As an individual with access to health care, what country would you want to be in when struck with a catastrophic illness?

The choice would be Sweden, but there is a tad bit of bias in this choice. I did a post doc at the Biochemistry Institute, University of Uppsala many years ago. The University Hospital at Uppsala is world class. Seventy miles down the road in Stockholm lies the Karolinska Institute, which is akin to our own NIH, with available expertise. As Sweden is part of the EU, a treatment that is not available in Sweden, but available in Germany, would be fully covered. Although I could stumble along in Swedish, most Swedes are fluent in English, and if you are a physician, fully aware of what is being published in American Medical Journals.

As you are talking about a catastrophic illness, one has to consider such aspects as terminal care, home care services, rehabilitation, and nursing home facilities. I will not piece out these individual areas, but just between you and me, they are equal and exceed those found in my home area of Rochester, NY. (Both towns have Universities with major Medical Centers, and are comparable in population density). It is these services which are essential in the management of chronic disease or the recovery of catastrophic illness that tipple the choice in Sweden's favor...

All you ever wanted to know about the Swedish Medical system can be found at the web site of European Observatory on Health Systems and Policies. At the very top of this link is a large PDF file. The content page of this PDF file will allow you to pick what chapters might be of interest to you. If you go to the home page of this link, you can input your country of choice, and scan their health care system.

I must confess that this statement of yours has me stumped:

So, the point is that universal access anywhere in the world has come at the expense of excellence.

Better average results at lower cost can come with mediocrity however, since most people rarely need excellence, and those that do can therefore die without significantly skewing the statistics. (My Italics, OP)

On one hand it seems you argue that excellence in medical care is not achieved in those countries listed in the European Observatory link, above. That my friend, has the slight odor of the Ugly American view of the world, everything is absolutely much better in the Shining City on the Hill. I suspect that if you ever had any contact with European medicine you would change your mind as to the ability to render high powered medicine.

On the other hand it seems to imply a triage function in these countries. Resources flow to support availability of low level medical care, and away from technology, research, and innovative exploration of medical care. I do not think you will be able to substantiate that claim. We are not talking about under-developed countries where an electrolyte solution will dramatically alter mortality rate of diarrhea disease.

Of course, one could argue that data presented by the Organisation for Economic Co-operation and Development (presented and discussed above in my previous post) is slanted by those dreadful Europhiles. The Common Wealth Fund studies health care in the US and in a 2007 study opened up with this lovely:

Among the six nations studied—Australia, Canada, Germany, New Zealand, the United Kingdom, and the United States—the U.S. ranks last, as it did in the 2006 and 2004 editions of Mirror, Mirror. Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last on dimensions of access, patient safety, efficiency, and equity. The 2007 edition includes data from the six countries and incorporates patients' and physicians' survey results on care experiences and ratings on various dimensions of care.

The most notable way the U.S. differs from other countries is the absence of universal health insurance coverage. Other nations ensure the accessibility of care through universal health insurance systems and through better ties between patients and the physician practices that serve as their long-term "medical home." It is not surprising, therefore, that the U.S. substantially underperforms other countries on measures of access to care and equity in health care between populations with above-average and below average incomes. (My Italics, OP)

You will note that the disparity in care in the US is not income dependent. The full report, plus its graphics can be found at the top of The Commonwealth Fund in yes, (horrors) PDF files.

Of course you will able to find alternative views, such as the drive by shooting by the Spectator. But, you will note no data is presented, no problems are explored, and as such, no solutions are presented. On the other hand, Karen Tumulty presents a personal account of her brother's health care crisis in Time Magazine (Time, March 16, 2009) which is well worth a quick read.

Please come back with any comments, or if you have any questions. I will keep this thread open on my desk top for a few more days.

Let's not forget that generalities are always false.

Universal access to mediocre health care may improve average results at a lower cost, while limited access to to superior health care will certainly yield superior results for those with access.

Now, consider that most people with access to adequate food and shelter will live three score and ten without ever visiting a doctor.

It is primarily intervention medicine that prolongs life for the percentage that need it, and it is just this group that needs more than mediocrity.

So, the point is that universal access anywhere in the world has come at the expense of excellence.

Better average results at lower cost can come with mediocrity however, since most people rarely need excellence, and those that do can therefore die without significantly skewing the statistics.

Places like Canada and Sweden, they won't pay more, so they're not charged more. This also means that if a drug company can't make money selling at the prices they're willing to pay, those drugs aren't available in those markets.

First of all, the national governments negotiate a price, with a reasonable profit built in. Second, if if commonly used meds were not available, John McCain’s Health Care proposal to allow US citizens to easily buy meds from Canada would have immediately been shot down.

