Re: [openhealth] Re: Nationalized Medicine was: article re IBM and others contributing open source epi and other

[Karsten Hilbert]

On Sat, May 20, 2006 at 07:01:46AM +1000, Tim Churches wrote:

> Sorry for my ignorance, but how can govt-funded health insurance/payment
> schemes "go bankrupt"?
Hehe :-)   The govt itself goes bankrupt but does not know
it yet. Look at Germany.

Karsten
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Re: [openhealth] Re: Nationalized Medicine was: article re IBM and others contributing open source epi and other

[Tim Churches]

Tim.Churches wrote:
> David Forslund wrote:
>  > Tim Churches wrote:
>  >  > Despite having one of the highest per-capita spends on healthcare in the
>  >  > world, the US ranks in the bottom half (and often right at the bottom)
>  >  > of all OECD countries on just about every health and health outcome
>  >  > measure, on a population basis. Sure, for wealthier people in the US who
>  >  > can afford good health insurance, health outcomes are excellent, but
>  >  > those people represent about 50% of the total population. The rest of
>  >  > the population have really very bad outcomes, so the overall results are
>  >  > remarkably poor given the overall expenditure. And even amongst the
>  >  > insured, the quality and nature of the care is very patchy, due to the
>  >  > incredibly fragmented nature of the US healthcare system.
>  > Where do you get your numbers?   The percentage that isn't covered is
>  > much smaller, I believe, particularly since people who haven't applied
>  > and thus don't show up on a list are, in fact, covered.  The quality
>  > of healthcare is patchy, but not necessarily based on income, but on
>  > locality.
> 
> The healthcare insurance coverage is a figure I recall from a CDC Health
> People report, probably 5 years old or so - but it is at work. I'll look
> it up on Monday. The population-based health outcomes are documented in
> many places - again I'll look for a summary in some OECD reports on  Monday.

I had a quick look around and you are quite right - only about 15% of
the total US population are completely without health insurance,
according to figures quoted in this (excellent) paper:
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0010039

However, the aboveURLed paper also mentions the problem of
under-insurance and intermittent insurance in the US health system,
which is rather widespread, because a) the US health insurance system is
not nearly as tightly regulated as it is in many other countries, so
insurance companies get away with whatever they can and b) there is no
concept of mandatory "community rating" i.e. health insurance companies
are not forced to spread the financial risk across all their customers,
and so can charge differential premiums, making higher levels of cover
unaffordable for those who most need it, and c) as you mention,
insurance is employment-related, so many people end up without health
insurance during periods of unemployment. The 50% figure I mentioned may
have included some definition of under-insurance or intermittent
insurance as well as the chronically uninsured. Or I may just be wrong.
However, the conclusion is the same: the health outcomes of the
uninsured (and under-insured) drag the average health outcomes for the
whole US down, by a large amount.

Tim C





  
  
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Re: [openhealth] Re: Nationalized Medicine was: article re IBM and others contributing open source epi and other

[Tim.Churches]

David Forslund wrote:
> Tim Churches wrote:
>  > Despite having one of the highest per-capita spends on healthcare in the
>  > world, the US ranks in the bottom half (and often right at the bottom)
>  > of all OECD countries on just about every health and health outcome
>  > measure, on a population basis. Sure, for wealthier people in the US who
>  > can afford good health insurance, health outcomes are excellent, but
>  > those people represent about 50% of the total population. The rest of
>  > the population have really very bad outcomes, so the overall results are
>  > remarkably poor given the overall expenditure. And even amongst the
>  > insured, the quality and nature of the care is very patchy, due to the
>  > incredibly fragmented nature of the US healthcare system.
> Where do you get your numbers?   The percentage that isn't covered is
> much smaller, I believe, particularly since people who haven't applied
> and thus don't show up on a list are, in fact, covered.  The quality
> of healthcare is patchy, but not necessarily based on income, but on
> locality.

