The Sucess of Socialized Medicine

[gojujay]

Originally Posted by jeff

Interesting theory, that Wall Street became a destination for brainpower because the government stopped being the place to go, but it's not consistent with widely observed and noted changes in the market and how candidates were selected. Wall Street used to be very clubby, and "outsiders", no matter how smart, were not valued the way you would expect today. Post-Vietnam disillusionment with government had nothing to do with it (and the timing was wrong for it to have been a factor). The real story is that the market became a dramatically more active way to make or lose money than it had in the sleepy earlier days, so there was a much bigger premium on brain power. Cute theory, with Keynes and all, but not what happened.

Okay, okay, I'll bone up on me history about this. I seem to be on an anti-Keynes kick right now.

[jeff]

Originally Posted by gojujay

Okay, okay, I'll bone up on me history about this. I seem to be on an anti-Keynes kick right now.

I noticed that! Cool - let's catch up later. cheers, Jeff

[gojujay]

Originally Posted by jeff

Healthcare has both high labor costs (doctors, techs, nurses) and high capital costs (an MRI machine is a big budget item for a hospital), and recurring cost for consumables (drugs - as you've probably noticed pharmaceuticals can be very expensive) so it's a mixture of multiple factors. I'll see if I can get info on how costs break down. Also, alas, in the US we have far higher administrative costs than in the European countries. Our system burns 30% overhead (approximately) in administration. That HMO paperwork, and the people "providers" have to hire to fight with clerks in the HMO, adds up to a big, big burden the other countries avoid.

Ah, yes. Adminstratium, heaviest element known. If we can learn anything from them furinners', it's how they managed to reduce THAT! The other stuff is debatable, but on that I believe everyone can agree, with the possible exception of the bureaucrats. Cheers!

[Inquartata]

Originally Posted by jeff

Inq: there's a substantial pattern - too substantial to be ignored - that suggests that those countries with universal healthcare do better.

Isn't this tantamount to claiming that correlation proves causation, though? Does the fact that roosters crow just as the sun rises prove that their crowing causes it to rise?

Patterns are interesting, but they are not in themselves proof of anything, unless and until other possible factors have been identified, examined and eliminated ( or their effects at least accounted for ).

As far as their rising costs: their numbers still are far lower than ours, and we have no proof that they will not level off at lower costs than we have.

True. And I do not assert that they will, simply because that is the way their "patterns" seem to predict.



[quote[I wonder if ess fell asleep last night with his nose leaning on one of the keyboard keys? [/quote]

If so, I'll bet it was the 'Z' key.

[Inquartata]

Originally Posted by jBirch

Objective Health is measured, currently, by increased life span, lower infant mortality and lower death rate / 1000.

As imperfect as such aggregative measures are, yes.

Strongly correlated with those figures is Obesity and # of Smokers.

Actually, the single factor that correlates most strongly with health cuts across all those. It's per capita income, at least up until around the $4000 per year mark. This IMO is why the health indicators are so much lower for third-world countries generally, whether or not the nations themselves are wealthy and whether or not they have universal health care plans.

Currently, there does not exist an objective "healthyness" indicator that takes into account physical wellness in any more of a comprehensive manner. The assumption seems to be that the longer your population lives, the healthier they are.

Yes. Even this may skew the results, though. I mean, what if you have a civil war going on in your country? Or a lot of auto accidents? A high suicide rate or murder rate? A big drug problem, or, as in Russia, a big alcoholism problem? What if you have a lot of natural disasters? ( I suspect that Indonesia's average life expectancy will be lowered for some years, unless they somehow control for the tsunami deaths. )

The lack of good metrics is a problem, you are right. But I suppose we have to make do with what we've got. Probably they are still predictive to a useful extent, I'm not really arguing that they aren't---just that it doesn't do to accept conclusions based on them uncritically.

Less obese is considered more healthy for interim measurements. Yes, this makes things like crime prevention, sports and poverty "health related" activities.

How, for at least 2 out of the three? ( Many athletes are overweight, as are many criminals---and even the poor do not seem to be the ones ducking the obesity trends. )

Second, we need to define just what is proposed by Universal Healthcare and what is proposed by socialised health care. The current definition is that Universal Health Care means that all emergency and routine maintenance is provided for every citizen.

