[andyt]

Psuudo is going to have to dumb it down a bit for me - even when he tells me I'm right, I don't totally get what he's saying. My main point was that there are big savings to be had in US health care. I don't know if they can get there from here, since it would be such a huge shift in attitude and actuality. If they went to a single payer system, what would happen to the insurance industry, for instance, and would it be a bad thing if it shrunk drastically?

I'll concede the thing about research. But, a lot of US profit driven research seems to be about finding new drugs for diseases that didn't exist before. In BC they've just announced they may be on the way for a vaccine for cancer - research carried out under our commie system. Captialism, A Love Story talks about Jonas Salk, who didn't apply for a patent for the vaccine for polio because he was satisfied with his researchers salary and wanted to help the world. Maybe it's possible for us to continue with medical research without quite as much greed driving it.

The stuff about people in US getting A+ care and Canadians only getting B care is a canard. Some outcomes in Canada are better than in the US, some slightly lower. The proportion of the US population that really has access to A+ treatment is very small - just those that can pay on their own. Even the full on medical insurance has all sorts of limitations, co-pays and denial of coverage.

Williams, as has been pointed out, could have received excellent care in Toronto. We don't need to go to the US for MRI's, or wouldn't if provinces would fund their uses more fully. The machines often sit idle or are rented to private people. And, a lot of the US use of things like MRI is because somebody is making a buck off it, not because it's really medically necessary.

Our system isn't perfect. I'd look to France and other European countries before I look to the US for ideas. If you're OK with people going bankrupt (50% of all bankruptcies are due to medical costs) or committing suicide under the US system, or being denied care until it becomes critical (or not even then), maybe just move there.

[andyt]

@psudo. I won't pretend I really know my way around all these figures. But, this: http://www.reuters.com/article/idUSTRE60U00220100201 says the projected 2010 deficit is 1.56 trillion, or 10.6% of GDP. So even if the US were to be able to save 5% of GDP with adopting a single payer system (and that's the max, probably be a bit less) it wouldn't eliminate the deficit. They could eliminate the military and homeland security all together (800 billion or so) and not eliminate it. But lets say they save 400 billion, as the congression study found - that's still a quarter of the deficit - better than a kick in the pants.

[Psudo]

Incidentally, Kjorteo: Who's bad at math now?

andyt wrote:

Psuudo is going to have to dumb it down a bit for me - even when he tells me I'm right, I don't totally get what he's saying. My main point was that there are big savings to be had in US health care.

Your main point is right. I thought it was only about a nickle saved from every dollar ($122 billion total), but it's actually something more like a quarter from every dollar ($580 billion total). I was way off.

My mistake was comparing total Canadian health care spending to only the government portion of US health care spending.

As for dumbing it down, I had my wife (who is not dumb!) read this post to ensure it made sense. She isn't interested in politics or math, so her okay suggests it's understandable even for laypeople.

(Strange... the country would save $580 billion, but the US government would save $650 billion. Does that mean the country would be giving the government $70 billion?)

andyt wrote:

Jonas Salk [...] didn't apply for a patent for the vaccine for polio because he was satisfied with his researchers salary and wanted to help the world.

People are free to act without profits as their motive under capitalism, but people are not free to act with profits as their motive under anti-capitalism. Without that freedom, you lose the results of the work of the profit-minded segment of the population.

andyt wrote:

The proportion of the US population that really has access to A+ treatment is very small - just those that can pay on their own.

You're mostly right; insurance is a mess, and lots of people can't get that A+ health care. I think you exaggerate how few people pay for their own health care. I'm not rich (I stock shelves at Walmart, for heaven's sake!), but I pay for my own health care. But, for a lot of people aspiring to a better life, the fact that the A+ health care is available to anyone at all is a beautiful, inspiring thing.

Also, it's funny that you need me to "dumb it down a bit," yet I had to look up "canard" in the dictionary.

andyt wrote:

If you're OK with people going bankrupt (50% of all bankruptcies are due to medical costs) or committing suicide under the US system, or being denied care until it becomes critical (or not even then), maybe just move there.

