TWO DIFFERENT DOCTORS' OFFICES

Boy, if this doesn't hit the nail on the head, I don't know what does!

Two patients limp into two different medical clinics with the same
complaint. Both have trouble walking and appear to require a hip
replacement.

The FIRST patient is examined within the hour, is x-rayed the same day and
has a time booked for surgery the following week.

The SECOND sees his family doctor after waiting 3 weeks for an
appointment,
then waits 8 weeks to see a specialist, then gets an x-ray, which isn't
reviewed for another week and finally has his surgery scheduled for 6
months
from then.
Why the different treatment for the two patients?

The FIRST is a Golden Retriever.
The SECOND is a Senior Citizen.

Next time take me to a vet!

The vet will cost you more.

and they don't take insurance

Actually, the 1st. is in the USA.
The 2nd. is in Canada.

quote:

Originally posted by conifer:
Actually, the 1st. is in the USA.
The 2nd. is in Canada.

why the flag, have trouble speaking???????????????

quote:

Originally posted by Alberta Canuck:

quote:

Originally posted by conifer:
Actually, the 1st. is in the USA.
The 2nd. is in Canada.

Actually, the second patient lived in Canada.
Sorry, I didn't see that someone beat me to it, but, living here, I can tell you it ain't no BS.

Grizz

Money talks.
We will soon have a two tiered system.
Great care for those with money, and government care for ordinary citizens for those without.

quote:

Originally posted by Grizzly Adams:
Actually, the second patient lived in Canada.
Sorry, I didn't see that someone beat me to it, but, living here, I can tell you it ain't no BS.

Grizz

Yes, but have you lived here and experienced the system here?

I have lived a considerable number of years in each country, and have experienced medical care in both in depth, having had over 40 surgeries in my life, along with some other problems caused by a chronic illness. Having also run hospitals in both countries, I have also seen the differences in the corporate operation of those, both public and private.



It is true that you can't easily get on-demand "elective" un-needed surgery rapidly in most parts of Canada. But when the need merits quick care, it is forthcoming. For instance, when my father-in-law was diagnosed here in Phoenix with lung cancer when he fell ill during a vacation, Alberta Health Care paid for all of his treatment , tests, meds, everything here, housing and board for his wife during his hospitalization here, his special med-evac to Canada (and her flight too), and all of his care there.

It is also true that there is no "Canadian" sustem. There are 10 provincial systems and the federal system. And believe me, Alberta Health Care Insurance Corporation does not handle requests for service the same as does (for instance) Saskatchewan Government Insurance Office in your neighboiring province to the east. Even more so is the U.S. system different.

In Alberta, your eye, dental, medical, pharmaceutical, hopital, etc. bills are all covered with no deductible (and no "co-pay") for how many $ per quarter? Under $200 per month isn't it?

In the U.S., if you want that ALL covered with no deductible AND NO CO-PAY, you are likely looking at roughly $1,000 per month or more...if you can get insurance at all! (Many folks can't, as American insurance companies don't have to cover folks with certain pre-existing conditions. Might hurt their CEO's bonuses and corporate stockholders' profits, you know.) The U.S. system is more about making money than curing people or keeping them well.

Some doctors do leave Canada for the U.S. They read all those reports about Yank doctors who make $1 million a year or more and the B.S. about the research opportunities here, too. But, in private practice in Canada, they have no dead-beat patients to put up with, as everyone is insured. They also don't have to pay a crew of accountants on staff to pursue and collect all their bills from their customers. Plus, their malpractice insurance costs are a fraction of what similar insurance here costs the average physician. Bottom line is that a reading of the NET income to doctors in each country is on par with the other.

Then too, with only one major health inmsurer in every province, they don't have 150 or more insurance companies each paying CEOs, Personnel Directors, CFOs, etc., to raise the cost of care to the ptients. Nor is there any advertising cost for the Canadian insurers, while in the U.S. the TV stations and local nespapers get many millions of dollars per DAY in ads for the insurers...all of which is paid for by the insured.

Other areas are also better in even Alberta. Vor instance, drugs which have been tested and used for many years in Europe tend to be very rapidly vetted and approved in Canada....not so here. In Canada we were using drugs deeveloped in Germany to dissolve gall stones (instead of surgery) in the late 1970s. Here some of those drugs still aren't available. And that's just one example.

I am not going to give a free seminar on comparative medical systems here, but for anyone to say that the Canadian system is much worse than the American system is simply ignorance and part of the educational propaganda taught to Americans from the time they are children.

In actual ranking of healh-care systems throughout the world, the number one ranked system is that of France. The American system is about 10th or 11th.

Having said that, I leave the B.S. flag raised.

You may believe whatever you wish.

Then these stories we here on a regular basis about Canadian politicians flying to the US for major surgeries are all false?

I read about it, but apparently it is not so...
Another one of those urban myths, like the basic 46% income tax you pay, and the VAT thing.


Rich

quote:

Originally posted by Idaho Sharpshooter:
Then these stories we here on a regular basis about Canadian politicians flying to the US for major surgeries are all false?

I read about it, but apparently it is not so...
Another one of those urban myths, like the basic 46% income tax you pay, and the VAT thing.


Rich

Rich, you know that is a red herring and proves nothing at all about the quality of the whole system for the whole of the people in each country.

