quote:

Originally posted by Blutarski2004:

..... I'm sorry, Urufu, but how do people who live outside the US and have no practical experience of the US healthcare system know enough to make a measured judgement about how US healthcare stacks up against their levels of care???

From some statistics I've seen (like cancer cures and infant mortality) there in fact >>appears<< to be a difference in favor of the US, but I'm careful about arguing the point because the data I have been able to come by are rather incomplete.

My mistake, I thought you meant an equality of care between those with private and those who use public care in these countries, not quality between their countries and US care.

This from the Associated Press:

"House Democrats, meanwhile, were working overtime to put the finishing touches on their 10-year, $1.2 trillion bill, which they released last week."

and

"Across the Capitol, senators are waiting to see the final language and price tag on a health bill that Majority Leader Harry Reid and a few other top officials wrote in secret. It's not clear when those details will be available and Reid, D-Nev., may not be able to begin debate on the issue until the week before Thanksgiving."

hi blutarski,

there are 'rankings' been done by the WHO, as well as detailed listing of 'Core Health Data' for (nearly) every country in the world.
the data have been critisised for being largely outdated (between 1997 and 2002), but the latest report has been published lately (haven't read it so far).
the old data are available at http://www.who.int/whr/2000/en/whr00_annex_en.pdf
the whole report can be read at
http://www.who.int/whr/2000/en/whr00_en.pdf

i think, that it is perhaps more interesting for you to have a look at the complex report on Health Data from 2006 - collected by OECD (2009), which includes besides health status also the data for health care ressources, like number of beds, physicians/nurses per capita, pharmaceutical research, average stay in hospital and such (huge excel-file):
http://www.irdes.fr/EcoSante/D...tlyRequestedData.xls


just as a selection of the overall data (all by OECD, 2006):

- provided acute beds per 1,000
US 2.7, OECD 3.8, Ger 6.4

- provided beds in general per 1,000
US 3.1, UK 3.4 Ger 8.2

- actual length of stay, acute care
US 5.5, UK 7.2, Ger 7.8

- physicians per 1,000
US 2.4, OECD 3.1

- nurses per 1,000
US 10.6, OECD 9.6
(this is probably reasoned in the fact, that nurses can achieve higher training, and take over some of physicians tasks in the US)

- medical graduates per 1,000 practising physicians
US 26.0, UK 37.7, Ger 30.6

- doctor consultations per capita
US 3.8, UK 5.1. Ger 7.5


and some ranking (by admittedly questionable mix of hard and weak data, all by WHO, 2002):

- overall quality of of healthcare
1. France
10. Japan
18. UK
20. Suisse
25. Germany
37. USA

- treatment of patients
1. USA
2. Suisse
5. Germany

- healthy life expectancy at birth
1. Japan 75.0
4. Suisse 73.2
14. Germany 71.8
24. UK 70.6
25. USA 69.3
(here it is noted, that the USA has also the widest spread of life-expectancy, sorted by social status)

there are some other notes on waiting time - overall shorter in the USA than OECD, but more or less same regarding acute cases for both - and free choice of treatment/physician - best in systems with compulsory insurance (fe Germany) and least in public healthcare (fe UK), with USA reaching to both (depending on HMO, PPO or others). i couldn't find the relating chapter in the reports anymore though.


without the detailed data, i find the rankings not to be taken as gospel.
the OECD-report has more value to me, but still leaves some points open, mostly due to the rather complicated differences in the american insurances.
however, i think it can be said, that the quality of healthcare in the european states with universal healthcare is not worse than the quality delivered in the USA.


there are also reports of private foundations, which paint a darker image.
by it's 2007 comparison of six nations (Australia, UK, Germany, Canada, New Zealand, USA) the Commonwealth Fund ranked the performance of the US-healthcare last, only excelling in provision of 'preemptive care', but on the low end in 'chronic care', 'coordinated care' and 'patient-centered care'.

