Life Expectancy in the U.S.
Is it the poor health care system, or is the U.S.’s poor showing in life expectancy statistics due to something else such as behavioral or social factors? These are the questions that Samuel Preston, Jessica Ho asks and try to answer.
Life expectancy in the United States fares poorly in international comparisons, primarily because of high mortality rates above age 50. Its low ranking is often blamed on a poor performance by the health care system rather than on behavioral or social factors. This paper presents evidence on the relative performance of the US health care system using death avoidance as the sole criterion. We find that, by standards of OECD countries, the US does well in terms of screening for cancer, survival rates from cancer, survival rates after heart attacks and strokes, and medication of individuals with high levels of blood pressure or cholesterol. We consider in greater depth mortality from prostate cancer and breast cancer, diseases for which effective methods of identification and treatment have been developed and where behavioral factors do not play a dominant role. We show that the US has had significantly faster declines in mortality from these two diseases than comparison countries. We conclude that the low longevity ranking of the United States is not likely to be a result of a poorly functioning health care system.
I’ve been criticizing the comparison of life expectancy between countries for some time now. I’ve often suspected that behavioral and social factors could play a role.
Don’t have a cite handy, but I think I’ve read that our herculean attempts to save premature babies and how statistics are compiled on them skews the numbers appreciably as well.
Also saw this recently and the accompanying idea that when you take out motor vehicle deaths our numbers improve significantly, which implies that health care is better than average when we aren’t killing ourselves in our cars. mpw
Per capita medical expenditures (see http://tinyurl.com/24kp2k )
in the UK and Spain (socialized medicine) are in the low to mid $2000’s; expenditures in the Netherlands and Germany (Bismark type plans) are in the low $3000’s; expenditures in France and Canada (Medicare for everybody) are also in the low $3000’s. Here in the good old USA, the per capita expenditure is over $6000.
For paying twice as much, we get the same results. That’s wonderful. No wonder those tight-fisted conservatives love our system. It makes me proud to be an American.
Stan, unless you factor in the average income and/or per capita GDP in those countries you cited the analogy is just not valid. Or perhaps you think you can buy a detached single family home in Orange County for what one goes for in suburban St. Louis.
And by the way, life expectancy is merely one measure, not the only measure. Quality of life is just as, if not more important and there I don’t think those other systems match ours. In fact, it’s not even close.
Something else that needs to be factored into both life expectancy and costs in the United States is our high rate of immigration and large number of immigrants per 1,000 population—both about twice that of France (cf. here).
Something like a third of the uninsured in the United States are either immigrants or the native-born children of immigrants. There’s also a high correlation between poverty in the United States and being an immigrant.
Please note that I’m not complaining about immigration, arguing for ejecting all immigrants, or anything of the like. I’m just pointing out that our circumstance are very different from those in other OECD countries and, consequently, it’s hard to make comparisons.
Yes, you’re right. When I lived in Germany I thought the quality of life was rather higher over there. However, warts and all the U. S. is still home to me and always will be. Germany was, well, too German.
Another reason for the US’s lower life expectancy is that the US uses a broader definition of live birth than most countries so that a lot of neonates that get counted for the US’s infant mortality rate would be considered stillbirths (and thus not counted) in many European countries.
Dave Schuler, I enjoyed my time in England very much as well, but that wasn’t what I meant. With respect to quality of life issues related to health care, I don’t think anyone has to wait up more than a few days for an MRI in the United States, whereas average waits in 2006 under the NHS in the UK were seven weeks according to their Department of Health and up to twenty weeks in 2007 in several provinces of Canada according to the CBC.
Is this where Obamacare will take us?
Something else that needs to be factored into both life expectancy and costs in the United States is our high rate of immigration and large number of immigrants per 1,000 population—both about twice that of France (cf. here).
LOL, did you even click to the graphs your artice linked too? Did you see the immigrant stats of all other countries? Luxembourg being about 4 times as high, Canada being more than twice as high? Yeah, great correlation.
@stormy dragon: I compared the mortality figures per age group. Premature birth doesn’t seem to be the biggest difference.
