Surprising Facts about American Health Care

[roster]

hmmm - exactly what is being debated here?

Well it started out with an article I posted purporting to compare health care in Canada and the U.S. and comparing major innovations from the U.S. with innovations from all the rest of the world.

I posted it without comment and used the headline of the original article for the post.

The discussion then took quite a few turns, but to this moment no one has pointed out a single inaccuracy in the original article.

[diboja]

I suppose if we start a hunt and peck and list a multitude of sites - we will find out that most of the original post is correct but there is a "slant" to it for obvious reasons. 32 of the 33 developed nations must be doing something right as we all have Universal Health care and most of us live longer than our USA counterparts.... It is nice to see that the USA will have a "sort of" universal healthcare sytem....long overdue.

August 9, 2009: Thirty-two of the thirty-three developed nations have universal health care, with the United States being the lone exception [1]. The following list, compiled from WHO sources where possible, shows the start date and type of system used to implement universal health care in each developed country [2]. Note that universal health care does not imply government-only health care, as many countries implementing a universal health care plan continue to have both public and private insurance and medical providers.

Country Start Date of Universal Health Care System Type
Click links for more source material on each country’s health care system.
Norway 1912 Single Payer
New Zealand 1938 Two Tier
Japan 1938 Single Payer
Germany 1941 Insurance Mandate
Belgium 1945 Insurance Mandate
United Kingdom 1948 Single Payer
Kuwait 1950 Single Payer
Sweden 1955 Single Payer
Bahrain 1957 Single Payer
Brunei 1958 Single Payer
Canada 1966 Single Payer
Netherlands 1966 Two-Tier
Austria 1967 Insurance Mandate
United Arab Emirates 1971 Single Payer
Finland 1972 Single Payer
Slovenia 1972 Single Payer
Denmark 1973 Two-Tier
Luxembourg 1973 Insurance Mandate
France 1974 Two-Tier
Australia 1975 Two Tier
Ireland 1977 Two-Tier
Italy 1978 Single Payer
Portugal 1979 Single Payer
Cyprus 1980 Single Payer
Greece 1983 Insurance Mandate
Spain 1986 Single Payer
South Korea 1988 Insurance Mandate
Iceland 1990 Single Payer
Hong Kong 1993 Two-Tier
Singapore 1993 Two-Tier
Switzerland 1994 Insurance Mandate
Israel 1995 Two-Tier

Update 3/21/2010: With the House’s passage of the Democrats’ reform bill tonight, the US will have close-to universal health care in 2014, using an insurance mandate system.

http://coto2.wordpress.com/2010/03/22/l ... ealthcare/

As far as Medical innovations - Canada with its very small population has been a leader---
Many innovations listed here - and I didn't want to clutter up the posting with a huge list - but if your interested:
http://www.canadianmedicinenews.com/200 ... earch.html

Bottom line - the life span of Canadians is longer than our friends in the USA....so, we must be doing something right?!
Dave

[BlackSpinner]

In 1944 the Office of Strategic Services (OSS) published the "SIMPLE SABOTAGE FIELD MANUAL" for use by field operatives. The section on "General Interference with Organisations and Production" (starting on page 28 [32 in PDF numbering]) is hilarious in a very Dilbert sort of way.

http://svn.cacert.org/CAcert/CAcert_Inc ... Manual.pdf

(a) Organizations and Conferences
(1) Insist on doing everything through "channels." Never permit short-cuts to be taken in order to expedite decisions.
(2) Make "speeches." Talk as frequently as possible and at great length. Illustrate your "points" by long anecdotes and accounts of personal experiences. Never hesitate to make a few appropriate "patriotic" comments.
(3) When possible, refer all matters to committees, for "further study and consideration."
Attempt to make the committees as large as possible — never less than five.
(4) Bring up irrelevant issues as frequently as possible.
(5) Haggle over precise wordings of communications, minutes, resolutions.
(6) Refer back to matters decided upon at the last meeting and attempt to re-open the question of the advisability of that decision.
(7) Advocate "caution." Be "reasonable" and urge your fellow-conferees to be "reasonable" and avoid haste which might result in embarrassments or difficulties later on.

Later:

(d)(8) If possible, join or help organize a group for presenting employee problems to the management. See that the procedures adopted are as inconvenient as possible for the management, involving the presence of a large number of employees at each presentation, entailing more than one meeting for each grievance, bringing up problems which are largely imaginary, and so on.

You been reading this Rooster?

