by Ralph Silverman, MD, FACS, FASCRS
I am tired of the comparisons people make between health care in the United States and other countries. For instance, there are those who think that we should have universal health care because some European countries and Canada do.
It is true that those countries do have universal health care, but is it a fair comparison?
Who does Canada rely on to defend its borders? When the Germans invaded France in World War II who stormed the beaches at Normandy? The point is, these countries rely on the United States for security when peace is compromised. America allocates trillions of dollars to defend both itself and the rest of the world. No other country does this. That money could easily be used for universal health care.
Furthermore, President Obama has consistently said that health care costs are rising and we aren’t any healthier. The White House uses statistics that demonstrate that, in the U.S., childhood disease is more rampant than in European countries, and that people die earlier Stateside. They ask the question, “Why are we not healthier than other countries when we spend more on health care?”
The answer may lie with American patients, who are more obese than patients in other countries. We eat a diet high in fat and carbohydrate content. As a population, we smoke like there’s no tomorrow. We drive everywhere we go and don’t get any exercise. Instead of exercising to control our blood pressure or diabetes, we sit on the couch and take a pill. We eat ice cream and cake, and then take some insulin to bring down our sugar levels.
Consider Asia. People there eat mainly rice and fish and walk everywhere they go. Smoking is a problem there, but it is worse in the United States. How many 300 pound Asian men and women do you see walking into Burger King in Tokyo? The same is true in France. And guess what? People in these countries are healthier than we are. It’s not surprising.
If anything, the United States should give itself a pat on the back. We have managed to treat our bodies like trash, and yet, the length of life is comparable to other countries that live a much healthier lifestyle. Just imagine if we kept health care at the same level and we, as a population, decided to really change our way of life for the healthier.
The White House and the rest of the government need to make fairer comparisons when contrasting our health care system with those of other countries.
After doing so, perhaps things may not be as bad as they appear.
Ralph Silverman is a colorectal surgeon who blogs at The Colon Doctor.
Submit a guest post and be heard.
Related posts:
- If health reformers want to emulate Canada and Europe, can we copy their malpractice systems too?
- Countries with worse health care systems than the United States
- Government-run health care
- Will integrated systems become a reality in American health care?
- A major obstacle impeding universal coverage in the United States
- Single-payer and the American patient
- The cold war of American health care
{ 44 comments }
‘…perhaps things may not be as bad as they appear.’
Hmmm… so the thousands of desperate people we see queueing for the Remote Area Medical free healthcare in Los Angeles is not so bad, Ralph. It’s like we see this everyday in the UK, France and Canada…
I agree with Dr. Silverman. Yes: blame the patients! Of course it’s the fat people’s fault that a lot of sick people in our system can’t get or can’t afford the care they need. So all of you larger folks: lose some weight, so the rest of us can (somehow) get health care – that’s Dr. Silverman’s orders!
Oh, they were queuing up all right. For dental work and free eyeglasses. Very little actual medical work was done there. Even the disclaimer on RAM’s website says so.
You put that RAM event in the UK you will see the same crowd.
“America allocates trillions of dollars to defend both itself and the rest of the world. No other country does this. That money could easily be used for universal health care.”
Hahahahaha… some US citizens are really simple-minded. Defend the world?… better say defend your way of life around the world.
You are right just in one point of your analysis (probably by chance): socioeconomic factors explain better the health of populations than health care systems. But socioeconomic factors are strongly related with the access to primary care preventive medicine… there is where your system fails: providing primary care medicine to poor (and no so poor) crowds of people. Is not about cathetherisms or expensive medical care… is just about prenatal care and preventive management of cardiovascular risk factors.
@Healthcare Observer
They que up at 7-11 stores on Free Slurpee days. Why do you think that is? Maybe it has something to do with free! Doesn’t matter what it is – free eyeglasses, free dental work, free anything — people will always line up. If you do not use price as a method of allocating a scarce resource, you will end up with black/gray markets, shortages, etc. Try looking for toilet paper in Cuba.
What Dr. Silverman misses in his argument is both the excesses of our healthcare system and the impact of those excesses on our health. Yes, there is a treatment for everything, and this gives us the false security that we can just take insulin if obesity and diabetes strike. While I agree that we need to look broadly at our lifestyle for answers, we do not need to be wasting $1.2 trillion on unnecessary interventions.