Right...at the expense of the few who can afford it. This is my fundamental objection to the idea. Well, along with the conviction that it means greater economic inefficiency and warps the proper working of the market by having government take over a large portion of an industry.

Supplementary health services, such as premier nutrition, massage, cosmetic and holistic health are not included in "Universal Health Care".

Now there's an encouraging incentive for luring people interested in making a good living AND saving lives to go into the medical profession. Tell them that standard medicine is not the way to go, becaue you're going to be, in effect, a civil servant...

Total socialisation and zero socialisation are currently unrealised ideals. "Socialised medicine" is therefor a fuzzy term that clutters our discussion.

True enough...though that problem exists in all areas of human interaction. We still have to make decisions nonetheless.

The argument I'm putting forth is that Universal Healthcare directly correlates to objective health improvements as measured by the primary Health Indicators. Ie// all other things constant, those populations with Universal Health Care have better Health Indicators then those without.

Correlates, perhaps. Causes? That's another matter entirely.

I fully acknowledge that there are other things that also effect those indicators. I admit the possibility that some are more strongly correlated (poverty for one). However, those are tangential to the discussion here which is whether "more socialisation" in the current US health care system in an effort to reach "Universal Health Care" is better or worse for the US population and whether this can be provided at lesser or equal cost as a % of GDP.

Unfortunately, we cannot really know the answer without trying it here, in the US. And once we do, given the tenacity of government programs and agencies, there will be no undoing it if the answer proves to be "worse, and/or more costly". And in any event, the gains to be had, even if our experience proved exactly that other countries experience, seem rather smallish to me.

Plus, there's still my whole economist's public-good objection.

[Inquartata]

Originally Posted by jeff

Yes, if your primary goal is to make money, then the government is not where you're going to go.

I cannot disagree strongly enough. Why else would anyone spend millions of dollars to get elected to a job that pays only a few hundred thousand a year?

I think that's only the case if you're looking at salary. If you are talking about future sweetheart jobs in industry or speaking fees, book deals and the like, government would seem to be THE place to go...

However, I dispute the idea that it's where the less talented go. That, by the way, was the stereotype about Wall Street, until the 1960s. Believe It Or Not. It's really just stereotyping.

Yep. It's all about personal interests and preferences.

What is relevant isn't the talent pool (talented people go into medicine in Europe,

In the same numbers as here? In sufficient numbers to meet demand? ( I would suggest the answer to the latter at least is "no". )

But I agree that the converse is also true: higher rewards do not necessarily guarantee better doctors. One thing the advocates of, say, higher teacher pay seem to forget is that better pay doesn't only "attract more good people", as they argue. It also attracts more bad and mediocre people. One still has to distinguish the one from the other, and there's the rub. It always has been.

Let's face it: there's not a lot of money to be made providing any service (medical, legal, etc) to poor or even middle class people for the obvious reason that they don't have a lot of money.

I dunno, Al Sharpton seems to be doing allright for himself.

[jeff]

Originally Posted by Inquartata

Isn't this tantamount to claiming that correlation proves causation, though? Does the fact that roosters crow just as the sun rises prove that their crowing causes it to rise?

Patterns are interesting, but they are not in themselves proof of anything, unless and until other possible factors have been identified, examined and eliminated ( or their effects at least accounted for ).

Of course not. What it illustrates is the commonsense and highly predictable result that providing universal healthcare to a population provides measurably better overall health in that population. People who work in the field, unlike us mere kibitzers, understand this very well. The causality is not hypothetical or the results coincidental. Hm, countries that do pre-natal screening have lower infant mortality, what a surprise. It has nothing to do with vague patterns.

Originally Posted by Inquartata

ITrue. And I do not assert that they will, simply because that is the way their "patterns" seem to predict.

Tell you what - I'll concede that their system is more expensive if and when it becomes so, if you concede that our system is more expensive until that point.

[jeff]

Originally Posted by Inquartata

As imperfect as such aggregative measures are, yes.

The above responds to James listing of "Objective Health is measured, currently, by increased life span, lower infant mortality and lower death rate / 1000." As imperfect as they may be, aggregate measures (even if not these in particular metrics) are exactly what you use to describe effects on populations. What's the alternative to statistics that describe a population - details about an individual?

