Palin Speaks

[helene_t]

I could use help on a specific issue. My congressman, Roscoe Bartlett, was asserting yesterday that in England no one over the age of 65 can get into an intensive care unit. The thought that a 66 year old is hit by a truck and left to die because he is too old to go to an ICU is, I presume, another fantasy of the right wing. Could someone direct me to information to learn what British policy is being distorted here? I would like to call him on this, but I need facts with some precision.

http://www.angelfire.com/pa/sergeman/issue...ukcarebeds.html

 

The article is from a journalist of a not-so-serious newspaper, sorry that I couldn't find anything better. It is somewhat vague.

 

Edit: The source is the newspaper Telegraph, http://www.telegraph.co.uk/news/uknews/334...-care-beds.html

 

Anyway, it is fair to say that:

- UK has severe shortage of IC beds, only 2.7% of all hospital beds, compared to e.g. 4% in Denmark and 6% in the US.

 

- The admission of old people (>80 years) is probably much lower than what would be optimal. It is not clear to me what exact age group the figures in the article are about, though. He talks about a high-risk group of patients characterized by a combination of age and other factors.

[mike777]

I could use help on a specific issue. My congressman, Roscoe Bartlett, was asserting yesterday that in England no one over the age of 65 can get into an intensive care unit. The thought that a 66 year old is hit by a truck and left to die because he is too old to go to an ICU is, I presume, another fantasy of the right wing. Could someone direct me to information to learn what British policy is being distorted here? I would like to call him on this, but I need facts with some precision.

http://www.angelfire.com/pa/sergeman/issue...ukcarebeds.html

 

The article is from a journalist of a not-so-serious newspaper, sorry that I couldn't find anything better. It is somewhat vague.

 

Edit: The source is the newspaper Telegraph, http://www.telegraph.co.uk/news/uknews/334...-care-beds.html

 

Anyway, it is fair to say that:

- UK has severe shortage of IC beds, only 2.7% of all hospital beds, compared to e.g. 4% in Denmark and 6% in the US.

 

- The admission of old people (>80 years) is probably much lower than what would be optimal. It is not clear to me what exact age group the figures in the article are about, though. He talks about a high-risk group of patients characterized by a combination of age and other factors.

Helene if the UK has a severe shortage of IC beds and they know it, why don't they simply get more? I would think greedy capitalists in America would gladly sell them all they want. I assume money cannot be the issue, the UK controls the printing presses and taxing policy.

[helene_t]

Mike, people are already complaining that they pay too much for health care. It is ridicolously expensive here, appr. one third of what you guys pay.

[kenberg]

Interesting article. It appears that the concern over icu care in Britain is reality based.

[mike777]

Mike, people are already complaining that they pay too much for health care. It is ridicolously expensive here, appr. one third of what you guys pay.

Helene I am trying to understand this single payer system that Winston and other posters advocate. I thought the UK loves the single payer system. BTW as far as I can tell Canada does not have a single payer system that covers what we would call basic health care.

 

If there is a severe shortage of IC beds do not the voters demand a better quality of healthcare, in this case alot more IC beds? If need be the UK can just borrow the money like we do or tax the top 5% and worry about paying it back later.

[mike777]

I would only add the suggestion that there seems to be a real need for effective special interest groups that can lobby the government for more IC BEDS. At the very least I would think corporate IC bed makers in the UK would apply pressure. :)

[Winstonm]

There are a number of good points brought out in several posts - obviously, this is not a simple problem with simple-minded solutions.

 

Of what is health care comprised? As Ken mentioned, is it paying less for meds or does it mean insuring against catastrophic loss?

 

I am of the opinion that no needed procedure, treatment, or drug should be denied because it is unprofitable. In my opinion, health care should be acknowledged as a cost to society. We spend more than the rest of the world combined on our defense budget - to do so and not have universal health care should be considered a moral crime in the universe.

 

As to the ICU beds, I am not so certain how to determine necessity of those beds. I have seen hospitals with not-very-ill people in the ICU beds because they were available (at a huge cost to whoever had to pay the bill.)