I’ll be honest, I order way too much on my (many) morbidly obese patients – I can’t rely on my physical exam. How am I supposed to tell if your lungs are clear when their is 10 inches of soft tissue between my stethoscope and your lungs. And sometimes, I just don’t have the strength enough to elicit pain in the right upper quadrant, especially not if the patient weighs 5x what I do. The lowest BMI on my service right now is 26 – and that is a malnourished alcoholic. The average BMI (I just did the math) is 36.2.
Hospitalizations are expensive. People NEED to start taking care of themselves. Most of the patients I admit to the hospital are there because of lifestyle choices. Smoking, overuse of alcohol, meth, heroin and obesity/morbid obesity. I don’t “want to keep people sick so that I can make money off of them.” That is such a ridiculous statement. I would rather take care of people who care about their own health and unfortunately developed a disease than someone that expects me to fix their years of bad habits with a pill – preferentially a pain pill and a sleeping pill. It is ridiculous and makes me sad to be an American sometimes.
That should be “there” not their. Before the onslaught of doctors are idiots responses come. Well, this isn’t the NYTimes health blog, so it may not be so bad.
‘Very little actual medical work was done there.’
Silly me – and there was I thinking they were performing triple bypasses in the center circle and kidney transplants on the sidelines. Actually, if you read what they do they also carried out pap smears, mammograms, immunisations and blood pressure and tubercolosis tests – and like it or not, dental and sight tests are also part of healthcare.
‘You put that RAM event in the UK you will see the same crowd.’
No – Britons on benefits, as well as groups such as older people, children and pregnant women get free dental, sight tests, vouchers for glasses, and free drug prescriptions. Primary care visits for all are also totally free.
‘Maybe it has something to do with free!’
Maybe it’s something to do with a huge burden of untreated chronic disease and conditions among millions of uninsured and underinsured Americans.
As an oncologist in the UK I can see the downside of the UK system very well-many people do not have access to the best treatments because of rationed healthcare. On one level this is unacceptable, but of course there is nothing to stop people taking out private health insurance and looking after themselves, as they do in most countries.
On the other hand the 90% of our population who are uninsured seem to have a much better standard of medical care than uninsured patients in the US, especially in key public health areas such as primary and antenatal care. Surely it must be generally agreed that the apparently very poor access to healthcare “enjoyed” by a large number of US citizens cannot be right or sustainable in the future.
So the question is what is the solution? The staus quo looks very unattractive. I would not advise the US to go down the UK route of a single inefficient monolithic health system for all, but it does not seem to me as an outsider to be unreasonable for the government to provide some sort of insurance scheme to try and address what is a real problem for millions of Americans. Or maybe that is naive!
Perhaps Doctor Silverman should reread his history books before waxes poetic about Canada’s lack of participation in the World Wars.
Surely he can contribute a reasoned argument to the healthcare debate without falling back on the old, false stereotype of the US saving everyone else’s behinds?
Yes, human beings are not perfect and often don’t do what is in their best interests. Such human beings live in Europe, Canada and Asia as well as the US. Our obesity epidemic is the result of complicated socioeconomic and cultural forces, some of which we are exporting to other countries. Why this would excuse the need to look honestly and critically at our underperforming healthcare system and try to improve it, I don’t understand.
I did understand that empathy and compassion were supposed to be some of the more important attributes of physicians. Or maybe I am hopelessly old fashioned….
‘I can see the downside of the UK system very well-many people do not have access to the best treatments because of rationed healthcare.’
Can you give some examples, Talldoc?
Here are Brits lined up to register with a NHS dentist. I can find many such pictures.
http://www.timesonline.co.uk/tol/news/uk/health/article1615073.ece
Queued up to see the dentist, pulling their own teeth for lack of dental care, the stories are actually quite esasy to find in the UK press.
You put this fair up in the UK and you WILL find the same response. Right in front of you eyes and you won’t believe it. Yes, the service is provided…..on paper. Good luck actually accessing the service. So when there is a NHS dentist available, they line up for the free service, same as in these fairs.
“…..Silly me – and there was I thinking they were performing triple bypasses in the center circle and kidney transplants on the sidelines…..”
Reading the comments after these articles on the RAM fairs, you wouldn’t be the only one thinking that.
“……Actually, if you read what they do they also carried out pap smears, mammograms, immunisations and blood pressure and tubercolosis tests – and like it or not, dental and sight tests are also part of healthcare…….”
