Paying for Healthcare
| Thu Sep. 3, 2009 10:23 AM PDT
Bob Somerby is unhappy about liberals' inability to construct a decent message on healthcare — or anything else, for that matter:
In the past few months, we have seen the other side churn their messages about the failures of “big government,” driving the fear of a “government take-over,” of “government-run health care.” Democrats have managed to produce little clear messaging, despite being blessed with the most comical set of data in the world’s history:
Total spending on health care, per person, 2007:
United States: $7290
United Kingdom: $2992
Average of OECD developed nations: $2964
Japan: $2581You almost have to twist a mustachio as you read such ridiculous data. But Democrats refuse to discuss those data — refuse to say what they so plainly mean. The other side rails against Big Government. Our side is mostly silent about the Big Interests which have produced those comical data — at the people’s expense.
Well, there's a reason that data is rarely mentioned: it's because the Democratic plans on offer right now do very little to change it. For all the sturm und drang about rationing and killing grandma and so forth, the House and Senate bills currently on the table would have a pretty modest impact on the future growth of healthcare costs.
And there's a reason for that too: the only way to cut costs is to piss off the people who benefit from those high costs: doctors, hospitals, insurance companies, device manufacturers, and big pharma — all aided and abetted by patients who never, ever want to be told no. It would be nice to think that we could enrage all these groups and still pass a healthcare bill based on sheer populist rebellion, but that's not in the cards. It just isn't.
So, yeah: we spend a lot more money than other countries. Our doctors get paid a lot more. Our insurance companies have way higher administrative costs. The pill makers charge us twice as much as they charge Danes and Italians. We should have spent the last ten years filling the airwaves with this stuff.
But we didn't. Conservative were in charge of the country and we were busy with a terrorist attack, a couple of wars, endless tax cut fights, Social Security privatization, Republican scandals, warrantless wiretapping, torture in U.S. prisons, global warming, and a hundred other things. There's only so much you can do. So now that we have a chance to do something, our only option, really, is to bribe all the special interests and try to get something passed that does about a tenth of what it should. And even at that, it'll pass — if it passes — by the slimmest of margins.
And then we go back and keep pushing. And get another tenth. And another. Because every tenth that works well makes it easier to pass the next tenth. And every tenth helps restore public faith in the ability of government to work. That won't happen overnight, but at least Obama's first tenth will get it started.
And for those of you who want to get started now, the most recent international comparisons from the OECD are below. The United States clocks in at $7,290 per person as of 2007 (the latest data available), twice as much as nearly every other country in the world. And whether you realize it or not, that all comes out of your paycheck, one way or another. Cut the costs and your paycheck goes up.
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Comments
OMG
Submitted by optical weenie on Thu Sep. 3, 2009 10:32 AM PDT.
I had no idea how profligate the Norwegians are.
Sorry, comparisons used PPP,
Submitted by g. powell on Thu Sep. 3, 2009 10:57 AM PDT.
Sorry, comparisons used PPP, so Norway's overpriced currency has nothing to do with it's relatively high healthcare spending.
Exactly (I think), Real
Submitted by B on Thu Sep. 3, 2009 11:25 AM PDT.
Exactly (I think),
Real income keeps dropping and folks in the health industry don't realize that they have to make sacrifices too. Stating the case (country comparisons, GDP % comparisons, etc.) is the first step. Until recently the AMA and state medical boards were strongly against medical school enrollment increases because of worries about compensation (which is about double that of France for a general practitioner). Now even those of us with insurance get to see doctors for about 5 minutes per visit and it's come to the point where I can diagnose myself better with teh google because at least I listen to my own symptoms. Even in hospitals you can go into a downward spiral because of lack of attention and lack of strong personal advocates.
I'd love to see medical school scholarships increased by a factor of 10 for folks aiming to be general practitioners. Double the enrollment. More than enough smart kids out there. The threat might be enough to get things moving this direction.
BTW, the same thing goes for unions considering strikes because upcoming raises have been put on hold. Now is not the time to argue for more and more pie. The people will not be entertained.