 

 

The idea of a publicly-held corporation determining my need for a procedure or treatment goes against all I believe in as a part of the health care providers in this country, because I know the interest of that company is not in my well being but in appeasing the shareholders by earning higher profits.

 

I really don't want an Enron or WorldCom executive making decisions that affect my ability to receive health care.

[nigel_k]

The idea of a publicly-held corporation determining my need for a procedure or treatment goes against all I believe in as a part of the health care providers in this country, because I know the interest of that company is not in my well being but in appeasing the shareholders by earning higher profits.

 

I really don't want an Enron or WorldCom executive making decisions that affect my ability to receive health care.

Firstly, the political motive (to get elected and stay elected) is even more corrupting than the profit motive. Surely you have been paying enough attention to notice that the interests of politicians are not in your well being either. The difference is that when a corporation screws you over, you are not obliged to keep giving them your money.

 

Secondly, how do you feel about a corporation supplying the food you eat? Medical care is important, but not as important as food. If we accept the premise that the profit motive is incompatible with the proper provision of essential goods and services, the surely sovietizing the supermarkets should take priority over sovietizing the health system?

[hrothgar]

Secondly, how do you feel about a corporation supplying the food you eat? Medical care is important, but not as important as food. If we accept the premise that the profit motive is incompatible with the proper provision of essential goods and services, the surely sovietizing the supermarkets should take priority over sovietizing the health system?

Idiotic question/statement

 

There is a (broadly) competitive market for food here in the United States.

There is nothing resembling a competitive market for health services.

[Winstonm]

Firstly, the political motive (to get elected and stay elected) is even more corrupting than the profit motive. Surely you have been paying enough attention to notice that the interests of politicians are not in your well being either. The difference is that when a corporation screws you over, you are not obliged to keep giving them your money.

 

The politicians are owned to a large degree by the corporations - 97% of incumbents are re-elected. Do you think that happens because because their constituents want it to happen or because the corporations donate strongly to their reelection?

 

Secondly, how do you feel about a corporation supplying the food you eat?

Fine.

 

Medical care is important, but not as important as food.

Tell me that when you have acute appendicitis or a perforated bowel.

 

 

If we accept the premise that the profit motive is incompatible with the proper provision of essential goods and services, the surely sovietizing the supermarkets should take priority over sovietizing the health system?

 

There was no mention of sovietizing - what are you trying to do, promote fear by trying to compare socialized medicine to the U.S.S.R.?

They are not the same. Your argument is invalid - no one but you said that the profit motive was incompatible with the proper provision of essential goods and services.

 

What I argued was that some aspects of health care should not be classified as essential goods and services but basic human rights.

 

How Stalin-esque of me, I'm sure.

[mike777]

Again Socialized medicine does mean having the economic and political power in the same pair of hands by definition. That is what socialism means.

 

Again I do not claim this is what the President is calling for but it does come across as what Winston is calling for.

 

At the very least Winston comes across as prefering that to what we have now.

 

If you do not want the economic and political power of health care to be in the same hands then you are calling for something other than socialized medicine, what I do not know.

 

 

"There was no mention of sovietizing - what are you trying to do, promote fear by trying to compare socialized medicine to the U.S.S.R.?

They are not the same. Your argument is invalid - no one but you said that the profit motive was incompatible with the proper provision of essential goods and services."

 

 

 

 

Since you make this claim at the very least back it up, just do not dismiss it by saying it is not the same, please.

[kenberg]

I am of the opinion that no needed procedure, treatment, or drug should be denied because it is unprofitable. In my opinion, health care should be acknowledged as a cost to society. We spend more than the rest of the world combined on our defense budget - to do so and not have universal health care should be considered a moral crime in the universe.

 

As to the ICU beds, I am not so certain how to determine necessity of those beds. I have seen hospitals with not-very-ill people in the ICU beds because they were available (at a huge cost to whoever had to pay the bill.)

