DebateGate
General Category => 3DHS => Topic started by: _JS on October 15, 2007, 01:13:16 PM
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Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care
May 15, 2007 (updated May 16, 2007) | Volume 59
Authors:Karen Davis, Ph.D., Cathy Schoen, M.S., Stephen C. Schoenbaum, M.D., M.P.H., Michelle M. Doty, Ph.D., M.P.H., Alyssa L. Holmgren, M.P.A., Jennifer L. Kriss, and Katherine K. Shea
Editor(s):Deborah Lorber view citation
Link (http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=482678)
Overview
Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries. This report?an update to two earlier editions?includes data from surveys of patients, as well as information from primary care physicians about their medical practices and views of their countries' health systems. Compared with five other nations?Australia, Canada, Germany, New Zealand, the United Kingdom?the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives. The U.S. is the only country in the study without universal health insurance coverage, partly accounting for its poor performance on access, equity, and health outcomes. The inclusion of physician survey data also shows the U.S. lagging in adoption of information technology and use of nurses to improve care coordination for the chronically ill.
Executive Summary
The U.S. health system is the most expensive in the world, but comparative analyses consistently show the United States underperforms relative to other countries on most dimensions of performance. This report, which includes information from primary care physicians about their medical practices and views of their countries' health systems, confirms the patient survey findings discussed in previous editions of Mirror, Mirror. It also includes information on health care outcomes that were featured in the U.S. health system scorecard issued by the Commonwealth Fund Commission on a High Performance Health System.
Among the six nations studied?Australia, Canada, Germany, New Zealand, the United Kingdom, and the United States?the U.S. ranks last, as it did in the 2006 and 2004 editions of Mirror, Mirror. Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last on dimensions of access, patient safety, efficiency, and equity. The 2007 edition includes data from the six countries and incorporates patients' and physicians' survey results on care experiences and ratings on various dimensions of care.
The most notable way the U.S. differs from other countries is the absence of universal health insurance coverage. Other nations ensure the accessibility of care through universal health insurance systems and through better ties between patients and the physician practices that serve as their long-term "medical home." It is not surprising, therefore, that the U.S. substantially underperforms other countries on measures of access to care and equity in health care between populations with above-average and below average incomes.
With the inclusion of physician survey data in the analysis, it is also apparent that the U.S. is lagging in adoption of information technology and national policies that promote quality improvement. The U.S. can learn from what physicians and patients have to say about practices that can lead to better management of chronic conditions and better coordination of care. Information systems in countries like Germany, New Zealand, and the U.K. enhance the ability of physicians to monitor chronic conditions and medication use. These countries also routinely employ non-physician clinicians such as nurses to assist with managing patients with chronic diseases.
The area where the U.S. health care system performs best is preventive care, an area that has been monitored closely for over a decade by managed care plans. Nonetheless, the U.S. scores particularly poorly on its ability to promote healthy lives, and on the provision of care that is safe and coordinated, as well as accessible, efficient, and equitable.
For all countries, responses indicate room for improvement. Yet, the other five countries spend considerably less on health care per person and as a percent of gross domestic product than does the United States. These findings indicate that, from the perspectives of both physicians and patients, the U.S. health care system could do much better in achieving better value for the nation's substantial investment in health.
Key Findings
Quality: The indicators of quality were grouped into four categories: right (or effective) care, safe care, coordinated care, and patient-centered care. Compared with the other five countries, the U.S. fares best on provision and receipt of preventive care, a dimension of "right care." However, its low scores on chronic care management and safe, coordinated, and patient-centered care pull its overall quality score down. Other countries are further along than the U.S. in using information technology and a team approach to manage chronic conditions and coordinate care. Information systems in countries like Germany, New Zealand, and the U.K. enhance the ability of physicians to identify and monitor patients with chronic conditions. Such systems also make it easy for physicians to print out medication lists, including those prescribed by other physicians. Nurses help patients manage their chronic diseases, with those services financed by governmental programs.
Access: Not surprising?given the absence of universal coverage?people in the U.S. go without needed health care because of cost more often than people do in the other countries. Americans were the most likely to say they had access problems related to cost, but if insured, patients in the U.S. have rapid access to specialized health care services. In other countries, like the U.K and Canada, patients have little to no financial burden, but experience long wait times for such specialized services. The U.S. and Canada rank lowest on the prompt accessibility of appointments with physicians, with patients more likely to report waiting six or more days for an appointment when needing care. Germany scores well on patients' perceptions of access to care on nights and weekends and on the ability of primary care practices to make arrangements for patients to receive care when the office is closed. Overall, Germany ranks first on access.
