Thursday, August 27, 2009

The American Way of Death

Understanding the American health care debate from abroad has been rendered difficult, if not impossible, by the cretinous, Palinesque rhetoric which now seems to be the preferred discourse of the Republican Party. There will be, according to these knuckle-draggers, government death panels and the whole Obama scheme is either Nazist or socialist or both. In fact, what the current health insurers get up to seems to be far worse than anything imaginable in any state scheme and, besides, America's position as the only wealthy country not to look after the health of all its citizens does look increasingly weird as the years go by.
This is not to defend the NHS, which needs very radical reform indeed, but it is to say that American suspicion of any government involvement in health insurance and the resulting denial of medical care to millions of its citizens needs more explaining than I have yet seen.
Part of the answer, I think, is the deep American conviction that failure should be punished so that success can be rewarded. This is seen both as a moral and an economic imperative. In this context, failure involves the loss of health insurance. If this penalty is removed then there will be less incentive to be successful. The three big flaws in this are: a)rampant and demonstrable private sector abuse of the system b) the fact that very little failure is actually deserved and, even if it were, death or serious illness must be an excessive punishment and, therefore, the moral aspect of the imperative drops out of the equation and the only justification becomes economic. But this too is weakened by the fact that c) the current US system is not very effective in that life expectancy is not that high, it encourage massive over-medication to the point where iatrogenesis is the third biggest killer and it is fantastically inefficient and expensive.
Health would seem to be a perfectly legitimate extension of the state to correct market failures. Nevertheless, I understand the need to reward success and punish failure in the context of the American imagination. The potency of the idea is what makes the US so different from Europe. Unfortunately, to stir up the knuckle-draggers and damage Obama, the Republicans have decided to exploit and debauch this idea. American individualism thus becomes American savagery and true conservatism withers.

58 comments:

  1. This is very good - I learnt something new.

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  3. I was shocked - shocked I tell you - to read that the US spends 16% of its national income (twice what we do) on healthcare, yet still fails to insure over 40 million citizens.

    In my experience, parts of the NHS are excellent (no complaints about maternity services), but parts are just dire. The yanks obviously need to do something, but I wouldn't recommend the NHS as a model. It's a bit weird that a debate about the US vs the NHS, as if those were the only two options, even arose.

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  5. As a regular user of the NHS I have to say the product is pretty dire and is clearly so to others as well, demonstrated by the fact that not one other country has imitated the "envy of the world".

    (And isn't that phrase a good marker for whatever it describes to be on the brink of terminal decline? The armed forces were being described so when we went into Iraq and have been on the slide ever since, and two weeks ago I heard our higher education system being similarly described. Time to get the brochures for those fine Indian universities: can't afford the Ivy League).

    US healthcare needs reform. In particular, pricing power needs to be removed from the exclusive grip of the medics and ridiculously expensive tort actions need to be curbed. Unfortunately, in his desire to ensure there are no screams from the losers, Obama and the more shrill Democratic congressmen are devising a scheme which will be even more fantastically expensive and with very little discernible improvement in those areas that matter.

    If the Republicans were smarter, they would just stay shtum whilst the Democrats start tearing themselves apart.

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  6. Like you and Stephen Fry, I've long been a defender of the good old USA. But more recently they're looking increasingly unhinged. The loony lefties of the Huffington Post, who seemed to be in the ascendant, are being out gunned by Palin's death panel crazies. Smug, righteous 'liberals' and snarling conservatives are all too common these days. As for Bill O'Reilly/Limbaugh and Olbermann/Maher - if this is how Americans get their information then God help them!

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  7. The immutable law of British and American health care states that the more money applied to it, the worse it becomes.
    Both countries health poo bahs should be made to spend 12 months in Wiesbaden's Horst Schmidt Kliniken and learn all about efficiency and true cost effectiveness.

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  8. Part of the answer, I think, is the deep American conviction that failure should be punished so that success can be rewarded.

