"If It's From Europe, Forget It" and Other Comments on Health Care
Posted by Joerg Wolf in Transatlantic Relations, US Domestic and Cultural Issues on Thursday, August 16. 2007
The Boston Globe writes about "France's model healthcare system."If it's from Europe, forget it: Conservative dismissals of Democratic healthcare plans as "socialist" explains a lot about the hole America is presently in.
And MSNBC adds this to the debate (HT: David):
In our second Gut Check America vote, readers rated health care as the issue of most concern for them. After a false start in Oregon, we found reader Kathleen Aldrich, a Lompoc, Calif., resident who wrote to us about how her battle with cancer drove her to bankruptcy, even though she had health insurance.The Simpson's have a German guy lecturing Americans: "Problem number 35 with America: No universal health care."
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Subscribe to one of our RSS-Feeds or to our newsletter, which is emailed twice per month.Speaking as someone who worked in the medical field back in the late 70's and early 80's, if you want to reform our medical system, you're going to have to start by reforming our legal system. Unfortunately, our medical system has been shaped, distorted might be a better word, by our insanely litigious legal system. I would suggest prohibiting trial lawyers from working on contingency as a good place to start. Making the loser in any civil suit pay all legal fees (on both sides) and court costs might be a good idea as well.
Sounds good to me, but I don't know anything.
What about the pharma system?
I read some time ago that the pharma industry is one of the most profitable ones. Not just a few companies, but most of them. Not just in the US but globally. Perhaps they charge too much? Is it market failure?
US health care is more expansive, but not necessarily better than those in other countries... Some problem with lack of market economy?
Anyway, the American Institute of Contemporary German Studies just published a report about HEALTH CARE AND PENSION REFORM IN THE UNITED STATES AND GERMANY.
http://www.aicgs.org/documents/pubs/polrep30.pdf
I once read (in the NYT?)that administration costs make up a ridiculous amount of health care costs in the U.S. Does anybody know more about this?
Also, some more interesting figures: According to a recent investment article in the International Herald Tribune” (not available online, as far as I can tell), “In the United States, increased spending on medical treatment will push total health care disbursement from its current 16 percent of the economy to 20 percent by 2015, according to government reports.” In the EU, costs are forecast to grow from 4 percent to 8 percent of GDP in the next decade.
Movies like "Sicko" notwithstanding, I'm skeptical that single-payer national health insurance will really get off the ground in the USA. People think it sounds like a good idea until they get wind of the details. The problem is that 75% of Americans have private health insurance and are more or less happy with their coverage. To make a single-payer system appealing politically, you'd have to assure that 75% that they would not lose their current level of quality, access, and choice. Also, we're not starting from scratch, as was the case with other systems in industrialized countries after WWII. There are huge lobbies and interest groups (doctors, nurses, hospital corporations, insurance companies) that will fight to retain control over their portion of the system, not always for nefarious and selfish reasons. Anyway, the demand for high-tech medical care will increasingly outstrip supply. Do you tell old people that they can't have hip replacements and artificial hearts? You either ration it by price, or by politics. You can always find heartrending examples of the losers in either rationing system.
The pharmaceutical industry is unfairly picked on, in my opinion. It takes millions of dollars to develop and test a drug, let alone get it approved by the FDA. High prices on drugs for common ailments (high blood pressure, arthritis) subsidize the development of drugs for less common, but no less unpleasant, conditions which would otherwise be uneconomical to research and develop drugs for. What price do you put on innovation?
What choice?
Most Americans have their health care plans chosen by their employers. Those healthcare plans in turn tell people which doctors they are allowed to see (doctors in the plan )if they want their insurance to pick up the costs (or at least some of it.) Further, if they want to see a specialist, they first have to get their designated doctor to approve it and refer them there.
They have far fewer choices than the typical Frenchie.
Not being able to pick your own doctor or to have to see a so-called gatekeeper first is part of a HMO. Which is only one or the dozens of different health plans available. And even then there are ways, mainly by raising a big stink to see your first choice and then a specialist is simply a matter of a phone call, to finesse even the most Scrooge like administrator.
Most health coverage in the US allows the patient to see whatever doctor they want, sometimes with a co-pay such as the $20.00 per visit I pay, and then not surprisingly to see a specialist has warranted. Self-diagnosis and then chosing your own specialist is not the hallmark of any medical insurance plan that I've ever heard.
One of the undiscussed problems in the US is that the young, those 18-34, according to the AMA, generally chose not to have medical coverage if they can avoid it. The young being relatively healthy and also having more interesting things to spend a couple of hundred dollars on each month. As a result families, the elderly and the infirm simply do not have access to the money that the young might spend on health insurance and thus the money crunch.
Most Americans probably do not care that Europeans live an extra year to a year and a half. Most realize that like most statistics that average simply does not take into account that the constant stream of immigrants coming from countries with extremely poor health care and much lower life expectancy will always hold the average in the US down.
Huh?
Managed care is pretty much all that's offered by employers in the US (if anything is offered at all, that is...).
In 2006, it consisted of 20% HMOs, 60% PPOs, and 13% POS.
From wiki:
About POS (Point of Service)
pat: //Most realize that like most statistics that average simply does not take into account that the constant stream of immigrants coming from countries with extremely poor health care and much lower life expectancy will always hold the average in the US down.//
Hummm...
Life expectancy in the US is for people BORN in the US!
Lower life expectancy has to do with obesiy rates, lack of preventative care, and infant mortality.
Besides, Europe has about 20 million more immigrants than the US (56.1 million vs. 35 million). France has 4 millions of them, or 6.6% of its population.