Efficiency: On indicators of efficiency, the U.S. ranks last among the six countries, with the U.K. and New Zealand ranking first and second, respectively. The U.S. has poor performance on measures of national health expenditures and administrative costs as well as on measures of the use of information technology and multidisciplinary teams. Also, of sicker respondents who visited the emergency room, those in Germany and New Zealand are less likely to have done so for a condition that could have been treated by a regular doctor, had one been available.
Equity: The U.S. ranks a clear last on all measures of equity. Americans with below-average incomes were much more likely than their counterparts in other countries to report not visiting a physician when sick, not getting a recommended test, treatment or follow-up care, not filling a prescription, or not seeing a dentist when needed because of costs. On each of these indicators, more than two-fifths of lower-income adults in the U.S. said they went without needed care because of costs in the past year.
Healthy lives: The U.S. ranks last overall with poor scores on all three indicators of healthy lives. The U.S. and U.K. had much higher death rates in 1998 from conditions amenable to medical care?with rates 25 to 50 percent higher than Canada and Australia. Overall, Australia ranks highest on healthy lives, scoring first or second on all of the indicators.
Summary and Implications
Findings in this report confirm many of the findings from the earlier two editions of Mirror, Mirror. The U.S. ranks last of six nations overall. As in the earlier editions, the U.S. ranks last on indicators of patient safety, efficiency, and equity. New Zealand, Australia, and the U.K. continue to demonstrate superior performance, with Germany joining their ranks of top performers. The U.S. is first on preventive care, and second only to Germany on waiting times for specialist care and non-emergency surgical care, but weak on access to needed services and ability to obtain prompt attention from physicians.
Any attempt to assess the relative performance of countries has inherent limitations. These rankings summarize evidence on measures of high performance based on national mortality data and the perceptions and experiences of patients and physicians. They do not capture important dimensions of effectiveness or efficiency that might be obtained from medical records or administrative data. Patients' and physicians' assessments might be affected by their experiences and expectations, which could differ by country and culture.
The findings indicate room for improvement across all of the countries, especially in the U.S. If the health care system is to perform according to patients' expectations, the nation will need to remove financial barriers to care and improve the delivery of care. Disparities in terms of access to services signal the need to expand insurance to cover the uninsured and to ensure that all Americans have an accessible medical home. The U.S. must also accelerate its efforts to adopt health information technology and ensure an integrated medical record and information system that is accessible to providers and patients.
While many U.S. hospitals and health systems are dedicated to improving the process of care to achieve better safety and quality, the U.S. can also learn from innovations in other countries?including public reporting of quality data, payment systems that reward high-quality care, and a team approach to management of chronic conditions. Based on these patient and physician reports, the U.S. could improve the delivery, coordination, and equity of the health care system by drawing from best practices both within the U.S. and around the world.
Citation
K. Davis, C. Schoen, S. C. Schoenbaum, M. M. Doty, A. L. Holmgren, J. L. Kriss, and K. K. Shea, Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care, The Commonwealth Fund, May 2007
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Hillary will, once again, attempt to fix this. A friend of mine on the DNC indicates that is one of her primary missions once in office.
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And yet ironically, I'll still chose our system over ANY Federally run universal system
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And yet ironically, I'll still chose our system over ANY Federally run universal system
That's not irony.
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don`t forget heathcare in the U.S. is designed for people to seek help elsewhere for minor problem.
ex. if you get a severe rash .it will most likely cost you 2 days work to get treatment.
1day to get a referal 2nd to finally see a dermatologist.
this kind of stuff deters people from seeking medical help as much as possible
which is kinda clever
it means insurance saves money by not treating as many people.
and after hours treatment cost more.
big money
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And yet ironically, I'll still chose our system over ANY Federally run universal system
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They live longer in France, and their healthcare costs a lot less as well.
Your vision is, as ever, faulty, sirs.
Every year, "your" system is more expensive and fewer and fewer people can afford it. Eventually even you, as privileged as you are, will find it unaffordable, and you will have no choice: it will be universal healthcare or nothing at all.
The Postoffice, a federally run entity, is generally cheaper and more convenient than FedEx or UPS, with thousands more pickup points. The premium next day service is quite competitive with FedEx.
The same sort of people deliver the mail no matter which you choose. You are quibbling only over who the boss is and how much of a bite goes for profit, and how hard it might be to fire the rascals in charge. If they are government employees, this would be easy, if they are corporate types, MUCH harder. Observe how Roger Smith ran GM for year after year, every year GM made worse and worse cars and every year Ol' Rodge got a raise, until he retired his fat, freckled self on a huge pension.
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well if you think about it
it`s more a economic class situaition
people with jobs that has good benifits package are more likely to vote
so universal healthcare does not benefit them and not get thier votes
people who don`t have good benefits are less likely to vote so universal heathcare will get less votes
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And yet ironically, I'll still chose our system over ANY Federally run universal system
That's not irony.
