The US: a nice place to live, but don't get sick

I'm confused (not about what the state is in the US, but about what you're saying Americans think it is). Is there an extra negative in your opening paragraph? i.e. did you mean "myth ... has the best health care"?

(Also, your para near the end reads oddly given that "universal health care" means something like "health care available to every citizen of the country", but maybe I'm just reading it too literally; it's been a long day.)

Here's the description of The Federal Employees' Health Benefit Plan which covers the Congressthings and most federal employees. It is one of those plans that Bush calls "cadillac." Twenty years ago, it was called "ordinary."

Yeah, I think revere meant:

The one that says the United States, the country that spends more on health care than any other, {has|provides|delivers} the best medical care in the world to go with it.

Mathematician: Bad writing confuses you? How strange. I will rewrite. Thanks.

There are a lot of reasons why the US health care system is expensive (mainly because there is so much money and so little incentive to economize). But the issue about quality has been fascinating to watch over the last 20 years. Polls showed as early as the late 80's that when people reflected on their OWN experience with the health care system that quality was an issue its just that the same polls also suggested most people assumed that everyone else was fine. Then quality issues started sinking in but many peripheral issues provided scapegoating over the years (bedside manner, managed care, too many MBAs around, etc.).

I am starting to think that the growing perception around the world that the US cannot be bothered to be detail oriented and other-centered is coming true. When I see the medical error rates and amount of death from the delivery system itself, all I can think about is a lot people I grew up with that are not quality focused and too self-absorbed as the workforce in the health industry. Wishful and delusional thinking that satisfies so much of the US polity on other social issues will not be enough to provide quality patient-centered care.

I've been through several health care plans (and was uninsured for a long period in which I simply did without hernia surgery. And had to wait for a time period after I finally did get insurance)

Under one plan, I went to the ER for chest pain. Turned out to be acid reflux, and insurance declined to cover the ER visit because it didn't turn out to be an emergency. Perhaps it was their way of ensuring all heart attacks turn out to be fatal (and therefore cheap).

Now I work for a university and have a pretty good health plan.

I expect that every year, fewer U.S. residents believe this country has the best medical care. I couldn't Google up any statistics on this issue specifically, but according to a recent CBS/NYT poll, 9 out of 10 Americans thinks the U.S. system is in need of serious repairs.

Would this dissatisfied 90 percent concede that some other countries have better care? That's a different question. Our system's current beneficiaries have done a good job pushing the "rationed care" bogeyman (failing to note that care is rationed, here, too, just by different mechanisms), and it seems like everyone knows or has heard of someone in Britain or Canada who had to wait months for X procedure.

For once I come up with just a paragraph or two.

Hoow you going to pay for it?

How can you guarantee that this would better? Dont use the adage that it cant get worse. Wanna bet? Cuts in Canada, increases in costs to the consumer in Germany, France and Italy in the last two years. Germany is cutting services.

How come so many of those socialized medicine countries have people flocking into them and fighting to get some sort of legal status. Do you want us to support Mexico too? Put this in and they will come across like a wave. Thanks Hillary.

Spoke to someone in the Canuck consulate today and got onto the subject of the what ifs of Mexico. Be advised that they are terribly afraid that Mexicans will be able to make it thru their even more porous borders than the US. They apply for benefits there after having a baby and they will get the bills. They have a hugely small population compared to even one of our bigger states and it will flatten them.

As for the poor, they will be there always. This isnt UHC. Its a Universal Tax Code. You make your money, we will control it. Its as simple as that. It will just put more people out of work. Its a tax and a massive one, and it will bankrupt our system not from the medical side. Think not? Look what happened when all of those illegally registered voters that put Gray Davis into office applied for benefits and entered the schools. Oh sure they pay taxes right. Uhmmm nope. The State never forced them to pay. Why? Because they are illegal aliens. How to tax someone that has no status. They stated that more than once in the news. They are US citizens when it suits them.

RIP the US of A. when UHC hits our shores. It will be nice for a year or two and then the shortfalls will hit.

Randy: Well your paragraph or two was seven paragraphs. Similarly you tend to inflate the costs for others and minimize the costs to us. You and I are already paying for it. A lotl. We pay more than anyone else per capita and we get less -- in terms of real health outcomes -- than those who are paying less. We are already paying. We are already paying. We are already paying. Too much. And getting less. Less. Less.

