[mike777]

Trinidad, on Sep 3 2009, 06:35 AM, said:

mike777, on Sep 2 2009, 10:20 PM, said:

Al_U_Card, on Sep 2 2009, 09:36 PM, said:

Let's see...."socialized" medicine works in virtually all of the western nations EXCEPT the US. They are also rated better at dealing with health-related issues than service in the US. I wonder what could possibly be the impediment to the adoption of a similar system in the US.....oh right....the word "socialized" (and also the constant death panels that we must deal with....) but surely not the Health insurance companies and HMO's ....they couldn't possibly be against improving US health care by adopting a previously proven methodology....could they?

Al, I have discussed this often, as far as I can tell no country in Europe or even Canada has socialized(socialism) their entire health care system.

I think that you are misinformed.

While I am not sure that all EU countries have "socialized" health care, many of them did. There are different variations, though.

It ranges from "Government paid health care for all" in e.g. Sweden to "Mandatory insurance. If you can't pay the premium, the government will." in countries like The Netherlands.

The basic idea in the Swedish system is that no individual has Health insurance. If you get sick you just visit your doctor. You pay a tiny fee for visiting. The fee is enough to prevent people from visiting the doctor for getting a band aid and low enough so that everyone can go to the doctor when needed (think of about 5-10 US$). Whatever that physician (and the following doctors) decide upon is free of charge. In practice it doesn't work 100 % like that, but it is awefully close.

If you don't call that "socialized health care", I wonder what "socialized health care" would look like.

Rik

I will repeat as far as I can tell no European country or canada has socialized(socialism) their entire health care system. I grant many countries use that term. Keep in mind the health care system includes, medical supply companies, medical equipment companies and drug companies. It is just not doctors, hospitals and nurses.


If true socialism by definition their health care industry would place all the economic and political power of the health care industry in one pair of hands, the government.


It appears that these countries have some sort of hybrid, granted with alot of central government intervening in the economy.


btw thanks for the useful information, does the gov. pick up eye doctors, dentists and all your medicine, etc also? These of course are also part of the health care system. Will they pay for live in home nursing care?


btw2 Insurance companies love the idea of forcing workers to buy mandatory insurance, more profit, more customers. Even better if you can get the taxpayer to pay the premiums.

[blackshoe]

In general, it seems to me, if you look at "central government intervening in the economy" they almost invariably screw it up. I doubt health care will prove to be an exception.

[awm]

blackshoe, on Sep 4 2009, 12:18 AM, said:

In general, it seems to me, if you look at "central government intervening in the economy" they almost invariably screw it up. I doubt health care will prove to be an exception.

People say this, but I'm not sure what the evidence is.

European governments take a much more active role in the economy, and they're doing okay. The US government runs Medicare and Social Security (both very popular). State governments in the US are in charge of our education system (we have some great public universities; our pre-college educational system may not be great, but the other countries with better systems are also run by the government). Government intervention arguably ended the great depression.

Obviously if you go too far with government control you might get to the old Soviet system or the Chinese system of a few decades ago, neither of which worked well. But the US currently has one of the least active governments in our economic system. Our current financial crisis is arguably caused by too little government oversight of financial institutions. The Canadians (with government much more involved) have been one of the least-effected countries.

It seems weird that folks think it's okay for our government to take huge amounts of tax money out of our pockets in order to help poor citizens of foreign countries, or help treat diseases in foreign countries (or for that matter, to kill citizens of foreign countries). Yet any attempt to spend money to help poor or sick people in the US is "socialism." It's really embarrassing the number of homeless, mentally ill people wandering the streets of our major cities. This does not happen in major European cities.

[helene_t]

blackshoe, on Sep 4 2009, 06:18 AM, said:

In general, it seems to me, if you look at "central government intervening in the economy" they almost invariably screw it up. I doubt health care will prove to be an exception.

But the French government, and the Scandinavian governments, haven't screwed health care up. The British and Canadian government have screwed it somewhat up but we still get better value for money than the US.

Does the US government has some special ability to screw things up which we haven't invented here?

The people I know in the US government, dealing with health related issues, seem to me, if anything, to be more competent and less corrupt than their European colleagues. OK, the NIH and FDA people I encounter at conferences might be a biased sample.

[luke warm]

helene_t, on Sep 4 2009, 05:13 AM, said:

blackshoe, on Sep 4 2009, 06:18 AM, said:

In general, it seems to me, if you look at "central government intervening in the economy" they almost invariably screw it up. I doubt health care will prove to be an exception.