Sure it is, since even with the apparent flaws of our system, I'll take it over the exponentially worse flaws of a Federally run system
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And yet ironically, I'll still chose our system over ANY Federally run universal system
That's not irony.
Sure it is, since even with the apparent flaws of our system, I'll take it over the exponentially worse flaws of a Federally run system
No, that isn't irony at all.
Gads, it really is true that Americans don't understand irony.
You might call that counterintuitive, but it has nothing to do with irony.
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Whatever you say, Js ::)
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One of the definitions of irony is "an outcome of events contrary to what was, or might have been, expected."
So, had someone expected people like to sirs to accept universal health care after reading this article, and he does not, then it is irony.
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That was kinda my train of thought Ami, but apparently I'm not able to grasp the complexity of true irony ;)
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So, had someone expected people like to sirs to accept universal health care after reading this article, and he does not, then it is irony.
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I would not expect Sirs to accept universal health care under any circumstances.
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As for irony, I don't think that it has been sufficiently explained.
Here are some illustrations of irony: http://www.cvco.org/education/etohc/irony.htm
Irony is generally amusing in some way. Such as in these examples:
Situational irony: some examples, to wit:
Definition: irony of a situation is a discrepancy between the expected result and actual results when enlivened by 'perverse appropriateness.'.
Examples:
In Noel Coward's Oscar-winning Cavalcade, extremely happy honeymooners wonder how long their joy will last. The camera pulls back to reveal a life preserver stenciled “RMS Titanic.”
A situation immortalized in O. Henry's story The Gift of the Magi, in which a young couple is too poor to buy each other Christmas gifts. The man finally pawns his heirloom pocket watch to buy his wife a set of combs for her long, beautiful, prized hair. She, meanwhile, cuts off her treasured hair to sell it to a wig-maker for money to buy her husband a watch-chain. The irony is twofold: the couple, having parted with their tangible valuables, is caused by the act to discover the richness of the intangible.
When John Hinckley attempted to assassinate President Ronald Reagan, all of his shots initially missed the President; however a bullet ricocheted off the bullet-proof windows of the Presidential limousine and struck Reagan in the chest. Thus, the windows made to protect the President from gunfire were partially responsible for his being shot.
Rock trio ZZ Top are famously associated with the chest-length beards of guitarist Billy Gibbons and bassist Dusty Hill. The group's drummer, who only has a mustache, happens to be named Frank Beard.
A man jumps over a giant waterfall e.g. Niagara Falls in a barrel and survives, only to take a cleanup shower where he slips on the soap and dies from trauma.
Arnold Schwarzenegger, an actor famous for his violence in film, campaigning against violence in video games in general - which ironically includes those featuring his own characters
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<<One of the definitions of irony is "an outcome of events contrary to what was, or might have been, expected.">>
That definition was 5th out of 8 in Random House Unabridged Dictionary 2nd Edition and none of the other definitions would have characterized sirs' situation as irony. The commonest definition of irony was the first, which was the use of words to convey the exact opposite of their literal meaning, as for example, saying "How nice" when someone throws horse shit at your car.
Just as I wouldn't expect sirs to have enough sense to come in out of the rain in a thunderstorm, so I wouldn't expect him to avail himself of socialized medicine if every study in the world showed it to be superior in every respect to private health care, so there is nothing at all ironic in sirs' declaration, even using the obscure definition of "irony" that you pulled out of fifth place in the dictionary.
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That definition was 5th out of 8 in Random House Unabridged Dictionary 2nd Edition
It was the second definition in the American Heritage Dictionary.
Also, according to Bartleby's usage notes:
By contrast, 73 percent [of the Usage Panel] accepted the sentence Ironically, even as the government was fulminating against American policy, American jeans and videocassettes were the hottest items in the stalls of the market, where the incongruity can be seen as an example of human inconsistency.
I postulate that the sentence described in this usage note is functionally similar to Sirs' quote earlier in the thread.
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The US government being in charge of health care for Americans may not be the same situation as the government of France being in charge of health care for the French.
If ,after the US government assumes responsibility for Health care , they do the job no better than they manage water projects, would that be ironic or predictable?
If the government of France runs low on cash available for health care and begins to ration care in a displeasing manner just as we begin to emulate them would that be Irony or not?
If the number of foreigners who come to the US to practice medicine and the number of foreigners who come here to have Medicine practiced on them is any indication , then there is some advantage to our system that some people can perceive.
Who exactly are the underserved?
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<<It was the second definition in the American Heritage Dictionary.>>
Out of how many entries?
