TheBigDog Posted August 6, 2009 Report Posted August 6, 2009 Speaking of straw men, does your silly claim about "flawed presentation of facts" apply to the World Health Organization, as well? :dog: WHO | World Health Organization Assesses the World's Health Systems http://www.who.int/whr/2000/en/whr00_en.pdfYes. Quote
InfiniteNow Posted August 6, 2009 Report Posted August 6, 2009 Bill, I'd like to say that I'm surprised by your response, or that I'm shocked you would make such a bold assertion without supporting it, but... frankly... I'm not. Since you've cast aside the entire WHO report I shared as a "strawman used to condemn the US healthcare system," and just a "flawed presentation of facts," can you please at least show the courtesy to specify which data points, which methods, or which references within the report you find flawed and why? I put forth the gold standard on global healthcare data, and you've dismissed it out of hand. I can't take you seriously if you continue forward like this. Please act like a site-elder and be precise with your criticisms. I asked, does your assertion about "flawed presentation of facts" apply to the World Health Organization, as well.You responded, "Yes." Now it's time for you to explain why in a precise, clear, and articulate manner which is respectful of reality. Quote
lawcat Posted August 6, 2009 Report Posted August 6, 2009 Really? Funny. I feel the same way about our energy sector. :dog: (nonsequiter...sorry) I feel the same about pollution: light, air, water, ground pollution. (nonsequiter) It's all about stability and longevity, yet profits are all about today and immediate future. The thinking must change. There is still profit in stability and longevity, but it is slightly more responsible. Quote
TheBigDog Posted August 6, 2009 Report Posted August 6, 2009 Bill, I'd like to say that I'm surprised by your response, or that I'm shocked you would make such a bold assertion without supporting it, but... frankly... I'm not. Since you've cast aside the entire WHO report I shared as a "strawman used to condemn the US healthcare system," and just a "flawed presentation of facts," can you please at least show the courtesy to specify which data points, which methods, or which references within the report you find flawed and why? I put forth the gold standard on global healthcare data, and you've dismissed it out of hand. I can't take you seriously if you continue forward like this. Please act like a site-elder and be precise with your criticisms. I asked, does your assertion about "flawed presentation of facts" apply to the World Health Organization, as well.You responded, "Yes." Now it's time for you to explain why in a precise, clear, and articulate manner which is respectful of reality.You called my assertion silly (Poisoning the well). Assuming I am being silly then why not make the same assertion of everything. So I answer a simple "yes". I made my case initially that the Whitehouse paper uses a specific measure to condemn the US healthcare of being inefficient. You quoted a portion of this paper. The paper itself says that the measure is an over generalization (a fact you chose to omit when you quoted it). There are cases in the WHO link where similar measures are shown that oversimplify the issue of healthcare in attempt to "grade" the care provided by various countries. Much of the WHO data is in the form of "satisfaction" surveys taken around the world. In another section they give advice to leaders about making unpopular decisions regarding healthcare, and present strategies for implementing changes that will be unpopular with the public, but provide overall better health services. So on one hand they rely on popularity to at least partially rank one system as better than another; and on the other hand they are recognizing that good health care decisions in terms of governmental policy can be unpopular. Be popular, but do unpopular things. Is this an effective measure? I am not being silly. I am discussing the topic of health care. Bill Quote
InfiniteNow Posted August 6, 2009 Report Posted August 6, 2009 You called my assertion silly (Poisoning the well). Assuming I am being silly then why not make the same assertion of everything. So I answer a simple "yes".I note you've still failed to specify precisely what is flawed or faulty in either report I've shared. Care to try again, or is hand-waving and red-herrings good enough of an argument for you? I made my case initially that the Whitehouse paper uses a specific measure to condemn the US healthcare of being inefficient. Yes, I remember, and you were wrong then, too. You accuse others of strawmen, yet that is precisely what you are arguing, and it seems rather obvious to me that you never bothered to read past section 1. A note on the metric of spending as a portion of GDP versus life expectancy. I would not expect to see a direct correlation unless the purpose of all healthcare spending was to extend lifespan. <...> My point is that such a simplistic measure of such a complex topic is a strawman used to condemn the US healthcare system. The fact that it is being used by the Whitehouse does not justify the flawed presentation of facts. I ask again... which of these references is using "a simplistic measure" as a "strawman" to "condemn the US healthcare system?" The Economic Case for Health Care ReformREFERENCES Abraham, Jean, T. DeLeire, A. Royalty. "Health Insurance, Pensions, and Paid Leave: Access to Health Insurance at Small Establishments in a Broader Benefits Context." Inquiry, forthcoming. America’s Health Insurance Plans. "Individual Health Insurance 2006-2007: A Comprehensive Survey of Premiums, Availability, and Benefits." AHIP Center for Policy and Research, December 2007. American Hospital Association. "Uncompensated Hospital Care Fact Sheet," November 2005. http://www.aha.org/aha/content/2005/pdf/0511UncompensatedCareFactSheet.pdf. Anderson, Gerard and B. Frogner. "Health Spending in OECD Countries: Obtaining Value Per Dollar." Health Affairs, 2008, 27(6): 1718 – 1727. Audet, Anne-Marie, M. Doty, J. Shamasdin, and S. Schoenbaum. "Physicians Views on Quality Care: Findings From the Commonwealth Fund National Survey of Physicians and Quality of Care." The Commonwealth Fund, May 2005a. Audet, Anne-Marie, M. Doty, J. Shamasdin, and S. Schoenbaum. "Measure, Learn, and Improve: Physicians’ Involvement in Quality Improvement." Health Affairs, 2005b, 24(3): 843-853. Autor, David H. and M.G. Duggan. "The Growth in the Social Security Disability Rolls: A Fiscal Crisis Unfolding." Journal of Economic Perspectives, 2006, 20(3): 71-96. Baicker, Katherine and A. Chandra. "Medicare Spending, the Physician Workforce, and Beneficiaries’ Quality of Care." Health Affairs, 2004, Web Exclusive, W4-W184. Becker, David, D. Kessler, and M. McClellan. "Detecting Medicare Abuse." Journal of Health Economics, 2005, 24(1): 189-210. Birkmeyer, John, A. Siewers, E. Finlayson, T. Stukel, F. Lucas, I. Batista, H. Welch, and D. Wennberg. "Hospital