[DreamStalker]

I have sent several people who PMed, a list of links to organizations that I do support. If you would like the links, just send me a PM. Give me some time to reply because I am very busy with some travel this month.

I see. So you are establishing a little cult following. Congrats!

[BlackSpinner]

Some of you might find your self here- Living in denial: Why sensible people reject the truth

The conservative character of much denial may also explain its success at winning hearts and minds.

George Lakoff, a cognitive psychologist at the University of California, Berkeley, argues that conservatives have been better than progressives at exploiting anecdote and emotion to win arguments. Progressives tend to think that giving people the facts and figures will inevitably lead them to the right conclusions. They see anecdotes as inadmissible evidence, and appeals to emotion as wrong

How to be a denialist

Martin McKee, an epidemiologist at the London School of Hygiene and Tropical Medicine who also studies denial, has identified six tactics that all denialist movements use. "I'm not suggesting there is a manual somewhere, but one can see these elements, to varying degrees, in many settings," he says (The European Journal of Public Health, vol 19, p 2).

* 1. Allege that there's a conspiracy. Claim that scientific consensus has arisen through collusion rather than the accumulation of evidence.
* 2. Use fake experts to support your story. "Denial always starts with a cadre of pseudo-experts with some credentials that create a facade of credibility," says Seth Kalichman of the University of Connecticut.
* 3. Cherry-pick the evidence: trumpet whatever appears to support your case and ignore or rubbish the rest. Carry on trotting out supportive evidence even after it has been discredited.
* 4. Create impossible standards for your opponents. Claim that the existing evidence is not good enough and demand more. If your opponent comes up with evidence you have demanded, move the goalposts.
* 5. Use logical fallacies. Hitler opposed smoking, so anti-smoking measures are Nazi. Deliberately misrepresent the scientific consensus and then knock down your straw man.
* 6. Manufacture doubt. Falsely portray scientists as so divided that basing policy on their advice would be premature. Insist "both sides" must be heard and cry censorship when "dissenting" arguments or experts are rejected.

[PST]

The discussion then took quite a few turns, but to this moment no one has pointed out a single inaccuracy in the original article.

I was interested in this article, which I hadn't seen before, when it was first posted, and I started to go through the list of facts with the intention of reading the sources cited. That can be especially rewarding with material you feel skeptical about, since there's always a chance to learn something new (or unlearn something you thought was true). I was disappointed, though.

I started where Rooster did with "Americans have lower cancer mortality rates than Canadians." The original footnote in the Scott Atlas article he is quoting is this:

U.S. Cancer Statistics, National Program of Cancer Registries, U.S. Centers for Disease Control; Canadian Cancer Society/National Cancer Institute of Canada; also see June O'Neill and Dave M. O'Neill, "Health Status, Health Care and Inequality: Canada vs. the U.S.," National Bureau of Economic Research, Working Paper No. 13429, September 2007. Available at http://www.nber.org/papers/w13429.

That's pretty frustrating to work with because of the lack of specific information needed to actually check the sources. The first citation is to "U.S. Cancer Statistics, National Program of Cancer Registries, U.S. Centers for Disease Control." No year, no specific publication. I rooted around the web site for the National Program of Cancer Registries, http://www.cdc.gov/cancer/npcr/, but I couldn't out what data the author was using. It was even more difficult with Canada, since the citation was simply to the names of two organizations. So I pinned my hope on the third source, the O'Neill paper, which can be downloaded free from http://www.bepress.com/fhep/10/1/3/ if you register as a guest. (It costs $5 from the source the author cites.) Anyway, Table 11 on page 30 has mortality rates and cites to "United States Cancer Statistics, National Program of Cancer Registries, U.S. Centers for Disease Control; Canadian Cancer Society/National Cancer Institute of Canada." Bingo! That looks like it must be the source. But for the life of me I can't see where the author gets his numbers. They don't match up. For example, the article says that the mortality rate for prostate cancer is 184 percent higher in Canada than in the United States. But here is what the O'Neills' table says for prostate cancer:

U.S.
Incidence rate, 162.0
Mortality rate, 27.9
Mortality/Incidence, 0.17

Canada
Incidence rate, 124.7
Mortality rate, 25.2
Mortality/Incidence, 0.20

There is simply no way I can think of to derive from these figures that the mortality rate for prostate cancer is 184 percent higher in Canada. I can't match of the statistics for breast cancer or colon cancer in men either. The O'Neills have a second table, Table 12, on page 31. Those numbers don't support the author's statistics. Moreover, they are derived from only parts of the U.S. and Canada. The U.S. statistics are from what is called the SEER 17 areas: Alaska Natives, Arizona Indians, California, Connecticut, Detroit, Atlanta, Rural Georgia, Hawaii, Iowa, Kentucky, Louisiana, New Jersey, New Mexico, Seattle area, and Utah. That's a weird selection. According to the National Cancer Institute (http://seer.cancer.gov/about/) this covers 26 percent of the population. The Canadian statistics exclude Quebec. I can't imagine what comparing random parts of the U.S. to Canada with the middle cut out is supposed to prove.