ICU: Knowing the exact number of beds needed is asking too much of me, but hardly necessary to contrast the situation here with the situation in Britain as reported in the Telegraph article. In 1977 my father, aged 77, was carried by helicopter from a smaller hospital to one with a respected icu facility. The attempt to save him was ultimately unsiccessful but I believe that a very strong effort was made. I am surprised and dismayed to learn that in Britain there might not have beem space available. I gather the Brits are working on this and I wish them well.

 

Cost: I believe that there are limits. Individually we can only afford so much, and collectively this is true as well. There is a lot of wastage as we do things now, we should do better, but I think there will always be limits. I don't see the ICU example as determining, it's there not here for one thing, they may well solve the problem for another thing, but it is a reminder that there are costs and therefore limits to what we might wish to do.I favor having an adequate supply of ICU beds. I favor doing many things. I favor paying for the choices we make. I accept being taxed. I do not believe, in health or in any area, that we will not have to choose. This thing we do, this other thing we do not.

[mike777]

"I am of the opinion that no needed procedure, treatment, or drug should be denied because it is unprofitable. In my opinion, health care should be acknowledged as a cost to society. We spend more than the rest of the world combined on our defense budget - to do so and not have universal health care should be considered a moral crime in the universe."

 

 

I do think this is your main point and you make it clearly.

 

 

But we come back full circle to other threads:

1) There is an unlimited demand for health care

2) There is a limited supply of health care.

3) We must ration health care.

 

 

You clearly prefer the government to make these political and economic decisions and not free capital markets via the pricing mechanism.

 

 

This decision, security vs loss of freedom is never an easy one.

 

Increased security provided by a central government making both the economic and political decisions always comes at some cost.

 

 

That is what elections are for and the people have voted.

 

 

"I am of the opinion that no needed procedure, treatment, or drug should be denied because it is unprofitable."

 

Side note, All countries deny health care on the basis that they cannot afford it. Europe and Canada certainly deny health care on this basis. See Helene's post.

 

 

 

"What NICE has become in practice is a rationing board. As health costs have exploded in Britain as in most developed countries, NICE has become the heavy that reduces spending by limiting the treatments that 61 million citizens are allowed to receive through the NHS. For example:

 

In March, NICE ruled against the use of two drugs, Lapatinib and Sutent, that prolong the life of those with certain forms of breast and stomach cancer. This followed on a 2008 ruling against drugs -- including Sutent, which costs about $50,000 -- that would help terminally ill kidney-cancer patients. After last year's ruling, Peter Littlejohns, NICE's clinical and public health director, noted that "there is a limited pot of money," that the drugs were of "marginal benefit at quite often an extreme cost," and the money might be better spent elsewhere."

 

http://online.wsj.com/article/SB124692973435303415.html

 

In 2007, the board restricted access to two drugs for macular degeneration, a cause of blindness. The drug Macugen was blocked outright. The other, Lucentis, was limited to a particular category of individuals with the disease, restricting it to about one in five sufferers. Even then, the drug was only approved for use in one eye, meaning those lucky enough to get it would still go blind in the other. As Andrew Dillon, the chief executive of NICE, explained at the time: "When treatments are very expensive, we have to use them where they give the most benefit to patients."

[PassedOut]

Certainly there are always going to be limits on what health care costs are covered, and some hard questions will have to be answered. That's true now and will be true in the future. Better to get those questions on the table instead of sweeping them under the rug.

 

We need to know reliably what is covered and what is not, and that the coverage will not disappear when folks need it. No doubt companies will offer supplemental policies to cover the rest, including extreme end-of-life measures for those who wish to pay for them.

[Winstonm]

Thanks for a reasoned reply, Mike. Although I understand your point I believe you are not making a valid comparison. It appears to me you are comparing reasonable access to health care with unreasonable expenses of limited value.

 

It is much different not getting a needed bowel resection for a perforated bowel than being denied access to a cancer drug with limited benefits to the terminally ill. In the first case, you will surely die without the procedure; in the second case, you will surely die with or without the medication.

 

I don't think you should use case two to prove the reason why case one should have a profit motive.

 

1) There is an unlimited demand for health care

2) There is a limited supply of health care.

3) We must ration health care.