This message has been edited. Last edited by: deepo_HP,

quote:

Originally posted by erco415:
Urufu, from what I've gathered from talking with various people who live in Canada, Scotland, and England is that the system is good for urgent care, routine care, but maybe not so good at fixing significant chronic problems and embracing cutting edge therapies.

hi erco,

actually, it is quite opposite in most parts.
especailly regading treatment of chronicle deseases, the US-performance is far behind.
to get a picture, which is not based on hearsay, you might have a look at the data, which i related to in my before reply to blutarski.

quote:

Originally posted by Blutarski2004:
From some statistics I've seen (like cancer cures and infant mortality) there in fact >>appears<< to be a difference in favor of the US

hi blutarski,

actually, this is not the case.

the infant mortality rate in USA is pretty much above every nation in Europe (deaths per 1,000 live births):
USA 6.7, UK 5.0, Ger 3.8, rest of EU between 1.4-5.0

discharges, neoplasms (per 100,000 population, 2006):
USA 549, UK 981, Ger 2,360, other EU between 600-2,200

(data taken from the OECD-report, as linked before)

You can't compare raw data of infant mortality and chronic disease care from one country to another as the best health care in the world is of no use if the people do not take advantage of it. Similarly, no matter how good the technology and health care available, an alcoholic crack addicted pregnant mother is not going to produce a healthy baby. Along those same lines, an alcoholic, diabetic, chronically unemployed, big fat tub of goo who refuses to go to the doctor b/c it interrupts his/her drinking and lying around doing nothing will NOT have a long life expectancy.

Adjust for lifestyle differences between countries adequately and then compare the rates.

--Outlaw.

quote:

Originally posted by Outlaw---:
Along those same lines, an alcoholic, diabetic, chronically unemployed, big fat tub of goo who refuses to go to the doctor b/c it interrupts his/her drinking and lying around doing nothing will NOT have a long life expectancy.
Adjust for lifestyle differences between countries adequately and then compare the rates.

--Outlaw.

perhaps you want to read more about the term 'healthy life expectancy'.
it is used as a statistical measurement of the number of years, which an individual can expect to live in 'full health' (not included the years of disease and injury). it is one of the factors in measuring 'human development', others are literacy, education and standard of living.

'infant mortality' correlates strong with state failure. it is commonly used as an indicator of a country's level of health and a component of indexing physical quality of life.

there is no need for adjustment for life-style...

quote:

Originally posted by Outlaw---:
You can't compare raw data of infant mortality and chronic disease care from one country to another as the best health care in the world is of no use if the people do not take advantage of it.

that is, why the 'number of consultations' is mentioned above. other indicators are 'length of stay' in hospital and 'discharge' (here for cancer, other discharges are available in the documents cited from).

for very sure one can compare the above data.
i don't know, what 'lifestyle' has to do with it. if noone makes use of healthcare, it can hardly be the best... pretty much a basic point in the discussion.

quote:

hi erco,

actually, it is quite opposite in most parts.
especailly regading treatment of chronicle deseases, the US-performance is far behind.
to get a picture, which is not based on hearsay, you might have a look at the data, which i related to in my before reply to blutarski.

Thanks for the data, Deepo. When I was referring to chronic problems, I was meaning things that won't get better on their own, but won't kill you either. Like my friend's sister, who lives in Scotland and had to come to the States for a knee surgery that was put off for over a year. Or the Canadians who cross the border into Montana, such as this reported in the LA Times:



"When the pain in Christina Woodkey's legs became so severe that she could no long hike or cross-country ski, she went to her local health clinic. The Calgary, Canada, resident was told she'd need to see a hip specialist. Because the problem was not life-threatening, however, she'd have to wait about a year.

So wait she did.

In January, the hip doctor told her that a narrowing of the spine was compressing her nerves and causing the pain. She needed a back specialist. The appointment was set for Sept. 30. "When I was given that date, I asked when could I expect to have surgery," said Woodkey, 72. "They said it would be a year and a half after I had seen this doctor."

So this month, she drove across the border into Montana and got the $50,000 surgery done in two days.

"I don't have insurance. We're not allowed to have private health insurance in Canada," Woodkey said. "It's not going to be easy to come up with the money. But I'm happy to say the pain is almost all gone."