@ chares austin: you guys are not limiting the available healthcare, you are assigning a basic package. Our MRI’s in the Netherlands have waitinglist too, if you’re not urgent. But there are plenty of clinics that will make one for you, and your insurance will pay the part they would have to pay to the hospital so you’re only charged for the excess. At the same time: I read some personal anecdata from peope implying that their MRI in the US was quickly available, but with older machines (less clear, took longer to get a good result, no familysupport while you were doing it) so one should compare quality and quantity too.
I don’t think US healthcare is bad. I think the availibility/distribution are horrendous.
Beware quality of data, peoples.
Especially you, Dutchy.
Yeah, because you are an ideologue who only likes data that confirms your opinions. But don’t let that stop you from only ever citing one-sided arguments.
@drew: I assume you mean me with ‘dutchy’. Since I quote mortality figures from the CDC and the Dutch CBS per age group I don’t really know what would be wrong with that data. Please explain.
@Drew: maybe I should clarify, for those who don’t click links:
I compared which part of our total mortality fell in which age group, and compared that to the USA.
0-15 years old: 0.75% of Dutch deaths in 2008 fell into this group.
15-30: 0.67% of deaths in 2008
30-45: 2.07%
45-60: 8.68%
60-75: 22.46%
>75 years: 65.38 % of deaths in 2008.
0-15 years: 1.62% of deaths in USA in 2006
15-30: 2.23% of deaths in USA in 2006
30-45: 4.33%
45-60: 13.11%
60-75: 22.19%
>75 years: 56.47% if deaths in USA in 2006
So in the Netherlands 12.17% of deaths in 2008 were younger than 60.
In the USA 21.29% of deaths in 2006 occured before people are 60.
So in the Netherlands 18.36% of the deaths occur bevore peope are 65 and in the USA 27.4% of deaths occure before peope are eligible for medicare.
Yes, and behavior and social factors play no role.
Don’t post like a moron Bernard its unbecoming of you.
Added via edit:
Bernard, I think you are being a complete fool here. If I were the ideologue you are claiming I’d be arguing for a fully private/market oriented system. I’m not. I’ve posted quite a few times I think switching the French system or even better the Dutch system would be a good way to go. But the current legislation in the House and Senate don’t do that. They go in precisely the wrong direction. If this is being an ideologue, then fine. But its being and ideologue to what appears to be working (the Netherlands) or working better than what we have now (France). Both systems have quite a bit of government involvement.
By the way, I’ve often stated that I have yet to see a health care system that appears to be sustainable. The Netherlands may very well be quite close. Last I read their costs were increasing at about a rate of 3%. If that is true (maybe Dutchmarbel can confirm this), then that is extremely good and would suggest that we look very closely at the Dutch system.
I don’t recall mentioning Luxembourg or Canada because I didn’t. They’re irrelevant to any discussion other than insane maunderings.
Please make the case that Luxembourg is exactly like the United States. Please.
Dutch,
I’m going to back up Dave here as well. While immigration can be a variable at work in health care expenditures and also possibly life expectancy and other statistics it is but one of probably quite a few. So it is possible that Luxemborg has a high rate of immigration, but doesn’t have high health care growth rates like the U.S.
The U.S. for example has health benefits provided by employers and are essentially untaxed which provides a distortionary incentive to…well…”gold plate” health care. Not that people are going to get triple bypass surgery for shits and giggles, but they might add on lots of bells and whistles like covering eye glasses, or other items that really shouldn’t be part of health insurance.
I’ve been criticizing the comparison of life expectancy between countries for some time now.
Yeah, so have I.
I’ve often suspected that behavioral and social factors could play a role.
Allow me the honor of shining a spotlight on the unmentionable. The authors of the study make this observation:
How can we take researchers seriously if they model an incomplete picture? Here is what we do know about breast cancer – all breast cancers are not the same. Let’s look at one metric – Estrogen Receptors:
Here’s more on Estrogen Receptors:
So it seems that the ERN type of breast cancer has a poorer prognosis. Here are the implications of this finding:
And this biological factor ultimately plays out in the national breast cancer statistics, which show that blacks have a lower incidence of breast cancer but a higher incidence of mortality.