The healthcare insurance coverage is a figure I recall from a CDC Health
People report, probably 5 years old or so - but it is at work. I'll look
it up on Monday. The population-based health outcomes are documented in
many places - again I'll look for a summary in some OECD reports on  Monday.

> But most people I know would much rather have their
> operation in the US rather than going to another country for the same
> or similar procedure.

I'm just guessing, but could that be because most people you know are
Americans?

> The IT problem of rigid stove pipes of proprietary systems contributes
> to the problem but
> probably isn't the biggest contributing factor, in my opinion.   I'm not
> sure how FOSS
> works in countries that have nationalized healthcare.  Aren't their
> requirements that
> one use the "national IT system"?

Or at least a small number of approved systems. That is certainly the
way the UK NHS is heading, for better or worse. None (or very few) of
those systems are FOSS, though. But typically even if health care is
funded centrally by govt, administration is done on a regional basis and
that often permits (for better or for worse) quite a lot of IT
diversity. Even completely centrlist administrations try to avoid
complete monocultures in IT, especially where commercial suppliers are
involved, for fear of being price-gouged.

Tim C





  
  
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Re: [openhealth] Re: Nationalized Medicine was: article re IBM and others contributing open source epi and other

[David Forslund]

Tim Churches wrote:
> David Forslund wrote:
> > Tim Cook wrote:
> >  > -BEGIN PGP SIGNED MESSAGE-
> >  > Hash: SHA1
> >  >
> >  > ivhalpc wrote:
> >  >
> >  > >
> >  > > I wonder how this is all going to end and I fear it will end 
> badly as
> >  > > in Nationalized medicine in the US
> >  >
> >  > Would that truly be a bad thing?  I'm not sure how a transition would
> >  > work but answer these questions:
> > The transition is already underway with Medicare and Medicaid, both 
> of which
> > are about to go bankrupt in the US.
>
> Sorry for my ignorance, but how can govt-funded health insurance/payment
> schemes "go bankrupt"?
So I guess this speaks of the curious way that the US works.  Medicare 
and Medicaid
are not paid for out of the general revenues, but out of a specific 
tax.  Since this
involves "entitlements", i.e., obligations into the future, the 
projected income
won't meet the projected outgo in the years ahead.  This is a "classic" 
definition
of bankrupt.   Much of the problem comes from unfunded mandates, where any
hospital ER can't turn anyone away based on their ability to pay even if 
they
aren't covered by Medicare or Medicaid.  This is one of the reasons that we
have an immigration problem here as people can come from Mexico, for 
example,
illegally and get healthcare coverage.
>
> >  > 1) What western country spends the largest portion (by a wide 
> margin) of
> >  > GDP on healthcare?
> > This, by itself, doesn't mean that healthcare in the US is bad.  It
> > might mean the opposite.
>
> Despite having one of the highest per-capita spends on healthcare in the
> world, the US ranks in the bottom half (and often right at the bottom)
> of all OECD countries on just about every health and health outcome
> measure, on a population basis. Sure, for wealthier people in the US who
> can afford good health insurance, health outcomes are excellent, but
> those people represent about 50% of the total population. The rest of
> the population have really very bad outcomes, so the overall results are
> remarkably poor given the overall expenditure. And even amongst the
> insured, the quality and nature of the care is very patchy, due to the
> incredibly fragmented nature of the US healthcare system.
Where do you get your numbers?   The percentage that isn't covered is
much smaller, I believe, particularly since people who haven't applied
and thus don't show up on a list are, in fact, covered.  The quality
of healthcare is patchy, but not necessarily based on income, but on 
locality.
I've heard horror stories from other countries, too, but I largely 
discount such
reports.
>
> >  > 2) What western country has the largest percentage of citizens 
> without
> >  > healthcare?
> > Do you have any idea what the percentage of citizens in the US is
> > without healthcare
> > coverage?   The main stream media  and some politicos grossly
> > misrepresent this
> > number.  The fact is that healthcare for those that need it in the US
> > can't be denied.
> > The type of coverage isn't the same for everyone, but essentially
> > everyone has coverage
> > of some sort.  People may not have signed up for it, but, in fact, may
> > have coverage.
> > Take a look at the sign in every ER room in America, e.g.
>
> It may be that acute, emergency care is mostly available to everyone in
> the US (but I constantly hear horror stories of denied or badly
> truncated emergency care in the US due to lack of insurance or cash,
> stories which you never hear here in Australia or in the UK - they are
> just inconceivable).
The problem here is that ER care is the most expensive and is the one
that can't be legally denied. In northern New Mexico, ER is the primary
care for a number of people.  There is a continuous effort to provide
care in a different way which will reduce costs.
>
> However, it is lack of access to ongoing, routine medical care for
> poorer people in the US which is the problem. It may be that even the
> struggling single parent unskilled casual worker in the US can have
> their myocardial infarct treated at an ER, but it would have been better
> if they had had free or subsidised access to regular care by a family
> physician or community clinic for the decade before that, as well as
> access to subsidised antihypertensive and cholesterol lowering drugs
> instead of paying the full, ridiculous inflated US market prices for
> such medications.
The problem also is how healthcare insurance is paid for as part of
one's employment.  One doesn't have a real choice in healthcare
in the US, which would make a difference if a real free market could
take place. We have neither a free market nor a federal system, and suffer
as a result.  But most people I know would much rather have their
operation in the US rather than going to another country for the same
or similar procedure. 

