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Medical Forum / General / Dentistry / March 2005AMERICAN MEDICAL SYSTEM FAR BETTER FOR YOU THAN THE SOCIALIZED BRITISH VERSION
In "Die in Britain, survive in U.S.," the cover article of the February 2005 issue of The Spectator (registration required), a British magazine, James Bartholomew details the downside of Britain's universal health care system. Read the article at the following link: http://flapsblog.blogspot.com/2005/03/american-medical-system-far-better-for.html Flap http://flapsblog.blogspot.com This is easily proved to be unmitigated nonsense. US residents have the 46th-highest life expectancy in the world, practically the worst of developed countries. UK is 38th. US has the 41st-best infant mortality rate in the world, behind the UK at 27, and even Cuba at 39. Our health care sucks. And it's the most expensive. Those are the simple facts, jack. > In "Die in Britain, survive in U.S.," the cover article of the February > 2005 issue of The Spectator (registration required), a British [quoted text clipped - 7 lines] > > http://flapsblog.blogspot.com > This is easily proved to be unmitigated nonsense. > [quoted text clipped - 6 lines] > Our health care sucks. And it's the most expensive. Those are the > simple facts, jack. I suspect that low US life expectancy has a lot to do with lifestyle choices. Obesity and fast food are taking their toll on the american population. As for infant mortality, it's probably because UK and Cuba have free healthcare, while the US doesn't, this leads to a better overall figure. I Live in the UK and the health system here lies in shambles, but even the poorest people have some kind of access to it. On the other hand, in the US there are very good doctors, facilities and equipment, but not all people can afford them. So I think the answer is somewhere in the middle, as with most things in this world. Full socialised medicine has always been a failure anywhere it has been tried in the world, not only because it removes any kind of personal responsibility from the individual. Fully private medicine commercialises the most noble of sciences and brings doctors in close contact with practice managers, financiers, lawyers and other scum of the earth. I wonder if a mixture of the two would be the best. George "George Chatzipetros" <chpetros@hotmail.com> wrote in message > I suspect that low US life expectancy has a lot to do with lifestyle > choices. Obesity and fast food are taking their toll on the american [quoted text clipped - 17 lines] > > George Well stated. The problems in the US health care system are similar to those that you report as problematic with systems elsewhere. For those who can afford healthcare, or have a job that provides such coverage, the same lack of personal responsibility exists. This is what drives up costs and makes health coverage move further out of reach of others. None of the "solutions" to healthcare concerns seem to take this issue into account when trying to find a solution, and thus they will never find one. T The US healthcare system is awful by any realistic measure. There's no question that access to care is a big issue in the US. But that's just for starters. Even with access, if one looks at real statistics, not "apples to oranges" statistics as in the article referenced by the OP, the US has the worst outcomes in the developed world. There are two big problem in the US: 1 Payment is based on doing something, rather than being based on outcomes 2 "Shoot-from-the-hip" medicine, is perfectly acceptable - evidence of efficacy is not needed for procedures. These two issues, combined with greed, turn into a poisonous cocktail that badly harms Americans. We do things, whether they harm or help, so that physicians can make yacht payments. New and costly "miracle" procedures and medications are foisted on Americans based on theory, rather than knowledge. When studies are actually done to see if these "miracles" are helpful, they rarely turn out to be helpful, and often turn out to be harmful - think Vioxx, hormone replacement therapy, whole-body MRIs, and a host of similar "breakthroughs". Vioxx alone, which was never demonstrated to be more effective than, say, ibuprofen, killed roughly 10 times as many Americans as the 9/11 attacks. Pity the poor dumb socialists in other countries that, by-and-large, were deprived of paying huge bucks for this murderous little "breakthrough". There are many instances where " > "George Chatzipetros" <chpetros@hotmail.com> wrote in message > [quoted text clipped - 32 lines] > > T > The US healthcare system is awful by any realistic measure. > [quoted text clipped - 9 lines] > > These two issues, combined with greed, turn into a poisonous cocktail > that badly harms Americans. We do things, whether they harm or help, so > that physicians can make yacht payments. New and costly "miracle" > procedures and medications are foisted on Americans based on theory, > rather than knowledge. When studies are actually done to see if these > "miracles" are helpful, they rarely turn out to be helpful, and often > turn out to be harmful - think Vioxx, hormone replacement therapy, > whole-body MRIs, and a host of similar "breakthroughs". That's because medicine has been hijacked by CEOs, managers, paper pushers, yuppies and other sleazy individuals who smelt of the money there and have eroded the thics of the medical profession in general. When you take a 25-year old kid that has just graduated and you promise him magnificent mansions and expensive cars, that's what's going to happen (note that I'm not an enemy of fair remuneration for medical professionals). On the other hand, in the British system there are other types of managers and paper pushers. There are those who are obsessed with access figures and pointless statistics, those obsessed with red tape, those obsessed with cutting down to budgets to provide "a more efficient service" (my arse), those blatantly against medical professionals etc etc. It's a whole different kind of game, but in the end the middle men and management are the ones inflicting most of the harm. We have a "good" (health) with almost unlimited demand. The British system tries to offer it for free, but because the demand is effectively unlimited (as is with the demand of every free good) while the resources aren't, the system tries to ration it, hence the long waiting lists. This causes frustration among patients, especially those hit the hardest by it. On the other hand, the American system limits access to it by the fact that you have to pay for its expensive system. This causes social inequalities and dissent. Both systems are bad. It seems that those outspokenly against socialised medicine have enough money or medical insurance to cover any health problems they had in the past (or didn't have a problem). Similarly, those in favour of fully socialised medicine have never found themselves in a country with such a system having a serious health problem and finding out that their consultation/scan/operation have been delayed - again. Both categories are privileged individuals who don't know that they're talking about. George > The US healthcare system