could have a single payer system tomorrow if federal employee health care was opened up to everyone. Low income health care would still be a problem, but this would go a long way to providing an well functioning, affordable system to millions of currently uninsured folks.

 

The insurance and drug companies have spent copious amounts on misinformation regarding single payer healthcare. The most common form of propaganda centers on the mythical need to create some brand new, untested system (which, of course, would be a botch) rather than simply and easily making an available system, such as the one I've mentioned above, openly available. All the civilized countries in the world with such a system, and that would be all of them except us, created their systems from what they already had. They're all unique by country and history, yet, despite this diversity, they're all are far less expensive and produce better outcomes than ours.

 

The U.S. is something like #30 in the world in the quality of its healthcare, using a broad array of performance measures, and that ranking continues to drop.

 

Yeah, we've got a problem, and a major part of the solution (some form of universal healthcare) is pretty clear at this point.

Edited March 27, 2009 by tvashtarkatena

[jordop]

Following up on what Jayb says is this fairly balanced web site:

http://healthcare-economist.com/2007/10/02/health-care-system-grudge-match-canada-vs-us/

 

Since all hospital and physician services are free, demand surged in Canada leading to skyrocketing costs. This lead to government spending cuts in the 1990s; shortages and waiting lines resulted.

 

Wicked logic. Guess it didn't having anything to do with a rapidly aging population?

[JayB]

More fear-mongering by the corporate media about "commie healthcare" while industry lobbyists and their toady politicians develop policy "reform" behind close doors. Canadians have among the longest life expectancy on the planet (3 years longer than americans on average) which certainly couldn't happen without a healthcare system benefitting the population.

 

 

If you are going to make a relevant comparison of the precise contribution that a healthcare system makes to longevity, you first have to make sure that you are measuring outcomes that are actually affected by what happens in clinics and hospitals, no?

 

Not only, because healthcare is also in large part about prevention and because what happens in hospitals is only valid for those who make it to the hospital. Although life expectancy isn't a precise gauge of healthcare system performance, it does give a better indication of how a given system serves it population than a detailed study of outcomes for a specific illness. Here is the last existing ranking of population health and healthcare system performance by the World Health Organization, Canada ranked at #30 and the US ranked at #37: http://www.photius.com/rankings/healthranks.html

 

I'd very much enjoy an entirely separate thread dedicated to evaluating the methodology that the WHO used to develop its rankings.

 

Having said that, I'm familiar enough with the WHO study to assert that it doesn't actually tell you much that's useful about how effectively the health care delivery systems in country A and country B do at dealing with things that doctors, nurses, hospitals, clinics, etc can *actually* so something about. If you define prevention carefully, it makes sense to include it in this category - but throwing every behavior that increases mortality into the mix doesn't make much sense if your aim is to make a logically and methodologically sound comparison of how good the healthcare systems in country A and country B are relative to whatever criteria is under consideration.

 

 

 

 

 

 

[JayB]

We could have a single payer system tomorrow if federal employee health care was opened up to everyone. Low income health care would still be a problem, but this would go a long way to providing an well functioning, affordable system to millions of currently uninsured folks.

 

The insurance and drug companies have spent copious amounts on misinformation regarding single payer healthcare. The most common form of propaganda centers on the mythical need to create some brand new, untested system (which, of course, would be a botch) rather than simply and easily making an available system, such as the one I've mentioned above, openly available. All the civilized countries in the world with such a system, and that would be all of them except us, created their systems from what they already had. They're all unique by country and history, yet, despite this diversity, they're all are far less expensive and produce better outcomes than ours.

 

The U.S. is something like #30 in the world in the quality of its healthcare, using a broad array of performance measures, and that ranking continues to drop.

 

Yeah, we've got a problem, and a major part of the solution (some form of universal healthcare) is pretty clear at this point.

 

I'll grant you the less expensive portion, but I'd be very interested in the data concerning outcomes for specific medical conditions. age-adjusted average survival rates from onset for X, etc.

 

I have already mentioned the methodological controls that are necessary to insure that measures like life expectancy and infant mortality have to incorporate in order to render them valid, so if you have studies that control for those points, I hope that you'll share them.

 

Looking forward to seeing the data.

[JayB]

Then there is cost. The U.S. has the most expensive health care system in the world, speding $4,178 per capita, more that twice the OECD median of $1,783, without any appreciable results, and almost twice as much as Switzerland - which has a govenrment conrolled private system. Currently we're about 15% of GDP spending on health care predicted to go to near %19 by 2017. 20% of this is just on adminstrative costs because of multiple carriers and inefficies.