So, to make a long story short, I tried to follow up the source of the initial comparison of U.S. and Canadian cancer mortality statistics, but I couldn't find the actual numbers in the first two vaguely cited sources, and the third source, which claimed to be based on the first two, doesn't support the author's statement. I would love to see someone else take a crack at it. I can say for sure that Table 11 in the O'Neill paper doesn't come close to supporting the high mortality difference claimed for prostate cancer, which was the only startling difference. I'm not very impressed by small differences, since we don't know anything about variances between countries in how data is collected or defined.

In some ways I am more bothered by what the author did with his Fact No. 7. I think someone else has already pointed this out. He says:

People in countries with more government control of health care are highly dissatisfied and believe reform is needed. More than 70 percent of German, Canadian, Australian, New Zealand and British adults say their health system needs either "fundamental change" or "complete rebuilding."

He cites to Cathy Schoen et al., "Toward Higher-Performance Health Systems: Adults' Health Care Experiences In Seven Countries, 2007," Health Affairs, Web Exclusive, Vol. 26, No. 6, October 31, 2007, pages w717-w734. Available at http://content.healthaffairs.org/cgi/reprint/26/6/w717.

Here is the chart from Schoen's paper. I downloaded it from the link called Chartpack at
http://www.commonwealthfund.org/Content ... -2007.aspx because that was free, but it is from the same author, title, and year, and is clearly what is referred to in the cited paper:



It clearly shows that of all the countries surveyed, the U.S. had the largest number who said that the system should be rebuilt completely and the smallest number who said that only minor changes were needed. The author didn't actually lie. He omitted any mention of the U.S. results. But the whole idea of the article was comparison of the U.S. to other countries, so it was intellectually dishonest to cite the dissatisfaction of the residents of the other countries, while failing to state that the U.S. was also surveyed and that we hate our system even more than other people hate theirs.

Heck, I'm a lawyer. I am paid to take a side and then muster the evidence that supports it. I expect more from academics, though. The author of this article leaves the strong impression that he is an advocate, not a scholar. He seems to have cherry-picked evidence that supports the side he has decided to take and ignored conflicting evidence. This makes me less inclined than I was previously to take seriously anything by Scott Atlas or anything published by the Hoover Institution.

In answer to Rooster's specific challenge to find a single inaccuracy, in one case I can't verify the author's sources and in the other he has left out something that makes what he says seriously misleading.

[DreamStalker]

Why of course!

The name of Rooster's secret cult party is the Cherry Pickers!!

At first I was thinking it might be the Constitutionalists but there is already a party called that I think. Then I thought maybe the Glen Beckers or the Rodeo Clowns ... but yes, the Cherry Pickers is more likely the right one.

BTW - Just for the record, I do not support the Republican party, the Democratic party, Sarah Palin or the Tea Party or any other single party. I think I may be an independent in that I support which ever candidate is likely to support the people rather than inanimate entities like corporations. However, lately those candidates seem to be slim pickings. Maybe I can start a cult too and call it the Slim Pickers.

[DreamStalker]

I forgot to note ... nice work PST.

One other bias that most may not be aware of is the insolation factor (variation of solar radiation over surface of the earth). Vitamin D (or lack of it) has become an increasing factor in cancer development and perhaps the fact that Canada gets less solar radiation and thus less potential for optimal vitamin D levels plays a role in skewing any epidemiological data.

http://www.physorg.com/news162183735.html
http://www.sciencedaily.com/releases/20 ... 081212.htm

I asked my wife to look further into the differences in cancer mortality rates between US and Canada ... she has worked as a cancer registrar for over 20 years and currently works for the CDC through Emory University. She said she would look into it. I'll PM you when she has some thing of interest.

She said to check this site out ...

http://www.cancer-rates.info/naaccr/

[So Well]

I was interested in this article, which I hadn't seen before, when it was first posted, and I started to go through the list of facts with the intention of reading the sources cited.