<<...73 percent [of the Usage Panel] accepted the sentence Ironically, even as the government was fulminating against American policy, American jeans and videocassettes were the hottest items in the stalls of the market, where the incongruity can be seen as an example of human inconsistency.>>
I'm not sure why this isn't the same as sirs' use of the term, but I have a gut feeling there's a difference. For one thing, the example provides a current of underlying hypocrisy or false pretension - - the government, which supposedly represents the people, is cussing out the Americans while the people themselves are avidly buying into American culture. If the government does in fact represent the people, this would indicate a two-faced and hypocritical nation, denouncing America while buying into it at the same time. More than likely, it indicates that the government does NOT represent the people. The people have no beef with America but their government, which supposedly represents them but obviously doesn't, is busy denouncing America.
The irony is akin to the first definition in the dictionary, words which taken literally are at odds with a reality which the audience understands. "In the name of the [Romanian? Hungarian? Chinese?] nation, we pronounce anathema upon America" while at the same time the "real" Romanian or whatever nation is snapping up everything American it can get its hands on. To have irony, the government speaking has to genuinely believe that it speaks for the nation and the irony lies in the fact that the nation's own actions clearly belie the idea that the government is speaking for it.
Translated to sirs' example, sirs would have to possess a genuine faith in poll results, and then it would be ironic that someone who believes in polls nevertheless acts as if he didn't accept the results. In fact the polls have no effect at all on sirs because sirs is a True Believer in capitalist bullshit - - to someone who "thinks" like sirs, state-run anything (health-care of course included) MUST be ten thousand times inferior to privately-run anything, polls or no polls. So there's nothing ironic in sirs' ignoring the poll because his mind was already made up anyway. The polls couldn't possibly have influenced him.
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<<One of the definitions of irony is "an outcome of events contrary to what was, or might have been, expected.">>
I wouldn't expect sirs to have enough sense to come in out of the rain in a thunderstorm, so I wouldn't expect him to avail himself of socialized medicine if every study in the world showed it to be superior in every respect to private health care, so there is nothing at all ironic in sirs' declaration, even using the obscure definition of "irony" that you pulled out of fifth place in the dictionary.
The problem to that egregiously flawed theory, is that study after study that I've seen, not to mention the practical applications I'm intimately aware of being a healthcare provider demonstrates nothing even remotely approaching superior in ANY respect, outside of providing one peace of mind that "everyone is covered" Damn the repercussions, but at least "everyone is covered"
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Out of how many entries?
Four.
I'm not sure why this isn't the same as sirs' use of the term, but I have a gut feeling there's a difference.
I have a gut feeling that it's not.
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<<The problem to that egregiously flawed theory, is that study after study that I've seen, not to mention the practical applications I'm intimately aware of being a healthcare provider demonstrates nothing even remotely approaching superior in ANY respect, outside of providing one peace of mind that "everyone is covered" Damn the repercussions, but at least "everyone is covered">>
Well, in the first place, my remarks were hypothetical, so there's nothing at all "egregiously flawed" about my theory, which isn't to say that it might or might not be true. It has no "egregious" flaw in it and you have not pointed out any. Even if you saw 10,000 studies all supporting the superiority of private health care, my theory started with the hypothesis "IF every study in the world showed . . . "
Have you ever read another study as detailed as the Romanow Report? And what about the study at the top of this thread? You say you've seen "study after study" but how many studies are you actually referring to, and were they conducted by or on behalf of parties with a vested interest in the status quo?
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<<The problem to that egregiously flawed theory, is that study after study that I've seen, not to mention the practical applications I'm intimately aware of being a healthcare provider demonstrates nothing even remotely approaching superior in ANY respect, outside of providing one peace of mind that "everyone is covered" Damn the repercussions, but at least "everyone is covered">>
Well, in the first place, my remarks were hypothetical,
Yea, I knew that. Point was, REALITY demonstrates studies that debunk much of the nonsense of how great Federally run UHC is supposed to be. It's bovine excrement to think folks like Soros, Gates, Spielberg, and Limbaugh need to be covered with health insurance by MY tax dollars
so there's nothing at all "egregiously flawed" about my theory,
Of course there is, because not only hypothetically, but realistically your position is "egregiously flawed"
Have you ever read another study as detailed as the Romanow Report?
Have you read any studies from the CATO institute
And what about the study at the top of this thread?
What about it? I never said the American Health Care system was perfect. Far from it, and MADE WORSE by ever increasing Federal intervention, waste, & bureacracy. Apparently there's this drive to make our healthcare system as bad as our Public Education system >:(
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In Noel Coward's Oscar-winning Cavalcade, extremely happy honeymooners wonder how long their joy will last. The camera pulls back to reveal a life preserver stenciled ?RMS Titanic.?
Now, that is irony.
What Ami describes is simply incongruity or as I told Sirs - counterintuitive. Perhaps in sloppy English dialogue "irony" has become a synonym for "incongruity" but that really just destroys the literary meaning of the word.