I'm Canadian, and have lived in both Toronto and rural Ontario. The system isn't perfect, and people have lots of complaints about it. That's to be expected with something like health care where the demand is essentially infinite and the resources available limited. We allocate relatively scarce resoures at the ballot box, not the market. Life expectancy, infant mortality, etc, suggest we do pretty well. Canada spends less per capita on it's system that provides full coverage than the US spends per capita on Medicare that covers only the very poor and the elderly (yes, per capita - not per person covered by Medicare). It's also a competitive advantage in that companies need not provide expensive health care plans. GM plants in Canada, for example, benefit to the degree that GM is now calling for a single payer system in the US.

Randy, are you immune to math? We in the US are paying more to get less in terms out outcome. Even before you figure in the cost of lost wages due to sick people, chronic care, etc. our 'best-in-the-world' health care system delivers higher infant mortality, more years in nursing homes, and shorter overall lifespan. These are verifiable outcomes in black and white.

"Hoooow you gonna pay for it?" With some of the money we already overspend on health care. What's left over, we can use for something else.

Revere, you are deluding yourself if you think that the poor are going to pay jack crap for healthcare in this country. They expect it to be given to them. We have 12 million non payers now that are blowing holes in every state budget trying to care for them. I can do the math. The systems in Canada, UK, France, Germany, Italy are all in financial trouble and thats THEIR assessment, not mine. The answer, raise taxes and rates again, curtail services.

Add in the fact that a pandemic looms and then what, universal death? That not withstanding the only way they could pay for it is by taxing the Social Security payments and then the inflation rate goes to about 20% for 15 to 20 years. Long enough for the economy to fall apart like a two dollar watch. There is no difference in this government spending than that when Carter was President. It makes NO diff one bit what the money is spent ON, only that it is being spent. Inflation rises, then you have very tight money as interest rates.

Kevin, GM wants the USGovt to take over the liablilities of their corporation is all this is. They have to pay healthcare and retirement. The GM argument is as bogus an argument that there is. They cant afford to pay the retirees and their healthcare. Push it off onto the USGovernment. Bullshit.

Then there is the FACT that this finally gives the USGovernment total control over your life. Its not constitutional and would be ruled as such. There is no provision for giving life, liberty or pursuit of happiness only that you shall have the right to find it. We are paying more because of the litigation we have from crappy services when doctors make mistakes. Its very simple. We cap the maximum amount that a doctor can be sued for. Then if you want UHC get the poor to pay for it. This is a spread risk assumption. Fine, let those that want to participate in it do so. Dont come to me and tell me I have to work even harder than I do to support someone who already gets food stamps, has six kids so they can get more money for Aid to Dependent Children. This Utopia-Camelot if you will would last only about ten minutes before it gets into trouble. Then you dump it and those poor that are struggling will go down the tubes even more quickly.

Revere you assert that healthcare is a right. Uh-huh. Show me where. Our problems are based in the assumption that we are afforded that. Not so.

No Revere, its a cooking of the books and it sounds soooo enticing. The poor dont want to pay a damned thing. Never have and we are responsible from all of the giveaway, Great Society programs of the 1960's-80's for that mindset. They got used to the government dole. The poor wont pay a thing, they will rob Social Security and tax it to pay for it and you worry about your grandchildren. I am no where near worried about them. They aint here yet. This is up in my face stuff and the ONLY way to pay for it is taxation that will not generate anything but more taxation as the services drop and costs rise. Those that would do this are socialists and that simply will not work and the revolt might cause a civil war.

This isnt a system, its a cradle to the grave social program. It will not do one damned thing to change the effects on the poor. The UK had a horrendous time trying to find beds for the people who were sick with H7. What in heck do you think will happen when the not if but when it happens comes to bear. The lawsuits because we didnt have enough of X or there were no N's. It will cost the country the farm. We are already on the brink with Social Security. The day that foreign nations dont come to buy our paper then we are screwed. Put this in and within five years... the Second Great Depression. Then what and the question will come up again. How are you going to pay for it? The answer is that without jobs, everyone will be broke and no way to pay the taxes and then the services go to hell and then it spirals down. Get out there and do what the rest of the country is doing and then tell them that they are going to pay yet again for health care. More for less, initially. Then it reverses and once in they tax the living shit out of us.