is awful by any realistic measure. > [quoted text clipped - 22 lines] > by-and-large, were deprived of paying huge bucks for this murderous > little "breakthrough". You make a some points with merit, unfortunately poisoned by your antipathy to the medical profession. Most of us work and expect to be compensated for it. Physicians deserve to make a living just as anyone else does. Like it or not, highly-skilled people tend to be highly compensated. You should not confuse issues of access with issues of compensation. You could control compensation. If you don't think this will affect quality, you haven't been paying attention. BTW, as reprehensible as the Vioxx debacle has been (and it HAS), you won't help anything by manufacturing a death toll. And saying Vioxx is no more effective an antiinflammatory than ibuprofen is a straw man. Steve > There are many instances where " > [quoted text clipped - 36 lines] >> >> T  SignatureCut the nonsense to reply Sorry, you're a little confused. Physicians should be fairly compensated for their work, in the US as elsewhere. But US physicians make a lot more than do physicians from other countries - and those from other countries get better results. (Since you're in favor of paying more for worse results, I'm guessing that you vote Republican. Probably one of those "Libertarian" types.) I suppose "compensation issue" could be used as nice euphemism for "accepting cash in order to practice inferior medicine". Or as a euphemism for bank robbery, loan sharking, or larceny. As to your claim that the Vioxx numbers cited were "manufactured" - you are in space. The FDA's best estimate, as reported to Congress, was over 27,000. 27,000 people killed and more than 100,000 people badly damaged by a ferociously expensive drug dispensed by "highly-skilled people", who could have been alive and undamaged and relieved of pain by ibuprofen or naproxen. A lot of people should be ashamed. Including you, for defending this behavior. >> The US healthcare system is awful by any realistic measure. >> [quoted text clipped - 79 lines] >>> >>> T > Sorry, you're a little confused. > [quoted text clipped - 15 lines] > ibuprofen or naproxen. A lot of people should be ashamed. Including > you, for defending this behavior. You obviously know me very well. Please cite the source for your claim that the FDA estimates 27000 deaths from Vioxx. Steve SignatureCut the nonsense to reply Do a Google: plenty of references for this. For example, http://www.consumeraffairs.com/news04/vioxx_estimates.html or, to go right to the testimony: http://finance.senate.gov/hearings/testimony/2004test/111804dgtest.pdf Note that further studies have revised the estimates sharply upwards: perhaps 55,000 or more deaths. Superb medical care. Just marvelous. >> Sorry, you're a little confused. >> [quoted text clipped - 21 lines] > > Steve > As to your claim that the Vioxx numbers cited were "manufactured" - you > are in space. The FDA's best estimate, as reported to Congress, was [quoted text clipped - 3 lines] > ibuprofen or naproxen. A lot of people should be ashamed. Including > you, for defending this behavior. I have read numbers even higher, but they seem based on a lot of guess work. It is interesting that 20 years ago when drugs were approved more quickly in other parts of the world, and problems like those we have had with Voixx occurred in Europe or elsewhere, people were yelling that the FDA moved too slow. Now that the FDA moves faster, and those in the US have become the guinea pigs for meds, and are being exposed to risks that did not exist in the past, the FDA moves too fast. Hard to hit a moving target. T The problem is that the FDA had ample evidence of Vioxx causing these issues prior to approval. Very ample evidence. When the FDA pointed out the excessive cardiovascular issues to Merck, Merck made up a totally (and obviously) fallacious excuse. Total BS - do a little reading and you'll see. It's not a case of moving fast - depending on the motivation, it's either a case of moving stupid, or moving evil. >>As to your claim that the Vioxx numbers cited were "manufactured" - you >>are in space. The FDA's best estimate, as reported to Congress, was [quoted text clipped - 14 lines] > > T The FDA also had 30+ years of evidence that aspirin reduced the risks of heart attacks. How few years it has been since Bayer and others were permitted to advertise this note-worthy side benefit. What would that be considered; moving slow or moving evil? FWIW, based on my dealings with the FDA, I suspect that they were not ill behaved here, although I don't know the facts. In general, as soon as: - You ask to be able to make a claim - This claim can be supported with evidence The FDA will let you go forward. > The FDA also had 30+ years of evidence that aspirin reduced the risks > of heart attacks. How few years it has been since Bayer and others were > permitted to advertise this note-worthy side benefit. What would that > be considered; moving slow or moving evil? 27,000 people killed and more than 100,000 people badly > damaged by a ferociously expensive drug dispensed by "highly-skilled > people", who could have been alive and undamaged and relieved of pain by > ibuprofen or naproxen. Well, that's open to debate. ************** From http://tinyurl.com/5bb88 A statement from a July 1998 issue of The American Journal of Medicine states the following: “Conservative calculations estimate that approximately 107,000 patients are hospitalized annually for nonsteroidal anti-inflammatory drug (NSAID)-related gastrointestinal (GI) complications and at least 16,500 NSAID-related deaths occur each year among arthritis patients alone. The figures of all NSAID users would be overwhelming, yet the scope of this problem is generally under-appreciated.” And again a year later (June 1999) in the prestigious New England Journal of Medicine there is a similar statement: “It has been estimated conservatively that 16,500 NSAID-related deaths occur among patients with rheumatoid arthritis or osteoarthritis every year in the United States. *********************** Regardless of the suppression of Vioxx morbidity information, its risk must be viewed in the context of the risk of alternative treatments. That is the basis by which the FDA recommended that Vioxx and other drugs of its class remain on the market. It's like comparing the bubonic plague to the flu. Given a choice, maybe Republicans and Libertarians would prefer the plague, but thinking people will take the flu. The risk of serious gastrointestinal complications when using conventional NSAIDs is something like 1%-2% per year. The risk of dying from Vioxx was something like 1%-2% per year. I tried to find the abstract to the NEJM statement that you referenced; however, it is from a letter, not an article, so there is no abstract in Medline. In any case, the *total* number of deaths from GI complications attributable to NSAIDs seems to be somewhere around 15,000 per year. Heck, let's be conservative and double that to 30,000. Vioxx was killing somewhere around 10,000-15,000 people a year, give or take. Let's be conservative and say 10,000. The Graham study that the FDA tried valiantly to suppress looked at a large sample of folks that tried to represent the general population. It turns out that 27,000 folks in their study had used Vioxx, vs. more than 1,000,000 who had used other NSAIDs (other than aspirin). Generalizing from this sample, folks were 40 times more likely to use other NSAIDs than to use Vioxx. So, if we were to have replaced other NSAIDs with Vioxx, we'd have saved 30,000 lives from GI complications, while killing 400,000 from cardiovascular complications, for a net loss of 370,000 or so lives. Where's the bargain here? What am I missing? And that doesn't even take into account: 1. Other NSAIDs seem to be strongly protective of various cancers and neurological conditions. 