Cut the costs and your
Submitted by Model 62 on Thu Sep. 3, 2009 10:51 AM PDT.
Cut the costs and your paycheck goes up.
Fat chance. It'll go to the usual suspects. After a bit of churn, maybe we'll see some of it in our 401ks.
I'll be dead by the time
Submitted by Anonymous (not verified) on Thu Sep. 3, 2009 11:02 AM PDT.
I'll be dead by the time 3/10 is enacted; so, I guess I don't really care about this solution.
This is exactly the point
Submitted by scott1959 (not verified) on Thu Sep. 3, 2009 11:05 AM PDT.
We need to be comfortable with imperfection, pass a bill, then keep the spotlight on the issue and keep pushing. The bill we get may be imperfect and may not reign in costs....it may just cover the uninsured, but it will do so while keeping the corporate healthcare interests fat and happy.
So take it. Guess what? In five years we realize that we need to take another step.We take that one. Each step we take puts enormous pressure on the 'system' and makes the next step easier. If we get no public option and costs are up another 40% in 5 years, guess what will happen? Huge pressure for a public option.....businesses will be pinched, households will be squeezed.
We just need to make sure we take the first step.
For all the discussion about the healthcare in France, Germany, Norway, etc, they have their issues too....and they continue to work on their systems. We will do the same.
That's exactly right. The
Submitted by g. powell on Thu Sep. 3, 2009 11:12 AM PDT.
That's exactly right. The way we deliver healthcare here will always have problems and will constantly evolve. Progressives just have to make sure to apply constant pressure so that the system evolves in a better direction -- whether the steps are large or small.
Republicans run against
Submitted by cld (not verified) on Thu Sep. 3, 2009 11:30 AM PDT.
Republicans run against things.
Liberals run in favor of things.
Republicans run against people.
Liberals try to talk about the issues.
Republicans complain that liberals are doing whatever it is Republicans are actually doing.
Liberals now have their issue stolen.
Well, somebody's paycheck
Submitted by crswa on Thu Sep. 3, 2009 11:33 AM PDT.
Well, somebody's paycheck goes up. I think it'll take a lot of 1/10th measures before I start seeing it in mine. Not gripin'. Just sayin'
finally, honesty about healthcare
Submitted by EB (not verified) on Thu Sep. 3, 2009 11:46 AM PDT.
First honest post on healthcare from Mr. Drum in a long, long time. One more thing could be added - healthcare reform is losing public support because the public is starting to realize that it is an entitlement bill, not a bill that would improve their healthcare in any way.
As for tackling healthcare costs in the future, I will believe it when I see it. Reducing costs will mean reducing doctors' and nurses' educational requirements and salaries, and increasing their numbers. Since doctors and nurses are an integral part of the Democratic party, I expect hell to freeze over before something will be done about current medical culture, and its costs.
Are you entitled to cost controls?
Submitted by MarkH on Thu Sep. 3, 2009 1:25 PM PDT.
One more thing could be added - healthcare reform is losing public support because the public is starting to realize that it is an entitlement bill, not a bill that would improve their healthcare in any way.
The degree to which Medicaid subsidizes some people is entirely debatable. If it's too much then reduce it, but realize that as you do there will be fewer people able to buy insurance and the overall benefit to cost control and improved public health will be reduced.
The bill increases funding to produce more primary care physicians and nurses. That ought to increase care to the public. The provision which would have the gov't study what works could improve care AND reduce costs.
The subsidies and public option are designed to get more people the regular care they need. That's better care than no care.
The added money for Information Technology can improve efficiency and reduce costs and eliminate a lot of errors. That's improved care.
if you want to claim the bill won't achieve it's goals require you'll have to try harder.
Let's see - if we get 1/10
Submitted by Julene (not verified) on Thu Sep. 3, 2009 11:57 AM PDT.
Let's see - if we get 1/10 of what we need and let's say that it takes only one year to get each additional 1/10 then in 10 years with my average of insurance costs going up 20% per year (true, at my work at least for the last 10 years). Then I will go from paying $1872/year in insurance costs to $11,591. Yeah, I'm sure my pay rate will go up enough to cover the extra $10K I will be paying in 10 years - not to mention the other half that my employer pays (for now).... thank god the democrats are on my side and encourage incremental plans that will end up bankrupting me anyway.
