H. Lee Scott, president and CEO of Wal-Mart joined Andy Stern, president of the Service Employees International Union, at a press conference to announce a campaign to win public acceptance for a set of principles on health-care policy that include providing affordable health coverage to all Americans by 2012.
“What unites us here today is our shared belief that it will be a far greater America when we get affordable health care for all American,” said Stern, who has been one of Wal-Mart’s staunchest critics but also publicly invited CEOs to work with him on the health-care problem. “This is not just a moral problem but a major drag on American business competitiveness and job creation.”
Now, give Wal-Mart some credit: Who better knows how to externalize their costs? And in this case, it would seem that it’s causing them to pursue doing the right thing. Very cool.
Good on Stern for breaking through old barriers and old thinking on this.
Think Progress had a posting on this today.
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The unusual partnership, called “Better Health Care Together,” is motivated around four organizing principles:
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This new strange bedfellows coalition has been ramping up for a while; it’s a good thing to have business (finally) take up the call for sensible fundamental overhaul of the U.S. HC System, especially the wasteful financing mechanisms that are the root cause of what’s worst about it. But beware, although it’s a fine place to start, coalition rhetoric comes cheap and the substance of proposed reforms must be scrutinized before any wholesale cheering can take place. Their 4 priniciples look good, and would look better if combined with the ones below.
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The National Academy of Sciences Institute of Medicine (IOM) Report Calls for Universal Health Coverage by 2010 from Press Release Jan 14, 2004 (things are really ramping up now…in Feb. 2007)
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The IOM Report and its “5 Priniciples to Judge, Compare Proposed Solutions for Universal Health Care” might be of interest and of use to folks who are following (and maybe even participating actively in) health reform on the state and/or national levels.
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(side note: when these priniciples were announced in 2004 they were celebrated but it did seem to many advocates that Principle #5 cheats somewhat, in that is tries to wrap quite a few principles into one). MassCare has been using the IOM Principles in their work as have many other groups in MA and across the country.
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The full IOM Report is very good and well worth a look .
both for the same reason, as you mentioned above. It lowers their costs.
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They are the epitome of a profit maximizing organization. They don’t care if it involves working people off the clock, underpaying women, doubling the fuel efficiency of its trucks, or paying itself rent to decrease its tax burden — lower costs results in higher profits.
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So, that’s cool. Good public policy helps induce companies to “do the right thing ™” by making sure their interests line up with the interests of the community.
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But, even if Wal*Mart is wholly responsible for the rolling our of single payer health care and 18 wheelers getting 20 mpg (instead of 4-6 like now), I still won’t shop there. đŸ™‚
I also refuse to shop at Wal-Mart for a slightly different reason, I prefer to support the local guy over the box store.
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I’m glad to see businesses stepping up on the health care issue. Hopefully this will go somewhere.
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One quick point about something you pointed out, Wal-Mart paying itself rent to decrease its tax burden. This is nothing new to big or small business. I’m willing to bet that your local liquor store, pub, any stand alone business (not in a minimall) has a realty trust or LLC that owns the building and a different one that owns the business and the business pays rent to the realty trust/LLC.
or that the actions are illegal. Often, bad public policy helps (or encourages!) companies to take actions that are detrimental to their local community, or at the very least, cause them to jump through hoops wastefully.
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A system that encourages needless hoops is wasteful and often inappropriately shifts the tax burden. Good public policy eliminates this hoop though, just as higher gas prices encourage Wal*Mart to find trucks with higher mpg.
Medical spending is a drag on business. If we spend 15% of revenues on health care, and the rest of the industrialized world spends 8% (on average), then it badly damages our competitiveness. It costs us more to produce goods, and this hurts us in the global marketplace.
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Business is a BIG winner if we can slash spending on medical care, while providing medical outcomes that are as good or better than they are now. Wal-Mart sees that – they are successful for a reason: they’re smart, even if they have no soul.
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Our state should see this too – if we can enact a world-class single-payer system instead of RomneyCare, then it will slash the cost of doing business here. And that will be a magnet for business. Might well reverse the flow of good people who are leaving our state – wouldn’t that be fantastic!
