US dead last in health care

[guyser]

Maybe it doesn't. I have never seen population density used as a criteria for health care cost studies. Perhaps that's because those who study health care costs don't consider it to be of any substantive effect. I've certainly never seen it used as an excuse by any of our politicians, and I'd expect it to be if they thought it could fly. I don't see how a hospital plunked down in rural Alberta has any higher costs than one in downtown Toronto. If anything, given land costs it's a lot cheaper.

I have not seen it either but that doesnt mean it doesnt exist.

But looking at it all, it has to have an effect on the cost and availibility of healthcare.

If the facts of Swizterland are such that people can get MRI's (for example) more timely or other procedures it may well be times are affected by the closeness of the patient seeking same.

Govt pays for commuting costs of patients from far out regions. People seeking certain types of healthcare may only get it in large urban areas, and therefore have to travel 500km or more...somtimes less of course.

That 500k is farther than the farthest distance in all of Switzerland. Thats added costs, primarly to the patient granted but the picture gets a little clearer.

We can transport all medical equipment by truck in all southern parts of all of Canada. But once we reach certain areas all transport must be by plane. Costs are enormous

The market in Switzerland is compact and right outside the door,

The market in Canada is spread out very far and supplying and maintaining it is far more exepnsive.

[Mighty AC]

I haven't found any break downs that include logistics yet. I may be wrong, but I still suspect that when considering costs like wages, maintenance, equipment, supplies, pharmaceuticals, etc that transportation costs are not a significant piece of the pie.

[Argus]

I have not seen it either but that doesnt mean it doesnt exist.

Doesn't mean it DOES either.

If the facts of Swizterland are such that people can get MRI's (for example) more timely or other procedures it may well be times are affected by the closeness of the patient seeking same.

The waiting time in Ottawa for an MRI, aside from emergencies, is seven months. I don't think that's because we have a low population. I think it's because we have an incompetent government.

Govt pays for commuting costs of patients from far out regions. People seeking certain types of healthcare may only get it in large urban areas, and therefore have to travel 500km or more...somtimes less of course.

Yes, but for the most part they do that traveling on their own dime. And most types of health care are available in rural hospitals and clinics.

We can transport all medical equipment by truck in all southern parts of all of Canada. But once we reach certain areas all transport must be by plane. Costs are enormous

I think you're stretching there. Medical equipment only gets transported once. Yes, it will cost more to fly it to Yellowknife than Toronto, but that's a one-time expense. I order lots of stuff over the internet that comes to me from thousands of miles away, and it often comes for free.

[

The market in Canada is spread out very far and supplying and maintaining it is far more exepnsive.

I'm sure there are a few additional expenses here and there, but I think they're minimal given the size of the bill. I don't see it being 'far' more expensive at all. And I think if it was someone in the business would have mentioned it by now

[Pliny]

Not as efficient or effective as it should be. It seems to be better than the one down south, however.

Not it doesn't. Better or worse is not an opinion which can be ascribed to personal judgement. The American system costs much more than anyone elses. Therefore, in order to be of equal efficiency and effectiveness with other systems, it must produce much better results. Yet it doesn't. Every comparison I've ever seen says their results are not as good as systems which cost much less money,

It's like Joe and Fred both go to different dealers and lease the same model car, the exact same car with the exact same conditions. But Joe pays 30% more than Fred. Can any reasonable person suggest that Joe should be content? So they go back next year, and again, Joe pays 30% more, and they do this year after year. Why would Joe be so stupid as to not even check out the other dealer and see if he can get the same deal as Fred?

Actually, it's not like that, because in most assessments the expensive American system isn't the of the same quality as others, it's worse.

Health care seems to be unique, not unlike education, in that it affects everyone to some extent. It will impact everyone's life at some point. In some cases the American system does produce better results or else no Canadian would be procuring its services but many are. Besides the more prominent public cases, such as Chretien, there are quite a few that are willing to purchase its services. It shows some confidence in its results and its efficiency.

[Argus]

Health care seems to be unique, not unlike education, in that it affects everyone to some extent. It will impact everyone's life at some point. In some cases the American system does produce better results or else no Canadian would be procuring its services but many are. Besides the more prominent public cases, such as Chretien, there are quite a few that are willing to purchase its services. It shows some confidence in its results and its efficiency.

The reason it gets visits from Canada is its competitive nature leaves it with excess capacity right across the board. Every hospital has to have every piece of fancy equipment, even if rarely used. That makes it immediately accessible by outsiders. That's good for outsiders, but the cost of all that excess capacity is enormous to those who have to pay for it. Expensive equipment which is not being used to capacity, and then is replaced quickly due to the next piece of fancy equipment that comes out leads to gross inefficiencies which burden the system with costs without really benefiting it much. Of course, our system's problem is that it has not enough capacity in many cases. That's mostly an aspect of cost-saving measures, political cowardice, and the static nature of the regulatory framework which everyone seems loath to change.