Yeah, we really should act slowly during crises. Heaven forbid if cooler heads don't prevail when it comes to corporate profits at the cost of my life.
Simultaneous Multi-system Failure
Submitted by Anonymous (not verified) on Thu Sep. 3, 2009 12:00 PM PDT.
What a rolling disaster the United States has become...wars of choice, really bad medical care delivery with huge kickbacks to corporate interests, crooked voting systems, rampant incivility in public political discourse, stunningly awful public schooling, unresolved racism, porous borders, 2 million plus citizens in jail, bankrupt governments that have lost their tax bases, all bankrolled by monumental loans from Peoples' Republic of China. Quickly now, tell me how this could all be fixed without pixie dust? Sooner or later some tough guy is going to promise to make the trains run on time and then the ugliness will really begin.
Trains? What trains? We get
Submitted by MarkH on Thu Sep. 3, 2009 1:28 PM PDT.
Trains? What trains? We get trains?
Can they at least be fast clean comfortable safe trains?
And then we go back and keep
Submitted by Brett (not verified) on Thu Sep. 3, 2009 12:25 PM PDT.
And then we go back and keep pushing. And get another tenth. And another. Because every tenth that works well makes it easier to pass the next tenth. And every tenth helps restore public faith in the ability of government to work. That won't happen overnight, but at least Obama's first tenth will get it started.
That's certainly possible - it's the history of Social Security, for example, and to a lesser extent Medicaid. The only problem I can see with it is twofold:
1)We need to get health reform passed to such an extent that it doesn't hurt the Democrats' chances in 2010. That's the only way we'll even get a chance to pass another tenth.
2)The Republicans will be literally attacking whatever we pass, every single, painful step of the way. If it passes, they'll promote ridiculously high expectations of it, then use the failure to meet those expectations as political points to kill the plan. They'll scaremonger as much as possible about anything, just like they are now.
I agree, Brett
Submitted by scott1959 (not verified) on Thu Sep. 3, 2009 1:58 PM PDT.
....but we have to believe (I know I do and I think polls support this) that Americans want reform and will appreciate what is done, even if it is just 1/10th. It will be popular and it will allow us to take the next step. Republicans are increasingly in the minority and the far right may yell loud, but that wears thin. Let them fight. I really don't think it will change anything.
Look at Social Security. It was incremental but here it is, very popular, and it ain't going anywhere (yes, there is a funding issue in the out years, but one can make an argument that there are some fairly simple fixes that will sustain the program). Heck, even Bush and a Repub majority could not get a privatization bill to be even discussed!!
The Common Good is Best
Submitted by cld (not verified) on Thu Sep. 3, 2009 12:37 PM PDT.
The Common Good is Best Achieved Through Rewards, Not Punishment,
http://www.scientificamerican.com/blog/60-second-science/post.cfm?id=com...
'Just how these findings translate beyond the home and office into a broader, more codified legal context needs further examination. "It's unclear to what extent these results generalize to politics," said Rand in the podcast. But he and his team are looking into this question of whether standardizing a reward or punishment for a specific action will change the decisions in public goods games.
'Other similar games across the globe have found some cultures where punishment is doled out to high contributors rather than low contributors, a dynamic that Rand singles out as particularly harmful to the overall public good. "Punishment can be really destructive when the low contributors punish the cooperators," he said. "But with rewards, there's no such danger of that because if you have people rewarding each other when they shouldn't that's good, really." '
It's like a bucket brigade of love or hate. Punishment leads to retaliation of punishment which degrades the value of goods and social activities, while reward leads to reflection of the reward state as a kind of self-assertion.
"So now that we have a chance to do something, our only option, really, is to bribe all the special interests and try to get something passed that does about a tenth of what it should. . . . And then we go back and keep pushing. And get another tenth. And another. "
That's gonna be some mighty expensive bribery.
Bug or a Feature
Submitted by coyote (not verified) on Thu Sep. 3, 2009 1:05 PM PDT.