Big deal. All the services provided…….ALL of them…….can be done at the respective county health departments for free. Los Angeles, Wise County Virginia, all the places where they work in the USA. Wise County Virginia is actually a larger medical community than the rural area where I practice. Their hospital actually has some postgraduate training, and they have some specialists available. More than I can say in my area. Even in my county, the poor can access all the services described, for free. The blood pressure checks, the TB testing, the vaccines, all of it. They get vouchers to get the mammograms at the local imaging facility. RAM does the same thing. The PAP’s AND the colposcopies (alluded to in one of the stories covering the fairs), are done at the health department, for free, even in my rural impoverished area.
When you look at the flyers for the RAM fairs, you will see what they do is provide vouchers for the service to be done at the local facilities.
“….and like it or not, dental and sight tests are also part of healthcare……”
wow, no kidding. Problem is, it’s provided on paper, not in reality. I can access the UK press, I can see the complaints about it from the public and the physicians themselves, and I can see them lined up ’round the block when someone DOES provide the service.
‘I can see the downside of the UK system very well-many people do not have access to the best treatments because of rationed healthcare.’
Can you give some examples, Talldoc?
Pending his response, here’s a few from a quick scan of British medical literature and their press.
http://nhsblogdoc.blogspot.com/2007/03/tale-of-two-cancers.html
Two patients, same cancer, same medical practice. One privately insured, the other in the NHS. See the difference in treatment.
http://www.nature.com/bjc/journal/v92/n7/full/6602463a.html
An audit of 29 lung cancer patients awaiting radical radiotherapy in Glasgow (O’Rourke and Edwards, 2000) found a median delay between the first hospital visit and starting radiotherapy of 94 days. During this time, six potentially curable patients became incurable.
O’Rourke N, Edwards R (2000) Lung cancer treatment waiting times and tumour growth. Clin Oncol 12: 141–144
http://www.guardian.co.uk/politics/2001/dec/16/health.publicservices
London’s Observer (3/3/02) carried a story saying that an “unpublished report shows some patients are now having to wait more than eight months for treatment, during which time many of their cancers become incurable.”
Another story said, “According to a World Health Organisation report to be published later this year, around 10,000 British people die unnecessarily from cancer each year — three times as many as are killed on our roads.”
The Observer (12/16/01) also reported, “A recent academic study showed National Health Service delays in bowel cancer treatment were so great that, in one in five cases, cancer which was curable at the time of diagnosis had become incurable by the time of treatment.”
http://www.guardian.co.uk/society/2006/jul/09/cancercare.health
http://www.guardian.co.uk/society/2003/mar/23/nhsstaff.health
http://www.guardian.co.uk/society/2002/mar/10/NHS.cancercare
http://www.guardian.co.uk/society/2002/mar/10/health.uknews
Perioperative mortality: “Patients who have major surgery in Britain are four times more likely to die than those in America, according to a major new study.” http://www.guardian.co.uk/politics/2003/sep/07/health.nhs
Actually not surprised. The stories of ambulances backed up in the parking lot. They don’t let the patient in their ER because it starts tolling the clock and you get long ER waits. Rather than fix the problem, the administrators keep the patients in the ambulance outside. Then when they’re lying on the gurney all day, into the next, the administrators remove the wheels, set up a portable screen, and call it a “room”. Same spot, same gurney, they just call it an “admission”. So now, in the hallway, no nearby sink to wash, not surprising to see more perioperative infections. It’s reflected in their own statistics.
So…….people go private for elective surgery to avoid infection and failed total joint surgery. The poor, of course, are stuck. So you STILL get inequality based on socioeconomic status. The Brits themselves in their own commissioned reports on the NHS, they themselves say the inequality is as bad as it was in 1948, maybe worse. Follow their Beveridge report, Black report, etc…….
How about the fact that in UK, anybody over the age of 65 doesn’t get kidney dialysis? How about the fact that the NHS is ageist?
Is it fair to compare the US system to Canadian or English systems? I suppose it’s fair if you ignore the rigor of training for our medical students, the cost of training our medical students/doctors, the philosophy of saving every possible life, the philosophy of defensive medicine, the terrible reimbursements offered by Medicare (going back to the cost of training our students)… as you can see there are a great deal of issues as to why we can’t compare these systems. I believe it was a mistake for Dr. Silverman to discuss defense, but I completely empathize with him; he’s angry and scared because Obamacare believes in slashing physician compensation to reduce medical costs.