Or this from the NY Times, which chronicles the rise of private medicine in Canada, sometimes in violation of the law. And the recent article in the London Times detailing the plan to allow patients to use private health care when their waits on the NHS get too long suggests to me that not all is quick and prompt- all the time. (And we won't even get into the age 70 cutoff for certain cancer treatments, or this bit in the WSJ:



"Hmm, so the British medical system has waiting lists. It also has death panels, another Times story suggests:

A father whose son was born with a rare neuromuscular condition will go to the High Court today to try to stop a hospital withdrawing support that keeps the child alive.
Doctors treating the one-year-old boy say that his quality of life is so poor that it would not be in his best interests to keep him alive. They say that they are supported in their action by the baby's mother. The couple are separated.
The child, known for legal reasons as Baby RB, was born with congenital myasthenic syndrome, a muscle condition that severely limits movement and the ability to breathe independently. He has been in hospital since birth.
If the hospital doctors succeed in their application it will be the first time that a British court has gone against the wishes of a parent and ruled that life support can be discontinued or withdrawn from a child who does not have brain damage."



Despite this, and knowing full well that finding similar stories about the US system failing it's customers is also a simple Google away, I still have no doubt that the system is quite good for a number of users.

erco415 writes:

quote:

"Hmm, so the British medical system has waiting lists. It also has death panels, another Times story suggests:

A father whose son was born with a rare neuromuscular condition will go to the High Court today to try to stop a hospital withdrawing support that keeps the child alive.
Doctors treating the one-year-old boy say that his quality of life is so poor that it would not be in his best interests to keep him alive. They say that they are supported in their action by the baby's mother. The couple are separated.
The child, known for legal reasons as Baby RB, was born with congenital myasthenic syndrome, a muscle condition that severely limits movement and the ability to breathe independently. He has been in hospital since birth.
If the hospital doctors succeed in their application it will be the first time that a British court has gone against the wishes of a parent and ruled that life support can be discontinued or withdrawn from a child who does not have brain damage."

Read the original times story here: Baby RB at risk of more painful death if cared for at home, says infant's doctor

Now decide for yourself what is in baby RB's interests, and if anything remotely resembling a 'death panel' has been involved in the decision process? You could also ask yourself how long RB would have survived if his parents were living in the US, and without adequate health insurance.

Decisions like this are never easy, but having a system that tries to decide on the basis of the child's interests, rather than the wealth of the parents, must surely be a good thing.

Alternately, don't bother, carry on spouting this ignorant garbage about NHS 'death panels' you heard about on Fox. After all, they can't possibly be biased, can they?

Thanks for the link, Andy. But, if I understand correctly, when people refer to 'death panels' in this country, it refers to some third party, doctors, whomever, making a life or death decision instead of the patient him/herself or their legal guardian. In this case, the doctors going to court to gain the authority to let the child die over the wishes of one of it's guardians would fit that definition. There was a similar case in the US not long ago where the parents of a semi-comatose woman were in court over the issue of letting her die or continuing treatment. Doctors appeared in court to give testimony, but, significantly, did not initiate the court action. That is a crucial difference.

I think it is up to the parents to decide what to do. If they must go to court, that should be up to them. There was an outstanding article in the Dallas paper about a couple who chose to deliver a child they knew couldn't last a week, rather than abort. Some people, doctors included, thought this was the wrong choice. Reading the article, I couldn't imagine a wiser choice. I'll try and find a link for you.

EDIT: Here it is, Part 1 and Part 2

The point being, it must be the parent's decision.

quote:

Originally posted by erco415:
Thanks for the link, Andy. But, if I understand correctly, when people refer to 'death panels' in this country, it refers to some third party, doctors, whomever, making a life or death decision instead of the patient him/herself or their legal guardian.

Erm, no, actually it was a silly misinterpretation of rules about providing end-of-life counseling. I.e. like if you know your father is near death, your health plan would cover you talking to your doctor about what your options are. It's already in pretty much any private plan, but people decided to put it into the public plan in the bills being discussed and suddenly conservatives started lying about how it would mean that a Stalinist panel of bureaucrats would sentence old people to death.



