eglamkowski's Journal: Question for nationalized health care advocates

It is common to point out how first-world countries with socialized medicine spend less and have better health compared to US health care spending. Couple of questions in this:

1) Are you confusing cause and effect? Might it not be that other countries people live healthier lifestyles and thus require less health care spending? I would expect (not going to take the time to look it up at this very second) that the US has the highest rate of obesity, and with that comes extra health problems that non-obese people rarely have. More health problems per person means more health care spending per person, the source of health care funding doesn't enter into it.

2) Also, we have tens of millions of people coming from Central and South America and SE Asia and Southern China, bringing with them diseases that otherwise wouldn't exist in the US, adding to our health problems beyond what would normally be the case. And many of these diseases are very expensive to treat, including the drug-resistant stains of common disease, like TB, that are becoming increasingly common in the third world. We have as many immigrants in the US from these areas as some countries have their entire population! Something like 25 million ILLEGALS from Mexico alone, millions more from Asia, who knows how many from South America, to say nothing of the legal immigrants. Canada has a population of, what, 33 million? Our entire illegal population is probably larger than the entire population of Canada. Do any of the health care cost studies normalize for this?

3) Also, what about psychological problems and addictions? Are these numbers consistent across countries when looking at reported health care costs? Are they consistently included or not included? If included, at what level of treatment are they included and can that be normalized meaningfully?

4) Even more troublesome is cosmetic surgery, particularly elective vs. reconstructive, and to what extent one or the other or none or both is or is not included. Is this accounted for in comparative analyses?

5) Also, are you considering ONLY the cost of treatment, or also the cost of health insurance? I'm not entirely certain it's intellectually honest to add into the comparison the cost of private insurance versus government paid insurance when examining the total cost of health care, but I am having trouble putting into words exactly why that is. It just doesn't compute to my mind.

6) Are pharmaceuticals included? While only a relatively small portion of the total cost of health care (maybe around 5% in the US), our drugs here in the US cost a lot more, both because our government doesn't just dictate the price companies are allowed to charge (as is the case in Canada, for example), and also to support our research industry (which is non-existent in most other countries, and even German firms, a country historically noted for its pharmaceutical industry, has moved most of their research to the US since the research laws in Germany are far more highly regulated and restrictive and more costly). How are these factors incorporated into cost comparison studies, if at all?

I don't want to get into the question of whether it is "right" or "wrong" or "morally imperative" or what not to have a nationalized health care. We've already had that discussion in my journal in the past, so I consider that totally out of bounds for this JE. I'm purely looking to the question of how "normalized" are the cost comparison studies that exist.

There are no doubt many other areas I missed that require normalization, but let's just start with the above six. Inquiring minds want to know!

I'm actually thinking about efficiency

[Marxist Hacker 42]

Right now, to me, none of the rest of that matters as much as the fact that in the United States we're wasting money on duplicated effort. With hundreds of insurance companies, each with their own claims forms and management structure, up to a third of our health care costs are getting wasted in paperwork and upper management bonuses. Because of this, our businesses are less profitable, less able to compete globally. I can find no rational excuse for the waste this "competition" (which isn't really becau

Re:

[ncc74656]

Right now, to me, none of the rest of that matters as much as the fact that in the United States we're wasting money on duplicated effort. With hundreds of insurance companies, each with their own claims forms and management structure, up to a third of our health care costs are getting wasted in paperwork and upper management bonuses.

You're not actually suggesting that a government bureaucracy would be more efficient, are you? The IRS (to name one infamous example) says you're not really supposed to tru

Re:

[ces]

You're not actually suggesting that a government bureaucracy would be more efficient, are you? The IRS (to name one infamous example) says you're not really supposed to trust the answers its own advisors give people who call in with tax questions. Is that the level of competence you want in your health care?

Well Medicare seems to do a pretty damn good job with a heck of a lot less overhead than private insurance. Health care providers generally like dealing with Medicare and Medicaid because they pay on time without a lot of BS about arguing every single treatment code.

Consider the recent kerfuffle over facilities maintenance falling behind at Walter Reed. It's bad enough (inexcusable, really) that GIs who've put their butts on the line and the doctors who patch them back up are subjected to that kind of indignity. If Uncle Sam has a hard enough time keeping a high-profile military hospital in good working order, what are the odds he'll do any better with your local hospital?

I don't think the VA or Military hospitals is a fair comparison. For the simple fact that nobody (at least nobody sane) is seriously suggesting the Federal Government take over hospitals from their current management.

Re:

[Marxist Hacker 42]

I don't think the VA or Military hospitals is a fair comparison.

