Deinonychus antirrhopus

A significant part of our healtcare problem is exactly that, Medicare has been reducting its payments for years to lower costs. in turn the Drs, hospitals, etc., are increasing the prices they charge private providers to offset the cut in Medicare payments.

As for the lead time on MRIs, I had a rather trivial knee injury (capillary hemorrhage inside the bursa) but the surgeon suspected I also had cartilage damage. There was almost a week's wait for the MRI, but that was before a private for-profit imaging center opened in Milwaukee. The arthroscopic surgery was deemed optional, but could have been done within a month for a copay (against relatively crummy insurance) of under $1000.

It's interesting though that in general, the Canadian health care system manages to allow Canadians a longer average lifespan than Americans.

A socialized medical system has some advantages.

1. the non-insured aren't beggared (or just plain die) in the event of medical problems. They also receive earlier care which often prevents expensive care later.


2. there is greater freedom in the economy because workers don't have to worry about losing medical insurance when changing/leaving jobs.


3. very few can "allow Grandma to die" when intensely expensive medical procedures which will do almost nothing to further either quality or length of life are available. In a socialized medical system, when you are told "there is nothing that can be done", this might not be technically true, but is enough to allow families to accept the inevitable without guilt and without wasting hundreds of thousands of dollars.

I strongly suspect that we have reached a point of diminshing returns for medical expenditures. i.e. a lot of (American) money will be spent for very little gain in quality or length of life. Obviously from an economic rationalist point of view, it makes sense to spend every penny you own to have any possibility of increase of life, but society doesn't really benefit. Socialized medical schemes can control an impulse that might otherwise economically undermine society.

Tom,

Actually the average life span is not that significant. I've looked at some data on this and the differences just aren't that big on average. I suspect that there might be differences due to other variables (such as how much do Canadians smoke and how over weight are they vs. Americans). For example, Germany actually has the government paying for more medical care (both in total expenditures and as a percentage of government expenditures of the total), but has lower female life expectancy. Similarly with Denmark, Iceland, Norway, and Luxemborg.

The average life span in countries that have more than 50% of their medical care expenditures covered by the government have an average life expectency of about 80.5 for women and 74.3 for men. The U.S. has ALEs (average life expectancy) of 79.4 and 73.9 respectively, not all that much.

The only place there has a clear cut definitive difference is in infant mortality.

the non-insured aren't beggared (or just plain die) in the event of medical problems. They also receive earlier care which often prevents expensive care later.

While financial problems could occur due to medical illness, the death thing is an over-wrought hysteria that simple is not true.

there is greater freedom in the economy because workers don't have to worry about losing medical insurance when changing/leaving jobs.

True, but the same thing could be accomplished here in the U.S. quite easily. Allow people to purchase health insurance in a manner similar dependent care. Many companies allow employees to pay for dependent care with pre-tax dollars. Allowing for medical expenditures to be non-taxed would remove the big advantage of having an employer pay for it. Further, once those expenditures are coming directly from the consumers pocket it might induce them to go for coverage that is not complete. That is if I am healthy I might opt for catastrophic coverage, but pay for doctor's visits out of my own pocket.

very few can "allow Grandma to die" when intensely expensive medical procedures which will do almost nothing to further either quality or length of life are available. In a socialized medical system, when you are told "there is nothing that can be done", this might not be technically true, but is enough to allow families to accept the inevitable without guilt and without wasting hundreds of thousands of dollars.

Yes, this is a big problem and it is compounded by the fact that hospitals will perform any procedure the family asks for to keep a person alive. Perhaps if insurance would not cover such cases, and hospitals weren't going to be sued this would stop being a problem. That is, if a family wants grandma to be kept alive on a ventilator fine, but they'll have to come up with the scratch for it though.

Obviously from an economic rationalist point of view, it makes sense to spend every penny you own to have any possibility of increase of life, but society doesn't really benefit.

I'm not sure I agree with this. My Great-Grandfather had a living will that stipulated that he did not want to be kept alive via mechanical means (e.g., a ventilator). So when he became very ill, my mother and grandmother took him home to his house, and made sure he was comfortable until he died. He never regained conciousness in the hospital, and it is what he wanted. So there is definitely a quality vs. quantity trade off there.

"I'm sure when there is a serious problem the wait time is small"

Actually, here in British Columbia, people regularly die waiting the 9 months to receive critical, life-saving surgery.

Paul

Here's another goodie on Canada's MRIs that I saved:

A country where dying like dogs would be an improvement

Yesterday's Citizen reported that Ottawa will probably get another MRI machine soon. As it should, since there are only 2.5 of them per million people in the Ottawa area, against six per million in you-know-where (and even Toronto's total is way below comparable American cities). Unfortunately it's a veterinary clinic that has applied for permission to install and operate that new MRI.