I wonder if the graph you show is a bug or a feature. My guess is that you could draw the same chart in the same shape with the US on the far left for consumption of items as diverse as "big screen TVs" and "pro sports tickets." We would chalk up spending in any other area as simply a result of wealth. Why not on health care? Why is it so bad that we spend more money on something like health care which is arguably less frivolous and more critical than TV's or baseball games?
I would understand it if the argument was that we are not getting our money's worth, but that meme is just about dead. The evidence is pretty clear that though life expectancy in the US is lower than some of these other countries, this is due to issues unrelated to health care (specifically murders and auto accidents). When the cause of death is limited to things amenable to the health care system, the US ranks #1 in the world in life expectancy. This is not even to mention the customer experience in accessing the health care system, which for all its irritations, is still ranked the best in the world. We pay the most, and get the best results, because we can afford the best.
It makes me nervous that you think this is a problem.
PS- I certainly think there are efficiencies that could be wrung out from the health care system if people actually shopped with their own money for their own health care, as they do for every other product and service they buy. This is proved out in the falling prices for non-insurance covered health procedures, such as laser eye surgery. But it is a laugh to think the government will wring these savings out. The government has never, ever, ever made a process more efficient. All it can do to cut costs is a) institute price controls on suppliers, which eventually lead to shortages and reduced R&D and/or b) Eliminate services.
We spend more whether you measure per-capita, or as a percentage of GDP.
AND WE GET LESS, using metrics that are very hard to fudge.
Life expectancy at birth -- we suck (years sooner than many of those countries). If you have evidence otherwise (I get my numbers at nationmaster.com), kindly provide a pointer to it.
Infant mortality -- we suck (thousands of unnecessary deaths, compared to those countries). Not sure how we blame this one on murders and auto accidents.
Medically induced bankruptcies -- hundreds of thousands for us, ZERO for most of the rest of the OECD
Somehow, most of the other OECD governments manage to do things more efficiently and effectively than American free enterprise. Not just one country kicking our ass, TWENTY, on a solid metric (how many people die, how old are they when they do) that matters to most people.
Still might be a feature
Submitted by mjh (not verified) on Fri Sep. 4, 2009 5:29 AM PDT.
Perhaps you would consider this alternate explanation as to why the statistics that you quote are unreliable indicators of the quality of our healthcare system
a little picky-choosey with their numbers
Submitted by dr2chase on Fri Sep. 4, 2009 5:45 PM PDT.
Just for example, making prenatal care "available" does not mean that it is actually adopted. "Reason" is the sort of magazine that assumes that therefore, the poor mothers simply chose not to partake of the available care, as opposed to being unable to get to it, or that they were poorly informed. One of the advantages of universal care is that it is simple; one message, care for all, no stigma for getting poor person's care, etc.
The other interesting thing about universal care (in its many guises) is that it changes the incentives -- if the insurers (whether the government, or the regulated companies that cannot cherry pick their customers) know that they are on the hook for some of these costs, they will take other steps to improve health. Arguably, the high cost of gasoline in much of Europe, is a health care measure, because it discourages driving and promotes the inconvenience of getting a little exercise, whether walking to/from mass transit, or biking, or just plain walking. If you've got national health insurance, or national health care, that is a rational policy. In our system, it's not a rational policy; the costs are scattershot, and insurers are allowed (somewhat) to dodge them.
Physicians have not been
Submitted by Anonymous (not verified) on Thu Sep. 3, 2009 2:16 PM PDT.
Physicians have not been required to pay income taxes in Japan for over 200 years. In France physicians (and nurses) get 2/3 of their sécurité sociale refunded (equal to about 25% of their annual income). That would be a grand way to pay doctors "less" that would make Republicans happy too.
"And whether you realize it
Submitted by Anonymous (not verified) on Thu Sep. 3, 2009 2:16 PM PDT.
"And whether you realize it or not, that all comes out of your paycheck, one way or another. Cut the costs and your paycheck goes up."
The solution is pretty damn clear, and helps fix other problems as well.