The old “infant mortality” line. Mostly it was deconstructed long ago, but I found this in the BMJ earlier this month. Found it interesting.
http://www.bmj.com/cgi/content/abstract/339/aug04_2/b2892
“…Social deprivation, ethnicity, and maternal age are important predictors of infant and perinatal mortality. Spearhead PCTs are performing in line with expectations given their levels of deprivation, ethnicity, and maternal age. Higher spending on maternity services using the current configuration of services may not reduce rates of infant and perinatal mortality……”
In England, that is. And actually I agree. Certain socioeconomic realities will result in inequalities in outcome, perinatal mortality in this case. I agree, because we see the same thing here. Of course, when we say it, we’re accused of making excuses for our evil capitalist medical system.
And, again, speaking of inequalities, there’s this:
http://www.guardian.co.uk/politics/2001/dec/16/health.publicservices
The NHS trusts have the capacity but do not use it. They rent it out to private patients. So, even in NHS hospitals, the poor wait, and the rich go to the head of the line. The inequalities in outcome and access, march right through, despite socializing their medical system and creating the third largest employer on Earth. Chinese military, Indian railway, Britain’s NHS, the top three employers on the planet. The Brit’s own commissioned reports on the NHS report that their healthcare is just as unequal now as it was in 1948, maybe even a little worse.
All the fuss is about very cheap primary care visits in these “preventative medicine” rants. A patient can see me for 75 or 100 bucks. Big deal. That goal would be so easy to attain.
Its the drugs that cost so much. Its the lab tests that cost so much. A tetanus shot is 70 bucks. It’s the hospitalizations that cost so much.
Seeing the doctor in his office is cheap in this country. Their cell phone bill for a month is more than a visit to me. And I charge 25 bucks for an EKG.
“Smoking is a problem there, but it is worse in the United States.”
Completely erroneous: http://www.gallup.com/poll/28432/smoking-rates-around-world-how-americans-compare.aspx
And funny thing about smoking, I’m being told in med school it’s the most important thing you can do to improve your health, more than an obese person cutting weight. Maybe Silverman should do some research before espousing falsehoods.
Also, using the US military budget is unrelated. Yes it’s high, yes it could fund universal healthcare. That still doesn’t change the fact that we spend more on healthcare than any other nation. It just means other nations have a lot of money to have parties with or do whatever they do with it.
Ooops. I think Ralph missed it.
Q – “Who does Canada rely on to defend its borders?”
A – Uhhh…this is rhetorical, right? Yes, they do rely on the U.S. like when we Americans thwarted that attack from…uh…you know…those uh…youlookitup!
Q – “When the Germans invaded France in World War II who stormed the beaches at Normandy?”
A – Well a quick check reveals that it included the U.S., the U.K., Canada, Norway, Poland, and some Free France forces. Don’t belittle the lives those other countries gave up. Like, for real.
Statement: “America allocates trillions of dollars to defend both itself and the rest of the world. No other country does this. That money could easily be used for universal health care.”
Response: But ON TOP OF THAT the U.S. spends MORE on healthcare than any other nation. So now imagine that we ALSO spent some of that defense/offense budget on healthcare. That’d be an awfully big pot. The argument would stand if the U.S. were sacrificing healthcare spending to keep world peace, but we’re spending more than anyone else and just not getting much to show for it!
Wow. Perhaps the White House is making comparisons because when compared to other industrialized nations in respected international studies, we rank near the bottom of the health care heap on a preponderance of factors?
And believe me, nobody is more tired of comparisons between the US and the UK/Canada when it comes to health care systems than the UK and Canada. Just take a look at all the groups that have started up on the internet since the US media has begun to allow partisan groups to demonize (in most cases, unjustifiably) how these two countries manage the health of their citizens. They are outraged, and they should be – they didn’t ask to be a part of this rather nasty, irrational national conversation.
White people health statistics in the US out perform even the best of Europe, especially when matching for ethnicity, e.g. Swedes in Minnesota and in Sweden.
Overall data here.
http://www.aei.org/book/859
Minorities in the US do not get enough health care and that is why they are behind, and bring US Statistics behind.
I think many of the commenters miss Silverman’s point, which is that many of the comparisons between health outcomes in USA as opposed to Europe (infant mortality, life expectancy, etc) are not apples-to-apples comparisons.
