Friday, June 29, 2012

american healthcare

tom hunter (3,216) Says: 

Based on Measures of Quality, Efficiency, Access, Equity, and Healthy Lives
Lies, damned lies and statistics …..
I’ll look at the link at some point but I suppose it will be the usual stuff focusing on life expectancy and infant mortality. But the latter numbers are unreliable for international comparisons and the former appear to be affected more by basic things such as demographics, clean water and sewerage systems, and diet. Similarly infant mortality rates are five times the national average on Indian reservations (which have publicly financed health care through the Indian Health Service) and quite low in places like Utah and Washington.
When it comes to things that can actually be linked directly to health care it’s quite a different story – like cancer:
American women have a 63 percent chance of living at least five years after a cancer diagnosis, compared with 56 percent of women in Europe. For American men, the numbers are even more dramatic. Sixty-six percent of American men live five years past a diagnosis of cancer, but only 47 percent of European men do.
Of cancers that affect only women, the survival rate for uterine cancer is 5 percentage points higher in the U.S. than the European average, and 14 percent higher for breast cancer. Among cancers that affect only or primarily men, survival rates for prostate cancer are 28 percent higher in the U.S., and for bladder cancer, 15 percent higher.
 tom hunter (3,216) Says: 
It should be fun to watch!
Children up to the age of 26 were already covered under the SCHIP legislation, as poor people were covered by Medicaid for the last four decades.
It’s a rather sad commentary on the left that two apparently failed Government healthcare programs are going to be fixed by creating and even larger, more extensive government health care program over the top of them.
As far Romney is concerned he may not even have any arguments to deal with since most of the Democrats have been reluctant to mention it on the stump. Given that the mandate has now been converted into the largest tax increase on the middle class in decades that should make the stump debates even more fun than you imagine.

 Sonny Blount (1,525) Says: 
It is absurd to expect the ‘cost’ of healthcare to be directly comparable between the US and other counries. Here are some reasons:
Different countries are treating different populations of people, the US has 3 times the obesity rate of Sweden, and therefore 3 times the obesity related costs.
Different services are being performed, the US has the most plastic surgeons in the world by a huge margin, their be 100 times the number in US as in a country like Sweden. So many of the costs in the US system are voluntary and standards are different, British teeth are not acceptable over there.
Healthcare is one of the top places to spend disposable healthcare. Because the US are wealthier, people are able to spend a higher part of their incomes on healthcare and they do. If you can get a room to yourself and better meals while in hospital, people want this and will pay.
The US is one of the hotbeds of medical innovation. Because there is a market for $100 a pop pills that may save your life, there is an incentive to innovate and eventually we are able to get those same pills 5 to 10 years later for $10. People pay for these latest and greatest medicines because they would rather be alive and bankrupt than dead with money in the bank.
The US model is not the free market model. It should be a lot better than it is, but socialism is not the right response to their problems.
And then there are other things:
The largest international study to date found that the five-year survival rate for all types of cancer among both men and women was higher in the U.S. than in Europe. There is a steeper increase in blood pressure with advancing age in Europe. A 60% higher prevalence of hypertension. The aggressive treatment offered to U.S. cardiac patients apparently improves survival and functioning relative to that of Canadian patients. Fewer health- and disability-related problems occur among U.S. spinal-cord-injury patients than among Canadian and British patients.
Britain has only one-fourth as many CT scanners per capita as the U.S., and one-third as many MRI scanners. The rate at which the British provide coronary-bypass surgery or angioplasty to heart patients is only one-fourth the U.S. rate, and hip replacements are only two-thirds the U.S. rate. The rate for treating kidney failure (dialysis or transplant) is five times higher in the U.S. for patients between the ages of 45 and 84, and nine times higher for patients 85 years or older.
Overall, nearly 1.8 million Britons are waiting for hospital or outpatient treatments at any given time. In 2002–2004, dialysis patients waited an average of 16 days for permanent blood-vessel access in the U.S., 20 days in Europe, and 62 days in Canada. In 2000, Norwegian patients waited an average of 133 days for hip replacement, 63 days for cataract surgery, 160 days for a knee replacement, and 46 days for bypass surgery after being approved for treatment. Short waits for cataract surgery produce better outcomes, prompt coronary-artery bypass reduces mortality, and rapid hip replacement reduces disability and death. Studies show that only 5 percent of Americans wait more than four months for surgery, compared with 23 percent of Australians, 26 percent of New Zealanders, 27 percent of Canadians, and 36 percent of Britons.
There are also weird outcomes, such as the logical conclusion that under a system where one pays, one would skimp on preventative care. However …
… the proportion of middle-aged Canadian women who have never had a mammogram is twice that of the U.S., and three times as many Canadian women have never had a Pap smear. Fewer than a fifth of Canadian men have ever been tested for prostate-specific antigen, compared with about half of American men. Only one in ten adult Canadians has had a colonoscopy, compared with about a third of adult Americans.
These differences in screening may partly explain why the mortality rate in Canada is 25 percent higher for breast cancer, 18 percent higher for prostate cancer, and 13 percent higher for colorectal cancer. In addition, while half of all diabetics have high blood pressure, it is controlled in 36 percent of U.S. cases, compared with only 9 percent of cases in Canada.
I would not get too cocky about the cost aspect either as it’s another apples to oranges comparison between our 80:20 public/private system and their 50:50 system. Our costs are low because, among other things, we suppress the incomes of doctors and nurses – which also means we lose them to places like the USA. That sort of rationing also explains things like the grossly lower numbers of scanners, treatments, surgeries, etc. So yes the cost is lower, but we pay the price in other ways, most of which are probably not measured.

