29 replies to this topic

[Rov Judicata]

http://observer.guar...1036970,00.html

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Patients who have major surgery in Britain are four times more likely to die than those in America, according to a major new study.
The comparison of care, which reveals a sevenfold difference in mortality rates in one set of patients, concludes that hospital waiting lists, a shortage of specialists and competition for intensive care beds are to blame.

Read the whole thing.

Given this study-- and countless others like it-- do we really want so many candidates proposing moving over to socialized medicine? Or can the problems so rampant in most of those systems be overcome if the will is strong?

[Jid]

And so it begins... I've loved these kinds of articles ever since writing my GRE.

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A team from University College London (UCL) and a team from Columbia University in New York jointly studied the medical fortunes of more than 1,000 patients at the Mount Sinai Hospital in Manhattan and compared them with nearly 1,100 patients who had undergone the same sort of major surgery at the Queen Alexandra Hospital in Portsmouth.

Is this even a comparable comparison?

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The New York patients had paid through private insurance to go to hospital and were therefore likely to be of a higher social class and healthier, whereas the NHS patients were from all social classes. The researchers attempted to level out social differences by rating each patient according to clinical status.

Attempted?  Hrm.  How successful were they?

Overall, an interesting read, but...

I would question the validity of drawing conclusions about an  entire health system from a comparison of a high-price hospital in Manhattan and a large publically funded hospital in Britain.

Seems a rather dubious claim to me.

[Bad Wolf]

But is the problem the *idea* of socialized medicine or the fact that it's piss poorly executed in Great Britain?

I mean yeah, they got it wrong there.


Does this invalidate the idea or should we perhaps be looking for better ways to implement the idea?

Lil

[Shalamar]

But has any one gotten socialized medicine *Right* and how much does it cost to do it *Right*...

and is the American public at large willing to shoulder the costs of doing it right?

I am a person with a chronic dissease, I have diabetes and will have to deal with that the rest of my life, with all the attendant side effects diabetes has on a person.

I have been thouhg my local  county health care system...I was unemployeed, and no health insurance ...I really don't want to experience that again ...I like private insurance with easy access to my prefered doctor, specialists, and available when needed surgery...

To be put on a waiting list ...shudder.  I have many times in the recent past needed surgery 'now'...not emergency surgery say following an accident, or other traumatic event, but simply 'lets get it done before it gets worse' and it was scheduled quickly and easily...

The only time I have had to wait for a bed here was after an emergency, and I waited for nearly 6 hours in ER at midnight, so it is rather understandable...people don't tend to check out of the hospital at that time of night

[Delvo]

No matter how many times socialism fails or how soundly, the same old refrain from those who can't or won't admit that it's really a failed idea is always "but it just wasn't done 'right', give it another chance". And another, and another...

[Nice Delvo Mode]I kindo-sorto gotta hand it to you socialists: at least that could be called perserverence...[/NDM]

[Uncle Sid]

Well, socialized medicine might well be something that we have simply not yet been able to figure out how to do correctly.  Or it might be something that will just about always end up in failure because government, particularly a democracy, is not equipped to make the decisions to impliment quality health care.  

So, yeah, it's possible that it could work out when it's been such a problem for everyone else.  On the other hand, do we feel like being the latest participant in an experiment that hasn't worked well anywhere else?  Personally, I don't like those odds.  Not with something as important as medicine.

Further, I dislike the idea that people who do all of the worst things for themselves such as smoking are then guarunteed free health care subsidized by everyone else and then, through the inevitable shortfalls that will eventually occur, people who do take responsibility for themselves, but fall upon something unavoidable, are then cared for poorly through a lack of resources and medical expertise.  The thought makes me, ironically, ill.  

The government is not the panacea for all problems.  The sooner people get over that, the better off we'll all be.  I'm not saying our current system is perfect, I'm not even saying capitalism is all that great, but socialism isn't the only possible alternative.  We need to start thinking of better solutions than the old tired calls for government to run our lives for us, especially when we don't want to give the government the power over us to make running our lives anywhere near possible.