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Single-payer (or few-payer) universal health care is a rare gem – better care, lower costs, and everyone’s covered. And it’s good for Business. And it’s been proven to work in every instance where it’s been tried.
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So what’s keeping us from taking an enormous step towards helping the citizens of our commonwealth?
Single payer? No, that’s your preference-
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based only on the information in this thread, not only has single payer not been endorsed by Walmart, but it hasn’t been endorsed by the partnership outlined by think progress. All plans call for “affordable” health care (who would argue with that??) and where mentioned, the “burden” i.e. cost is to be shared by individuals, corps, etc.
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Doesn’t sound like single payer to me.
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If we kill innovation in the world of health, we may in the very best case succeed in provisioning everythign we have today to everyone, forever. Is there any past decade during which you would have made that compromise?
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The problem with health care today is that the market is broken on both supply and demand sides. Single payer will break the demand side infinitely worse – in fact, it will break it all the way.
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I heard an old quote I liked, don’t remember whose:
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“If you think health care is expensive now, just wait until it is free.”
that every advanced industrialized nation on earth has single payer health care except for the United States, and every one has better healthcare outcomes and lower costs than we do.
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Really, the dead-enders are getting kind of boring.
No room for debate in your mind, eh? nice.
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This whole “superior health care” now apparently “better outcomes” imo is rather deceptive. In my view the US has the best health care in the world by a far far cry – this is why people come from all over the world (including socialized medicine states like Canada) to get life saving treatments that they either can’t get or would have to wait dangerously long for.
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But whatever, as long as we exist and keep innovating, then the rest of the world can keep sponging off our innovation. Once we stop, we’ll all have stopped.
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Get it?
I’m thinking that these legions coming to the US for care are basically nonexistent. It happens – but not a lot, and they rarely come from industrialized countries – the sole exception being Canadians coming to the US for procedures that have not been shown to be safe or effective. (in the US while drugs and devices must be shown to be safe and effective via the FDA, procedures need no such proof.)
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Let’s try a little experiment. I’ll provide 10 statistics that show that we have outcomes which are mediocre at best.
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In exchange, you provide 3 statistics which show that people from other countries are more likely to come here for treatment than to go to another industrialized nation – e.g., France or Germany.
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Neither of us is allowed to show the same thing multiple times, e.g., the WHO’s ranking on infant mortality and the CIA’s ranking of infant mortality can’t count as two stats.
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That’s more than a 3-1 handicap to help you out: Do we have a deal?
… I really do, I think statistics are an awful, awful way to decide whats right, and it drives me nuts. Another comedic saying that you might attribute my opinion to: There are three types of lies: lies, damn lies and statistics. Statistics, boy I really hate them.
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Nonetheless, your challenge is far too tempting not to take, therefore I accept.
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I would ask you in return to answer the questions that I asked of you about innovation and principle.
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Looking forward to it,
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D
Surely not all statistics are useful, and not all facts can be put into statistics. But you’re just avoiding having a factual argument, demolisher.
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Bring something to the table aside from just bald assertion, will ya? Otherwise, boring boring boring. “Did so!” “Did not!” etc.
What – did you miss that I accepted his challenge?
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In any case, its not about statistics being useless, its about them being useful for deception.
I have to run now – I’ll address innovation later this evening – I’ll have another funny story to tell, this time about Paul Tsongas…
Many moons ago, I was deeply involved in the presidential campaign of Paul Tsongas. Mr. Tsongas was usually an honest and accurate fellow – except for one incident that I recall:
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Paul had famously battled leukemia, and was saved by a bone-marrow transplant. At one point in his presidential campaign he came out against Canadian-style health care -“because”, he said, “if I’d lived in Canada I would not have had the transplant, and I’d be dead today”.
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Foot in mouth.
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Turns out that the transplant procedure was actually developed in Canada! The doctor who developed the procedure was asked about Paul’s remark – “nonsense – he’d be a perfect candidate for a transplant in Canada, and would have received one.”