I have seen every scenario, every projection thats out there. It drops initially, then it goes up. EVERY country experienced this. This is nothing more than a smoke screen to provide the USGovernment with cash flow. You think there is going to be money for research. Nope its all gone when this comes. Its the same in the UK and you add in our normal little cash earmarks and we are going to go down by the head and fast. The last thing to go? Healthcare, but go it will or be degradated to the level of an Indonesia. .

Then you add in the doctors that are going to refuse to see these patients as they did here in Tennessee, waiting in some cases 20 hours to be seen in emergency rooms, the totally indigent paying nothing of course and the poor (only what they can afford and then GOVERNMENT decides who is poor and rich). They will say someone who is making 50,000 a year with three kids (single mom designation) is RICH. Guess what? That was Bill and Hillary's designation under their BS UHC program. Rich huh?

The GDP of the US will be totally eaten up the day this comes and with it the end of the US as we know it. You will not be able to get blood out of a turnip. Jobs because of the new cost basis will simply melt away...Just as they did here in Tennessee under UHC. Our unemployment rate went from 4.3 which is almost full employment to 7.9% in under six years. We dumped it two years ago under our DEMOCRAT governor.Reason most given in the surveys, TennCare. UHC plain and simple. Guess what? The unemployment rate is now 4.7%. Wonder why?

Look Revere, you keep harping that we are paying more for less. Thats an opinion and geared only towards the people who can pay. The poor get better care than I do right now and I pay 450 per month. This could shift to the less for more initially and THEN the costs will rise to meet the numbers. The insurance companies arent stupid and neither am I. I would sock it to them and demand an increase every time it got to the less than 15% number. All of them in the UK offer secondary policies now to cover the shortfalls in the damned UHC system. So the poor get basically poor service while someone who has the backup gets the better. Give me a break with the smoke and mirrors. We the payors would have to get supplemental policies to cover the things that are not covered. Sixty years in the UK and they are in deep trouble. The assertion that they pay only 14% of their GDP is crap. They have raised it across those sixty years from only 3% to 14%. As ours and their populations age, they are requiring more and more and more. Pensioners cant pay anymore and we go right back to the decision between food and healthcare. Again, how are you going to pay for Social Security, National Defense, UHC and the some four hundred other programs. Oh, this guarantees a nuclear war. Keep it conventional and the only way to do that is to pay for a conventional military. It gets out of hand somewhere and we dont have the forces and it goes to the nukes. Not enough options.

Now do I think we need something for these people? Yes. It should be a states problem with the people in their states. The federal government shouldnt even be involved in health care except for a national issue such as a pandemic. Then it should be minimal at best. The states rights thing is a provision of the constitution. This isnt. We have gotten into the position of having an ever increasing gray population voting themselves an ever increasing portion of an ever decreasing pie. Social Security goes bust in 10 years. It will bring on inflation on a scale you have never heard or seen before and that includes Carter. Want to pay 15 dollars for a gallon of gas?

What do we do when the Arabs dont want our paper dollars? How do we fund the military. AGAIN, how do you intend to pay for it? Dont give me single payer rate stuff. The poor dont pay crap and they are the ones demanding the services, like its a right. It aint in the Constitution so it becomes a constitutional issue in short order. Then if voted in, what do they do when the South says f you guys in the North? What? Hmm? Urp! Secession is always available as an option. One state goes and the others will join in. Wont be a civil war in the shooting sense but an economic one. Here is the new federation of the United States of Freedonia. Your property cant be taken by a municipality for a new shopping mall would be the first rule.

There is nothing in this future but total collapse. UHC would bring that on in a fast damned hurry. Our kids who are saddled as of last year by the population with a little over $230,000 per would be faced with the USGovt having to float bonds which have to be paid back. God help them if they raised the income tax rate instead to cover it. WE MUST be competitive in todays world and we arent. This would send everything to China, India, SE Asia.

Consumerism would fall here and vanish in a collapse. It would take about two generations as it did with Carter to get things back on track, if ever. Or look out secession here we come. Sometimes its better not to play the game. You'll disagree of course and cite Sweden as such a shining example. Okay let me do it for you and save you the typing. Just let the post stand as the one right winger here and see what happens. Its not going to happen and if it does there is going to be hell to pay in the future and fast at that. There are no savings except in the short term. Then it goes to hell in a bucket along with the services. No more rich doctors, no more rich lawyers. Thing of the past with UHC.