 

I'm not bent on a government system, but we need a sigle payer system. And we need universal coverage. There is no other industrialzed country where you could lose your home and go bankrupt because of medical costs.

 

I also think that, like everything else, it's important to be careful when we're talking about health care spending numbers.

 

Is this number just the total amount spent on hospitals, drugs, procedures, dentists, non-prescription drugs etc divided by the population? Or is it the total amount of non-discretionary spending? Are we comparing the total amount that people have to spend on medical care, or a combination of what people have to spend and choose to spend?

 

I think that this distinction is important, and here's why. It stands to reason tht if people in country A make twice what people in country B make, this will affect how much they spend on health care. They may be able to afford to treat conditions that the people in country B just have to suffer with (like acne, mild arthritis, etc) that don't necessarily manifest in increased mortality. Then there's medical care for things that don't even fall into the "medical problem" category, like many cosmetic procedures. Then there's the stuff that falls into borderline areas like the $8,000 that my wife and I spent on LASIK procedures.

 

Medical problem? Sort of - we both had terrible vision. Medically necessary? Nope - glasses work just fine, but worth it? To us - yes, absolutely. Did it add to the top-line spending figure that's used to generate the per-capita spending figure that you cited? I'd sure be interested in finding out.

[j_b]

Not only, because healthcare is also in large part about prevention and because what happens in hospitals is only valid for those who make it to the hospital. Although life expectancy isn't a precise gauge of healthcare system performance, it does give a better indication of how a given system serves it population than a detailed study of outcomes for a specific illness. Here is the last existing ranking of population health and healthcare system performance by the World Health Organization, Canada ranked at #30 and the US ranked at #37: http://www.photius.com/rankings/healthranks.html

 

I'd very much enjoy an entirely separate thread dedicated to evaluating the methodology that the WHO used to develop its rankings.

 

Having said that, I'm familiar enough with the WHO study to assert that it doesn't actually tell you much that's useful about how effectively the health care delivery systems in country A and country B do at dealing with things that doctors, nurses, hospitals, clinics, etc can *actually* so something about. If you define prevention carefully, it makes sense to include it in this category - but throwing every behavior that increases mortality into the mix doesn't make much sense if your aim is to make a logically and methodologically sound comparison of how good the healthcare systems in country A and country B are relative to whatever criteria is under consideration.

 

I don't think anyone here has the time to conduct such an analysis, if it could be done well enough to deliver a better indicator of how a system serves the need of the population than an index such as life expectancy or child mortality that may be imperfect but are less fraught with errors in sampling methodologies and bias in what is a valid comparison. Studies looking at outcomes for specific conditions have been done and some find that the canadian system is more successful on many levels, others are inconclusive, others find that the US system does better in some areas but in general it is very diffcult to draw sweeping conclusions from an exercise like the one you suggest.

 

The corporate media continues its blackout of single-payer healthcare news so few know that Bernie Sanders, senator from Vermont, introduced a single payer health care bill yesterday:

 

Single-Payer Health Reform Bill Introduced in Senate

Would save $400 billion on bureaucracy, enough to cover all 46 million uninsured Americans

CHICAGO - March 26 - Challenging head-on the powerful private insurance and pharmaceutical industries, Vermont's Sen. Bernie Sanders introduced a single-payer health reform bill, the American Health Security Act of 2009, in the U.S. Senate Wednesday. The bill is the first to directly take on the powerful lobbies blocking universal health reform in the Senate since Sen. Paul Wellstone's tragic death.

 

The single-payer approach embodied in Sanders' new bill stands in sharp contrast to the reform models being offered by the White House and by key lawmakers like Senators Max Baucus (D-Mont.) and Edward Kennedy (D-Mass.). Their plans would preserve a central role for the private insurance industry, sacrificing both universal coverage and cost containment during the worst economic crisis since the Depression.

 

In contrast, Sanders' new legislation would cover all of the 46 million Americans who currently lack coverage and improve benefits for all Americans by eliminating co-pays and deductibles and restoring free choice of physician. The most fiscally conservative option for reform, single payer slashes private insurance overhead and bureaucracy in medical settings, saving over $400 billion annually that can be redirected into clinical care.

 

"This is excellent news for the nation's health," said Dr. Quentin Young, national coordinator of Physicians for a National Health Program and a past president of the American Public Health Association. "There is now an affordable cure for our dysfunctional health care system. In the face of our present economic calamity, this is an urgent necessity."