I am talking about common every day meds. You can check this with simple Google searches, for example “International comparison of medication costs”. Some of the more experimental, and in part unproven drugs may not be available as part of the health care plans in foreign countries. But guess what, the odds are your Insurance plan will not pay for them either…

Go back to my 11:04 am post, and ponder my Pssst #2. In none of the countries I have mentioned, or indeed visited, are prescription drugs advertised. OP tumescence index refers to the most commonly advertised prescription drug family in the US. To put it into perspective, US drug manufacturers spend more on advertising then they do on research.

Pssst: Pardon my rather soft and flaccid argument, but my insurance only gives me six of them pills per month, with significant co-pay. Any more is out of pocket…

The trick is to get you thinking. So I will start with a news release by the Business Roundtable which has this to say:

Americans spend $2.4 trillion a year on health care. The Business Roundtable report says Americans in 2006 spent $1,928 per capita on health care, at least two-and-a-half times more per person than any other advanced country. (Italics are mine, OP)

There is some between country comparison health care data, which is rather sparse. The news release goes on to say that:

The CEOs of the Business Roundtable believe health care for U.S. workers and their families should stay in private hands, with a government-funded safety net for low-income people.

Thus, no smashing solutions, just more of the same. If you click on the graphic bar chart of the Yahoo article it will enlarge. Inspection will confirm what that rate of increase in health care expenditures is greater for the US than the indexed countries.

Our host, James Joiner would surely sniff with disdain at the above presented information, he after all is data connoisseur. The link below is chosen with our host in mind. Then there is this dreadful fixation that Dave Schuler has that we cannot increase health care benefits to the disadvantage population because it will strain the system. This is from the abstract of a working paper by Organisation for Economic Co-operation and Development:

In spite of improvements, on various measures of health outcomes the United States appears to rank relatively poorly among OECD countries. Health expenditures, in contrast, are significantly higher than in any other OECD country. While there are factors beyond the health-care system itself that contribute to this gap in performance, there is also likely to be scope to improve the health of Americans while reducing, or at least not increasing spending. This paper focuses on two factors that contribute to this discrepancy between health outcomes and health expenditures in the United States: inequitable access to medical services and subsidized private insurance policies; and inefficiencies in public health insurance. (Italics are mine, OP)

This paper is a bear, but it does have a series of bar graphs which are informative. A PDF form is available at their web site or at a link at he top of the paper, and a printed version will allow study at your leisure.

Further information can be found at Wikipedia, with links that may prove helpful to you…

Said it before, but I will say it again. To the open mind, data speaks for itself. At your request, I will substantiate with links any points that I have made, or further nail down the above central contention.

Please come back with an acknowledgment, I am slow thinker and a slow writer and it would pain me to think that you would challenge, but not respond.

A lot of that wealth was an illusion, base on perceived, not real, value.

I don't actually believe in "real" value. There is only momentary agreement, based on people's continuously changing perceptions and expectations.

Between 40 and 45 percent of the world's wealth has been destroyed in little less than a year and a hal

Not sure I buy this. A lot of that wealth was an illusion, base on perceived, not real, value.

BTW, my hazy understanding is that the history of measuring unemployment is a chronicle of governments narrowing the criteria for classifying people as unemployed rather than widening it.

Justin Fox: Now Job Losses Are a LOT Worse than 1981-1982

Note:

"Between 40 and 45 percent of the world's wealth has been destroyed in little less than a year and a half," Schwarzman told an audience at the Japan Society. "This is absolutely unprecedented in our lifetime."

I really don't know what the answer is here, but I can observe that denizens of this blog seem to cope primarily by avoiding that kind of news.

We certainly have no responsibility to replace that global wealth - much of it paper profits anyway. At the same time, it provides a rough size for the air pocket we've hit. We may have to inject "enough" cash to cushion the fall.

The joke in some econ circles is to take the Jaws line "We're going to need a bigger boat" and recycle it as "We're going to need a bigger stimulus."

YMMV

Average unit cost in the US and test countries and compare. Lo, the US consumer is paying twice as much, an average, than folks in Canada, Sweden, etc.

Guess what, people in other countries get charged less for movies than we do. You'll pay more for a copy of Windows than someone in India or China. We get charged more in the USA because we'll pay more in the USA. If they halve the cost of a drug in the USA, you won't move double the volume, your volume will likely change very very little.

Places like Canada and Sweden, they won't pay more, so they're not charged more. This also means that if a drug company can't make money selling at the prices they're willing to pay, those drugs aren't available in those markets.

I think we would be better off if the Harvard trained MBAs did spend some time doing a real trade...

Bush is available...

I think we would be better off if the Harvard trained MBAs did spend some time doing a real trade...