I did not say there are not some really advanced treatment facilities in the U.S. Obviously there are...such as but not limited to the Mayo Clinic(s), the Scripps Clinic in La Jolla, the Houston Burn Center, etc.

But overall, for the average citizen without lots of bucks, the American system is not an outstanding (or even very good among industrialized countries) example of how to deliver good health care.

And if you want to talk taxes, you'll have to do it elsewhere. It turns out that when you roll all the taxes together in both countries, the money the average Joe has left over after taxes is just as much or more in Canada as in the U.S. Canadians pay fewer, but bigger, taxes. Americans pay a lot more individual, small taxes. But the sum total is very close to the same. Been there, done that.

I personally think anyone who REALLY loves the U.S. should be willing to critically review what it does well and what it doesn't, face reality, and try to make it the best it could be, not blindly buy into the B.S. that everything designed or done here is the best in the world.

And I also think that if anyone wants to continue this, we should move it to the "Miscellaneous" forum. It isn't humour in any way.

AB, the one thing I don't think you've taken into consideration is many, me included, don't want the govt involved in every facet of our lives.

quote:

Originally posted by dempsey:
AB, the one thing I don't think you've taken into consideration is many, me included, don't want the govt involved in every facet of our lives.

The way this government works, I don't blame you for feeling that way. It is all partisan politics anymore, aimed solely at getting into and staying in office rather than an attempt to provide the country with workable, simple, systems in ANY field the executive or legislative branches touch. Too bad, isn't it? Things could be so much better if we had honest hard working people tying to improve the nation in those offices instead of folks dependent on spin-doctoring and who are bought by lobbyists.

quote:

In actual ranking of healh-care systems throughout the world, the number one ranked system is that of France. The American system is about 10th or 11th.

Would you happen to have a primary source for the rankings?

Thanks

AC, that's one way to look at it. The other is it's the principle this country was founded upon. We fought for it, Canada didn't. I think that plays a large role in how the two countries view the role of govt. From day one of the founding of the United States there was, still is, plenty to bitch about. However, the fact is, with all it's problems, it's still the greatest nation on the planet. Canada, is where it is today soley by it's location on the map.

You're welcome to your opinion Dempsey, but if you don't think Canadians fought for their country, then you have no knowledge of history at all. Anyway, enough of this. Once again it comes across that America is the biggest, the greatest, the most moral, etc.....in their own minds.

I still believe it would be an even better and nicer cuntry if it was weighed more objectively by all its inhabitants. Why do you think big league athletes look at slow-mo video of their own performances? To make themselves even better, that's why. The same kind of examination and careful scrutiny could help our country too.

quote:

Originally posted by interested:

quote:

In actual ranking of healh-care systems throughout the world, the number one ranked system is that of France. The American system is about 10th or 11th.

Would you happen to have a primary source for the rankings?

Thanks

Rankings obviously differ according to when and by whom they are done.

One of the more commonly accepted as valid is done by the World Health Organization.

Here is it's link:

www.photius.com/rankings/healthranks.html -

(I hope it works for you. If it doesn't, simply google "national health care system rankings",or "health care system rankings by nation."

Please note, I did not quote this particular one, because in its latest rankings, the U.S. system, as it affects all citizens in the country, actually ranks 37th in the world, not the higher "11th" ranking I cited. If anyone disagrees, they can take it up with the W.H.O., not me.)

quote:

Originally posted by Alberta Canuck:
You're welcome to your opinion Dempsey, but if you don't think Canadians fought for their country, then you have no knowledge of history at all. Anyway, enough of this. Once again it comes across that America is the biggest, the greatest, the most moral, etc.....in their own minds.

I still believe it would be an even better and nicer cuntry if it was weighed more objectively by all its inhabitants. Why do you think big league athletes look at slow-mo video of their own performances? To make themselves even better, that's why. The same kind of examination and careful scrutiny could help our country too.

You clearly know I'm speaking of the fight for independance. And yes, objectively, I feel the U.S. is at the top of the heap, warts and all. I won't waste our time arguing that point.

quote:

Originally posted by Alberta Canuck:

quote:

Originally posted by interested:

quote:

In actual ranking of healh-care systems throughout the world, the number one ranked system is that of France. The American system is about 10th or 11th.

Would you happen to have a primary source for the rankings?

Thanks

Rankings obviously differ according to when and by whom they are done.

One of the more commonly accepted as valid is done by the World Health Organization.

Here is it's link:

www.photius.com/rankings/healthranks.html -

(I hope it works for you. If it doesn't, simply google "national health care system rankings",or "health care system rankings by nation."

Please note, I did not quote this particular one, because in its latest rankings, the U.S. system, as it affects all citizens in the country, actually ranks 37th in the world, not the higher "11th" ranking I cited. If anyone disagrees, they can take it up with the W.H.O., not me.)

I had hoped that you had found a recent authoritative study. The WHO study, frequently quoted in newspapers and in political speech (particularly when seeking more healthcare funding) is widely discredited. Even the editor-in-chief of the report which accompanied the rankings, Philip Musgrove, says the methodology had many made-up numbers and the result was a nonsense ranking. He wrote an article in 2003 for The Lancet in which he said the rankings were “meaningless.” Even WHO says the rankings are no longer current and they have no plans to release a new rankings report. Others are currently working on new rankings studies.