45 million Americans without health insurance, a like number without adequate coverage: when will the US join the ranks of other industrialized nations and provide its citizens with universal health care?
The results of our broken system are predictable and tragic.
I read your link, David, but I don't see why some guy murdering his sick wife by throwing her over a balcony is a tragedy and not a barbaric crime. There was nothing inevitable or preordained about it. There's plenty to criticize in the US health system, but no one needs to kill someone over it.
To be honest, I don't believe that universal health care is economically viable anymore. It's no longer possible to provide everyone with what they want and need in medicine. Single-payer systems were designed when the state of medical science was relatively primitive; the doctor listened, prescribed two aspirin, and sent you home to suffer. The standard of care has risen tremendously, and will continue to rise with new medical innovations. We can't afford to give everyone state-of-the-art treatment for every serious condition. How, politically, do you draw the lines of restriction? This is a question that I have never heard proponents of universal coverage address forthrightly.
Of non-US systems, I have heard that the French one is best. However, I cannot understand how universal health care systems are going to pay their bills as the population ages, without drastically cutting benefits.
Sue, I refuse to believe this. We spend $600 billion on a pointless and immoral war, and we can't find $100 billion to implement a comprehensive healthcare plan?
What is your solution for the 100 million Americans who have no coverage or severly inadequate coverage. Don't you think we have the moral obligation to try and match what other nations do for their citizens?
It's going to cost a lot more than $100 billion. And it's going to go on and on. We'll be out of Iraq in two years.
I do not think we have a moral obligation to do what other countries do if it is based on unsustainable magical thinking. I don't want us to go down that road because I just don't see how the numbers add up. In fifty years (or less), the single-payer systems will not be able to offer "free" medical care to everyone. There is no solution to the funding of everyone's medical treatment. We will have to accept some rationing and limitations no matter what system we adopt.
I don't really know how actuarial tables are constructed in France but in the US they are mainly based on the numbers produced by the Census Bureau every ten years. All "inhabitants", note not citizens, are to be counted for determining congressional districts and to provide the statistical information that governments around the world love. Life expectancy in the US is most asssuredly not based on those born in the US.
Some of the other figures bandied about I must point out simply fly in the face of the documentation. For one 4 million immigrants of a population of 82 million in France is closer to 5% than 6.6%. France allows in 100,000 immigrants a year or 1.52 per 1000 while the US takes in 3.05 per 1000 which equals over 800,000 to 1,000,000 per year. The US is over five times the size in population of France yet manages to take in double on a per capita basis. And to compare the number of immigrants that Europe takes in solely to the US is somewhat disingenuous. By that reasoning the US should be allowed to count the total number of immigrants in the entire Western Hemisphere or at least the NAFTA signatories.
Plus the definition offered by Wikipedia, though somewhat reliably generally, in this case was written so poorly as to leave exactly the opposite impression of what the differences between HMOs, PPOs and PPO-POSs are. HMOs are truly managed care where you are limited to your local area but can get permission to see specialists that are not available and emergency care if needed.
These same businesses that offer HMO coverage most often also offer PPO and PPO-POS if the employee wishes to pay the difference. A PPO also has a list of doctors it recommends but does not require the insured use. Under this program the insured can generally chose their own doctors but do have deductibles and co-pays though that is offset by not having to clear these visits with the HMO gatekeeper. Most Americans prefer this type because it keeps costs down compared to fee for service but allows many more options in choice of doctors and treatments.
A PPO-POS is basically private insurance through a group policy with higher co-pays and deductibles but few restrictions on treatment options. Neither of these last two could be fairly called managed care except as getting the insurance through a group plan.
Americans can also opt out and or in some cases their employer will pay for them to get indemnity insurance, private insurance. Which have higher deductibles and co-pays but higher limits on treatment and sometimes will take insurees with previous conditions.
I'd actually like to learn someting about health care in France or Germany in comparison to the US but the discussion needs to be based on at least what actually is the situation and not what one guesses the situation to be.
Pat: //I don't really know how actuarial tables are constructed in France but in the US they are mainly based on the numbers produced by the Census Bureau every ten years. All "inhabitants", note not citizens, are to be counted for determining congressional districts and to provide the statistical information that governments around the world love. Life expectancy in the US is most asssuredly not based on those born in the US. //
So how does that work? Does the Census Bureau ask people when they intend to die, or are they more rigorous (pun intended) and directly ask the dead at what age they died?
//Some of the other figures bandied about I must point out simply fly in the face of the documentation. For one 4 million immigrants of a population of 82 million in France is closer to 5% than 6.6%. //
Yeah right. Since France has a population of 60 million, guess whose numbers are flying in the face of documentation?
[Note to flying numbers: here is documentation ]
Speaking of flying numbers:
//The US is over five times the size in population of France //
The US has 300 million people. So if France had as you asserted 80 million people, the ratio would have been 3.75, not 5.
Someone seriously needs a math class to keep all these numbers from flying all over the place!
//And to compare the number of immigrants that Europe takes in solely to the US is somewhat disingenuous. //
Not at all. Pretty much every single Euro country with significant immigration (Germany, UK, France, Italy, Spain) is above the US for life expectancy.
//Americans can also opt out and or in some cases their employer will pay for them to get indemnity insurance, private insurance. Which have higher deductibles and co-pays but higher limits on treatment and sometimes will take insurees with previous conditions. //
Look, I have lived for more than 20 years in the US, and I have never had a real choice of plan (sometimes, 2 were offered...) even when I was the employer myself (under 50 employees, you get very limited choices from insurance companies). Moreover, I have never had full choice of doctors. You always have to choose from within a published directory of physicians. Sure, you can go elsewhere, but 1. you have to be pre-authorized and 2. reimbursements are limited. Let me add this: I do not know a single person that has their complete choice of doctors, although I will concede that it is possible they might be able to yell in the phone as you suggested and get what they want. I just don't call that a real choice!
