If the Republicans taught us one thing, it is that there are no tradeoffs. Trillions in tax cuts and trillions in war. Unfettered spending on health care for white people with good jobs and no pre-existing conditions.

Socialism! Boo!

You should be writing this at Daily Kos. Someone needs to do more for the left grassroots movement than nyceve, who wants to lead people to believe they will get everything they want for free under single payer health care.

Where we are the priciest, [the Canadians] are the cheapest.

Uh, no. That would be the Singaporeans.

Ezra . . .
Don't we "sort of" have that system now? People with money
receive better healthcare than those who do not have it.

Sounds like the British system puts a floor under everyone but - if you can afford it - can't you pay for and receive better care?

Would you suggest that those with means NOT be permitted to pay for healthcare beyond that available to all under universality?

It is difficult to understand how there is not enough money in our "health" system to pay for what should be done - for everyone. . . Does your $6,000 figure reflect what is being spent per person here?
(Does it include profits for insurers and shareholders?)

I would pay a lot more than $22K for six extra months of my currently healthy life with interesting things going on and hope for the future; I would pay a lot less for six extra months of dementia in a mediocre nursing home, and I might well ask for a big pile of money if you wanted me to spend six extra months undergoing pointless chemo.

In the early-mid 90s, surveys of cancer patients showed that they were indifferent-to-hostile with respect to treatments that offered them an expected three months of additional survival, free of charge but with the then-expected side effects of nausea and lassitude.

Also in the US, isn't the canonical regulatory number something like $1M per life saved, which would translate to about $2000 a month for a person of median age?

Sounds like the British system puts a floor under everyone but - if you can afford it - can't you pay for and receive better care?

Basically, no.* That's the big difference between the British and the continental systems.

What I'd like to see in the US is a NICE equivalent, and only coverage under the cap would be paid (Medicare, Medicaid) or subsidized (non-taxability) by government.

*(Technically, you can pay for non-standard treatments; however, you have to pay for the entire course of treatment--even the standard part--if you do.)

I guess the first thing that occurs to me is the marginal cost of the expensive Pfizer kidney cancer pill is much less then $50k or $20k, so more than simply withholding the pill from patients, we should think about changing how we compensate the drug companies, something like Dean Baker's prize proposals, or compensating them Medicare style for all their R&D and clinical trials, in exchange for lower marginal costs per pill.

It's worth noting that that's how the British have arranged their compensation for doctor's visits. Each doctor has a number of patients, and those patients can visit the doctor however many times they want, for a nominal fee. So while they are (IMO, too) stingy on the expensive stuff, they're in some ways more generous with the cheap stuff, despite spending much less.

They can't arrange the same compensation system for drugs because either the drug companies are too powerful, or people are scared with tampering with drug company innovation.

My bias is somewhat in favor of heroic medicine, of being willing to spend quite a lot in the potentially last 6 months of life, etc. For example, for your earlier post on lumbar back surgeries, my inclination is not to outright deny the patient the surgery on grounds of cost, but to tell the patient "exhaust all the simple, easy, cheap alternatives first, before trying the expensive stuff." Since exhausting all the simple, cheap alternatives will take some time, time in which most lower back pain improves on its own, this should reduce the number of surgeries, without outright denying them.

Anyway, for a concrete number, I'd defer to David Cutler, who I sense has the same slight inclination in favor of paying for stuff, rather than denying it, that I share.

You know what's weird? In the Allhat article, the doctor getting lots of money from Pfizer accused Furberg of having "a vendetta against the calcium channel blockers." Now in this new article, an oncologist says the chairman of nice has a " 'personal vendetta' against cancer treatments."

There sure are some weird personal vendettas in the medical profession. I mean, what did calcium channel blockers ever do to Furberg? Insulted his mother?

Do any of these health spending calculations take into account the research value of interventions?

In some circumstances, keeping someone alive for six months might eventually lead to keeping people alive for a year, maybe then longer. Or it might improve the quality of those six months, or lead to other treatments.

I suppose this is roughly analogous to our situation regarding drug development. Other countries can pay very little for them because they're not the ones worrying about where new drugs will come from. Letting someone else do the R&D and then reaping the benefits lets you stretch your dollars/pounds/whatever further.

(Note: I'm well aware that "lots of new drugs" is not some cure-all -- not even always a good thing)

So is it plausible to argue that we're subsidizing the British decision to some degree?

Good post.

So here's the question: In a government system in the US, should the government be on the hook for more than that? If six more months of life -- not a cure, but a six month reprieve-- would cost $50,000, should we pay for that, keeping in mind that that money is coming from priorities like education and food stamps and wages increases? Or should we have limits? Should the system itself ration?

So let's broaden the thinking. Improving car technology (e.g. airbags) has a cost and potential life-savings. Same with environmental regulation. Same with others. In fact, if you do the research, you'll find out that EPA, DOT, CPSC and other US regulatory bodies, do have "value of life" measures that are used to sense-check their stringency of their regulations. So what do you you find? IIRC (its been a while since I've looked at this), they value a year of life at $400K to $700K, depending on the agency. What's interesting is that the health policy "consensus" in the US is that for health interventions: cost effective is $100K is considered cost-ineffective. In other words, we are probably harsher in medicine than other related regulations. Ideally, these would be all harmonized.

But this is a great topic of discussion, and good to see a post on it.

Part of my prior post got messed up, it should say:

What's interesting is that the health policy "consensus" in the US is that for health interventions: cost effective is $100K is considered cost-ineffective.

"They have valued six months of life at $22,750."

That's a really low number for a Quality-Adjusted Life-Year (QALY); it probably is mostly based on earning power. In the U.S., I think health economists are using ~$150,000 per QALY, which seem more reasonable.

Ha-- it happened again, and realized I can't use less than/great than symbols... so here it really is:

What's interesting is that the health policy "consensus" in the US is that for health interventions: cost effective is less than $50K per year of life saved, $100K is considered the gray zone and greater than $100K is considered cost-ineffective.

I'm so glad you blogged this article.