Cut the tie between employer and health insurance.
Missing data
Submitted by Quaker in a Basement (not verified) on Thu Sep. 3, 2009 2:44 PM PDT.
Somerby mentions these data over and over again. In most cases, he references these numbers as he evaluates media coverage of the health care debate, not the messaging of partisans.
His question is pertinent. Why won't our press tell us how much we spend compared to the rest of the world?
Greatly exaggerated
Submitted by Quaker in a Basement (not verified) on Thu Sep. 3, 2009 2:48 PM PDT.
I would understand it if the argument was that we are not getting our money's worth, but that meme is just about dead.
The reported death of that meme has been greatly exaggerated.
We spend more on big screen TVs because we get more big screen TVs. We spend more on sports tickets because we get more sports tickets. We spend twice as much per person on health care. We do NOT get twice the health benefit.
outcomes? Japan??
Submitted by keith on Thu Sep. 3, 2009 4:02 PM PDT.
Coyote,
Do you have data to show that when you control for car accidents and homicide, U.S. health outcomes exceed those of countries like France, the Netherlands, Japan, or Canada? I'm pretty certain that if you look at life expectancy at age 35 or 40 (after which death rates from homicide and car accidents is quite low), you'll still find that a number of OECD countries outperform the U.S. Frankly, I have no idea what you mean when you say that "the customer experience in accessing the health care system... is still ranked the best in the world," because that's almost certainly false. Therefore, your conclusion that we get the most because we pay the most is also wrong.
Anonymous @3:16
No one paid income taxes in Japan more than 200 years ago! The modern government, with western-style tax collection, is 140 years old. In any case, physicians do indeed pay income tax, calculated in terms of government compensation for services. However, physicians are able to take a discount of 72% for "medical costs," even when those costs are less (they average 52%). This tax discount system was put in place in 1954, so it's 55 years old, not "over 200 years". Here is the reference.
> Physicians have not been required to pay income taxes in Japan for over 200 years.
The Wonderful Thing About Triggers
Submitted by Anonymous (not verified) on Thu Sep. 3, 2009 4:33 PM PDT.
Is insurance companies are horrible things. They'll fail any reasonable benchmark we can set:
http://www.youtube.com/watch?v=dqd0XiNvtI0
And we'll be there to mock up the pieces.
sp
What? No name callin?!
Submitted by gap (not verified) on Thu Sep. 3, 2009 4:40 PM PDT.
I am for free market based reforms, but that's not why I am commenting. I visit lots of different web sites, blogs, and etc (pro and con). Most of the comment sections are filled with individuals calling each other names. I would like to commend most of the contributors on here for "arguing" their points with civility. How refreshing!!
-g
This data means nothing to Republicans
Submitted by Anonymous (not verified) on Thu Sep. 3, 2009 5:07 PM PDT.
I've had several Republicans tell me that Americans spend lesson health care. I showed one Republican the data, and his answer was literally "Nope! Nope!". They've decided, and they do not want to hear any facts to cloud the issue. If Republicans don't hear it on Fox News, facts just do not exist.
10% at a time?
Submitted by michael7843853 on Thu Sep. 3, 2009 8:05 PM PDT.
This has got to be satire. How long between heroic advances? I'm a big fan of incremental improvement as a practical necessity, but only if universal single payer is the objective and we gradually expand coverage, seriously negotiate reasonable prices, and start creating more public non-profit health care infrastructure. One who tosses around quantum mechanics references should know that 10% of nothing is nothing.
every tenth ...
Submitted by rbe1 (not verified) on Thu Sep. 3, 2009 8:10 PM PDT.
Kevin,
I think you're delusional on this one. Cite for me the significant tenth's we've passed since the Clinton initiative of 1993.
life expectancy and per-captia health spending
Submitted by Matt (not verified) on Fri Sep. 4, 2009 6:25 AM PDT.
Someone asked for data showing that life expectancy is tops in the US, after adjusting for homicides and car accidents. (i.e. lifestyle deaths that more health care spending would not prevent)
Here's a good post explainging the data, and it has link to the study.
http://angrybear.blogspot.com/2009/07/per-capita-spending-and-life-expec...