Ironically, Sirs chooses a rotten apple over the many good apples available.
See, that's not irony at all. Misfortune perhaps. Counterintuitive perhaps.
But not irony, Alanis.
Regardless, the article I posted was a serious article on the underperformance of the most expensive healthcare system in the world. Quite simply put, the Europeans and Canadians do it better and for less money, including less administrative costs.
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<<It's bovine excrement to think folks like Soros, Gates, Spielberg, and Limbaugh need to be covered with health insurance by MY tax dollars>>
That's a totally bogus argument. Soros is no more covered by YOUR tax dollars than you are by his. All the tax revenues are pooled. The real issue is whether there should be universality of coverage or a means test. In the long run, the cost of applying a means test to weed out the relatively small portion of those who can afford the procedure is greater than the savings that would be realized by cutting them off.
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<<Of course there is [something egregiously flawed about your theory] because not only hypothetically, but realistically your positionis "egregiously flawed">>
Since my theory was ONLY expressed as a hypothetical, it could neither be flawed nor supported by anything in the real world. There
is no known way to evaluate the "truth" or "falsity" of a hypothesis, because it's not MEANT to be a representation of the real world.
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Question (by MT) <<Have you ever read another study as detailed as the Romanow Report? >>
"Answer" by sirs: <<Have you read any studies from the CATO institute?>>
No comment necessary.
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<<What about [the study at the top of this thread?] I never said the American Health Care system was perfect. >>
That is a typical sirs evasion. The study had absolutely NOTHING to do with the non-issue of whether the American health-care system was perfect or not. The study made careful comparisons between objectively-measured benchmarks of the American health-care system and found them all to be inferior to the performances of the systems of five other countries. Obviously, sirs has no answer to that.
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<< . . . and MADE WORSE by ever increasing Federal intervention, waste, & bureacracy. >>
and the evidence for that is . . . ?
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<< Apparently there's this drive to make our healthcare system as bad as our Public Education system >>
Oh, yes. By the America-haters, undoubtedly.
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Sirs, often uses the Soros, Gates, et al argument. He constantly brings it up to me in any argument on healthcare. Note that he never brings up the multitude of poor and low income folks who would be covered by universal health coverage. Nor does he ever discuss the businesses that very much enjoy that burden being lifted from their backs.
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<<If, after the US government assumes responsibility for Health care , they do the job no better than they manage water projects, would that be ironic or predictable?>>
We can't say, at this point we have no way of knowing how well the U.S. government does on water management; for examples, were the failures of the system unavoidable or preventable? And if the failures were avoidable, would underfunding have been a significant cause of failure, and are the costs of that failure worth the pain of a tax increase to ensure that it doesn't happen again or not?
Do you have any reason to believe that the U.S. government would be any worse at managing health care than the governments of Canada or any of the other countries in the survey, which by virtually all objectively measured benchmarks had out-performed the U.S. system and at a lower per-capita cost? And if you DO believe that the U.S. government would be worse than all those other governments at managing health-care, to what cause would you attribute such inferiority?
<<If the government of France runs low on cash available for health care and begins to ration care in a displeasing manner just as we begin to emulate them would that be Irony or not?>>
What would really be ironic would be to find that after years of disrespecting the French, Americans were to find that their government was no better at managing its money than the French government. And doubly ironic that despite the French inability to manage their cash more efficiently, they had STILL managed to deliver more effective health care to their population than the Americans had to theirs, and at a lower per capita cost.
<<If the number of foreigners who come to the US to practice medicine and the number of foreigners who come here to have Medicine practiced on them is any indication , then there is some advantage to our system that some people can perceive.>>
No, because there are no comparative figures on people who go elsewhere for medical treatment. Mexico, India and Cuba come to mind. People come to Canada for treatment.
There are many factors that influence medical tourism, cost, accessibility, advertising, promotion, proximity, shopping opportunities, patient sophistication,presence or absence of family members, etc.
I think for quality of care delivered, a survey which studies the actual care provided and then reports is more reliable than raw numbers of who goes where for treatment. That's just silliness and "wishing away" on your part, plane. A survey specifically examines quality of care and you don't like the results. So you grasp at straws - - how many people come to the U.S. for treatment. You want to do your own survey so you pick a measurement standard that you think will deliver results to you that you want to see. And ignore the survey that actually studies the very questions that need to be answered. Shoddy thinking, my friend. Doubly shoddy because you haven't even got the comparative figures for medical tourism and you never took into account any of the factors other than quality of care which could affect medical tourism numbers.