I think the point that we need to repeat until it catches on is that there will *always* be rationing. Resources are finite. The NHS blog doc John Crippen puts it well here:

"The only decision to be made about health-care rationing is how we want to control it. Health care has always been rationed. In the UK by waiting lists; by post-code; by luck and by wealth, or, more correctly, lack of wealth. It is different in the USA where health care has been rationed primarily by wealth. Some USA citizens get virtually no health care at all. More recently it has been rationed by the insurance companies who are beginning to have the same level of control as UK government exercises over the NHS."

This is a crucial point to keep going over until people stop hiding behind "Life is priceless", and the sloganeering is no longer effective.

It's very helpful to make comparisons to possible non-health related expenditures. You could ask, "Which is a better expenditure of $75K, six months of poor quality life for an 85-year old, or a college education?"

Private health insurance is available in the UK to anyone who wants it. There are all sorts of plans, most of them "topping up" the National Health Service precisely to provide treatments that the NHS won't pay for.

So it's false to say that "the British system" values 6 months of life at $22,000. The truth is that the British have decided that they don't want to be taxed to pay more than that much, but anyone can purchase as much additional insurance as he or she likes and can afford. You set the value of your own life yourself.

And there is no rationing. If you want to jump the queue, you can do it by paying for it.

In this country, of course, "we" as a society set the value of 6 months of life at zero. Your employer may induce you to work for it by giving you a better deal than that, but if it decides it doesn't need to, then, hell, you can go ahead and die.

Brian: There are holes in your hypothesis but for now, let's just agree with you.

Isn't the best way for the US to get other countries to pay their fair share - cutting back on the subsidy?

I think the truth is much more murky about where innovation is financed, but one thing for sure, cutbacks will give us proof. Then US citizens can decide whether they want to remain the money font for this drug company innovation.

Teasing apart what the government/insurer should be willing to pay for end-of-life care from what the patient/family are willing to pay would be a big step forward in savings.

In both cases, however, I think quality of life estimates should be a major variable, and we should encourage all involved to attempt to quantity the life-quality/cost equation.

One thing seems clear, that given the means (for instance, Oregon's legal right to end one's own life in the last 9 months - with physician prescriptions, but no physician assistance), very few people avail themselves of that choice.

Another obvious thing: the families of the terminally ill are very reluctant to make decisions to withdraw quality treatment, or life support. There's a huge guilt burden that few are prepared to take on regarding loved ones, even in many cases where expressed views of the patient are against prolonging life (through a living will or power of attorney).

Scientic American MIND magazine (Oct/Nov 2008) has a fascinating article: "Never Say Die: Why We Can't Imagine Death
Why so many of us think our minds continue on after we die"

A couple of must-reads on the issue of life-valuation:

"The Life You Save May Be Your Own", by Thomas Schelling.

Anything by Kip Viscusi on the subject.

Carry on.

This is partially what makes me uneasy about the NHS. I'd much rather let the doctors make the decision on who gets care first, than a more impersonal system. That may not be entirely rational, but it's why I prefer single-payer to the NHS.

Wisconsin Reader,

"Sounds like the British system puts a floor under everyone but - if you can afford it - can't you pay for and receive better care?"

No you can't, for example if you pay out of your own pocket for a new experimental cancer drug the NHS stops paying for any other treatment. You follow their treatment plan or get nothing. Imagine having a treatment that cost $22751 and not being allowed to have it even if you pay for it yourself....

Meh, I'm not sure I really have a formal hypothesis, and I admit I'm glossing over lots of issues in drug development.

I'm more wondering -- 'cause I'm really not sure -- if in fact we learn very much from heroic efforts to prolong life, and how we might value those, as long as we're monetizing things.

Efforts over the years to save premature babies, for example, have led to improvements in methods and treatments to the point where we're bumping up against stages in development where they're really just not viable. Whatever price you would put on the effort to save an infant born at, say 28 weeks of gestation 20 years ago, I would argue that the (real) cost is much less now.

I'm wondering if the same might be true at the other end of life...

Here's my system:

Older than 85: no more than $5000 per 6 months

Older than 65: no more than $10000 per 6 months

Older than 45: no more than $50000 per 6 months

Younger than 45: no more than $200k per 6 months

BTW, doesnt the UK NHS control drug prices? Why do they have to worry about the cost of pharmaceuticals? I'm pretty sure the NHS negotiates drug prices directly with big pharma.

"What is six months of your life worth?"

To whom?

Six months of your life isn't worth ten cents to me. I can't afford it. This government has priced me completely out of the market.

No sale, Klein. Never, ever.

Your move, sonny.

Ezra, have you seen this proposal for the patent system? http://volokh.com/posts/1177326127.shtml I didn't make the connection at the time that I read the post, but I think it's got enormous implications for health care to the extent that treatments are expensive because of patents. The idea is that, whenever a patent application is granted, the government conducts an auction for the rights to the patent. At the conclusion of the auction, the government man drives up in a van and rolls a ten-sided die. If it comes up as a 1, the winner of the auction pays the money and gets the patent. If it comes up as anything else, the government man writes a check on the U.S. treasury to the inventor in the amount of the highest bid and then opens the patent to the public domain. (Well, in the health care industry, I guess we'd come up with a regime where the patent was public domain in the United States but had to be licensed as usual abroad to prevent international freeloading.)

The upshot is that it is horribly inefficient for anyone to forego a treatment that has a negligible marginal cost because they can't afford the amortized fixed cost, but that's the necessary evil of our intellectual property system. This new system would eliminate that inefficiency 90% of the time.

If you can afford it, you should be able to pay as much as you want for your six months.

If not, $22k is better than nothing.

Is there any part of the Constitution you understand, Klein? Ever hear of the 5th Amendment? Or is this slow expansion into Marxism what you want?

What a disgusting slime.

"[D]enying care based on criteria that makes the denial the fault of the patient rather than the system."

Well, I'm smart. I'm not one o' them rubes in The Stupid Party who believes in Creationism. I'm enlightened, like you, Klein. I believe in Evolution. Natural selection. It's what Science tells us is The Way. Therefore, I believe that those incapable of ensuring their own survival on their own dime should be allowed to fall by the way. Survival of the fittest. Evolution.

And, since I don't believe in God, I don't believe government should be in the business of trying to play God. The days of The High Muckety Muck standing atop the big structure/formation and pronouncing with faux authority upon all our fates, ought to, once and for all, be put behind us. Tommy Daschle may be a pygmy, but his face isn't painted brightly enough to make him my pygmy medicine man.