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People in other industrialized countries get the same medicines, devices, and procedures that we do, more or less. The US tends to push things that are less proven. The rest of the world has a tendency towards carefully selecting for safety and cost-efficacy. Which is newer always better?
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Actually, newer is usually (but certainly not always) worse. Humans are very complex, and it’s difficult to find new things that are safe, and that are better than the old ways of doing things.
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Vioxx is a perfect example of the difference between the biases of new vs. proven. Vioxx was a cool new drug a few years ago – it is roughly as effective at relieving pain as is ibuprofen (Advil, Motrin, …). There was a suspicion, but no proof, that Vioxx might safer on the tummy than ibuprofen – although ibuprofen is really not that big of a deal in this department. But Vioxx was new and it’s long-term large-scale effects were not known. Vioxx cost more than $100 a month, vs. well under $10 a month for ibuprofen.
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The US went mad for Vioxx – the new, expensive, unproven drug – it was prescribed like M&Ms, even to people who never ever had a problem with ibuprofen. The rest of the world, for the most part, said “hmmm… costs more… not more effective… safety not well established… how ’bout we wait on this for a while?”
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Well it turns out that Vioxx is safer for the tummy. But it also turns out to cause a lot of fatal heart attacks. According to the FDA, about 50,000 Americans were killed by Vioxx. And the stuff cost a lot more than good ‘ol safe ibuprofen, and was no more effective.
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There are many other examples that are similar. There are also, of course, innovations that turn out to be good.
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Innovation is a good thing! But it’s better to introduce innovations in measured steps. And it’s better to consider cost-efficacy, e.g., to use our money to do the most good, as other countries’ health care systems do.
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I’ll try to get some stats for you tomorrow.
You say:
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First, you reference infant mortality. The US infant mortality rate is 6.4 deaths per 1000 live births.
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Aha! you say, that’s far down the list of countries who have universal single payer. Universal/single payer must be better!
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BUT, Hawaii infant mortality rate was recently 6.4 per 1000 and that state has universal health. Massachusetts doesn’t have universal and is at 4.8. Here’s my source 4.8! Why that puts the Massachusetts system in the top 10 of the world’s countries (if Mass were a country).
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What does that tell us? a) Mass health system is better than a Universal system ? Credit to Mitt Romney. b) Statistics are wrong and are to be ignored when they conflict with our preset opinion c) something more is going on here than just universal/single payer.
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Yes, C.
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Fact is, the infant mortality rate has more to do with demographics: poverty and education. It’s misleading to dispatch infant mortality statistic as an outcome determinated by the particular health system.
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Here, I’ll offer a statistic: Universal health/single payer often causes its users to speak French. Just look at Quebec and France. Que?
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Carve up the US statistic: infant mortality among African Americans in early 2000 was 14.1. SIDS was a big contributor, which is cured by education moreso than healthcare. BTW, the American Indian and Alaskan rate of SIDS is over twice the SIDS rate of that of a causian mother.
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So let’s see your 10 stats and let’s pick them apart. In the end, I believe you’ll see that there is in fact LITTLE difference in outcomes among different populations despite differences in expenditure.
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So, your argument is that the US spends 2-3 times the per capita expenditure of single-payer countries to no benefit whatsoever?
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In any case, the demographic argument is so old it’s moldy. Studies have already held constant for demographics, as in the study that showed white, middle-aged men in Britain have far better outcomes than their American counterparts even after you hold constant for income, status, weight, and preferred TV sport.
In any case, the demographic argument is so old it’s moldy. Studies have already held constant for demographics, as in the study that showed white, middle-aged men in Britain have far better outcomes than their American counterparts even after you hold constant for income, status, weight, and preferred TV sport.
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First, old doesn’t make it wrong. Second, my comment on demographics was with respect to infant mortality, which, doesn’t have much to do with british, white, middle aged men. Does it?
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Second, without doubt the US spends more and gets the same results. No argument here. It’s a crisis of excess: premium care, the largest component of cost inflation, doesn’t increase life span, doesn’t reduce infant mortality.