My own intuition is that US provides fairly remarkable healthcare service in 3 fields: (a)Emergency Room medicine, (b) diagnostic testing and (c) surgery.

But, there are some serious problems elsewhere that are systemic, in the same way that there are serious problems in, say, the public schools in most large cities.

Dr. Barbara Starfield, MD, PhD at Johns Hopkins noted this in JAMA in 2000.

She calculated that doctors and hospitals cause about 225,000 deaths/year. She cited adverse reactions to prescription drugs as a major factor in these deaths (106,000 deaths/year)

I'm always suspicious of statistics, for instance, in the ones you quote Revere, i wonder how much lifestyle plays a part, not health care. I will fully agree that the U.S. has some of the worst lifestyle induced health problems, for example, type II diabetes.

Awhile ago I did a comparison between U.S. survival rates and European survival rates for someone with Lynch Syndrome type II. I don't have at hand the papers I pulled showing survival rates for all the possible cancers, but my conclusion was that survival rates in the U.S. were statistically significantly higher than in Europe. Here is one that i could find quickly.

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_ui…

Perhaps that is due to Europe's emphasis being more on palliative care, and the U.S. emphasis more on chemotherapy and cure. That would take more in depth analysis than i am capable of doing. For now, I just hope I'm in the U.S. when my genetics catch up with me. I'd like to make a nod to the NIH right now for their excellent genetics research btw.

I've had excellent health care in a pay as you are able county system(albeit with long waits in clinic lines), and excellent health care in the 'private' system as a state employee with a PPO. I understand it's the people in the middle that have a hard time. As I said above, my experience and my research has shown that I want to be here in the US when I really need the system, although a move might be in my future.

Oil prices will continue to rise for many reasons but as long as I benefit from my investments I will be able to cover any future medical expenses. Hey, we encouraged outsourcing (I have stock in those companies too, plus I'm enjoying the cheap suits). I agree with you, M.R.Kruger. I'm a right-winger too.

MikeP: US Emergency rooms are stretched to their limits. Many are on "diversion" in normal summer months. If you've been in one recently you would see they are not delivering could and timely care. See some previous posts here and here.

CC: Haven't reviewed the literature on this, but I note that the paper you cite explains the difference thusly: "The main explanatory difference is the proportion of adenocarcinoma in polyps." In other words, the main reason for the difference isn't the medical care system.

"Doctors get paid for "procedures." Handsomely paid, I might add. "

...does SEED have a top-ten list for understatements of the week? That is my nomination.
I have very frequently wondered how doctors cope with the guilt that must arise from making hundreds of thousands of dollars per year and spending days performing procedures on people who can't afford health insurance. Golf must help with that.

Studies show that approximately 50% of patients do not obtain good quality medical care in the U.S. (Schuster et al., 1998; McGlynn et al., 2003; Asch et al., 2006) and that the use of evidence-based medicine guidelines is low relative to national benchmarks (Keckley, 2004). In addition, clinicians cannot keep track of everything they need to do for every patient. For example, in 2005, 85% of physicians could not generate a list of current medications for their patients, 15% of abnormal tests were not followed up, and only 18% of physicians had data on patient outcomes (O'Kane, 2005). The USA spends twice as much per capita on health care as Sweden, the Netherlands, and the United Kingdom, yet these countries achieve better overall health outcomes. Why? They are modernizing the management of medical information at a much faster pace, particularly their implementation of electronic medical records (EMRs) (Taylor &Leitman, 2002). In contrast, less than 20% of U.S. physicians are currently using EMRs (Audet et al., 2004). So, I don't think we have a lot to crow about.

(References available on request; the blog compiler wouldn't let me post them.)

Marissa: You are quite right. One of the hidden costs of not having a NHS is our non-existent medical information system. There are enormous costs in not having this informaiton avaialble.

Note that the publishing system holds comments that have links in them for approval, at least if there are more than one. This includes me. If I put links in my responses and forget to approve them (since I am away from the keyboard a lot during the day) my comments don't show up either. It is infuriating but apparently necessary for spam control.

UHC would lead to the collapse of the US within a decade financially. We would be taxed to such a level that all jobs would leave this country, especially manufacturing and we would fall to second tier status. National defense would be out and gone. You can bet that total confiscation of guns would follow...Have to, cant have that possibility of an overthrow being out there after that. Crime would be off the scale as those same poor people who might have some piece of a job would be out robbing and burglarizing just to eat. But hey we got healthcare. We are a capitalistic society and socialism has proven time and again this country when they introduced it that it shut us down. Carter was the greatest shining example of this. Most here probably are not old enough to remember the 13% and then finally the 21% interest rates that were with us for 18 months. I do. The stock market was at 850 but it started at 1470 when he took office.