The IT problem of rigid stove pipes of proprietary systems contributes 
to the problem but
probably isn't the biggest contributi

Re: [openhealth] Re: Nationalized Medicine was: article re IBM and others contributing open source epi and other

[Tim Churches]

David Forslund wrote:
> Tim Cook wrote:
>  > -BEGIN PGP SIGNED MESSAGE-
>  > Hash: SHA1
>  >
>  > ivhalpc wrote:
>  >
>  > >
>  > > I wonder how this is all going to end and I fear it will end badly as
>  > > in Nationalized medicine in the US
>  >
>  > Would that truly be a bad thing?  I'm not sure how a transition would
>  > work but answer these questions:
> The transition is already underway with Medicare and Medicaid, both of which
> are about to go bankrupt in the US.

Sorry for my ignorance, but how can govt-funded health insurance/payment
schemes "go bankrupt"?

>  > 1) What western country spends the largest portion (by a wide margin) of
>  > GDP on healthcare?
> This, by itself, doesn't mean that healthcare in the US is bad.  It
> might mean the opposite.

Despite having one of the highest per-capita spends on healthcare in the
world, the US ranks in the bottom half (and often right at the bottom)
of all OECD countries on just about every health and health outcome
measure, on a population basis. Sure, for wealthier people in the US who
can afford good health insurance, health outcomes are excellent, but
those people represent about 50% of the total population. The rest of
the population have really very bad outcomes, so the overall results are
remarkably poor given the overall expenditure. And even amongst the
insured, the quality and nature of the care is very patchy, due to the
incredibly fragmented nature of the US healthcare system.

>  > 2) What western country has the largest percentage of citizens without
>  > healthcare?
> Do you have any idea what the percentage of citizens in the US is
> without healthcare
> coverage?   The main stream media  and some politicos grossly
> misrepresent this
> number.  The fact is that healthcare for those that need it in the US
> can't be denied.
> The type of coverage isn't the same for everyone, but essentially
> everyone has coverage
> of some sort.  People may not have signed up for it, but, in fact, may
> have coverage.
> Take a look at the sign in every ER room in America, e.g.

It may be that acute, emergency care is mostly available to everyone in
the US (but I constantly hear horror stories of denied or badly
truncated emergency care in the US due to lack of insurance or cash,
stories which you never hear here in Australia or in the UK - they are
just inconceivable).