    Getting in touch with our inner Marxist, are we? Sorry, but that is the kind of simplistic, sniffy putdown Europeans and Canadians revel in. In addition to spending twice as much as everyone else on health care, Americans are far and away the largest donors to private charity. The average American in the higher tax brackets donates over 8% of after tax income to charity compared to his Canadian counterpart, who stumbles in at under 2%. Where do you think all those state of the art hospitals and universities come from? There is a bewildering and quite confusing array of private charitable medical services available to the poor and uninsured, and a very confusing debate about their effectiveness.

    Of course Americans prize self-reliance more than anyone, but there is little beggar-thy-neighbour about this. The opposition stems from a profound distrust of government that is bred in the bone for many of them and quite foreign to the rest of us, even bizarre. Plus Obama is not being straight about his plans and is hiding behind mind-numbing complexity and confusion. It is absurd to try and sell this as a cost-cutting initiative. It will not save money and most commenters seem to be using a one trillion dollar price tag. Seeing as the States now has a per capita debt larger than anyone else in the West except Italy and Japan, the fiscal worry is most rational. Overheated rhetoric about death panels notwithstanding, rationing is forseen, especially for seniors and it is perfectly fair to worry mightily about that. Plus he is trying to ram through this bureaucratic behemoth that will overhaul everything they are used to without much debate, just as he did with that gargantuan bailout package that is still controversial.

    At bottom, this is about whether universal health care is or should be an essential service and delivered equally regardless of means. Most of the rest of us answered yes several generations ago when state involvement was seen as benign, if not benevolent, the economic future looked sunny and there was no reason to doubt its comparative efficiency. I still don't understand why they can't do something about those 10-15% uninsured, but I'm not sure we wouldn't do things differently and less comprehensively if we were having that debate today.

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  9. Sorry, but to add to my comment, there is also a sub-text to this debate nobody wants to talk about, and it touches arguments about public health care in other countries too. When Britain, Europe and Canada instituted public care, life expectancy was much shorter, there were more income-earners relative to the retired and non-working, the elderly were seen as an economically needy class and high-end medical technology was not nearly as advanced as now. Today, the elderly live much longer after retirement and are perhaps the wealthiest age group. Medical advances make the extension of life possible and expensive. I remember seeing a study a few years back that claimed it cost the average American one hundred thousand dollars to die. We all know a crunch is coming for public healthcare and it isn't going to be resolved simply or realistically by calls of "Tax the Rich!".

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  10. Peter, the reason for such overwhelming generosity by America's rich is possibly because.. "Hello rich folks, Mr President here, I'll do a deal with you, we won't tax the socks off you so long as you good folks make large donations to charity"

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  11. That's unfair, Malty. Charity, like generous tipping and a love of peanut butter, is embedded in US culture. Anti-Americans always forget this.

    Brilliant comments, Peter. The bottom line seems to be: drugs are going to have to become a lot cheaper soon, or we're just going to have to ban retirement completely. Otherwise we're going to need those buy-one-get-one-free suicide shops in the malls.

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  12. Brit, the NHS maternity services are the worst of all, what you dont see is whats going on around the back.

    My wife is a trained midwife who refuses to practice and many others are just like her.

    The main problem is litigation which is brought about by the errors of the medical staff, which drive the need for more form filling which discourages women from going into midwifery, a spiral of failure.

    So instead of training students from here in the UK who will be attacked when they go into sink estates, we go to Philippines and recruit midwifes trained in the back streets of manila.

    Off the top of my head the UKs infant morality rate is 4.7 compared against Ireland's which is 3.1

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  13. Well I can only speak for Southmead Hospital in Bristol, Sean, which is great and is full of student midwives, none of whom were from Manila. I have heard horror stories about certain London units though.

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  14. Bryan, I don't defend the American way of health care and insurance as it is, but I must note that your post is about as accurate and informative as the inflammatory comments by the knuckle-draggers you despise.

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  15. Brit, it may not be fair but it happens to be true.

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  16. Unfortunately, every word of Bryan's post, including "of" and "the", is wrong.