As an example of the methodology used, accept for the moment that the US has wide disparities in the healthy vs. unhealthy. Then think of a country where everyone is uniformly unhealthy so there is no “disparity gap.” The latter country would outrank the US in WHO’s methodology in the health disparities factor. Does this make sense?

Other factors used in the study raise similar conundrums.

I just got back from visiting a family member hospitalized in a leading European hospital. I was astounded at how low-tech was the in-patient care. Not even a pump for IVs. As a hospital administrator, I suspect that virtually all your patients have pumps for their IVs. Technology is what is driving US healthcare costs, not administrative costs. If a patient were given the choice between healthcare/drugs available on the date of his birth (presumably inexpensive – certainly for the Medicare pt) and today’s technology-driven healthcare (expensive), what would be the likely choice, particularly when the patient thinks his insurance is paying for it, rather than all premium payers/ taxpayers as a whole? I would add that the European hospital did not even have phlebotomists on staff to do blood draws. One had to search the hospital for a nurse capable of doing a draw. This certainly lowers costs. I suspect your hospital has a number of phlebotomists on staff, presumably driving up costs.

I will give the European country great credit for its ability to coordinate all post-op care in a single 15 minute appointment, including transport to/from appts, 6 weeks of daily in-home rehab, 2 weeks of rehab in a coastal 4-star facility all at “no-cost” to the pt. The pt did have a supplemental private insurance which was responsible for picking up any co-pay. So credit where credit is due -- not everything in the US healthcare system is better than elsewhere.

quote:

Originally posted by fla3006:
The vet will cost you more.

Are you serious?

My Lab had hip surgery, and the TOTAL bill was only $650. For a human doctor, the first office visit and x-rays will cost more than that.

quote:

Originally posted by interested:

quote:

Originally posted by Alberta Canuck:

quote:

Originally posted by interested:

quote:

In actual ranking of healh-care systems throughout the world, the number one ranked system is that of France. The American system is about 10th or 11th.

Would you happen to have a primary source for the rankings?

Thanks

Rankings obviously differ according to when and by whom they are done.

One of the more commonly accepted as valid is done by the World Health Organization.

Here is it's link:

www.photius.com/rankings/healthranks.html -

(I hope it works for you. If it doesn't, simply google "national health care system rankings",or "health care system rankings by nation."

Please note, I did not quote this particular one, because in its latest rankings, the U.S. system, as it affects all citizens in the country, actually ranks 37th in the world, not the higher "11th" ranking I cited. If anyone disagrees, they can take it up with the W.H.O., not me.)

I had hoped that you had found a recent authoritative study. The WHO study, frequently quoted in newspapers and in political speech (particularly when seeking more healthcare funding) is widely discredited. Even the editor-in-chief of the report which accompanied the rankings, Philip Musgrove, says the methodology had many made-up numbers and the result was a nonsense ranking. He wrote an article in 2003 for The Lancet in which he said the rankings were “meaningless.” Even WHO says the rankings are no longer current and they have no plans to release a new rankings report. Others are currently working on new rankings studies.

As an example of the methodology used, accept for the moment that the US has wide disparities in the healthy vs. unhealthy. Then think of a country where everyone is uniformly unhealthy so there is no “disparity gap.” The latter country would outrank the US in WHO’s methodology in the health disparities factor. Does this make sense?

Other factors used in the study raise similar conundrums.

I just got back from visiting a family member hospitalized in a leading European hospital. I was astounded at how low-tech was the in-patient care. Not even a pump for IVs. As a hospital administrator, I suspect that virtually all your patients have pumps for their IVs. Technology is what is driving US healthcare costs, not administrative costs. If a patient were given the choice between healthcare/drugs available on the date of his birth (presumably inexpensive – certainly for the Medicare pt) and today’s technology-driven healthcare (expensive), what would be the likely choice, particularly when the patient thinks his insurance is paying for it, rather than all premium payers/ taxpayers as a whole? I would add that the European hospital did not even have phlebotomists on staff to do blood draws. One had to search the hospital for a nurse capable of doing a draw. This certainly lowers costs. I suspect your hospital has a number of phlebotomists on staff, presumably driving up costs.

I will give the European country great credit for its ability to coordinate all post-op care in a single 15 minute appointment, including transport to/from appts, 6 weeks of daily in-home rehab, 2 weeks of rehab in a coastal 4-star facility all at “no-cost” to the pt. The pt did have a supplemental private insurance which was responsible for picking up any co-pay. So credit where credit is due -- not everything in the US healthcare system is better than elsewhere.

Unfortunately, we have to use what we have as sources, which is why I mentioned the rankings in the first place.

Flawed as it is, it seems that much of the world demands that everything be quantified and then bowed to as if an ultimate guide chisled in stone. I am aware that the WHO study is weak, debatable, and at least as much a political statement as anything else. But then, what isn't? Politics is well defined as "the system for determining who gets what and when and how". Pretty much all written and spoken work has as its goal the furtherance of a particular view, mine included.


I also know that I have personally experienced, seen, and worked in, better systems than ours. My goal, as I hope other folks' would be, is to reduce the smug self-admiration a wee bit and try to increase the push for something better without creating even more problems in health care delivery.

