A Forum for Grinches and Ho-Ho-Hoes

[Greedy,Greedy,Greedy]

Originally posted by Replaced_Texan
Anecdotally, which means absolutely nothing, most of the Canadians and Brits that I know love their respective healthcare systems. Friends and family whose insurance ran out here in the US weren't so enamoured.

I spend a fair bit of time in Canada and working with Canadians. Anecdotally as well, most businesses in Canada love the system - they know their people will get healthcare, and they have a competitive advantage compared to US companies that have to pay for healthcare.


BTW, are you people actually attempting to have a rational debate with Hank? WTF - doesn't anyone pay attention here?

[Hank Chinaski]

Originally posted by Greedy,Greedy,Greedy
they have a competitive advantage compared to US companies that have to pay for healthcare.

We went as a firm to the Grand Hotel, Mackinaw Island, you know, Somewhere in Time. It costs a lot of $$, and we're a smaller firm so it was directly less money for shareholders.

One shareholder's wife was at table with several of us. It was her first time at the Grand Hotel, and she was gushing about how plush it was, then she said "And it's all free!"

Did you go to school with her?

[Hank Chinaski]

Originally posted by Replaced_Texan
There are 24.6 million veterans in the US.

You're not claiming that many people rely primarially on VA are you? I don't know they don't, it's just the number is shockingly high.

[Bad_Rich_Chic]

Originally posted by Replaced_Texan
Anecdotally, which means absolutely nothing, most of the Canadians and Brits that I know love their respective healthcare systems.

This is what most of them tell me, too. The friend I took to hospital outside of London when he had a coronary incident, who was made to wait for 2 1/2 hours after arriving in emergency with no attendance by anyone other than the receptionist until I mentioned that he had private insurance, upon which he immediately got a doctor and a room, adores the NHS. One Canadian friend, whose father died because his cancer went undiagnosed through more than a dozen visits to the doctor, who gave him Tums and told him he didn't need to see a specialist until he had lost 50 pounds, and then had to wait for two months for diagnostic surgery by which time he was a goner, thinks the US system is barbaric. A Canadian family member, who suffers from a congenital joint defect that is routinely screened for and corrected at birth in the US but is untreatable in adulthood, loves OHP. A lot of the older Canadians I know, and not a few younger ones, come to the US for actual care and send the bill home, but they love the Canadian system.

Much as I presume that most Americans who tout the US system as the best in the world don't know what they are talking about, I think the same is true for our friends with socialized medicine.

BR(incidentally, Hank, Canadians do get better healthcare results if judged by the most basic of indicators - they have lower infant mortality and longer lifespans than we do. (So do Cubans.) The Brits do worse than us. I doubt that public provision and universal access per se are either the devil or the key to much of anything. I do however find it depressin1g to pay so much for mediocre results. Then again, my solution is well known - fuck the elderly, focus all public health funds on under 18s and preventative care, get bang for your buck and let those who have had a lifetime to sort their shit out take care of themselves. But so long as the majority of my healthcare taxes would go to some rich old fuck getting his piles looked at for the 18th time, or blowing huge amounts on iffy late stage cancer treatments, or even getting his hip replaced so he can continue to play golf, I will be opposed to nationalized healthcare.)C

Originally posted by Bad_Rich_Chic
Then again, my solution is well known - fuck the elderly

Hear, hear. Bilmore tells me he's never felt better.

[Hank Chinaski]

Originally posted by Bad_Rich_Chic
the majority of my healthcare taxes would go to some rich old fuck getting his piles looked at for the 18th time, or blowing huge amounts on iffy late stage cancer treatments, or even getting his hip replaced so he can continue to play golf, I will be opposed to nationalized healthcare.)C

that sounds so barbaric, but check this out-

My grandmother was very frugal. Gramps died at like 44 so she was on her own for a long time. She took in laundry, she scrimped pennies, she walked instead of taking cabs. She did that for 40 years after he died. At 80 she had a stroke, went into a coma for a month, then died. We got the bill, all paid by Medi-whatever. The total was almost $200,000.

I can't put a value on my grandmother's life, and if there was a chance she could have come out of it, maybe it was "worth it." It just seemed so odd that this incredibly frugal women went on this lavish government sponsored bender the last month of her life.

Would it be better to give them $50000 at 75 and say good luck?

[greatwhitenorthchick]

Originally posted by Greedy,Greedy,Greedy
I spend a fair bit of time in Canada and working with Canadians. Anecdotally as well, most businesses in Canada love the system - they know their people will get healthcare, and they have a competitive advantage compared to US companies that have to pay for healthcare.


BTW, are you people actually attempting to have a rational debate with Hank? WTF - doesn't anyone pay attention here?

The Canadian healthcare system is in serious trouble. My mother could not get a doctor for 3 years (!) and she lives 2h from Toronto - not exactly remote. She had to go to walk-in clinics for that whole time and she is 65 - not exactly a good age to not have your own doctor. My dad has Parkinson's - he has his own doctor, but he has to wait forever to see specialists. Waiting lists for routine operations are huge.

The only good thing about the system is that everyone is covered - maybe that outweighs the bad things, but not really for those that can afford to pay for something better (and don't want to travel to the US for it).

[ilikenewsocks]

Study reviews why exit polls showed Kerry ahead.

The problem is not new -- in every presidential election since 1988, exit polls have overstated support for Democrats nationally -- but the discrepancy in 2004 was more pronounced than in previous years.

Really, it was all about weather conditions.