    Most notably, the US government is massively involved in paying for health care. The US government spends, as a percentage of GDP, about the OECD average. That money is spend on the poor, who get government health insurance through Medicaid, and the old (65 and above) who get government health insurance through Medicare. There is no income threshold for Medicare and no asset threshold for Medicaid. Although specific eligibility thresholds vary from state to state, a family of four qualifies for Medicaid with incomes of up to 133% of the federal poverty guideline, which at the moment means households with incomes of about $33,000 or less.

    The 40 million people (not citizens) who don't have health insurance are thus neither poor nor old. They are illegal aliens, young people who choose not to buy insurance (the largest category) and people who can't get insurance for various reasons.

    I think it is fair for Americans to wonder whether it is worth a couple of trillion dollars of debt over the next 10 years in order to insure 13% of the population, many of whom could get insurance but choose not to. (In fact, one of the main purposes of health care reform is to force the young uninsured to buy insurance at so called "community rates" that will force them to pay significantly more in premiums than they, as a class, will use in services, thus subsidizing the old and the poor.)

    It's important to note that this is not an argument about health care. It's an argument about health insurance. Hospitals are prohibited from turning out people who need care; they have to cover some care themselves (which drives up costs) and can also seek partial payment from state funds set up for the purpose. This is in addition to the charitable funds and hospitals Peter mentioned. Medical bills can become overwhelming, but they are also dischargeable in bankruptcy. The uninsured have more trouble getting preventative care and routine checkups, but they are available. Vaccines, for example, are provided for every child free-of-charge.

    Finally, in the US in 2007, the top 1% of income earners paid 22.45% of their income in taxes -- the highest rate of any bracket. That accounted for 40.42% of total income taxes collected. The bottom 50% of taxpayers paid 3% of their income in taxes, accounting for 2.89% of taxes collected. At the same time, our corporate tax rates are the highest in the OECD.

    The system is by no means perfect. Your system also doesn't seem perfect, but your system is not what we're considering. In fact, there is no specific proposal on the table now that we can even judge (although a public option seems to be falling off the table). It is entirely unclear to be that any plan the government comes up with is obviously better than the current system.

    As for "death panels," even the New York Times has conceded that the administration is planning to spend less on health care by not providing care that is currently provided. They have talked about substituting palliative care for treatment and about considering the quality and length of life before approving treatment. They have also talked about cutting compensation to doctors and hospitals, which can only adversely effect the experience. (I'm not sure if people in the UK realize that there are almost no public wards in the US; private or semi-private rooms are the rule. Birthing rooms these days look more like hotel/spas than surgeries.)

    "Death panels" may strike you as an overly vivid way of describing this change, but it certainly cut through the blather.

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  17. And just what is wrong with knuckle draggers Bryan? Some of my best friends are knuckle draggers. Of course others have big long trunks, and some have webbed feet and others can spend ever so long under water and....and..

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  18. Interesting comments here.

    In fact, what the current health insurers get up to seems to be far worse than anything imaginable in any state scheme and, besides, America's position as the only wealthy country not to look after the health of all its citizens does look increasingly weird as the years go by.

    Yes - caught between a rock and a hard place.

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  19. Peter's comments are bang on the money. I might add that Obama has said nothing plausible about how his tinkering would bring down costs, he has stumbled over and over again when trying to define exactly what his reforms amount to, and that he has ruled out limiting the egregious amounts of money lawyers can score from suits. Thus he's plainly looking out for the rich lawyer class that constitutes most of his party.

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  20. By the way, level of spending seems like an odd sort of criticism. Would you be complementing us on our efficiency if we were spending less? What exactly do you think we need to buy more of, that we should spend less on health care?

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  21. Wait, David, I know A LOT of middle-class Americans who don't have health insurance. Luckily, I finally got ours covered for our family by taking an otherwise ill-paying job at a big city university. We were covering our family ourselves to the tune of $15,000 per annum, and that sum did not cover basic things like mammograms, much less dental or eye care. It was just catastrophic insurance in case one of us was in a car accident or got cancer.

    This country desperately needs some kind of national health insurance. And I might add that though I am nowhere near the top of the tax bracket, they take 28% of my pay in taxes and so forth.