I do believe that nurses get training on how to draw blood. If one has to go "hunting" a nurse that knows how to draw blood, you've got a pretty shitty staff.

I would like to add that I did not say that administrative costs were the major thing driving U.S. health care costs...they are a factor, but not the primary one.

My opinion is that the primary factor is the focus on maximizing profit by practitioners, suppliers, etc. rather than on availability of appropriate quality care to those who need it to survive. Sure there are exceptions..practitioners and suppliers who are noble, efficient, etc. But the system as it is here does not very well bend those involved in that direction.

quote:

But overall, for the average citizen without lots of bucks, the American system is not an outstanding (or even very good among industrialized countries) example of how to deliver good health care

AC:

You need to quit confusing them with facts. There are none so blind as true believers OR those who have a monetary finger in the pie.

For "interested" we spend SUBSTANTIALLY more per capita on our medical systmem than any other country in the world and taken as a whole, the US med system ranks well down the list of developed countries, ALL of whom spend less than we do per capita or as a percentage of GDP.

Here's part of a recent Ezra Klein article on medical care which might give some pause (bold emphasis mine):

quote:

Everyone knows — or should know — that the United States spends much more than any other country on health care. But the Kaiser Family Foundation broke that spending down into two parts, the government’s share and the private sector’s share (both measured as a percentage of total gross domestic product), then compared the results with figures from 12 other countries that are members of the Organization for Economic Cooperation and Development. And here’s the shocker: Our government spends more on health care than the governments of Japan, Australia, Norway, the United Kingdom, Spain, Italy, Canada or Switzerland.

Think about that for a minute. Canada has a single-payer health-care system. The government is the only insurer of any note. The United Kingdom has a socialized system, in which the government is not only the sole insurer of note but also employs most of the doctors and nurses and runs most of the hospitals. And yet, measured as a share of the economy, our government health-care system is the largest of the bunch.

And it’s worse than that: Atop our giant government health-care sector, we have an even more giant private health-care sector. Altogether, we’re spending about 16 percent of the GDP on health care. No other country even tops 12 percent. Which means we’ve got the worst of both worlds: huge government and high costs.

This is where a “serious conversation” on health-care costs would start — with what has worked, and what we can learn from it. Instead, it’s where our conversation about health-care costs never quite goes.

I have friends from Regina and Saskatoon that come to the Mayo clinic in Rochester Minn for their serious health care issues.
Yes they can afforsd it.

quote:

Originally posted by Gatogordo:

quote:

But overall, for the average citizen without lots of bucks, the American system is not an outstanding (or even very good among industrialized countries) example of how to deliver good health care

AC:

You need to quit confusing them with facts. There are none so blind as true believers OR those who have a monetary finger in the pie.

For "interested" we spend SUBSTANTIALLY more per capita on our medical systmem than any other country in the world and taken as a whole, the US med system ranks well down the list of developed countries, ALL of whom spend less than we do per capita or as a percentage of GDP.

Here's part of a recent Ezra Klein article on medical care which might give some pause (bold emphasis mine):

quote:

Everyone knows — or should know — that the United States spends much more than any other country on health care. But the Kaiser Family Foundation broke that spending down into two parts, the government’s share and the private sector’s share (both measured as a percentage of total gross domestic product), then compared the results with figures from 12 other countries that are members of the Organization for Economic Cooperation and Development. And here’s the shocker: Our government spends more on health care than the governments of Japan, Australia, Norway, the United Kingdom, Spain, Italy, Canada or Switzerland.

Think about that for a minute. Canada has a single-payer health-care system. The government is the only insurer of any note. The United Kingdom has a socialized system, in which the government is not only the sole insurer of note but also employs most of the doctors and nurses and runs most of the hospitals. And yet, measured as a share of the economy, our government health-care system is the largest of the bunch.

And it’s worse than that: Atop our giant government health-care sector, we have an even more giant private health-care sector. Altogether, we’re spending about 16 percent of the GDP on health care. No other country even tops 12 percent. Which means we’ve got the worst of both worlds: huge government and high costs.

This is where a “serious conversation” on health-care costs would start — with what has worked, and what we can learn from it. Instead, it’s where our conversation about health-care costs never quite goes.

Gatogordo,

Of course we spend more on health care. Why is that necessarily a bad thing?

I'm quite familiar with the KFF data.

Ezra Klein is a well-know columnist for the Washington Post. Prior to that he was with the American Prospect. Presumably he, too, has a "finger in the pie."

And, finally, what is your primary source for saying that"the US med system ranks well down the list of developed countries."

I'm not looking to pick an argument. This is a topic in which I have a deep interest for a number of years and have reviewed most of the primary source material.

AC, my only question is why with all your medical problems are you living in the USA?

quote:

Of course we spend more on health care. Why is that necessarily a bad thing?

Because we are spending more than anyone else, getting lesser results, and medical spending will eventually break the economy, if it hasn't already. A big part of GM, etc's problems was the unanticipated rising costs of medical care. We are above 17% of our GDP in medical spending at this point and the costs CONSISTENTLY outpace inflation every year. An unsustainable cycle and you wonder why it's a problem. Obviously you are one of those on the receiving end of the money stream.