Finally, my current plan is Kaiser Permanente and it sucks to the highest degree. Here is a personal horror story with Kaiser:
http://superfrenchie.com/?p=912
And another one about my experience with your most lousy emergency rooms:
http://superfrenchie.com/?p=446
//I'd actually like to learn someting about health care in France or Germany in comparison to the US but the discussion needs to be based on at least what actually is the situation and not what one guesses the situation to be.//
I guess that's why Jorg posted the link to the Boston Globe. This is the most factual and accurate column I have ever read on the topic in the US.
Joerg:
My last comment in response to Pat is in moderation (too many links, I imagine).
When you have a minute, thanks for freeing it up…)
superfrenchie-I just noticed a rather major blunder in claiming the population of France to be 82 million which it would be if it were Germany. So that 6.6% figure is correct. But France still lags very far behind the US as that 35 million figure(closer to 33 million) is over 10% of the US population. And the statistics on per capita immigration still stand. We have more illegal immigrants in the country, 9-12 million then France has total immigrants, legal and illegal.
Plus, unless the law has changed again since 2005, illegal immigrants in France are no longer eligible for subsidized medical care. I'm not sure what happens in emergency situations but in the US many illegal immigrants go to emergency rooms, in emergency situations and sometimes for basic medical care, and they cannot be turned away under any circumstances. The hospitals are required to treat anyone in the emergency room without asking for papers or insurance. Though you can bet there will be someone with a clipboard around eventually to get the patient to sign for the treatment even if it is likely that no payment will be made.
Yeah well, there's this one and many others. Like, does the Census Bureau ask people when they intend to die, or do they directly ask the dead at what age they died?
ok, now you are not really trying. The actuarial tables use the census numbers to determine the basis for their tables. If say in 2000 my congressional district or zip code had some 500,000 enumerated inhabitants then the tables would use the number of death certificates, which are required, to determine the deaths per 1,000 and also the life expectancy in this district from the age printed on the death certificate.
Another thing the Census Bureau does is ask people, unless they refuse to answer, what is their country of national origin, either by extraction or birth. And regardless of what some may claim even those 20,000 plus French citizens that emigrated to the US last year were not forced to wear Von Dutch trucker caps, Gap khakis or I'm with Stupid t-shirts.
Dying is easy comedy is hard!
Well, while we're waiting for Joerg to get my comment out of moderation purgatory, let's settle that one:
From the Census Bureau FAQ page:
Question: What is the average life span of the U.S. population?
Answer: The U.S. Census Bureau does not produce data on life expectancy.
(Can't post the link without being moderated, so just go to the Census Bureau page, and search the FAQ for "Life Expectancy")
Besides, from everything I can read on this topic, life expectancy for most immigrants groups including Hispanics is actually HIGHER than that of Americans.
The explanation usually given in the studies is that immigrants (legal and illegal) are generally in good health to begin with (immigrants in bad health may not be able to run across the border, nor find a job once in the US) and often return to their country in old age and close to death, so since they die outside of the US they do not increase mortality for their group.
In other words, without its immigrants, the US' life expectancy would actually be lower, not higher!
(Sorry, can't send links without being moderated)
First problem is that the basic sources, the CIA World Factbook and WHO contradict the idea that, for the sake of argument, immigrants from Mexico, El Salvador or Costa Rica, have a higher life expectancy before coming to the US. Mexico has an average of 75.63, El Salvador is at 71.78 and Costa Rica is close enough at 77.21 to the US at 78 to call it a tie. Costa Rica, probably because it has surfing and thankfully not a lot of Che wannabes in fatigues hiding in the jungles, has one of the highest life expectancy rates in Central America and one of the lowest infant mortality rates.
https://www.cia.gov/library/publications/the-world-factbook/index.html
I simply don't know how you arrived at the erroneous idea that the Census Bureau issues life expectancy estimates. As I have tried to explain, obviously not as well as I'd like, that different private and public institutions use the results of the census to create the various tables that actuarys use to determine insurance rates, life expectancy, infant mortality, ethnic composition etc. So it still is safe to assume that part of the shorter life expectancy in the US remains the result of all inhavitants in the US being counted and not excluding illegal aliens. Which, and I would gladly be corrected, is not the way most European nations conduct their national census.
Ok, here's the link to an explanation of how actuary tables are created. Even Wikipedia can't mess that up.
http://en.wikipedia.org/wiki/Actuarial_table
Spam, me?
Well, while we're waiting for Joerg to get my comment out of moderation purgatory, let's settle that one:
From the Census Bureau FAQ page:
Question: What is the average life span of the U.S. population?
Answer: The U.S. Census Bureau does not produce data on life expectancy.
http://tinyurl.com/3yorvx
Looks like my original comment has been freed up and is now above those latest ones in the thread. (Thanks Joerg).
Pat, I didn't say that Mexico or whatever country providing immigrants to the US has a higher life expectancy than the US, but that those people from those countries who choose to emigrate to the US, whether legally or illegally, have a higher life expectancy. Apparently, it's primarily due to 2 things: 1. they are in better health than their countrymen to begin with, and 2. they tend to return to their country of origin in old age, thus skweing their own subgroup stats since they are not dying in the US.
Therefore, immigration INCREASES the US' life expectancy, and does not lower it.
Here is an article on the topic.
And a summary of the NIH study.