Volume and Surgical Mortality in the United States." New England Journal of Medicine, 2002, 346(15): 1128 – 1137. Blinder, Alan S. and J. L. Yellen. The Fabulous Decade: Macroeconomic Lessons from the 1990s (New York: Century Foundation Press, 2001). Burton, Wayne N., D. Conti, C. Chen, A. Schultz, and D. Edington. "The Economic Burden of Lost Productivity Due to Migraine Headache: A Specific Worksite Analysis." Journal of Occupational & Environmental Medicine, 2002, 44(6):523-529. Card, David, C. Dobkin, and N. Maestas. "Does Medicare Save Lives?" Quarterly Journal of Economics, 2009 124(2): 597-636. Cebul, Randall, J. Rebitzer, T. Lowell, and M. Votruba. "Organizational Fragmentation and Care Quality in the U.S. Health Care System." NBER Working Paper 14212, August 2008. Chassin, Mark R. "Achieving and Sustaining Improved Quality: Lessons from New York State and Cardiac Surgery." Health Affairs, 2002, 21(4): 40-51. Chernew, Michael, D. Cutler, and P. Keenan. "Increasing Health Insurance Costs and the Decline in Insurance Coverage." Health Services Research, 2005; 40(4):1021-1039. Congressional Budget Office. "Factors Contributing to the Infant Mortality Ranking of the United States," Feb. 1992. http://www.cbo.gov/ftpdocs/62xx/doc6219/doc05b.pdf. Currie, Janet and J. Gruber. "The Efficacy and Cost of Recent Changes in the Medicaid Eligibility of Pregnant Women," Journal of Political Economy, 1996a, 104(6): 1263-96. Currie, Janet and J. Gruber. "Health Insurance Eligibility, Utilization of Medical Care, and Child Health," Quarterly Journal of Economics, 1996b, 111(2): 431-66. Currie, Janet and B. C. Madrian. "Health, Health Insurance and the Labor Market," Handbook of Labor Economics (O. Ashenfelter & D. Card, eds.), Elsevier: New York, 1999. Cutler, David. "Employee Costs and the Decline in Health Insurance Coverage." Forum for Health Economics and Policy, 2003; 6(3). Cutler, David. "Health System Modernization Will Reduce the Deficit," Center for American Progress Action Fund, 2009. Cutler, David and A. Gelber. "Changes in the Incidence and Duration of Periods without Insurance." New England Journal of Medicine, 2009, 360(17): 36 – 44. Cutler, David and M. McClellan. "Is Technological Change in Medicine Worth It?" Health Affairs, 2001, 20(5): 11 – 29. Daysal, Meltem. "Does Uninsurance Affect the Health Outcomes of the Insured? Evidence from Heart Attack Patients in California," University of Maryland Working Paper, 2009. DeNavas-Walt, Carmen, B. Proctor, and J. Smith. U.S. Department of Commerce. U.S. Census Bureau. "Income, Poverty, and Health Insurance Coverage in the United States: 2007." August 2008. Dowd, Bryan E., R. Feldman, and J. Christianson. Competitive Pricing for Medicare (Washington: American Enterprise Institute Press, 1996). Doyle, Joseph J. "Health Insurance, Treatment and Outcomes: Using Auto Accidents as Health Shocks," Review of Economics and Statistics, 2005, 87(2): 256-270. Dranove, David, and M. L. Millenson. "Medical Bankruptcy: Myth Versus Fact," Health Affairs, 2006, Web Exclusive, W74-W83. Eissa, Nada and J. B. Liebman. "Labor Supply Response to the Earned Income Tax Credit." Quarterly Journal of Economics, 1996, 111(2): 605-637. Elmendorf, Douglas W. and N. G. Mankiw. "Government Debt," Handbook of Macroeconomics, (J. Taylor and M. Woodford, eds.), Amsterdam: Elsevier, 1999. Evans, William N. and S. Snyder. "The Impact of Income on Mortality: Evidence from the Social Security Notch," Review of Economics and Statistics, 88(3), 2006, 482-495. Executive Office of the President. Council of Economic Advisers. Economic Report of the President. February 2000. http://www.gpoaccess.gov/usbudget/fy01/pdf/2000_erp.pdf. Executive Office of the President. Council of Economic Advisers. Economic Report of the President. February 2008. http://www.gpoaccess.gov/eop/2008/2008_erp.pdf. Feachem, Richard, N. Sekhri, and K. White. "Getting More for their Dollars: Comparison of the NHS with California’s Kaiser Permanente" BMJ, 2002, 324: 135-43. Finkelstein, Amy and R. McKnight. "What Did Medicare Do? The Initial Impact of Medicare on Mortality and Out of Pocket Medical Spending 2008." Journal of Public Economics, 2008, 92: 1644-1669. Finkelstein, Erik A., I. C. Fiebelkorn, and G. Wang. "National Medical Spending Attributable to Overweight and Obesity: How Much, and Who’s Paying?" Health Affairs, 2003, Web Exclusive, W3-291-226. Fisher, Elliot S., D. Wennberg, T. Stukel, D. Gottlieb, F. Lucas, and E Pinder. "The Implications of Regional Variations in Medicare Spending. Part 1: The Content, Quality, and Accessibility of Care." Annals of Internal Medicine, 2003, 138 (4): 273-287. Fisher, Elliott S., J. P. Bynum, and J. S. Skinner. "Slowing the Growth of Health Care Costs – Lessons from Regional Variation." New England Journal of Medicine, 2009, 360(9): 849-852. Gabel, Jon, R. McDevitt, L. Gandolfo, J. Pickreign, S. Hawkins, and C. Fahlman. "Generosity and Adjusted Premiums in Job-Based Insurance: Hawaii Is Up, Wyoming Is Down." Health Affairs, 2006, 25(3):832-43 Garber, Alan M., and J. Skinner. "Is American Health Care Uniquely Inefficient?" Journal of Economic Perspectives, 2008, 22(40: 27-50. Garthwaite, Craig. "Economic Effects of Medical Innovation: Vioxx and Labor Supply." University of Maryland Working Paper, October 2008. Gaynor, Martin, H. Seider, and W. B. Vogt. "The Volume–Outcome Effect, Scale Economies, and Learning-by-Doing," American Economic Review, 2005, 95(2): 243-247. Gibson, Teresa B., R. Ozminkowski, and R. Z. Goetzel. "The Effects of Prescription Drug Cost Sharing: A Review of the Evidence," American Journal of Managed Care, 2005, 11(11): 730-740. Glied, Sherry, and K. Jack. "Macroeconomic Conditions, Health Care Costs, and the Distribution of Health Insurance." NBER Working Paper No. W10029, October 2003. Goetzel, Ron Z., S. Long, R. Ozminkowski, K. Hawkins, S. Wang, and W. Lynch. "Health, Absence, Disability, and Presenteeism Cost Estimates of Certain Physical and Mental Health Conditions Affecting U.S. Employers," Journal of Occupational & Environmental Medicine, 2004, 46(4):398-412. Gordon, Robert J. "Foundations of the Goldilocks Economy: Supply Shocks and the Time-Varying NAIRU." Brookings Papers on Economic Activity, 1998, No. 2: 297-346. Gruber, Jonathan. "Health Insurance and the Labor Market." Handbook of Health Economics. (A. Culyer and J. Newhouse, eds.), Elsevier: New York, 2000. Gruber, Jonathan and B. Madrian. "Health Insurance, Labor Supply, and Job Mobility: A Critical Review of the Literature," Economic Research Initiative on the Uninsured Working Paper 4, University of Michigan, November 2001. Gruber, Jonathan and M. Lettau. "How Elastic is the Firm’s Demand for Health Insurance?" Journal of Public Economics, 2004, 88(7-8): 1273-1293. Hackbarth, Glenn. "Reforming America’s Health Care Delivery System". Statement before the Senate Finance Committee Roundtable on Reforming America’s Health Care Delivery System, 2009, p. 5. http://www.medpac.gov/documents/Hackbarth%20Statement%20SFC%20Roundtable%204 %2021%20FINAL%20with%20header%20and%20footer.pdf. Hadley, Jack and J. Reschovsky. "Small Firms’ Demand for Health Insurance: The Decision to Offer Insurance." Inquiry, 2002, 39(2): 118-137. Hadley, Jack, J. Holahan, T. Coughlin, and D. Miller. "Covering the Uninsured in 2008: Current Costs, Sources of Payment, and Incremental Costs." Health Affairs, 2008, Web Exclusive, W399-W415. Hay/Huggins Company, Inc. As appeared in: "Cost and Effects of Extending Health Insurance Coverage" Congressional Research Service (CRS), October 1988. Herring, Bradley. "The effect of the availability of charity care to the uninsured on the demand for private health insurance." Journal of Health Economics, 2005, 24(2): 225-252. Holtz-Eakin, Douglas and C. Kao. "Entrepreneurship and Economic Growth: The Proof is in the Productivity." Center for Policy Research, Maxwell School of Citizenship and Public Affairs, Syracuse University, Working Paper No. 50. February 2003. Huckman, Robert S. and G.P. Pisano. "The Firm Specificity of Individual Performance: Evidence from Cardiac Surgery," Management Science, 2006, 52(4): 473-488. Institute of Medicine. "Hidden Costs, Value Lost: Uninsurance in America." June 2003. http://www.iom.edu/?id=12313&redirect=0 . Institute of Medicine. "Preventing Medication Errors." Institute of Medicine Report Brief, 2006. http://www.iom.edu/Object.File/Master/35/943/medication%20errors%20new.pdf. Institute of Medicine. "Performance Measurement: Accelerating Improvement." Institute of Medicine Report Brief, December 2005. http://www.iom.edu/Object.File/Master/35/324/PerformanceMeasurement_Brief.pdf. Kaiser Family Foundation and Health Research and Educational Trust. "Employer Health Benefits: 2008 Annual Survey." http://ehbs.kff.org/. Karaca-Mandic, Pinar, J. M. Abraham, and C. E. Phelps. "A Burden or Merely a Load: New Empirical Estimates of Health Insurance Loading Fees by Group Size," University of Minnesota Working Paper, May 2009. Karoly, L. and J. Rogowski. "The Effect of Access to Post-Retirement Health Insurance on the Decision to Retire Early." Industrial and Labor Relations Review, 1994, 48: 103-123. Lee, Jason. "Are Health Insurance Premiums Higher for Small Firms?" Robert Wood Johnson Foundation Research Synthesis Report No. 2. September 2002. http://www.rwjf.org/pr/synthesis/reports_and_briefs/pdf/no2_policybrief.pdf. Lerner, Josh. "The Government as Venture Capitalist: The Long-Run Effects of the SBIR Program," Journal of Business, 1999, 72: 285-297. Madrian, Brigitte C., G. Burtless, and J. Gruber. "The Effect of Health Insurance on Retirement," Brookings Papers on Economic Activity, 1994, No. 1: 181-252. Madrian, Brigitte C. "Employment-Based Health Insurance and Job Mobility: Is There Evidence of Job-Lock?" Quarterly Journal of Economics, 1994, 109(1): 27-54. Manning, Willard G., J. Newhouse, N. Duan, E. Keeler, A. Leibowitz, and M. Marquis. "Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment," American Economic Review, 1987, 77(3): 251-77. Marquis, M. Susan, M. Buntin, J. Escarce, K. Kapur, T. Louis, and J. Yegian. "Consumer Decision Making in the Individual Health Insurance Market," Health Affairs, 2006, 25: W226–W234. McGlynn, Elizabeth, S. Asch, J. Adams, J. Keesey, J. Hicks, A. DeCristofaro, and E. Kerr. "The Quality of Health Care Delivered to Adults in the United States." New England Journal of Medicine, 2003, 348: 2635-2645. McKinsey Global Institute. "Accounting for the Cost of U.S. Health Care: A New Look at Why Americans Spend More." December 2008. http://www.mckinsey.com/mgi/reports/pdfs/healthcare/US_healthcare_report.pdf. Monheit, Alan C. and P. F. Cooper. "Health Insurance and Job Mobility: Theory and Evidence," Industrial and Labor Relations Review, 1994, 48(1): 68-85. O’Connor, Annette M., H. A. Llewellyn-Thomas, and A. B. Flood. "Modifying Unwarranted Variations in Health Care: Shared Decision Making Using Patient Decision Aids," Health Affairs, 2004, Web Exclusive, W63-W72. Office of Management and Budget. "Analytical Perspectives, Budget of the U.S. Government, Fiscal Year 2010." http://www.whitehouse.gov/omb/budget/fy2010/assets/spec.pdf. 2009. Organization for Economic Cooperation and Development. OECD Health Data 2008. Frequently Requested Data. December 2008. http://www.oecd.org/document/16/0,3343,en_2649_34631_2085200_1_1_1_1,00.html Pauly, Mark V. Health Benefits at Work: An Economic and Political Analysis of Employment-Based Health Insurance (Ann Arbor: The University of Michigan Press, 1998). Rhoades, J. and S. Cohen. Agency for Health Care Research and Quality, U.S. Department of Health and Human Services, "The Long-Term Uninsured in America, 2002-2005." Statistical Brief #183, 2007. Robert Wood Johnson Foundation, Commission to Build a Healthier America. "Beyond Health Care: New Directions to a Healthier America," April 2009. Rust, J. and C. Phelan. "How Social Security and Medicare Affect Retirement Behavir in a World of Incomplete Markets." Econometrica, 1997, 66: 781-831. Selby, Joe V., B. Firemand, and B. E. Swain. "Effect of a Copayment on Use of the Emergency Department in a Health Maintenance Organization," New England Journal of Medicine, 1996, 334(10): 635-642. Simon, Kosali. "Adverse Selection in Health Insurance Markets: Evidence from State Small-Group Health Insurance Reforms." Journal of Public Economics, 2005, 89: 1865-1877. Studdert, David, M. Mello, W. Sage, C. DesRoches, J. Peugh, K. Zapert, and T. Brennan. "Defensive Medicine Among High-Risk Specialist Physicians in a Volatile Malpractice Environment." Journal of the American Medical Association, 2005, 293(21): 2609-2617. U.S. Department of Commerce. U.S. Census Bureau. "U.S. Population Projections." 2008. http://www.census.gov/population/www/projections/files/nation/download/NP2008_D1.xls. U.S. Department of Commerce. U.S. Census Bureau. Current Population Survey, Annual Social and Economic Supplement, 2008. http://www.census.gov/cgi-bin/broker. U.S. Department of Commerce. National Income and Product Accounts. "Table 1.1.5. Gross Domestic Product." Last revised April 29, 2009. http://www.bea.gov/national/nipaweb/TableView.asp? SelectedTable=5&Freq=Qtr&FirstYear=2007&LastYear=2009 U.S. Department of Commerce. National Income and Product Accounts. "Table 3.2. Federal Government Current Receipts and Expenditures." Last revised April 29, 2009. http://www.bea.gov/national/nipaweb/TableView.asp?SelectedTable=85&Freq=Qtr&FirstYear=2007&LastYear=2009 . U.S. Department of Commerce. National Income and Product Accounts. "Table 7.8. Supplements to Wages and Salaries by Type." 2007. http://www.bea.gov/national/nipaweb/TableView.asp? SelectedTable=288&Freq=Year&FirstYear=2006&LastYear=2007 . U.S. Department of Health and Human Services. Agency for Healthcare Research and Quality. Center for Financing, Access and Cost Trends. "1996 Medical Expenditure Panel Survey-Insurance Component." http://www.meps.ahrq.gov/mepsweb/data_stats/summ_tables/insr/national/ series_1/1996/tid1.pdf. U.S. Department