I've got my sources about where the US med system ranks, but until I give them, why don't you show one that shows we're #1.

Like any system anywhere, if you're rich with unlimited resources, you tend to receive the best care. I think you can judge a system not on it's BEST results for a few, but on it's AVERAGE results for all. Otherwise, it would be like taking a fluke 1/2 inch group for a 1 1/2 inch rifle and telling everyone, "It's a half MOA rifle."

There should not be any "unanticipated rising cost of medical care" and it will continue as long as the government is involved. Look back in history and see when the "rising costs" started. I think you will find it began with the birth of Medicare.

quote:

Originally posted by Die Ou Jagter:
There should not be any "unanticipated rising cost of medical care" and it will continue as long as the government is involved. Look back in history and see when the "rising costs" started. I think you will find it began with the birth of Medicare.

Not really, it was during WWII when the Price and Wage Control board, or whatever it was called back then, told GM and other critical war materiel manufacturers that they couldn't raise wages but that they could INCLUDE medical benefits as part of their job package. It's been downhill ever since. However, it was a governmental agency that started it.

Gatogordo, possibly but with the advent of Medicare and Medcaid people could go to a doctor for no cost and the doctors just loved it. Give an old lady some candy pills and bill the government $25. It just spiraled upward from there. The medical benefits started as a way for companies to reward good employees, much like pensions and now it is going to be required.

People respect what they have an investment (cost) in much like hunting the most hard fought for trophy has the most meaning and respect.

I certainly can't disagree with that. The same thing applies to "all in" union and employer medical plans. People will go for the smallest of reasons because it costs them nothing. One of the problems with our system today is that it forces people who are not in the system, via insurance, medicare or medicaid, to use the ER as a family doctor visit.

I'm still waiting for the studies showing we have the best health care system in the world.

In the interim, which I fear will be quite long, read and think on this......

quote:

Life expectancy in the U.S. varies widely by region, in some places is decreasing

By David Brown, Updated: Wednesday, June 15,

Large swaths of the United States are showing decreasing or stagnating life expectancy even as the nation’s overall longevity trend has continued upwards, according to a county-by-county study of life expectancy over two decades.
In one-quarter of the country, girls born today may live shorter lives than their mothers, and the country as a whole is falling behind other industrialized nations in the march toward longer life, according to the study.

Led by Christopher J. L. Murray and Sandeep C. Kulkarni of the Institute of Health Metrics and Evaluation at the University of Washington, the study covers the years 1987 to 2007 and updates an earlier analysis of U.S. life expectancy through the 1990s. That study identified areas of the country where life expectancy was stagnant or declining; this report found that not only was that still the case, but more places are experiencing a decline. The study will be published Wednesday in the journal Population Health Metrics.
As they had previously, Murray and his colleagues found huge variation in life expectancy in the United States, with some of biggest extremes right around Washington. Fairfax County’s men, for example, had the longest life expectancy in the country, 81.1 years in 2007. In the city of Petersburg, 25 miles south of Richmond, life expectancy was 14 years less, and at 66.9 years among the lowest for men in the country.
The District is one of the places that has seen a big recent jump in life expectancy for a particular demographic group — black men, from 61.7 years in 1997 to 68.9 in 2007, a huge jump in demographic terms. The reason for the big increase isn’t entirely clear.
The region where life expectancy is lowest, and in some places declining, begins in West Virginia, runs through the southern Appalachian Mountains and west through the Deep South into North Texas. Places of high life expectancy are more scattered. In addition to Northern Virginia they include counties in Colorado, Minnesota, Utah, California, Washington state and Florida.
Although the research didn’t look for causes, there are several possible reasons for the slowing of longevity in parts of in the United States. The rising rate of obesity and plateauing of the smoking cessation rate among women are two. Poorly controlled blood pressure and a shortage of primary-care physicians are two others.
What surprised Murray and his team was that despite increased consciousness about disparities and per capita spending on health care that is at least 50 percent higher than European countries, the United States is falling farther behind them with each passing year.
“My expectation was that in the last decade we would at least be keeping up in terms of the pace of progress. But that’s not what’s happening,” said Murray.

Among the places with the biggest increases in life expectancy in the last two decades is New York City. The arrival of triple-drug antiretroviral therapy for HIV infection, along with dramatic declines in homicide and infant mortality, caused great gains in the late 1990s.

“The critical insight this work underscores is something that we’ve known for years — that both health and health care are produced locally,” said Elliott Fisher, a physician at Dartmouth Medical School who studies regional variations.

Life expectancy is an abstract concept that summarizes the health and threats to longevity that exist at a particular moment in history. It is not an actual measure of how long people are living.

To calculate life expectancy, researchers imagine a large group of people — say, 100,000 — born in a particular year, such as 2007. They then statistically move that “birth cohort” through life, subjecting it to the risk of dying that exists for every five-year period (0-5 years old, 6-10 years old, 11-15 years old, etc.) in that particular year. A few members of the group will die as infants, a few as children, a few as young adults, some in middle age, most in old age, and a few in extreme old age. The average age at death is this artificial population’s life expectancy.

The actual risk of dying at each age is determined from death certificates, which also include information about where the deceased person lived most of his or her life. Because of that, life expectancy can be calculated for geographical areas as small as counties. However, in the new study Murray and his team collapsed the nation’s 3,147 counties and large cities into about 2,400, merging some if their populations were too small to produce statistically meaningful populations.