Elsewise, any pygmy claims that we have an obligation (or duty) to our fellows less fortunate, begs the question: And what are their obligations to us? If I buy a man an unbroken arm, doesn't he then have an obligation to chauffer me around (at his expense) for a defined period? No?

There must be a thousand reasons against the rot underlying Klein's musings.

Regardless of how much you value those 6 extra months, in England life expectancy is almost one year longer than the US (78.7 versus 77.8). And it's almost 3 years longer in Canada (80.4). They also don't have millions of uncovered citizens. I don't understand why my American friends fear socialized medicine so much.

Ezra Klein

You are a fucking idiot.

My values are mine. I couldn't give a toss how you value me, as long as your views remain opinion. I hold no value for you except as an exemplary shitbag.

I have been treated by both systems. The UK system is a disaster, and the US system is a disaster in the making, thanks to platoons of twats acting in step with your opinions.

Go and play in the traffic.

Alex, even cursory searches of the net will reveal the well known fact that the difference in life expectancies between various countries is not attributable to the respective health care systems in those countries. Demographics, life styles (to include such things as fast-food related obesity), and even the way health statistics are compiled are the factors that are important. Granted, socialism will inevitably lead to a skinnier population, but maybe that would lead some to resent the terminable happy face of the thing. Not Klein, of course.

On the other hand, if life expectancy stats are what really floats your boat (rather than making personal choices directed at prolonging your own life), get on the bullhorn to your favorite, recently-elected statists, and get them thinking about taking away our booze, fast food, ciggies, and (this will help solve the growing unemployment problem, too) to provide cadres of machine gun toting fitness instructors to march the populace through the GovGym three times a week. It would only be for our own good, and why, we might be able (on average) to live to eighty five! Why would your American friends fear that so much?

I am always amazed at the fact that so many people believe that we do not have RATIONED health care system here in the USA. Don't think you do? Go to a hospital that is not "IN NETWORK" and you will find out about it. The majority of all Americans that have health care policies, are those provided by an employer. He/she decides what company or companies you can choose from, not you. The insurance companies then decide who you may go to see, without paying a premium above the normal charge. You must stay IN NETWORK to get the best deal. You must be pre-approved for most specialist visits and hospitalizations. They decide what medicines you can get, without paying either extra, or the entire cost of the medicine. Non-preferred or non-formulary drugs.

Then when you go to make your appointments, you are told it will take 2 to 3 months to see the specialist.

The rich don't care, because they just pay cash, and can buy the needed coverage from a private physician.

And why is a single payer system such a boggy man here? The health insurance industry has told us for years that the reason group policies cost less, is that the larger the group, the lower the average cost to care for each person in the group. If this works for a group of 300 at a small manufacturer, or a group of 5000 at a corporation, or a group of 60,000 at a giant company; why does it suddenly stop working if you put everyone into the group, all 350,000,000 of us? Is it because the insurance companies would not be able to soak individual for huge premiums while paying for less coverage?

The answer to me is a hybrid of several system.

-Put everyone in the US into one mega group for coverage.
-Let the insurance companies bid to provide the servicing of the plan in geographical regions.
-Require ALL doctors to accept the payment negotiated for the given treatment - BUT do not limit them to this amount. They can charge a higher fee if they publish these in advance, so a consumer/patient would know that this doctor will bill for added fees. Verses another doctor down the street that will accept the standard fee as full payment. The free market will deal with those that charge to much.
-Set prices paid to the drug companies for medicine based on the true cost to produce, and not on some inflated price that includes billions of free samples being given out to physicians to hype the latest pill.
-Require that a drug company prove that the new pill offers tangible benefits to the patient, before it is accepted for use. Case in point, the little purple pill that combines to drugs that are available as generics into one, which is patented, high cost pill. The sole true purpose for this pill is to soak the consumer. A $70 prescription for $15 worth of medicine.

If we are truly spending 2.5 times as much for the care of each person in the US vs the UK, and getting a lower life expectancy; then the problem is not the money. It is how we are spending the money. We should be able to provide care for every man woman and child in the country. But not by letting twenty layers of middlemen and HMO's suck all the money up as profits and waisted bureaucracy.

A closing thought - Medicare, which is always blamed for being so inefficient, delivers 90 cents on the dollar of paid services. Ten cents going to bureaucracy. The most efficient private insurance companies deliver 70 cents on the dollar in services, chewing up the rest in bureaucracy and profits. So tell me again why the private insurance system is more efficient than the government one.

"If we are truly spending 2.5 times as much for the care of each person in the US vs the UK, and getting a lower life expectancy; then the problem is not the money. It is how we are spending the money."

Except, once again, life expectancy differences between the U.S., Canada, England, etc., have less to do with the particular "health care system" in place than with demographics, lifestyles, and the manner in which the different countries gather and report their health care stats. In other words, your two sentences there are abject nonsense. Likewise, someone who didn't mind wasting his time arguing with a moron could point out that your recipe of "Put", "Let", "Require", "Set", and "Require" is nothing more than a penchant for control riding on the horse of ignorance.

It is how we are spending the money

No. It's about whose money it is in the first place. All the rest is cannibals at the pot.

It is how we are spending the money

No. It's about whose money it is in the first place. All the rest is cannibals at the pot playing statistics like dice.

Mike, your point about life expectancy is certainly valid, but it's only one of many comparative measures in which the US system is found wanting. Infant mortality rates come to mind. The binge drinking English, and gaulois smoking French, not to mention impoverished Cubans all manage to keep more of their babies alive than the US.

But I don’t want to cherry pick stats to back up my argument. You could equally find areas in which the US excels. For example, I’ve been told that prostrate cancer treatment and survival rates are better in the US system than anywhere else in the world.

I do want to say that I’m a Canadian, who has lived in the US, and presently lives in the UK. I’ve used all the systems. The socialized versions are excellent at the little things and the big things. If you want to quit smoking, lose weight, sort out an STD, lance a boil, get a flu jab etc. No problem. As well, if you have cancer, a heart attack, or a car accident they are brilliant. It’s in all the non-life threatening annoyances in between at which they suck. Hip replacements, cataract removal, and such may involve waiting longer than would be case if cash was being waved around. There is a down side.

