Thoughts on Healthcare

 

Recently I have been interested in the healthcare debate that has been going on in many developed nations, but specifically the United States. As most people probably know, the United States is the only developed nation in the world without some kind5), despite the U.S. paying a substantially larger sum of money for its system (WorldBank, 2014). Obviously, the degree to which state control is in place varies country by country, but you get my point being that most other countries are able to do something the majority support; [1] that being a single-payer healthcare system or just a more state-run system. Now I personally have not developed my opinion fully on this issue, hence why I’m looking into it and just plan on going over my understanding of the debate and offering some possible policy suggestions.

This post is mostly going to be centered around arguments I’ve heard defending the United States healthcare system, of which I was very pleased to see because it was not until recently that I had even heard of such a thing as defending the U.S.’s healthcare system, given how openly it just dismissed as horribly inefficient and expensive. As many on the right have pointed out, the U.S. leads in most areas of cancer survival rates when compared to other developed nations such as Canada, Sweden, Denmark, etc. From this, they often conclude that single payer system is inferior because cancer treatment is a very difficult process, and one can easily use it to judge a country’s healthcare efficiency given that more efficient systems should have higher survival rates for such a complex procedure.

This is a very common argument given by the staunch defenders of the U.S. system that I take issue with. It is true that the United States has very good cancer survival rates, [2] however this comes at an enormous cost. As Soneji and Yang (2015) have pointed out, [3]

“Compared to Western Europe, for three of the four costliest U.S. cancers—breast, colorectal, and prostate—there were approximately 67,000, 265,000, and 60,000 averted U.S. deaths, respectively, and for lung cancer, there were roughly 1,120,000 excess deaths in the study period. The ratio of incremental cost to quality-adjusted life-years saved equaled $402,000 for breast cancer, $110,000 for colorectal cancer, and $1,979,000 for prostate cancer—amounts that exceed most accepted thresholds for cost-effective medical care.”

So, what does this all mean? Well, we see that from 1982 to 2010, the U.S. spent $435 billion, $325 billion and $434 billion more than Europe on care for breast, colorectal and prostate cancer. [4] Now, defenders of the system may say that at least our extra spending is helping people live longer, but such a conclusion is short lived when you factor in lung cancer, which kills almost as many people as breast, colorectal and prostate cancer combined.

Although lung cancer mortality rates in the U.S. have dropped over the past few decades, those rates remain higher than Europe’s. Soneji and Yang estimate that there have been 1,120,000 more excess lung cancer deaths in the U.S. than in Europe from 1982 to 2010. During this same period, the U.S. spent $406 billion more on lung cancer care, adjusted for population size, than Europe did. Soneji and Yang calculate that for every extra $19,000 spent on a lung cancer patient in the U.S. compared to Europe, that patient loses a year of quality-adjusted life. Americans die more frequently than Europeans of lung cancer even though Europeans have higher smoking rates (WHO, 2016).

Another point I wanted to bring up is regarding wait times. People often go on and on about how wait times are much higher for medical care in countries other than the United States. Now, while this is true to an extent and is one of the main reasons I don’t support a fully single payer system, the issue is a bit more complicated than it seems. First off, as Viberg et al. (2013) shows, the methods by which wait time data is collected in varying countries are all over the place and there is a general lack of good data on the subject as a result of this.

Despite the lack of hard data on the subject, I was able to find a study by the OECD (2013) which Viberg et al. actually recognized as one of the few case studies that is up to code with good data. What they show is that this lack of data on wait times actually has been a real problem for the governments of countries that have single payer systems. Canada, for example, had a very difficult time in the early 2000s dealing with their long wait problems because different clinics in different provinces kept collecting and storing the data differently or sometimes not at all.

But what the OECD reports are that the data situation has been under better control in the years following 2004, and the Canadian government has been able to implement wait time guarantees that have been quite successful in reducing wait times. Similarly, in the case of Sweden, the OECD report states,

“The last two decades display a pattern of temporarily reduced waiting times due to the guarantees. However, the current guarantee, designed in 2005, seems to have had a more positive, long-term effect on waiting times. More patients than before are receiving treatment and surgery within 90 days.”

They attribute this success to the economic incentives the government gave individual clinics to reduce wait times by giving more money to those which met the requirements of The Queue Billion which mandated certain wait times. This trend of governments finding their own paths to reducing wait times through more effective methods of data gathering, reporting, and taking action to be a common trend throughout all countries with single payer systems. So while yes, they do tend to have longer wait times, this isn’t something that can’t be fixed. My personal recommendation would be a system still largely state-controlled, but with more economic incentives and independence to individual clinics in order to reduce wait times and improve quality.