And, what about them specifically do you find inadequate? They are primary metrics used by public health professionals. Do you have knowledge that trumps theirs?

Originally Posted by Inquartata

Correlates, perhaps. Causes? That's another matter entirely.

Just how would you structure an experiment or analysis to demonstrate or refute causality (to your satisfaction) of healthcare policy applied to populations of millions of people?

[jeff]

Originally Posted by Inquartata

I cannot disagree strongly enough. Why else would anyone spend millions of dollars to get elected to a job that pays only a few hundred thousand a year?

Ask Corzine, Forrester, Lauder, or Bloomberg. All made their money in private sector, and went to public sector (or tried to) with entirely different motivation.

Originally Posted by Inquartata

I think that's only the case if you're looking at salary. If you are talking about future sweetheart jobs in industry or speaking fees, book deals and the like, government would seem to be THE place to go...

Speaking fees work very nicely for Gerstner and Welch too. Being a titan of industry is at least as a good path to the lecture circuit as being at the top of the heap in government, and pays hundreds of times better. As for the sweetheart contracts and kickbacks, that's just preparation for private sector later on, where they actually make the big bucks.

Originally Posted by Inquartata

Yep. It's all about personal interests and preferences.

And differing stereotypes, changing circumstances in those sectors, and sometimes outright exclusion.

Originally Posted by Inquartata

In the same numbers as here? In sufficient numbers to meet demand? ( I would suggest the answer to the latter at least is "no". )

Do you have evidence to support a contention that there is a shortage of practitioners in Europe that exceeds ours. or are you just suggesting this as a mere guess?

The nursing shortage in this country is acute, as most know. There are USA shortages of doctors in many specialties or localities: serving rural and poor areas, or in litigation-rich specialties like OB/GYN. For example, there are about 50 neurosurgeons in New Jersey, while the need for them is substantially higher. There used to be more, but litigation and malpractice costs chased them out of state. Not the AMA imposing a cartel, I'll add!

Originally Posted by Inquartata

But I agree that the converse is also true: higher rewards do not necessarily guarantee better doctors. One thing the advocates of, say, higher teacher pay seem to forget is that better pay doesn't only "attract more good people", as they argue. It also attracts more bad and mediocre people. One still has to distinguish the one from the other, and there's the rub. It always has been.

Difficulty of evaluating performance is difficult and imperfect in all professions and in both private and public sectors. Nonetheless, we should try to do our best and reward for performance as best we can. I'm not in favor of high pay for jerks.

Originally Posted by Inquartata

I dunno, Al Sharpton seems to be doing allright for himself.

He provides a service? (A penny-ante operator, anyway, next to the bigger fish)

[jBirch]

Originally Posted by Inquartata

Actually, the single factor that correlates most strongly with health cuts across all those. It's per capita income, at least up until around the $4000 per year mark. This IMO is why the health indicators are so much lower for third-world countries generally, whether or not the nations themselves are wealthy and whether or not they have universal health care plans.

Right, but Cuba provides a fascinating case-study. Very poor population, excellent universal health care. Average Health Indicators. By your analysis, the poverty in Cuba (not to mention embargo on goods) should significantly trump the effect of universal healthcare and have significantly reduced indicators as compared to a working market economy providing market based health care. At the very least, the case bears study to see what can be applied to the US system to improve its indicators (way more money, higher educuation level of populace, yet health indicators on a par with Cuba???)

How, for at least 2 out of the three? ( Many athletes are overweight, as are many criminals---and even the poor do not seem to be the ones ducking the obesity trends. )

Well, generally, active populations are less obese and have a longer life-expectency all other things held constant.

Right...at the expense of the few who can afford it. This is my fundamental objection to the idea. Well, along with the conviction that it means greater economic inefficiency and warps the proper working of the market by having government take over a large portion of an industry.

I don't dispute that Universal Health Care warps the market. I think though that the proper equilibrium for the Health market doesn't allow for low prices. In fact, I suspect that left to its own devices, the Health market would significantly increase prices and decrease supply. This is fine if we're talking BMW's, but when it comes to an individual's health (much like their security) I think that forcing the market to behave in a less efficient manner is best for the people of a nation.

Correlates, perhaps. Causes? That's another matter entirely.