My point is that international comparisons that don’t control for population variance purposely exclude an important explanatory variable and thus the results that they report are distorted. If black women in the US have ERN cancers at a rate that is three times higher than white women, and these cancers are more aggressive and more difficult to treat and have a higher mortality rate than ERP cancers, then comparing the US where Black citizens comprise 13.5% of the population to nations that don’t have a similar degree of racial diversity, and in this case, a similar degree of distribution between EN and EP type breast cancers, results in a comparison that really isn’t valid.
I compared the mortality figures per age group.
I traced the provenance of this observation back to the source and it seems to me that no one along the attribution chain has corrected the fundamental error inherent in the conclusion, which is that there is absolutely no support for the conclusion that type of medical system is the principal determinant of longevity at various life stages. Klein, the “wunderkind” of health care analysis was the worst transgressor with his statement “In other words, the difference in life expectancies is about the economics of how we finance health care.”
The data show no such causal relationship.
Of course “behavioral and social factors … play a role”. Tens of millions of Americans don’t have health coverage. That’s a pretty significant social factor right there.
Oh! You meant it’s all the sick people’s fault. I misunderstood.
I know you can find those words lying around anywhere in the crowd of big government lovers, Mithras, but how did you hold Steve down long enough to stuff them in his mouth?
Yes, if you can’t fight the argument, lie about what your opponent says. It’s much easier that way.
Well, the Fraser Institute has openly advocated getting rid of public health in Canada, so I’m not sure I’d put much stock in their figures. Though you’re certainly correct that it takes more than a few days to get an MRI in Canada, my father had to wait three weeks for his, and I know several people who had to wait over a month.
Again, the Canadian system is not nearly as good as Democrats say, nor not nearly as bad as Republicans say. There definitely is some waiting, on the other hand we’re really not dying in the streets up here. Its got enough problems that some people are always trying to make it an election issue, but works well enough for 95% of the population that it remains a non-issue in elections (except for its cost).
One thing about immigration as well is that Canada and some other countries have very demanding criteria for immigration-the populations that are going to meet those qualifications are likely to have more education and more income to begin with.
Also, the US has a very high rate of illegal immigration.
Anyone who want’s to claim the life expectancy is tilted by immigration: find some data and normalize for it. There has to be expectancy data of immigrants out there.
BTW, I do remember that auto deaths are big in this as well. An area where we don’t want to change?
It is remarkable how much “stuff†Steve Verdon links to is from NBER where he quotes from an abstract, focuses on one or two sentences, and proceeds to draw conclusions. The problem with the NBER citation is that it is unavailable to readers of this blog without forking over a fee.
Being some what of a data hound, my interest in the paper was stimulated by this:
Off to the web, as I sit outside the Adams Center Public Library (closed this morning, but WiFi active) while the House Engineer is engaged in womanly activities.
The paper, presumably the same as the one posted on NBER, all of 48 pages, can be found here in pdf form. It ain’t easy reading, and in the allotted time, I cannot comment on it. For those of us who love to watch Steve Verdon trap himself, I suggest that the paper be downloaded and the summary (pages25 and 26) be read. A fragment will suffice:
Actually I’ve read most of the article. Have you?
And Paul, when did I indicate that this paper proves that U.S. health care is efficient and reform is unnecessary? I didn’t. Like usual you are constructing a strawman and running with it. You are rather dishonest, IMO. You’ve posted at least once here about how many “conservatives” decry European systems as socialist, when in fact I’ve come out in favor of moving to systems like France, Switzerland or perhaps best of all the Netherlands. I’ve also stated uncatagorically that our current system is horrendous. It doesn’t work efficiently and costs way too much money.
Your view seems to encapsulate the assumption that if we swtiched to the European view we’d get better outcomes in regards to life expectancy. I admit its possible, but to the extent that some of the life expectancy results are due to behavioral/social factors such gains will be muted.