of Health and Human Services. Agency for Healthcare Research and Quality. Center for Financing, Access and Cost Trends. "2006 Medical Expenditure Panel Survey-Insurance Component." http://www.meps.ahrq.gov/mepsweb/data_stats/summ_tables/insr/national/series_1/2006/tia2.pdf. U.S. Department of Health and Human Services. Centers for Medicare and Medicaid Services. The Boards of Trustees, Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds. "2008 Annual Report." March 2008. http://www.cms.hhs.gov/ReportsTrustFunds/downloads/tr2008.pdf. U.S. Department of Health and Human Services. Centers for Medicare and Medicaid Services. National Health Expenditure Accounts. "National Health Expenditure Web tables." http://www.cms.hhs.gov/NationalHealthExpendData/downloads/tables.pdf. U.S. Department of Health and Human Services. Centers for Medicare and Medicaid Services. National Health Expenditure Accounts. "National Health Expenditure Projections 2008-2018." http://www.cms.hhs.gov/NationalHealthExpendData/downloads/proj2008.pdf. U.S. Department of Labor. Bureau of Labor Statistics. Current Population Survey. Labor Force Statistics. "Employment status of the civilian noninstitutional population by age, sex, and race." Table A-13. April 2009." http://www.bls.gov/web/cpseea13.pdf. U.S. Department of Labor. Bureau of Labor Statistics. Payroll Survey. Employer Costs for Employee Compensation Summary. "Private industry workers, by major occupational group and bargaining unit status." Table 5. March 2009. http://www.bls.gov/news.release/ecec.nr0.htm. U.S. General Accounting Office. "Medicare Part B Imaging Service: Rapid Spending Growth and Shift to Physician Offices Indicate Need for CMS to Consider Additional Management Practices," Report to Congressional Requesters. June 2008. http://www.gao.gov/new.items/d08452.pdf. van Praag, C. Mirjam and P. H. Versloot. "What is the Value of Entrepreneurship? A Review of Recent Research." Small Business Economics, 2007, 29: 351-382. Wennberg, John, E. Fisher, and J. Skinner. "Geography and the Debate over Medicare Reform." Health Affairs, 2002, Web Exclusive, W96-W113. Wharam, J. Frank, B. Landon, A. Galbraith, K. Kleinman, S. Soumerai, D. Ross-Degnan. "Emergency Department Use and Subsequent Hospitalizations among members of High-Deductible Health Plan," Journal of the American Medical Association, 2007, 297(10): 1093-1102. Your behavior in this thread is the antithesis of science, and directly counter to the stated purpose and rules of Hypography. If you're not ashamed of yourself, then you should at least be embarrassed. :) Quote
TheBigDog Posted August 6, 2009 Report Posted August 6, 2009 I am going to make an attempt to communicate on this issue with you, but you really need to make an effort to read and comprehend what I am writing. It is endlessly frustrating to have to reexplain things to you because you cannot get off of your rant. Here is the first quote you supplied from The Economic Case for Health Care ReformFurther evidence that the high level of spending in the United States reflects inefficiency comes from the behavior of spending over time. U.S. health care spending has risen dramatically in recent decades relative to spending in other countries, with no evident gains in relative outcomes. In 1970, we devoted only a moderately higher fraction of our GDP to health care than other high-income countries. As described above, today we spend dramatically more. Yet, during that period, life expectancy has actually risen less in the United States than in other countries.30 Unless one believes that other influences on life expectancy have deteriorated dramatically in the United States relative to other countries, this suggests that much of the increased U.S. spending is inefficient.Looking at the document I found the preceeding paragraph interesting...As a crude indicator, one can use the difference in health care’s share of GDP between the United States and similar countries to gauge the magnitude of inefficiency. Looking at the average for Canada, Germany, Japan, Sweden, Britain, and France, it appears that the amount of resources devoted to health care in the United States that may be due to inefficiency is roughly 5 percent of GDP (15.3 percent in the United States in 2006, versus 9.6 percent, the average for the six comparison countries, all of which have better health outcomes).28 Put another way, judging from the spending and outcomes in other countries, efficiency improvements in the U.S. health care system potentially could free up resources equal to 5 percent of U.S. GDP. This is, however, only a rough measure. It may well be that because of other differences between the various countries the true level is smaller. But, this estimate is a useful guidepost.29The report stipulates the limited use of this as a metric because of the number of unknowns. It instead elects to use it as a 'guidepost'. My point that not all healthcare spending has the purpose of extending life remains a valid criticism of this metric (health care spending versus GDP as it relates to Longevity). Bill Quote
InfiniteNow Posted August 6, 2009 Report Posted August 6, 2009 I am going to make an attempt to communicate on this issue with you, but you really need to make an effort to read and comprehend what I am writing. <...> The report stipulates the limited use of this as a metric because of the number of unknowns. It instead elects to use it as a 'guidepost'. I suggest that you read the report more closely, and try to comprehend what it states. They suggest that "one can use the difference in health care’s share of GDP between the United States and similar countries to gauge the magnitude of inefficiency," that it's possible to use this as a "crude indicator." And yet, that is not the indicator used by the report, or its references. It was just a statement... "if you want to use a crude indicator, try this." That was taken from this reference:28. OECD (2008) And the comment regarding "guidepost" shows this:29. A recent report by McKinsey Global Institute (2008) concluded that the United States spends $630 billion more than expected on health care after adjusting for differences in wealth. This is over 4 percent of GDP in 2008. You are wrong precisely because you are implying that the entire report rested on one crude indicator alone... that this statement somehow suggests all they are doing is using "guideposts" and GDP based comparisons. In fact, it does not. Care to try again? Quote
Southtown Posted August 8, 2009 Report Posted August 8, 2009 As I laid out (and thoroughly referenced) previously, the explanation is plainly a collective failure of citizens in our nation to understand that the free market can't work with healthcare coverage.I've been under the impression lately that the insurance companies by nature act as a shock absorber between the supply and demand of the free market, therefore, the healthcare industry is not really afforded any opportunity to swim without floaties. Quote