Which brings me to my final point. The biggest down side to the US system is a difficult to quantify social cost. Setting aside the millions of people who lack any cover, there are millions more who find the coverage they have been paying for doesn’t come through for them when they need it most. The sharp spike in personal bankruptcies the US is going to experience in the current economic climate is going to be exasperated by nice middle class people struggling to pay medical bills. When they go under, communities go under. Bankrupt ill people are a drain on a society. Healthy people are more likely to be productive. The mistake socialized medicine promoters in the US have made is coaching the argument as a wishy-washy liberal “fairness” issue. In fact, it’s a rock solid capitalist imperative.

Infant mortality"

You are confused, mistaken, or lying, Alex. You could look it up, on Wikipedia, for instance. You're pushing misinformation for the sake of a political goal. What's that called, Alex? And you're not even good at it, but then, the heart of socialism is incompetence.

"The mistake socialized medicine promoters in the US have made is coaching the argument as a wishy-washy liberal “fairness” issue. In fact, it’s a rock solid capitalist imperative."

Capitalism requires socialist health care to survive? To incompetent collectivists the world round the simple pronouncement serves as its own substantiation, but it's just another ugly absurdity.

The depression is coming to your country, too, Alex. While the NHS says your life is worth $22K, today, your ministers can revise it downward any time they feel like it. I wonder how much your life will be worth a year from now, and what the hell you think you'll be able to do about it.

Thanks for the suggestion Mike. I have looked it up on Wikipedia as you suggested.

CIA 2008 World FactBook accessed on Wikipedia:

Deaths per 1000 Live Births
UK 4.93, France 3.36, Cuba 5.93, USA 6.30.

http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate_(2005)

My point was a capitalist society benefits by having healthy productive members rather than sick, bankrupt members. It's better for business. I've tried to be polite and contribute to an important discussion. You're just an arse.

Alex, I want to commend you for the civil tone that you took in your response to Mike. I have often found that the stronger the language that someone uses, the weaker their argument. That certainly appears to be the case with Mike. It actually seems to me that Mike was accusing you of the very thing he was doing.

You know, I don't mind having a civil discussion with those whose views disagree with mine, but am turned off when they resort to name-calling to try to make their point. In those cases, my opinion is that it is better not to feed the trolls.

Alex, you apparently conceded his points about life expectancy, then brought forth another statistic which has the exact same issues with it.

The real issue is the premise espoused that it's our money to try and spend wisely, as opposed to it being each individual's money to spend as they choose.

My point was a capitalist society benefits by having healthy productive members rather than sick, bankrupt members.

Absent all other considerations, you're going to posit it's better to be well than sick as an argument supporting an over-riding interventionist political policy?

Would not a socialist, fascist, hunter-gatherer, Buddhist or Goth society share that same attribute: it's better to be well than sick?

From Mike:

“You are confused, mistaken, or lying, Alex. You could look it up, on Wikipedia, for instance. You're pushing misinformation for the sake of a political goal. What's that called, Alex? And you're not even good at it, but then, the heart of socialism is incompetence.”

Notice he is calling Socialism the heart of incompetence.

From Alex:

“You're just an arse.”

So, who resorted to name-calling?

BTW, after a wiki examination, I see that infant mortality rates are counted using wildly different criteria between nations. I wonder why Alex neglected to see this? I don’t want to resort to any name-calling, but I wonder, again, why is the truth ignored here?

Hi Philinn,

I think I'm not conceding points on life expectancy or infant mortality so much as acknowledging that maybe statistics between different systems are going to be flawed even though they are often collected by US Govt agencies. I'm being polite when I really want to grab someone and shake them. The stats are overwhelmingly on my side though.

Your premise about an individual's right to spend their money as they see fit still applies to the UK system though. The vast majority of UK and Canadian citizens have decided to use their combined bargaining power. In my experience, both the Canadians and British bitch constantly about their health services, but if any politician suggests major changes regarding access they go mad. I think both governments would love to privatize the system and at least get if off the books, but daren't. That's a reflection of people's individual choices at the ballot box. I suspect that without Big Medicine lobbyists US citizens would feel the same.

Hi Ron,

God help me...it's Friday night here in London and I've had 2 pints...but I can't work out what the hell you're on about. If I understand you correctly, and forgive me if I have lost the plot, you feel that my endorsement of being well rather than sick makes me a socialist, fascist, Buddhist, Goth, subsistence nomad? Er...yeah. I'm perfectly healthy now, and you can call me what the hell you like. If I had cancer, I'd come around yours and you could call me anything you wanted...you could even throw things at me.

Ideologies are usefull and fun. What works when you need it is even better.

Ax

ps. Thanks Tom. The funny thing is that I'm totally open to having my mind changed on the issue. I like principled decisions. I just like reality better. Change that reality and I'm there.

No, Alex, you retard, I wasn't arguing that your lists didn't exist, but that the meaning you apply to them is ridiculous. It's the same point I made two other times last night. Wikipedia, "Infant Mortality" (leads to U.S. News and World Report):

First, it's shaky ground to compare U.S. infant mortality with reports from other countries. The United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths. In Austria and Germany, fetal weight must be at least 500 grams (1 pound) to count as a live birth; in other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless. And some countries don't reliably register babies who die within the first 24 hours of birth. Thus, the United States is sure to report higher infant mortality rates. For this very reason, the Organization for Economic Cooperation and Development, which collects the European numbers, warns of head-to-head comparisons by country.

I would further add that socialist countries, and countries with socialist health care systems, have a great deal of incentive (bound up with a great deal of incompetence, and a great deal of lack of funding) to under report anything and everything that might be construed as reflecting negatively on the bureaucrats. In addition to the differing criteria for reporting live births, I instinctively distrust reporting coming out of the entities whose livelihood depends on those reports.