In the jargon of statistics, one would say that there is an omitted variable bias in comparing life expectancy between the U.S. and U.K., and this is well documented for anyone intellectually honest enough to read up on it.
Also, while I agree with the analogy of U.S. foreign policy, I think it was sloppily executed in this post.
“As an oncologist in the UK I can see the downside of the UK system very well-many people do not have access to the best treatments because of rationed healthcare”
Dont forget to mention that in UK, as in US, if you want to pay a private insurance (or just directly the treatment) you will recieve it no matters how expense it is.
I mean: universal basic coverage does not mean comunism. As far as public police services does not prevent you from paying a private bodyguard.
“the philosophy of saving every possible life,”… I think you mean every insured life…
“he’s angry and scared because Obamacare believes in slashing physician compensation to reduce medical costs.”. I agree with you. In spain (and most european countries) a family doctor earns no more than 50.000€/year. Working at public hospitals a anesthesist could reach 80.000-100.000, but no more. Far from the US salaries.
Of course, if you are a dermatologist (or plastic surgeon) in Europa with a private practice you can earn a lot of money. That’s the reason most medical students want to get into that specialities.
Probably if you want to reduce health-care costs, you (doctors) will need to loose something. And that is the real debate: no body wants to loose (including doctors and insurance companies). The only losers by the moment are the uninsured.
Does someone have a legitimate link to that claim that the NHS won’t cover dialysis after age 65? I’ve heard it in several places, but nothing official.
Average GP salary in the UK: 118,000 pounds (Daily Mail, January 2007).
Better pay that primary care in the USA.
> Does someone have a legitimate link to that claim that the NHS won’t cover dialysis after age 65?
That is not true in the spaniard NHS… limits to treatment efford are based in clinical judgment (avoiding overtreatment without quality of life expectatives), at least for life threathing illness (that have a cure available).
There are of course some rationing… for example NHS dermatologists do not treat cosmetic problems, for recieving in-vitro fertilization you need to try for one year with your partner… A back pain does not recieve automatically a MRI (that is not clinically relevant in most patients) but only if conservative therapy does not work. Psycologists for daily problems (as for example family therapists on divorce) are not covered… and so on.
‘Does someone have a legitimate link to that claim that the NHS won’t cover dialysis after age 65?’
It’s a lie, like so many other things propagated by the Palinites and Birthers. The scale of the lies of the right is truly breathtaking – and for what? To protect the profit of the insurance industry. Nothing to do with health.
By the way, what is true is that many over-65s won’t get a kidney transplant, but that’s down to medical reasons (you have to be in good health otherwise) and is the same anywhere. And by the way, 30% of Americans with renal failure don’t make it past the first year of dialysis.
Does someone have a legitimate link to that claim that the NHS won’t cover dialysis after age 65?
Age 65? It used to be 50.
Berlyne GM: Over 50 and uremic equals death. The failure of the British National Health Service to provide adequate dialysis facilities. Nephron. 1982; 31(3):189-90
They’re cleaning up their act in that regard, but it used to be true, not all that long ago, and the cutoff was as low as 50. I don’t know where their rates are now, compared to USA or the Continent.
Here’s the full letter:
http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowPDF&ArtikelNr=182644&Ausgabe=241630&ProduktNr=223854&filename=182644.pdf
http://www.bapn.org/assets/clinical_standards/dialysis-manifesto.pdf
Treatment rates for end-stage renal failure are lower in England than in other comparable countries and this is considered an indication of unmet need. (NSF, 2004) There is also variation in treatment rates in different parts of England that cannot be fully explained by demographic differences.
Inequalities of access based on socioeconomic status continue in the UK, same as here. Google the phrase “Postcode lottery” to see it discussed in their own press. Earlier in this thread, I referenced one such study that just came out in the BMJ, with respect to infant mortality.
In the UK’s own age discrimination organizations, they have talked about it continuing to this day, with respect to dialysis and cancer treatment. Looking at the number of people receiving such treatments in Germany, compared to the USA. See: “Age discrimination: an historical and contemporary analysis” By John Macnicol. Cambridge University Press, Page 59
And any of a number of newspaper articles, easy enough to access.
http://www.independent.co.uk/life-style/health-and-families/health-news/dialysis-shortage-exposes-failings-of-nhs-601353.html
With respect to Canada, I can’t do any better than the court ruling in Chaoulli v. Quebec. “Access to a waiting list is not access to health care….[T]here is unchallenged evidence that in some serious cases, patients die as a result of waiting lists for public health care. Where lack of timely health care can result in death, section 7 protection of life itself is engaged. The evidence here demonstrates that the prohibition on health insurance results in physical and psychological suffering that meets the threshold requirement of seriousness.”