 

This does not equate - I don't agree with either premise, but even accepting those premises does not bring about your conclusion in #3. The economic answer would be #3: health care becomes more costly, followed by #4: health care costs decline over time as supply catches up to demand.

 

That is how a true and free market would work - but all we see are rising health care costs. It is therefore obvious to even the most ardent Phil Gramm fanatic that the current system is NOT a free market system.

 

It is crony capitalism with supply held tightly in a few hands.

 

 

That is what elections are for and the people have voted.

 

If you truly believe this then I have to say you are IMO grossly naive. I would strongly urge you to read today's Salon.com article by Glen Greenwald about the changing thoughts on Democratic centrists.

 

While I may be overly cynical, Greenwald seems to hit a nice, reasoned balance with an explanation of reality.

[mike777]

"It appears to me you are comparing reasonable access to health care with unreasonable expenses of limited value."

 

 

1) I thought the above was your main point. That government makes the political and economic decisions of what is unreasonable expenses of limited value and what is reasonable health care.

 

See Helene's post about IC beds.

 

 

To reword your point hopefully fairly, should the guiding ethical medical question be what is of the greatest value to the most people or what is best for this patient.

 

"Peter Littlejohns, NICE's clinical and public health director, noted that "there is a limited pot of money," that the drugs were of "marginal benefit at quite often an extreme cost," and the money might be better spent elsewhere."

 

http://online.wsj.com/article/SB124692973435303415.html

 

In 2007, the board restricted access to two drugs for macular degeneration, a cause of blindness. The drug Macugen was blocked outright. The other, Lucentis, was limited to a particular category of individuals with the disease, restricting it to about one in five sufferers. Even then, the drug was only approved for use in one eye, meaning those lucky enough to get it would still go blind in the other. As Andrew Dillon, the chief executive of NICE, explained at the time: "when treatments are very expensive, we have to use them where they give the most benefit to patients."

 

 

2) I have no idea what you mean about the voting thing or how you could disagree.

 

Clearly the Democrats won big and clearly the Democrats are for some public option. I am not saying they are for socialized medicine that you appear to be for but they may be.

 

 

3) I have no idea how you disagree with my comments about limited supply and unlimited demand or how they do not equate for you.

 

I agree health care costs are much higher than 1954 but who wants 1954 health care at 1954 prices.

 

 

4) as for your comment about supply in a few hands, I dont understand what you mean. There are over a 1000 health care insurance companies. I grant they are not allowed to compete over state lines and that limits competition, I would be for allowing competition across state lines.

 

I do believe a public option will crowd out for profit companies but many think that is a good thing.

 

As for Passed OUT comments I am not sure how private insurance companies or private health care providers are allowed in a single payer context. That does not sound like a single payer system but then I really am unsure how they work.

[helene_t]

surely sovietizing the supermarkets should take priority over sovietizing the health system?

That strikes me as a purely ideology-based remark.

 

If you have the theory that a strong role for the government in the supply of health care is inefficient then you should reconsider that theory, because the fact is that it works. The shortage of IC beds in the UK notwithstanding, the fact is that most if not all developed countries achieve better health care results than the US, at far lower costs.

[OleBerg]

If we accept the premise that the profit motive is incompatible with the proper provision of essential goods and services, the surely sovietizing the supermarkets should take priority over sovietizing the health system?

Definately not.

 

I don't mind a doctor dictating me what medication I should take for an infection, but I would mind the very same doctor dictating me what brand of cereal I should eat.

[hrothgar]

You clearly prefer the government to make these political and economic decisions and not free capital markets via the pricing mechanism.

Please point meet at any country where these decisions are made by free capital markets using a pricing decision.

(The US most certainly does not fall into this camp)

[mike777]

USA and almost all countries. Price is used as a rationing mechanism and an information discovery mechanism.

 

There are very few Socialist Health care systems, most certainly not in the USA are the economic and political power in the same pair of hands.

 

As I pointed out in my previous post there are state limitations on the free flow of capital, which should be changed. But for the most part there is a free flow of capital with increasing government regulations.