But all that is just to show what an idiot you are for using statistics you don't understand to push for a drastic overhaul of a huge system, the outcome of which you cannot foresee. Beyond all that, as a matter of principle, you do not have a right to health care out of my pocket. It doesn't matter if half the babies are dying. It doesn't matter if seventy five percent of them are dying. You don't get to come around, pointing your gun at my head because you need money to solve whatever it is you think your problem is. I would rather live in a free country that lagged slightly behind others in a set of arbitrary statistics, than have to listen to morons like you, or Klein, or Bush, or Obama, slavering over the disposition of my belongings.

Classic....err...I'm using information supplied by the CIA World FactBook for 2008. I know they don't have a brilliant reputation these days, but I prefer to give the CIA the benefit of the doubt. I've only met one spook in my life and he was a very smart and dedicated civil servant.

BTW I'm a generally a Conservative voter. But even I can see that it's not a good thing to have a significant portion of citizens without access to health. I mean Haiti isn't exactly thriving. Fuck the compassion, think of yourselves and sort out your health system.

The pub calls.

Ax

The CIA world fact book uses the numbers provided by those countries. There isn't any realistic way to extract what the numbers would be if every country used the same methods across the board.

Every US citizen has access to health care. If they lack insurance, they may not get quite the same quality of care, but they do get treated for major problems via emergency care. I am not claiming the current system is good, mind you. I could pursue this further, but I really only brought it up to derail your appeal to emotion.

As far as "..citizens have decided to use their combined bargaining power" goes, it's not accurate. SOME citizens made that choice. They aren't bargaining, they are taking cash by force from the minority who disagrees. The supporters of public health care don't just want to spend their money. If they did, I would have no complaint. But they want to spend mine as well. I will concede that democracy is better than many of the alternatives, but that doesn't actually make it ethical.

"The pub calls."

... sez Alex, demonstrating why the UK lags so far behind the U.S. in worker productivity, while at the same time contributing (albeit slightly, and depending on how much he drinks) to an overall decline in health in his country.

"My point was a capitalist society benefits by having healthy productive members rather than sick, bankrupt members."

Drink enough, Alex, and you'll be sick and bankrupt. Which, of course, is your business, but you look a hypocrite for not conducting your life for the "benefit" of your "society".

Just sayin'.

Alex: you're using the statement "it's better to be well than sick" as an argument for interventionism.

It's also better to be strong than weak. What's next: mandatory exercise classes?

That's just dumb.

I didn't call you any of those things...I was just noting that *everybody* works better well than sick.

Mike seems to be one of those people who engage in Frankfurtian bullshit. In fact, it is easily determined that differential definitions of live births have a negligible effect on life expectancy. Let me quote myself:

I've tried to post this at least five times now in refutation to Mankiw's piece. I pointed out that health professionals should probably be the authorities cited for health statistics. Here are the life tables from WHO:

http://www.who.int/whosis/database/life_tables/life_tables.cfm

They make it very easy to make at least rough corrections for some of the claims here. For instance, the claim that what is recorded as infant mortality skews the statistics in different countries. Looking at the tables for the U.S. vs Canada we see that life expectancy after the first year (I used the years 1-4 row), we see that this figure is 77.4 years for the U.S. vs 79.9 for Canada. So the differential metric theory doesn't seem to hold here. Let's look at the life expectancies from 30 years and on to get past the years when so many young men presumably meet untimely violent deaths. There we see (in the 30-34) row that from this point on, the life expectancy in the U.S. is 49.3 years vs 51.4 years for Canada.

"Here are the life tables from WHO"

Fascinating, to be sure, and you're a brave person for trying "five times" to bring that to everyone's attention... can everyone give ScentOfViolets a big {{{{hug}}}}. There.

Unfortunately, WHO forgot to run a banner across the top of each page saying, "See! See! Socialist Health Care makes you live longer", BUT, even if they had, and EVEN IF THEY COULD PROVE THE CLAIM (which neither you nor they can do), it still wouldn't justify throwing the weight of almighty government upon another seventh or so of the economy, even if the government has already encroached almost fifty percent into that fourteen percent (like the U.S. government has.)

First, collectivism, under any of its various noxious guises, isn't right simply for the fact that it violates those little, tiny things called freedom, individual rights, and personal responsibility.

Second, socialism doesn't, and indeed, can't, work in the long run. Look at Alex, there. I nearly made the point earlier: If he's going to manage to force me to pay for his health care, then sooner or later I'm going to manage to force him to stay home from the pubs. And indeed, that's the fight that's been shaping up in jolly old socialist England of late:

The U.K. government proposed a ban on “happy hour” at bars and organized pub crawls in an effort to curb excessive drinking.

All that drinking affects the health care stats, don't you know, and costs the innocent tea-totalling taxpayer an exhorbitant amount. Likewise ciggies. Likewise lots of things, and we'll get around to all of them eventually.

Like: People who drive too fast should be jailed, permanently, because, they, too, you know, kill and maim quite excessively, and are a cost to society, what with all their carbon emissions. And littering. And the leather in their car seats.

And: People in general just aren't taking care of themselves properly, and therefore, only nutritious food, as approved by the appropriate ministry, will be allowed, at home and out at restaurant.

Suck it up: It's no longer about you. It's about those little numbers in the WHO life tables that you so thoughtfully made the bedrock of your life policy.

And then, after that, the whole thing collapses into one of those nasty little spells of barbarism, because at some point, even after I've locked Alex up because he just won't take care of himself, I'm going to get tired of paying the guards to watch him, and I'm going to quit working and paying the taxes that make all the little socialist schemes possible.

One of those spells is on its way, now. Government is driving it. And you're standing there barfing up the government's nostrums, and probably not getting ready to dodge the chunks of beautiful edifice that are about to come crashing down around and upon you.

Mike, I've read your last few posts and am honestly trying to understand what you are trying to say. I find that I have a few questions for you.

First, do you think a government has the right to tell its citizens (both human and corporate) what they can or cannot do?

Second, what role, if any, do you think government has in our society?

Third, if members of our society disagree on the rules governing our society, how do you think we as a society should decide on those rules? We can happily rant and quote statistics at one another until we are blue in the face. At the end of the day, decisions have to be made. How do YOU think that we as a society should make those decisions?

I'm not Mike and I'm not speaking for him, but you can have my answers. Tom:

do you think a government has the right to tell its citizens (both human and corporate) what they can or cannot do?

Governments don't have rights. Individuals do.