In 2007, life expectancy for American men was 75.6 years, compared with 73.7 years a decade earlier. For women it was 80.8 years in 2007, up from 79.6 in 1997. Both rank the United States as 37th in the world in 2007.

The county-based life expectancy for men ranged from 65.9 years in Holmes County, Miss., to 81.1 years in Fairfax County. Women had the longest life expectancy in Collier County , Fla., which includes Naples (86 years) and the shortest in Holmes County, Miss. (73.5 years).

Among states, Mississippi fares the worst. Of its 82 counties, 26 had life expectancies for men in 2007 that were roughly 66 to 69 years.

The most striking trend was the slowing of life expectancy in women. From 1987 to 1997, there were 314 counties with either a loss of life expectancy or no growth in it. From 1997 to 2007 there were 860 counties in which that was the case.

quote:

Originally posted by Gatogordo:
I'm still waiting for the studies showing we have the best health care system in the world.

In the interim, which I fear will be quite long, read and think on this......

quote:

Life expectancy in the U.S. varies widely by region, in some places is decreasing

By David Brown, Updated: Wednesday, June 15,

Large swaths of the United States are showing decreasing or stagnating life expectancy even as the nation’s overall longevity trend has continued upwards, according to a county-by-county study of life expectancy over two decades.
In one-quarter of the country, girls born today may live shorter lives than their mothers, and the country as a whole is falling behind other industrialized nations in the march toward longer life, according to the study.

Led by Christopher J. L. Murray and Sandeep C. Kulkarni of the Institute of Health Metrics and Evaluation at the University of Washington, the study covers the years 1987 to 2007 and updates an earlier analysis of U.S. life expectancy through the 1990s. That study identified areas of the country where life expectancy was stagnant or declining; this report found that not only was that still the case, but more places are experiencing a decline. The study will be published Wednesday in the journal Population Health Metrics.

(snip)

.

I wanted to read the article you cited b/4 returning to the discussion. Time got away from me. First, the authors are respected researchers. The article is a contribution. Have you read it, since I’m not sure what it has to do with the larger discussion with which this thread is concerned, i.e. ranking of national health care systems? This article is a study of life expectancies across US counties. The authors concede they do not fully understand the linkages between the mortality rates and our healthcare system, an important point since your posts imply there is one, perhaps in one of primary source articles you are now ready to share.

I hesitate to quote passages from the article, but since some will not be interested in reading the entire article, here are a few salient points made by the authors which indicate that problem seems to be more of a personal responsibility issue than a healthcare system failure:

“How much of the poor performance of the US is due to differences or less favorable trends in
critical risks to health such as tobacco smoking, hypertension, diabetes, physical inactivity,
obesity, LDL cholesterol, diet, and alcohol? At the national level, these risk factors together lead
to close to one million premature deaths [39]. If the leading four risk factors were addressed
(smoking, high blood pressure, elevated blood glucose, and adiposity), life expectancy in 2005
would increase 4.9 and 4.1 years, respectively, for males and females. Disparities across eight
race-county groupings would reduce by approximately 20% [39]. Given that risk factor
exposures vary by county, and based on evidence from state-level analysis that risk factor
exposures are larger in places with higher mortality rates [40-42], (duh!!) we would expect that addressing these risk factors would also tend to narrow disparities. An analysis that takes into account county exposures will be critical to fully understand the potential to reduce disparities.”

And: “ Comparisons for specific outcomes, including breast and prostate cancer survival and acute myocardial infarction, suggest that the US, on average, has higher quality than many of the countries with better health outcomes [48,49].”

So what outcomes is each of us interested in? I live in a high longevity area. I do not have the above health risks – yet, anyway. Nonetheless, I am pleased that my local rural hospital has the latest technology to treat a heart attack/stroke, unlike many of the countries to which we are being unfavorably compared, where one may recover but will be impaired for the remainder of one’s life unlike here in many cases. Quality of life counts!

Look at the maps at the end of the article. Slice off the SE US and one wonders what the rest of country life expectancy would be. Stand outside our leading grocery chain and you will see all the above illnesses/abuses in action. Go to the Japanese or European equivalent grocery. What will you see? Eliminate the above illnesses/abuses and the global longevity rankings change considerably.

Further, while the article does acknowledge our extremely large geographical and racial disparities, it does not extend the thought to how our hugely non-homogenous population, unlike Japan or the ”tiny” countries of western Europe against which the US is compared (whose populations as a whole could fit into the greater Washington D. C. metro area)with largely homogeneous populations is not a good basis for drawing conclusions about country rankings of health care systems. Nor does it get into any depth about many other factors which diminish life expectancy in the US that are not present in other countries, such as motor vehicle accidents or firearms death among the young, particularly minorities.

Interestingly, the article points out that Canada has poorer outcomes for it natives than does the US. Why is this so if the Canadian healthcare system is superior to that of the US? Again, the dangers of a selective piece of data.