The study you refer to(the summary), All Cause and Cause Specific Mortality of Immigrants and Native Born in the United States by Gopal K Singh et al., but not linked was not an NIH study and has not been peer reviewed. However the main problem is that on pg. 393 the composition of the study is revealed to be made up of 84% non-Hispanic whites which means that the bulk of the study concerned itself with immigrants from mostly the other developed countries which I agree do have longer life expectancy rates than the US. Hispanics were listed as only 4% or 12,342 out of a total of 308,554 studied.
Plus I'm not sure how one can claim that immigrants coming to the US have higher life expectancy than their fellow countrymen without providing any documentation. Referring back to Singh's study it should be noted that most of the data was collected between 1979 and 1989 which was mainly the period where the number of illegal immigrants to the US doubled and sometimes tripled yet the demographic sampling more closely resembled that of the 60's and 70's. In 1982 foreign born, legal and illegal, made up barely 5% of the population while today it is up to 10%.
Here is another link:
In the United States, Asian Americans live the longest, and Hispanics live slightly longer than whites.
Look up the topic, there's plenty about it.
Blaming everything on immigrants is a favorite American sport. But it simply does not stand up to facts!
And since my original moderated comment is now buried high in the thread, I'll repost it here:
Pat: //I don't really know how actuarial tables are constructed in France but in the US they are mainly based on the numbers produced by the Census Bureau every ten years. All "inhabitants", note not citizens, are to be counted for determining congressional districts and to provide the statistical information that governments around the world love. Life expectancy in the US is most asssuredly not based on those born in the US. //
So how does that work? Does the Census Bureau ask people when they intend to die, or are they more rigorous (pun intended) and directly ask the dead at what age they died?
//Some of the other figures bandied about I must point out simply fly in the face of the documentation. For one 4 million immigrants of a population of 82 million in France is closer to 5% than 6.6%. //
Yeah right. Since France has a population of 60 million, guess whose numbers are flying in the face of documentation?
[Note to flying numbers: here is documentation ]
Speaking of flying numbers:
//The US is over five times the size in population of France //
The US has 300 million people. So if France had as you asserted 80 million people, the ratio would have been 3.75, not 5.
Someone seriously needs a math class to keep all these numbers from flying all over the place!
//And to compare the number of immigrants that Europe takes in solely to the US is somewhat disingenuous. //
Not at all. Pretty much every single Euro country with significant immigration (Germany, UK, France, Italy, Spain) is above the US for life expectancy.
//Americans can also opt out and or in some cases their employer will pay for them to get indemnity insurance, private insurance. Which have higher deductibles and co-pays but higher limits on treatment and sometimes will take insurees with previous conditions. //
Look, I have lived for more than 20 years in the US, and I have never had a real choice of plan (sometimes, 2 were offered...) even when I was the employer myself (under 50 employees, you get very limited choices from insurance companies). Moreover, I have never had full choice of doctors. You always have to choose from within a published directory of physicians. Sure, you can go elsewhere, but 1. you have to be pre-authorized and 2. reimbursements are limited. Let me add this: I do not know a single person that has their complete choice of doctors, although I will concede that it is possible they might be able to yell in the phone as you suggested and get what they want. I just don't call that a real choice!
Finally, my current plan is Kaiser Permanente and it sucks to the highest degree. Here is a personal horror story with Kaiser:
http://superfrenchie.com/?p=912
And another one about my experience with your most lousy emergency rooms:
http://superfrenchie.com/?p=446
//I'd actually like to learn someting about health care in France or Germany in comparison to the US but the discussion needs to be based on at least what actually is the situation and not what one guesses the situation to be.//
I guess that's why Jorg posted the link to the Boston Globe. This is the most factual and accurate column I have ever read on the topic in the US.
According to statistics compiled by the National Center for Health Statistics, the Americans born in the US have a life expectancy of 77.9 years, which earns us a ranking of 42nd in the world. Last week I linked to an article on this study. Here are a couple of brief excerpts:
"Researchers said several factors have contributed to the United States falling behind other industrialized nations. A major one is that 45 million Americans lack health insurance, while Canada and many European countries have universal health care, they say."
"Policymakers also should focus on ways to reduce cancer, heart disease and lung disease, said Murray. He advocates stepped-up efforts to reduce tobacco use, control blood pressure, reduce cholesterol and regulate blood sugar.
"Even if we focused only on those four things, we would go along way toward improving health care in the United States," Murray said. "The starting point is the recognition that the U.S. does not have the best health care system. There are still an awful lot of people who think it does."
David: // "The starting point is the recognition that the U.S. does not have the best health care system. There are still an awful lot of people who think it does."//
Impossible. People like Pat and Sue have had it drilled in their minds since kindergarden that the US is best at everything.
Facts, figures and studies ain't about to change that!
Or you can offer studies that compare apples to oranges and make cheap shots that completely misrepresent what Sue and I said. If the statistics used are collected differently, which I notice you have not refuted, then how can comparisons be made.
Superfrenchie,
that is the authoritarian mindset: Dear Leader told them we have the best healthcare system, so it must be true...
David, the essence of the authoritarian mindset is believing that the government can solve all of life's tragic conundrums if only we had good leaders. I never claimed that that US health system was the "best." You're projecting your own political resentments, not reflecting on what I said.
The US system needs reform, but there will always be political debates over what constitutes adequate coverage and treatment. Single-payer systems have big problems, not the least of which is long-term sustainability in the face of demographic realities and technological advances in the standard of care. I don't see how believing this makes me an authoritarian.
Sue, I agree with you that there will be funding problems in the future. In fact, there already are. But that is not an excuse for doing nothing. As David pointed out, money can always be found when it comes to funding the war in Iraq...