Or to put it another way, I didn’t quote that part of the article because that wasn’t what I was posting about right now. However, I do agree with the quote, and have said pretty much the same thing, if not stronger versions, regarding the U.S. health care system.
The only trap here Paul is that you’ve created an argument, attributed it to me, then proclaim how smart you are for beating up your own argument. You’re right, you’re brilliant. At what I don’t know, but I’m sure something.
TangoMan,
Nice to see you commenting here. Hope you stay and/or come by once in awhile (and I need to be reading Gene Expression more often).
There definitely is some waiting, on the other hand we’re really not dying in the streets up here.
That’s because you can rely on the resources of the US. If there were no American safety net, then you’d certainly have needless deaths arising:
Population of Vancouver = 2,100,000
Population of Spokane = 460,000
Canadians having to rely on ONLY Canadian resources would mean that these babies would die in their cribs, so yeah, maybe they’re not dying in the streets, but dead is dead, whether you die in full public view or inside an ill-equipped hospital.
Its got enough problems that some people are always trying to make it an election issue, but works well enough for 95% of the population that it remains a non-issue in elections (except for its cost).
A non-issue for the living. A huge issue for the dead who’ve died because of an ill-equipped and centrally rationed medical care system. The dead in Canada, unlike in the US, don’t get to vote.
Well of course! The dead are the Democrats’ best friends…
Or at least the “brain dead”![lol]
“As the OP notes, you don’t have to be a doctor to sew stitches. Letting non-doctors do it would increase competition, IMO and quite possibly lower costs.”
You may be right. Regardless, I would like my sewer to be very experienced at stitching.
@Steve Verdon: I’m going to back up Dave here as well. While immigration can be a variable at work in health care expenditures and also possibly life expectancy and other statistics it is but one of probably quite a few.
Which was the point I (appearantly unsuccesfully) tried to make. Dave brought it up as a possible explenation.
About the Dutch system: you can find the health related statistics over the last 40 years at the OECD site. That includes health costs per capita and as percentage of GDP of the OECD countries.
Frankly, comparing purely on stats is still hard. We have a higher percentage of deaths on cancer and you have a higher percentage of deaths on diabetes, but is that the care of is that lifestyle? What matters to me is that people here do not go bankrupt because of medical costs while everybody gets the care they need and we perform above average in international health care comparisons.
Our government (minister of Health) is advised by The Council for Public Health and Health Care about long time policies, what should be in the obligatory basic package of health insurance and about area’s where we can still improve ourselves. Their latest advise for instance concludes that in the European health ‘league table’, the Netherlands is now about in the middle. We are better than average, but we are no longer amongst the best and opportunities for improving public health are currently being missed. They advise more emphasis on preventing disease, for instance by making quiting smoking more attractive, of make people more aware of unhealthy lifestyles and how to change those. If the advise is followed (and they usually give an economic justification) part of our ”tax money†may be used for that, either by things like making smoke-quit-aids part of our basic healthinsurance package, or by changing laws about what info is obligatory on food labels, or by a general advertisements campaign, or by a combination of those kind of actions.
One of the things the government did to fight waitinglists for example, is creating a publicly accessibe webpage where you can compare hospital quality figures, waitinglists for treatments, etc. I looked up MRI & CT scans and hip-replacement waiting lists and there are today ca. 6 hospitals with a waitinglist of 1 week for those procedures.
We also have the NzA. The Dutch Healthcare Authority (NZa) is the supervisory body for all the healthcare markets in the Netherlands. The NZa supervises both healthcare providers and insurers, in the curative markets as well as the long-term care markets. They focuse on controlling the total costs (macrocosts) by funding healthcare providers and ensuring the correct implementation of insurance legislation in healthcare. On their site you can find the maximum tarifs for treatments .
For what it is worth: though we have legalized euthanatia the age group that uses it least is the one above 70. Most people who apply for euthanatia have cancer, followed by peope with neurological progressive diseases. We have a board checking all deaths involving medical decisions, they yearly report with a summary of the statistics and a list of cases where the rules weren’t strictly applied. If I link I’ll probabely end in the spamfilter, but you can google euthanasiecommissie for the site.