However, it is lack of access to ongoing, routine medical care for
poorer people in the US which is the problem. It may be that even the
struggling single parent unskilled casual worker in the US can have
their myocardial infarct treated at an ER, but it would have been better
if they had had free or subsidised access to regular care by a family
physician or community clinic for the decade before that, as well as
access to subsidised antihypertensive and cholesterol lowering drugs
instead of paying the full, ridiculous inflated US market prices for
such medications.

Tim C



  




  
  
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Re: [openhealth] Re: Nationalized Medicine was: article re IBM and others contributing open source epi and other

[Joseph Dal Molin]

Tommy Thompson was quoted on this subject today (he must be a subscriber 
to openhealth):

"Even though American health care is the best in the world, said 
Thompson, he predicts the health care system will collapse about 2013. 
"The first reason is that we spend about 16 percent of our GDP on health 
care, while other countries spend from four to 11 percent. Japan spends 
7 percent. We spend a lot more than any other country." And, he said, by 
2013 we'll double the expenditures; from $2 trillion to $4 trillion -- 
from 16 percent of GDP to 20 percent of GDP."
http://www.govtech.net/magazine/channel_story.php/99517


David Forslund wrote:
> Tim Cook wrote:
>  > -BEGIN PGP SIGNED MESSAGE-
>  > Hash: SHA1
>  >
>  > ivhalpc wrote:
>  >
>  > >
>  > > I wonder how this is all going to end and I fear it will end badly as
>  > > in Nationalized medicine in the US
>  >
>  > Would that truly be a bad thing?  I'm not sure how a transition would
>  > work but answer these questions:
> The transition is already underway with Medicare and Medicaid, both of which
> are about to go bankrupt in the US.
>  >
>  > 1) What western country spends the largest portion (by a wide margin) of
>  > GDP on healthcare?
> This, by itself, doesn't mean that healthcare in the US is bad.  It
> might mean the opposite.
>  >
>  > 2) What western country has the largest percentage of citizens without
>  > healthcare?
> Do you have any idea what the percentage of citizens in the US is
> without healthcare
> coverage?   The main stream media  and some politicos grossly
> misrepresent this
> number.  The fact is that healthcare for those that need it in the US
> can't be denied.
> The type of coverage isn't the same for everyone, but essentially
> everyone has coverage
> of some sort.  People may not have signed up for it, but, in fact, may
> have coverage.
> Take a look at the sign in every ER room in America, e.g.
> 
> Dave
>  >
>  >
>  > TWC
>  >
> 
> 
> 
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Re: [openhealth] Re: Nationalized Medicine was: article re IBM and others contributing open source epi and other

[David Forslund]

Tim Cook wrote:
> -BEGIN PGP SIGNED MESSAGE-
> Hash: SHA1
>
> ivhalpc wrote:
>
> >
> > I wonder how this is all going to end and I fear it will end badly as
> > in Nationalized medicine in the US
>
> Would that truly be a bad thing?  I'm not sure how a transition would
> work but answer these questions:
The transition is already underway with Medicare and Medicaid, both of which
are about to go bankrupt in the US.
>
> 1) What western country spends the largest portion (by a wide margin) of
> GDP on healthcare?
This, by itself, doesn't mean that healthcare in the US is bad.  It 
might mean the opposite.
>
> 2) What western country has the largest percentage of citizens without
> healthcare?
Do you have any idea what the percentage of citizens in the US is 
without healthcare
coverage?   The main stream media  and some politicos grossly 
misrepresent this
number.  The fact is that healthcare for those that need it in the US 
can't be denied. 
The type of coverage isn't the same for everyone, but essentially 
everyone has coverage
of some sort.  People may not have signed up for it, but, in fact, may 
have coverage. 
Take a look at the sign in every ER room in America, e.g.

Dave
>
>
> TWC
>






  
  
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