<<Who exactly are the underserved?>>
That's easy. Pick any benchmark in the survey. Where does the U.S. stand and what's the average score for the other countries surveyed? The percentage by which the U.S. fails to meet the average benchmark status of the other countries in the survey, applied to the general population of the U.S., should give you a rough idea of who the underserved are. If for example the benchmark is how many residents make it to age 90, and it's 50% in the U.S.A. and 60% average in the other countries surveyed, than the underserved, for making it to age 90 in the U.S., would be 10% of the U.S. population. (Hypothetical figures used for the example)
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Sirs, often uses the Soros, Gates, et al argument. He constantly brings it up to me in any argument on healthcare. Note that he never brings up the multitude of poor and low income folks who would be covered by universal health coverage. Nor does he ever discuss the businesses that very much enjoy that burden being lifted from their backs.
a) it's brought up to show just another validation of how idiotic (well intentioned, yes, but idiotic all the same) to the mindset that "well, at least everyone's covered", is
b) poor and low income folks are already covered for emergencies, not to mention the centuries we've had were EVERYONE, not just "the poor and low income folks) had to take care of their own healthcare needs
c) It's NOT the duty of businesses to provide healthcare. Never has been. What it has always been is a benefit for working at x company or y busniess. See, this is where your rhetoric really falls off the tracks. It's here where your message of good intentions mutates into a message of how healthcare is some proverbial right. It's NOT. Someone else's resource is not YOUR right to have. Just because it sounds good "everyone should be covered", doesn't make it a right, nor does it deal with the exponential repercussions of such a system applied to an already increasing mess made largely by Federal intervention
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<<If, after the US government assumes responsibility for Health care , they do the job no better than they manage water projects, would that be ironic or predictable?>>
We can't say, at this point we have no way of knowing how well the U.S. government does on water management; for examples, were the failures of the system unavoidable or preventable? And if the failures were avoidable, would underfunding have been a significant cause of failure, and are the costs of that failure worth the pain of a tax increase to ensure that it doesn't happen again or not?
Do you have any reason to believe that the U.S. government would be any worse at managing health care than the governments of Canada or any of the other countries in the survey, which by virtually all objectively measured benchmarks had out-performed the U.S. system and at a lower per-capita cost? And if you DO believe that the U.S. government would be worse than all those other governments at managing health-care, to what cause would you attribute such inferiority?
\\\\\\\\\\\\\I am a Civil Servant myself. The Civil Service is not as bad as it used to be because we are being more competed against , I remember the days when we had no alternatives and all of our jobs were sinctures.Priviateization has helped the public get its moneys worth and helped us get our act together.//////////////////
<<If the government of France runs low on cash available for health care and begins to ration care in a displeasing manner just as we begin to emulate them would that be Irony or not?>>
What would really be ironic would be to find that after years of disrespecting the French, Americans were to find that their government was no better at managing its money than the French government. And doubly ironic that despite the French inability to manage their cash more efficiently, they had STILL managed to deliver more effective health care to their population than the Americans had to theirs, and at a lower per capita cost.
\\\\\\\\\\\\\\\\\\\\\I have heard several good things about the French system , my point was that their competance doesn't prove ours .///////////////
<<If the number of foreigners who come to the US to practice medicine and the number of foreigners who come here to have Medicine practiced on them is any indication , then there is some advantage to our system that some people can perceive.>>
No, because there are no comparative figures on people who go elsewhere for medical treatment. Mexico, India and Cuba come to mind. People come to Canada for treatment.
There are many factors that influence medical tourism, cost, accessibility, advertising, promotion, proximity, shopping opportunities, patient sophistication,presence or absence of family members, etc.
I think for quality of care delivered, a survey which studies the actual care provided and then reports is more reliable than raw numbers of who goes where for treatment. That's just silliness and "wishing away" on your part, plane. A survey specifically examines quality of care and you don't like the results. So you grasp at straws - - how many people come to the U.S. for treatment. You want to do your own survey so you pick a measurement standard that you think will deliver results to you that you want to see. And ignore the survey that actually studies the very questions that need to be answered. Shoddy thinking, my friend. Doubly shoddy because you haven't even got the comparative figures for medical tourism and you never took into account any of the factors other than quality of care which could affect medical tourism numbers.
\\\\\\\\\ There are Americans who travel to have procedures unavailible in the US or procedures forbidden here , but I am unaware of any traveling for the reson of cost.////////////
<<Who exactly are the underserved?>>
That's easy. Pick any benchmark in the survey. Where does the U.S. stand and what's the average score for the other countries surveyed? The percentage by which the U.S. fails to meet the average benchmark status of the other countries in the survey, applied to the general population of the U.S., should give you a rough idea of who the underserved are. If for example the benchmark is how many residents make it to age 90, and it's 50% in the U.S.A. and 60% average in the other countries surveyed, than the underserved, for making it to age 90 in the U.S., would be 10% of the U.S. population. (Hypothetical figures used for the example)
Americans drive more and skydive more on any risk factor you care to pick Americans have more freedom to be foolish , are risk factors corrected for in these surveys? I drove 500miles Sunday which exposed me to a lot of risk especially as I drove thru Atlanta , I might live longer without the freedom to do so .