Start there.

Second, what role, if any, do you think government has in our society?

It meddles, disturbs and distorts things.

Third, if members of our society disagree on the rules governing our society, how do you think we as a society should decide on those rules?

Make whatever plans and rules you wish, but leave me out of it, and keep your hands off my stuff unless you are polite enough to ask for my agreement, and persuasive enough that I agree to cooperate with you.

There's no way the ethics of anything I've just written changes because more people become involved, Tom. Ethics is not a numbers game.

Sorry Ron. I misunderstood you.

Phlinn, Good point regarding the ethics of individual choice. Your US system is even better protected with your division of powers than the Parliamentary system to fight against the Tyranny of the Masses. As Churchill said "democracy is the worst form of government...except all the others that have been tried."

Mike, you seem to think the gov't isn't already intervening with your health. They supply huge subsidies to Corn producers who need to find something to do with all that cheap corn syrup that ends up in all your processed food. It has a hugely detrimental effect on your obesity problem. Maybe if the gov't was responsible for paying the cost of their own political meddling, instead of continuing the fiction that individuals are soley responsible, they'd stop poisoning their own populace.

You are afraid of gov't intervention in health care, but it's okay for them to pay for the police, military, infrastructure, and now finance systems. And the subsidies to various business sectors is incredible. The one area you've decided to draw a line in the sand is taking care of your and everyone else's basic medical needs.

I added to this thread, because as someone who's had direct experience of the systems being discussed I thought I could add a bit of insight. I want people to pay less, live longer, more productive lives. Even you Mike. In return, you've called me a retard and a liar. If anyone needs to spend an evening in the pub with friends, it's you. Your blood pressure needs looking at by a trained professional. You made some interesting points, but wrapped them in bile.

Tom: What Ron said.

Alex...

"Mike, you seem to think the gov't isn't already intervening with your health."

Maybe you should lay off the booze. Last night, me: "[I]t still wouldn't justify throwing the weight of almighty government upon another seventh or so of the economy, even if the government has already encroached almost fifty percent into that fourteen percent (like the U.S. government has.)"

Most of the "crisis" in the U.S. health care system is a direct result of government meddling and involvement. The state, at its various levels, now accounts for approx 50% of health care spending, with the state regulator's and overseer's utensils stuck up deep in the rest of it. The more the gov't involves itself, the greater the "crisis" will get, along with "the need for something to be done", alá the housing industry, alá the auto industry, alá the energy sector.

"They supply huge subsidies to Corn producers [...]"

They should stop.

"You are afraid of gov't intervention in health care, but it's okay for them to pay for the police, military, infrastructure, and now finance systems. And the subsidies to various business sectors is incredible. The one area you've decided to draw a line in the sand is taking care of your and everyone else's basic medical needs."

You're lying, again. You're making it up. Cite me saying what you claim, or retract it.

"I want people to pay less, live longer, more productive lives. Even you Mike. In return, you've called me a retard and a liar. If anyone needs to spend an evening in the pub with friends, it's you. Your blood pressure needs looking at by a trained professional. You made some interesting points, but wrapped them in bile."

You've heartily endorsed socialism, Alex, the abridgement of my and other's freedom. Implicit in your endorsement of socialized medicine is the endorsement of the government's necessary force to bring it about. If I refuse to comply with the government's schemes, I'll risk impoverishment or incarceration. If I go so far as to oppose the government's efforts to punish me for refusing to comply, I'll likely wind up dead. And you want to feel offended because I call you a retard, an idiot, and a liar? Would you feel better if I kept the pointed assessments to myself, and instead sent the threat of force back in your direction, the same force that you so stupidly and cavalierly endorse against me? Who should feel insulted here, Alex? You, in your breezy, incompetent, useful tool-ness, or me and everyone else watching the government get ready to cock another gun behind the blank smiley-faced endorsement of your ignorance? Where's the real insult, Alex? The insult to my freedoms, or the insult to a pride you don't deserve?

As we already knew, Mike is just pushing Frankfurtian bullshit. Here was the original post I was responding too:

Infant mortality"

You are confused, mistaken, or lying, Alex. You could look it up, on Wikipedia, for instance. You're pushing misinformation for the sake of a political goal. What's that called, Alex? And you're not even good at it, but then, the heart of socialism is incompetence.

Too which I replied with evidence showing that differing definitions of infant mortality simply don't explain the numbers (probably for the good and sufficient reason that the difference in the definitions don't make much difference in the numbers.) What does Mike say? Absent the boring and completely unoriginal and unnecessary abuse that is.

Unfortunately, WHO forgot to run a banner across the top of each page saying, "See! See! Socialist Health Care makes you live longer", BUT, even if they had, and EVEN IF THEY COULD PROVE THE CLAIM (which neither you nor they can do), it still wouldn't justify throwing the weight of almighty government upon another seventh or so of the economy, even if the government has already encroached almost fifty percent into that fourteen percent (like the U.S. government has.)

Iow, Mike could care less that his original claim was wrong. He really didn't know what the numbers were, and he made no effort to find out. His little diatribe against Alex was based upon . . . nothing. As I said, Frankfurtian bullshit

For this reason, telling lies does not tend to unfit a person for telling the truth in the same way that bullshitting tends to. ...The bullshitter ignores these demands altogether. He does not reject the authority of the truth, as the liar does, and oppose himself to it. He pays no attention to it at all. By virtue of this, bullshit is a greater enemy of the truth than lies are.

Mike, a suggestion. If that was your take from the beginning, that the numbers don't matter, then don't act as if they do, and then completely dismiss them when they go against you. Just go with your 'socialism bad' rant so we know to scroll by.

Give her another hug:

"Too which I replied with evidence showing that differing definitions of infant mortality simply don't explain the numbers (probably [...])"

You gave a link to some WHO tables, which are built of extrapolations, i.e., not consistent rigorous data, from many sources. Even you can only say "probably".

Furthermore, "differing definitions" was only one of at least three factors I named as calling into question the idiotic attempt at turning data tables into a referendum on socialized medicine. I have stipulated that the tables all line up very prettily, and that the numbers in them are the best that governments of disparate competence can produce, but the people of England and Canada are not the people of the United States.