Edited January 19, 2013 by Argus

[Canuckistani]

Pliny is why I don't want to open the healthcare debate to changing our system. I would have no problem learning from Europe, but there's too many Plinys that would be pushing for us to adopt that crap US system. I've lived and worked there. The system is crap. Even HMO coverage costs both the employer and the employee more than we pay here in premiums, and you can't choose any doctor you want, go to any hospital as needed, and there's some highschool grad deciding whether your condition is covered. Then there's the co-pays and pre-existing conditions exemptions.

[Bonam]

The reason it gets visits from Canada is its competitive nature leaves it with excess capacity right across the board. Every hospital has to have every piece of fancy equipment, even if rarely used. That makes it immediately accessible by outsiders. That's good for outsiders, but the cost of all that excess capacity is enormous to those who have to pay for it. Expensive equipment which is not being used to capacity, and then is replaced quickly due to the next piece of fancy equipment that comes out leads to gross inefficiencies which burden the system with costs without really benefiting it much. Of course, our system's problem is that it has not enough capacity in many cases. That's mostly an aspect of cost-saving measures, political cowardice, and the static nature of the regulatory framework which everyone seems loath to change.

If one has money, and is in need of substantial health care, I'd much rather be faced with a system with a lot of excess capacity. Someone should do a study comparing health outcomes only for the top 50% of households by income between different countries. Bet the US wouldn't be last anymore.

[Smallc]

I'm not sure that would be something to brag about.

[Canuckistani]

If one has money, and is in need of substantial health care, I'd much rather be faced with a system with a lot of excess capacity. Someone should do a study comparing health outcomes only for the top 50% of households by income between different countries. Bet the US wouldn't be last anymore.

From the original article :

"The news is that this is across the lifespan, and regardless of income," said Georges Benjamin, executive director of the American Public Health Association, who was not an author of the study. "A lot of people thought it was underserved populations that were driving the statistics -- the poor, the uninsured. They still are a big part of our challenge, but the fact that even if you're fairly well-to-do you still have these problems shatters that myth."

Do you have that money? Do you care about others who don't? Actually even those with the money would not want a system with a lot of excess capacity, since it would drive up their costs so much. Lots of concern in the US about the high cost of their system and the drag it puts on the economy. they're just not getting their money's worth, even less so than we are.

[bush_cheney2004]

.... Someone should do a study comparing health outcomes only for the top 50% of households by income between different countries. Bet the US wouldn't be last anymore.

You got that right...no wonder many Canadians of means skip the wait times back home, including MPs and PMs.

[Moonbox]

So let me get this straight...You're saying that because wealthy Canadians can go south and pay top dollar for the best doctors in the United States, that means that US care is better overall? What was the life expectancy ranking again???

That's classic US political thinking.

[Canuckistani]

Since the US is a country run by millionaires in the pockets of billionaires, it makes perfect sense to think that way. Even if the person themselves is a poor shlub who'll never have access to the same healthcare these rich folks do.

America is the wealthiest nation on Earth, but its people are mainly poor, and poor Americans are urged to hate themselves. To quote the American humorist Kin Hubbard, “It ain’t no disgrace to be poor, but it might as well be.” It is in fact a crime for an American to be poor, even though America is a nation of poor. Every other nation has folk traditions of men who were poor but extremely wise and virtuous, and therefore more estimable than anyone with power and gold. No such tales are told by the American poor. They mock themselves and glorify their betters. The meanest eating or drinking establishment, owned by a man who is himself poor, is very likely to have a sign on its wall asking this cruel question: “if you’re so smart, why ain’t you rich?” There will also be an American flag no larger than a child’s hand – glued to a lollipop stick and flying from the cash register.

Americans, like human beings everywhere, believe many things that are obviously untrue. Their most destructive untruth is that it is very easy for any American to make money. They will not acknowledge how in fact hard money is to come by, and, therefore, those who have no money blame and blame and blame themselves. This inward blame has been a treasure for the rich and powerful, who have had to do less for their poor, publicly and privately, than any other ruling class since, say Napoleonic times. Many novelties have come from America. The most startling of these, a thing without precedent, is a mass of undignified poor. They do not love one another because they do not love themselves.

An American said that.

[bush_cheney2004]

So let me get this straight...You're saying that because wealthy Canadians can go south and pay top dollar for the best doctors in the United States, that means that US care is better overall? What was the life expectancy ranking again???