[Ilphi]

Seriously, the NHS isn't a great thing to look at right now. It's one of the biggest issues at the labour party conference about how this kind of public service can improve... I think things will look up...

[QueenTiye]

Why is it that the only way we can think of to implement universal health care is to socialize it?

Socialized medicine has failed in Britain.  I have no idea how it does in other places it exists.  But I don't know why this is even the issue.

We in this country tend to have fairly good health insurance if we are working people.  Those of us who don't tend to have fallback systems (medicaid, medicare).  Why aren't we talking more about improving those services, for instance, making it possible for the working poor to pay into medicaid for insurance, rather than fiddle with the insurance that we have that mostly works?

QT

[Godeskian]

I'll skip the 'should we' debate, if you don't mind as I am still a little unsure of htat in my own mind.

However, i can think of one palce where it worked, or did around 4-5 years ago at least. I haven't lived in the Netherlands for a few years now so I don't know if it is still like that, but back around 1998-1999 ish, they had a national coverage, available to all under a certain wage limit.

They also had a simple three tyr policy that functioned at the time which was zero time on critical surgeries, 3 days on major surgeries and i believe it was 1 month on other surgeries as the top limits

Back when there was a big fireworks disaster they even flew in specialist from other countries (most noteably germany) to help deal with the fallout under the national coverage.

still, it's part of wha they paid 60% income tax rate for /shrug/ draw whatever conclusion you will from that

[Jid]

I still find it amazing people (especially those who don't live in Britain) are willing to declare the following, based on a comparison of two hospitals:

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Socialized medicine has failed in Britain.

Erm.... Okay.  I can think of a few people who might disagree, but I suppose the potential for miraculous recoveries without a good health system are always possible.

Speaking as someone who lives in a country with universal health care (and whose Prime Minister won a Nobel Peace prize for making it happen), and also living in the province where it all began...

It sure as hell does have it's drawbacks.  Elective surgeries *do* have a bit of a ridiculous wait.  (Some as long as a year, for a correction to a broken nose, for example.)

Quality health care, on the other hand, is not some distant dream like you might think.  Anything requiring immediate attention, gets it.  If you make an appointment with your doctor, you not only get one, you get in on time.   It's not as if you have to wait in line for three hours just to have a nurse tell you to take a seat and wait another nine.

Despite the horror stories you might hear, people are actually quite well taken care of.

(And as I said before, a sample size of 1 hospital each strikes me as somewhat poor for statistical conclusions the likes of which they are drawing here.)

[QueenTiye]

Jid, on Sep 30 2003, 12:13 PM, said:

I still find it amazing people (especially those who don't live in Britain) are willing to declare the following, based on a comparison of two hospitals:

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Socialized medicine has failed in Britain.

Erm.... Okay.  I can think of a few people who might disagree, but I suppose the potential for miraculous recoveries without a good health system are always possible.

My quote, and I'll apologize.  You are right - it is an overstatement based on this article.  

My point was actually to move away from that discussion altogether - I don't want to talk about socialized health care as if it is the only possible way to get to universal health coverage.  It is only ONE possible solution, and I think there are others.

QT

[Jid]

It wasn't my intent to pick on you, QT(pie), promise

It was just a great soundbite for what seems to be the opinion of an overwhelming majority of current posters

[Rhys]

I've got to reiterate what Jid said in his first post:

This compares patients who had major surgeries, and only in two hospitals.

Even if we take the two hospitals as effectively equivalent - and I'm not sure they are, because Mount Sinai is a big name - there are a lot of questions raised on the sample space.

This compares patients that had the surgeries.  What about patients that didn't have them, but should have?  Are the UKers more likely to operate on someone who has a low chance of survival anyway, while the Americans are more likely to decide it's not worth the money & effort?

