Fiscal Cliff

That's actually pretty close to reality in most other OECD countries. I'm tempted to say "all", but I'll hedge just to be safe. The International Monetary Fund discussed it a few years ago in one of its World Economic Reports. I can dig it out if Merry Andrew's statement really seems that unrealistic to you.

If it doesn't, the next question becomes, what's so different about the US? people in America get sick the same way they do in any other country. When that happens, Americans need the same medicines, surgeries, and cures as people in any other country. But Americans insure themselves against against this financial risk in a substantially different way than citizens of other countries do. So if Americans pay absurdly much more for coverage that is, charitably put, no better than it is in the rest of the developed world, why shouldn't we suspect America's health-insurance system to be the culprit?

We also have a regulatory burden that surpasses most other countries. Americans want their healthcare to be perfectly safe.
The lead time for drugs to become available here is five years longer than in most other countries. And, they want their doctors to be perfect too.

Frank, I suggest you get out your phone book and start calling a few local internists, presenting yourself as a candidate new patient. Not the questions they ask about your insurance coverage and the responses if you say medicare only. Then I suspect you will have a better idea of the reality.

Countries and cultures are different from one another. Compared to our European friends with well-developed public insurance and social welfare programs, we have much higher immigration (a good thing in my view), greater population growth (or lately some growth at all as our European friends are now starting to see population declines), and much less developed and accepted government control of daily life. There are reasons the United States has been so relatively slow and reluctant to accept such things, and they are associated with our different histories and adaptations to different circumstances. There are also differences within Europe. Apparently the Danes and the Germans are a good deal better at operating such systems than are, for example, the Greeks or the Italians. All of these countries are a good deal more homogenious (within theiur borders) than are we: cultural norms are nearly universal and immigration is, in comparison to ours, very highly restricted (except within the EU). They all have traditions of authoritarian governments, and most of them have been through often bloody revolutions to limit their excesses: we haven't.

I don't contest the statistics often cited to demonstrate the supposed superiority of their systems, but do not assume they would work the same way here. Moreover, I'm also aware that there are many important elements left out in these statistical comparisons, and among them is the simple mathematical observation that the easiest and cheapest way to maximize (say) life expectancy is to deny care (and cost) to those who are sick and, as a result, have the lowest life expectancy. If one is willing to be but a part of the herd that may be OK. I'm not a great fan of herds, and won't willingly accept being forced to become one.

This is also in part a response to Thomas' question above.

Rather than just get into an argument on this, I am going to limit my response to just your first paragraph.

You wrote:



Why would you suggest that? I do not exist with ONLY Medicare...and I suspect neither do you. I happen to have supplemental insurance through AARP. I live barely above the poverty level, but I can certainly afford that...and surely you can.

Any internist around here would take me as a patient under those conditions.

Are you meeting the resistance you say you are meeting because you are testing whether you can get a doctor ONLY with Medicare?

If so...why?

It's true that more doctors are refusing Medicare patients, but I'm not aware of any community where there is wholesale refusal. If there are, I would like to see any study or polls on this subject.

george, you're several generations out of date about immigration. France 11.1% immigrant, US12.5% immigrant, Germany 18.5% immigrant. It's been going on since the '40s. And a large percentage of immigrants are from Islamic countries (N. Africa, Turkey amongst them), so that doesn't work as an explanation. they're as disparate as we are. Greece's and Italy's health plans work as well as other countries, and cost about the same (i.e. half of what we pay). If they had to pay our private costs they'd have foundered decades ago. It;s aspects of the rest of their economies that are screwing them up. No, for whatever reason, conservatives demand a system that can cut off their insurance at the whim of private corporate bureaucracies and charge us twice as much as the rest of the world. in a system that is much less accountable to the people it serves than single-payer plans are.

You are confusing the cumulative effects of decades of European immigration with ongoing rates. You can easily verify the correct information in the CIA World factbook or many other sources.

It's true that the Germans have grown to depend on their former Turkish gestarbiters, anf the French are stuck with a lot of Algerians as a result of their post colonial struggles (same with the Dutch and Indonesians). The whole EU also has a problem of illegal and quasi legal immigrants mostly from the Middle East and North Africa. However, none of this approaches the current and cumulative relative rates of legal and illegal immigration to this country. In addition I believe you are including internal migration within the EU in your numbers, something which I noted and excluded from the comparison.

Finally most European countries work hard to preserve their own traditional cultural norms, resisting the two way effects of assimilation - the French and Germans especially. The British do appear to be exceptions in this area.

All these differences are indeed just as I described them.