2. H2 antagonists and other over-the-counter stuff seem to strongly decrease the GI side effects of NSAIDs. Bottom line: Vioxx is a window into the provably poor-quality, greed-based medicine practiced in the US. > 27,000 people killed and more than 100,000 people badly > [quoted text clipped - 25 lines] > That is the basis by which the FDA recommended that Vioxx and other > drugs of its class remain on the market. > It's like comparing the bubonic plague to the flu. Given a choice, > maybe Republicans and Libertarians would prefer the plague, but thinking > people will take the flu. The bizzare part of this discussion is how you can turn this into anything political. Believing Republicans to be evil and Democrats to be the humanitarians of the country is completely unfounded. Fawks > > It's like comparing the bubonic plague to the flu. Given a choice, > > maybe Republicans and Libertarians would prefer the plague, but thinking [quoted text clipped - 7 lines] > > Fawks I guess we have the last two very contentious elections to thank for this mindset. I too am amazed at how so many people seem incapable of discussion without first putting a blue or red hat on everyone in the room. T > > > It's like comparing the bubonic plague to the flu. Given a choice, > > > maybe Republicans and Libertarians would prefer the plague, but thinking [quoted text clipped - 13 lines] > > T Could I have a baseball cap instead? carabelli >>>>It's like comparing the bubonic plague to the flu. Given a choice, >>>>maybe Republicans and Libertarians would prefer the plague, but [quoted text clipped - 23 lines] > > carabelli We have a buddy who's a Cardinals fan. We try to be nice to him. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > >>>>It's like comparing the bubonic plague to the flu. Given a choice, > >>>>maybe Republicans and Libertarians would prefer the plague, but [quoted text clipped - 27 lines] > > Steve In many cases, the stereotype fits...Cardinals, Texas Rangers...red hat, Yankees, Mets, RedSox, Dodgers, Cubs...blue hat...hmmm, maybe the assignment of hats isn't such a bad idea after all! T > In many cases, the stereotype fits...Cardinals, Texas Rangers...red hat, > Yankees, Mets, RedSox, Dodgers, Cubs...blue hat...hmmm, maybe the assignment > of hats isn't such a bad idea after all! > > T Where'ud you put us Kaannnaadiaans, wearin' beaver pelt hats with the tails still on?.... Those're blondish-brown... an' we usually show up with a musket, checkered shirt, , white suspenders, rubber boots up till our knees, and we're totin' a ceramic beer jug with a cork in it. An' some of us're pickin' the goose grease outta our mustaches.... Wassail.. SP SignatureNot a real Addy, yet > > In many cases, the stereotype fits...Cardinals, Texas Rangers...red hat, > > Yankees, Mets, RedSox, Dodgers, Cubs...blue hat...hmmm, maybe the assignment [quoted text clipped - 9 lines] > Wassail.. > SP Let's see...Expos (late, not so great) wore blue hats, Blue Jays, also blue hats. Based on the Canadians I know, I'd say blue hat is closer to reality than red hat, so the hat theory stands up again! Anyway, your description of a Kaannnaadiaans sounds more "Red Green" than red vs. blue (;^D) T > Anyway, your description of a Kaannnaadiaans sounds more "Red Green" than > red vs. blue (;^D) > > T Yep.... 'ceptin' he wears that stupid green waterproof hat... SP SignatureNot a real Addy, yet That's nice. Now quit bringing gun control into health care. :-) Fawks >> Could I have a baseball cap instead? >> [quoted text clipped - 3 lines] > > Steve > That's nice. Now quit bringing gun control into health care. We once had a gunfight in the ER of one of the hospitals where I did my residency. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >> That's nice. Now quit bringing gun control into health care. > > We once had a gunfight in the ER of one of the hospitals where I did my >residency. > >Steve OK Corral ? -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > >> That's nice. Now quit bringing gun control into health care. > > [quoted text clipped - 9 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com There was an incident at the hospital where we rotated thru to gain experience extracting teeth where a prisoner was brought in for care and took a gun away from the cop who was guarding him but instead was hitting on nurses. One of the surgery residents got shot in the foot. Who says being a dentist isn't dangerous! T > OK Corral ? It was pretty rough. Steve > -- > > W_B > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >> OK Corral ? > > It was pretty rough. > >Steve >> -- We had the Saturday Night Knife and Gun Club. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > We had the Saturday Night Knife and Gun Club. > -- > > W_B > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com It seems to me that there is a web site devoted to bikini babes and rifles, or guns, as it were... Where did I see that...? Don't remember but if you Google babes and guns you'll probably find it.... Me? I stay away from those sites..... SP SignatureNot a real Addy, yet >> We had the Saturday Night Knife and Gun Club. >> -- [quoted text clipped - 8 lines] >away from those sites..... >SP >">Saturday Night Knife and Gun Club" Was talking about the ER at my school. One of my roomies was a med student, went down there some nights to alleviate boredom. BTW what are the firearm possession laws in Kaanaadaa ? I.E. pistols, revolvers, semi-autos, versus shotgun and rifle ? Concealed carry ? Just curious. BTW googled 'bikini' and found wickedweasel... not sure if that is what you meant. -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE > > That's nice. Now quit bringing gun control into health care. > > We once had a gunfight in the ER of one of the hospitals where I did my > residency. > > Steve That's not gun control... that's fees negotiations. SP SignatureNot a real Addy, yet >> We once had a gunfight in the ER of one of the hospitals where I did my >>residency. [quoted text clipped - 3 lines] > That's not gun control... that's fees negotiations. > SP (rim shot!) Steve SignatureCut the nonsense to reply As long as it doesn't have NY or a Jayhawk on it, sure. ;-) Fawks > Could I have a baseball cap instead? > > carabelli > As long as it doesn't have NY or a Jayhawk on it, sure. > > ;-) > Fawks Jayhawks? I forget, did they play this weekend? carabelli With the last couple of seasons that the Tigers have had, I wasn't going to bring that up. It does make one wonder