The study was not a peer
Submitted by B on Fri Sep. 4, 2009 7:19 AM PDT.
The study was not a peer reviewed paper but a powerpoint presentation, and the authors (consultants for HMO's and pharmaceutical companies) don't appear to have access to high resolution demographic data. It's really not clear how they "adjusted" for violent deaths as they have the life expectancy of many countries go down after adjusting. The assumptions in standardization might be more or less correct, but it would make more sense to eliminate violent deaths instead of massaging for them.
I agree that a more formal
Submitted by Matt (not verified) on Fri Sep. 4, 2009 7:54 AM PDT.
I agree that a more formal study would be desirable. But at the moment we are not exactly in good company on the per-captia murder rate chart. It is a simple fact that our life expectancy *must* go up relative to other countries with lower murder rates, if deaths by murder are removed from the life expectancy numbers. Same for automobile accidents. The question is only, "by how much?", and I concede that the answer is still inconclusive.
Violent deaths are highly
Submitted by B on Fri Sep. 4, 2009 8:08 AM PDT.
Violent deaths are highly correlated with joblessness and low income. I'm actually curious how much they might go down if these folks had reduced stress (because of access to health care), and reduced risk taking (because of access to health care).
infant mortaility?
Submitted by Matt (not verified) on Fri Sep. 4, 2009 6:35 AM PDT.
I seem to recall that infant mortality numbers are measured differently in the US than other countries, and that we have a higher standard for what is considered a “live birth.” But setting that aside, how do you deal with the cognitive dissonance of worrying infant mortality rates while supporting abortion? I’m sure we could give our infant mortality rates a nice boost if we convinced ourselves that infants “weren’t really people” until a week after being born, and then just “terminated” the ones that didn’t look like they would be “viable”.
Really? Liberals hate
Submitted by B on Fri Sep. 4, 2009 7:23 AM PDT.
Really? Liberals hate babies and atheists are amoral?
Forget it.
Submitted by Matt (not verified) on Fri Sep. 4, 2009 7:48 AM PDT.
I said neither of those things; I was simply trying to demonstrate the inconsistency between harping about about infant mortality rates and supporting abortion. Oh well.
I just don't understand the
Submitted by B on Fri Sep. 4, 2009 8:30 AM PDT.
I just don't understand the logic and I don't "support" or encourage abortion. One could use the same type of logic to find a contradiction between both opposing abortion and opposing healthcare for pregnant mothers and children.
I agree that the healthcare
Submitted by China Hand (not verified) on Fri Sep. 4, 2009 8:23 AM PDT.
I agree that the healthcare debate needed more framing in order to inform Americans that we are not living in the health care Valhalla. When something like 35% of people with no healthcare say that they are satisfied with the situation, it's probably because they aren't aware of a better alternative. And that means reduced popular traction for reform.
However, whether years of PR were needed is open to question. People seem to forget pretty quickly that we were living under one of the worst presidencies in history with Bush, and Obama, who is doing a pretty good job with the hand Bush dealt him, can register 40% disapprovals.
And I suspect health care attitudes are equally susceptible to weathervaning.
It's worth noting that Michael Moore came out with a very persuasive health care film, Sicko, a couple years ago, and he was able to drive the debate for a few months. It's worth watching again for his visits to Canada, France, and GB. If that film was viewed in America's schools, it would probably be more persuasive than Obama's upcoming speech.
However, it seems that Moore is a marginal figure in the liberal sphere because of his willingness to adopt the accusatory, naming names approach to assign blame to specific people, companies, and institutions for conscious misdeeds that perpetuate and exacerbate the health care mess.
This is an approach that is the bread and butter of the right, but liberals seem remarkably squeamish about adopting it. And we've seen the nadir of Democratic risk-averse gamesmanship in the "bi-partisanship" chatter associated with the health care bill. Consensus-building may be the essence of democracy, but it's not good politics. And the political fight has to be pressed effectively before the nice democratic elements can be brought into play.