I think you also harbor a number of illusions about company provided health insurance. It is a simple fact that the pooled liability asperct of insurance is profoundly changed in the information age. Our company employs mostly professional engineers, geologists and scientists. Our insurance plans are fairly typical with several options including Blue Cross/Blue Shield, an intermediate option, and HMOs, all including a component of employee payment. Our company premiums for this coverages from the conventional insurers are simply our recent claims plus a fixed administrative fee, which has ranged from 9% to 13% over the past several years on an annual basis. We do keep note of our costs and apply some degree of market feedback in provider selection. That sure doesn't appear to validate the standard "progressive" propaganda about insurers. (I do believe a lot of improvement could be achieved by licensing nationwide insurance standarda, enabling much greater competition in thius area.)

Additionally, a good deal of the often goofy inflation of medical and hospital charges for various services are side effects of mandated capped fees by government mangate and insurer contracts. If Medicare authorizes a high payment for anything, the univeral charge for it will quickly rise to that level. If, conversely they suppress the max payment to something that doesn't cover the provider's costs, he will quickly raise other prices. Much of this stuff would disappear quickly in a free market.

There are more values than simply total cost involved in this issue. Individual freedom is one. Food is even more essential to life than medicine, and on average it costs about as much as health care.. All of the arguments you put forward for public health care could apply equally as well for food. Perhaps we should create a system of govermnment operated or financed cafeterias and require everyone to eat there. How would you feel about that?

really? the experience in Canada is that drugs that are approved for use in the U.S. are often not approved until testing here is completed - sometimes many years later

I don't know all the facts but there may be some confusion here between the approval for use of some drugs and their selection for inclusion in the formulary of available drugs by the Public Health service.

I am aware that for various reasons (both good and bad) our FDA approval for use process is generally a lot slower than in other countries. In addition I believe that in Canada the Public Health service is the exclusive or priomary buyer of medical drugs from the makers, giving it enormous buying leverage, sometimes including forced production of generic substitutes.

How do the others cope George? We all know how demanding engineers, geologists and scientists can be regarding the services they need to emphasise their special status.

I think you are the biggest snob on A2K old boy.



It might become necessary at some point. It has advantages as you well know. My guess is that your eating is more or less disconnected from preparation and washing up.

Hey, I like Cyclo. I'm so glad he's here and talking.
He is way more debate rigored (another new word) than I am and I'm countlessly both expecting and pleased with seeing his takes.

I like you, Finn, too, when you are less into your castigating mode about evil liberals roaming the earth.

Agreeing? Not usually, but I know I've agreed with you some bunch of times. Maybe I need to do some kind of signal so they get counted.
Swastikas are out. I'll have to consider possible signals.

Ok, look, I was weeks behind.

Whatever.

Engineers, Geologists & Scientists are all working stiffs. You are confusing us with Lawyers & Bankers. The point was we don't have any labor union involvement in our health care plans.

You appear to be carrying a lot of residue from the past in your kit. Too bad.

"Appear to be" ?? I can handle that.

In a "free market", a mystical concept, those needing medical assistance would have to shift for themselves.

It's odd how the expression "appear to be" is perceived to mean "are" to inattentive readers in order for it to be expected to have any meaning.

Good for you. My use of the phrase was merely an acknowledgment of the fact that I can't possibly know what your real motivations are - any more than you can know mine. You should try it some time.



Agreed. However we have ample means, both governmental and private, for mitigating those effects. Moreover, such initiatives, when they arise from individuals or groups of them, are good for the souls of those involved.

Would you like mandatory use of government operated cafeterias? With a universal monopoly they could surely lower the cost. Then they could go on to nationalizing the Pubs.

I think, too, that drugs are approved faster in the USA than in many other countries - at least, in Europe it takes mostly longer (And we have got something similar to the FDA, but 146 different insurers in the mandatory health insurance and 43 private health insurance companies offering their service all over Germany [plus some dozen regional insurers] ....)

I'm not sure about the approval process in Canada but, you're right, even on the diagnostic side (which runs parallel to the pharmaceutical side) we'd always submitted for Canadian approval after we were on market in the US. The regulatory burden in Europe and Japan was much less than in the US. Then, the ICH guidelines were supposed to standardize clinical trial guidelines so that a single set of trials could satisfy all regulatory agencies. For some reason the FDA is wary of accepting data generated outside of the US resulting in multiple additional evaluations. That may have improved since I left the biz.

Another problem is the delay in getting generics on-market. Plavix is a prime example of what I believe to be classic crony capitalism between big pharma and the feds.

The European Medicines Agency (EMEA) approved it in 1998, because it's (slightly) different to the original and thus wasn't approved as a generic but a new drug.

My neurologist keeps prescribing it saying, "It's due to become available as a generic in a few months." That's a joke. They strike another deal with the FDA to do another study in exchange for keeping their cash cow to themselves.

Edit: apparently FDA approved a generic in May 2012.

http://www.medicalnewstoday.com/articles/245615.php