Your collectivist mindset is ignoring the value of liberty and choice. Even basic health care is not a right, not even in Canada.

That's classic US political thinking.

...and the Canadians still keep coming. Why ?

[Accountability Now]

Sorry for jumping in late on this but the thing I don't get is how this study makes a claim on how healthy people are by using stats like violence or road collisions. Having high deaths in those categories may mean they are violent or poor drivers but doesn't necessarily mean they are unhealthy. You could have an otherwise healthy guy die in a crash and now he's put on the unhealthy chart?

Furthermore, this thread seems to be focused on the thought that since the article says Americans die more that their health care system is not as good. Again...I would again argue this isn't the case. I trust other stats might prove this position but I don't think this article does.

Personally I do think that Canada's system is better than the US not because we have better doctors or better technology but because our system reaches all of our population. I am the first to say that the US leads the way in technology and availability of services but that doesn't mean their system works for all which tends to be the guideline for most of these rankings.

[Bonam]

From the original article :

"The news is that this is across the lifespan, and regardless of income," said Georges Benjamin, executive director of the American Public Health Association, who was not an author of the study. "A lot of people thought it was underserved populations that were driving the statistics -- the poor, the uninsured. They still are a big part of our challenge, but the fact that even if you're fairly well-to-do you still have these problems shatters that myth."

Got some data on that? Actual numbers? I would be genuinely interested in seeing them.

[Canuckistani]

Got some data on that? Actual numbers? I would be genuinely interested in seeing them.

Given the racial and ethnic diversity of the country, might the US health disadvantage reflect the profound health disparities and socioeconomic disadvantages that affect low-income and minority racial/ethnic populations? The data reviewed by the NRC/IOM panel indicate that the US health disadvantage is more pronounced among vulnerable populations, but it also can be found among more privileged groups. Even non-Hispanic white adults or those with health insurance, a college education, high incomes, or healthy behaviors appear to be in worse health (eg, higher infant mortality, higher rates of chronic diseases, lower life expectancy) in the United States than in other high-income countries.^{1,7- 8}

http://jama.jamanetwork.com/article.aspx?articleid=1556967#qundefined

If you don't believe the journal of the american medical association, I guess you'll have to look up those numbers yourself. The references are given if you follow the link. Personally I'm willing to take their word for it.

Edited January 20, 2013 by Canuckistani

[Bonam]

Ok so looking at the three references (1,7, and 8) for that assertion, 1 is not a scientific source, and neither 7 or 8 support what the sentence says. Still waiting for the numbers.

[Canuckistani]

Sorry for jumping in late on this but the thing I don't get is how this study makes a claim on how healthy people are by using stats like violence or road collisions. Having high deaths in those categories may mean they are violent or poor drivers but doesn't necessarily mean they are unhealthy. You could have an otherwise healthy guy die in a crash and now he's put on the unhealthy chart?

Furthermore, this thread seems to be focused on the thought that since the article says Americans die more that their health care system is not as good. Again...I would again argue this isn't the case. I trust other stats might prove this position but I don't think this article does.

Personally I do think that Canada's system is better than the US not because we have better doctors or better technology but because our system reaches all of our population. I am the first to say that the US leads the way in technology and availability of services but that doesn't mean their system works for all which tends to be the guideline for most of these rankings.

The United States spends more on health care than does any other country, but its health outcomes are generally worse than those of other wealthy nations. People in the United States experience higher rates of disease and injury and die earlier than people in other high-income countries. Although this health disadvantage has been increasing for decades, its scale is only now becoming more apparent.

A new report¹ from the National Research Council and Institute of Medicine (NRC/IOM) documents that US males and females in almost all age groups—up to age 75 years—have shorter life expectancies than their counterparts in 16 other wealthy, developed nations: Australia, Austria, Canada, Denmark, Finland, France, Germany, Italy, Japan, Norway, Portugal, Spain, Sweden, Switzerland, the Netherlands, and the United Kingdom. The scope of the US health disadvantage is pervasive and involves more than life expectancy: the United States ranks at or near the bottom in both prevalence and mortality for multiple diseases, risk factors, and injuries.

diseases don't count? Risk factors don't count?

US newborns begin life with a health disadvantage: they have a shorter life expectancy than newborns in other wealthy countries, and not just because of the diseases of aging. For decades, US infants have been less likely to reach their first birthday than infants born in peer countries.² Outcomes such as low birth weight are more prevalent in the United States, and mortality rates up to age 5 years are also higher.