Unwittingly Anon makes the case for state medicine, as of course the US passed a law in 1972 guaranteeing a large percentage of dialysis costs for anyone with renal failure.
No one is denying that all heathcare systems are under great pressure and in the UK’s case more resources are being allocated – much more since Labour took over from the wilderness years of Thatcher and co. In the US, many more people die of preventable conditions per capita a year – the Commonwealth Fund puts the toll at 100,000 a year I believe – and no American is in a position to lecture any western country on inequalities given the the third world conditions that exist in too many urban and rural settings. But as you ask, yes inequalities in the UK are unacceptable. But that’s what we get from apeing the US much more than our European neighbours.
Talldoc,
Thank you for a reasoned comment.
re:
“As an oncologist in the UK I can see the downside of the UK system very well-many people do not have access to the best treatments because of rationed healthcare.”
and
“On the other hand the 90% of our population who are uninsured seem to have a much better standard of medical care than uninsured patients in the US”
I am an American physician and this is my suggestion for the solution?
Primary care is much CHEAPER than disease-associated care. A yearly PE with all the basic screening studies (barring infrequent screens such as colonoscopies) is very cheap, relative to on-going care for diabetes or leukemia. I suggest we start to view health insurance in the same way as any other form of insurance: the benefits are provided in illness/catastrophe. Our car insurance does not provide for oil changes & tires. No wonder the system cannot sustain itself in a cost-effective way; there are too many users.
Americans should pay for their own primary care–out of pocket. If the US govt wants to spend money, let it spend money on changing our attitudes about health & savings. I feel certain that, over time, non-profits & charities (i.e. breast cancer societies, churches, etc.) could provide preventative care to those unable to pay. Then, insurance would be available & affordable for catastrophic illness.
Our entire perspective has to change, in that Americans must start taking personal responsibility for their health. The days of smoking & eating ding dongs all day, while letting the VA system or the tax payer fund your CABG should be over.
“Dont forget to mention that in UK, as in US, if you want to pay a private insurance (or just directly the treatment) you will recieve it no matters how expense it is”
A point I believe I made in the next line of my comment!
As for examples:
Drugs:
No access to bevacizumab for patients with colorectal lung or breast cancer.
No access to cetuximab or panitumumab in colorectal cancer Limited access to erlotinib for lung cancer.
Limited or no access to sorafenib in hepatocellular cancer.
Limited access to sorafenib/sunitinib for renal cancer.
Very limited access to temozolomide for brain tumours.
No access to lapatinib for breast cancer
No access to pemetrexed in non small cell lung cancer.
Almost any new agent takes approximately 2-3 years from licensing to approval even if it is approved by NICE (except in breast cancer where hordes of middle class women have to assault politicians physically and verbally to get their way). Then another 3 months before it will be funded, once of course you have made an individual business case for introduction for each regimen in each individual hospital.
And don’t get me started on radiotherapy where there is a major shortfall incapacity and therefore unaccepotable waiting times or inappropriate fractionation in wide swathes of the country
I do think you can compare the US and the UK. The UK has a similar obesity epidemic, worse smoking statistics, and a lifestyle that is becoming more and more “American”- and their life expectancy is higher than that in the US! Talldoc is right that the latest cancer drugs may not be on offer, but better primary care coverage does make a difference.
To place all the blame of a broken healthcare system on obese patient is unfair and a gross oversimplification.
How much money is spent on Aids research? Is that not a behavioral disease? And the rise in other sexual transmitted diseases that have become resistant to antibiotics. Let us be careful when speaking of behavioral reasons for health care costs. Let us not forget illegal immigrates. I can speak first hand because we took a neighbor to the er with her child that was sick, no insurance, illegal. Of course no one in this country will ever deny a child of medical help but her parents are responsible for not having insurance and being here illegal. And why is it our government leaders make enough money to afford good health care when they are suppose to be civil servants of the people. Read the Constitution, love country fear government! Politicians have pitted Americans against each other for their own political whims of power and to make sure they have a good job and health insurance. Does anyone think Senator Kennedy would choose government health care especially at his age? Or any government civil servant? It should be mandatory that all government officials should be enrolled in any government health care before imposing it on any American!