Well, a strong correlation implies a strong relationship between two phenomenae. In this case, Universal Health Care indicates better Health Indicators. Perhaps it is the cultural environment that prizes "people over profits". Perhaps it is the general social-liberal oriented political climate. Dunno. But the lack of a functional Universal Health Care system (as different from a state sponsored system) indicates average or below average health indicators.

I agree that understanding what specifically it is about Universal Health Care that provides this positive correlation is key to applying the lesson in the most efficacious manner. Whether that means that the state provides it is an outgrowth from the understanding.

<grin>

And I'd suspect that the only way to provide "Universal Health Care" is as a public good. The reason? "Universal" means non-exclusive. "Non-Rival" is required to provide "Universal" at universal quality.

James.

[esskreemr]

Originally Posted by Inquartata

Right...at the expense of the few who can afford it. This is my fundamental objection to the idea.

Uninsured people with medical problems wait to the last minute to seek care. They typically seek care in the local emergency room where laws often prohibit the hospital from refusing care no matter the financial circumstance. Emergency care is more expensive. In addition, a minor problem becomes severe. Even a cold can lead to pneumonia. Who do you think absorbs the cost right now? Do you think the medical facilities just subtract it from their profits? Not hardly, the funds come from two sources: 1) Government subsidy programs (taxes), 2) Higher premiums.

I think I've mentioned this before. It's more relevant with millions more Americans losing their health care each year (an increase of over 6,000,000 in 2005 alone).

In addition, as Jeff mentioned, a large chunk (30%) of our health care costs is eaten by administration overhead. Insurance companies apparently challenge nearly every cost.

How much more are we paying now?

The ONLY ones who seem to be saying that the US has the best health care are the lobbyists and other special interest groups.

Report after report after report states clearly that we pay too much for too little, we live less, are less and less satisfied with our health care, and it's getting worse. System induced errors are rampant leading one article to claim that "America's healthcare-system-induced deaths are the third leading cause of the death in the U.S., after heart disease and cancer."

There are only a few people winning from our system. It certainly isn't the businesses that have seen their employment costs skyrocket with growing health care program bills.

One of the most widely reported reasons that people stay on government support is from fear of losing their health benefits.


As for the correlation does not prove causation, that is true, but it does imply a relationship. We can't manipulate the variables in this situation to test for causation. So we have to look for the relationships.

[Inquartata]

Originally Posted by jeff

Of course not. What it illustrates is the commonsense and highly predictable result that providing universal healthcare to a population provides measurably better overall health in that population.

Ah, the old magic incantation: "It's common sense". Dispells all objections...granting that one believes in magic. Which I only do when it's in a young girl's heart.

The world is full of things which appeal to "common sense"...and still manage to be wrong somehow. I prefer facts, or at least tested, established theory all of whose assumptions are out on the table.

Now, that universal health care=better health might be true assuming that all else is equal. But all things being equal, all things are never equal. There are a lot of possible caveats omitted from that would-be conclusion.

People who work in the field, unlike us mere kibitzers, understand this very well.

And of course, their understanding could not possibly be faulty? Their perceptions and judgements are infallible? They could not be missing relevant factors acting from outside the field?

The causality is not hypothetical or the results coincidental.

Assertion is not evidence, no matter how fervently spoken or firmly believed.

Hm, countries that do pre-natal screening have lower infant mortality, what a surprise. It has nothing to do with vague patterns.

And nothing to do with anything else in the world, either, I suppose? This is the ONLY possible explanation for the phenomenon? Is that a scientist speaking?

Tell you what - I'll concede that their system is more expensive if and when it becomes so, if you concede that our system is more expensive until that point.

Oh, I do concede that the figures you've cited appear to show that. But of course the raw numbers do not necessarily tell the whole story, do they?

I've already pointed out several possible things which might skew the numbers for health statistic differentials. Anon I will try to cite a few which might skew the spending figures---or at least offer explanations for them other than "government is really a more efficient provider than industry". Thursday night being a holiday, I ought to be able to put in some time without undue interruptions and distractions.

[jeff]

Originally Posted by Inquartata

Ah, the old magic incantation: "It's common sense". Dispells all objections...granting that one believes in magic. Which I only do when it's in a young girl's heart.

The world is full of things which appeal to "common sense"...and still manage to be wrong somehow. I prefer facts, or at least tested, established theory all of whose assumptions are out on the table.