 

Highlights of the bill include the following:

 

Patients go to any doctor or hospital of their choice.

 

The program is paid for by combining current sources of government health spending into a single fund with modest new taxes amounting to less than what people now pay for insurance premiums and out-of-pocket expenses.

 

Comprehensive benefits, including coverage for dental, mental health, and prescription drugs.

 

While federally funded, the program is to be administered by the states.

By eliminating the high overhead and profits of the private, investor-owned insurance industry, along with the burdensome paperwork imposed on physicians, hospitals and other providers, the plan saves at least $400 billion annually - enough money to provide comprehensive, quality care to all.

 

Community health centers are fully funded, giving the 60 million Americans now living in rural and underserved areas access to care.

 

To address the critical shortage of primary care physicians and dentists, the bill provides resources for the National Health Service Corps to train an additional 24,000 health professionals.

 

"We are confident that Sen. Sanders' bill will accelerate the national drive for the only reform that we know will work," Young said. "A majority of physicians endorse such an approach. Fifty-nine percent of U.S. physicians support national health insurance. Two-thirds of the public also supports such a remedy. We remember well that President Obama once acknowledged that single-payer national health insurance was the best way to go. It still is."

 

Sanders, who serves on the Senate Committee on Health, Education, Labor, and Pensions, is a longtime advocate of fundamental health care reform. His new bill draws heavily upon the single-payer legislation introduced by the late Sen. Paul Wellstone (D-Minn.) in 1993, S. 491, and closely parallels similar legislation pending before the House, H.R. 1200, introduced by Rep. Jim McDermott (D-Wash.).

 

A single-payer bill introduced by Rep. John Conyers Jr. (D-Mich.), H.R. 676, obtained 93 co-sponsors in the House during the last session. It has been reintroduced in the new Congress as the U.S. National Health Care Act with the same bill number.

 

http://www.commondreams.org/newswire/2009/03/26-15

 

[JayB]

At the very least I hope you'll furnish methodologically sound studies, conducted by people who make their living doing such things, that demonstrate that the sampling methodologies and bias in life expectancy and infant mortality stats are actually *less* fraught with logical and methodological shortcomings than than studies like the one comparing survival rates for given cancers that I linked to above. In the absence of that, you may as well admit that you have no defensible basis to ground an empirical comparison of health system performance in developed nations upon. I'll happily cede the point that your approach (infant mortality, life expectancy) makes sense when comparing nations with differences where the magnitude of the difference in these stats is so large that controlling for factors that are outside the scope of what the healtcare system can influence makes little or no difference, like Sweden vs Botswana, etc.

 

Having said that, let's have a look at the studies you mentioned that demonstrate that the Canadian health-care system does better than the US system in cases where the health system can actually make a difference. In addition to apples-to-apples survival rate data, there's surely some low hanging fruit like vaccination rates, screening exams, etc on the preventive side as well.

 

 

 

 

[JayB]

More About Life Expectancy Stats for The Evil Homonym:

 

Speaking of statistical studies:

 

Click Here to See Table of Life Expectancy Data wtih and Without Corrections for Fatal Injuries

 

"Two University of Iowa researchers, Robert L. Ohsfeldt and John E. Schneider, reviewed the data for the nations of the OECD to statistically account for the incidence of fatal injuries for the member countries. The dynamic table below presents their findings, showing both the average life expectancy from birth over the years 1980 to 1999 without any adjustment (the actual "raw" mean), and again after accounting for the effects of premature death resulting from a non-health-related fatal injury (the standardized mean). You may sort the data in the dynamic table from low to high value by clicking on the column headings, or from high to low value by clicking a second time.

 

"If you've sorted the data in the dynamic table, you find that without accounting for the incidence of fatal injuries, the United States ties for 14th of the 16 nations listed. But once fatal injuries are taken into account, U.S. "natural" life expectancy from birth ranks first among the richest nations of the world."

 

*I think this is even with our way-more-generous-than-average definition of a "live birth" that accounts for a significant reduction in US life expectancies versus other developed countries.

 

**There's a link to the PDF of the original study there as well.

[JayB]

One more statistical nuance that's quite a bit less flattering for the US...