If the vets get the go-ahead, you could take your dog to it by the end of this year. But you won't be able to go yourself unless, like that guy who was going to have to wait six weeks for a crucial MRI until his doctor discovered the local hospital machine was leased to veterinarians at night, you book yourself in as "Fido." ...

....OK, I don't see why it's good news. But yesterday's Citizen quoted a veterinary clinic spokesman who was vaguely apologetic about the fact that the news could upset some people, especially the roughly 6,500 in the area who've been waiting months for an MRI. "We are only working within where we can make a difference, which is the veterinary side. I'd love everyone to have an MRI as soon as they need one." Ottawa planners will be mighty tempted to appease the mob by refusing the application. But social justice is very complicated.
The clinic was trying to get an MRI machine because local pet owners didn't want to have to travel elsewhere. Unless and until we get a local MRI, we face the horrors of two-tier veterinary care. While the rich rush Fluffy to Florida, the poor are told "Sit!" "Stay!" "Don't beg!" Surely even dim socialists can grasp that the result is social exclusion (though I would enjoy a cage match between them and animal rights activists who consider it speciesist to think humans deserve better medical care than dogs, gerbils or ants).....

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In a nutshell, since Fido and Fluffy's owners can PAY beaucoup loonies to have MRIs for their pets, their pets were moving ahead of people.

Just goes to show capitalism rules again.

A few replies to replies:

My thesis was not that socialized health care is better in terms of life expectency, but that for all the extra money expended (and remember, we're talking about % of a *much* larger GDP), there seems to be little real difference in life expectencies, a strong indication that encouraging/allowing people to spend their own money (i.e. not rationing health care) may be a waste of resources.

That is if I am healthy I might opt for catastrophic coverage, but pay for doctor's visits out of my own pocket.

That tends to be penny-wise and pound foolish. Primary care is supposed to catch lots of things before they evolve into catastrophic problems, and is one reason why infant mortality rates are high compared to other countries.

Perhaps if insurance would not cover such cases, and hospitals weren't going to be sued this would stop being a problem.

Actually, even if people pay for it themselves. "keeping grandma alive" may eventually cause economic problems if enough people beggar themselves to "save" (or more likely, extend the life by a day or two of) a loved one.

Actually, here in British Columbia, people regularly die waiting the 9 months to receive critical, life-saving surgery.

Obviously, rationing *is* going to cost some lives, although governments tend to react when wait times get *too* long. And MRI's are amazingly scarce compared to the United States. (I was amazed at the ratio.) However, I find it interesting that despite the massive availability of MRI's and other expensive procedures, American health care doesn't seem to be providing (all-in-all) much better health to its receipients. In which case socialized medicine makes macroeconomic sense (although, of course, limiting people's economic freedom).

Does anyone have some stats about the average life expectency of the top quintile earners in the US? That might give some idea of how much having every possible medical procedure available helps increase life span and poke some holes in my argument.

My thesis was not that socialized health care is better in terms of life expectency, but that for all the extra money expended (and remember, we're talking about % of a *much* larger GDP), there seems to be little real difference in life expectencies, a strong indication that encouraging/allowing people to spend their own money (i.e. not rationing health care) may be a waste of resources.

Or an alternate, and IMO more likely hypothesis, is that life expectancy is a function of things besides how much is spent and who spends it.

In looking at the data, spending does play a big role, but it doesn't explain everything. For example, what about crime rates? Could that be a factor? I dunno.

That tends to be penny-wise and pound foolish. Primary care is supposed to catch lots of things before they evolve into catastrophic problems, and is one reason why infant mortality rates are high compared to other countries.

Yes, I am aware of this bromide, but I think for most people it is like using a canon to kill a house fly. It'll probably work (at keeping some people from developing catastrophic problems), but for most people it'll just have the perverse effect of inducing them to go to the doctor every time they have the sniffles. There is definitely a trade off here, IMO.

Actually, even if people pay for it themselves. "keeping grandma alive" may eventually cause economic problems if enough people beggar themselves to "save" (or more likely, extend the life by a day or two of) a loved one.

Actually I don't think this will be as much of a problem. When the price tag is $250,000 bucks people might decide, "Well grandma has had a nice rich life, and she'd hate being kept alive by a machine...." It may sound cruel and avaricious, but this is what life is about; making choices about different unpleasant states.

See the problem with health care reform is nobody is being honest, at least not brutally honest. Everybody wants to make it out that there is a pony in there somewhere when in reality there isn't. You can't have nationalized health care and fancy slick state of the art health care on demand like we do now...at least not without paying for it. So what the proponents of nationalize health care are advocating is restricting the amount of health care that is available to keep costs low. The current system is going to go on getting more and more expensive due to the way it is structured. Any choice (including making no choice) is going to come with costs as well as benefits. Politicians wont tell you this because their currency is bormides, aphorisms, platitudes and bullshit (when all else fails).