InfiniteNow Posted August 8, 2009 Report Posted August 8, 2009 I've been under the impression lately that the insurance companies by nature act as a shock absorber between the supply and demand of the free market, therefore, the healthcare industry is not really afforded any opportunity to swim without floaties. An interesting suggestion, and true to an extent, but it doesn't really negate my point. The point, at its heart, is really that insurance companies are a business seeking to maximize profit by minimizing payouts. Also, even if we took insurance companies out of the equation and had a purely free market... such as during times of less (or zero) regulation... we must note that life for people living under that free market tends to be worse according to every relevant metric. This is especially so when discussing healthcare. Far too often people in these discussions don't seem to realize that we the people in our free society are ultimately intolerant of non-regulation... we as a people REFUSE to tolerate avoidable pain and suffering and needless death. Just think about it for a moment. In a free market, people who cannot afford quality care or coverage die in the streets, as do their families and their orphaned children. The possibility of a free market in this country never existed... definitely not for healthcare anyway, and this is true regardless of the participation of insurance companies in the healthcare arena. Further (and perhaps more importantly) regulations are never created for their own sake in a free market. Instead, regulations are created in direct response to the failures or shortcomings of the free market. Finally, this actually goes much deeper than insurance companies being a buffer of supply and demand. The standard concepts of supply and demand don't really apply in healthcare. For example, when you're having a heart attack, you don't take time to research which hospital will give you the best deal and which doctor is the most skilled for the price you can afford... or which ambulance service has the best success record. That's not how it works with our healthcare... it's not like buying a TV or a new car or some other tangible good... so the suggestion of a free market seems to fail on that front, as well. Here's what healthcare reform is all about: Health reform made simple - Paul Krugman Blog - NYTimes.comThe essence is really quite simple: regulation of insurers, so that they can’t cherry-pick only the healthy, and subsidies, so that all Americans can afford insurance. Everything else is about making that core work. Individual mandates are a way to prevent gaming of the system by people who don’t sign up until they’re sick; employer mandates a way to hold down the on-budget costs by preventing a rush by employers to drop insurance; the public option a way to create effective competition and hold costs down further. But what it means for the individual will be that insurers can’t reject you, and if your income is relatively low, the government will help pay your premiums. That’s it. Any commentator who whines that he just doesn’t understand it is basically saying that he doesn’t want to understand it. Quote
Southtown Posted August 8, 2009 Report Posted August 8, 2009 Originally Posted by Paul Krugman The essence is really quite simple: regulation of insurers, so that they can’t cherry-pick only the healthy, and subsidies, so that all Americans can afford insurance. Everything else is about making that core work. Individual mandates are a way to prevent gaming of the system by people who don’t sign up until they’re sick; employer mandates a way to hold down the on-budget costs by preventing a rush by employers to drop insurance; the public option a way to create effective competition and hold costs down further.But what it means for the individual will be that insurers can’t reject you, and if your income is relatively low, the government will help pay your premiums. That’s it. Any commentator who whines that he just doesn’t understand it is basically saying that he doesn’t want to understand it.Sounds great. I agree, the fire of capitalism must be mitigated by the cool river of legislation. Why even vote for our leaders if they just side with our unethical oppressors/lobbyists. My family has no insurance, not because we're gaming the insurance companies, but because I lost my job, and I owe 19 k to credit cards, plus the car. And what's the use? Me and mine have all been to the doctor with pneumonia and ring worms recently, sometimes repeatedly, and been turned away empty-handed, my son additionally with a 103-ish fever given tylenol, each time costing a C-note or more. I know **** happens, but goddamnit, I'm fed up with paying through the nose in the hopes of getting permission for some stupid antibiotics that I already knew I needed but didn't have access to because of our glorious medical system. I would like to see the strong arm come down on the insurance companies rather than on the tax payers. More over, when the insurance companies pick-and-choose what they're going to cover, doctor's choice of treatment, or even diagnosis, is effectively railroaded. Congress and the FDA are supposed to be representing the people, not the corporations. Burning at both ends,ST Quote
Turtle Posted August 8, 2009 Report Posted August 8, 2009 Sounds great. I agree, the fire of capitalism must be mitigated by the cool river of legislation. Why even vote for our leaders if they just side with our unethical oppressors/lobbyists....Burning at both ends,ST Oregon just passed their own new insurance that might help you & yours. i recommend applying immediately if not sooner. :hyper: Health care reform bills clear Oregon Legislature - OregonLive.comSALEM -- The Legislature on Thursday put an end to the need for uninsured Oregon children to depend on safety net clinics or emergency rooms for health care. A health reform bill that cleared the Legislature will provide health coverage for 80,000 uninsured children and an additional 35,000 uninsured low-income adults and put the state on a path toward covering all of its more than 600,000 uninsured residents. ... Quote