Lastly, the article suggests as a possible solution for the above illnesses/abuses, i.e., increased government regulation of food, alcohol and tobacco including content and taxes. Is this a solution most AR members would vote for? Why not just say if you are fat, smoke, drink alcohol, don’t exercise then you pay $X in extra insurance premiums or, alternatively, you only qualify for limited treatment. Doesn’t the mind boggle at the thought that disparities cut both ways? We need to be cautious in our conclusions.

Turning to your “you show me yours and I’ll show you mine”:
“I’ve got my sources about where the US med system ranks, but until I give them, why don’t you show one that shows we’re #1.”

Where in any post did I ever say we were #1?

No single study states that any country is "#1” based on a single criterion. All studies have various criteria on which the methodology is based. Depending on which criteria fit one's views, one can find some study that will lean toward or support one's view.

I do believe the WHO finding (even if the overall study itself has been discredited) that the US is #1 in healthcare responsiveness, is not an unusual finding.

WHO defines responsiveness as "Responsiveness includes two major components. These are (a) respect for persons (including dignity, confidentiality and autonomy of individuals and families to decide about their own health); and (b) client orientation (including prompt attention, access to social support networks during care, quality of basic amenities and choice of provider)."

This happens to be one of the most important criterions on how I personally would choose a healthcare system. Perhaps you have another. In many USG clinics serving minorities (for free), this responsiveness is not available and medical care, e.g., imaging (unless for life or limb endangerment) is rationed. Similar rationing under the new healthcare law is coming to a theater near you as well.

As to your other point, I don't think increased medical costs are unanticipated. If I go to the ER for a particular condition and want expensive imaging that I would not get in Europe under similar circumstances (I have lived and have been treated/hospitalized in a number of European countries over the decades), I will get it. Was imaging truly necessary as opposed to “watchful waiting”? Who decides? Under our system, I do – and I get it NOW! I like that.

France (where I have lived and enjoy returning to greatly) is cited by some as having the #1 healthcare system. Who does not remember the ambulance carrying Princess Diana plodding along about 15-20 mph? Traveling at US ambulance speeds, she might well be alive today. But let’s not indict a system on a single or even multiple aberrant factors, as we are prone to do with the US system.

As I said previously, technology is the primary driver of healthcare costs. The last year of life under Medicare consumes a disproportionate amount of total Medicare costs. Shall we just put all the seniors on “Do Not Resuscitate”? It would save enormous sums. Are you DNR? I am.

As you point out, medical care costs began their inexorable rise during WWII wage/price controls. When employers (and now Medicare w/supplemental) offer what is essentially a free good with no price signals to the consumer, why would not the consumer utilize all health care available? If we had “food insurance,” would we not consume filet mignon over hamburger if there were little/no cost difference to us? Make medical co-pays realistic (with catastrophic stop-loss) and one will probably see health care consumption decline. Physicians see many sniffles and sneezes which our grandparents would shrug off because our grandparents would have had to pay out-of-pocket (or more likely were made of sterner stuff), but for which modern consumers get service at essentially no or minimal cost, wasting the physician’s time and burdening the health care system. (Yes, the counterargument is that poor sick people would not get treated and therefore increase overall costs later. Few mention the free/low-cost clinics to which they now have access but do not go to. There are two such clinics in my small community alone.) I don’t think anyone on this forum carries “oil change” insurance, but we do carry auto insurance. Why the difference?

By the way, why no discussion about the high cost of dentistry and eye care, and why it should not be available to all comers? How about hearing aids – a special point for all the hunters here with hearing loss. A $7500 ticket for the slick computerized aids. The politicians who are seemingly deaf to our country’s current economic ills could certainly use a pair.

I look forward to receiving your afore-mentioned primary sources on country healthcare rankings.

And – this would have been shorter if I had had more time. 

quote:

No single study states that any country is "#1” based on a single criterion. All studies have various criteria on which the methodology is based. Depending on which criteria fit one's views, one can find some study that will lean toward or support one's view.

Well, no shit. You must be a lawyer if you're not a doctor. Why don't you show me studies that indicate that the US is in the TOP 3 in overall health care world wide, while keeping in mind that we are spending at least a third more per capita than any other nation? Otherwise your "criteria" argument is just a smoke screen. That should support your view........until then you're just an apologist who is either rich enough so that the inadequacies of our system don't impact you INSPITE OF IT COSTING SIGNIFICANTLY MORE than others that without question serve their countries population better or you're part or were part of the system which delivers poorer results at higher costs.

I am inspired by your logic above which puts all the increase in costs on patients and insurance while ignoring the vast leaps of greed by doctors and hospitals.

Dentistry and eye care are so cheap compared to medical care they are not even on the charts.

Yes I'm am DNR and not only that I don't go to Doctors very often, if at all, because I hate being fucked by the current US medical system and I am self insured AND pay ALL my bills. Dying early is certainly going to be one result of that decision and I am more than willing to pay it.

BTW I did read the whole article, and, not surprisingly, not only are you misquoting it and ignoring it's findings at large but specifically it DOES NOT say the below.

quote:

Interestingly, the article points out that Canada has poorer outcomes for it natives than does the US. Why is this so if the Canadian healthcare system is superior to that of the US? Again, the dangers of a selective piece of data.