But the French government, and the Scandinavian governments, haven't screwed health care up. The British and Canadian government have screwed it somewhat up but we still get better value for money than the US.

Does the US government has some special ability to screw things up which we haven't invented here?

The people I know in the US government, dealing with health related issues, seem to me, if anything, to be more competent and less corrupt than their European colleagues. OK, the NIH and FDA people I encounter at conferences might be a biased sample.

btw helene, i see you and arend had birthdays while i was away... happy belated birthday to both of you

[Trinidad]

mike777, on Sep 3 2009, 05:27 PM, said:

Trinidad, on Sep 3 2009, 06:35 AM, said:

mike777, on Sep 2 2009, 10:20 PM, said:

Al_U_Card, on Sep 2 2009, 09:36 PM, said:

Let's see...."socialized" medicine works in virtually all of the western nations EXCEPT the US. They are also rated better at dealing with health-related issues than service in the US. I wonder what could possibly be the impediment to the adoption of a similar system in the US.....oh right....the word "socialized" (and also the constant death panels that we must deal with....) but surely not the Health insurance companies and HMO's ....they couldn't possibly be against improving US health care by adopting a previously proven methodology....could they?

Al, I have discussed this often, as far as I can tell no country in Europe or even Canada has socialized(socialism) their entire health care system.

I think that you are misinformed.

While I am not sure that all EU countries have "socialized" health care, many of them did. There are different variations, though.

It ranges from "Government paid health care for all" in e.g. Sweden to "Mandatory insurance. If you can't pay the premium, the government will." in countries like The Netherlands.

The basic idea in the Swedish system is that no individual has Health insurance. If you get sick you just visit your doctor. You pay a tiny fee for visiting. The fee is enough to prevent people from visiting the doctor for getting a band aid and low enough so that everyone can go to the doctor when needed (think of about 5-10 US$). Whatever that physician (and the following doctors) decide upon is free of charge. In practice it doesn't work 100 % like that, but it is awefully close.

If you don't call that "socialized health care", I wonder what "socialized health care" would look like.

Rik

I will repeat as far as I can tell no European country or canada has socialized(socialism) their entire health care system. I grant many countries use that term. Keep in mind the health care system includes, medical supply companies, medical equipment companies and drug companies. It is just not doctors, hospitals and nurses.


If true socialism by definition their health care industry would place all the economic and political power of the health care industry in one pair of hands, the government.


It appears that these countries have some sort of hybrid, granted with alot of central government intervening in the economy.


btw thanks for the useful information, does the gov. pick up eye doctors, dentists and all your medicine, etc also? These of course are also part of the health care system. Will they pay for live in home nursing care?


btw2 Insurance companies love the idea of forcing workers to buy mandatory insurance, more profit, more customers. Even better if you can get the taxpayer to pay the premiums.

In Sweden patients buy medical supplies (prescription medicin, aides (crutches, etc)) from the government run pharmaceutical monopoly. Annual costs for the patient are capped at a low level. (The first part you pay in full, the next part you get a 50% rebate, the next part everything is free of charge.)

For dentists, I truely don't really remember, but when I lived in Sweden I never felt that it was a financial burden to go to a dentist. (I think it was so that you pay a -relatively small- part yourself and the rest is covered. I've had quite a bit of dental work done while I was in Sweden and money was never even close to being an issue.) I would expect eye doctors to work along similar lines as dentists, but this I truely don't know since I have really good eyes.

I assume that by "live in home nursing care", you mean that you are sick at home and a nurse stops by to check that all is well and take care of things (or is there 8 hours a day or so). In a socialist country like Sweden, these things are all free of cost or available for a small fee. The same goes with things like daycare for children (available for a very small fee) and elderly homes. These are considered "basic needs" that the government makes available to every one (for fees that are just a tiny fraction of the actual costs).

An example from my own life that you can only dream of in the USA:
When I was working in Sweden I had a 60 km (40 mile) commute by car to work. At some point, I couldn't drive for medical reasons for a period of three months, but I was perfectly capable of doing my work. Since there was no convenient public transportation, the Swedish government provided for a taxi cab to pick me up in the morning to drive me to work. In the evening the taxi would be waiting for me to drive me back home. Only costs for me: The phone calls to the taxi company to tell them when I would like the taxi to be there (i.e. about $0.10 per day).

I guess that the USA is just mentally not ready for a system like that.

But when you think about it, economically it makes sense. It is just much cheaper to keep me productive. It is also much cheaper to let a taxi company drive me than to have my wife take off 4 hours from work every day to drive me to work. After all, taxi drivers are trained for driving cars. My wife is trained for her job and more productive at that.