Read the Boston Globe article linked by Joerg in the post. It explains how France is trying to work it out, by moving away from employer-based funding to taxing earned and unearned income. Also, by moving the age of retirement up.
Pat: //make cheap shots tgetting the French population wrong by hat completely misrepresent what Sue and I said. //
Yeah, like getting the French population wrong by more than 20 million!
//If the statistics used are collected differently, which I notice you have not refuted//
Pat, studies of life expectancy for international comparison purposes make sure that stats are either collected the same way, or that adjustments are made to account for differences.
At any rate, like I said, Europe has more migrants than the US, and every one of the major immigrant countries has a significantly higher life expectancy.
This time from the UN, here are numbers for Pat (like it matters...):
Estimated number of international migrants for 2005 (UN numbers):
Europe: 64,115,850
US: 38,354,709
France: 6,471,029
So France would have about 10.78% of immigrants and the US would have 12.78% (Europe would have 14.22%). Not withstanding studies that say exactly the reverse, you want to blame a 3-year life expectancy discrepancy on 2% of the population?
http://esa.un.org/migration/index.asp
Pat, here are numbers from the UN about immigration (like numbers matters...):
2005 estimated number of international migrants:
US: 38,354,709 (that's 12.7% of the population)
Europe: 64,115,850 (that's 14.2% of the population)
France: 6,471,029 (that's 10.7% of the population)
Sorry, I tried to provide link but comment was moderated. Look it up on the UN site.
So even if you were right that immigrants drag down the life expectancy numbers (and you're not), how would you explain that a 2% difference in immigration rates would result in a nearly 3-year discrepancy in life expectancy?
Just a question: does the number of "international migrants" include internal migration among European countries (sorry if you already addressed this)? If so, then it's not a meaningful comparison to the number of migrants the US takes in, which does not include the massive number of internal migrants within US borders.
I doubt it since the EU has open borders for all EU member states. An EU resident moving to another EU state is not really migrating. You don;t even have to show a passport when crossing the border.
At any rate, EU residents take little advantage of moving to other countries in Europe. Except for some recent immigration from the Eastern EU countries, the numbers are and remain very low.
Why not follow your own link and discover that Sue is correct in that the UN makes no distinction between external and internal migration(not immigration which was the original point I made) and that this number "...generally represents the number of persons born in a country other than that which they live." By that definition the current President of France is classified by the UN as a migrant. Bad statistics create bad results.
But until I see some better documentation I will restate that these comparisons between the US and particular France, which does seem to have an admirable health care system, are meaningless unless the outcomes of both systems are being measured with the same yardstick. It's not enough to simply claim that the measurements are the same by assuming that logically they should be. But the link to Arthur Hu is very informative but I doubt if you read any of the charts or his commentary concerning the differences between different races and ethnic groups.
One way to clear this up, as I asked earlier, would be to show that the census numbers in France are tabulated exactly the same as in the US. My understanding is that France and most of Europe do not count illegal aliens while the United States does. This in itself will skew the statistics just like relying on infant mortality rates by assuming that everyone uses the UNICEF yardstick of counting a child as live after one year. The US, Britain and Canada count a birth as live if after delivery, regardless of weight, malformation or whether it is breathing, the baby breathes independently and has a pulse even briefly. This again causes the US to look much worse in comparison then it is in reality.
There should indeed be room for agreement but I'd prefer seeing whether the claimed amount of money needed to be spent is merely closing a gap in health care that may be statistically insignificant. But I do like the idea of limiting the liability of medical professionals except wonder what Sen. Edwards will do after he withdraws from the presidential race and has to get a job that might not be as lucrative as before.
Ah, my comment concerning infant mortality was hastily written and thus easily misunderstood. In the US, Britain and Canada as well as some others, a baby is born live if it breathes at some time independently of continued mechanical assistance. So babies that are malformed, underweight or dehydrated are counted as live but in most of the world are not counted as live until one year. A baby born not breathing or without a pulse can be resuscitated for a while then stop breathing and still be counted as a live birth.
I mean, where does one even begin with Pat?
One time he's (she's?) adding 20 million people to the population of France and gets 5 when dividing 300 by 80, the next time he makes Sarkozy, who was born in Paris, a migrant to France.
//My understanding is that France and most of Europe do not count illegal aliens while the United States does.//
Your understanding is wrong. Numbers are tabulated with and without immigrants. As David link's to the AP article shows, the numbers for life expectancy concern "bab[ies] born in the United States in 2004."
Further, it doesn't matter much since immigrants to the US have a longer life expectancy than the natives anyway!
I notice that superfrencie has simply given up defending his own citations and now relies on David's, which are ESTIMATES of the future life expectancy of babies born in the United States circa 2004, which somehow has become an issue. Which are very close to the current life expectancy rates posted by WHO and the CIA. Sarkozy was indeed a monumental goof while I note that superfrenchie simply cannot advance his argument anymore due to a sudden lack of decent statistics. The fact that I got 5 when dividing 300 by 80 might indicate that the 80 was mistaken when the ratio was correctly gotten from 60.
The US still does on a per capita basis allow twice the immigrants as France, we still have as many illegal immigrants as France does legal and illegal. We do not count movement internally as migration except when we notice an awful lot of people at the beach with Michigan t-shirts and farmer tans. We still count all inhabitants, which are the basis for the actuarial tables which produce the life expectancy rates, while France counts only it's own citizens conveniently leaving out of the mix immigrant groups that might lower the life expectancy rate. I'll repeat show me some statistics that describe the methadology that France uses in its census.