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  23. Susan:

    The only people you can possibly know without health insurance will be middle-class. The rich buy it and the poor get it. But I'm not sure what the point is about "lots." The plural of anecdote isn't data and the 40 million number (about 13% of the population) is probably a pretty good number. But why don't the middle class buy insurance? And how much should we subsidize them?

    You say that "they" are taking 28% of your pay in taxes "and so forth." I was talking about federal income taxes. Even the marginal rate doesn't reach 28% until a couple filing jointly earns $130,000. If you're paying 28% of your income in federal income tax, you have the worst accountant in the world.

    The "and so forth" indicates that you're including state taxes, Medicare and Social Security, which ought to be somewhere around 10% of your income, although state income taxes vary wildly. The rich pay those too, although they pay less, as a percentage of total income, in Medicare and Social Security taxes because their contributions and benefits are capped.

    Anyway, that doesn't really change anything. My point was simply to counter Malty's argument that charity happens because the rich aren't taxed, and Bryan's argument that we reward success and punish failures. In fact, we tax the heck out of the rich to give excellent health insurance to the poor.

    As to the $15,000, I don't believe it. I believe the premium; both my wife and I were between jobs a while back and that's about what we paid for insurance. But it was excellent insurance and, when we had a health scare, the insurer ponied up hundreds of thousands of dollars without a complaint. We both then got jobs that provide health insurance, because so long as you don't have a lapse of coverage, pre-existing conditions are not a problem.

    Also, I don't know where you live, but we're in Massachusetts. In Massachusetts, the health insurance is particularly expensive because of legal mandates that require, for example, any policy that covers pregnancy to cover in vitro fertilization. The insured can't waive it, and it forces the insurer to price policies to deal with the fact that any insured woman can force them to spend tens of thousands of dollars whenever she wants.

    Is that going to be the law when the feds takeover? If so, who's going to pay for it and where's the money going to come from?

    Finally, I'd love to know what state you live in, because I'm skeptical that you had to pay $15,000 for a policy that only covered catastrophic care. Nonetheless, a good health care reform would be to stop allowing business to provide insurance to their employees tax-free, allow an individual deduction for medical expenses and insurance premiums bought directly, and then have people pay directly for routine care and annual checkups, with insurance saved for catastrophic care. For those who can't afford it, free health care and insurance by all means.

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  24. Hi Bryan,

    I agree with your comment about "the need to reward success and punish failure in the context of the American imagination". But putting the failures and their families at the mercy of a unevenly distributed health care system is cruel.

    That workers have health care through employers, means that many stay in jobs when it would otherwise be wise to quit. Some stay for the sake of their own health situations, and some for the sake of family members who are "covered" by the insurance the worker gets. This is an assumed physical threat addressed directly at the employees and their families, thus a gross conflict of interest, and therefore ought to be illegal. Furthermore, employers should be forced to maintain employees on the merits of the employment opportunity only.

    Secondly, that we choose to have a system that rewards business acumen and inventiveness with royalties and profits, and also allows these great financial rewards to pass onto beneficiaries--it does not follow that these people who so benefit from our economic system should also get better health care than anyone else. If it wasn't true, it would be a horrifying prospective.

    I find myself essentially out of this debate, because there is no movement to take the employers out of the health care loop. Certainly any money that is fair for an employer to spend on health care, ought to be taxed and used to create a humane system. At this juncture, though, with the fueling of the employer-funded insurance programs being part of "reform", we have well-meaning and intelligent people working diligently on this project that can only fail at what ought to be considered a basic human rights level.

    Yours,
    Rus

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  25. Please, please, please, Bryan, visit Instapundit daily for a while and get some actual cutting edge knowledge of what is happening in the U.S. Because David is right. You know I am your friend, but I feel intervention is necessary. Only today I spent some time with one of your countrymen ("from Portsmouth, in the south," as he told me). He was in Philadelphia seeking cancer treatment unavailable in his homeland.