Jway Posted August 8, 2009 Report Posted August 8, 2009 Ahhh, the first (actual) thread I posted on when I first came to this site. And as I noted in post 125, if this thread ever gains some steam again, I'll perhaps read the other posts. Well, as of this moment, I have now read every post on this thread. Maybe not every single word, but I'd say around 92% with a +/- of .8%. I don't know if I have much to add since my earlier post because as I reviewed it today, it says much of what I am still feeling. Though I do believe I can add some new nuggets. I know that just about every time HydrogenBond (OP) has weighed in on this thread, I agree with what this poster is saying. I felt like making the point that strictly speaking private health insurance isn't socialistic because a) I can opt out at any time (thus not mandated) and :hyper: it is not a governmental body that is at the helm controlling the "system." And yet, to this moment, I still think that it (private insurance) feels socialistic. It seems like the industry has set up a 'governing body' that has developed such obvious influence on the provider side of business, so much so they they are in virtual control of the system by mandating management, and costs. And I felt HyrogenBond was making very similar point in post #102 (as well as OP). I agree with BigDog (in recent days) saying that doctors / providers over treat / over prescribe in effort to prevent lawsuits. This drives up costs. But as I reviewed this thread, I found bucketful of items that "drive up costs." For sure consumers increase costs by either a) taking advantage of the system in fraudulent ways or taking from the system in 'frivolous' ways. Thus to lay all blame at doorstep of private insurance is unfair, IMO. Since my last post, I tend to lay more blame at health providers feet. Like BigDog was conveying (I think), it is the over zealous use of 'diagnostics' that seems to both drive up costs and confuse the sensibilities of 'average' patient (consumer). Cause everyone then thinks they need these tests in order to "stay healthy." I recall years back when I went to get test on STD. I can't remember if I was insured or not, and since I ended up paying out of pocket, the point is moot. The reason I bring this up, is cause there was like 4 lab tests the doctor ordered that day. And after 2 of them, I was shuffled to other part of clinic for blood work. Well, I wanted to take care of payment in the meantime. But I'm not kidding when I say they wouldn't let me pay for it. Perhaps if I raised hell, they would've. But I was standing before them with debit card in hand telling them I'd like to pay. And they told me twice, "oh no, we just bill you for that." And because it was busy, I didn't argue the point. But had I known the (hidden) costs, I wouldn't have gotten the 2nd test that I was later billed for (and paid). I still think getting the test was wise decision on my end (turns out I was disease free), but the cost, was astronomical given what was actually done, and given that it truly felt hidden from me. Which is why I also agree with BigDog (in recent days) who said that "hiding costs, breeds overuse of the system." I do for sure lay blame at my own feet. Again, like BigDog recently said, I thought of healthcare as "free" when in 1990's I had (near) 100% coverage from large employer. So, in essence, I became somewhere between naive and spoiled at costs to the system, and yet I was individual insured and would assure anyone that cares that I didn't take advantage of the system. I went when I felt sick or thought it prudent to have preventative treatment done or consulted about. I can't shake idea though that doctors have big role in all this. I have personal experience where I was diagnosed with wrong item by primary and suffered for a good 2 weeks because of this, while specialist later determined, I would say rather easily, what was actually occurring with me, and provided suitable treatment. Not healing. Treatment. And then I have close relative who had misdiagnosis on more serious health issue, that fortunately didn't turn into tragedy, even while it too caused undue suffering. Neither doctor faced a lawsuit. And in both cases, I believe the individual patient placed 'reasonable' trust in the provider. For me, this is where 'science' somewhat fails. Not the strict science that we all here love. But something very similar to that. Something that has doctors convinced that their educated opinion carries far more weight than sensibilities of average consumer / patient. Cause I remember telling my doctor a couple days later, "I don't think it is what you say it is." And his response was akin to, "hmmm, maybe the dosage I gave you needs to be raised. Let's have you call me back and go this route in no more than 48 hours from now." Okay doc. Golly gee, that sounds like a swell idea! I truly do not believe I know more about medicine than medical providers. I feel high appreciation for what they do, and what seems like a fairly stressful job. And yet, I get this feeling just about every other time in last 10 visits that they aren't so much interested in healing me as they are in treating me via 'routines' they are accustomed to and/or via practice that amounts to - they better cover their legal ***. That sense of "care" that I swear existed 20+ years ago in the industry, seems to have all but vanished in my experiences with health providers. Okay, so I'm possibly a bit off topic, but IMO, this post is presenting actual reality of what occurs in the system, with an INSURED individual. And my point on doctors in last few paragraphs, is they are very much answering to insurance industry that DOES manage / control health care in this nation. If it did not, Obama and dems would've passed legislation a few weeks ago. But because they do, I can see it plausible that legislation is a) delayed for long time to come :doh: is watered down heavily or c) is met with rejection in which case I'm yet to hear what the alternative is. The current system is breaking, if not yet broke. I have insurance and I'm now at point where I will virtually refuse to tell providers that I have it, and will essentially say, you don't get paid unless I know costs up front. They treat you vastly different if you have insurance card, by assuming payment is guaranteed. To me, it shows up a lot like a "pay to play" scheme. Except, not everyone is playing fairly, nor honestly IMO. Again, I've had recent experience (2009) where I either waited in room to be treated for like 30 minutes (not unusual, everyone reading this I'm sure has had that happen), or when the doctor was in room with me, we had chit chat session (for good 20 minutes) prior to consultation (that was maybe 10 minutes). And it turns out that I got billed for "their" time. In neither case was I actually treated for what I went to see them about, but was billed at what would honestly be a rate of around $1600 an hour, for "their" time. Instead I got to pay less for "their" time, which included frivolous items. Cause in all honesty, it was OUR time. For me, the most dishonest aspect of all this is the whole thing with pre-existing conditions. I don't expect everyone to agree with this, and do believe I understand the issue, from more than one side, fairly well. To not cover pre-existing conditions of paying consumers, strikes me as epitome of system that is broke. And is why Obama's plan suddenly makes very good sense to me. That he has this as #1 on his list of "consumer protections" works for me. I don't think I've seen that list brought up here, and do think it a valid contribution to this thread. It is what is being offered up as solution to a system that is breaking (or broke): No Discrimination for Pre-Existing ConditionsInsurance companies will be prohibited from refusing you coverage because of your medical history.No Exorbitant Out-of-Pocket Expenses, Deductibles or Co-PaysInsurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.No Cost-Sharing for Preventive CareInsurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.No Dropping of Coverage for Seriously IllInsurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.No Gender DiscriminationInsurance companies will be prohibited from charging you more because of your gender.No Annual or Lifetime Caps on CoverageInsurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.Extended Coverage for Young AdultsChildren would continue to be eligible for family coverage through the age of 26.Guaranteed Insurance RenewalInsurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won't be allowed to refuse renewal because someone became sick. Source: Health Insurance Consumer Protections Quote
