[ExI] Private and government R&D [was Health care in the USA]

Stathis Papaioannou stathisp at gmail.com
Mon Jul 20 14:53:06 UTC 2009

2009/7/20 Mirco Romanato <painlord2k at libero.it>:

>> Charity is fickle and demeaning, although better than nothing.
> Charity is fickle mainly because don't give blindly to anyone asking
> without minding at the real needs.

Actually, the government can and does do means tests, while charities
can't or don't want to and don't.

>> I know a lot of people who on principle would not accept charity, but
>>  do accept government provided services, since they are provided
>> under a binding and reciprocal agreement: i.e., if they earn enough
>> money, they will also contribute to these services.
> Nonsense.
> If they don't accept charity, they don't need charity. But they don't
> need welfare also. This stance is only a facade.

I'm simply telling you what some people do. Probably they would accept
charity if that's all that was on offer and they were in great need.

>> In Canada, you pay less tax for public health care per capita than
>> you do in the US and you get high quality universal health care, with
>>  minimal need to rely on charity or private insurance. Why is the
>> Canadian system so much more efficient?
> Because they rationed the health care.
> http://edition.cnn.com/2009/POLITICS/07/06/canadian.health.care.system/index.html

They ration health care so that those with immediate needs can get
treated first. I don't know the details of the problem you have a
lluded to: perhaps it was a slow-growing adenoma that didn't require
immediate surgery, otherwise they would have just done it. And if
something like this happens and is in fact medically negligent, it
makes the news and there is a public outcry, so the situation may get
rectified. The public health system is *accountable* to its users, the
Canadian population. If she needed the surgery but didn't have the
$100,000 (which sounds like a total ripoff to me, but anyway) in a
wholly private system, then what would have been the use of
complaining to anyone? Rationing on the basis of income rather than on
the basis of medical need is still rationing!

IN any case, this misses my point about the Canadian *public* health
system being cheaper than the US *public* health system. If you are a
Canadian taxpayer and use the US private health system, you are still
better off than if you are an American taxpayer and use your own
private health system. And yet the cheaper Canadian system is
universal, while the US one is not.

>>> "My family doctor at that time tried to get me in to see an
>>> endocrinologist and a neurologist," Holmes recalled. "It was going
>>> to be four months for one specialist and six months for the other."
>>> Even with the warning from U.S. doctors in hand, Holmes said she
>>> still couldn't get in to see Canadian specialists. Because the
>>> government system is the only health care option for Canadians, she
>>> says she had no choice but to have the surgery in the U.S.
> http://www.cbc.ca/health/story/2007/10/15/waittimes-fraser.html
>>> A typical Canadian seeking surgical or other therapeutic treatment
>>> had to wait 18.3 weeks in 2007, an all-time high, according to new
>>> research published Monday by independent research organization the
>>> Fraser Institute.
> http://content.nejm.org/cgi/content/full/331/16/1068
>>> Conclusions Waiting times for initial orthopedic consultation and
>>> for knee-replacement surgery were longer in Ontario than in the
>>> United States, but overall satisfaction with surgery was similar.
>>> The median waiting time for an initial consultation was two weeks
>>> in the United States and four weeks in Ontario (Table 1). The mean
>>>  waiting time was consistently shorter in each U.S. survey area
>>> than in Ontario (P = 0.009 for the national sample, and P<0.001 for
>>>  Indiana and western Pennsylvania). The median waiting time for
>>> knee replacement from the time surgery was planned was three weeks
>>> in the United States and eight weeks in Ontario (Table 2). The mean
>>>  waiting time was consistently shorter in each U.S. survey area
>>> than in Ontario (P<0.001). Because some people did not proceed with
>>>  surgery immediately after the initial consultation, we did not
>>> calculate the median total waiting time.
>>> In the United States, 98.4 percent of patients in the national
>>> sample considered the waiting time for an initial orthopedic
>>> consultation acceptable, as compared with 91.5 percent in Ontario
>>> (Table 1). In the United States, 95 percent of patients in the
>>> national sample considered the waiting time for surgery acceptable,
>>>  as compared with 85.1 percent in Ontario. Overall satisfaction
>>> with surgery (85.3 percent of U.S. respondents and 83.5 percent of
>>>  Ontario respondents were "very or somewhat satisfied") was not
>>> associated with the duration of the wait for surgery (Pearson R =
>>> -0.14, P = 0.23).
>>> In both the United States and Canada, the proportion of patients
>>> who considered their waiting times to be acceptable declined as the
>>>  duration of the wait increased (Figure 1 and Figure 2). For
>>> patients facing similar waiting periods, the acceptability of
>>> waiting times did not differ significantly between the countries.
>>> For example, the acceptability of waiting times for patients in the
>>>  U.S. national and Ontario samples who waited no more than four
>>> weeks for knee replacement was 97.0 percent and 92.7 percent,
>>> respectively (P = 0.09). Similar results were obtained for the
>>> Indiana and western Pennsylvania samples (data not shown).
> Canadian system could be "more efficient" on a $/procedure basis, but
> the average patient will pay the difference in 10 weeks more time to
> obtain a knee replacement surgery (that is a elective surgery that is
> easy to plan and are done a lot).
> This is interesting:
> http://books.google.it/books?id=A4ytL9h0wYgC&pg=PA85&lpg=PA85&dq=waiting+time+heart+surgery+US&source=bl&ots=0RLmzYQbGc&sig=mK5M-qj9D9zUqfIIZoBGXgHtODU&hl=it&ei=52NkSqG4KYarjAf6-Yj8Dw&sa=X&oi=book_result&ct=result&resnum=10
> http://www.wales.nhs.uk/documents/NHS_Wales_meets_heart_surgery_waiting_times_target-e.htm
>>> NHS Wales meets heart surgery waiting times target
>>> Long waits for heart surgery have been eliminated in Wales. No one
>>> in Wales is waiting over 12 months for heart surgery, the latest
>>> quarterly waiting times figures show. This meets the target agreed
>>> with the health service last year.
> How efficient is waiting for 12 months for a hearth surgery procedure
> instead of 3 like in the US?

Waiting lists are monitored and if the wait is unacceptable
money/people are shuffled around or (as a last resort, usually) extra
money is provided to rectify the problem. In the Australian state
where I live it is sometimes faster to get a joint replacement in the
public than in the private system, but the wait for a cataract
operation is much longer in the public system. I guess they may move
resources from orthopaedics to ophthalmology to compensate, although
the respective specialists will argue that their field is more
important. In theory you could have teams of surgeons around every
corner scrubbed and ready to operate whenever the fancy takes you, but
that would be enormously expensive and wasteful, and people have
decided they only want to pay so much for health care in total.

Stathis Papaioannou

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