 

As I suggested (a long ways) above, a big chunk of the drop in our murder rate has more to do with improved trauma-care than it does in a reduction in violence:

 

http://www.nytimes.com/2002/08/12/us/medical-gains-reduce-deaths-from-assaults.html?sec=&spon=

 

 

 

 

 

[j_b]

I just told you that you could cite individual studies but none could be used to draw sweeping conclusions about the respective worth of different systems. Moreover, I sincerely doubt these studies account adequately for the huge discrepancy in access to health care in the US. When more than 1/10 of your population has no health insurance none of the statistics concerning outcome or wait time should look good unless you forget about those who do not get care.

[JosephH]

Yes, it is a bit odd and specious to advocate for SCOTUS' recent interpretation of the second ammendment on one hand and with the other say why, if you remove gun violence, our healthcare systems provide equivalent care even if far more expensively.

 

And hey, none of this isn't rocket science, it's actually pretty straightforward. Take the Medicare Plan D for instance. Funny how you can't even find a national list of 'providers', but last I heard back when the plan started there were at least 47 insurance providers doing business in Plan D. Think about it. 47 companies hired a sales force, policy folks, claims folks, and all 47 designed custom software for every aspect of the system. Not only does this represent a massive government giveaway to corporate America, it imposes an amazing amount of completely unnecessary complexity, and what efficiencies and cost savings do we get for that - aside from massively confusing seniors - none. That's right, none - in fact by comparison, the VA consistently pays half for the same drugs. It's a vast and wide clusterfuck of epic proportions to the tune of billions of dollors of overhead and lost cost opportunities all flushed directly down the drain in the name of "free enterprise".

 

And actully, aside from the fact that I'm from Chicago, you knew Obama was a player, a pragmatist, and going to be sadly disappointing progressives again and again the minute he said on the campaign trail that insurance companies were going to be part of healthcare reform. READ MY LIPS - by definition healthcare reform that results in the existence of private insurance companies involved with the administration of a baselevel of universal healthcare isn't healthcare reform.

 

Insurance companies provide no value in the stack. Period. And to answer jayb's question, of course healthcare providers recover their costs by any means possible - they have to and the insurance companies are in on the game. And that game is played across the insurance business. Ever been quoted one price for something with insurance and another price if you don't have any? New windshield, body work, dental work, eyeglasses - it's all fraud gaming the system.

 

Bottomline - U.S. corporations will never be able to compete on the world stage if they are responsible for employee and retiree healthcare. Again, it's an infrastructure and public health concern; it's not a business businesses should be in. And purely from a pandemic public health perspective, it is rank insanity that every human in the U.S. doesn't have access to a [universal] baselevel of healthcare - extremely resistant TB just doesn't give a rats ass about economic, class, suburban, or coach boundaries once it's bred in healthcare coverage dead zones.

 

And don't kid yourselves - rationing happens, it's happening now - we just do it differently. And that would work fine so long as we didn't have public emergency rooms, but with that back door open we're just kidding ourselves about how we go about it. You want homeland security, you want a return to a lasting economic recovery, you want businesses to thrive - then deal with healthcare - establish universal coveverage at some baselevel, build a single payer system with no insurance company involvement, and allow insurance companies and well-off consumers to create a new market for value-added coverage.

 

Think the government can't do it? The VA is proof it can it has the best medical records technology on earth and has had for years now. Pharmaceuticals? Texplorer on this board is about to start his second pharmacuetical residency at the Reno VA hospital doing data mining and national efficacy studies - pharmaceutical companies HATE the VA because they actually are on top of the games and play hardball.

 

It's all a game, a sham, and one riddled with parasitic middlemen. It's not much differently gamed than the one that just collapsed on Wall street. It's all propped up on 'free market' propaganda and the righteous politics of indignation and fear on main street. But again, tell the folks in SE Oregon about free market healthcare and they'll tell you they now have to drive hundreds of miles and book a hotel room to avail themselves of it.

[mattp]

Joseph:

Take the Medicare Plan D, funny how you can't even find a national list of 'providers', but last I heard back when the plan started there were at least 47 insurance providers doing business in Plan D. Think about it. 47 companies hired a sales force, policy folks, claims folks, and all 47 designed custom software for every aspect of the system. Not only does this represent a massive government giveaway to corporate America, it imposes an amazing amount of completely unnecessary complexity, and what efficiencies and cost savings do we get for that - aside from massively confusing seniors - none. That's right, none - in fact by comparison, the VA consistently pays half for the same drugs. It's a vast and wide clusterfuck of epic proportions to the tune of billions of dollors of overhead and lost cost opportunities all flushed directly down the drain in the name of "free enterprise".

Anybody else around here tried to help som older folks like maybe their parents or grandparents deal with this mess and concluded differently?