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How to spend less? Several options, only one of which is single payer.
Your math is fascinating.
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I’m too darned tired just now to give you a math lesson – but I’ll do so tomorrow.
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I’ll start with a hint, in case you’re self-motivated: it’s true that correlation does not show causality, but what possible things are shown re: causality when things correlate well? Try to apply this to the statistics that we’re discussing.
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And here’s a big ‘ole softball lobbed over the plate for you: What does the inverse correlation between cost and privatization tell us about the hypothesis that privatization reduces cost.
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And that’s just for starters.
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It tells me that you wove a hypothesis from whole cloth.
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Care to point to a study that broadly concludes that costs and privatization are inversely related ?
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And once again, you completely avoid the argument. You imply that universal/single payer countries have lower infant mortality. I point out that massachusetts too has a very low infant mortality and suddenly you’re too tired to give me a math lesson. Strong rebuttal.
The US is the only industrialized country in the world that has “privatized” health care. The US has the highest per-capita spending, by far, on healthcare.
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There are three possible broad correlations between cost and privatization that are possible:
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1. Privatization correlates with lower costs
2. Privatization does not correlate with cost
3. Privatization correlates with higher costs
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Based on the data, 1. is the most likely and 3. is very unlikely. I’m not sure that we could “prove” 3. from the data – but based on how far out the US data point lies on the cost axis, it’s very unlikely to be chance.
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(Of course, in the science world, nothing is proven – it’s just shown, using appropriate statistical methods, to be very unlikely to have happened due to chance.)
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On to infant mortality. As you point out, within the US there is a range of infant mortality rates – this is to be expected. There are a number of factors that affect this rate – probably the % of mothers with good health insurance, the quality of the local hospitals, and so forth)
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One pretty-good predictor of infant mortality is how Liberal or Rightist a state is: see my blog for details..
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Massachussets is a very Liberal state. Massachusetts also has world-class hospitals, thanks to Harvard. Most other states do not.
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Your SIDs argument is a non-starter. If you looked up the death rate from SIDs, it’s only 0.5 per thousand, vs 7 per thousand for all causes. SIDS is responsible for only a tiny fraction of all infant deaths – the difference in SIDS deaths between states or ethnic populations will not change anything.
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More later.
what is the example you are using for “privatized”?
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The US?
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How much of it is private? How much of it is government funded? 50/50 maybe?
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Beyond that, I’m not sure I’d characterize the current non government paid system as particularly privatized, its sort of an old jury-rig from the WWII days is it not?
Just started looking now, initially finding anecdotes (albeit with stats on waiting times in, e.g. canada) but having fun with it.
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BTW I’m not particularly concerned with “medical outcomes” on the statistical whole, rather the top end of medicine.
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If we have by far the best top end medicine in the world, but because not everyone gets it our outcomes are statistically even or poorer than other countries, does that mean we dont have the top medicine in the world?
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Only if your yardstick is per capita, rather than top end measures. The top end can never be doled out to everyone, no matter what.
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I guess what I’m saying is I dont really care if you come up with the 10 stats or not because giant averages like infant mortality imo don’t tell us anything about the top end of our health care system, they mash it all together. Such stats are great if you look at the world as necessarily mashed together, but deceptive if you want to talk about whose has the best stuff in an absolute sense.
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Anyhow, here’s a nice article to whet your appetite:
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http://www.readersdi…
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I’ll start a new thread when I have your stats.
The best medical care in the US is found at the Harvard hospitals, the Mayo Clinic, and few other places. The care their is the best in the US – but no better than average care in most other countries.
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Why?
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In the US, most medicine is practiced as “lone-cowboy medicine”: physicians just make quick and speculative guesses at things, and prescribe pretty much whatever medicine or procedure strikes their fancy that day. Treatments are ordered based on “buzz” rather than evidence.
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Do you know why pharma reps are always smoking-hot babes? Because it works! – it drives prescriptions up. Does this sound like something that encourages good health care practices?
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This is why, for example, 50,000 Americans were needlessly killed by Vioxx. 50,000 – 10x more Americans than will likely be killed in Iraq.