Saturday, June 23, 2012

transmission gulley

libertyscott (305) Says: 

What happened to wanting road projects to have positive BCRs David?
Transmission Gully doesn’t even reach 1, or is only when the other lot are in power that it’s time to damn wasted money? You can’t argue against the ridiculous rail schemes of the Greens when you support these bloated road schemes.
It remains roughly 30% more expensive to do this compared to upgrading the existing route, which only needs a bypass at Pukerua Bay and some widening from there to Mackays to be more than adequate. The only argument in favour of it was that it wouldn’t mean buying off a few NIMBYs at Paekakariki, confronting defenders of the rocky foreshore along the coast. Yet it will cost easily $250-300 million more – or rather, the cost of doing the Basin Reserve-Mt Victoria Tunnel-Ruahine St-Wellington Rd upgrade, but who cares? It’s POLITICS and POLITICIANS always know best how to allocate resources and win votes by conceding to lobbyists whose main interest is increasing the value of their properties in Kapiti and along Mana Esplanade.
I remember when Maurice Williamson and the last real National government actually proudly stated that it didn’t interfere in the decisions of Transfund when it chose how best to allocate revenue from motoring taxes based on economic efficiency.
The congestion arguments at Mana largely evaporated when it was widened for $15 million, the Pukerua Bay bottleneck would take around $90 million to fix and Paekakariki’s nasty little intersection would take a bit over $100 million to trench and grade separate. Then it’s about $300 million to widen the coastal stretch (which hasn’t been killing people since a few million was spent on a median barrier). In the long run a big bypass of Plimmerton and Mana can be considered, but it’s far from necessary now.
It’s notable that Labour took BCR calculations out of the National Land Transport Programme and the Nats have decided that’s really convenient. So there is no longer a principled basis to resist the Greens’ whacky ideas about rail based on wasting money – when you waste money on grandiose excessive road projects that could never be funded from tolls or the fuel tax/RUC paid on a per km basis by the expected users.
Oh and while Wellington City continues to engage in its absurd smartgrowth anti-sprawl planning framework, this will open up Kapiti and beyond for an even faster growing commuter belt.

War right? winner take all?
  • Having grown up with this story, I am fully aware both of the horrors of that period, and also the lack of attention it has received in histories of, and discussions about, the end of World War II.  But I have two critical clarifications to make:  language does not equal ethnicity, and ethnicity is rarely homogeneous, particularly in a heterogeneous country such as the former Czechoslovakia.  In some points of the article, Mr. Douglas refers to the deportees as "German-speaking" but then conflates that with being ethnically German or just German.  German-speaking is also conflated with being sympathetic to the political cause of the state of Germany during the war, and, by association, the Holocaust.  Neither characterization is true. 
    Taking my own family as an example, while primarily German-speaking (family members spoke both German and Czech) genealogy traced back to the 15th century shows both Slavic and Germanic heritage, along with a variety of other ethnicities.  The labelling of any group of individuals, as one singular ethnicity based on their language, hair color, or any other aspect is a slippery slope, as DNA testing is increasingly showing. 
    Politics loves simplicity, so by characterizing a group of individuals based on their language, it is easy to set one group against a recognizable "other."  But historical analysis, in striving to clarify the the wrongs of policy and in an attempt to prevent it from happening again, should strive for clarity.  Deportations and executions during the periods of mass expulsion were cloaked in "German-ness" but were really an excuse for the political forces in power to rid themselves of those they felt we undesirable in one way or another.  Many citizens, with only a tenuous link to "German-ness" or really no link at all, were either executed or expelled in those post-war years when combat had ceased and peace supposedly reigned.
    I thank Mr. Douglass for presenting the horrors of the expulsions, horrors that attend all forced migrations, and should never be condoned in a modern world.  But I would ask for clarity in describing the excuses for the expulsions - for that is what they were.  Excuses.  That is the only possibility we have for ensuring that the same excuses will not be used again, in another place, by the "righteous" victors of war.

  • "Was the punishment against the Germans justified?"
    Another phony question but I'll bite.
    *It is Absolutely Justified*. 
    Millions of people fought and sacrificed to win struggles which
    ultimately came to be known as World War 2.  If these people, who worked
    so hard to win the war are not in a position to pass judgment on the
    Germans, then who is Douglass to pass judgment from atop an ivory tower
    decades afterwards? - Professor Douglass who sacrificed nothing, knows
    nothing, suffered nothing, risked nothing.
    As we say in the military "You were not there".  You risked nothing.
    You won nothing.  And so you are not in the position to affect the
    outcome.  You're judgment means nothing