dagblog - Comments for "A special place in Hell for Republican governors who eschew expanded Medicaid"

Besides the quite convincing

jollyroger — Thu, 21 Nov 2013 00:03:27 +0000

In reply to My open mind on the issue has

Besides the quite convincing level of satisfaction evinced by the Brits, what to make of the striking 75% of US consumers who want to toss "the world's best medical care".

With that sort of popular groundswell, how can it be that the best achievable reform was such a caricature?

My open mind on the issue has

artappraiser — Wed, 20 Nov 2013 16:35:13 +0000

In reply to In response to your comment

My open mind on the issue has closed a little bit more after seeing this chart: UK's NH is far more popular with its users than many other systems; Canada for example, looks pretty lousy in comparison:

From a Nov. 18 WaPo Wonkblog post.

[edit] According to the World

jollyroger — Sat, 09 Nov 2013 22:49:38 +0000

In reply to In 2005, Cuba had 627

[edit]

According to the World Health Organization, Cuba provides a doctor for every 170 residents,^[53] and has the second highest doctor-to-patient ratio in the world after Italy.^[54]

Medical professionals are not paid high salaries by international standards. In 2002 the mean monthly salary was 261 pesos, 1.5 times the national mean.^[55] A doctor’s salary in the late 1990s was equivalent to about US$15–20 per month in purchasing power.

In 2005, Cuba had 627

jollyroger — Sat, 09 Nov 2013 22:48:01 +0000

In reply to Just looking at this, it is

In 2005, Cuba had 627 physicians and 94 dentists per 100,000 population. That year the United States had 225 physicians and 54 dentists per 100,000 population;

Just looking at this, it is

jollyroger — Sat, 09 Nov 2013 22:46:28 +0000

In reply to ooh, I just lucked out on a

Just looking at this, it is hard to see how private insurance profit could be the only problem causing us to spend 17.9% of GDP

Its not the only problem by a long shot.

The drug companies with their government enforced monopolies profiting from NIH research are a biggie, the device manufacturers are insanely avaricious, and of course the doctors insist on grossly outsized incomes (cf Cuba...).

We really need to begin with vastly expanded medical education subsidized by the state...I still like the Ben Nelson autobody and medical school chain.

ooh, I just lucked out on a

artappraiser — Sat, 09 Nov 2013 22:42:06 +0000

In reply to In response to your comment

ooh, I just lucked out on a search and found the 2011 figures applicable to that chart, for what we in the U.S. spent all that on, from cms.gov:

Historical NHE, including Sponsor Analysis, 2011:

NHE grew 3.9% to $2.7 trillion in 2011, or $8,680 per person, and accounted for 17.9% of Gross Domestic Product (GDP).

Medicare spending grew 6.2% to $554.3 billion in 2011, or 21 percent of total NHE.

Medicaid spending grew 2.5% to $407.7 billion in 2011, or 15 percent of total NHE.

Private health insurance spending grew 3.8% to $896.3 billion in 2011, or 33 percent of total NHE.

Out of pocket spending grew 2.8% to $307.7 billion in 2011, or 11 percent of total NHE.

Hospital expenditures grew 4.3% to $850.6 billion in 2011, slower than the 4.9% growth in 2010.

Physician and clinical services expenditures grew 4.3% to $541.4 billion in 2011, a faster growth than the 3.1% in 2010.

Prescription drug spending increased 2.9% to $263.0 billion in 2011, faster than the 0.4% growth in 2010.

As a share of total health spending, households (28 percent) and the federal government (28 percent) accounted for the largest sponsor shares. From 2010 to 2011, state and local government (17 percent) shares increased by about 1 percentage point while households and the federal government shares dropped by a percentage point. Shares of private businesses (21 percent) remained constant from 2009 to 2011.

For further detail see NHE Tables in downloads below.

There you have one of the problems right at the top, Medicare spending grew the fastest, followed by hospitals & physician & clinical.