Are the Benchmarks strictly the diffrence in medical care? If not then we could already have optimum medical care and die younger anyway.
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a) it's brought up to show just another validation of how idiotic (well intentioned, yes, but idiotic all the same) to the mindset that "well, at least everyone's covered", is
b) poor and low income folks are already covered for emergencies, not to mention the centuries we've had were EVERYONE, not just "the poor and low income folks) had to take care of their own healthcare needs
c) It's NOT the duty of businesses to provide healthcare. Never has been. What it has always been is a benefit for working at x company or y busniess. See, this is where your rhetoric really falls off the tracks. It's here where your message of good intentions mutates into a message of how healthcare is some proverbial right. It's NOT. Someone else's resource is not YOUR right to have. Just because it sounds good "everyone should be covered", doesn't make it a right, nor does it deal with the exponential repercussions of such a system applied to an already increasing mess made largely by Federal intervention
A) I know of no one who claims "at least everyone is covered." Equality is what is important to me. Everyone is covered, from George Soros, to the homeless man on the street corner. I think that is wonderful. There is no "at least" to it.
B) That is quite possibly the dumbest argument I have ever heard in a plethora of really dumb arguments. Emergencies? Yes. If their child has a cleft palate? No. So their child can grow up to live a normal life? No. Not in the United States. Not in Sirs wonderful healthcare system. Why not? Because his middle class lifestyle might be encroached upon.
"not to mention the centuries we've had were EVERYONE, not just "the poor and low income folks) had to take care of their own healthcare needs"
Wow, what a powerful argument. And you know what? Once children worked in factories for 14 to 18 hours a day. Once, the meatpacking industry sent what was left of your spouse's remains to your door in a bag. Once, blacks weren't allowed to be treated in the same hospital and received second class care based only on skin color. Once, the mine owners paid their workers in script that was only redeemable at the stores run by the mine owners.
Honestly Sirs, is that really your argument? Absolutely ridiculous.
C. Welcome to reality where large businesses pay an unbelievable amount of money to private insurance companies to attract a decent workforce. You make your ivory tower comments about rights and what isn't a right, meanwhile companies look at countries where they do not incur this massive expense. Suddenly Canada and other nations look a lot better.
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Ironically, even as the government was fulminating against American policy, American jeans and videocassettes were the hottest items in the stalls of the market, where the incongruity can be seen as an example of human inconsistency.
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How is it in any way inconsistent to despise American foreign policy and simultaneously like Levis and Hollywood films?
We all (most of us, anyway) have houses filled with Chinese goods made in the PRC and yet we do not approve of the government of the PRC.
That isn't actually irony for me.
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<<Americans drive more and skydive more on any risk factor you care to pick Americans have more freedom to be foolish , are risk factors corrected for in these surveys? I drove 500miles Sunday which exposed me to a lot of risk especially as I drove thru Atlanta , I might live longer without the freedom to do so .>>
Now you're getting really crazy. Longevity was only ONE benchmark, the survey had America losing on ALL benchmarks. It's a crappy system, plane, why grasp at straws to defend it? How do you know skydiving is more hazardous than adultery, fucking with another man's wife? Maybe the Latin nations in the survey are living more dangerously than you are. Maybe accidental deaths were already compensated for in the data - - these guys are not amateur pollsters. If you have a beef with the methodology, submit it to them, at this point it remains a poll taken by experts, who probably have figured out and accounted for any factors that pure amateurs like you or I can think of.
If you are going to speculate that random and unknown polling errors could explain why American benchmarks are lower than they should be, it makes just as much sense to speculate that other random and unknown polling errors have actually boosted the American benchmarks higher than they really should be. In the absence of any known polling errors, we have to take the poll results for what they are - - the poll, admittedly not infallible, is a good indicator until proven otherwise that American health care, when compared with other nations' health care, sucks.
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"...In the absence of any known polling errors, we have to take the poll results for what they are - - the poll, admittedly not infallible, is a good indicator until proven otherwise that American health care, when compared with other nations' health care, sucks...."
I don't accept this , the pollster has a lot of advantage if he has an agenda. How could I prove an error or an intentional ommision without the ability to observe the polling itself?
I don't think you accept the CATO institue research results as proof of much , neither sould anyone expect that the results of their favoriate poll will be ultimately persuasive.
Among the six nations studied?Australia, Canada, Germany, New Zealand, the United Kingdom, and the United States?the U.S. ranks last...."