Thank you PST for taking a shot at researching the "facts".

I try to ignore the juvenile mudslinging that others did (Canadians and Americans). I am getting better at it and know what to skip over in searching for your comments.

As far as what we are doing in the U.S. with the new legislation, I have to quote one of our leaders. She said, as well as I remember, "We have to pass the legislation to find out what is in it."

So I guess we are going to find out bit-by-bit what is in the bill. I was shocked to hear from my accountant this morning that one section of the bill concerns 1099s. His understanding is that I will have to start creating 1099s for everything over $600, even credit card charges. That is going to be a significant unproductive effort that is forced on me. It is an anti-job clause.

I would say, "What the h**** do 1099s have to do with healthcare?" But I am afraid I know.

[DreamStalker]

I was interested in this article, which I hadn't seen before, when it was first posted, and I started to go through the list of facts with the intention of reading the sources cited.

Thank you PST for taking a shot at researching the "facts".

I try to ignore the juvenile mudslinging that others did (Canadians and Americans). I am getting better at it and know what to skip over in searching for your comments.

As far as what we are doing in the U.S. with the new legislation, I have to quote one of our leaders. She said, as well as I remember, "We have to pass the legislation to find out what is in it."

So I guess we are going to find out bit-by-bit what is in the bill. I was shocked to hear from my accountant this morning that one section of the bill concerns 1099s. His understanding is that I will have to start creating 1099s for everything over $600, even credit card charges. That is going to be a significant unproductive effort that is forced on me. It is an anti-job clause.

I would say, "What the h**** do 1099s have to do with healthcare?" But I am afraid I know.

Anti-job? ... Obviously it is to tighten the net on tax evadors ... is that what you are afraid of?

But I'll ignore your juvenile comments and again urge everyone to take a look at the "graphics" that the anti-government free-market folks can't bear to look at because it arouses their conscience ... take a look at the "facts".

http://news.yahoo.com/s/ap/20100605/ap_ ... ird_images

[PST]

Thank you PST for taking a shot at researching the "facts".

I try to ignore the juvenile mudslinging that others did (Canadians and Americans). I am getting better at it and know what to skip over in searching for your comments.

I trust that it wasn't a "shot" at me putting "facts" in quotation marks. I put some effort into trying to figure out where Atlas was getting his facts and digging out what the purported sources really say. I think writers on both sides of this issue and many others get away with way to much. Real peer-reviewed research gets cite-checked, but out in the world of commentary, in the rare event someone actually uses footnotes, there is a tendency to take for granted that the source supports the statement. In any event, few bother to check.

I will confess to one juvenile aspect to my post. I took a little extra, unnecessary shot at the Hoover Institution in the hope that if anyone here felt compelled to defend its honor he would be drawn into justifying Atlas's use of evidence.

As far as what we are doing in the U.S. with the new legislation, I have to quote one of our leaders. She said, as well as I remember, "We have to pass the legislation to find out what is in it."

Are you implying that the bill is so complicated that even it's adherents didn't know what was in it? I don't think that is a fair reading of what Pelosi was saying. Her remarks are here: http://www.speaker.gov/newsroom/pressreleases?id=1576 . In context, I think her meaning was a lot closer to "The proof of the pudding is in the eating." Pass the bill and we'll learn who was right about it.

I found the passage of the PPAC Act to be the most transparent legislative process I've ever seen. It was a real civics lesson, not so much because of the virtue of its proponents, but because the internet made it possible to follow each step in as much detail as anyone could possibly want. Each committee draft and each amendment could be downloaded. Anyone could read and compare the versions. While the big media ignored the substance -- it was interested only in the politics -- there were plenty of specialists (the Kaiser Family Foundation comes to mind) with analysis and commentary of each revision. Then the final drama of parliamentary procedure was played out on CSPAN for all to see. I know that purported secrecy was a big point of attack, but it followed the usual Rovian pattern of trying to flip the facts. Compared to any major legislation I can think of over the last 40 or 50 years, I was able to find out more, earlier, about what this bill said, and follow its progress through Congress in a way never before possible. Nothing in it should come as a surprise.

[DreamStalker]

Rove flips facts? (and here I thought only cherry pickers did that )



Just a little juvenility for the ignorant.

[So Well]

I trust that it wasn't a "shot" at me putting "facts" in quotation marks.

Not at all. It was just echoing your shot at Atlas's questionable "facts".