[Replaced_Texan]

Originally posted by Hank Chinaski
You're not claiming that many people rely primarially on VA are you? I don't know they don't, it's just the number is shockingly high.

No but that's how many people are in the system. A lot of them also have Medicare, and rely on both. As they get sicker, they rely more and more on the VA. http://www.ussvi.org/veterans/040429.htm

[Greedy,Greedy,Greedy]

Originally posted by greatwhitenorthchick
The Canadian healthcare system is in serious trouble. My mother could not get a doctor for 3 years (!) and she lives 2h from Toronto - not exactly remote. She had to go to walk-in clinics for that whole time and she is 65 - not exactly a good age to not have your own doctor. My dad has Parkinson's - he has his own doctor, but he has to wait forever to see specialists. Waiting lists for routine operations are huge.

The only good thing about the system is that everyone is covered - maybe that outweighs the bad things, but not really for those that can afford to pay for something better (and don't want to travel to the US for it).

Not to diminish the point, but every health care system is in trouble, and to some extent it's a pick your poison world out there. In the US, a disproportionate amount of healthcare is doled out in emergency rooms, which are not necessarily the place to get the best care or the most efficient care. Much of that is because of how the payor system works and because of the regulatory environment.

The question for the US is, are we ready to experiment with approaches that strengthen the weakest elements of our system, and learn from some other countries? Or are we ready to say the benefits of our system (including the fact that we create a disproportionate share of the breakthrough science and technology in the medical world) are such that we don't want to try anything new that might affect those benefits? It is a tough question.

My view: I have little patience for and see few contributions to healthcare from the payor side of the healthcare industry, and see no reason not to radically reshape that side. I think the charitable/educational healthcare system has been radically outperforming the for-profit healthcare system, and would generally push policy to favor the better performing charitable institutions.

Does this lead to single payor? Perhaps. I'm not dismissing it. But it could just as easily lead to a differently regulated multi-payor system or a system where the providers take on some of the payor responsibilities. If we had anyone in government ready to take on the issue.

[Bad_Rich_Chic]

Originally posted by Hank Chinaski
I can't put a value on my grandmother's life, and if there was a chance she could have come out of it, maybe it was "worth it."

Maybe it was, but, not to be callous, worth it to whom? To you? To her? If it is worth it to you, then you should be willing to pay for it. It's hard to make an argument that it is worth it to society in general, in just about any way. It is difficult to see how most end of life care, except palliative care, has much benefit to society in general.

Contra: funds spent on the young and preventative meds. Everyone has an interest in keeping the young healthy so they aren't around being feeble and a societal and economic drain for the next 70 years. And everyone has an interest in good preventative medicine for everyone else - we all benefit from more knowledge on how not to get sick in the first place, not getting infected by other sick people, having fewer resources expended to treat disease early instead of paying more to treat advanced disease, and keeping otherwise productive people productive.

[Replaced_Texan]

Originally posted by Hank Chinaski
that sounds so barbaric, but check this out-

My grandmother was very frugal. Gramps died at like 44 so she was on her own for a long time. She took in laundry, she scrimped pennies, she walked instead of taking cabs. She did that for 40 years after he died. At 80 she had a stroke, went into a coma for a month, then died. We got the bill, all paid by Medi-whatever. The total was almost $200,000.

I can't put a value on my grandmother's life, and if there was a chance she could have come out of it, maybe it was "worth it." It just seemed so odd that this incredibly frugal women went on this lavish government sponsored bender the last month of her life.

Would it be better to give them $50000 at 75 and say good luck?

I wrote my undergraduate thesis on this subject. Most healthcare dollars are spent on the last few months of a person's life, but it's impossible to ration elderly healthcare.

[Replaced_Texan]

Originally posted by Bad_Rich_Chic

Contra: funds spent on the young and preventative meds. Everyone has an interest in keeping the young healthy so they aren't around being feeble and a societal and economic drain for the next 70 years. And everyone has an interest in good preventative medicine for everyone else - we all benefit from more knowledge on how not to get sick in the first place, not getting infected by other sick people, having fewer resources expended to treat disease early instead of paying more to treat advanced disease, and keeping otherwise productive people productive.

The problem is that the private payors could give a rat's ass about keeping people healthy in the long term, because they know that they're not going to end up taking care of them. Managed care only works if people stay in the system. If people move from payor to payor or from health system to health system, there's no incentiveto the healthcare providers to keep the population healthy. You're only saving your competitor money that way.

[Bad_Rich_Chic]

Originally posted by Replaced_Texan
The problem is that the private payors could give a rat's ass about keeping people healthy in the long term, because they know that they're not going to end up taking care of them. Managed care only works if people stay in the system. If people move from payor to payor or from health system to health system, there's no incentive to the healthcare providers to keep the population healthy. You're only saving your competitor money that way.

Hence the attractions of a single-payor, no-opt-out system. It forces rational rationing (as opposed to economic rationing, which is basically what we have). Problem is, as GGG pointed out, a single payor has WAY too much power over pricing and ends up depressing innovation because innovators aren't inspired by potential huge profits. That said, most innovation in the US system is in ... well, elder care generally and end of life care specifically, because that's where the money is. Which means the innovation is of limited benefit to the rest of us, so I'm not sure how I'd weigh its loss.

[Mmmm, Burger (C.J.)]

Originally posted by Replaced_Texan
it's impossible to ration elderly healthcare.

I assume you mean as a political matter. Canada seems to be able to do it by making them wait. That solves (in a financial sense) many of the problems.