Everyone agrees that health care is too expensive in the USA, and that people shouldn't be denied care solely because they're poor. The objection is not to the poor getting aid at all, but to their getting money out of our pockets whether we offer it or not. Any government program inevitably takes some money from some people who wouldn't volunteer it if they had a choice. How is that different than stealing?

andyt wrote:

the projected 2010 deficit is 1.56 trillion, or 10.6% of GDP. So even if the US were to be able to save 5% of GDP with adopting a single payer system (and that's the max, probably be a bit less) it wouldn't eliminate the deficit.

I was only counting deficit spending not related to the stimulus and bailout stuff, which is not typical and cannot continue if the USA is to avoid bankruptcy. (Vote Republican in 2010!) That makes it several hundreds of billions a year instead of the around $1.5 trillion per year we've seen since 2009.

[Kjorteo]

Psudo wrote:

Incidentally, Kjorteo: Who's bad at math now?

You had a mistake in your figures. I not only failed to spot it, I failed to even comprehend what I was seeing at all (let alone comprehend it enough to start looking for errors) until just now, when I was only finally made aware of it because of your specifically-for-laypeople summary of what apparently had happened. I don't think you have to worry about me challenging you for the math king position any time soon, even after this!

Psudo wrote:

I was only counting deficit spending not related to the stimulus and bailout stuff, which is not typical and cannot continue if the USA is to avoid bankruptcy. (Vote Republican in 2010!)

I'd like to think that even the Democrats understand that bailouts and stimulus bills are one-time emergency things and not a regular part of our yearly budget....

[andyt]

So many points, so little time:

I'm not talking about socialism, ie where everything is state controlled and no profit motive. Nobody does that anymore. But universities doing govt funded research has a long and proud tradition in all countries, even in the capitalist bastion USA. My point was that profit motive also leads to a lot of unnecessary research, and only funds that which can make a buck, while often what's important is doing research that may not make anybody any money. We need a mix, as we've always had. If the insane amount of money Big Pharma makes is reduced a bit, we won't all die because nobody is doing research.

I doubt if you'll be funding your own health care if you really get sick. You'll go broke and then i guess have to get Medicaid or some hospital will throw some charity at you. In Canada you'd still go broke, because working at Wal Mart you probably aren't able to save up enough of a cushion to survive joblessness, but you'll get the same care I would, with no bills hanging over you to pay back when you get better.

All govt programs are about wealth redistribution (but mostly not from rich to poor, the middle class is the biggest beneficiary of govt spending). Education - I don't have kids, why should money be taken out of my pocket to pay for other people to educate their kids? Yet I benefit from a society with educated people in it. Etc. I don't think our military should be in Astan, why do I have to pay for that? Etc. I could afford US style health insurance, let those who can't suffer - I don't think that makes much of a society. So, without govt programs you have no govt, so you have no society. I prefer govt stealing some of my money to anarchy.

You're saying the "natural" deficit is only a few hundred bill? Even so, people were worrying about the deficit starting to approach 100% GDP, in which case you'd be fucked. Social Security and health costs are going to keep rising, and even with "only" a few hundred bill deficit every year, the interest on that money compounds. At some point it will overwhelm you, and that point doesn't seem to be so far away. You're going to have to do what all western countries will have to do, raise taxes and cut spending. The trick is where to raise and cut. I say milk the rich, of all western countries are in the same boat they won't have anywhere to run with their money, unless they all want to live in China or something.

What motivates someone working at WalMart to vote Republicon? Are you doing it to fund your MBA and expect to be able to pillage on Wall Street at some point? Those days may be over.

[Psudo]

Kjorteo wrote:

[...]math king[...]

I would love that job!

Kjorteo wrote:

I'd like to think that even the Democrats understand that bailouts and stimulus bills are one-time emergency things and not a regular part of our yearly budget....