>>But as you ask, yes inequalities in the UK are unacceptable.
Oh, so the inequalities do exist. It was a breathtaking lie a few posts ago.
You’re right, Med Student “….The UK has a similar obesity epidemic, worse smoking statistics, etc…..” and lifespan is longer. In a population. Population statistics have little to do with the healthcare you will be providing. You don’t treat populations, you treat individuals. Africans have a shorter life span than whites, and it marches through if that African is an Afro-American or an Afro-Briton. The Japanese have a longer lifespan even when they move to the USA and their progeny are born stateside. For me, when I’m looking for healthcare, meaning I’m sick, I want the place with the best chance of getting better. Lifespan statistics reflect population genetics.
As pointed out before, if one wants to play the game of comparing populations, at least compare apples with apples. European Scandinavians compared to American Scandinavians. African Americans compared to Afro Brits and native Africans. Japanese versus Japanese-Americans.
When their own statistics show inequality of outcome for certain deprived populations in the UK, it’s called a result of poverty, ignorance, drug abuse, deprivation, the inevitable problems associated with poverty. Same population in America, it’s the evil Capitalist system.
Of course we can’t lecture anyone else. Not that it stops others from lecturing us.
Interesting point talldoc – “…..Almost any new agent takes approximately 2-3 years from licensing to approval even if it is approved by NICE (except in breast cancer where hordes of middle class women have to assault politicians physically and verbally to get their way)…….”
Political pressures continue to influence healthcare. Not that I wish breast cancer on anyone, but cancer is cancer, and it’s not the only thing that harms women (and a few men for that matter, Richard Roundtree comes to mind).
On par with Anon & Talldoc,
If a UHC system is the panacea, then why does the medical literature still detail “health care disparities” in these countries?
The British Heart Foundation discusses disparities in care in their current document on CHD (www.heartstats.org).
(see here: http://www.heartstats.org/temp/2008.Chaptersp1.pdf)
An interesting comment I saw on a page for the British National Health Service, while perusing their entry on CHD:
“If Coronary Heart disease is the ‘UK’s biggest killer’ why does it take so long to get a first appointment to see a cardiologist?
Surely, on the basis that ‘prevention is better than cure’ it would be more efficient to quickly diagnose and treat cardiac problems thus reducing the number of heart attacks and the resultant strain on ambulance and A&E services!!
My current wait to see a cardiologist is my first contact with the NHS for 10 years and quite frankly I’m not impressed!!!”
http://www.nhs.uk/conditions/Coronary-heart-disease/Pages/Introduction.aspx
Do you ever study history in school? If yes, it sure seems like you may have been sleeping during the class on WWII?
Timeline of US and Canada’s involvement in WWII is below.
5 September 1939 – US formally becomes a neutral country (this means they chose NOT TO ENTER THE WAR).
10 September 1939 – Canada Declares war on Germany
23 December 1939 – The first Canadian troops land in Britain
13 November 1941 – US Congress revises the Neutrality Act of 1939 to allow US merchant ships to unload munitions in British ports
7 December 1941 – Japanese launch surprise attack on U.S. fleet at Pearl Harbor [United States]
8 December 1941 – United States declares war on Japan [United States]
11 December 1941 – Germany and Italy declare war on United States
27 January 1943 – American 8th Air Force conducts its first raid against Germany HOW MANY YEARS AFTER CANADA?
6 June 1944 – D-Day, the Allied Invasion of Normandy, France [France]
1944
June 6: 14,000 Canadians land on Normandy beaches apart of ‘Operation Neptune.’ 1,000 Canadian casualties.
June 8-12: Canadians repel fierce German counter-attacks and hold the Normandy beach head
As to who protects the Canadian borders? The answer is Canadians! Have you ever been to Canada? Were you questioned by a US Immigration and Customs officer that allowed you into Canada? Use some common sense if you have any. You probably also think 911 terrorists were let into the US by Canada – The US Customs and Immigration Service is the correct answer.
I would seem that the largest correlation is between detractors of UHC and their profession – and guess what, the biggest detractors are in fact DOCTORS.
Doctors in UK, Canada and US are all against UHC. Patients, on the other hand, are in the majority in favour of UHC.