what is wrong in Columbia though. They almost beat Illinois. They do beat Kansas, Oklahoma, and Gonzaga. Then they lose to teams that would struggle in D-2. Oh well, I didn't go to school down there, and I'm not a die hard fan. Avila's softball team is 8-0 right now and KCKCC Baseball has beaten Benedictine (twice) and Maple Woods. I'm rooting for those teams with a little more interest. :-) Fawks >>As long as it doesn't have NY or a Jayhawk on it, sure. >> [quoted text clipped - 4 lines] > > carabelli >> I guess we have the last two very contentious elections to thank for this >> mindset. I too am amazed at how so many people seem incapable of [quoted text clipped - 6 lines] > >carabelli Only if it's from 'Monster Garage'... -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >> It's like comparing the bubonic plague to the flu. Given a choice, >> maybe Republicans and Libertarians would prefer the plague, but thinking [quoted text clipped - 5 lines] >Believing Republicans to be evil and Democrats to be the humanitarians >of the country is completely unfounded. George Bubes Bush? "Joel M. Eichen" .......... > George Bubes Bush? Relax Joel - Only 44 months before you can cast your vote for Hillary (no military uniforms in the White House) Clinton. carabelli >"Joel M. Eichen" .......... > [quoted text clipped - 6 lines] > >carabelli Do you think she'll quote Marx anytime between now and then? The good old 'from each according to his means, to each according to his needs' or 'fair shares for all'. >"Joel M. Eichen" .......... > [quoted text clipped - 6 lines] > >carabelli What about lewinsky cigars ? -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > 27,000 people killed and more than 100,000 people badly > [quoted text clipped - 25 lines] > That is the basis by which the FDA recommended that Vioxx and other > drugs of its class remain on the market. That was my thought too--that the calculations of death due to increased cardiac risk did not compensate for decreased morbidity and mortality due to gastrointestinal complications. However, I certainly don't want to rationalize Merck's corporate behavior in this matter--I think they were definitely ignoring clear evidence of harm. This has nothing to do however, with making payments for doctors' yachts--unless the pharmaceutical companies' freebees have become even more lavish than I thought. Steve SignatureCut the nonsense to reply The payments from pharma companies to top-level docs (opinion leaders, FDA panel members, ...) are enormous, enormous, and they get results. Witness: http://query.nytimes.com/gst/abstract.html?res=F30A1EF73C590C768EDDAB0894DD40448 2&incamp=archive:search Read it and weep. This is what drives prescribing habits in the US. That Merck et al tried to pull this stunt is less disturbing to than the FDA letting it slide, or that physicians prescribed this poison. If physicians were truly skilled professionals then they would have recognized that there was no good reason to prescribe Vioxx in all or almost all cases. However, as amazing as the money is in pharma, pharmaceuticals are only 10% of the US healthcare bill. In the other 90% we have all kinds of huge and bogus moneymaking opportunities for physicians that often harm: all kinds of imaging, the two-thirds of coronary angioplasties that don't fit established criteria, most back surgeries, many knee surgeries, virtually all prostatectamies (sp?), ... the list goes on and on. Healthcare is the single largest sector of the US economy. And, by all measures, it is driven by provider greed rather than any sort of health outcomes. >> 27,000 people killed and more than 100,000 people badly >> [quoted text clipped - 37 lines] > > Steve > The payments from pharma companies to top-level docs (opinion leaders, > FDA panel members, ...) are enormous, enormous, and they get results. [quoted text clipped - 21 lines] > measures, it is driven by provider greed rather than any sort of health > outcomes. Correcting the pernicious effects of bought influence is a worthy goal, but I find throwing stones is often easier than offering useful solutions. It is certainly easier to paint the medical profession as evil and venal--such as your charge that "all kinds of imaging" are a "bogus moneymaking opportuniy". Certainly any technology can be abused. A discussion of how specifically to see that these technologies are used appropriately would be more fruitful than trashing the entire medical profession. Steve PS. You were close on the prostatectomies. Steve SignatureCut the nonsense to reply The "useful solution" obvious and proven: socialized medicine. Every other major developed nation has it, in one of several different forms. In all cases, it both costs less and provides for better outcomes (and better patient satisfaction) than does US "free market" healthcare. By nature, I'm actually a free market guy. And I used to be a big believer in free market medicine. But I'm also a numbers guy, and the evidence is so incredibly overwhelming - half the cost with substantially better outcomes - that I just have to go with observed reality. >> The payments from pharma companies to top-level docs (opinion leaders, >> FDA panel members, ...) are enormous, enormous, and they get results. [quoted text clipped - 37 lines] > > Steve > The "useful solution" obvious and proven: socialized medicine. Every > other major developed nation has it, in one of several different forms. [quoted text clipped - 6 lines] > substantially better outcomes - that I just have to go with observed > reality. Of course other countries have better "outcomes" if by this you mean gross measures of infant mortality, life expectancy, etc. But it is a leap to assert this is mainly (or even significantly) due to the fact that medicine is not socialized. Obviously, statistics for patients on public assistance (the segment receiving the benefits of "socialized medicine" in this country fare worse than those receiving medical care through the private sector. This has (of course) more to do with extramedical factors than it does with the inferiority of medical care through medicaid. Socializing medicine in this country will not magically eliminate the economic and social factors that plague this segment of the population. I don't doubt that the standard of socialized medicine in this country would improve as more of the population opts in. I have my doubts that it would eliminate the markers of social inequity unless these extra-medical factors are addressed. Steve >>> The payments from pharma companies to top-level docs (opinion >>> leaders, FDA panel members, ...) are enormous, enormous, and they get [quoted text clipped - 37 lines] >> >> Steve SignatureCut the nonsense to reply I don't know about Medicaid outcomes vs. everyone else. I do know that even Cuba has a lower infant mortality rate than we do. Think about that: even Cuba has a lower infant mortality rate than we do. As does every other "first world" country. However, in trying to pin the blame for the practice of bad medicine on socialized medicine, you're forgetting that Medicare is also socialized medicine. Strangely enough, once Americans hit age 65, when Medicare kicks in, their medical