That's an example of selective lying. It DID NOT state that "Canada has poorer outcomes for it (sic) natives than does the US" but rather that the "poorest" outcomes were worse in Canada than in the US. There is a significant difference between "poorest" referring to specific communities than there is to "poorest" as used to represent an entire population sub-group, nicht wahr? BTW I'm sure you noted the authors lumped Asians, who typically have a higher life expectancy, in with Native Americans.

I'm waiting for you to find a authoritative ranking showing the US in the top 3 worldwide while spending significantly more per capital.

quote:

I'm waiting for you to find a authoritative ranking showing the US in the top 3 worldwide while spending significantly more per capital.

G, you say,

"I'm waiting for you to find a authoritative ranking showing the US in the top 3 worldwide while spending significantly more per capital."

Does it raise the level of discourse to point out typos? Note your last word above.

I have never claimed that the US was in top 3 worldwide rankings. Re-read my post re methodology.

Finally, I withdraw from further comment while awaiting your primary sources.

great debate. Personally, all of mine is free; including dental and eyeglasses, so I really have no dog in this fight.

But, it would seem that between the 46(?)% basic tax rate and the VAT thing, Canadian citizens are paying as much or more per "Capita", just up front instead of at and when medical care is necessary. It seems much like socialism.

regards,

Rich

quote:

Originally posted by interested:

quote:

I'm waiting for you to find a authoritative ranking showing the US in the top 3 worldwide while spending significantly more per capital.

G, you say,

"I'm waiting for you to find a authoritative ranking showing the US in the top 3 worldwide while spending significantly more per capital."

Does it raise the level of discourse to point out typos? Note your last word above.

I have never claimed that the US was in top 3 worldwide rankings. Re-read my post re methodology.

Finally, I withdraw from further comment while awaiting your primary sources.

I note that you didn't bother to say anything about your lying about the intent of the article and didn't quote its many mentions of the failure and worsening of US healthcare. I also note that I read it in its entirety, maybe you didn't and just glommed onto something that suited your agenda? That doesn't excuse your lack of accuracy, some would call it lying.

I also note that I didn't "point out" your typo, I simply used (sic)to show that the typo was in the original, not my quote.I also manage to write without quoting the same sentence twice in one post.

Finally I can sum up your position thusly.......we spend significantly more than any other country in the world per capita, have significantly worse results than many and you're defending that system. Let me add, it also means "if I'm rich, I'm in great shape, if I'm poor and in the South or a Native American, I'm fucked."

As far as "withdrawing", withdraw all you want. You're attempting to defend the indefensible and I note that you have not bothered to deny that you are or were part of the system that costs more and delivers less. You seem to want to pick apart various sources without providing any of your own. Sorry, we don't play that game. Again, give me one that shows the US healthcare system reflects your statement that "not everything in the US healthcare system is better than elsewhere", implying that most things are. That statement is bullshit and, as I have said before, show me where we rank "better than elsewhere"or even most wheres on any reasonable scale of nationwide citizen's healthcare INSPITE of spending more money than anywhere else to line the healthcare provider's pockets.

quote:

Originally posted by Idaho Sharpshooter:
great debate. Personally, all of mine is free; including dental and eyeglasses, so I really have no dog in this fight.

But, it would seem that between the 46(?)% basic tax rate and the VAT thing, Canadian citizens are paying as much or more per "Capita", just up front instead of at and when medical care is necessary. It seems much like socialism.

regards,

Rich

Rich:

In fact, the US Government and it's medical payment systems spend more as percentage of GDP (7.4%) than the countries of Australia, Switzerland, Spain, Japan, Italy, Norway, United Kingdom, and Canada. This is NOT counting US private health costs which add another 8+% and does not include the VA. (Source: Kaiser Family Foundation, which has hundreds of interesting tidbits about the US healthcare system, few of which are favorable)

Including these:

quote:

•Health spending in the United States averaged $8,086 per person in 2009, totaling $2.5 trillion, or 17.6% of our nation's economy, up from 7.2% of GDP in 1970 and 12.5% of GDP in 1990

•When the U.S. population is ranked by their health care expenditures, the 1% who spent more than $44,000 on health care was responsible for 20% of health care spending in 2008

•45 million nonelderly Americans were uninsured in 2007, and eight in ten were in families with at least one worker

•Medicare covers 44 million Americans --16% of whom are under age 65 and disabled -- at a projected cost of $420 billion in 2009

•Medicare accounts for 14% of the total federal budget, more than the 7% accounted for by Medicaid, but a smaller share than Social Security (22%) or defense (20%)

•The average premium for family health coverage through an employer was $13,770 in 2010, of which covered workers paid an average of $3,997

•Since 1999, family premiums for employer-sponsored insurance have increased 138 percent, while wages have gone up 42 percent and inflation has gone up 31 percent

•The annual increase in national health spending per capita exceeds the increase in the Consumer Price Index, 3.1% vs. -0.4% in 2009

•The 24% of Medicaid enrollees who were elderly or disabled accounted for 70% of the program's $275 billion in federal and state spending on services in 2005 while only 30% of spending was for the 45 million children and adults who make up 76% of total enrollment

•Medicaid pays 41% of all the nation's long-term care costs -- making it by far the largest payer for long-term care

PS: The Kaiser site is a little confusing, you have to dig around for a while to get to info that you are interested in. The slide shows have most of it: Try this to get started

i believe the OP was relaying a JOKE about health care. which was well told and funny.