They rant and rave that this is the "less for more, its really nothing more than control over your daily lives. Fewer doctors, fewer hospitals because that managed cost control thing comes into play. The government takes over all hospitals, limits their exposure even though they are operated under contract to the government. We dont need fewer doctors and hospitals right now, we need more, by about 1/2 to take care of all the older people that are going in right now.

E.g. the UK health ministry had a hell of a time finding enough beds for the sick during the H7 outbreak. How much are you willling to pay to provide healthcare for the poor in the US? Your job? National defense? Crime rising to unprecedented levels? Make a decision, those poor people DEMAND that you the better off take care of them. Where is the equal protection under the law?

Providing health care to all does NOT mean better health care. Far from it. The people who could afford to opt out would and pay for their own insurance policies as they are in the UK now and leave a pool as it has in the UK and other countries of elderly, indigent and sick people to pay into the system. When it collapses, they'll just raise the rates again to those who can pay. A good example is the various states "Blue" Plan for the police. They get a pay raise, they get a rate increase. The same for school teachers, they get a pay raise, they get a rate increase within days. Think not? Ask one. Its happened every time we increased the min wage too. The raise was automatic. Duh....

Below are some cites. 25 weeks for heart surgery in the UK? Months for a hip replacement? Healthcare becomes a government limited commodity and you as taxpayer Americans will have to pay for people who pay no taxes now. You will also subsidize indirectly Mexican healthcare even more than you are now. It is financial suicide, Romney and Hilary had better go thru a rethink really fast because the vast right wing conspiracy is going to hammer them straight into the ground on this one.

http://www.cato.org/pub_display.php?pub_id=8172

http://www.cato.org/pub_display.php?pub_id=3057

http://www.cliffsnotes.com/WileyCDA/CliffsReviewTopic/The-United-States…

Hey you under 40's, I am from a state that had UHC and it cost us almost a billion dollars in under six years in a state with 6 million people and it was as B. Clinton put it "The model for the rest of the US" when it was implemented. Do the math. Divide 1 billion by 6 million. Thats math I can understand Revere, can anyone else? At the end of the six years it accounted for every dollar of the state budget. It took another four to shut it down. Damage done. The jobs left for other states and literally other countries.

Interesting article, thanks for the coverage.

However, I do wonder what the distribution of outcomes looks like. Comparing us to the average may not be that informative, unless care in industrialized nations follows a normal distribution (I doubt it does). We may do better or worse than the median.

What's striking is that per capita costs are so much higher, 2x, compared to other nations with similar or better outcomes. Part of that might be poverty and or education: nations with national systems may better avoid such inequalities in care. Locking a substantial proportion of the public out of the system will tend to hurt outcomes. However, whether a national system could open the market to these people at or below the present cost is an empirical question.

Of those in America who can afford the cost, are they doing equal or better than in other nations? I suspect if they are told they pay 2x as much, but don't get 2x as much care, or get worse care, you might see more political action on this topic (the poor are disproportionately locked out of both health care and lobbying). If you tell Jane Q Stockbroker that the HMO she's driving is a lemon, it may be more effective.

When our daughters were ages 1 and 5 we moved just outside Toronto. During the eight years we lived there our girls were seen by a group of topnotch pediatricians for shots and everyday health problems; if our child was sick, she was seen the same day. The youngest one required ear tubes, and there was merely an average wait for that to happen.

As I see it, the benefit of UHC is that everyone can receive health maintenance medical care, not just survival medicine. Doesn't that make the need for those expensive, lifesaving procedures less likely?

No Nym and HatT-For years we have subsidized every country out there with what we pay here for the pills that across the border are cheaper by half. So we wonder why its so expensive? Its because it IS a subsidy. We pay all of the R&D, liabilities, and everything else and we ship the pills to Canada, Mexico, Brazil (dont know about the EU but its assumed).

We pay all of the costs and they sell them over the counter in some of those countries. Near zero liabilities. Then when we try to import those pills that were made by our companies, we start to upset the apple cart.. Oh shit cant have that, they are substandard pills made under license in those other countries. You might have the wrong stuff and on and on.

