American Elephants


A Warning Voice from Across the Water: by The Elephant's Child

As the Supreme Court hears arguments about the fate of ObamaCare, it is useful to once again take a look at the country with the longest experience with socialized medicine. Britain adopted their National Health Service just after World War II.

When we read the accounts of NHS care in the British papers, we are told that they are only “scare stories.” They would never happen here, we are told. Yet, we were told, Obama’s health care advisers — Dr. Ezekiel Emanuel, Peter Orzag, Tom Daschle, and Dr, Donald Berwick — were all extravagant admirers of the National Health Service.  They talked a lot, we were told,  about the fact that the highest costs of medicine came in a person’s final years.

That’s where the ideas for the Independent Pay Advisory Board (IPAB) that Congress is trying to repeal right now, came from.  That’s where “comparative effectiveness research” came from. Obama even referred to it when confronted with a woman in one of his campaign events, who wanted to know what value ObamaCare would place on ‘zest for life’ when deciding on a procedure for an older person (in this case, her mother who needed a pacemaker at age 100 — got it— and has enjoyed 5 more years and is still going strong). Obama mumbled a little and said something about there was a time when radical expense maybe wasn’t worth it, and pain pills were more in order.

Monday, March 25, 2012, The Telegraph reports: Elderly Dying due to Despicable Age Discrimination in NHS.

A lack of treatment or insufficient treatment is contributing to 14,000 deaths a year in people over the age of 75, Macmillan Cancer Support has found, in what it called an ‘unacceptable act of discrimination’.

Deaths from cancer are reducing in most age groups but at a slower rate in those aged 74 to 84 and are increasing in people aged 85 and over, the report said.

Professor Riccardo Audisio, Consultant Surgical Oncologist at St Helens Hospital, said: “It is despicable to neglect, not to offer, not to even go near to the best treatment option only on the simple basis of the patient’s age. “This has been a horrible mistake that, particularly in the UK, we have suffered from.”

According to research published in the journal Cancer Epidemiology, there would be 14,000 fewer deaths from cancer in those aged over 75 per year if mortality rates from cancer matched those in America.

Keep in mind that this is just, we are told, a “scare story” from England, and has nothing to do with ObamaCare.

Free market medicine is based on competition, which helps to keep the costs down, and rewards excellence. Socialized medicine, which offers all things pretending to be “free,” encourages overuse, because nobody really knows what anything costs. It’s just that the taxes keep going up. And both the providers and the administrators focus becomes reducing the cost. Providers try to receive adequate recompense for their efforts; administrators make more rules to slash expenses. The incentives have changed, and excellence goes by the wayside. It’s just the way of the world.

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Britain is not the country with the longest history of socialized medicine. (That belongs to Russia.) Numerous European countries (and, indeed, many non-European countries) have systems of universal health care — have had them for about as long as Britain — with varying degrees of direct government involvement. And many of them deliver excellent results for less than what the United States spends on medical care. It’s just that, because it is the English-speaking country with the most extreme form of socialized medicine, it is the one that everybody likes to point at for its faults. The other one that gets written up about most is that of Canada.

How many articles have you seen in the U.S. press, or on blogs, that analyze in depth the pros and cons of Japan’s, The Netherlands’, or France’s health care systems? Hardly any, because hardly any reporters or bloggers have the medical, economic and language skills necessary to examine these countries’ systems with a cold, dispassionate eye.

Comment by Subsidy Eye

Did I offer a comparison of US health care and the rest of the world? Funny, I thought I was just mentioning a recent article from a British paper, drawing some comparisons with ObamaCare. Straw man arguments are not persuasive.

We were quite directly lied to about “the spiraling costs of health care” in this country. Costs have been declining for more than ten years back towards the rate of inflation. The improvements are due to innovation in medicine, competition, new treatments, new drugs, and new expertise. Comparisons of survival times, experience with the major diseases and excellence of care as well as important innovation have demonstrated US excellence — statistically. I don’t go for being lied to.

Comment by The Elephant's Child

Did I offer a comparison of US health care and the rest of the world?

No, you didn’t. I was reacting to the fact that the vast majority of articles that do look for evidence of what can go wrong in the U.S. health system bring in examples from Britain.

