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Kistaro Windrider, Reptillian Situation Assessor

Unfortunately, I Really Am That Nerdy

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An opinion
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Let’s say you start a business. In this business, you provide a service to people.

Let’s say there are only two to four providers of this service in any given area. Now people who need this service can’t reject it. If they reject it, they will probably die. They can’t choose which provider they go to most of the time, because someone else takes them there and decides which one to go to. Often, they won’t let you say no to the service.

Now let’s say, in return for this service, you charge them all of their money.

Why wouldn’t you? The law says you can charge what you want to provide a service, and the free market says that if you charge too much, they would go somewhere else or simply forgo the service. But they keep coming to you, so obviously your prices are usual, conventional, and reasonable.

This is the fundamental problem with health care in America.

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I like the fact that we spend more money on healthcare per-capita than any other country in the world (according to the World Bank), yet our healthcare quality is rated at #37 (according to WHO). Something seems very broken about the correlation of those two figures.

Those quality figures are /terribly/ bad statistics. You've heard lies, damn lies, and statistics before? This is a great example of them.

The problem is simple. They assume every population is the same at base, and the only differing factor is health care available. The factors they judge on /completely/ ignore this.

For example, take the African nations at the bottom. Now, it is likely that their actual health care is pretty much down there too, however, the WHO even admits that's not what they looked at for these countries: these countries are near the bottom because of the rampant spread of HIV/AIDS. Now, even the best medical care in the world cannot cure or stop that virus yet. So even if you put in the best hospitals possible with the best doctors, nurses, etc free to the public, their ranking would barely budge because of /lifestyle/ issues.

The U.S. has a higher crime rate than many of these countries. It certainly has more issues with obesity, diet and drug abuse than many of the nations above it on the list. All of these bring down it's "ranking" yet neither are directly related to the availability of health care.

The basic issue is thus: a small, clean community with no crime and a healthy lifestyle, that had /no professional medical care at all/, would probably rank #1 on the WHO list were it evaluated against the nations. If you got a disease your body couldn't fight on its own or were seriously injured, you'd have no help at all, but that's only part of one of the five different statistics measured. The other four are evaluations of health (health, /not/ health care) of a population.

This is not an argument against health care reform, just a mention that the WHO statistics are a fundamentally flawed evaluation of health care to start with. They're a great evaluation of overall life expectancy and health per nation, but a LOT more goes into that in a nation than the availability of care.

The reason why we're #37 in the world isn't because the statistics are lies. It is because any form of social sciences have to make all other things equal to determine the one thing that they're measuring (or experimenting).

The term is known as ceterus paribus (and I might have even spelled it correctly!). In anything measured in a social situation; in order to have a standard way of comparing apples and oranges (such as both of those statistics), they have to use some heavy mathematics to make everything else equal; and then conduct their measurements.

They cannot just take the measurements and leave it at that, since there are too many variables affecting it, meaning that nobody in their right mind can figure out any causal relationships (e.g. SCIENCE!) to be able to say, such as for this, why health care in the US is the most expensive in the world, but not the most effective.

Something else to note about our #37 position in that WHO study: I've heard, but not confirmed, that one of the metrics for determining health care quality was whether or not a country had a nationalized health system. If it didn't, it got a lower score.

The US also suffers from its unreasonably high infant mortality rate, I believe, and if mental health services were taken into account, that couldn't have helped any.

You're right on a lot of what you say, however, I utterly disagree with this bit: It certainly has more issues with obesity, diet and drug abuse than many of the nations above it on the list. All of these bring down it's "ranking" yet neither are directly related to the availability of health care.
I would argue that the better-functioning health-care systems of countries higher on the list are -directly- responsible for the lower incidences of obesity and dietary issues in other countries, and likely drug abuse as well. When a population has access to effective healthcare in a truly affordable manner, the focus tends to slide, naturally, towards preventative care, instead of the break/fix attitude that happens when care is neither accessible nor economically attainable. Healthy lifestyle in a small community can be done without professional healthcare, yes; In a country-sized system, no; In such a large population, the medical system is a key component.
Now, of course, I'm not saying that inexpensive, accessible medical care will magically fix our woes; Of course it won't; The positive effects it will have on people's lifestyles will take time, and yes, a genuine effort from individuals as well; You can have the best healthcare system in the world, and still not take advantage of it.