Southtown Posted August 8, 2009 Report Posted August 8, 2009 Well, as of this moment, I have now read every post on this thread. Maybe not every single word, but I'd say around 92% with a +/- of .8%.lol Oregon just passed their own new insurance that might help you & yours. i recommend applying immediately if not sooner. :hyper: Health care reform bills clear Oregon Legislature - OregonLive.comThanks for the info, Turtle. I guess I should read the paper once in a while, ay? Quote
Pyrotex Posted August 17, 2009 Report Posted August 17, 2009 Well, I thought I had nothing to contribute to this (important) thread -- until now. Here is an interview with an ex- insurance executive whose job was to generate the arguments against expanded health care, and put these arguments in the hands of Republicans, conservatives, radio talk show hosts, and Congressmen. Wendell Potter has served since May 2009 as senior fellow on health care at the Center for Media and Democracy, a nonprofit organization that says it seeks to expose "corporate spin and government propaganda." After a 20-year career as a corporate public relations executive, Potter left his job last year as head of communications for one of the nation's largest health insurers, CIGNA Corporation. Ex-insurance company spokesman Wendell Potter says the industry seeks to drive the health care debate, and they are not above using various forms of mis-information in order to deceive the electorate into being 'tools' of their corporate agenda. He says he is now blowing the whistle on his industry because he doesn't want to (again) be an agent for preventing reform. I am not surprised to see that this is going on. Quote
Turtle Posted August 17, 2009 Report Posted August 17, 2009 ...I don't think I've seen that list brought up here, and do think it a valid contribution to this thread. It is what is being offered up as solution to a system that is breaking (or broke): No Discrimination for Pre-Existing ConditionsInsurance companies will be prohibited from refusing you coverage because of your medical history.No Exorbitant Out-of-Pocket Expenses, Deductibles or Co-PaysInsurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.No Cost-Sharing for Preventive CareInsurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.No Dropping of Coverage for Seriously IllInsurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.No Gender DiscriminationInsurance companies will be prohibited from charging you more because of your gender.No Annual or Lifetime Caps on CoverageInsurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.Extended Coverage for Young AdultsChildren would continue to be eligible for family coverage through the age of 26.Guaranteed Insurance RenewalInsurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won't be allowed to refuse renewal because someone became sick. Source: Health Insurance Consumer Protections i haven't seen that list put up either. good call. i think it is a good list, both accurate and reasonable to seriously consider legislating. the single-payer idea looks like it won't make it into a/the bill the US legislatures are working up, & now they are talking about possible co-ops instead. i watched a lot of news this weekend on the subject and one interesting note is how up in arms the brits are now over having our conservatives impune their system. :rant: :doh: that's a democaratic monarchy for ya! :lol: this program is noteable for good journalism: >> NOW on PBS Gambling With Health Care . NOW on PBS How to Fight Health Care Fearmongers and Demagogues . NOW on PBS Quote
Jway Posted September 26, 2009 Report Posted September 26, 2009 Back at it again. The thing that prompted me to come to this site 3.5 months ago, as cited in post #125 of this thread, has finally moved to place of resolution. I had coverage claims denied, due to medical rider (pre-existing condition = pec) that eventually got paid off by insurance company, for the most part (had some out of pocket costs). I'm still convinced current system is socialistic. Not 100% in vein of socialism, but IMO, it is more socialistic than free-market at work. The amount of bureaucracy I had to go through, as paid member of private insurance, made me really (really) believe that the government version cannot be worse. It could be equal, but if it means coverage for all, I truly see it as better. I came close to not renewing insurance, but given that things turned out okay to well, I went for it. For me, it is just covering myself against catastrophic case, and really not much more. I truly wish it was, even just a little bit, more. While discussing renewal with agent that works in call center of my insurance company, there was a very interesting revelation that I thought I would share here. IMO, it validates just how bureaucratic things have become in the industry. For me, it justifies why I may show up at doctor's office for scheduled appointment, and claim to them, I do not have insurance, when in fact I do. In my experience (twice in 2009), I had appointments with medical providers that ended up triggering my pec. If someone is curious on details, I can elaborate. But suffice it to say, one of my 2 appts, ought not to have triggered pec based on layperson understanding of healthcare. Essentially, I went in for physical / check-up, and the whole claim was denied because pec was triggered. The other appt. is one where I can see why pec was triggered. But at end of that one, insurance ended up paying for whole thing, minus co-pay. So, I asked the agent recently, how can I handle situation where I'm in office of medical provider, and they ask for my health issues, and I mention anything remotely related to my pec, doing the thing called being honest with my doctor? There was a little bit of discussion on this with the agent (very respectful dialogue on both ends), and he essentially said, there is no way around this. That it wouldn't be prudent to lie to a doctor about my health history, and that if I do mention it, it is likely that it will trigger pec based on what doctor must note in his/her records. And so, I'm at a point where I don't feel I can go to a doctor for ANYTHING