Think also about the amount of financial administrative work that is done in the USA. What patient belongs to what HMO? What part is covered? Who should be billed for what? What doctors were treating him/her?

In Sweden: Patient comes to health care center/family physician and pays the standard fee. Administration: Fee received for 1 patient. Visit recorded in system.

Family physician refers patient to a medical specialist in the hospital.
Patient is treated by medical specialist. (Doctor's salary paid by the government health system.)
Specialist prescribes medication.
Patient picks up medication from government pharmacy. Administration: Pharmacy's computer system tells how much the patient has paid during the year so far. This will tell how much the patient needs to pay for this time's medication. Patient pays (if needed), data updated in computer.

End of story.
No questions about what bill goes to whom or anything of the kind. The system is extremely simple (and therefore economic).

But what is needed is the philosophy that the government (that is: all of us) pays for all our needed medical costs, whether we are chronically ill (and get cheap medical help) or lucky to be healthy (and loose on the deal financially, but are blessed with good health). But isn't that what the philosophy of an insurance should be: We all pay a little, so that we don't need to pay a lot when something bad happens?

Regarding your BTW2: Why is it necessary to have a (private) insurance company in between? Get the insurance company out of the equation and there is no government money flowing to private insurance companies. I am aware that it is politically (and practically) unthinkable to just throw out all these money sucking insurers, but it just makes sense. Isn't it strange that dividend pay to shareholders in insurance companies is considered a "health care cost" in the USA?

Rik

[PassedOut]

helene_t, on Sep 4 2009, 05:13 AM, said:

Does the US government has some special ability to screw things up which we haven't invented here?

The truth is that, when you get below the thin layer of political appointees at the top, you find a mix of many competent hardworking people along with some hopeless cases. This is not unlike what you find in the corporate world, but my experience is that the overall competence of government employees is at least as high as that in businesses and organizations, and probably higher.

Of course I'm looking at this mostly from a business perspective, but I have some personal examples too. Two summers after we moved into our current home, Constance made an appointment with a DNR (Department of Natural Resources) specialist to get recommendations about how best to manage our property to protect the lake. (Our lake connects directly with Lake Superior in two places.) When the day came, he walked all around our land with us and provided a huge amount of helpful and practical information.

But it wasn't only that. His interest, enthusiasm, and knowledge was captivating. He knew the names of all the plants and which ones were native to our area. He pointed out some rare plants and explained how to keep them thriving. It turned out to be a great experience, even though I had not expected that at all.

The US does have the problem that some presidents have appointed agency heads philosophically opposed to the missions of their agencies, with the perverse goal of reducing the effectiveness of those agencies. When that happens, competent workers get frustrated and leave, while the less competent remain.

[kenberg]

I found the following interesting. [Corrected link, thank you Helene. I'm not sure how I managed to insert the other one!]


http://www.washingtonpost.com/wp-dyn/conte...ml?hpid=topnews

Some highlights:

The town's [La Crosse WI] biggest hospital, Gundersen Lutheran, has long been a pioneer in ensuring that the care provided to patients in their final months complies with their wishes. More recently, it has taken the lead in seeking to have Medicare compensate physicians for advising patients on end-of-life planning.

****************************************

"We'd turn to the family and say, 'We need your input. If your mother or father could speak now, what would they tell you?' And the family would say, 'If we only knew,' " said Hammes, 59. "I could see the distress. They were going to have to live with themselves, with the worry about making a mistake. This was unacceptable."

*****************************************

Gundersen patients spend 13.5 days on average in the hospital in their final two years of life, at an average cost of $18,000. That is in contrast with big-city hospitals such as the University of California at Los Angeles medical centers (31 days and $59,000), the University of Miami Hospital (39 days, $64,000) and New York University's Langone Medical Center (54 days, $66,000).

****************************************



The article explains that Hammes is "the the director of medical humanities, charged with educating resident physicians about ethics". The article also suggests that some of the success may spring from Midwest pragmatism, a concept that, like all generalizations, is suspect but may have an element of truth to it.

The article also mentions that the big city hospitals have to deal with greater diversity, hence the higher costs in end-of=life care. Some truth to that perhaps, but then we have to somehow reconcile that claim with the assertion that the socially diverse are being short-changed in medical care. Maybe this can be done, but it is not obvious.


I'm learning a lot about health care, especially from these posts. I liked the article in the Atlantic a lot.