In 2005 in 43% of the deaths involved a medical decision and due to those decisions people died on average 4 days sooner.
Well of course! How else will they be able to implement their evil Marxist schemes? Why, only noble stalwart heroes like you are around to stop them and their dastardly deeds….
Well, you’re right that we don’t allow the dead to vote in Canada. I’m at least mildly surprised that they’re allowed to vote in the US … is it done with seances?
There certainly are cases in Canada in which people don’t get the care they need. I’m assuming the same happens in the US (otherwise why the debate about health care). But in both the US and in Canada, by far the majority of people seem to be doing fine. Look, the population of Canada is 30 million, and if a significant proportion were going to the US for health care, you’d find better links than one speaking of 10 women in a province with a population of 10 million.
Curiously enough, despite your perception that our health care system is more or less useless, our our life expectancy is the same as yours. Is your ultimate conclusion that medical services are irrelevant to life expectancy?
Well, Steve (August 12, 2009 | 12:25 pm) it is a matter of different strokes for different folks. Where I come from, it is considered rather gauche to quote an abstract and fail to give a reference that is easily available for the quoted paper. The NBER paper is not available at my local library. I have not checked whether it is available at the University of Rochester or its Medical Library, but would not be surprised if it was not available on demand.
But hey mon, who am I to impose my archaic views on this blog. Certainly you should be kind enough to thank me for giving a web link to this paper, but perhaps my giving the link and pointing to the summary could be considered a hostile act, to wit:
The House Engineer would agree with you, by no means am I brilliant. She would argue that I am bit old fashioned in this world of the blagosphere, that the nominal rules of discourse do not apply to the ethers. For sure she is right when the Center Right decides to discuss Health Care for you can say any inanity, without reasonable substantiation, that you wish.
In closing, let me make two comments. The next time you quote from an abstract that does not reference the whole paper, I will call you out again. Intellectually that is not acceptable. If you ever say this:
I will do what I am doing now: Give me the links…
Well, you’re right that we don’t allow the dead to vote in Canada. I’m at least mildly surprised that they’re allowed to vote in the US … is it done with seances?
Yes, seances are the means that allow the dead to vote. The dead are summoned from beyond by ACORN mystics and are channeled into the bodies of other ACORN activists allowing them to vote multiple times because they have multiple people inhabiting the same body. It’s a marvel of our voting system. Republicans are a bit peeved and want people to show photo ID in order to vote, but the Democrats stop such nonsense because who has ever heard of the dead traveling through the ether with valid photo ID, why it’s not like they have border checks or speed limits to enforce in the great beyond.
There certainly are cases in Canada in which people don’t get the care they need. I’m assuming the same happens in the US (otherwise why the debate about health care).
The debate is about cost. A health infrastructure costs money to maintain even if it’s not being used. It’s kind of like a coal-burning power plant. You still have to pay the mortgage on that plant even when you turn off the switch and don’t generate power. Canada saves a lot of money by not building up its health infrastructure to the point where it has sufficient capacity to handle all of the health-related needs of its citizens. What Canada has done is built their health infrastructure to the point where it is running at full capacity all of the time and there is no slack in the system. Every little blip in health related matters that are beyond the expected means that Canadians are sent down to the US. This is why we so often see periodic surges in premature birth not being able to be accommodated by the Canadian medical system and why, from BC, a province of 4 million, there is no neonatal slack, so expectant mothers are sent to Spokane, a city of only 400,000, to give childbirth.
The point is that it’s easy to save money when you skimp on health-related infrastructure. Canada can do this because it has a safety net for its citizens, the US. When is the last time you read an account of a capacity problem in the US requiring a patient be flown to Canada for treatment?
Curiously enough, despite your perception that our health care system is more or less useless, our our life expectancy is the same as yours. Is your ultimate conclusion that medical services are irrelevant to life expectancy?