outcomes become similar to the rest of the developed world. I wonder why. So, you're basically saying that it's purely coincidence that our medical outcomes are the worst among developed nations, our costs are the highest among developed nations, and we are the only developed nation that has "free market" healthcare. I suppose that's possible. But is it really likely? >> The "useful solution" obvious and proven: socialized medicine. Every >> other major developed nation has it, in one of several different [quoted text clipped - 67 lines] >>> >>> Steve > I don't know about Medicaid outcomes vs. everyone else. I do know that > even Cuba has a lower infant mortality rate than we do. Think about [quoted text clipped - 12 lines] > nation that has "free market" healthcare. I suppose that's possible. > But is it really likely? I actually did not say it was a coincidence. Our medical outcomes are very poor. (I might add parenthetically that you are being quite hostile to someone whose views on socialized medicine might not be too far from yours). I said it is difficult to confirm that the poor outcomes are due primarily to differences in mode of medical care delivery. My suspicions are that most of the differences are due to poor prenatal care and poor nutrition. While socialized medicine certainly ought to address these issues, they should be addressed now even in the absence of the political will to change to a single payer system. Furthermore, there are extramedical aspects to social policy that should also address these issues, whether medicine is socialized or not. There has to be a recognition of some of the societal issues that distinguish the US from (for example) western Europe. Living in a blue state, it is easy for me to forget how (as Bush would say) "out of step with the mainstream" my particular political inclinations are. Exactly why that is I cannot say; certainly the way Europeans view our attitude towards firearms is another example of how different our societies are. As far as socialized medicine is concerned, there is a recognition that it will aid the poor and working classes far more than the wealthy. In fact, to the extent that there will always be limits and effectively rationing of care in any socialized medical system the wealthy have a vested interest in keeping things the way they are. Europeans have learned to forfeit some of their individual rights in order to benefit the society--as with both medical care and firearms. In the states, we don't have the political will to do this--not yet anyway. Things do change--as with the Supreme Court's recent decision with regard to the death penalty for juveniles--so we can still be hopeful with regard progress in healthcare delivery. Steve >>> The "useful solution" obvious and proven: socialized medicine. Every >>> other major developed nation has it, in one of several different [quoted text clipped - 68 lines] >>>> >>>> Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >The "useful solution" obvious and proven: socialized medicine. Every >other major developed nation has it, in one of several different forms. > In all cases, it both costs less and provides for better outcomes (and >better patient satisfaction) than does US "free market" healthcare. Prove it numbers guy. >By nature, I'm actually a free market guy. And I used to be a big >believer in free market medicine. But I'm also a numbers guy, and the >evidence is so incredibly overwhelming - half the cost with >substantially better outcomes - that I just have to go with observed >reality. Here is an interesting reality http://nobelprize.org/medicine/laureates/index.html That is an awful lot of Nobel Laureates from the US. Go ahead, count them up over the last 60+ years. For a very long time selfish dedication of a few has benefitted vast numbers of people in so many ways. Just like Smith, Hayek, Friedman, Hazlett et al said it would. Start screwing with the traditions that brought these results, and many, many others, you may regret what you wished for. >>> The payments from pharma companies to top-level docs (opinion leaders, >>> FDA panel members, ...) are enormous, enormous, and they get results. [quoted text clipped - 37 lines] >> >> Steve Very interesting post, but I believe that there's a relevance problem here - you must be a Republican (or a Libertarian, if you can pronounce "nuclear" properly). Can you help me to understand what the Nobel Prize in medicine has to do with the practice of medicine in the US? Does a percentage of our exorbitant health insurance premiums go to funding these fine minds? What would you consider to be proof of the superiority of socialized medicine, if not the numbers cited earlier in this thread? Also, what do Smith, Hayek, Friedman, Hazlett et al have to say about our diminished life expectancy? About the 20,000 - 50,000 murdered by Vioxx? About the thousands of babies that would survive each year if our infant mortality rate was as low as Cuba's? >>The "useful solution" obvious and proven: socialized medicine. Every >>other major developed nation has it, in one of several different forms. [quoted text clipped - 60 lines] >>> >>>Steve > Very interesting post, but I believe that there's a relevance problem > here - you must be a Republican (or a Libertarian, if you can pronounce [quoted text clipped - 11 lines] > Vioxx? About the thousands of babies that would survive each year if > our infant mortality rate was as low as Cuba's? This thread, including the article that started it all, shows you can tell whatever story you want with statistics. The original article painted a picture of socialized medicine that is very different than yours. If I get sick, I'll take my chances here rather than Cuba. T > This thread, including the article that started it all, shows you can tell > whatever story you want with statistics. The original article painted a > picture of socialized medicine that is very different than yours. If I get > sick, I'll take my chances here rather than Cuba. > > T ...Or Kaannaadaa SP SignatureNot a real Addy, yet >Very interesting post, but I believe that there's a relevance problem >here - you must be a Republican (or a Libertarian, if you can pronounce [quoted text clipped - 3 lines] >with the practice of medicine in the US? Does a percentage of our >exorbitant health insurance premiums go to funding these fine minds? No relevance problem at all. You say you used to be a free market guy when it came to health care so my post gave one example of the benefits of a free market system. Leading the world in innovations is a great way to start. Thats not happening in Europe nearly at the same rate here. I doubt you ever were or that you fully understand what market systems do. >What would you consider to be proof of the superiority of socialized >medicine, if not the numbers cited earlier in this thread? Your going to have to do better. You said overwelming evidence of half the cost and better outcomes: Prove it. You might just sway me ;) >Also, what do Smith, Hayek, Friedman, Hazlett et al have to say about >our diminished life expectancy? About the 20,000 - 50,000 murdered by >Vioxx? About the thousands of babies that would survive each year