The fact is, UHC does place some real conditions on doctors. It becomes the determinant in what treatments doctors may offer. Doctors do not like this. They would like to treat you the way they see fit, and any universal system will get in their way in some fashion.
However, none of the anti-UHC doctors I have heard have anything to say for those who are not insured. The fact is, for those people, any system at all, even the least efficient system out there is better than what they have, which is NOTHING. I think it behooves the US to come up with the BEST system, not to sit around making excuses for the worst system (no system at all, and yet still more costly per person than any of the UHC systems out there).
Sigh.
“America allocates trillions of dollars to defend both itself and the rest of the world. No other country does this. That money could easily be used for universal health care.”
Imagine if people actually had some fundamental knowledge of the facts before pretending to knowledge.
In 2007, the USA spent 16 % of its GDP on health care. Its military budget was 4 %. (which, incidentally is half a trillion, not “trillions”) The nearest OECD country in health care spending is Switzerland, with just over 11 %.
The difference in health care spending between the US, and the second worst performer is bigger than the US military expenses.
The average first world country spent 9%. The difference between the US medical expenses and the average is nearly twice the US military budget.
Of course, saying that “That money could easily be spent paying for UHC” isn’t wrong. The US government already has an expense of almost 9 % of GDP on health care. The money already paid in taxes could pay for UHC.
Of course, countries such as France and the UK already spend about 2,5 % of GDp on their military budgets. So the difference between the US and UK military budgets is 1,5% of GDP. The difference in health care spending is 5 times as large.
US medical overspending is so large that it dwarfs the military budget into insignificance.
Defend its borders from what? The only nation that could possibly threaten Canada is the United States.
Who did the United States rely on to place its Early Warning defense system.
The idea that somehow the United States was defending Europe altruistically is basically a false argument. After WWII, even in free elections, the communist parties were winning majority seats in the parliaments of many European elections. As usual the United States kept military forces in Europe, often against the will of the electorate in those nations, to protect our own business interests and our own economic markets, not to defend Europeans from anything they were all that concerned about to begin with.
One of the primary causes of the Great Depression was that the U.S. industrial capacity had outstripped our internal markets. Everybody in America had purchased everything they could purchase or use.
After WWII, the United States economy plunged right back into recession. We needed Europe as a market for American goods.
That was our reason for “defending Europe” Indeed, we defended them so much that we had the government in France throw the party that won the most votes in the first national election out of office and denied the seats they had won in that election, It was the French Communist Party that won 25 percent of the seats in their parliament, the largest single party to win seats. Combined with the seats won by the Socialists, the far left had a majority vote. That would not do for U.S. policy makers so we had the right wing militarists remove them from office.
This occurred all over the world. In Iran the U.S overthrew the legitimately elected Mossadegh. In Guatemala we had the military remove Arbenz and in Vietnam we simply cancelled the agreed on free elections of 1956.
This defense argument is one that is usually given, but is also usually false. The people in most of the countries we were “defending” didn’t want us to be defending them. In fact all we were doing were defending pro American political parties that could not legitimately win free election in countries all over the world
The good doctor makes an extremely dumb statement in trying to make an extremely dumb case about national defense versus health spending. He says: “When the Germans invaded France in World War II who stormed the beaches at Normandy?” The implication being that the U.S. heroically invaded while the Canadians and others cowered and waited to be rescued by the Americans.
First of all, the invasion of Normandy was in no way contemporaneous with the German invasion of France; the two events were years apart.
Second, and more importantly, Americans were not the Lone Rangers the doctor ignorantly portrays.
In fact, D-Day began with a late-night air assault by landing of American airborne troops — along with a GREATER NUMBER of airborne troops from Britain, Canada, and the Free French.
There was then the famous beach landings to which the doctor refers — and again gets wrong. The U.S. committed about 78,000 troops to the D-Day effort. The British, Canadian and Free French, far from sitting idly by as in the doctor’s fantasy, committed MORE troops than than the U.S.
It is also worth noting that Canada and Britain started fighting against Nazi aggression in 1939, when Hitler invaded Poland. The brave and mighty Americans, far from leading the way in the fight for freedom, avoided the fight altogether until late 1941.
Finally, the doctor’s implication that Canada is free to lavish funds on health care because it hides under the American umbrella is grossly misleading and wrong. As every study has shown, Canada spends LESS on health care than the U.S., both per capita and as a percentage of GDP, yet provides care for all residents and has better outcomes.
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