I just brought up quality because this is something I wanted to finish on. Despite the U.S. leading in areas like technological advancement in medicine, cancer survival rates, and the potential for high-quality care, most Americans simply don’t receive it (AHRQ, 2012) and this is something many American policymakers have been concerned with for a very long time, (Brook, 2011) not some liberal conspiracy. Some studies (McGlynn et al, 2003) suggest that the average American only receives about 50% of their recommended health care services. As Woolf and Aron (2013) [5], in their amazing book I highly recommend you check out, note:

“Although the United States does well in providing access to many specialists, access to primary care physicians and a regular health care provider is more limited than in many other countries (OECD, 2011b; Schoen et al., 2009b, 2011; Starfield et al., 2005; World Health Organization, 2008b). According to the OECD, only 12.3 percent of U.S. physicians engage in primary care, the lowest proportion among 15 peer countries providing data: see Figure 4-1.10 Macinko et al. (2003) applied 10 criteria to rank the primary care systems of 18 high-income countries (including Canada, Australia, Japan, and 14 European countries). The United States had the weakest primary care score of all the countries in 1975 and 1985 and the third weakest in 1995 (Macinko et al., 2003). Continuity of care from a regular provider, which is important to effective management of chronic conditions (Liss et al., 2011), may be more tenuous in the United States than in comparable countries. Only slightly more than half (57 percent) of U.S. respondents to the 2011 Commonwealth Fund survey reported being with the same physician for at least 5 years, a lower rate than all comparison countries except Sweden (Schoen et al., 2011). In another Commonwealth Fund survey, U.S. patients were more likely than patients in other countries except Canada to report visiting an emergency department for a condition that could have been treated by their regular physician had one been available (Schoen et al., 2009b).”

Ending with that, I think it’s safe to conclude that the U.S. healthcare system is not among the most efficient, and should certainly not be praised. That said, it should also be noted that the single payer systems of Western Europe and other developed nations should also be criticized for their inefficiencies, but I believe that my analysis helps show that a system closer to single payer is more desirable than the current U.S. system. Thanks for reading!

Notes:

[1] As Kiley (2017) notes: “A majority of Americans say it is the federal government’s responsibility to make sure all Americans have health care coverage. And a growing share now supports a “single payer” approach to health insurance, according to a new national survey by Pew Research Center.”

[2] This has been confirmed by numerous studies, most notably Coleman et al. (2008)

[3] You can find a critique of Soneji and Yang’s article here and a critique of that critique here.

[4] In a discussion with John Horgan, Soneji notes that: “In 2010, the National Cancer Institute estimated the cost of US cancer care was $126 billion (see p. 31, http://progressreport.cancer.gov/sites/default/files/archive/report2011.pdf). For the 12 selected cancers we studied, we estimate the U.S. spent an additional $569 per capita in cancer spending in 2010.  Or equivalently, if the U.S. and Western Europe were the same population size, the U.S. spent an additional 80.7 billion dollars in cancer care of the 12 most common cancers in 2010.”

[5] For all of Woolf and Aron (2013)’s references, see their bibliography starting on page 293 of their book.

References:

AHRQ. (2012) National Healthcare Quality Report

https://archive.ahrq.gov/research/findings/nhqrdr/nhqr12/index.html

Brook, R. (2011) Health Services Research and Clinical Practice

http://jamanetwork.com/journals/jama/article-abstract/896883

Coleman, M., et al. (2008) Cancer survival in five continents: a worldwide population-based study (CONCORD).

https://www.ncbi.nlm.nih.gov/pubmed/18639491

Greenberg, J. (2015) Bernie Sanders: U.S. ‘only major country’ that doesn’t guarantee right to health care

http://www.politifact.com/truth-o-meter/statements/2015/jun/29/bernie-s/bernie-sanders-us-only-major-country-doesnt-guaran/

Kiley, J. (2017) Public support for ‘single payer’ health coverage grows, driven by Democrats

http://www.pewresearch.org/fact-tank/2017/06/23/public-support-for-single-payer-health-coverage-grows-driven-by-democrats/

McGlynn, E., et al. (2003) The Quality of Health Care Delivered to Adults in the United States

http://www.nejm.org/doi/full/10.1056/NEJMsa022615#t=article

OECD. (2013) Waiting Time Policies in the Health Sector WHAT WORKS?

http://www.fcass-cfhi.ca/sf-docs/default-source/on-call/2015-05-19-siciliani2013waiting-time-policies-in-the-health-sector.pdf?sfvrsn=2

Soneji, S., Yang, J. New Analysis Reexamines The Value Of Cancer Care In The United States Compared To Western Europe

http://content.healthaffairs.org/content/34/3/390.abstract

Viberg, N., et al. (2013) International comparisons of waiting times in health care – Limitations and prospects

http://www.sciencedirect.com/science/article/pii/S0168851013001759#bib0135

WHO. (2016) Prevalence of Tobacco Smoking

http://gamapserver.who.int/gho/interactive_charts/tobacco/use/atlas.html

Woolf, S.H. and Aron, L. (eds.) (2013) U.S. Health in International Perspective: Shorter Lives, Poorer Health

https://www.nesri.org/sites/default/files/US_Health_in_International_Perspective.pdf

WorldBank. (2014) Health expenditure, total (% of GDP)

http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS


 

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Demonstrators organize to celebrate a meme

In such a polarizing political climate, we don’t often have that many opportunities to go out of our way to take a break from serious discussions and find a way to enjoy ourselves. This will not be the case on September 11th in Chicago, however.