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  26. David, I live in Philadelphia, PA, and work at Temple University. They -- the university (union & add'l benes), city, state, Soc. Security, and feds -- take out 28% of my pay and it's a paltry check already.

    Until I took this job, my husband and I were both self-employed. He is a statistical consultant; I am an editor & freelance writer who also worked a couple of days a week at the Phila. Inquirer as a copy editor. We covered our own insurance with a group called Golden Rule, rec'ed by our neighbor, a self-employed therapist married to a cabinet maker.

    Our premiums for a family of four were $3,500 every quarter -- which I know as I am the bill payer in the family. Our deductible, in the event of a serious catastrophe, was $7,000. If you can manage to get up to $7,000 in the course of one year while paying for all the mammograms, blood work, dental cleanings and contact lenses that the insurance did not pay for, then they will cover the rest. We, being a healthy family, never managed to spend more than a few K a year (thank God).

    I waited until this summer to have surgery done that I've needed for years b/c my new job covers it.

    Frank, I love you, but you are always very conservative on social issues (I know you say "libertarian," as I've known you for decades) and you've hated Obama since Day 1. This country desperately needs some kind of health care for the middle class. And, David, if you were saying that -- I agree. I thought you were blaming those who didn't have health care for their own failures, much as the Victorians always blamed the poor for their poverty.

    I don't know what hard data you want (everyone's stats seem to be disagreeing here), but I have at least a dozen friends, middle-class academics and journalists who either have no insurance or are paying through the nose to cover themselves.

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  27. That was me, btw, not Anonymous. Susan B., never anonymous!

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  28. Susan, I understnad your frustration. At the same time, you should be aware that routine eye exams, glasses and dental care are extremely unlikely to become part of any public option insurance program. BTW, did you know that the actual Medicare premium (Part A+B) per person is in excess of $400 per month per individual (not including the Part D prescription benefit)? This is the premium those ineligible for subsidy pay. It is calculated based on actual costs. As you know, Medicare regularly significantly underpays all healthcare bills as the under-65's insurance ends up subsidizing those costs. Your $3500 per quarter for a family of four would be about what you would pay for a public plan once passed, particularly if, unlike Medicare it has a cap on 80/20 co-pays.

    Remember, the government already spends half of all money spent on providing healthcare in the country, underpays all bills it receives and covers less than 25% of the population in the process. It is highly unlikely they can take on the rest of us and save money. Not arguing against a public option, but it is best not to pretend, like Bryan and others do, that there are real savings to be attained or some sort of evil gross profit-making driving up costs.

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  29. Anybody who is against universal, affordable healthcare should be sent to their rooms without dinner. When a conservative starts talking about reforming the NHS I reach for my revolver.

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  30. It comes down to a choice between three basic options:

    1. Equality of mediocrity as in the NHS. (Systems which idealise equality tend to mediocrity).

    2. Rabid pursuit of excellence at the price of severe inequality as in US.

    3. A mixed system which allows private money and extends as much cover as affordable to the poor.

    If you have two identical patients but can only save one, do you do so and accept the inequality, or do you let them both die for the sake of equality?

    If you want to maximise the number of lives saved you have to accept that the best treatment is often too expensive to be given to all patients with that condition. You either accept that inequality to save lives, or you enforce an equality of mediocrity that will see people die unecessarily. Until the row over co-payments, the NHS refused to partially subsidise private treatment because of 'equality' and people almost certainly died as a result.

    I would guess that the poorer you are the better you do in the UK, and the wealthier you are, the better you do in the US. Any number of socially-minded countries in the world (and Europe!) have more private involvement than we do. A more mixed system would hardly be a vicious assault on the poor.

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  31. If from each person, a hospital, a doctor, a clinic, or a skilled nursing facility, would receive the same amount of compensation, then the economic decision to neglect or replace and sometimes to allow the death of a poorer patient, would not be in the question--it would not be a good business decision.

    Yours,
    Rus

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  32. David:

    Excellent comments, thanks.

    Nonetheless, a good health care reform would be to stop allowing business to provide insurance to their employees tax-free ...