Pure, total and complete BS. Congress wants to do something? Put a dis-incentive in there to make it far less profitable for them. But they wont. Its so much easier as an out to assert that UHC will fix all the woes. Hat you arent wrong, everyone would be seen.... eventually. Health maintenance? We arent talking about cars here, we are talking about people and you might be showing up in the US to see after many, many hours of waiting a substandard doctor. No bucks in that. Hell no, the good ones will only accept private insurance. Kind of what we are seeing now. All it will do is separate the poor from the upper class farther. Private insurance got seen ahead of everyone who was on the TennCare UHC. Why? Because they were money makers for the hospitals.

From Wikipedia on TennCare

"In its first four years, TennCare accomplished what the state set out to do: stop the escalating costs of Medicaid, a problem that drove many other states to subsequently explore alternatives. But through those years, problems began to develop related to the operation of the seven managed care organizations (MCOs). A first one simply pulled out of the program, and the state shifted enrollees to the other managed care organizations. But then two other MCOs developed financial problems, and physicians began complaining loudly that they were not being paid. The state was forced to take over one contractor, and attempted to keep the MCO afloat through receivership. Another larger MCO was bailed out by the state before it was finally liquidated. In both cases, health care providers were left with millions in unpaid bills. Though the state tried to pay off the debt, it was never able to fully compensate providers.

By 1999, it was clear a reform was necessary. Doctors and hospitals lobbied the state to require that a certain percentage of the money paid to the MCOs in the form of monthly capitation payments be routed on to providers. More problems developed, as the MCOs were unable to manage care or costs under the constraint of the new mandate.

In 2002, the states waiver agreement with the federal government was renewed, but CMS would not agree to many of the funding mechanisms Tennessee won in its original waiver, making the program even less cost-effective. In addition, although the states Medicaid eligibility remained intact with Tennessee offering more eligibility categories than most other states enrollment in the so-called waiver population was curtailed. After the new waiver went into effect, enrollees were either Medicaid-eligible or BOTH uninsurable and below 250% of the Federal Poverty Level."

In other words you had to be indigent, have a pre-existing condition, be uninsurable and 250% below the poverty level to become eligble. Uh, that means you had to be nearly dead anyway. So as I say, UHC doesnt mean better health care only that health care of dubious quality might be provided. In even better words the haves will be FORCED to provide for the have nots. Not an option. You also see what doctors did here. They refused to see patients and thats when they started showing up at the emergency rooms for flu and head colds. And this we are told would be better. Everyone will end up in the ER's as those doctors bail out of UHC participation. Why should they stay? There is no money in "negotiated rates".

Why isn't North American type of H5N1 dangerous? In Hong Kong they found an asymptomatic strain of H5N1 in birds and they said it's extremely worrying, and the scientists thought they should actually kill all birds in the area for that.
On the contrary, in USA when low pathogenic H5N1 found, it's only said don't worry be happy. Strange world.

Revere, you said 'Haven't reviewed the literature on this, but I note that the paper you cite explains the difference thusly: "The main explanatory difference is the proportion of adenocarcinoma in polyps." In other words, the main reason for the difference isn't the medical care system.'

But a lower proportion of adenocarcinoma means that the U.S. patients were generally diagnosed earlier in the polyp=>cancer progression. That is due either to U.S. patients having more access to diagnostic and screening tests, or more education about the need for those tests. Either way, it shows a strength in the U.S. medical care system.

Actually the lower proportion of adenocarcinoma more probably means that the polyps aren't found soon enough. If they were found soon enough, there would be larger proportion of the deadlier adenocarcinomas. Why? Because all the semi-benign are away from the pool ,and only the worst cases are left - those that cannot be cured in any possible way.

cc | June 20, 2007 03:15 PM: "But a lower proportion of adenocarcinoma means that the U.S. patients were generally diagnosed earlier in the polyp=>cancer progression. That is due either to U.S. patients having more access to diagnostic and screening tests, or more education about the need for those tests. Either way, it shows a strength in the U.S. medical care system."