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In most other industrialized countries, this nonsense is not tolerated. Through various mechanisms, Doctors are highly encouraged to use those treatments that have been demonstrated to produce the best outcomes – this is a very important reason for their enjoying better outcomes at lower costs. This is why Vioxx was not nearly as big of a problem outside the US – there was no good reason to prescribe it except on very rare occasions.
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Evidence-based medicine is also precisely how Harvard works (when their docs behave), and presumably how Mayo works although I don’t have experience with them. Vioxx was not a hot item on Harvard’s prescription pads.
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So while you’re finding your stats, if you can find anything that indicates that we have better top-end care, please include a link. But my experience that the very best medicine in the US is no better than average medicine elsewhere.
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I’ll have some stats for you early next week.
The quote is from P.J. O’Rourke – but based on the measured economic outcomes that the Right has given us, e.g.:
(warning – that’s a links to my blog)
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http://blueworksbett…
http://blueworksbett…
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I’m thinking that comedic writers are a seminal source of inspiration for Rightist policies.
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Back to the topic at hand – Single-Payer (or Few-Payer) is the [u]only[/u] way that has ever been demonstrated to slash costs, increase quality, and cover everyone.
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I suppose that we could try something that’s unproven, and for which efforts to date have yielded poor results. But why bother? If we know that something can work, and it’s produced superior results every time it’s been tried, we’d be a little meshuggah to not try it, nu?
Funny how the Right tries to put the burden of proof on those who oppose the untried, the untested and the ill-conceived.
I reject your assertions that single payer systems are better; you surely rely on stacks of subjectivity compiled by advocates of single payer – but hey, maybe thats not fair because I’m sposed to out-statistic you in order to win this one (as if) but really I’m interested in principle, and to some degree innovation.
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You’ve not addressed innovation that I’ve seen, yet.
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In principle, I have a hard time agreeing that goods and services should be automatically and universally free. The problems with this approach only begin with rationing.
Has anyone done any research on the German health care system? I was listening to an economics lecture on my iPod while walking the dog this morning and it was talking about various health care systems throughout the world. The German system with health care accounts sounds interesting, anyone know any more about it?
Still better than the US. Actually a multiple-payer system with significant government role. Important fact: all payers are non-profit.
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Read Ezra:
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It is excellent, excellent. The hospitals, in general, are fantastic facilities – some even include gyms, swimming pools, and so forth for people who are convalescing – because, in Germany, you can convalesce in a hospital, even though the care costs half as much! Five days in the hospital for childbirth, vs. 2 in the US. And it costs a lot less! With better outcomes!
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Too good to be true – but it IS true, and anyone can go see it with their own two eyes.
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There are definitely problems, but far fewer than in the US.
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Want to hear a cool thing? I was once having dinner with some doctors in Germany. During the meal, the chief of a hospital department and one of his docs had a conversation about how to keep spending down (while maintaining quality of care) because, down the road, The People were going to start getting angry as healthcare costs started hitting 10% of GDP (it’s already more than 15% here). I have never, ever witnessed a similar conversation in the US.
Is there any perticular reason it wouldn’t work here? Is a better option then the one on the table for Mass now?
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Sorry to keep asking so many questions but you seem to know alot about health care.
with the fact that the “private” companies in the German system are not really private by American definition. They are extremely heavily regulated; if they “accidentally” make a profit, they must turn it over to the insurers who didn’t do as well.
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Some critics have made the case that American insurers would weasel out of the degree of regulation that makes their German counterparts function within the system. There’s also the angle that such a system can be very complex to build from scratch–think “Hillarycare”–while America already has a functioning single-payer system with low overhead (Medicare) that can simply be tinkered with, rather than inventing one out of whole cloth.
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I have just read an article on this (scrunching brow), and if I can find it again I’ll come back and post.
Germany’s health care is not even regarded to be the best in the world! France’s system, which I’m not very familiar with, is generally regarded as even better. The US is only the world’s most expensive health care – by far – but it’s not particularly good healthcare by any measure of results.