 

Here is a basic example, interest rates are the price or cost of money. Interest rates affect the flow of capital. Price affects capital investment decisions.

 

Side note I need to go now and take my wife to the hospital for an operation. Hopefully our healthcare systems works in real life and I need to quit this thread. :)

[hrothgar]

USA and almost all countries. Price is used as a rationing mechanism and an information discovery mechanism.

 

There are very few Socialist Health care systems, most certainly not in the USA are the economic and political power in the same pair of hands.

 

As I pointed out in my previous post there are state limitations on the free flow of capital, which should be changed. But for the most part there is a free flow of capital with increasing government regulations.

 

Here is a basic example, interest rates are the price or cost of money. Interest rates affect the flow of capital. Price affects capital investment decisions.

 

Side note I need to go now and take my wife to the hospital for an operation. Hopefully our healthcare systems works in real life and I need to quit this thread. :)

As usual, the facts strongly contradict your claims

 

I strongly recommend looking at the following:

http://hcfan.3cdn.net/1b741c44183247e6ac_20m6i6nzc.pdf

 

There is a nice chart on page 4 that shows the combined market share for the two largest Health Care providers in each state.

 

Don't suppose that you'd care to provide the good working definition for a "competitive market". (You know, the kind of thing that I expected my Econ 101 students to be able to provide)

[blackshoe]

The shortage of IC beds in the UK notwithstanding, the fact is that most if not all developed countries achieve better health care results than the US, at far lower costs.

I have not seen these data. Have you a link, or an offline source?

[kenberg]

The shortage of IC beds in the UK notwithstanding, the fact is that most if not all developed countries achieve better health care results than the US, at far lower costs.

I have not seen these data. Have you a link, or an offline source?

Cost can, perhaps, be calculated. Quality issues of course get tougher. We rank badly in infant mortality, 33rd according to

http://en.wikipedia.org/wiki/List_of_count..._mortality_rate

 

 

While that suggests bad health care, it would be worthwhile to see where the deaths come from. Sixteen year old mothers are more likely to have their children die than would be the case, on average, with a twenty-four year old mother. Iceland has the best record, 2.9 deaths per 1,000 compared with the US 6.3 per 1,000.

 

But you can look further. The same reference puts the UK 22nd with a rate of 4.8. The Minnesota rate, available by following the links at

http://www.health.state.mn.us/divs/chs/infantmortality/

is 4.9. Not all that much to choose between the UK and Minnesota.

 

The Minnesota report gives an ethnic breakdown of the numbers. 9.2 for African Americans, 10.3 for American Indians. 4.4 for whites.

 

So Iceland outdoes us all, but Minnesota is fairly equivalent to the UK, and the real disparity is between races.

 

What this suggests to me is that analyzing any data can get pretty tricky pretty fast. Sample question: Is European health care more successful in reducing the gap between races in infant mortality?

 

 

The following is from the Guardian:

http://www.guardian.co.uk/lifeandstyle/bes...nfant-mortality

 

"Nearly 1 in 100 babies die in their first year of life in some parts of England, official figures show. A new study has found that babies are most at risk if they're born in deprived areas, areas where there is a higher proportion of mothers under 18, and areas with larger ethnic minority populations."

 

 

 

It is not unreasonable to speculate that class and race are more important here than the health care system.

[PassedOut]

The shortage of IC beds in the UK notwithstanding, the fact is that most if not all developed countries achieve better health care results than the US, at far lower costs.

I have not seen these data. Have you a link, or an offline source?

 

I did not realize that this was in question. There are many sources of information about this. Here are some links.

 

United Health Foundation: America's Health Rankings: Comparison to Other Nations (2008)

 

The Commonwealth Fund rates the U.S. last in health care system performance when compared to a group of six countries that include Australia, Canada, Germany, New Zealand and the United Kingdom.  The U.S. spends twice as much as these six countries on a per-capita basis, yet it is last on dimensions of access, patient safety, efficiency and equity. (see note 3)  So, while the U.S. is spending more on total health care when compared to other countries, the country is getting less access, patient safety, efficiency and equity.