if >our infant mortality rate was as low as Cuba's? Diminished life expectancy? A recent report just released demonstrated an increase in US life expectancy. Especially men. Murder is awfully strong language when risks and benefits of pharmacology have to be weighed. Infant mortality rates depend on more than the quality of healthcare. >>>The "useful solution" obvious and proven: socialized medicine. Every >>>other major developed nation has it, in one of several different forms. [quoted text clipped - 60 lines] >>>> >>>>Steve >> You said overwelming evidence of half the cost and better outcomes: >> Prove it. Healthcare spending as a % of GDP for some major developed nations: US: 15%: Switzerland: 11% Germany: 11% France: 10% Canada: 10% Italy: 9% UK: 8% Spain: 7% Poland: 6% The entire chart is at http://www.oecd.org/dataoecd/3/62/31938359.pdf. (The OECD is generally considered to be the best source for these types of statistics: it's sole job is to develop statistics for use by its members (pretty much all "first-world" countries) to normalize things). Looking at this chart, you'll see that we spend far and away the highest % of GDP on health care of the 25 or so countries. Looking at the next chart in the OECD document, you'll see that the US is also number two in the rate at which spending is increasing - looks like the rest of the world ain't catching up with us soon. If you look further in this document, you'll see that we also have fewer physicians per capita than than do most developed nations - which is a hint as to the poor medical care we get in the US. Take a look at the US Government's official list of life expectancies: http://www.cia.gov/cia/publications/factbook/rankorder/2102rank.html we are 46the in the world, behind virtually every other developed country. Next let's turn to infant mortality: http://www.cia.gov/cia/publications/factbook/rankorder/2091rank.html Once again, our ranking is terrible. If our health care were good, we'd likely have good numbers for life expectancy and infant mortality - but we don't. In fact, we have awful numbers. Our bad showing could be due to some other factor - however, the US has the lowest prevelance of smokers in the first world, which should tend to make our numbers even better. >>Very interesting post, but I believe that there's a relevance problem >>here - you must be a Republican (or a Libertarian, if you can pronounce [quoted text clipped - 96 lines] >>>>> >>>>>Steve >>> You said overwelming evidence of half the cost and better outcomes: >>> Prove it. You still havent proved anything. >Healthcare spending as a % of GDP for some major developed nations: > [quoted text clipped - 18 lines] >the rate at which spending is increasing - looks like the rest of the >world ain't catching up with us soon. We also lead in innovations and techniques, which has a price. >If you look further in this document, you'll see that we also have fewer >physicians per capita than than do most developed nations - which is a >hint as to the poor medical care we get in the US. I guess you skipped the chart on waiting time for elective procedures. My MIL had a knee replacement in December. The only thing that kept her from doing it the next day, after she finally decided to undergo the procedure, was arranging coverage and help at her business- under a week. A critical situation: I evaluated a fella in the ER to remove his bad teeth. He came in very short of breath. 10 hours after he came into the ER he had a new mitral valve. The per capita thingy is a red-herring. we are talking about efficiency and thats what you get here. >Take a look at the US Government's official list of life expectancies: > >http://www.cia.gov/cia/publications/factbook/rankorder/2102rank.html > >we are 46the in the world, behind virtually every other developed country. Explain to me what this has solely to do with healthcare? >Next let's turn to infant mortality: > [quoted text clipped - 7 lines] >the US has the lowest prevelance of smokers in the first world, which >should tend to make our numbers even better. Infant mortality is a relative measure of healthcare performance but has a direct link to low birth weight. It is measured for many reasons, including; easy to count, greater economic significance of foregone production, less influence on behavioural decisions unlike adult mortality & lastly, gov't policies would seem to have a greater impact. Real increases in GDP, education & literacy, woman in the work force, & greater quantities of medical services have a positive affect on infant mortality. You hinted 'due to some other factor', which is key in any of these charts. Regional specifics and influences are what keeps thses numbers lower. Something specific rather than relative comparisons, which these charts point to the latter. Diet & drug use are two specifics and are notably a problem in the US not included in this analysis that directly affect birth weight. Your probably a big fan of the Canadian system so here is a specific example pertaining to low birth weight (2500 grams or lower): African-American babies are more likely not to survive in comparison to Canadian babies only at the top of the range. IOW, the lower the birth weight the better off you will be born to an African-American family than a Canadian family. Speaking of Canada, what do you think is the bigger killer, cancer or HIV? Which do you think gets more funding from the gov't run plan? Well, I've clearly shown that US health care costs far, far more than that of any other country. And I've not seen anything that indicates that we have better care - our obvious indicators are all poor. If we spend twice as much, something ought to jump out that screams "better care here!", but it doesn't seem to exist. As to "innovations and techniques": How 'bout providing a list of proven helpful innovations and/or techniques that are generally available in the US, but not in other first world countries? I know of none. I do know of a fair number of techniques that are or were available primarily in the US that are either unhelpful or outright harmful. (Those crazies in other first world countries practice that dagblammit "evidence-based" medicine, which sucks all of the fun out of life, eh? Prove that something helps before we do it? Ridiculous! Blasphemy!) Yes, other countries put necessary procedures ahead of elective procedures. Where's the problem with that? At least when folks need help, they get it quick; unlike, for example, a friend of mine whose appendix burst while traveling to a second hospital because the first wouldn't honor his insurance. That doesn't happen in the rest of the first world. I'm glad that your MIL was able to quickly get a new knee; however, in the grand scheme of things, most people would think that waiting time for a new knee is a reasonable tradeoff for a system that prevents burst appendices. BTW, who paid for your MIL's knee? Was it... Medicare? Your saying that the "per capita thingy" is a red herring is silly, silly. What counts in a civilized society is how we do as a nation, not just the opportunities available to a select few. > Your probably a big fan of the Canadian system so here is a specific > example pertaining to low birth weight (2500 grams or lower): > African-American babies are more likely not to survive in comparison > to Canadian babies only at the top of the range. IOW, the lower the > birth weight the better off you will be born to an African-American > family than a Canadian family. Interesting info: may we have the source please? >> Speaking of Canada, what do you think is the bigger killer, cancer or >> HIV? Which do you think gets more funding from the gov't run plan Obviously cancer is a bigger killer. But HIV is 100% preventable, while it's not clear that much can be done to change outcome in most cancers; survival rates are increasing, but the increase may be explained by earlier detection (e.g., you live three years longer because it's detected three years earlier.) Even lung cancer is weird: I understand that Japan has the highest rate of smokers and the lowest rate of lung cancer, very odd. In all, I'm guessing that spending on HIV, if we include prevention, probably yields a lot more bang for the buck - but that's a guess. Anyway, what's the answer and what's your point? >>>>You said overwelming evidence of half the cost and better outcomes: >>>>Prove it. [quoted text clipped - 89 lines] > Speaking of Canada, what do you think is the bigger killer, cancer or > HIV? Which do you think gets more funding from the gov't run plan? One question..................... when you need emergency heart bypass surgery, which country do you want it done in? Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > Well, I've clearly shown that US health care costs far, far more than that > of any other country. And I've not seen anything that indicates that we [quoted text clipped - 143 lines] >> the bigger killer, cancer or >> HIV? Which do you think gets more funding from the gov't run plan? France. > One question..................... when you need emergency heart bypass > surgery, which country do you want it done in? >France. I see your France and raise you two Belgiums. >> One question..................... when you need emergency heart bypass >> surgery, which country do you want it done in? >>France. > >I see your France and raise you two Belgiums. Good one ! -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com good luck to you Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > France. > >> One question..................... when you need emergency heart bypass >> surgery, which country do you want it done in? >Well, I've clearly shown that US health care costs far, far more than >that of any other country. And I've not seen anything that indicates >that we have better care - our obvious indicators are all poor. If we >spend twice as much, something ought to jump out that screams "better >care here!", but it doesn't seem to exist. I took the time to read your B.S. atleast return the favor. Here is the link you avoided comment on. Then again, you could just be a troll. http://www.cato.org/pubs/pas/pa532.pdf 1. It's not BS. 2. The lovely little piece that you linked to is 26 pages long. It takes me a bit of time to critically go through things like this. >>Well, I've clearly shown that US health care costs far, far more than >>that of any other country. And I've not seen anything that indicates [quoted text clipped - 7 lines] > > http://www.cato.org/pubs/pas/pa532.pdf > Well, I've clearly shown that US health care costs far, far more than > that of any other country. And I've not seen anything that indicates > that we have better care - our obvious indicators are all poor. If we > spend twice as much, something ought to jump out that screams "better > care here!", but it doesn't seem to exist. There are a couple of big issues in all of this that haven't been addressed. 1. In the U.S. there are *lots* of lawsuits that end up being paid for by the patient. 2. The U.S. physicians and patients are both extravagant with the extremes of medical care beyond logic. Both of these factors add billions of extra cash spent on medical care. Fawks >> Well, I've clearly shown that US health care costs far, far more than >> that of any other country. And I've not seen anything that indicates [quoted text clipped - 15 lines] > >Fawks Not to mention 'defensive' medicine, where un-necessary tests are ordered to CYA... -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com No kidding! How many patients that just need an NTI have you had that have had CT scans, MRI's, and visited about every medical specialists that exists? Thousands and thousands of dollars wasted for a few hundred dollars at the dentist's office. Fawks > Not to mention 'defensive' medicine, where un-necessary tests are > ordered to CYA... > -- > > W_B Too many to count. >No kidding! > [quoted text clipped - 10 lines] >> >> W_B -- W_B wubbabubbazG@RBAGEyahoo.com Take out the G'RBAGE >Too many to count. For Jan that's any number over three. >>No kidding! >> [quoted text clipped - 10 lines] >>> >>> W_B >>Too many to count. > >For Jan that's any number over three. Her mental age ? -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com It's interesting that you mention overuse of imaging so prominently. Imaging and cardiac caths are the two major profit centers in medicine: as they say "a picture's worth a thousand dollars". > No kidding! > [quoted text clipped - 7 lines] >> Not to mention 'defensive' medicine, where un-necessary tests are >> ordered to CYA... >It's interesting that you mention overuse of imaging so prominently. >Imaging and cardiac caths are the two major profit centers in medicine: >as they say "a picture's worth a thousand dollars". Yup. Procedures not CARE. Joel > It's interesting that you mention overuse of imaging so prominently. > Imaging and cardiac caths are the two major profit centers in medicine: > as they say "a picture's worth a thousand dollars". I like that. Wish it were true in my office. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >> It's interesting that you mention overuse of imaging so prominently. >> Imaging and cardiac caths are the two major profit centers in medicine: [quoted text clipped - 3 lines] > >Steve Me too, I would just take pictures all day long. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >>> It's interesting that you mention overuse of imaging so prominently. >>> Imaging and cardiac caths are the two major profit centers in medicine: [quoted text clipped - 6 lines] > Me too, I would just take pictures all day long. > -- I do that now........... too bad I can't bill for them. We were talking about CT and MRI tests for a headache. >It's interesting that you mention overuse of imaging so prominently. >Imaging and cardiac caths are the two major profit centers in medicine: [quoted text clipped - 11 lines] >>> Not to mention 'defensive' medicine, where un-necessary tests are >>> ordered to CYA... -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >No kidding! > [quoted text clipped - 4 lines] > >Fawks I would say parafunction ...... (Even old dogs learn new tricks!) Joel >> Not to mention 'defensive' medicine, where un-necessary tests are >> ordered to CYA... >> -- >> >> W_B >>> Well, I've clearly shown that US health care costs far, far more than >>> that of any other country. And I've not seen anything that indicates [quoted text clipped - 23 lines] >Take out the G'RBAGE >wubbabubbazG@RBAGEyahoo.com Excellent points. I would also add another seemingly endless rise in health care costs is found to be the removal of the patient as a major participant in the financial and medical choices that are currently being made by others in the name of the patient resulting in consumption of medical resources beyond belief. I read a Duke study last year stating health care regulation alone costs the tax payers close to 400 billion with actual benefits barely reaching half of that. > Excellent points. > [quoted text clipped - 7 lines] > costs the tax payers close to 400 billion with actual benefits barely > reaching half of that. You probably don't hear it as much being an OS, but I can't count how many times people say, "do whatever my insurance will pay for". Can you ever imagine someone giving you their bank account info/balance and saying, "do whatever I can afford". Someone I know called it an "all you can eat buffet" mentality. T >> Excellent points. >> [quoted text clipped - 15 lines] > >T I hear it enough everday. Can you say indigestion? On the other hand though, I find myself fighting for payments on all things, especially trauma. I am being denied payment on a case I did during that last big snow storm about 8 weeks ago. A woman kicked in the face by her horse. Literally she was smashed, both upper & lower jaws. They said it wasn't done quick enough, mean while Delaware was closed down for two days. She came in the night before the storm, I had an orbital case the day of the storm that I did at my pediatric hospital. When I was finished, I was driving down to Christiana Care when they declared a state of emergency and my case kept getting bumped since the hospital was entirely backed up. I finally did it the following Monday, 5 hrs of OR time and Coventry is telling me TS. 2. is quite legitimate. However, since it's in the physician's best financial interest to do as many procedures as possible, and patients equate "doing something" with better care, we're stuck until our country gets a clue. 1. is not what most people think. Do a Google search and look at what % of medical spending is due to malpractice insurance and lawsuits. It's less than 1% - but check it yourself. >> Well, I've clearly shown that US health care costs far, far more than >> that of any other country. And I've not seen anything that indicates [quoted text clipped - 14 lines] > > Fawks >2. is quite legitimate. However, since it's in the physician's best >financial interest to do as many procedures as possible, and patients [quoted text clipped - 4 lines] >of medical spending is due to malpractice insurance and lawsuits. It's >less than 1% - but check it yourself. But both of these go way beyond stage one. With regards to your comments about 1, these are leading to massive malpractice premiums, doctors leaving their communities, a difficult bottom line to reach and a never ending snowball affect to everyone involved. To the best of my knowledge, it is still number two or three on the list of the major contributers to healthcare costs down the line. Keep thinking low copay but watch out for the avalanche. >>> Well, I've clearly shown that US health care costs far, far more than >>> that of any other country. And I've not seen anything that indicates [quoted text clipped - 14 lines] >> >> Fawks >>2. is quite legitimate. However, since it's in the physician's best >>financial interest to do as many procedures as possible, and patients [quoted text clipped - 8 lines] > > With regards to your comments Doc, he already knows and is jerking your chain. You and I have better things to do with respect to SMD participation. I always appreciate your dent/surgery comments and insight - others do to. Thanks for your time. Onanman is .............. don't waste your time. I would not have seen the sh#t, but my filters on this PC were just now updated. carabelli >>>2. is quite legitimate. However, since it's in the physician's best >>>financial interest to do as many procedures as possible, and patients [quoted text clipped - 16 lines] > >carabelli I hear ya. I suspected it and I appreciate your compliment. Dave >2. is quite legitimate. However, since it's in the physician's best >financial interest to do as many procedures as possible, and patients >equate "doing something" with better care, we're stuck until our country >gets a clue. I agree. >1. is not what most people think. Do a Google search and look at what % >of medical spending is due to malpractice insurance and lawsuits. It's >less than 1% - but check it yourself. >>> You said overwelming evidence of half the cost and better outcomes: >>> Prove it. [quoted text clipped - 25 lines] >physicians per capita than than do most developed nations - which is a >hint as to the poor medical care we get in the US. http://www.cato.org/pubs/pas/pa532.pdf You may not like the source but you cant argue the facts since many were taken straight from the country in question. > http://www.cato.org/pubs/pas/pa532.pdf > > You may not like the source but you cant argue the facts since many > were taken straight from the country in question. I had no idea John Goodman knew so much about public health. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >> http://www.cato.org/pubs/pas/pa532.pdf >> >> You may not like the source but you cant argue the facts since many >> were taken straight from the country in question. > >I had no idea John Goodman knew so much about public health. Too bad he doesnt practice what he preaches ;) >Steve > Physicians should be fairly compensated for their work, in the US as > elsewhere. But US physicians make a lot more than do physicians from > other countries This may be true of specialists, but family doctors are in a big squeeze - longer hours for less money. The insurance companies and medicare keep paying less, and the doctors aren't allowed to charge more to make up the difference. The practice I know the most about has three (3) full time people just working on insurance issues. Not taking care of patients or even making appointments. Just dealing with insurance. While GPs/FPs in the US are still better compensated then their peers in other countries, but they have to work a lot more. I find it perverse that while being a good GP/FP requires a lot more skill than being, say, a good cardiologist, the cardiologists are much better compensated. In any case, all of overhead of dealing with the insurers is due to the games that the insurers and physicians play so that each can maximize their profits. Physicians try to find amusing new procedure codes to bill so they can pocket a bit more, and insurers try to find clever ways to not pay anything. An incredible waste of good talent on both sides. Physicians in other developed countries generally don't have to go through all of that nonsense, since they have single-payer systems. Which not only decrease GP/FP aggravation, they cost a lot less and provide demonstrably better care than does the US "free market" system. >>Physicians should be fairly compensated |
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