As for the “lie” about “the spiraling costs of health care”, I guess we must be using different data. The comparisons compiled by the Organisation for Economic Co-operation and Development (OECD) show that expenditure on health care in the United States continues to rise strongly. The latest data show that total expenditure on health, as a % of gross domestic product (GDP) in 2009 (2008 data for Australia and Japan) was:

Australia .. 8.7%
Finland … 9.2%
France …. 11.1%
Japan ….. 8.5%
Norway …. 9.6%
UK ………. 9.8% (arguably too little)
USA …….. 17.4%

In 1999, the share was 13.6%. The recession in 2008 and 2009 accounts for some of the rise (health care costs don’t slump much), but the share was already up to 16% in the boom year of 2007.

Yes, there continues to be innovation in medicine (all around the world), and competition has helped, to the extent it is allowed. But new treatments, and new drugs, often lead to higher costs, as patients demand the former — and care givers, afraid of law suits oblige them — and new drugs still under patent, which may only be slightly better than their generic alternatives, are favored.

For the source of these statistics, and many more, click here

Comment by Subsidy Eye

Have a look also at doctors per 1000 population, and life expectancy at age 65 (i.e., the mean age that the person will live beyond the age of 65). Guess what, the United States does not look so brilliant, even compared with people in the UK.

Yes, there are some excellent surgical procedures that have been developed in the United States, and many important medical devices (like the electronic pacemaker, many years ago). But the USA no longer has such a lead in medical technologies as it had before. And when it comes to core statistics applicable to the average individual, the statistics speak for themselves.

Comment by Subsidy Eye

The statistics that are meaningful are survival rates from major diseases. The life expectancy rates are not, because the U.S. has high rates of murder and traffic deaths, and oddly, infant deaths because most nations cut off low-weight or premature infants, that according to their statistics will not survive, and neither count them as live births nor try to help them survive. We count all live births, and a fair percentage survive. As I said, Subsidy. I am careful with my sources and whatever I write is well sourced, whether I include a link or not. If it gives you pleasure to contradict whatever I write because you found a different source, have at it.

Comment by The Elephant's Child

The statistics that are meaningful are survival rates from major diseases. The life expectancy rates are not, because the U.S. has high rates of murder and traffic deaths, and oddly, infant deaths because most nations cut off low-weight or premature infants, that according to their statistics will not survive, and neither count them as live births nor try to help them survive. We count all live births, and a fair percentage survive.

I talk about life expectancy after 65 (which is heavily affected by disease survival rates, and also by the quality of care preceding the age of 65), and you talk about infant mortality, which has nothing to do with life expectancy after the age of 65. Murder and traffic deaths also do not affect the over 65 cohort either — or at least no more than in most other developed countries.

As I said, Subsidy. I am careful with my sources and whatever I write is well sourced, whether I include a link or not.

So, you are doubting my source, which is vetted by the governments of each country, and just expect me to take it on faith that your sources are superior?

If it gives you pleasure to contradict whatever I write because you found a different source, have at it.

I find it interesting to challenge ideas that challenge my own notions, which is why I read your blogs. Sometimes I agree with them, other times not. Are you only interested in responses from cheerleaders? Frankly, those are the only other responses I see, and even those are few. I thought that you were interested in intelligent debate.

Comment by Subsidy Eye

[...] A Warning Voice from Across the Water: [...]

Pingback by Do Old People Have a Duty to Die and Get Out of the Way? « American Elephants

Let me try to explain, Subsidy. I wrote a short post about a story in the British press about an obscene number of old people dying unnecessarily early because the government was more concerned about their budget than the well being of patients. I compared that situation, which I believe to be inevitable in socialized medicine, with ObamaCare because the people involved in forming ObamaCare wanted to imitate the British NHS and considered eliminating the high costs of old, frail and sick people important. That’s a very big ethical question about the purpose of medicine. There’s a lot to debate there, and interesting questions.

You weren’t interested in that, but wanted to pick at the fact that I claimed the British NHS was the oldest socialized medicine when you thought Russia was. I don’t care about Russia — it is not an example for anything. Then you wanted to get off on survival statistics, the fact that American medicine is more expensive than others, and claims that others have better survival rates. I have written about that more than once, considered the alternatives, and my conclusions are reflected in what I write. I don’t retain those statistics in my mind, but have to look them up.

I don’t retain those statistics in my mind, but have to look them up. I simply do not have the time to go so far afield from what I was writing onto a completely different tack. I have written on the international statistics, found they were not meaningful in the light of things I mentioned, but as I said, I have no time to go back and try to find the specific articles. That’s why we have a search function on the home page. You can look up past pieces. I have a cluttered mind, and I just don’t retain statistics or data well. I always have to go back and look it up again to get the numbers right, and typos aside, I do work hard at getting the numbers right.

Comment by The Elephant's Child




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