And even if the world was made up of a completely uniform, homogeneous population and the statistics as represented were accurate to several decimal places, you still don't have the right to point your gun at my head and command me to pay for your health care.

Get off it.

Give her another hug:

"Too which I replied with evidence showing that differing definitions of infant mortality simply don't explain the numbers (probably [...])"

You gave a link to some WHO tables, which are built of extrapolations, i.e., not consistent rigorous data, from many sources. Even you can only say "probably".

Uh-huh. If you dispute those figures, then come up with some of your own. Further, the 'probably' was part of a causal explanation, not anything to do with the figures themselves. Learn to read for comprehension. Now, you can either put up, or shut up.

Furthermore, "differing definitions" was only one of at least three factors I named as calling into question the idiotic attempt at turning data tables into a referendum on socialized medicine. I have stipulated that the tables all line up very prettily, and that the numbers in them are the best that governments of disparate competence can produce, but the people of England and Canada are not the people of the United States.

And even if the world was made up of a completely uniform, homogeneous population and the statistics as represented were accurate to several decimal places, you still don't have the right to point your gun at my head and command me to pay for your health care.

Get off it.

Posted by: Mike Soja

Iow, I was exactly right: you don't care if the figures are accurate or not, or if they support you or not. That was just an opportunity for you to be unpleasant to no good purpose. Quite apart from your obnoxiousness, your incompetence, and your general dimwittedness, it's considered very bad form to argue so dishonestly.

So thanks for being on the other team. I certainly don't want you on mine, even stipulating that it's on the side of angels.

Gosh Mike,

We're actually offering to pay for YOUR health care. It's a glass half full/half empty thing. Much like there being "no athiests in foxholes" there are "few libertarians in the cancer ward."

I wish you a long and healthy life.

Alex

{{{{{lobotomies}}}}}

"Iow, I was exactly right: you don't care if the figures are accurate or not, or if they support you or not."

No, drearie, I care very deeply about the accuracy of the figures, and am just as pleased as punch to have made their acquaintance. But they're still useless, in at least three ways, in discussions of socialist health care versus free market health care. (By the way, with respect to the latter, I thought this recent article was pretty okey dokey.)

First, the stats (forgive the locution here) don't even pretend to be a relative measure of health care system performance. The notions that that is what the numbers add up to are nothing less than the feeble flailings of insufficiently exercised minds. The numbers reflect snap shots of populations. The fact that illness and death are associated with health and health care is probably enough to confuse the average violet sniffer, but is, of and by itself, logically, insufficient to tie population data to one health care system or another. You can make all the inferences you want, but if you want to know specifically whether one system or another is responsible for the hundredths of percent differences teased out of the tables, you'll have to conduct specific long range studies to do it, and even then, you're facing a very tiny margin of error when looking at the "results" in yer industrialized nations.

Secondly, I don't know how many times it has to be said, but in addition to differences in the way different countries compile their data, the populations themselves are not directly comparable. Downtown Atlanta, USA is not downtown Birmingham, England. Los Angeles is not Toronto. Nebraska is not Nova Scotia. The top ten cities in the U.S. do not contain the same makeup of people as the top ten cities in the U.K. Rural America does not equal rural Canada, or even what's left of the rural UK. People in different countries eat differently, work differently, play differently, and choose to access their health care differently. There are major cultural and ethnic differences between the top three in our discussion. A complex interplay of all those and more ends up delivering different mortalities between populations, but again, that is the only thing you can know. You cannot wave your hand and say, "Socialist health care is better because Yorkshiremen live longer than West Virginia coal miners do." You're missing pertinent data with that, and you look a fool to be pretending that you're not.

Thirdly, the U.S. Constitution, for all its faults, does not say, "Whenceforth hie thee health care stats to make chagrinish all your morons, then must you cast your inalienable rights aside, and socialize, socialize, socialize." Nor would it be right if it did.

Now go pound something.

I'm pounding something right now: you. Poor Mikey, he has to pretend he can't remember what he just posted to imagine that he has a few scraps of dignity left.

No, Mikey, my figures refute the narrow claims made about about differing definitions infant mortality and life expectancy. Nothing more. You're completely discredited there. And I can happily repost where you said you didn't care if the figures were accurate:

And even if the world was made up of a completely uniform, homogeneous population and the statistics as represented were accurate to several decimal places, you still don't have the right to point your gun at my head and command me to pay for your health care.

Take you twentieth-C dreck opinions by soundbite elsewhere, dimwit. Speaking as someone who does close reasoning on 'facts and figures' for a living, you're a complete fraud.

"We're actually offering to pay for YOUR health care."

Ah, when your appeals to reason are almost wholly lacking in persuasiveness, and flattery fails (maybe you forgot to try flattery), then go for the bribe.

You're Farcical, Alex, with a capital F.

"No, Mikey, my figures refute the narrow claims made about about differing definitions infant mortality and life expectancy."

I must have missed the part where the WHO controlled for crack babies, obese suburbanite teens delivering underweight early term babies, etc. Could you post that again, please?

ps. I didn't really see where the WHO somehow managed to normalize data collection procedures across countries, either. I think they just massaged the data that was delivered up higgly piggly out of disparate regimes. Maybe you could present a nice rundown of what they did.

And, say, at what hundredth of a percent datapoint swing do you drop the hammer on socialism? I have a feeling the stats don't mean squat to you, either.

Mike, I flattered you by paying any attention to you in the first place.

You aren't open to persuasion or reason because you think that any stats which don't fit your narrow world view are the result of incompetence or fraud. A huge insult to thousands of hard working professionals.

"I must have missed the part where the WHO controlled for crack babies, obese suburbanite teens delivering underweight early term babies, etc." - Suddently it becomes clear. It's not so called "socialism" that you hold in contempt. It's your fellow citizens. I pity you.

pps. Laugh. Freedom, inalienable rights, personal responsibility: Just so much "twentieth-C dreck".

Your lives are not your own, now, folks. They belong to a happy face (with violet smells) holding a clipboard, calculating what your life is worth, and charging you for the immense trouble of it.

Me:

"I must have missed the part where the WHO controlled for crack babies, obese suburbanite teens delivering underweight early term babies, etc."