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A story: a friend of my family was visiting Paris a few years ago, when she had chest pains. Since she has a chronic heart condition, she went to the nearest hospital for a taste of French medical care. She’s smart, well-off, “connected” and capable – she used to be dean of a well-known college in New York. She’s normally seen by top cardiologists in New York City. To her shock, she felt that the care she received in France was better than she got in the US (well, the better food wasn’t a surprise – but the rest was…)
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Better care – but at what cost? The French spend about $260 per person for healthcare each month. We spend about $500. Better care, costs less – what’s the problem here?
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There are 30 or more countries in the world that have health care systems which are considered to be better than ours, e.g., see http://www.who.int/i…
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Each system is slightly different, but almost all have:
– Government-mandated universal healthcare
– Health care paid for by (but usually not actually provided by) the Government – or perhaps a small number of large organizations (e.g., unions).
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Nobody seems to be able to say why this, or something similar, wouldn’t work here. We The People simply need to stop fearing change, and get up off our butts and demand it.
The per capita spending is insane. And we get little or nothing for that extra money according to these sources.
The above comment title and its below content are cross-posted from “Think Progress” blog where a VERY lively conversation in ongoing about this new “coalition”. Well said.
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Whew! The national dialogue on this has gotten so “lively” that Andy Stern from SEIU and John Podesta from CAP have posted a special joint reply…
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Read Stern and Podesta’s “Why We Did It” reply here.
Health care reform is tough stuff becuase it requires sorting out the actual policy suggestions from the politics and power-plays of it all. Not easy to do but essential to attempt. What’s the driving force exerting the most influence in reforms that have been attempted? Why does that matter?
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What follows is very thoughtful and informative, has a different style than the food for thought shared above, and ends on a very constructive note and with a link that I try to visit regularly.
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comment #64 on the Think Progress blog “Why We Did It” post from Sterns and Podesta:
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“The Center for American Progress is being used as progressive cover by elements that have made clear they have no interest in genuine healthcare reform.
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Wal-Mart, for instance, has compiled one of the worst records of employee health coverage of any American employer; Intel sees healthcare as a market to be exploited, not as a fundamental human right to be guaranteed.
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Your partnership with them shows the hallmark of their thinking. Rather than working for a social guarantee for medical care for all Americans, you join these companies in stating: “individuals have a responsibility to maintain and protect their own health.”
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This statement seems straight-forward, but is in fact quite pernicious, carrying within it the idea that health is an individual concern-and that indiviuals do and should assume the risk for their healthcare.
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And now we see why Wal-Mart wants to join with you. When major employers shed risk and push it onto individuals, they make more money. Yes the employer-based system of health coverage is broken; but it can only be dismantled within the kind of SinglePayer health system that has been shown to work in every other industrialized nation in the world-not within a situation where it is pushed entirely onto individuals to work with.
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I don’t need to enumerate the reasons for SinglePayer healthcare: it is the only system proven to work, it is the only system that is patient-centered instead of market-based, it is the only truly universal system, and it is the only affordable system of healthcare.
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SinglePayer health systems, such as a “Medicare for All” set-up, achieves its cost-savings and focus on patients by removing the bad actors from our health system: the insurance companies who are in the business of denying care, not providing it. The major private insurers waste approximately one-third of their care dollars on overhead (marketing, bureaucracy, profit, and political contributions). We can save hundreds of billions of dollars a year by doing away this waste-something that your plan cannot address in any way as you are focused on working with the current system of private insurance, and working together with partners dedicated to protecting private insurers.
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The good news here? Americans are way ahead of their leaders and groups like the Center for American Progress on this issue. Recent polls have shown that 89% of Americans want “fundamental” reform to the health system and 56% of Americans want to do away with the current system and replace it with a system “like Medicare.”
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I invite readers to visit SinglePayer.com, a project of the California Nurses Association/National Nurses Organizing Committee, and join the nurses’ campaign to ensure a single standard of medical care to all people.
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Comment#64 by Shum Preston – February 7, 2007 @ 8:09 pm