I'm beginning to suspect that David's relapse into name calling should more likely be applied to superfrenchie for focusing on the two easily acknowledged and correctable mistakes I made and ignoring the multitude of his own mistakes by simply repeating the mantra of life expectancy of immigrants to the US primarily on the one pertinent citation from Arthur Hu's website concerning the small sample he used to show the longer life expectancy of wealthier Hispanic immigrants. As if that in itself is surprising considering the access to better and healthcare that the typical illegal immigrant from Oaxaca or San Salvador had.. Legal immigrants have qualities and lifestyles that give them advantages over most groups in the US but the inclusion of illegal immigrants to the census data make these comparisons meaningless.
Come on, provide some links that don't contradict your postion be either reading the second paragraph or checking the footnotes. And I have to note that spending twenty years in the US and not having a health plan you like doesn't say much for your ability to or interest in securing better.
Pat,
Forget about your stupid links and statistics. Come to my neighborhood and I'll introduce you to five families - all American-born, with high school education, and employed - and all without health insurance. They can tell you about the terrible tradeoffs they are forced to make, their inability to afford routine screenings and checkups for themselves and their children, and the anxiety of living one illness away from financial ruin.
Then tell me about the wonderful healthcare system in this country.
Pfew! Tough to talk to someone who just won't accept scientific study results!
One last try:
From the National Library of Medicine, which is part of NIH, and describing the study in question, and the results:
RESULTS: During 1979-81, immigrants had 2.3 years longer life expectancy than the US-born (76.2 vs 73.9 years). The difference increased to 3.4 years in 1999-2001 (80.0 vs 76.6 years). Nativity differentials in mortality increased over time for major cancers, cardiovascular diseases, diabetes, respiratory diseases, unintentional injuries, and suicide, with immigrants experiencing generally lower mortality than the US-born in each period. Specifically, in 1999-2001, immigrants had at least 30% lower mortality from lung and oesophageal cancer, COPD, suicide, and HIV/AIDS, but at least 50% higher mortality from stomach and liver cancer than the US-born. Nativity differentials in mortality, health, and behavioural characteristics varied substantially by ethnicity. CONCLUSIONS: Growing ethnic heterogeneity of the immigrant population, and its migration selectivity and continuing advantages in behavioural characteristics may partly explain the overall widening health gaps between immigrants and the US-born.
Further, this study:
Results: Compared to their US-born counterparts, black immigrant men and women had, respectively, 9.4 and 7.8 years longer life expectancy, but Chinese, Japanese, and Filipino immigrants had lower life expectancy. Most immigrant groups had lower risks of infant mortality and low birthweight than the US-born. Consistent with the acculturation hypothesis, immigrants' risks of disability and chronic disease morbidity increased with increasing length of residence.
So not only do immigrants have a higher life expectancy, but staying in the US increases their risk of morbidity!
Pat: //And I have to note that spending twenty years in the US and not having a health plan you like doesn't say much for your ability to or interest in securing better.//
As stated above, just like most Americans, I do not have a choice of plans. Employers choose for me. In this case, my spouse's employer. Choice, whether of insurance plans or of doctors, by and large is not part of what is offered to American consumers of health care.
Propaganda, on the other hand, they have plenty!
superfrenchie-These are still not peer reviewed and these are descriptions of the article much like browsing through the TV Guide plus its from the same two authors as the earlier citation you misrepresented, Singh and Hiatt. But now its even more confusing as Singh's premise is contradictory, especially in regard to one ofthe longest living group in the world and the US Japanese and Japanese-Americans to the other site you used, Arthur Hu. And since I know that you did not read these articles nor the original I'm not sure what your comment is supposed to prove except shifting justifications.
And of course morbidity increases with continued presence in the US just as it does for everyone else, it's called aging.
David-I thought you were at least trying to be civil but alas not. Please point out to me anywhere in the comments I have made where I defended the health care system in the US. In fact if you had bothered to notice that the one health care system I did refer to was France and that was positively. I think you sincerely belief in the rightness of your position but tend to fall back on sentimentality and anecdote. Again I'll repeat that it would be better if the examples to emulate in regards to health care systems are shown to have outcomes that derive from the same methadology. Until then I would prefer to keep my money in my pocket.
Or better yet you can come to my neighborhood and demand that five families here give up part of their health care coverage for the people in you neighborhood. Good luck!
Wat makes you think that NIH studies are not peer-reviewed, besides your inability to accept that immigrants can perform better than Americans at certain things?
And no, they're not contradictory. The earlier link said the same thing.
Pat: //Or better yet you can come to my neighborhood and demand that five families here give up part of their health care coverage for the people in you neighborhood. Good luck!//
The point of universal health insurance is that both your neighbors and David's neighbors would have it.
//Until then I would prefer to keep my money in my pocket.//
With the French system, you would keep half of it!
Here is another study:
OBJECTIVES: This study examined whether US-born people and immigrants 25 years or older differ in their risks of all-cause and cause-specific mortality and whether these differentials, if they exist, vary according to age, sex, and race/ethnicity. METHODS: Using data from the National Longitudinal Mortality Study (1979-1989), we derived mortality risks of immigrants relative to those of US-born people by using a Cox regression model after adjusting for age, race/ethnicity, marital status, urban/rural residence, education, occupation, and family income. RESULTS: Immigrant men and women had, respectively, an 18% and 13% lower risk of overall mortality than their US-born counterparts. Reduced mortality risks were especially pronounced for younger and for Black and Hispanic immigrants. Immigrants showed significantly lower risks of mortality from cardiovascular diseases, lung and prostate cancer, chronic obstructive pulmonary diseases, cirrhosis, pneumonia and influenza, unintentional injuries, and suicide but higher risks of mortality from stomach and brain cancer and infectious diseases. CONCLUSIONS: Mortality patterns for immigrants and for US-born people vary considerably, with immigrants experiencing lower mortality from several major causes of death. Future research needs to examine the role of sociocultural and behavioral factors in explaining the mortality advantage of immigrants.