My conclusion is that the funding aspect of medical services is mostly irrelevant to life expectancy. Further, other than basic medical care, the type that you would find in most of the poorer developed countries, the advanced care doesn’t really change the life expectancy factor. This is why we see so little variation in life expectancy between Jordon, Bosnia, Albania, Costa Rica, Libya, and the richer Western nations. Look up the figures. There is only a 1-3 year spread.
What all that health care funding really buys is an improvement in quality of life. It takes Nova Scotia 540 days to process 86% – 91% of the patients requiring hip replacement surgery. It takes so long because Nova Scotia skimps on the infrastructure which allows for increased capacity. This skimping doesn’t really affect life expectancy but what it does do is seriously impact the quality of life of patients who have to suffer for a year or more in order to get their hips replaced. The US spends more because it costs money to maintain that medical infrastructure that has the capacity to deal with medical issues in very timely manner. The quality of life of an American in need of hip replacement surgery is far better than what his Canadian counterpart endures. That quality of life doesn’t show up in statistics.
What would the Democrats do without ACORN…how else could they possibly control the Presidency, the Congress, 28 governorships, 28 upper statehouses, and 33 lower statehouses…wow, that Soros money must really be spread around…
Actually I agree with what you say there, its a far cry from the normal “Canadians are dying in the streets” you hear about, and which sounds so funny when you actually live up here and note that people look pretty healthy in general outside a growing obesity problem.
Part of what you’re referring to is a general Canadian policy not to be self sufficient in many things … we import far more things than we produce, including services, and the decision was made to extend that to medical care – and worse, to defense.
Every country does that to some extent or another (the US is not self-sufficient on energy, for instance), largely because its more efficient to do so. In the case of Canada and health care, it simply is more efficient to use facilities across the border to handle excess capacity, given that the US population (and so services) are 10 times ours, and what is a blip for us doesn’t even register for you.
Which is not to say that there aren’t pretty bad cost problems with our system, and in fact most Canadians would prefer a parallel private system … note that very few want to get rid of the public system, as it actually works very well for most things (life threatening illnesses, accidents etc are for the most part treated promptly and well). I’d predict that within a decade we’ll have both private and public health, and it’ll work pretty well for 99% of the population.
Quality of life measurements are notoriously suspect though – I agree that the quality of life for an American waiting hip replacement surgery will better than for most Canadian provinces, but I’m not so sure that the general quality of life (even restricted to health) is better in the US than in Canada, taking the populations as a whole.
For most Canadians its simply not an issue, something born out continuously in elections, where different parties have tried to make it election issues, only to find that most Canadians aren’t particularly interested. The counter argument is that the Canadian system works well for most of your life (ie assuming normally healthy people who get into a serious accident or come up with cancer etc), and so the ones not served well by it (the elderly needed replacement surgery, and some people with chronic illnesses) aren’t a large enough portion of the population to influence elections.
1. Most NBER papers are not usually available for free download. In this case, the exception, you got lucky.
2. I provided a link where you can download it for $5, even from your public library…that you are cheap is not my problem.
3. Even if I do get the free download, since NBER works are copyrighted I can’t go posting them for people so cheap as you.
You did see the link in my OP right? You did see that that references the paper. Its right there near the top of the page. You can also see at the linked page another link for downloading said paper, yes for $5, but that is pretty damned cheap compared to what most academic journals charge. In short, this “gotcha” of yours is completely false.
No. If you are lazy as well as cheap, that is again not my problem. I don’t have to provide links when we have a perfectly searchable website here where I have said these things. In fact, if you scroll down a bit you’ll likely find posts where I write this. In fact, I said precisely this in response to one of your earlier comments. Hell, I wrote something similar to Bernard further up stream in this thread.
You’re an insufferable ass who thinks you “traped” me, but in the end all you got is some “gotcha” moment in that I didn’t find your cheap butt a free down load. Mea culpa. What’s next, that you don’t like my dogs?
The slow move to mediocrity is the issue. Give it a few years and people will stop thinking it is reasonable to want to have extended treatment if you are very sick, whether you are young or old.
Listen to the way Obama talks when he discusses illness. It is the guiding hand.