I note that M.R. Kruger's predictions for disaster haven't happened to every single other industrialized nation in the world, despite the fact that they have UHC. Somehow it's going to be different for us. Sticking your fingers in your ears and shouting to ignore the truth just isn't a very good tactic to win arguments. Either that, or he really does believe Americans are just that incompetant, in which case I think I'm insulted.

cc: The higher proprotion of adenoCA could mean that there is better screening in the US (highly doubtful because we do a bad job of preventive services) but then the five year survivals would not be good indicators as it is well known screening increases 5 year survivals by advancing diagnosis and by preferentially picking up more indolent cases. So if there is truly more screening here accounting for it (which I doubt), then the five year survival figures are not meaningful. More likely there is a difference in some risk factor affecting adenoCA.

Perhaps a specific example of the waste in the current US system would help. The "denial management industry" soaked up twenty billion dollars in the USA in 2004 (doubtlessly, it is worse now). That is, insurance companies spend 10 billion dollars auditing claims to look for flimsy excuses to deny payment, and health care providers spend another 10 billion appealing those denials. Note that this is all arguing over minute technicalities. NO one is saying any of those claims is fraudulent.

With universal, single-payer coverage, that entire $20,000,000,000 could either be used to provide care, or it could be a reduction in expenditures. As it is, it is pure waste.

Oh, and the argument about illegal immigrants taking advantage of the system? Pure hogwash. Every system has parasites. Congress has parasites. The White House has parasites. The stock market has parasites. The entire K-Street project is teeming with parasites. The current health care system has parasites (almost the entire health insurance industry is a parasite.) Halliburton is the biggest parasite of them all right now. They are just sucking our blood. So you can't object to a system simply because there might be people trying to take advantage of the system. If you do, you will object to every single social institution there is.

No matter what you do, if there is money changing hands, there will be people trying to take advantage.

No Capt.B. Dont be insulted. Be afraid of a government that does everything (or tries) to do everything for you. They will soak you and then when this system collapses if implemented there will be nothing left for the people and the care will sink to an all time low. Its not just me thats piping this. Its not hogwash about the 20 billion either. Its the system. So we dump a shitty system for one that will lump the poor, elderly and super pre-existing conditions into a endless well. They will have a single payer system that will collapse because its a multi user program and assumes spread of risk. The risk? 7 elders trying to be paid for by 1 youngster in the very near and long term. They will try to cap it, link it to income or something like that and when they do as they did here in Tennessee we are screwed. 1.5 million people in the State were on it out of 6 million. It bankrupted us in six years...totally, completely and no one else could get onto it because of the federal laws.

I will fight this if they try to implement it, I will work to stop it if they do. Revere talks about grandchildren and his children. This will take care of their futures for sure. There will be no money for anything else and that includes S. Security. End result is huge taxes on S. Security payments, they will inflate the payments because of inflation ratio, then interest rates will go thru the roof as the federal deficit blossoms. But, take it FWIW.

Joe, your last para is totally correct. Thats the reason that nearly all the doctors will bail out, leave the ER's flooded with patients that are too poor to go to traditional insurance or backups AS they are having to do in Germany, UK, France, Netherlands, Italy, etc. Jack the rates, jack the tax. That is what WILL happen under this. Not fearmongering. Its been happening ever since they implemented it.

Are the lower U.S. health outcome measures (infant mortality, average lifespan, etc.) relative to other industrialized countries necessarily caused by differences in the way health services are provided? Is it possible that we suffer shorter lifespans due to getting less exercise, eating poorly, or some other behavior?

MRK: When I read this: "We dont need fewer doctors and hospitals right now, we need more, by about 1/2 to take care of all the older people that are going in right now".

Abstract to say the least however, prisons, we certainly have enough of those.

Let's keep the elderly in our hospitals and let the poor receive care from Trained Prison Inmates. Instead of pumping iron let's enroll them in Physician Assistant programs and the one's that show promise go on to Doctor.

So you can't object to a system simply because there might be people trying to take advantage of the system. If you do, you will object to every single social institution there is.

Many (fortunately not all) libertarians accept that there are parasites taking advantage of all social institutions, and proceed to insist that therefor all social institutions must be dismantled. To those folk, the fact that all extant social systems suffer from parasites is proof that the very idea of a social institution is intellectually and morally bankrupt.

Lea: Or how about this. Let's empty out most of the prisons, loaded since 1980 with vitimless criminals locked up in the war against drugs. We lock up more than any other nation in the world. we didn't used to. The huge increase is only a few decades old, was sudden and massive. Are we safer?

Dont come to me and tell me I have to work even harder than I do to support someone who already gets food stamps, has six kids so they can get more money for Aid to Dependent Children.