Carlos Smith, along with Nereo Rodriguez, David De El Rancho, Jonathan Carvajal, and Victor Smith, organized “Yelling ME HOY MINOY Like Doodlebob @ The Bean.” The phrase “me hoy minoy” is a reference to the popular cartoon Spongebob Squarepants.

“I wanted to do something where…people would get the chance to meet others with something in common,” Smith said over the phone. “I didn’t know what (to do), and the thing that I thought wouldn’t work blew up.”

This is the first time Smith has organized a demonstration. With an estimated 2,000 people are slated to attend the demonstration, Smith’s work is a success.

The phrase “me hoy minoy” is from the episode “Frankendoodle,” when it aired on January 21st, 2002

Smith chose to celebrate this phrase over other popular memes because of his love of Spongebob, as well as his desire to not repeat similar events in the past, such as “Everyone Point Their Fans At The Hurricane To Blow It Away,” which occurred earlier this week along the East Coast.

Smith made it clear that this would not be possible without the support of everyone attending. He plans of expressing is gratitude at the beginning of the event, as “this wouldn’t be possible without everyone who showed up.”

Demonstrations like these hold an importance in such a polarizing era. When people have the ability to laugh about something they mutually enjoy, they are inadvertently paving the way for more open, honest, and respectful conversation on varying issues.

There is a need for an increase in fun demonstrations that unify people from all walks of life. When asked if he had future plans for another demonstration, Smith replied: “yeah, I would like to do something similar to this again, although I’m not sure what.”

Written by Jacob Sutherland

Published on Berning Media Network

The Establishment Gets Their Karma by Jacob Sutherland

Relocating German military aircraft from a Turkish airbase to a new location in Jordan will halt the country’s activities within the US-led anti-Daesh (IS) coalition for at least two or three months

Via UBC News –  The process of relocating German military aircraft from a Turkish airbase to a new location in Jordan will halt the country’s activities within the US-led anti-Daesh (IS) coalition for at least two or three months, according to Germany’s defense minister.
The decision to replace Turkey’s Incirlik airbase to a new airbase in Jordan started as relations between the two countries worsened in mid-May, when Ankara denied a scheduled meeting of German MPs with German military personnels at the base. It came after Berlin granted asylum to a number of Turkish nationals, whom Ankara accused of participating in the July 2016 failed coup attempt in the country. Those people allegedly hold diplomatic passports and were stationed in NATO facilities in Germany at the time of the attempted coup.

The two countries have been trying to settle the Incirlik issue, Berlin weighed in possible alternatives for the base, eventually settling on a military airfield in Jordan. The decision to abandon the Turkish base was approved by the German cabinet last week.

Social Capitalism by Anthony Bennett


It’s weird to think that thinking about relationships in terms of “what I offer and what I give” as something negative. Consider this:

Transactional and status based approaches to relationships are social capitalism. We’re branding and selling ourselves for attention and approval. Psychopaths and narcissists just see it for what it is and go all the way with it. Manipulative people are just predatory social capitalists in this regard. 

Changing the nature of our economics, that is changing the big picture of society, demands first changing our relationships, our immediate social surroundings–the little picture of society. In a certain sense this can actually be quite a hopeful outlook (see? I’m selling my ideas here). Why? There’s somewhere for efforts and energy to go in making change. We have a little picture to start with.

US warship fired five warning shots at Iranian patrol boats in the Persian Gulf


For the second time in a week, a US warship fired five warning shots at Iranian patrol boats in the Persian Gulf, in what Tehran calls another “provocative and unprofessional move.” A similar incident involving the two parties took place in the region last Tuesday. 

The US Nimitz-class aircraft carrier and another warship fired warning shots at Iranian vessels in the middle of the Persian Gulf yesterday, according to the Islamic Revolutionary Guard Corps (IRGC). “With only a few days since a provocative move in the northern end of the Persian Gulf in which the US Navy ships fired warning shots at an Iranian vessel, the American warships have once again taken the same action in the middle of the Persian Gulf,” the IRGC said in a statement. 

The US Naval ships were intercepted by IRGC missile boats near the Resalat gas-oil field, when they approached the Iranians and dispatched a helicopter, according to the statement. US warships then opened fire, after the Iranians failed to stop after multiple warnings, in what the IRGC described as “a provocative and unprofessional move.” 

The Americans left the area afterwards, the IRGC added, while the Iranians went on with their patrol. “The US warships in a provocative and unprofessional move began firing warning shots at the Iranian vessels, to which the IRGC Navy’s ships paid no attention and continued with their mission.”  

Published by:@thewarfiles