Now, that universal health care=better health might be true assuming that all else is equal. But all things being equal, all things are never equal. There are a lot of possible caveats omitted from that would-be conclusion.

You know that's not what I'm saying, Inq. It's consistent with, but much more than common sense,. These results are shown from decades of experience in public health by people who track the programs and look for statistically valid changes. The theories and facts are there, even though you don't know them, despite my best efforts to show you a small fraction. I thank you now for at last conceding the point you previously denied in the other thread we argued this subject - that actual domain knowledge is necessary, rather than vague understanding and "general principles". I'm glad you've finally come around.

Your inconsistency is funny and revealing - advocates of policies you don't like must demonstrate causality, yet you're happy to rely on Adam Smith's Invisible Hand (Sorry, gojujay), where the whole point of "invisible" is that causality can't be seen, yet somehow we must bow our heads and just believe.

Take "universal healthcare -> better health" as a given. Prenatal screening -> healthier mothers and babies. Mass vaccination -> less disease. Universal screening for heart disease, cancer, etc -> earlier detection and more effective (and less costly) treatment. It's well known to those who've taken the effort to learn.

I asked you to devise an experiment that would prove or refute "causality" to your satisfaction, while asking what basis in fact you had to doubt James' evidence. Do you have either?

Originally Posted by Inquartata

And of course, their understanding could not possibly be faulty? Their perceptions and judgements are infallible? They could not be missing relevant factors acting from outside the field?

This is the rhetorical "old switcheroo". In the first snippet you complain that an argument must be supported by knowledge, and to cover yourself since facts and professionally accepted knowledge go against your argument, you then take the opposite stance that relevant professional knowledge shouldn't have primacy. Nice attempt to have your cake and eat it too.

Again, your inconsistency is obvious: in the original Universal Healthcare thread you looked askance at any source you didn't feel was sufficiently credentialed in economics - you went on at some length on this subject - while denying the legitemacy of credentialling authorities in medicine (while demonstrating confusion on who those authorities are and claiming that credentialling was a cartel by an organization that doesn't license or credential.) So, Inq - they're authoritative when they support your positions, but not so when they disagree. I see - all is clear.

Originally Posted by Inquartata

Assertion is not evidence, no matter how fervently spoken or firmly believed.

I quite agree - which is why my arguments are copiously documented by supporting evidence, while yours are very rarely more than your loudly repeated opinion. Which of us takes the trouble, Inq, to go find referencable articles, or quote specific facts and figures, eh? You even went so far as to argue at length that knowing the specific facts wasn't necessary.

Start doing more facts and less assertion, Inq, and address the facts presented to you even when they are inconvenient to your argument. There are slews of items you've not responded to, in this and the other thread (my Krugman post is an example), including the most recent points made by James and esskreemr.

Originally Posted by Inquartata

And nothing to do with anything else in the world, either, I suppose? This is the ONLY possible explanation for the phenomenon? Is that a scientist speaking?

It's merely the most plausible explanation, and supported by the appropriate experts. I suppose space aliens could have done it. Ockham's razor isn't the half of it.

Originally Posted by Inquartata

Oh, I do concede that the figures you've cited appear to show that. But of course the raw numbers do not necessarily tell the whole story, do they?

I've already pointed out several possible things which might skew the numbers for health statistic differentials. Anon I will try to cite a few which might skew the spending figures---or at least offer explanations for them other than "government is really a more efficient provider than industry". Thursday night being a holiday, I ought to be able to put in some time without undue interruptions and distractions.

They are far more than raw numbers, for starters.

You've suggested some hypothetical factors that might skew the numbers, but no evidence whatsoever that they are other than stabs in the dark. I refer you to "Assertion is not evidence" above. Frankly, some of them suggest the position opposite to that you wish to prove - I pointed that out in a few cases and don't recall you responding to my refutations.

Thursday night I'll recover from hosting Thanksgiving, and then off to Scottsdale AZ for a weekend's holiday in warm sun, instead of gloomy rain...

[jBirch]

And just to flip sides for the heck of it...

Two things that have yet to be shown:

1) Are better Health Indicators better for the US? We are assuming that longer lifespans are good. Are they really? We are assuming that lower infant mortality is good. Is it?

2) Can the US culturally implement Universal Health Care?

James.