I have come to the conclusion that Obama really is going at this all wrong. It's inevitable that politics will play a role, and politics includes lobbyists. This will happen, it couldn't be otherwise, so there is no point in railing against it. But Obama, by setting broad goals and then turning it over to the House and the Senate, magnified the political aspects of it while what is needed is a magnification of the wonkish aspects of it. The issues are very complex and getting them right necessitates reliance on people whose understanding of this surpasses Obama's or Pelosi's. Their job should be to back up and implement the well drawn plans of people who know what they are doing.

[mike777]

"I guess that the USA is just mentally not ready for a system like that."



Trin, thank you for all the helpful information. Indeed it does seem amazing that Sweden using 9% of GDP appears to get a higher quality of life/care than the USA does using roughly 17% of GDP. Something does seem wierd here.

Again ty.

I note with all of us having parents getting older and we ourselves getting older, live in nursing(nurses live in the home) or even nursing home care for 8 hours would be a huge selling point for a swedish/single payer/socialized medicine/whatever term you prefer health care system.

I also like how Sweden picks up your work pay if you are sick and pays for your taxi.

[Lobowolf]

awm, on Sep 4 2009, 01:33 AM, said:

blackshoe, on Sep 4 2009, 12:18 AM, said:

In general, it seems to me, if you look at "central government intervening in the economy" they almost invariably screw it up. I doubt health care will prove to be an exception.

People say this, but I'm not sure what the evidence is.

European governments take a much more active role in the economy, and they're doing okay. The US government runs Medicare and Social Security (both very popular). State governments in the US are in charge of our education system (we have some great public universities; our pre-college educational system may not be great, but the other countries with better systems are also run by the government). Government intervention arguably ended the great depression.



It seems weird that folks think it's okay for our government to take huge amounts of tax money out of our pockets in order to help poor citizens of foreign countries, or help treat diseases in foreign countries (or for that matter, to kill citizens of foreign countries). Yet any attempt to spend money to help poor or sick people in the US is "socialism." It's really embarrassing the number of homeless, mentally ill people wandering the streets of our major cities. This does not happen in major European cities.

I'm not sure about your two examples. Is Social Security really that popular as an institution? People don't want it screwed with after they've paid into it for years for years, i.e. they want to make sure they reap whatever rewards they feel they've earned as contributors, but I don't know that it's all that popular. It's just all they've got, so they want to make sure they get it, after facing decades of deductions.

I agree with you about universities, but I think it's a poor analog for health insurance- not everyone goes to the university, but we're talking about health coverage for everyone. Moreover, the people who DO go to universities pay a lot of money. Not in comparison to the percentage of the tab the state picks up, but it's still a lot of money, and there's opporunity cost in lost income while attending. These factors defray the cost a fair amount, and also mitigate the demand on the public system.

In contrast, the public pre-college system, as you say, is not so great...and that's the one that's a better analog for health care - everyone goes, and it doesn't cost anything.

I don't think it's weird about the tax money to help the poor citizens of foreign countries vs. ours (though I'm sure there's also a huge number of people who don't think it's ok, too, but that's a separate issue). With respect to foreign countries (or at least those markedly worse off than ours), we're adding resources into the system. That's a net plus regardless of government inefficiency. In the domestic context, we're getting our funds from our own citizens, paying a bunch of government salaries and administrative costs, and giving benefits to our own citizens. Maybe that can be done to create a net plus, but it's not the same thing, and it strikes me as more of an uphill battle. If I give you $100 to help your next door neighbors, and you keep $20 for your trouble and distribute the rest, that's a net plus to your neighbors. If they give you $100 to work out the best way to help them, and you keep $20, maybe you can do better for them with $80 than they could do for themselves with $100, but it's not clear, and it's not the same thing as the first instance.

[blackshoe]

helene_t, on Sep 4 2009, 06:13 AM, said:

Does the US government has some special ability to screw things up which we haven't invented here?

Sometimes it sure seems like it!

[blackshoe]

awm, on Sep 4 2009, 02:33 AM, said:

It seems weird that folks think it's okay for our government to take huge amounts of tax money out of our pockets in order to help poor citizens of foreign countries, or help treat diseases in foreign countries (or for that matter, to kill citizens of foreign countries). Yet any attempt to spend money to help poor or sick people in the US is "socialism." It's really embarrassing the number of homeless, mentally ill people wandering the streets of our major cities.

I certainly don't subscribe to that first view. I'm not so sure about some peoples' "taxation is theft!" view, but I'm a lot closer to that than to ""any tax the government wants to impose is okay with me".

Quote

This does not happen in major European cities.

Really?