What is the general social class and health status of the patients?  Does the UK hospital get a lot of octogenarians from nearby nursing homes, while Mount Sinai treats a lot of professional athletes?

What constitutes "major surgery"?  They do say "the same sort of major surgery", but that's a pretty vague statement.

What are the patients dying from?  Are they direct results of complications from surgery, or a lower standard of medical care, or does the UK have a higher incidence of more serious cancer that they couldn't deal with anyway, or weaker hearts, or other irrelevant factors?


I'm not saying the study is invalid - the answers to the above questions might very well show that the numbers are a fair comparison.  However, it always pays to cross-examine statistics.


Rhys

[CJ AEGIS]

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Jid:  Speaking as someone who lives in a country with universal health care (and whose Prime Minister won a Nobel Peace prize for making it happen), and also living in the province where it all began...

I have just one point to bring up without even questioning the quality of that health care that happens to be dismal failure in my opinion.  

At what cost to the other areas of Canadian society and Canadian National Interests does that come at?  I just can’t refrain from the mandatory joke about needing national health care to treat Sea King Pilots since it leads to my next point.  Canada pays for it’s socialist programs in other areas that would leave it at a severe disadvantage in a different situation.  I often question how many of those programs Canada could even afford if it wasn’t for the US sitting on her border.  Stick a North Korea or Iran on Canada’s border or have some situation where Canada actually has to invest in defending herself or national interests those programs would be the first thing to go do to inability to maintain them.  

Canada is a unique situation because she does happen to have the United States sitting right below her.  That gives I the advantage of not having to actually pay for other things that most countries have to like defense or monitoring borders.  Having a glass house works far better when the neighbor happens to be a big burly gun owning individual that shoots people who like to throw rocks.   

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Jid:  Despite the horror stories you might hear, people are actually quite well taken care of.

And those that aren’t would be far too dead to talk about it anyway…

[Rhea]

^Kind of rude, considering you don't even live there.    Canada is what Canda is. Who cares that they don't have Iraq or Korea on their borders? Neither do we. Irrelevant.  

I suspect that only someone who has used the system can judge it.

For instance, I hate Kaiser with a passion. I grew up in the military (and Kaiser mightily resembles military care), went to Kaiser's nursing school (yes, they had one in the 60's to mid-70's), and wouldn't let them treat a hangnail. If I thought that socialized medicine might resemble Kaiser, you'd have to drag me there kicking and screaming.

However, I would also suggest that universal health care doesn't necessarily mean socialized medicine, or poor care.

Edited by Rhea, 30 September 2003 - 02:59 PM.

[Kosh]

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than 1,000 patients at the Mount Sinai Hospital in Manhattan and compared them with nearly 1,100 patients who had undergone the same sort of major surgery at the Queen Alexandra Hospital in Portsmouth.

We are comparing one of the beter hospitols in the USA, to QAH. I don't know anything about QAH, is it one of the best, or just one average hospitol?



The difference in care has little to do with how the bills are paid, and much to do with the quality of Doctors working in the hospitol.

CAMC, Charleston Area Medical Center, has a good reputation, but if you compare them to Cleveland Clinic, CAMC looks bad, as they are ten years behind Cleveland. I wouldn't be surprised to find out that the differences between the rate of Death between Mount Sinaiand QAH, and CAMC and Cleveland Clinic are about the same.

[Ilphi]

Remember you Americans that the NHS compared here is the British welfare state SAFETY NET.

Just like you, we have all kinds of privite medical insurance. And they're not hidden or for just rich snobs, BUPA is massive here in England and is essentially the same as privite medical insurance. We just have a more secure safety net.

All my experiences with the NHS have been fine. Sure, I may have been kept waiting the odd hour but two broken bones have been healed perfectly in the care of the NHS and both times I was admitted to a personal room with toilet and television. Not bad at all considering I didn't pay a penny.