After all this really means that the US ranks seventh in the world , is that so bad?
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Among the six nations studied?Australia, Canada, Germany, New Zealand, the United Kingdom, and the United States?the U.S. ranks last...."
After all this really means that the US ranks seventh in the world , is that so bad?
No. Read the sentence again. It means that out of six nations studied, the United States ranked last. It was not a world study, just a study of six nations. I'm guessing we rank much lower than seventh in a worldwide study.
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Among the six nations studied?Australia, Canada, Germany, New Zealand, the United Kingdom, and the United States?the U.S. ranks last...."
After all this really means that the US ranks seventh in the world , is that so bad?
No. Read the sentence again. It means that out of six nations studied, the United States ranked last. It was not a world study, just a study of six nations. I'm guessing we rank much lower than seventh in a worldwide study.
You mean that six countrys were found that perform better , but this study means nothing more than that in terms of world standing.
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No Plane.
The Study only included the United States and five other countries. In other words n=6.
No where is it indicated that these are the top six countries in the world in healthcare standards. It is a simple comparison of six countries, all of which spend remarkably less on healthcare than the United States as a percentage of GDP.
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<< I don't accept this , the pollster has a lot of advantage if he has an agenda. How could I prove an error or an intentional ommision without the ability to observe the polling itself?>>
When you find an error or omission, get back to me.
<<I don't think you accept the CATO institue research results as proof of much >>
Fair enough, I KNOW that they are biased.
<< neither sould anyone expect that the results of their favoriate poll will be ultimately persuasive.>>
The difference between this and a Cato institute poll is that I KNOW Cato is biased and I don't know anything about the other pollster.
<< After all this really means that the US ranks seventh in the world , is that so bad?>>
Ranking seventh out of seven isn't so bad? That's news to me. If I finished seventh out of seven in a foot-race, would that be so bad? Would I be the loser? Probably not. I'm sure today the school would give me a medal for participation.
I know what. Let's give the U.S.A. a medal for participation in the health-care survey. Everyone's a winner if everyone participates.
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<< I don't accept this , the pollster has a lot of advantage if he has an agenda. How could I prove an error or an intentional ommision without the ability to observe the polling itself?>>
When you find an error or omission, get back to me.
<<I don't think you accept the CATO institue research results as proof of much >>
Fair enough, I KNOW that they are biased.
<< neither sould anyone expect that the results of their favoriate poll will be ultimately persuasive.>>
The difference between this and a Cato institute poll is that I KNOW Cato is biased and I don't know anything about the other pollster.
<< After all this really means that the US ranks seventh in the world , is that so bad?>>
Ranking seventh out of seven isn't so bad? That's news to me. If I finished seventh out of seven in a foot-race, would that be so bad? Would I be the loser? Probably not. I'm sure today the school would give me a medal for participation.
I know what. Let's give the U.S.A. a medal for participation in the health-care survey. Everyone's a winner if everyone participates.
Seventh in the world is not so bad .
Suppose that I wanted to prove that Canada was bad about something , could I find that on that particular subject there were only three nations in the world that did better than Canada and so I would study only those, so that Canada would surely come in last, what have I proven?
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The difference between this and a Cato institute poll is that I KNOW Cato is biased and I don't know anything about the other pollster.
The study was done by the "Commonwealth Fund" which has as it's goal universal health coverage for the US. In other words, they fund projects and research that advance universal health care.
<sarcasm>
No, not biased at all...
</sarcasm>
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<sarcasm>
No, not biased at all...
</sarcasm>
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You should read my posts a little more carefully. I did not claim the poll was unbiased. I specifically stated that I didn't know where it was coming from.
Now that both polls appear to be coming from opposite POVs, I suppose they each have to be examined on their own merits.
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You should read my posts a little more carefully.
You might be able to buy a sense of humour at Walmart. I'm pretty sure Sears has them as well.
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Oh no, I wanna know where you bought yours.
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Oh no, I wanna know where you bought yours.
Original equipment.
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Came with the Cracker Jacks
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OK, I walked right into that one.
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Just thought about my Canadain esteemed comrade just this morning as I was watching Forever Knight. It must have been filmed in Canada as the police display Canadian uniforms, etc.
I may be consulting with a Canadian military unit later this year. Perhaps we'll get together for a cold one.
The Canadians have well-trained, if smallish, marine units. Well-maintained equipment. You can always tell a great deal about a unit when you see how well they maintain their equipment. The only negative is that they tedn ot use outdated equipment. Probably a monetary issue.
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did you see moonlight?
it`s a lamer version of forever knight
cbs has no shame
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It IS Forever Knight Lite.
Too bad, too, since CBS has a much larger budget than Forever Knight ever did.