I would suggest that most people in the UK accept the protocol (When to start treatment) mandated by NICE that, according to the Cancer Journal, has 22,000 more people dying of cancer a year than need be. Why is there not an uproar?
For most Canadians its simply not an issue, something born out continuously in elections, where different parties have tried to make it election issues, only to find that most Canadians aren’t particularly interested.
The reason it doesn’t resonate with voters as an election issue is that it’s like asking them if they think that their lives would be improved if, instead of raising their own child, they raised someone else’s model child. Canadians are used to their medical system, they’ve ingested a lifetime of propaganda about it to the point where the propagandists have actually melded it into what defines Canadian identity, and thus to reject it would cause such mental seizures that it would be the equivalent of rejecting one’s own child and preferring to raise someone else’s child. However, Canadians would do well to ask the beneficiaries of private care within Canada why they don’t accept their care from within the socialized system like the rest of the population. It would seem, to an outside observer, that the WCB recipients, the LASIK patients, seem to prefer efficient privately provided medical care compared to the inefficient and rationed socialized care that is forced upon the rest of the population. Why do you think that is? If people really prefer socialized medical care then why are these people working against their own interests by receiving care from private providers?
Hmmm, not sure what this is worth, but one of the parents of a kid on my son’s swim team is Canadian and he works in the health care industry. His views on the Canadian system are decidedly not favorable to it. At the same time he thinks our system is seriously broken too. His take on the Obamacare is that for the next few years he and others in health care would make alot of money, then things would start to get bad and the money would start to dry up.
Totally anecdotal, but what the Hell, this is the intertubes after all.
I don’t understand why health care reform can’t start at the very foundation of health care interactions, insure sound principles are in play, and then escalate up the ladder to institutional reform.
One of the key fundamentals that I believe should be addressed is that over a “typical” person’s lifetime the premiums or health care expenses or health care surtaxes come to balance the “typical” person’s consumption of health care services.
As it is, my impression is that the “typical” person now consumes, over their lifetime, more in services than they will pay in the way of premiums and taxes. This is unsustainable.
Are there any health care systems which are self-sustained and don’t rely on intergenerational wealth transfer in order to keep afloat? If there are I’d love to investigate what they’re doing. If there aren’t then I’d say that most reform efforts that don’t address the fundamental level of analysis are little different than the band of the Titantic changing the songs they play as the ship is sinking. Changing from a somber musical score to an upbeat score may make people feel happier, but it doesn’t really change anything of import.
The counter argument is that the Canadian system works well for most of your life
Recent news from Canada:
Here’s the problem in a nutshell – one funder = one decisionmaker = lot’s of victimized patients with no alternative when MEDICALLY NECESSARY procedures are cut.
Steve Verdon (August 13, 2009 | 12:46 pm)
As I previously said, different strokes for different for different folks. I view OTB as a site were I might learn something, where criticism is viewed as a tool to further knowledge, and where a certain degree of civility is expected.
The web offers a major educational experience as it provides instant links, where a blog author can present information, or a participant in a blog can access information. Rest assured that when either a blog leader, or a participant references (links) to support his/her argument I hit the magic blue phrase. For example, dutchmarble in this, and other threads, has provided valuable links to support her arguments. Indeed, Dave Schuler thanked her when she referenced an OECD paper examining GP vs Specialist Physician pay.
Perhaps I am too rigid in my view that an abstract is not a valid representation of a paper. Perhaps you are right, I may be pecuniarily challenged in a specific anatomical region (cheap butt, is your rather droll description).
What I found of peculiar is that this paper by Preston and Ho present data that is of value, is referenced in detail, and would have been of interest to participants in this thread. You surely could have strengthened your premise by abstracting data from the paper and presenting it. Arguing that it is copyrighted is silly, abstraction of data and graphs is permissible in this setting.
As for your closing question: What’s next, that you don’t like my dogs? I need to know a bit more about them. Do they have flees? Are they aggressive and bite? Do they bark when they shouldn’t, or do they bark when they should? Do you carry baggies when you walk them?
Best wishes from an insufferable ass, and may we both walk in the light of truth…