Healthcare reform, IMHO, isn't just (or even primarily) about the direct economic issue of pricing; It's more about changing the broken practices and attitudes of our current system, and the current private insurance companies are a big part of the broken; They make things harder on patients, and equally, if not more importantly, they make things much harder on doctors.
So, even if the WHO statistics aren't entirely fair (which they aren't, though I would continue to argue that health-lifestyle is -partially- the responsibility of the healthcare system.), I don't think anybody can make a convincing argument that we have the -best- healthcare system in the world, and the World Bank statistics are, IMHO, fair, so we're still spending the most, and not getting the best. I want more for my dollar.

And another reason why I'm glad I live in the UK.

Sure the NHS (National Health Service) isn't perfect and the waiting lists can be horrific at times, but I know I'll get seen eventually and for no charge.

I think getting rid of this problem would help immensely in moving in the right direction.

(It also doesn't help that our government already spends more than Australia's GDP on broken health care entitlement programs.)

hmm, I should post this in my own journal

I don't know if you have *the* fundamental problem, but it is *a* fundamental problem. If health care it to be a fully free market, then the right for a provider or consumer to decline the transaction would exist. Except for emergency/unstable situations, this remains the largely the case. However, the EMTALA law in 1986 made it impossible for emergency rooms to turn away people who showed up. Over the years, costs have been jacked up largely by advances in techology. Such fancy devices and techniques have been in high demand with the national mentality of wanting everything done now. I happen to work for an academic referral where we do a fair share of extra tests because the patients have been through the basic workups by now. Also, for the record, I'm salaried so I get nothing extra for doing so; I have no performance bonus type evaluations or anything like that. Along with the extra fees incurred, there is the wonderful force of the insurance companies. It's an interesting free market where the buyer gets to set the price after the deal is done. It kind of reminds me of bargaining in third world countries, except it is more civilized there.

Health care could continue to function with a business model, which is more how non-academic practices work. There the extra tests and procedures go toward income. There's a sad pressure to push for these additional evaluations to frankly keep the office afloat. Reimbursement versus expenses have devolved to the point where primary care doctors have to churn through patients in 5-10 minutes to make ends meet. This is sorely insufficient for good patient care.

So, let's suppose we not treat health care as a private good in a free market. Instead it becomes a public good (like trains, highways, or parks... not the best comparisons) under a national health care system. Some downsides are longer waiting times since health care providers aren't pushing patients down the assembly line and can spend some time with them. Less extraneous tests are offered, and I suspect there would be a process (maybe quick, maybe slow) to advocate for a patient that we think really needs another procedure. Under such a market, obviously prices would be set the government, which frankly already has a significant hand in doing so via Medicare. I'd become a government employee and take a pay cut but probably get additional benefits.

America isn't moving anywhere close to that. I'm not sure the President or Congress really know what they're doing at all. Last I checked, there's still a public insurance option floating around the table, and rumblings of mandatory insurance like in Massachusetts have been mentioned. The mandatory insurance may force a cut of 15-20% in premiums, which is frankly still not afforadable for the families it's supposed to help. In fact it seems more like a boon to the insurance industry than anything else. Worry not, those who can't do it could just pay the government a fine instead. Look, it's obvious taxes are going to have to increase (or government has to become more efficient haha) to expand health care in any significant fashion, but there's something shady about this proposal. I'm not sure it even addresses the rising costs. Does anyone else feel like America is half-assing health care reform right now?

I thought you were talking about cable TV.

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