However, I wish you had not posted those full comments by Pelosi. A twinge of pain hit me when I read this,

Health insurance reform is about jobs. This legislation alone will create 4 million jobs, about 400,000 jobs very soon.

We already know our medical spending in the U.S. is huge. Now we are going to put four million more people to work in the field? Someone will have to pay for those four million people. That is very simple math and deduction to say the costs will continue to explode.

The population will spend more and more on health, so this means they have less and less to spend on recreation, transportation, shelter, food, education and many other good things in life.

I do agree with Pelosi on prevention as opposed to treatment. However, government programs will not get us there. That takes individual efforts to get off our butts and improve our diet.

I was involved for many years with a company that heavily promoted the health of their employees through exercise and diet programs. They had an equipment room with the best exercise equipment that could be bought, subsidized employees gym memberships, even brought in a yoga instructor three times per week, and ran all types of educational programs on diet, exercise and health topics.

But observing the employees, you saw about the same results as the general population. Most of the people who took advantage of the programs were people who already exercised frequently and controlled their diet. Then there was a group who gave a minor effort for the programs, and finally the largest group did nothing.

It takes individual effort to get out of the sedentary, overeating lifestyle. I take care of that on my own and my neighbor should too if he so chooses.

[WearyOne]

However, I wish you had not posted those full comments by Pelosi. A twinge of pain hit me when I read this,

Health insurance reform is about jobs. This legislation alone will create 4 million jobs, about 400,000 jobs very soon.

We already know our medical spending in the U.S. is huge. Now we are going to put four million more people to work in the field? Someone will have to pay for those four million people. That is very simple math and deduction to say the costs will continue to explode.

Another possibility, and not saying this will happen here, but is there ever a time when an industry or the government has said they're creating x-number of new jobs that that number was anything close to correct in itself, or that in the process of the change that creates the new jobs that who knows how many already in that field lose their jobs.

The population will spend more and more on health, so this means they have less and less to spend on recreation, transportation, shelter, food, education and many other good things in life.

I do agree with Pelosi on prevention as opposed to treatment. However, government programs will not get us there. That takes individual efforts to get off our butts and improve our diet.

I was involved for many years with a company that heavily promoted the health of their employees through exercise and diet programs. They had an equipment room with the best exercise equipment that could be bought, subsidized employees gym memberships, even brought in a yoga instructor three times per week, and ran all types of educational programs on diet, exercise and health topics.

But observing the employees, you saw about the same results as the general population. Most of the people who took advantage of the programs were people who already exercised frequently and controlled their diet. Then there was a group who gave a minor effort for the programs, and finally the largest group did nothing.

It takes individual effort to get out of the sedentary, overeating lifestyle. I take care of that on my own and my neighbor should too if he so chooses.

So Well, wonderful post.

[DreamStalker]

I trust that it wasn't a "shot" at me putting "facts" in quotation marks.

Not at all. It was just echoing your shot at Atlas's questionable "facts".

However, I wish you had not posted those full comments by Pelosi. A twinge of pain hit me when I read this,

Health insurance reform is about jobs. This legislation alone will create 4 million jobs, about 400,000 jobs very soon.

We already know our medical spending in the U.S. is huge. Now we are going to put four million more people to work in the field? Someone will have to pay for those four million people. That is very simple math and deduction to say the costs will continue to explode.

The population will spend more and more on health, so this means they have less and less to spend on recreation, transportation, shelter, food, education and many other good things in life.

I do agree with Pelosi on prevention as opposed to treatment. However, government programs will not get us there. That takes individual efforts to get off our butts and improve our diet.

I was involved for many years with a company that heavily promoted the health of their employees through exercise and diet programs. They had an equipment room with the best exercise equipment that could be bought, subsidized employees gym memberships, even brought in a yoga instructor three times per week, and ran all types of educational programs on diet, exercise and health topics.

But observing the employees, you saw about the same results as the general population. Most of the people who took advantage of the programs were people who already exercised frequently and controlled their diet. Then there was a group who gave a minor effort for the programs, and finally the largest group did nothing.

It takes individual effort to get out of the sedentary, overeating lifestyle. I take care of that on my own and my neighbor should too if he so chooses.

Wait. First you fear the bill because it is "anti-job" and then you twinge becuase it will put four million more people to work in the field? Please, show the "facts".

Then this company you were involved with buys the best exercise equipment that could be bought and then goes and subsidizes employees gym memberships? What company idiot came up with those conflicting programs?

Dude. That is one polarized world you live in.

What a doubtful post.