And I'd point out there is a difference- where VA hospitals got awards in the 1990s for their efficiency in providing the care they do, Walter Reed is a military hospital instead. And also, rule changes since the Bush Administration have erroded VA's budget to the point that they don't serve a quarter of the customers they did in the 1990s.

Some things the government does extremely well. Some things Congress screws up so badly that nobody c

Re:

[Marxist Hacker 42]

You're not actually suggesting that a government bureaucracy would be more efficient, are you?

In the arena of health care- I'm actually suggesting that the government bureaucracy IS more efficient in two out of three current programs (Medicare & Vetran's Administration, vs Armed Forces Health Service which fell down rather spectatcularily last week), which have only a 2% overhead vs a 33% overhead. Any time you have captive consumers, government bureaucracy will beat the free market all hollow on eff

2 fsck u lameness filter

[Captain Splendid]

As to point #2, I've got bad news for you: This is the global economy (or whatever), and all that exotic shit is going to hit your shores one way or the other, so I don't see how that's pertinent to a nationalized health care debate.

Oh, and the lameness filter can eat my shorts. Whaddya mean I can't use one letter for my subject line? Asshats.

Re:

[Marxist Hacker 42]

This is the global economy (or whatever), and all that exotic shit is going to hit your shores one way or the other, so I don't see how that's pertinent to a nationalized health care debate.

It is pertinent in three ways, all of which are in conflict with one another:
1. The global economy is NOT a given- we can always resist it to the point where we require *every* person coming across the militarized border to submit to a remote health scan of some sort, at which point we merely sterilize the chamber of

Going off on a tangent a bit...

[ncc74656]

Also, we have tens of millions of people coming from Central and South America and SE Asia and Southern China, bringing with them diseases that otherwise wouldn't exist in the US, adding to our health problems beyond what would normally be the case. And many of these diseases are very expensive to treat, including the drug-resistant stains of common disease, like TB, that are becoming increasingly common in the third world.

Here's something extra to consider. I got my first health card (issued by the coun

I'll take a stab at it

[ces]

1) Are you confusing cause and effect? Might it not be that other countries people live healthier lifestyles and thus require less health care spending? I would expect (not going to take the time to look it up at this very second) that the US has the highest rate of obesity, and with that comes extra health problems that non-obese people rarely have. More health problems per person means more health care spending per person, the source of health care funding doesn't enter into it.

Medicare and Medicaid would show this if it was a factor. Medicare and Medicaid costs are comparable to the rest of the industrialized world when adjusted for the populations they serve (the elderly and poor respectively)

2) Also, we have tens of millions of people coming from Central and South America and SE Asia and Southern China, bringing with them diseases that otherwise wouldn't exist in the US, adding to our health problems beyond what would normally be the case. And many of these diseases are very expensive to treat, including the drug-resistant stains of common disease, like TB, that are becoming increasingly common in the third world. We have as many immigrants in the US from these areas as some countries have their entire population! Something like 25 million ILLEGALS from Mexico alone, millions more from Asia, who knows how many from South America, to say nothing of the legal immigrants. Canada has a population of, what, 33 million? Our entire illegal population is probably larger than the entire population of Canada. Do any of the health care cost studies normalize for this?

Not really a driver for health care costs other than the lack of effective public health programs. Due to rapid travel pretty much everyone gets exposed to any new fun disease rather quickly. Look at the spread of SARS. Besides any added costs would also show up in Medicaid and Medicare.

3) Also, what about psychological problems and addictions? Are these numbers consistent across countries when looking at reported health care costs? Are they consistently included or not included? If included, at what level of treatment are they included and can that be normalized meaningfully?

Re:

[eglamkowski]

Re: 1 - Medicare and Medicaid would show this if it was a factor. Medicare and Medicaid costs are comparable to the rest of the industrialized world when adjusted for the populations they serve (the elderly and poor respectively)

How many elderly people are morbidly obese? You'll pardon, but I'd be surprised if there were a whole lot of 90 year olds who were 200 pounds over weight. Maybe I'm wrong on that, but I've never seen any with my own two eyes. If these people do not, in fact, exist, then Medicare

Re:

[Marxist Hacker 42]

But even I have to admit that one reason for increasing pharmco profits is lifestyle drugs rather than life-saving drugs. You can then ask the question of why that is happening (baby boomers who expect to live to a very old age regardless want a high quality of life in that old age!), but that's not necessarily relevant in a cost comparison analysis. Which brings up another good question: in countries with socialized medicine, does the government pay for the lifestyle drugs, or only life-saving drugs? Is th