    Exactly. Then the next step would be to get employers out of the business altogether.

    They don't what would otherwise be salary to buy my car insurance, either.

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  33. My niece who recently graduated from college is in the set of middle class Americans who can't get health care insurance. She can only get a part time job without benefits so she can't afford to pay for both health care and her student loan. She is keeping her fingers crossed that she doesn't get sick.

    If I lost my job I would be in a lot of trouble too. I could never get health care insurance because of pre-existing conditions so I would have to take COBRA which would be about $1,200 per month, a little more than I would be able to afford if I lost my job.

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  34. Sean - I just checked the infant mortality rates for the UK and Ireland. UK is 5.0 and Ireland is 5.2. And just for fun, the US is 6.4.

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  35. I believe Michael Smith's theory about NHS equalizing mediocrity is incorrect because wealthy people can always buy additional health care.

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  36. Just to add one more thing... the claim that the uninsured are just illegal immigrants. 48% of the 40 million people who are uninsured are white (Hispanics represent less than one-third). I am assuming that David does not believe that these white people are illegal immigrants. Or perhaps he thinks that there has been a huge influx of illegals pouring across the Canadian border. Anyway, the majority of these people are people who can't get insurance because it costs too much (my niece is an example). But if they get sick, we end up paying for their treatment because no hospital is going to refuse to treat a sick person. That is the reason we will require them to have insurance. If my niece gets swine flu, do you want a hospital to kick her into the street so she can give it to your kids? (She is a part-time teacher.) Health is not an individual concern. Diseases are contagious (in case you weren't aware).

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  37. Tom P. said:

    I believe Michael Smith's theory about NHS equalizing mediocrity is incorrect because wealthy people can always buy additional health care.

    Tom, that use of private health care would be outside the service provided by the NHS and would therefore be an example of inequality allowing higher standards. Everybody within the traditional NHS would be subjected to notionally identical standards ie you level down the top and level up the bottom: that's mediocrity.

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  38. Okay, then. So let's switch it around for a while to be fair, and give the poor people the finest health care this nation can provide, and the rich people the worse deal. That way we don't have to worry about everyone getting mediocre care.

    Yours,
    Rus

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  39. And just for fun, [US Infant Mortality] is 6.4.

    Just for fun, find the infant mortality for European Americans.

    If you are going to throw statistics around, it is best to compare like against like.

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  40. Skipper - Are you saying that there are no minorities in the UK? But OK, if it helps you. The infant mortality rate for non-hispanic white mothers in West Virginia was 7.67

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  41. If we are going to throw stats around, let's throw studies around. Here is a pdf document that offers a look into insurance status and infant mortality in Rhode Island in the 1990s:

    Rhode Island Infant Mortality 1990-1999: Changes in Causes of Death and Period of Death by Insurance Status

    Yours,
    Rus

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  42. Just to be clear, I'm not saying I prefer the American system to the NHS. I'd like a more balanced system than either of those, but if I had to choose between those two only, I'd choose the NHS.

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  43. Just to be clear about two things: First, I'm not saying that our system is problem free. I'm saying that the problems are not what the people pushing reform say they are and thus reform won't solve them.

    Second, I never said that the uninsured were only, or mostly, illegal immigrants (although in my part of the country a large number of the illegal imigrants are white, from Ireland and from Canada). I said that the largest group are young and middle class; basically people who are betting that they aren't going to get sick. Nonetheless, it's worth noting that the President absolutely denies that his reforms will make insurance available to illegal aliens.

    This includes Tom's niece, who he says "can't afford" health insurance and I say chooses not to buy health insurance. In 2008, the average health insurance premium for a single person in the US was a little less than $4400. That's pretty expensive, and it's a bad deal for a young, single woman, but if she really wanted it, it's not unaffordable.

    But this is the question of reform: should we take on trillions of dollars of debt, and bring 16% of GDP under government control, because young middle class women don't choose to buy health care?

    And if it is, then that has nothing to do with the most likely reform to be passed, which would require Tom's niece to buy health insurance that is intentionally overpriced so as to subsidize insurance for others.