It's possible, but why risk it? =D

Seriously, though, I'd at least like Republicans to get enough votes that Democrats at least have to consult with them occasionally. Maybe spending would reduce if both sides had enough influence to curb the other side's worst excesses.

[Kjorteo]

Psudo wrote:

Seriously, though, I'd at least like Republicans to get enough votes that Democrats at least have to consult with them occasionally. Maybe spending would reduce if both sides had enough influence to curb the other side's worst excesses.

Ever since Republicans decided to switch to the "filibuster EVERYTHING, ALWAYS" strategy, Democrats can't get so much as the time of day without Olympia Snowe breaking with her party to help them do it. Meanwhile, over in the House, they couldn't even get a health care bill for 9/11 rescue workers through because apparently the only way to keep the Republicans from poison pill amending it to death was to break out a different set of rules in which the bill can't be amended at all but, in exchange, needs a 2/3 majority instead of 50% to pass, which they than failed to get. I don't think Republicans need any more influence, at least not until they have an agenda beyond "stop the Democrats--it doesn't even matter what they're trying to do, just stop it anyway."

Also, if/when they do come up with something, hopefully it isn't generic "cut spending/small government" + tax cuts again. See what I said earlier about the former being completely meaningless beyond a nice sound bite for your base without some sort of specifics, and for the latter, we, uh, we tried that already. (On an unrelated note, why is it the party that talks more loudly about small government as the solution to invasive overreaching governmental tyranny and such the one that supports all the morally- and religiously-motivated laws, anyway? Fiscal libertarianism paired with social authoritarianism makes very little sense to me, possibly because I'm the exact other way around.)

[Psudo]

andyt wrote:

I doubt if you'll be funding your own health care if you really get sick. You'll go broke and then i guess have to get Medicaid or some hospital will throw some charity at you. In Canada you'd still go broke, because working at Wal Mart you probably aren't able to save up enough of a cushion to survive joblessness, but you'll get the same care I would, with no bills hanging over you to pay back when you get better.

I saved a few thousand so far this year despite my wife's constant medical bills. Also, Walmart doesn't fire you if you get seriously sick; instead, they issue a Leave of Absence or a light work load. I know a guy who hurt his back so he couldn't lift things or bend over; he still worked for full pay, either answering phones or straightening merchandise on the shelves. It was a few months before he was back to regular duty. He's a shift manager now.

andyt wrote:

Education - I don't have kids, why should money be taken out of my pocket to pay for other people to educate their kids? Yet I benefit from a society with educated people in it. Etc. I don't think our military should be in Astan, why do I have to pay for that? Etc. I could afford US style health insurance, let those who can't suffer - I don't think that makes much of a society.

Some concession has to be made for society, but some concession also has to be made for individuality. After all, lack of individual liberty doesn't make for much of a society, either. The two arguments cancel each other out, leaving the decision to other factors.

andyt wrote:

You're saying the "natural" deficit is only a few hundred bill?

Yep. And it's the national debt that is approaching 100% GDP, not the deficit. The deficit is annual change. The debt is all those annual changes added together.

I'm not doubting that either of them are dangerous; I'd love to see spending reigned in and more than just interest paid on the national debt. That'd be great for the country. I even realize that tax increases will almost certainly be necessary. I just wish spending cuts were to be a bigger portion of the fix than tax increases. I've had to dramatically reduce my spending because of the recession; why is government doing the opposite?

andyt wrote:

What motivates someone working at WalMart to vote Republicon? Are you doing it to fund your MBA and expect to be able to pillage on Wall Street at some point? Those days may be over.

I do dream big, but I certainly don't trust Wall Street. One dream of mine is to start a national chain of non-profit, government-independent, secular K-12 schools. In my public school days, I felt constantly restrained from succeeding by my school and it's flawed, awkward design; it got so bad in my college days that I dropped out. I doubt my experience is unique; for example, math is commonly thought scary and difficult because it is commonly taught in grade schools by people who don't really understand it. In my dreams, people would pay for what schooling they can afford and the rest would be provided by private donations up to the extent of their intellectual abilities. I mention this one dream (among my dozens of grand schemes) specifically because it pertains to what you said about education needing to be government-run. I disagree, but I haven't proven it yet.