Adolescents in the United States have the highest pregnancy rates and the highest prevalence of sexually transmitted infections. The United States has the second highest prevalence of HIV infection among 17 peer countries and the highest incidence of AIDS.¹

For decades, the United States has also had the highest obesity rates. The nation has the highest prevalence of diabetes among adults aged 20 years and older and the second highest death rate from ischemic heart disease. Lung disease and drug-related deaths are more prevalent in the United States, and older US adults report higher rates of arthritis and activity limitations than do seniors in England, other European countries, and Japan.

What accounts for this? What could explain a health disadvantage that involves conditions as varied as motor vehicle crashes, heart disease, preterm birth, and diabetes? The NRC/IOM panel explored this paradox and found clues in almost every class of health determinants it considered. The United States lacks universal health insurance coverage, and its health system has a weaker foundation in primary care and greater barriers to access and affordable care.⁴ Care coordination also is a problem. In multiple surveys of patients with chronic illnesses in up to 11 countries, The Commonwealth Fund has shown that US patients are more likely than patients elsewhere to report lapses in care quality and safety outside of hospitals.¹US patients appear more likely than those in other countries to require emergency department visits or readmissions after hospital discharge, perhaps because of premature discharge or problems with ambulatory care. Confusion, poor coordination, and miscommunication between clinicians and patients are reported more often in the United States than in comparable countries.

Cross-national comparisons such as those provided by the NRC/IOM report vividly demonstrate that people in the United States—notably children—are dying earlier and experiencing illnesses and injuries at rates that other countries have demonstrated are unnecessary.

[Canuckistani]

Ok so looking at the three references (1,7, and 8) for that assertion, 1 is not a scientific source, and neither 7 or 8 support what the sentence says. Still waiting for the numbers.

It's easy to say show the research. I don't have acess to it. JAMA does, and I'm willing to take their world for it. You want to hang on to your beliefs by not doing so, that's up to you.

[Bonam]

It's easy to say show the research. I don't have acess to it. JAMA does, and I'm willing to take their world for it. You want to hang on to your beliefs by not doing so, that's up to you.

No I have no really strong beliefs either way. However, as a scientist, I don't take people's word, but look at the data myself. If that data is not available or forthcoming, I remain unconvinced. Good published scientific research with important implications is almost always made public, by the way.

[Canuckistani]

No I have no really strong beliefs either way. However, as a scientist, I don't take people's word, but look at the data myself. If that data is not available or forthcoming, I remain unconvinced. Good published scientific research with important implications is almost always made public, by the way.

The study is in the form of a book, which is available for sale. You're free to buy it and report back. I'm willing to take the various doctors' and health experts' words on this.

[Bonam]

The study is in the form of a book, which is available for sale. You're free to buy it and report back. I'm willing to take the various doctors' and health experts' words on this.

If I was interested enough in the subject to spend money to buy a book, I wouldn't be asking you for data but would have seen said data myself and perhaps be presenting it here.

[Canuckistani]

If I was interested enough in the subject to spend money to buy a book, I wouldn't be asking you for data but would have seen said data myself and perhaps be presenting it here.

Hang on to your doubts. What do all those people involved in the field know.

[Bonam]

Hang on to your doubts. What do all those people involved in the field know.

See, this is the problem with talking about science on a board like this. People think science is about just believing what an expert tells you. It's not though, science is about the evidence speaking for itself. There's a reason when you learn about science in grade school that you do labs and experiments and don't just listen to a lecture: you are supposed to see the evidence for everything you are learning for yourself. All I asked for is to see the original evidence, and yet you seem to treat this as an unreasonable thing to ask for, as if I'm some kind of conspiracy nut. And this is moreover the problem with social science in general, people let their emotions and biases get in the way of even the most basic scientific principles, like taking a look at the evidence for oneself.

[Canuckistani]

See, this is the problem with talking about science on a board like this. People think science is about just believing what an expert tells you. It's not though, science is about the evidence speaking for itself. There's a reason when you learn about science in grade school that you do labs and experiments and don't just listen to a lecture: you are supposed to see the evidence for everything you are learning for yourself. All I asked for is to see the original evidence, and yet you seem to treat this as an unreasonable thing to ask for, as if I'm some kind of conspiracy nut. And this is moreover the problem with social science in general, people let their emotions and biases get in the way of even the most basic scientific principles, like taking a look at the evidence for oneself.

This isn't a scientific board. It's a board where people express their opinions. You're free to hang on to your doubts, but it's not as if you've scored some major point of argument. The experts are expressing what they took from the data. That's a lot more meaningful than you saying you have no data. If you want to go by hard data, you're limited to saying you have no opinion, since you haven't seen the data yourself. Kind of limits your participation here, doesn't it? I've got guys in the field we're discussing saying they've looked at the data and here's what they think. You've got nothing. I win.