The Democratic healthcare approach is distinctly Panglossian--everything will get better for everybody! with an added healthy dose of ward-heeling: everybody gets taken care of with a financial deal, especially the insurance companies and pharmaceutical makers! But the one element that isn't covered in these calculations is the unquenched desire of the Republicans to sabotage the Obama presidency.
o
So we have an avalanche of grease but some persistently squeaking wheels. There's cognitive dissonance between the Democrats "we've covered every angle" approach and the Republicans' non-stop ranting.
And that's why I think the Obama health care approach has stalled in arousing popular enthusiasm.
Mexico?
Submitted by Anonymous (not verified) on Fri Sep. 4, 2009 11:30 AM PDT.
What accounts for Mexico being all the way at the low-end?
Is that Mexico is basically a third-world rat-hole compared to
the others, or is there more to it than that ?
life expectancy stats/study
Submitted by keith on Fri Sep. 4, 2009 5:22 PM PDT.
Matt:
The links you provide don't necessarily support your case. Here are a few problems:
1) Adjusted life expectancy is determined largely by eliminating children who die before the age of 5. It might (or might not) make sense to ignore infant mortality (although poor coverage for poor women is almost certainly a factor in the high infant mortality rate in the U.S.), but what possible justification can there be for eliminating children who die at age 2, 3, or 4. That is precisely one of outcomes that highlights health-care problems in the U.S.
2) The authors attempt to eliminate the influence of violent death and automobile accidents as factors that drag down the U.S. life expectancy rates, but one reason the mortality rates are high in those cases is because residents of violent neighborhoods have poor access to healthcare; you don't necessarilly die of gunshot wounds car accidents, but wounds that don't automatically send you to the hospital can still prove fatal, and are much more likely to do so if you avoid treatment because you can't afford it.
3) As noted above, the life expectancy rates for several OECD countries appear to *drop* when the authors "control" for non-healthcare causes in the U.S. This can't possibly be correct.
In any case, life expectancy at birth in the U.S. is 66 years for men, and 69 years for women. Even when you look at life expectancy at age 60 -- an age at which you are very unlikely to die of a gunshot wound or in an automobile accident -- the U.S. remains at the bottom of the list in the study you cite. In fact, spending on the elderly is a huge percentage of U.S. healthcare costs, but even so making it to age 60 in the U.S. *still* gives you a poorer outcome than making it to 60 in Japan, France, Canada, etc.
So, given that we spend far more than any other country on health care (regardless of how much disposable income there is in the U.S.), and that life expectancy is lower than in any other developed country at age zero, at age 5, and at age 60, then we still have the poorest outcome. You can massage the statistics however you want, and provide explanations and rationales for poor outcomes (and you can provide such rationales for the U.S. only!), but you are still left with the brute fact that the U.S. spends for and gets less. We don't spend more and get more, and we don't spend less and get less; those results would be acceptable if not preferrable. We get the worst possible outcome -- more costs and poorer results. No sensible argument can be made that that's the best healthcare in the world; far from it, it's statistically the worst healthcare in the developed world, and *by far* the worst healthcare value.
As for the disconnect between wanting lower infant mortality yet being pro-choice, why is this any more irrational than being pro-life yet supporting a system that leads to higher infant mortality? If you start with the wrong premise and ask the wrong question, you will almost certainly produce a wrong answer.
I'm not sure about the
Submitted by Nancy Irving on Sun Sep. 6, 2009 1:26 AM PDT.
I'm not sure about the "patients who never, ever want to be told no."
I'm a cancer patient, and believe me, I was very glad to hear my doctor say that, after going through chemo and radiation, and recently learning that I had another abnormal Xray, while I may have to have another surgery, she will NOT recommend another course of chemotherapy or more radiation. My doctor said that more chemo or radiation now would be pointless, and I was quite relieved to be "told no."
I am strongly in favor of comparative effectiveness testing. I assure you that of all the various treatments I have been subjected to, and am still being subjected to, there is not ONE of them that I would not eagerly dispense with, were it to be determined to be useless and/or harmful.
The idea that ill people are eager "consumers" of healthcare comes from some crazy-pit. Don't give it credence.
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