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  45. I don't think Bryan has quite hit the nail on the head. One doesn't need to punish failure in order to reward success. It's a bit more venal than that...if that is possible.

    It's rather a case of the rich and powerful pulling up the ladder after them. What is the point in paying through the nose for healthcare if some interfering 'liberal' is going to pass laws to make it free for all, as opposed to the current free-for-all that is the American Way of Life (and Death)? Wouldn't that void the most visible display of one's wealth possible: the fact that you're live and kicking whereas the less wealthy aren't?

    The NHS isn't perfect, and you can always find statistics to pit against each other, but any system which costs twice as much of GDP while failing to cover one-sixth of the population has got something seriously wrong with it. The hysterical rhetoric of Palin and Limbaugh is really nothing more than a crass attempt to get people to ignore the failings of the US system.

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  46. And this is why I'm thick for letting myself get sucked into internet "discussions."

    THE POOR IN THE STATES GET GOVERNMENT HEALTH INSURANCE UP TO 133% OF THE POVERTY LINE.

    The US government spends as much on providing health insurance, as a percentage of GDP, as the UK.

    The top 50% of income earners in the US pay all the income tax, and the richer you are the more you pay.

    So, just like Hobbes' state of nature, except not. And yet, the next comment down is bound to take as its starting point the well-known fact that, in the states, the rich eat the poor.

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  47. Your system still stinks, though, as it costs twice as much as, but only provides 83% of the coverage that ours does (100%). You can make all the excuses you want for it, but one thing I don't have to excuse is the premise of the NHS, being that access to healthcare is totally decoupled from ability to pay for it. When Americans don't have to choose which finger they can afford to have sewn back on then you'll be in a position to criticise our way of doing things.

    Until then, give it a rest will you?

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  48. I have to laugh when people start throwing out meaningless statistics...

    THE POOR IN THE STATES GET GOVERNMENT HEALTH INSURANCE UP TO 133% OF THE POVERTY LINE.

    Yes, the government provides health insurance (hard to find doctors who take it) at 133% of the poverty level. That comes out to $29,327 for a family of four. That's right, less than $30,000 for a family of four. That means that if both parents work full time at a minimum wage job, they would earn too much to get health insurance from the government.

    "The top 50% of income earners in the US pay all the income tax, and the richer you are the more you pay."

    You can't get tax dollars from people who don't have any so this should be no surprise. That's like saying that the top 50% of income earners own 100% of the Jaguars in the country. But the fact is that as a percentage of their income, the poorest 50% pay more in taxes (all taxes) than the wealthiest 10%. By the way, the cutoff point for the top 50% is $33,000. Yes, 50% of Americans make less than $33,000 as their adjusted gross income.

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  49. Tom: I have no idea what your point is. If your point is that our system is not perfect, then we agree.

    If you have a point, before sharing it you should note that average household income is $50,000 and average household income of a family of four is $70,000.

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  50. Not to be too cryptic, but why shouldn't we expect two adults making $50,000 to spend $8,000 on health insurance? And if they choose not to, why should we object?

    Why shouldn't we expect a family of four making $70,000 to spend $12,000 on health insurance? And if they choose not to, why should we object?

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  51. God almighty, that's 16% of their income! $50,000 is not a lot of money in the grand scheme of things, and spending 16% of that on health insurance beggars belief.

    Besides, even if the product was faultless then it would be too much money to pay. There are too many ways that the health insurance providers can wriggle out of their obligations: no coverage for pre-existing conditions, failure to inform the insurer of even minior unlreated conditions, caps omn the amounts paid out...

    Your system stinks, sorry. Ours creaks sometimes, but the problems it has are good ones to have, lying at the margins of treatable medicine, such as cancer survival rates. Any system that fails to address mundane and perfectly tractable issues, such as infant mortality, is rotten to the core.

    ReplyDelete
  52. American health care institutions have boasted arrogantly for years, "Ours is the only industry in American society that will never go out of business. We strive everyday to put ourselves out of business, but we can weather any storm."

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