without it triggering my pec, and thus my claims being denied (initially). IMO, this is a bizarre predicament to be in. And given this as reality, I would much prefer to go to post office or DMV than to a doctor's office. IMO, it's a no brainer. And there are 2 things about my recent experience, that have me even more thinking the system is set up in socialistic way. Perhaps this is the same point, but one is that I find that the system (provider's front desk / billing dept. + insurance company) treats you much different if you have insurance card. Without it, it is like you are stripped of power. With it, there is assumption (by provider initially) that all costs will be covered. Like if there was governmental plan, and I walk in with my (hypothetical) health I.D. card, I'm guessing there would be assumption that regardless of the reason I'm there, my costs will be covered. No need for me to really get into the details of how much things are costing me or the provider, because it's all taken care of. I really believe (like without a doubt) that this is how providers treat individuals who present them with an insurance card. The 2nd thing is that I find it next to impossible to either find out about costs on the front end and/or attempt payment on the front end, unless they see me as uninsured. And in my opinion (to me this is fact) the rates are adjusted if you have insurance, compared to if you don't. Thus, I don't think they can actually come up with costs for an appointment, if you have insurance, cause I don't think on front end they know. Thus, no free market at work. I don't think this is automatically socialistic, but in age of sound bites, if it ain't free market, it must be socialism (right?). If anyone reading this has ways around the issues I'm bringing up, please respond either here on thread or in PM. As things stand now, because of the bureaucracy of the system, I cannot see why I would go to doctor for ANYTHING routine or what ails me in non-emergency way, and present to them my insurance card, thinking that I will be covered. So, I refrain. Which I've gotta to believe is exactly where insurance company would love for me to be. If I do go, I am very tempted to be ultra assertive in finding out costs before any work is done. I would agree with anyone that says, "well that's just common sense" to find out costs, but IMO, we don't live in that world. Instead, we live with healthcare system that is more socialistic than free market, and where costs are not even a little bit advertised up front, thus making competition something I find to be void in the system. Turtle 1 Quote
Turtle Posted September 26, 2009 Report Posted September 26, 2009 Back at it again. The thing that prompted me to come to this site 3.5 months ago, as cited in post #125 of this thread, has finally moved to place of resolution. I had coverage claims denied, due to medical rider (pre-existing condition = pec) that eventually got paid off by insurance company, for the most part (had some out of pocket costs). I'm still convinced current system is socialistic. Not 100% in vein of socialism, but IMO, it is more socialistic than free-market at work. The amount of bureaucracy I had to go through, as paid member of private insurance, made me really (really) believe that the government version cannot be worse. It could be equal, but if it means coverage for all, I truly see it as better. i think the whole thing with "socialism/socialized" hot term is that it is automatically associated with communism and there comes that train of baggage. i'll catch the next pullman, thanks. :hihi: So, I asked the agent recently, how can I handle situation where I'm in office of medical provider, and they ask for my health issues, and I mention anything remotely related to my pec, doing the thing called being honest with my doctor? There was a little bit of discussion on this with the agent (very respectful dialogue on both ends), and he essentially said, there is no way around this. That it wouldn't be prudent to lie to a doctor about my health history, and that if I do mention it, it is likely that it will trigger pec based on what doctor must note in his/her records. And so, I'm at a point where I don't feel I can go to a doctor for ANYTHING without it triggering my pec, and thus my claims being denied (initially). IMO, this is a bizarre predicament to be in. And given this as reality, I would much prefer to go to post office or DMV than to a doctor's office. IMO, it's a no brainer. ...If anyone reading this has ways around the issues I'm bringing up, please respond either here on thread or in PM. As things stand now, because of the bureaucracy of the system, I cannot see why I would go to doctor for ANYTHING routine or what ails me in non-emergency way, and present to them my insurance card, thinking that I will be covered. ... there is an efort, or are efforts, afoot to electronically store medical records. i'm thinking i should think more on what consequences that may engender. if you had an electronic record, you might eliminate office/doctor screwups, the time wasted filling the same info in form after form as you travel from provider to provider, lack of personal access to your record and ability to annotate it, and some other stuff i aint thunk up yet. on the other hand, there would be no hiding pec's. anyway, piqued my interest and here's an article as appetizer. . . . . ;) :phones: Getting to the electronic medical record -- Flegel 178 (5): 531 -- Canadian Medical Association JournalBy custom, the medical record has been stored as a paper file in the physician's office. The keeper of the record has been the physician — a banality in which lie 2 deeper concepts: one of ownership and one of access. Lately, it has come to be understood that the physician and the patient own the information in the record jointly and that each is entitled to control the access by third parties, though normally for different reasons. But now, driven by need and abetted by technology, much about the medical record is changing, raising new questions about how ownership and access are affected....There is a clinical need — one might say imperative — to proceed. Patient safety is the principal reason. For example, an electronic record could inform a physician not to prescribe a drug that is contraindicated by the patient's history. Emergency visits are another standout circumstance where access to the complete record will avoid harm, to say nothing of time and money. The question, then, is who shall keep the records and who shall own them? Although the keeper is likely to change to encompass a virtual network of health care providers, ownership should remain with the patient.1 But ownership here means the ability to grant privilege to others to contribute to or gain access to the information. It does not mean the patient can change the record (although there could be a place for him or her to add comments). ... Quote
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