There's well demonstrated solution to that - encourage widespread education of women, and widespread use of birth control. There's ultimately no other solution, since as long as those six poor kids exist they're munching resources, thus lowering availability of non-renewables (the majority of what our economy uses ... ) and therefor raising prices and making you work harder. Unfortunately for you, the American Religious Right has expended every erg it can steal in an insane quest to fight that solution - by all means, fair or foul. Thus, America is swamped with the poor children of not only one continent, but at least two (don't forget S. America), and probably more. It's religion that drives this madness, and you should place the blame on the irredeemably cruel and vile 'god' which discourages use of birth control and education of women.

It was an abstract idea revere, off the wall even, sorry to have upset your apple cart.
It would never happen anyway.

The people that are in prison for violent crimes should stay in prison.
Non-violent prisoner's are incarcerated mainly yes because of the bogus war against drugs.

Llewelly-You wont get me to argue the need for BC in the US. I would argue about "victimless" drug crims. Those that do drugs and move on from MJ to other drugs become worthless as humans and they burglarize, jack, hold up, steal in general to support their habits. Stoners also run into people with cars and if they do in the state of TN, they face life without parole. Hard but necessary. Not since 1980 either Revere, there are many in Miss. prison system for life as they never did away with their Title 2 laws. They just reduced the sentences since the 1980's. Working in Parchman outside of Drew MS is pretty bad and like something out of the Longest Yard.

Randy,

Sometimes I wonder if you really believe the cliches you espouse; is it mentally easier to not think 'bout the complexities of many individuals' experiences!?!

I was a "stoner" back in the late 90s -- dude, those really were the best years of my life. Following my time at university, I'd the wonderful opportunity to live out, for several years, the lyrics to Madonna's 1980s tune, "Holiday"!

It (((WAS))) so nice for a while to not be the person that I am -- "been to the mountaintop and looked over the other side, didnt like what I saw and has howled to the pleasure seeking wolfpack like some possessed pooch with a bone up its ass"!

EffectMeasure -- Bush's Surgeon General nominee. Holy
Shit! (Category: Federal health)
Posted on: May 29, 2007 3:26 PM, by revere

Excerpt: Posted by: M. Randolph Kruger (dude who has
served in the US Military) May 31, 2007 02:59 PM

"Jonny, still having trouble I see. Dont know what I
can do to help but will. You have my email if you want
to rant anytime you want. PTSD Jon is sometimes
referred to way to often as a catch all. Lets just say
I have been to the mountaintop and looked over the
other side, didnt like what I saw and ran the other
way as all good soldiers in the face of overwhelming
odds..."

2005 E-list message...

Subject: Re: News Store Alert -- H5N1(transgenic pathogen) ["Mind Wide Open" Version]

Mon, 15 Aug 2005

C21Psychotronik -- Hey, I'm in a net caf using up all my precious dole money in the vain attempt to perform the duties of my job as freelance health worker... A joke (perhaps?) to some Western Australian government employees, but this is how I've seen myself since the late 1990s.

I'm currently reading "Mind Wide Open: Your Brain and
the Neuroscience of Everyday Life" (2004) by New York
author, Steven Johnson. It's become a tad difficult
to find an engaging book since Dubya took office, so I
really suggest you take the time to explore a text
which "simplify-synopsizes" that stormy ol' Freudian
model of the conscious and unconscious mind...

Amazon Review by Jamo (California) Excerpt: "It was far more enjoyable learning than any homework I've done, and it's [just] amazing how much I've learned without any background at all in medical education. Great Book!"

One of the serious themes of "Mind Wide Open" is that almost spooky flash of insight you get every now and then...

A thought resembling a big ol' shift-perspective of the world or situation. And then, just as quickly, the thought dissolves never to be remembered...

Johnson discusses the biochem basis of thinking -- all those little n-transmitters doing a funky dance thang in the noggin.

When I used to imbibe THC during the late 90s, I'd gain some durn explosive insights into the world at large and people in general. Of course, "neuro-info-processing" at hi speeds whilst physically slowing down (due to the psychoactive "stoner" properties of THC), aint exactly socially acceptable behavior in Western cultures...

Anyhow, back to global antiviral stockpiles (or lack thereof): Perhaps an AmericanOztralian "work for the dole" scheme conducted by the Bush-Howard government administration is the next step!?!