Ok, now I'm doing this just for fun. The earlier links are to the NIH Library where these articles are available. If you bothered to look to the box on the right you would see that all of Singh's articles were published in various journals but none are cited as NIH studies. Plus since you completely ignored the claim from the UN website I'm simply going to have to assume that you still do not understand the difference between legal and illegal immigration and as Sue pointed out you still have not shown the slightest inkling to understanding the difference between immigration, legal or otherwise, and migration.
The samples cited by Singh et al, even he acknowledges are small and but suggestive of his point but he as well as the unlinked article above seem to be shifting to the argument that only in certain areas do immigrants have advantages.
My point still remains that the statistics from France and the US are obviously from different methadologies or else someone would have lined to that some evidence if otherwise.
And since I have only commented on one health care system I'll assume that this misrepresentation of my views are deliberate and dishonest. Or the result of finding that the soap box is not as firm as fantasized.
Pat: //If you bothered to look to the box on the right you would see that all of Singh's articles were published in various journals but none are cited as NIH studies. //
And if you bothered to check under the authors names, you would have seen that it says Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Executive Plaza North, Suite 343, 6130 Executive Blvd, MSC 7352, Bethesda, MD 20892-7352, USA.
I mean, there's even the guy's email address: gopal_singh@nih.gov.
//The samples cited by Singh et al, even he acknowledges are small and but suggestive of his point but he as well as the unlinked article above seem to be shifting to the argument that only in certain areas do immigrants have advantages. //
Huh? What the hell does that mean? Is that English?
//or else someone would have lined to that some evidence if otherwise.//
Same question!
You know, if it weren't for the French, you might be writing English today... ;)
//I'm simply going to have to assume that you still do not understand the difference between legal and illegal immigration//
Well, at least I knew the population of France, and that someone born in Paris is French...
For the sake of it, let me repeat your original statement:
//Most Americans probably do not care that Europeans live an extra year to a year and a half. Most realize that like most statistics that average simply does not take into account that the constant stream of immigrants coming from countries with extremely poor health care and much lower life expectancy will always hold the average in the US down.//
You can continue to repeat that false bigoted stereotype forever, it won't make it true!
Yes, I'm glad youfinally noticed that Dr. Singh works for the National Cancer Institute which is part of the NIH which I never even mentioned but you still have not shown that these are NIH studies else they would be clearly labeled as such. Having access to an article through the NIH Library is indeed important but assuming that it was peer reviewed, and there are no links to any reviews, is tantamount to assuming the the New York Public Library prints and distributes obscene material because it has an unedited original copy of Howl by Allen Ginsberg.
Plus what is really outrageous is that Allen Ginsberg has neither nominated or awarded the Presidential Medal of Freedom but Estee Lauder was nominated and received one. Perfume of poetry? France at least recognized his poetic genius by bestowing an Order of Arts and Letters on him. Now that is something the US shoud be ashamed.
Pat it might surprise you to learn that I live about 15 minutes from NIH, that it is one of my clients, and that the work I did for them was to develop a database of grant requests, which fund most of the studies there. So I know quite a bit about what an NIH study looks like and goes through. Believe me, those people are smart, and serious!
Shifting the topic again. I never said that Dr. Singh wasn't intelligent but rather that none of his studies on immigrants and morbidity were either peer reviewed or NIH studies. Now however his biostatician studies on cancer genes have been released through the NIH. Plus on the NIH homepage under the Disclaimer of Liability, "For documents available from this server, the US Government does not warrant or assume any legal liability or responsibility for the accuracy, completeness or usefulness of any information, apparatus, product, or process disclosed." In other words, caveat emptor!
Kaiser... as Moore's film suggests, perhaps the most abject instance of profiteering at the expense of the patient in all of America's (plentiful) system of gouging opportunities. Not for the faint hearted, but this will make you feel less lonely, superfrenchie: http://horror.kaiserpapers.info/
As for the NIH, I wonder why amidst the back and forth, one known fact is omitted: Any study conducted or listed by the NIH in the Bush junior years is liable to have been tampered with or selected. The skew, to be clear, being towards making the U.S. look good in comparisons. Got to please the relevant sub-masses.
One more thing about actuarial tables: Indeed, as Pat Patterson states, U.S. actuarial tables are paid for - by employers as well as insurers. The results is that the actuaries are often paid to understate the actual, current U.S. life expectancy - all the better for employers, including states and local governments, to avoid paying fully into their retirement funds. Texas offers an interesting example, with the corruption getting to the point of attempts to legislate *against* making (public) employers fund their retirement obligations. Meanwhile, PP-like smugness can continue on happily, until the private "funds" run out (well before social security, by the way) - and voila, the tables will become self-fulfilling.
Do you have any credible evidence for these claims about tampering with NIH studies or actuarial tables in Texas?
I'm sorry but all these arguments over statistics are irrelevant to the political fate of health care in the US. If Americans' life expectancy is a year or so lower than that of French citizens, it's probably because we have sedentary lifestyles and an overabundance of cheap, junky food. Instituting single-payer universal coverage won't change that.
I was interested to read that the Canadian natural quadruplets born this weekend had to be delivered in a Montana hospital because there were not a single neonatal unit in all of Canada that could accommodate them! What would they have done without the supposedly terrible US health system?
Sue, it's annoying to always hear Americans criticize the Canadian system and then deduct that they're still the greatest in the world. Canada, as the Boston Globe article underlined, is indeed not that good! In the WHO ranking, it comes at #30! The US is 7 spots lower, but if I were trying to improve the system, I would look at a country in the Top 5 or maybe Top 10, not at #30!