Violet Smells

"Suddently it becomes clear. It's not so called 'socialism' that you hold in contempt. It's your fellow citizens. I pity you."

Well, that's fairly nuts. I pointed out a couple of categories that might skew the U.S. stats. Do you deny the categories exist? Are you seriously contending that ethnic and cultural difference between countries, matter less than how the doctor gets paid?

In fact, Mikey, if you had actually bothered to look at the stats, you would have seen that the life expectancy for persons less than one year of age is 80.6 years in Canada vs 78.5 years in the U.S., and that the life expectancy for persons 1-4 years of age is 80 years for Canada vs 78.5 years for the U.S. Iow, in the first year of life, the difference in life expectancies between the two countries is about five weeks. Which in turn means (looking at the live births per 1,000 stat) that the differences in infant mortality are not explained by the different definitions of live births used by the two countries(though it may explain a rather small percentage of the difference.) That is, the claim that the difference in infant mortality is because of differing definitions of live births is just so much hokum, and that is the claim I was addressing.

But, as I've already noted, you're not a numbers sort of guy, you're not making even the briefest of exertions to convince us that you are. You're just a rum-dum low-IQ hack who loves to go off on 'liberal' for being 'stupid/dishonest', but who is, in reality, a rather stupid, rather lazy, rather dishonest git.

'Nuff said.

"In fact, Mikey, if you had actually bothered to look at the stats, you would have seen that the life expectancy for persons less than one year of age is 80.6 years in Canada vs 78.5 years in the U.S., and that the life expectancy for persons 1-4 years of age is 80 years for Canada vs 78.5 [sic] years for the U.S. Iow, in the first year of life, the difference in life expectancies between the two countries is about five weeks. Which in turn means (looking at the live births per 1,000 stat) that the differences in infant mortality are not explained by the different definitions of live births used by the two countries(though it may explain a rather small percentage of the difference.) That is, the claim that the difference in infant mortality is because of differing definitions of live births is just so much hokum, and that is the claim I was addressing."

All you're showing is that the numbers are internally consistent. The WHO sez:

The reliability of the neonatal mortality estimates depends on accuracy and completeness of reporting and recording of births and deaths. Underreporting and misclassification are common, especially for deaths occurring early on in life.

Perinatal mortality, defined as number of stillbirths and deaths in the first week of life per 1,000 live births, is a useful additional indicator, and work is ongoing to improve estimates of stillbirth rates, a major component of perinatal mortality.

Also, you admit that data factors might "explain a rather small percentage of the difference", so all you have to do now is cross that with the demographics and lifestyles that I mentioned at the same time, and you can run along and pretend you know something.

if you had actually bothered to look at the stats, you would have seen that the life expectancy for persons less than one year of age is 80.6 years in Canada vs 78.5 years in the U.S., and that the life expectancy for persons 1-4 years of age is 80 years for Canada vs 78.5 years for the U.S. Iow, in the first year of life, the difference in life expectancies between the two countries is about five weeks.

You say the difference between 80.6 and 78.5 years (or 80 and 78.5 years) is 5 *weeks*???

And you claim knowledge about doing close reasoning on 'facts and figures' for a living???

Sorry, that last post (December 6, 2008 6:00 PM) was me.

I don't post anonymously. I stand by what I say enough to put it out there under my real, and full, name.

Anonymous, she's got a typo in there for the last figure, but I understand what she means, i.e., a tenth of a year = five weeks. But it stills says nothing about how consistently different provinces in Canada (or even states in the U.S.) record and report their data.

Mike, that's fair enough...

...but none of the "fun with numbers" (still) addresses the morality of what they're trying to put over on people. They're still, like I said earlier, "cannibals at the pot playing statistics like dice".

You say the difference between 80.6 and 78.5 years (or 80 and 78.5 years) is 5 *weeks*???

And you claim knowledge about doing close reasoning on 'facts and figures' for a living???

Posted by: Anonymous

Sigh. No. The difference between the life expectancies of those less than one year old as opposed to those four and over is 80.6-80=0.6 years. Similarly, in the U.S., the difference is 78.5-78=0.5 years. So the differences in the first year amount to 0.6-0.5=0.1 years, or about five weeks. Thus, any difference in reportages of infant mortality can only account for _at_most_ five weeks, no matter what the causes. Iow, maybe the U.S. has a more stringent definition. But since this definition only makes a difference in perhaps one birth in twenty or fifty or one hundred, it can't influence the overall stats on infant mortality all that much.

This isn't rocket science; this is basic arithmetic. As an exercise, why don't you calculate how many extra infant mortalities the more exacting definition requires there must be to make up the entirety of this five week difference?

Sheesh. It's just not that hard, people.

why don't you calculate how many extra infant mortalities the more exacting definition requires there must be to make up the entirety of this five week difference?

Because I'm not a utilitarian or pragmatist. Instead, why don't *you* address the morality of the cannibals at the pot instead of playing the stats like dice?

Since I'm only making the narrow point that differences in definitions can only account for a small percentage of the excess mortality rate in the U.S., I fail to see what morality has to do with it. I'm also guessing this calculation - which is again only elementary arithmetic, we're only going for an upper bound, after all - is completely beyond you. I guess the fact that I _can_ do this sort of arithmetic makes me some sort of 'liberal' in your eyes. Which is confusing, given how you and people like you just love to go on at length about how 'liberals' just can't seem to do any of that hard science stuff.

I've long since given up wondering why events like this doesn't cause your mental processes to just seize up.

I guess the fact that I _can_ do this sort of arithmetic makes me some sort of 'liberal' in your eyes

No, it makes you a better, more experienced mathematician than me is all.

That said, I *can* handle the ethical questions, and I can do that well.

Which is confusing, given how you and people like you just love to go on at length about how 'liberals' just can't seem to do any of that hard science stuff

Didn't say anything of the sort. If you think I did, cite that.

...and this from me "And you claim knowledge about doing close reasoning on 'facts and figures' for a living???" was uncalled for when I wrote it.

It was *my* misunderstanding, and I apologize.

December 7, 2008 5:14 AM was me.

Mike said:

"... you still don't have the right to point your gun at my head and command me to pay for your health care."

Are you not paying taxes for Medicare and Medicaid?

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