Note also how Medicare and Medicaid spending adds up to $962 billion while private health insurance spending is $850.6 billion, 36% and 33% of total respectively. It's pretty clear that they are not the only culprit causing that.

Just looking at this, it is hard to see how private insurance profit could be the only problem causing us to spend 17.9% of GDP.

It is also interesting about state and local government share increased and household and Feds share went down; have no idea what that's about.

All because we don't have

jollyroger — Sat, 09 Nov 2013 22:41:19 +0000

In reply to To clarify. With your San

All because we don't have national medical licensure/NHS!

To clarify. With your San

artappraiser — Sat, 09 Nov 2013 20:33:31 +0000

In reply to I have only anecdotal

To clarify.

With your San Mateo example you seem to be talking garden-variety emergency condition. And about primary care with your "current clinician."

But when I said:

If that's the case, besides stories of unhappiness with long waits for treatment and/or poor care, you will have the promotion of stories along the lines of "Medicaid patient denied treatment to life-saving this or life-saving that."

I was implying more this kind of scenario:

His wife, performance artist Laurie Anderson, first disclosed the transplant in an interview with the Times of London newspaper published June 1. [....]

She said that Reed had the surgery in Cleveland instead of New York, where they live, "because the hospitals here are completely dysfunctional.

"Fortunately we can outsource like corporations. It's medical tourism. The Cleveland Clinic is massive. They have the best results for heart, liver and kidney transplants. Whenever I get discouraged about how stupid technology is and how greedy and stupid Americans are, I go to the Cleveland Clinic because the people there are genuinely very kind and very smart." [....]

Where New York Medicaid is probably not going to cover a liver transplant patient's charges at the Cleveland Clinic, even if they manage to get there on their own dime. Nor do I think, say, a rural Kentuckian on Medicaid with a preemie with extra special problems, will be getting care equal that available to similar at Philadelphia Children's Hospital. Where they then make a video about the dying liver guy or the preemie and it goes viral, like in the olden days (late 80's, early 90's) when they might instead call up the local TV station to cover how "my HMO won't cover this special care I need and I am going to die" and it went viral. Or where the Feds wouldn't allow certain AIDS drugs to be used in this country and where ACTUP took it viral...that kind of stuff...

And if all Bronze and Silver plans are as limited in network as they are starting to look like they are (who can know for sure?), and many Medicaid plans have very limited networks too, I fear them virals are going to start happening sooner rather than later. Where everyone starts agreeing "Obamacare sucks, it denies care by economic class" before all of its intended adjustment of the system functions can get off the ground.

In response to your comment

artappraiser — Sat, 09 Nov 2013 19:01:11 +0000

In reply to A special place in Hell for Republican governors who eschew expanded Medicaid

In response to your comment above @ 1:14

I am very partial to the NHS model myself.

But if I am very honest with myself, I know there is evidence that it only ranks middling in cost and life expectancy when compared against more Rube Goldbergian systems of other countries:

The Two Obamacare Charts That No One's Talking About
By Dan Munro, Forbes.com, Nov. 7, 2013

[....] All of which brings us to one final chart. Of all the ones I’ve seen – and used – this one (with OECD data from 2011) still represents (at least for me) the best graphic representation of our continuing national healthcare crisis.

We are currently way worse than all of those countries. But one should take us out of the picture then and look at what's working best elsewhere. I try to keep an open mind that maybe something different than what the NHS-type systems do is what is required for the future where we are assured costs are going to rise astronomically as population ages and more and more procedures become status quo. If you delve into their system, you find it is having lots of serious crises. Maybe just maybe it does need to be more complex than that. Japan, Italy, Spain, Korea, Israel: cheaper & better results than NHS? (Interesting that Canada is more expensive but not getting much better life expectancy results than NHS.)

how much paper it took to

jollyroger — Sat, 09 Nov 2013 18:14:14 +0000

In reply to On the subsidies, FWIW, I saw

how much paper it took to print ACA out

Per contra, I suppose Britain's NHS might be printed thus:

"You get sick, we treat you."