 

The results of these studies are a wake-up call to everyone in the United States to strive to improve all aspects of our health system however possible, including education, prevention and clinical care.  Other countries have improved their overall health by improving their health care system, indicating that we too can do the same.

 

Reuters: Healthcare costs in U.S. vs. rest of world (2006)

 

UNITED STATES: 15.9 pct of GDP, $6,657 per capita

 

FRANCE: 11.1 pct of GDP, $3,807 per capita

 

GERMANY: 10.7 pct of GDP, $3,628 per capita

 

SWEDEN: 8.9 pct of GDP, $3,598 per capita

 

CANADA: 9.7 pct of GDP, $3,430 per capita

 

UNITED KINGDOM: 8.2 pct of GDP, $3,064 per capita 

 

JAPAN: 8.2 pct of GDP, $2,936 per capita

 

Medical News Today: USA Spends More Per Capita on Health Care Than Other Nations, Study Finds

 

The United States spends more on health care per capita than other industrialized nations but does not receive more services, according to a study published on Tuesday in the July/August issue of Health Affairs.

 

- The United States has 2.9 hospital beds per 1,000 residents, compared with a median of 3.7 beds per 1,000 residents among the other nations examined;

 

- The United States had 2.4 physicians per 1,000 residents in 2001, compared with a median of 3.1 physicians per 1,000 residents among the other nations examined in 2002;

 

- The United States had 7.9 nurses per 1,000 residents in the United States in 2001, compared with a median of 8.9 nurses per 1,000 residents among the other nations examined in 2002;

 

- The United States has 12.8 CT scanners per one million U.S. residents, compared with a median of 13.3 scanners per one million residents among the other nations examined;

 

- The United States appears to have more magnetic resonance imaging machines per capita than many of the other nations examined, but the machines are used only 10 hours daily in the United States, compared with a median of 18 hours daily in other nations; and;

 

- The average medical malpractice payment, which included both settlements and judgments, was $265,103 in the United States in 2001, compared with $309,417 in Canada and $411,171 in Britain.

[awm]

It seems like this actually explains a lot of the problem in the US.

 

Compared to other countries with comparable wealth, the US has a shortage of medical resources (doctors, especially general practitioners, nurses, MRI machines, etc).

 

In a free market system, a low supply naturally leads to a higher price. But what's supposed to happen, is that as the price rises the demand goes down (people decide they don't really need this thing if it's so expensive) and the supply goes up (there is more money to be made producing the commodity in question).

 

However, the US health care system seems to break this free market process. The issue is that when the price of health care goes up, it does not directly effect people's use of health care, because they are covered by insurance through their employer, expenses are paid, etc. So increasing the cost of medical care does not change the actions of individual people. The increased price (price has to increase to prevent shortages) is hidden from consumers and is passed on to their employers. Basically the only way people's health care behavior changes substantially is if they don't have insurance, so the employer eventually cuts health care (too expensive) or cuts payroll (employees too expensive because of health care cost) leaving more people uninsured. So the price increases are much larger than they would otherwise need to be to change behavior, and the upshot is a lot of people without insurance.

 

Meanwhile, higher price is also supposed to increase supply. If general practitioners (and nurses etc) were making lots of money, then presumably more people would go into these professions and supply would increase etc. But in fact the pay rates for these professions are held down because of fixed pay-per-appointment rates from medicare and from large-scale bargaining by the insurance companies (many of which have local monopolies). So the extra money from the increased price mostly goes into the coffers of the insurance companies and not into the pockets of doctors and nurses. So supply does not increase as fast as it needs to, and the process continues.

 

Basically the issue is that insurance companies are acting as intermediaries, hiding the costs from consumers (so they don't cut down on unnecessary procedures) and also hiding the profits from doctors (so the supply of doctors doesn't increase). The obvious solution would seem to be getting rid of insurance companies and letting the government take over their role as intermediary. This works relatively well in a lot of countries. In most cases the free market would be more efficient than the government, but health insurance is a funny "market" where the free market paradigm seems to be broken.