Why am I Republican? Because I believe that others' need is not my obligation, but my chance to exceed expectations. Because I trust grassroots volunteer operations more than government mandates. Because I recognize the necessity of a populous sufficiently empowered to protect itself from government and a government sufficiently empowered to ensure the survival of that system which empowers it's citizens. Because I believe prosperity better serves freedom than does financial equality. Because I believe the philosophies behind the founding of the United States are more true than the historical ebbs and flows of sociopolitical fashion and novelty. Because I believe what is right is more important than what is popular.

Not that Republicans have a monopoly on these values and utterly exclude all others (in fact, Republicans are quite a mess), but they employ these principles better and more often than do Democrats.

Incidentally, Wall Street giant and bailout recipient Goldman Sachs donates twice as much money to Democrats as Republicans. (Most other Wall Street giants are about evenly split.)

Kjorteo wrote:

I don't think Republicans need any more influence, at least not until they have an agenda beyond "stop the Democrats--it doesn't even matter what they're trying to do, just stop it anyway."

I largely agree that Republicans are being idiots, too, though I think you're exaggerating the severity. It's quite similar to the vicious attacks by Democrats against anything Bush espoused about 2005 or so. The polarization for it's own sake is just ridiculous.

Think of the causes: senators elected by states' populations rather than their legislatures, the ridiculously extreme political polarization of the Viet Nam war to where it's still debated whether it was winnable, the Reagan ideological revolution, a campaign finance reform that did everything except help... the past century is full of examples of reforms that looked good at the time but, in fact, have given the country new reasons to pick a team and blindly follow rather than denounce teams on principle and do what they think is right on a case-by-case basis.

Kjorteo wrote:

why is it the party that talks more loudly about small government as the solution to governmental tyranny and such the one that supports all the morally- and religiously-motivated blue and "thou shalt not"-type laws, anyway?

I suspect it is because Democrats continually try to drag those issues from the state and local jurisdictions (where they rightly belong) to the national stage on the assertion that various "blue laws" are unconstitutional on legally flimsy but socially fashionable reasoning. If a small towns aren't allowed to disagree with each other on social issues, then everything ends up in the supreme court.

I'm being overly confrontational, though. I don't blame Democrats so much as I blame short-sightedness and centralization of power generally. If regional diversity held stronger sway, perhaps the major parties would pay more attention to that than to party affiliation and the polarized stagnation would end.

[andyt]

Quote:

Psudo wrote:

I saved a few thousand so far this year despite my wife's constant medical bills. Also, Walmart doesn't fire you if you get seriously sick; instead, they issue a Leave of Absence or a light work load. I know a guy who hurt his back so he couldn't lift things or bend over; he still worked for full pay, either answering phones or straightening merchandise on the shelves. It was a few months before he was back to regular duty. He's a shift manager now.

If you get seriously ill, how will your few thousand dollars pay for care? If you can't work, how will you even pay your day to day bills, never mind for medical care. I"m not talking about being put on light duty, I'm talking about having to spend some time in the hospital, maybe more time at home recuperating.

It's is a balancing act of state vs individual. Either extreme leads to disaster. Good luck with your grand schemes.

[Psudo]

A few thousand isn't much, except that it's August and I said "so far this year." Give it 10 years and I'll have a pretty good emergency fund.

If I get that sick, I'm probably dead regardless of how much money I have. Since I've never been sick or injured enough for hospital stay, it's not something I'm going to spend my life worrying about.

If I can't work? Then I'm already dead. If I can't get around anymore, I can still work with my hands; manufacturing, computing, etc. If I can't do that either, I can work with my mind; dictating books, solving problems, etc. If jobs in my industry disappear, I'll work in another industry; unlike some, I'm not afraid of hard construction work or banal fast food jobs. So long as you're breathing, there's always work to be had. If you're not, that's called "dead."