[Trinidad]

blackshoe, on Sep 4 2009, 04:05 PM, said:

awm, on Sep 4 2009, 02:33 AM, said:

It seems weird that folks think it's okay for our government to take huge amounts of tax money out of our pockets in order to help poor citizens of foreign countries, or help treat diseases in foreign countries (or for that matter, to kill citizens of foreign countries). Yet any attempt to spend money to help poor or sick people in the US is "socialism." It's really embarrassing the number of homeless, mentally ill people wandering the streets of our major cities.

I certainly don't subscribe to that first view. I'm not so sure about some peoples' "taxation is theft!" view, but I'm a lot closer to that than to ""any tax the government wants to impose is okay with me".

Quote

This does not happen in major European cities.

Really?

It does, but a lot less than in the USA.

The reason is simple: The gap between rich and poor (or healthy and sick) is much smaller in Europe than in the USA. Therefore, there are less rich people in Europe, but also less poor.

And just like Eskimo's have 20 words for 'snow', the American language has a lot more words for beggars, pan handlers and bag ladies than the European languages that I know.

Now, don't take me wrong. What the USA does is up to the Americans. I do not want to put any judgement on that. But I think it is entirely fair to say that there are a lot more street people in the American cities than in the European ones.

Rik

(I have lived and worked in the USA, Sweden, The Netherlands and Germany. I think that I know a little bit about each of these cultures/societies and the general ideas/values/leading principles of the people of these countries. But I could be thinking wrong about one or more of them.)

[Winstonm]

Quote

The gap between rich and poor (or healthy and sick) is much smaller in Europe than in the USA

Let me help you understand American culture: there is no rich and poor; there is only rich and not yet rich. - Anonymous Republican spokesman

[kenberg]

Wandering off topic, but the "anonymous Republican spokesman" reminded me of a recent article in the Post. They described in some detail Obama's thoughts on his upcoming speech, citing as their anonymous source someone who, in the Post's words, was not authorized to speak. They could have just used me as a source since I also am not authorized to speak.

I have a suggestion or two for Mr. Obama on what he might keep in mind preparing his upcoming speech..

1. Republicans wish to have good health care, just as Democrats do. I am speaking of the Republican next door, not the Senate leadership.


2. Earlier posts have pointed out the great strain our current system places on small businesses. The guy who owns the local auto repair shop may well have voted for McCain, for Dole, for both Bushes, and so on, but he might well be interested in a well-prepared description of a better way on health care.


3. Most people have trouble grasping the concept of a trillion dollars ($3,000 per person, roughly) but they understand that things have to be paid for.

4. Jimmy's point about this being a moral issue has merit. Morality has to be backed by practicality, but it's a good starting point.

I am not a very ideological guy. I early on expected to vote for McCain, I ended up voting for Obama. I do not favor failed presidencies, no matter who it might be. I think we are about to discover whether Mr. Obama is good at winning elections or good at leading the country. I hope for the best.

[y66]

I hope he sees passedout's recent post and checks out David Goldhill's piece in the Atlantic. Wow. That guy can write. How can anyone on either side of the aisle argue against a more consumer-centric system?

BTW, I met an 86 year old woman on the golf course Thursday who could have passed for late 60s. I asked her what her secret was, thinking she would say something about playing golf. Instead, she said her secret was having 6 kids. Oh well. I think I'll stick with my golf theory.

[Trinidad]

Winstonm, on Sep 5 2009, 07:04 AM, said:

Quote

The gap between rich and poor (or healthy and sick) is much smaller in Europe than in the USA

Let me help you understand American culture: there is no rich and poor; there is only rich and not yet rich. - Anonymous Republican spokesman

I have been away from the USA for too long. Of course, I knew that, but I must have forgotten over the past few years.

Rik

[hrothgar]

Good article in The Washington Post

http://www.washingtonpost.com/wp-dyn/conte...9082101778.html

[TimG]

hrothgar, on Sep 5 2009, 06:35 PM, said:

Good article in The Washington Post

http://www.washingtonpost.com/wp-dyn/conte...9082101778.html

Is this really true:

Quote

In terms of finance, we force 700,000 Americans into bankruptcy each year because of medical bills.

That seems very high to me even if it were possible to link a bankruptcy to a single cause.

[hrothgar]

TimG, on Sep 6 2009, 04:04 AM, said:

hrothgar, on Sep 5 2009, 06:35 PM, said:

Good article in The Washington Post

http://www.washingtonpost.com/wp-dyn/conte...9082101778.html

Is this really true:

Quote

In terms of finance, we force 700,000 Americans into bankruptcy each year because of medical bills.

That seems very high to me even if it were possible to link a bankruptcy to a single cause.

This article is based on data from 2001

http://content.healt...thaff.w5.63/DC1