[CJ AEGIS]

Rhea, on Sep 30 2003, 07:59 PM, said:

^Kind of rude, considering you don't even live there.    Canada is what Canda is. Who cares that they don't have Iraq or Korea on their borders? Neither do we. Irrelevant. 

Just pointing out a fact that compared to many countries Canada and most countries that have National Health Care have very little in the way of national interests that tie down their resources on other matters.  The sole exception I can think of is the UK; which still maintains quite a presence on the world stage.  I think I said Iran and not Iraq...  

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Rhea: I suspect that only someone who has used the system can judge it.

Somehow I seem to recall you being the person who was so vehemently defending your right to have an opinion in another thread.  I would think that would apply universally to all posters not just ones that happen to agree with you or I.  Other than that one sentence I was just pointing out the geopolitical reality that allows Canada to actually delve into socialism to the level that they do.  

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Rhea: However, I would also suggest that universal health care doesn't necessarily mean socialized medicine, or poor care.

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The American Heritage® Dictionary of the English Language, Fourth Edition: Socialism:  Any of various theories or systems of social organization in which the means of producing and distributing goods is owned collectively or by a centralized government that often plans and controls the economy.

If it looks like socialism, sounds like socialism, and fits the definition for socialism it must be something else?

[Jid]

You bring up some interesting concerns, CJ.  Let me see what I can do to reply.  

Okay, so, let's begin with the military spending you seem so concerned about.

As you've claimed, CJ, Canada's military is rather poorly funded.  Thankfully, the recent budget just gave it a 1.6 billion shot in the arm, and has more on the way   Canadians just payed $50 a person to increase our military.

Not enough, but, well, forgive us if we have healthcare and other such things on the mind.  By and large Canada seems content to let much of the world do as they like so long as they aren't committing genocide.  If the UN goes somewhere, we'll likely send something along.

So, let's talk health care.

So, from what I can dig up from every source I can get my hands on, the Federal Canadian government will pay out $42 billion this year in transfer payments for heathcare and social programs.

This means healthcare, welfare, and a whole host of other things, cost Canadians about $1300 per person, per year, in federal money.  (Plus provincial spending)

Not only that, the federal goverment intends to increase health care spending by about $17 billion over the next three years.

So, yeah, Canadians shell out a fair bit.  If these calculations here are right, I'm seeing about 9% of Canada's GDP being spent every year on healthcare.

Funny thing is this:  In the for-profit system the US currently has, the numbers crunch out to about 13% of the US GDP.  

And, it gets more interesting.  While Americans apparently spend a higher percentage of their GDP on Health care, an estimated 43 million people don't have *any* health insurance to speak of, and an estimated 100 million more don't have adequate coverage.

Meanwhile, anyone who needs healthcare, gets it free of charge in Canada.

Another interesting tidbit.  It would appear that of every dollar spent on healthcare in the US, 31 cents go into administrative costs.   Contrasted with about 17 cents on the dollar in Canada.  (And people here *still* complain there's too much bureaucracy.)

So....  is it fair that Canada doesn't spend enough on the military?  Perhaps not.  But really, most Canadians love the healthcare system and want it to keep going the way it is.

Socialized?  Yeah, pretty much.  Every tax payer pays in, but not necessarily everyone takes out.  (Though between prescription drug coverage and such, we all get a cut.)

However, you're also more than allowed to take out extra coverage.  It helps.  You can upgrade your hospital room, and so on, if you really want to.

Quality?  I have no complaints.  Some people complain that elective surgeries have too long a waiting list.  I think "Deal with it."  So you can't get your nosejob done tommorrow.  Someone needs a cancerous tumour removed today?  By all means, go right ahead, I say.

It could also be noted some are pushing for a two tier medical system here.  Healthcare intact, and on-demand for-profit care for those that can afford it.

We'll see what happens.  

I still think "Socialized" healthcare isn't exactly the devil some make it out to be

[Bad Wolf]

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Just because...