Maybe it's not for everyone, but that's my personal work philosophy.

[andyt]

Psudo wrote:

My earlier analysis included the claim that the $172 billion was the Canadian government's 70% of national spending. Your page clarifies that "public-sector health care spending is expected to reach $120.3 billion (70.0% of total spending)" and $172 billion is total spending.

A large part of the 30% non-govt spending would be non-medically necessary procedures, which would not be funded under any system, so should be irrelevant. (should be subtracted from the US total too.) And the way the govt likes to play "many pockets" I wonder if the 30% includes military and RCMP? They are obviously govt funded, but are out of the usual Medicare stream, so may not have been counted. I guess workers compensation and car insurance are privately funded, tho both are govt agencies, so maybe there's some govt money going in there too?

[Psudo]

andyt wrote:

A large part of the 30% non-govt spending would be non-medically necessary procedures, which would not be funded under any system, so should be irrelevant. (should be subtracted from the US total too.)

It was.

[CKASlacker]

andyt wrote:

The stuff about people in US getting A+ care and Canadians only getting B care is a canard. Some outcomes in Canada are better than in the US, some slightly lower.

True - but like I said, if you can afford it you can get A+ treatment in the US. Which is not to say that Canada doesn't have excellent health care too - it does. But often the world's leading research agencies (Massachusetts Ear & Eye, Dr. Steadman in Colorado for knee injuries) are in the US. By that simple scale, if the world's best is A+, everything else must be less.

andyt wrote:

Williams, as has been pointed out, could have received excellent care in Toronto. We don't need to go to the US for MRI's, or wouldn't if provinces would fund their uses more fully. The machines often sit idle or are rented to private people.

Unfortunately, the machines are stationary -- having an idle MRI in Montreal doesn't do the patient in Toronto any good. You actually need to have excess capacity in order to keep wait times down.

And I consider it a good thing if the machines are rented to private organizations -- this is when research happens. Clinical-use 24/7 means no new research.

andyt wrote:

If you're OK with people going bankrupt (50% of all bankruptcies are due to medical costs) or committing suicide under the US system, or being denied care until it becomes critical (or not even then), maybe just move there.

Sounds like typical Canadian-hysteria about the US system - but your arguments have been well thought out thus far, so I'm not going to make an issue of it.

Something Canadians (not AndyT particularly) often miss in their "we have free health-care" rah-rah patriotic trumpeting of our system is that it isn't so simple. What Canada has (and it certainly isn't free!) is universal *emergency* hospital coverage. So you break your arm, suffer a gunshot, need a blood transfusion... you get it. You pay nothing.

But lots of things *aren't* covered. Things which are really critical to health (or so I think anyways). Like dental care -- hopefully your employer gives you coverage, otherwise it's out of pocket. And prescription drugs - even ones that would otherwise be necessary (an
acquaintance is manic depressive -- without her drugs costing hundreds each month, it's much worse. No, she doesn't have a drug plan with her employer).

It's a discrepancy Canadians often overlook, and to be fair Americans often buy into that too. I live in western NY, and was told: "I guess you won't need our health insurance since you can just go back to Canada for treatment!" I then had to point out that dental and drugs aren't free.

Personally, I try to keep healthy (exercise, eat well) so I don't need medical treatment. But I do go to the dentist and have some minor prescriptions filled every year. I *might* visit a hospital once every 3-5 years, and then only for diagnostic imaging. I haven't stayed overnight in a hospital since I was born. The point is, the things I most likely use from the Canadian system I pay out of pocket
(or have private insurance cover it).

Psudo wrote:

Also, it's funny that you need me to "dumb it down a bit," yet I had to look up "canard" in the dictionary.

So did I.

[andyt]

Oh, I agree, we should cover dental care, psychological services (if we can figure out how not to make it a can of worms) various other treatments (physio for instance has been cut back in BC). Other countries do seem to do that and still not pay more per capita than we do.