From Wikipedia (if you don't trust what I'm saying):

Palin's death panel remarks were based on the ideas of Betsy McCaughey.[137] During 2009, former Alaska Governor Sarah Palin wrote against alleged rationing, referring to what by her interpretation was a "downright evil" "death panel" in current reform legislation known as H.R. 3200 Section 1233. However, Palin supported similar end of life discussion and advance directives for patients in 2008.[138] Defenders of the plan indicated that the proposed legislation H.R. 3200 would allow Medicare for the first time to cover patient-doctor consultations about end-of-life planning, including discussions about drawing up a living will or planning hospice treatment. Patients could seek out such advice on their own, but would not be required to. The provision would limit Medicare coverage to one consultation every five years.[139] Rep. Earl Blumenauer, D-Ore., who sponsored the H.R. 3200 end of life counseling provision, said the measure would block funds for counseling that presents suicide or assisted suicide as an option, and called references to death panels or euthanasia "mind-numbing".[140] Republican Senator Johnny Isakson, who co-sponsored a 2007 end-of-life counseling provision, called the euthanasia claim "nuts".[141] Analysts who examined the end-of-life provision Palin cited agree that Palin's claim is incorrect.[142][143][144][145][146] According to TIME and ABC, Palin and Betsy McCaughey made false euthanasia claims.[147][148] The federal requirement that hospitals help patients with things like living wills began when Republican George H. W. Bush was President. Section 1233 merely allows doctors to be paid for their time.[149] However, an NBC poll indicates that as of August, 2009, 45% of Americans believed in the death panel story.[150]

I seem to remember a hub bub regarding Arlon Specter and end of life counciling where some thought he was advocating a 'death squad' type scenario.

He was discussing the patients right to chose extreme measures that would only minimally increase (if at all) the patient's life - or to allow them the right to choose to die peacibly.



"Tucked inside a sweeping House bill to overhaul the health system is a provision that would require Medicare to pay physicians to counsel patients once every five years. During those sessions, doctors could discuss how patients can plan for such end-of-life decisions as setting up a living will, obtaining hospice care or establishing a proxy to make their health decisions when they are unable to do so.

The end-of-life counseling provision in the House bill is expected to cost a few billion dollars over the next decade. But health policy experts say it could lower medical spending by reducing end-of-life medical care that patients don't want.

Opponents say the provision shows that architects of the health-care overhaul want to ration seniors' care. Democratic lawmakers say no part of the House bill calls for rationing care. Physician counseling would be voluntary."


http://online.wsj.com/article/...012322203627701.html

You Americans all know about our t.v. sets being so dangerous we have to buy licences for them, right?.

Or shall we roll out the one about Stephen Hawking (that's the guy with the gadget chair and the 'speak & spell' voice in the Simpsons) being lucky not to be born in the U.K. as the NHS would have strangled him at birth?

Thanks for the info, Sword. I was aware of how the thing started. A shame, too, that a useful provision that had bipartisan support was a casualty of people's fears. It remains, however, that what people are afraid of is having some of the most important decisions that can be made taken out of their hands and placed into an uncaring strangers'. This is what people are afraid of and what they generally mean when they refer to 'death panels'. The assurance that health care would not be rationed is somewhat false, as rationing already occurs, after a fashion, in our public/private system through the mechanism of what is covered and what is not. I probably should have left the whole 'death panel' phrase out when I quoted the article, as it seems to have struck such a nerve that people are missing the point (and the rest of the post). I didn't, though, primarily to show that that particular phrasology had moved beyond Fox news and into more general useage. For the record, the WSJ was against the dropping of the end if life provision.

http://abcnews.go.com/Health/s...517492&page=1&page=1

quote:

Originally posted by Cajun76:
http://abcnews.go.com/Health/s...517492&page=1&page=1

Strange, the comments say the situation is the opposite: It wouldn't have been a private insurance company denying the drugs but the state's own universal health care. But that's just in the comments.