From the Boston Globe article, about the French system:
Moreover, in contrast to Canada and Britain, there are no waiting lists for elective procedures and patients need not seek pre-authorizations. In other words, like in the United States, “rationing” is not a word that leaves the lips of hopeful politicians.
Sometimes it looks like I'm the only one that has read the article linked by Joerg in the post!
I agree with you about the importance of lifestyle and food for life expectancy. 32% of American adults are obese compared to 11% of French adults.
//32% of American adults are obese compared to 11% of French adults.//
Although Pat will probably tell you that this is because the French likely have a different definition of obesity, that most obese people are illegal immigrants anyway, that the study has not been peer-reviewed, that the guy doing the study has a foreign-sounding name and who knows who published his study, that the US government does not warrant the accuracy and completeness of the obesity measurements, and that therefore Americans are still the leanest and most in shape people in the world!
Superfrenchie,
Actually there appears to be a correlation between obesity and Republican voting. Another reason why I am a strong supporter of exercise and good nutrition.
One reason why the US and Canada are compared in these debates is because well-known proponents of single-payer like Michael Moore are always bringing Canada up as a model, especially when it comes to drug prices.
I did read the Boston Globe article and it seems that France is not, in fact, a single-payer system like Canada's or Britain's NHS. That is promising.
I did wonder about the doctors' pay issue. Doctors in the US have to pay for their own training and malpractice insurance. This means that they expect big financial rewards to offset these expenses. (I understand that medical school costs about 60 K USD per annum). The first commenter, Kevin, was correct about the huge financial impact our tort system has on medical expenses. Also, nurses and medical technicians in the US make decent money, relatively speaking. Medical personnel in the US expect to be middle class and they don't live in an expansive welfare state, which means that they have to pay for their own children's education, etc. I don't foresee that labor costs in the US medical field are going to drop anytime soon, unless we are willing to accept entrants of lower caliber into these fields. No matter what system the US ultimately adopts, I believe you always get what you pay for.
superfrenchie-I am certainly glad that you read at least the Boston Globe article correctly and not just the description on the mast head. But since it is the weekend don't you think you should lay down and rest for a while. I mean, after all, carying on an argument with a figment of your imagination and then misrepresenting that figment must be exhausting.
Sue, you're absolutely right about the costs. Not just student loans but malpractice insurance also as well as the staff to handle all those stupid insurance forms.
Adopting the French system in the US might help with having to pay less for admistrative costs (staff) but will not help at all with malpractice and the student loans.
You might get better health care by adopting the French model, but you ain't about to get it cheaper!
Polls in Europe and North America seven to nine years ago found that only 40 percent of Americans were satisfied with the nation’s health care system, placing us 14th out of 17 countries. In recent Commonwealth Fund surveys of five countries, American attitudes stand out as the most negative, with a third of the adults surveyed calling for rebuilding the entire system, compared with only 13 percent who feel that way in Britain and 14 percent in Canada.
That may be because Americans face higher out-of-pocket costs than citizens elsewhere, are less apt to have a long-term doctor, less able to see a doctor on the same day when sick, and less apt to get their questions answered or receive clear instructions from a doctor. On the other hand, Gallup polls in recent years have shown that three-quarters of the respondents in the United States, in Canada and in Britain rate their personal care as excellent or good, so it could be hard to motivate these people for the wholesale change sought by the disaffected.
Sorry, this is the whole text of my earlier comment:
Wow! This health care entry must have been one of the most commented on ever!
Hope I didn’t miss any earlier posting of this , but the New York Times http://www.nytimes.com/2007/08/12/opinion/12sun1.html?ex=1187755200&en=7a3f2066be8d4b11&ei=5070 recently wrote about the allegedly perceived greatness of the American health care system, too. I found these figures rather interesting:
“Polls in Europe and North America seven to nine years ago found that only 40 percent of Americans were satisfied with the nation’s health care system, placing us 14th out of 17 countries. In recent Commonwealth Fund surveys of five countries, American attitudes stand out as the most negative, with a third of the adults surveyed calling for rebuilding the entire system, compared with only 13 percent who feel that way in Britain and 14 percent in Canada. […]
On the other hand, Gallup polls in recent years have shown that three-quarters of the respondents in the United States, in Canada and in Britain rate their personal care as excellent or good, so it could be hard to motivate these people for the wholesale change sought by the disaffected.”
I wonder if part of the problem everybody who wants to reform the U.S. health system faces is the fact that the people most actively involved in politics (read: voters) tend to have good to great healthcare? People lacking (adequate) health insurance might be the same people who don’t vote, run for public office or work for influential think tanks. What do you guys think?
I think you are right. From what I can see, most people who manage their lives fairly well and jump through the necessary vocational or educational hoops get at least an OK job that includes medical insurance. These are the people who vote and pay taxes. The feckless and the unlucky, on the other hand, bear the brunt of our non-guaranteed system. You have to be really poor, with basically no assets, before Medicaid kicks in. So the marginally middle class and the free spirits suffer under our system. I see this dynamic at work in my own extended family; my nephew ended up with a $6000 emergency room bill. He's too old to be covered under his parents' insurance and he can't be bothered to go to school because it's "boring;" he gets by with odd jobs in landscaping and construction. He rents a house with his buddies and parties a lot. He never votes.
The American political commentator and statistician, Ben Wattenberg, has always pointed out that the voters in the US are, to paraphrase, the not poor, the not young and the not minority. But if even the appearnce of a healthcare crisis can be created then the possibility for change becomes greater.
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