I get defensive about the Canadian system only when compared to the US system - we have so many fruitcakes here that want to emulate them. I was a student in the US when I couldn't afford health coverage, and it's a creepy feeling. Then I worked there for a while and had HMO coverage - definitely inferior to our system - I could only choose from an approved list of doctors. Thank fully I never had to access it, and so far I think even Medicare has received more from me in premiums than I've cost them.

Here are some countries health system rankings by the WHO:

1 France
2 Italy
3 San Marino
4 Andorra
5 Malta
6 Singapore
7 Spain
8 Oman
9 Austria
10 Japan
.
.
.
26 Saudi Arabia
27 United Arab Emirates
28 Israel
29 Morocco
30 Canada
31 Finland
32 Australia
33 Chile
34 Denmark
35 Dominica
36 Costa Rica
37 United States of America
38 Slovenia
39 Cuba

We can definitely do better, just not by looking south for ideas.

[Psudo]

Source for andyt's national rankings. Edit: andyt, do you prefer I capitalize your name or leave it lowercase? The numbers were published in the 2000 and are in reference to 1997-1999. Apparently WHO don't release such rankings anymore "because of the complexity of the task." I'm pretty sure that criticism from Americans aided in that decision.

More data is available on the WHO website (pdf), showing the eight factors that went into the ranking calculation and an "Overall Performance" that gives the ranking andyt quoted. The eight factors, with France's, Canada's, and the USA's rankings, are:
* Health Level [France: 3, Canada: 12, USA: 24] - the USA is notoriously unhealthy due largely to wide ethnic diversity, cultural bad habits, but also partially for reasons unexplained. I think any health care system, when addressing the US population, would have similar trouble.
* Health Distribution [FR: 13, CA: 18, US: 32] - the health gap between poor vs. rich and urban vs. rural. I have no criticisms of this factor. Maybe the bad health habits are more common among the poor, but more likely the USA really does need work in this area.
* Responsiveness Level [FR: 16, CA: 7, US: 1] - Speed at which health care can be attained. Interesting that the rankings are backward on this one; USA, then Canada, then France.
* Responsiveness Distribution [FR: 3, CA: 3, US: 3] - The gap in response times between rich vs. poor and urban vs. rural. 35 nations are tied for 3rd place. Ho, hum.
* Fairness in Financial Contribution [FR: 26, CA: 17, US: 54] - How much of health care costs are paid by the government or social insurance programs. Congrats, Canada, you beat France! But it's kinda kooky to measure how social our health care isn't in order to claim we need socialized health care. Circular reasoning. If my hope of private charities covering the poor's health care bills came true, the USA would still do badly on this list because it would still be private money. Boo.
* Overall Goal Attainment [FR: 6, CA: 7, US: 15] - This is a composite of all of the above scores.
* Health Expense per capita [FR: 4, CA: 10, US: 1] - This is considered a positive thing in this report, yet we first-class nations consider it a negative. Strange, isn't it? I guess it's more important to not be at the bottom of this list than it is to be at the top.
* Performance on level of Health [FR: 4, CA: 35, USA: 72] - This measures the effectiveness of your institutions at generating good health. If you implement more, you should expect more out of it, right? The USA dramatically does not, somewhat confirming my belief that Americans just don't respond to health care incentives as much as the citizens of other nations. Canada sees a little of this same effect, but far less than the USA.

Overall, the USA's low ranking on this list proves that the USA isn't getting much health improvement for the strong health care institutions it's got, and that it's got less social insurance than most. Which is pretty obvious. It's also a little biased toward a social insurance system; instituting a social health insurance system would increase the USA's standing in a hypothetical future version of this ranking system even if the health of Americans did not improve.

Let me say that again: if the USA adopted the French health care system and our national health did not improve at all, we'd still rise considerably on this list. People would be able to point to the final ranking and say "Look at all the good it's done!" even if it didn't actually benefit anyone's health at all. That. Is. Crap.

Although I do agree that there should be more done in the USA to improve the health of the poor, this ranking doesn't prove we need socialized health care. It only proves the international community wants us to have it.