Renovated Hall of Presidents previewed by passholders at Magic Kingdom

Hehe... you think another system is ideal. That may be true, but I appreciate the way you tossed that in there. :)

I meant more costly than any system that has no accountability. And all I mean to say by that is that before the entire bath water is thrown out, is it worth while to take a look and make sure there are no valuable babies in there?

The system we have now was deemed to be a solid plan at one point. Who thought so? Why was that? What exactly is broken about it? Are those issues not surmountable by addressing them directly? Does the new proposed system have any potential issues of its own?

Those are all questions I would want to understand through and through before I took any action on restructuring the process.

I am eerily reminded of our discussions about the US auto industry over and over again. The idea that "leave it alone unless you can devise a perfect system" baffles me. It's almost unfathomable that we could come across something better, but decline to adopt since perfection isn't within reach.

Certainly the Canadian system isn't the only model available, and I vaguely recall a TV program where some country (I'm thinking it was a middle-east oil-rich nation) thoroughly investiagted a wide array of national health care systems, along with the U.S. "system", then did a pick-and-choose among the options to devise and implement something that worked as a sort of patchwork philosophy.

Well, I know I didn't say leave it alone unless you can devise a perfect system. I'm saying do we really know what the problem is and that the change proposed will solve it without just shifting it to another area? That's important.

It was said earlier that the issue of waiting longer for care (that was illustrated in the article about Canada's system) was only due to the fact that there aren't enough doctors in their system. I understood from reading the article, that the actual reason is that there aren't enough doctors willing to practice in rural areas. The majority go to the urban areas where I presume they make the most money. So depending on where I live, I either wait for care or I travel to receive it, assuming I can do either.

I can't see how we get around this profitability issue with the doctors. And it's a legitimate question. Can someone address that?

^LOL, the five minutes between our posts....wasn't enough time for me to know you had posted. My typing, untyping, retyping meant your post directly above mine wasn't even there to respond to when I first clicked reply. I'm more responding to the argument of "it ain't broke enough to bother tinkering with". Now that I think of it more, maybe I am arguing with both you and Gonch. Separately. Or maybe not. I'll have to do more research and decide. Hehehe.... :)

Oh, my *issues* with the current system are: there are vast numbers of people using ERs instead of primary care physicians; "indigent care" dominates the books at too many hospitals; a minimum of 30% of the cost of care is to pay people like me who relentlessly bill Medicaid and insurers so that we can get claims and then bill the next possible payer (who in the end turns out to be just ANOTHER branch of Uncle Sam, because private insurance isn't really held accountable); there is roughly 2.5-3% of our healthcare budget going to Public Health (prevention, that kind of thing); media-friendly diseases get FAR too much of the research funding; end-of-life desperation measures eat up an enormously disprportionate amount of our healthcare dollar; there's almost no focus whatsoever on wellness and primary prevention; anti-smoking campaigns, so effective they reduced teen smoking to LOW levels, still get large amounts of funding (because of proven effectiveness) even though childhood and adolescent obesity are clearly going to present more future health problems at this point; many employers (like WalMart) do not provide insurance coverage for a majority of their workers; federal oversight of our food safety has clearly taken a dive (peanuts, anyone?)...meh, it's a START.... ;)

There's always going to be that issue, though. Right now the insurance companies make those decisions, and there are a plethora of stories about how they screw it up.

I'm not saying the system you are speaking of is the ideal one, but all things being equal, I'd rather have the decision made by someone who took the hippocratic oath.

Awesome, Gator. :)

kpjb said:
There's always going to be that issue, though.

Wait, you can't make that your point. That was my point. ;)

If that's always a concern, what do we gain in the fix? Is it more than what we lose? That's where I question that perhaps some accountability would be beneficial to helping the problem we have with the system we have now.

...but all things being equal,...

All things aren't equal. That's the problem. I'm not sure that all things will ever be equal.

kpjb said:
I'm not saying the system you are speaking of is the ideal one, but all things being equal, I'd rather have the decision made by someone who took the hippocratic oath.

That was going to be my next point. Well done.

With all of those doctors taking the hippocratic oath, how come so many people who don't have health insurance get turned away from the care they need? Weird.

And no one has still addressed my question - the value factor. It's not about what care is given, it's about what care is worth the cost. If cost weren't an issue, we'd all have care and have any old test or procedure done that we wanted at will.

Who has the final say on the 'importance of care' to 'cost of care' ratio?

Because if it's the doctors, then I think we're just back at square one. How does a system work where the doctors have all the say, yet somehow we're all magically covered and it doesn't cost more for all of us?

It's going to continue to cost more for all of us, medical/health costs have been going up 3-4 times the rate of inflation for at least the last decade. The value proposition is another question entirely.

I'm compelled to think that for financial costs alone (negating all human costs from the equation), providing basic health care such as immunizations or check-ups or prenatal care, etc., would more than offset the dollar cost to taxpayers by providing these services proactively rather than having taxpayers foot the bill later when sick people in poverty flood the ERs because of a failure to have disease prevented/detected early, lack of medication and/or the ability to use it appropriately for whatever reason, etc.

Then you're "stuck providing that expensive end-of-life treatment" for someone who maybe was never as productive for society as they might have been had those basic human needs been met. Strictly for society's gain, mind you. ;)

edited for your viewing pleasure... ;)

rollergator said:
It's going to continue to cost more for all of us, medical/health costs have been going up 3-4 times the rate of inflation for at least the last decade.

Then maybe I should have said, "...without it costing even more." :)

I'm compelled to think that for financial costs alone (negating all human costs from the equation)...

But that's just it. Everyone's ideas so far always have that little catch of ignoring part of the equation. Everyone's angle always assumes , "...everything else is right with the system so here's why X works."

I'm just not necessary convinced there'a a universal plan that, when all factors are considered, is better than what we're doing now. It seems everyone has a way to improve one aspect, but at the degredation (or ignoring) of other aspects.

If the goal is simply health care available for all regardless of the quality, efficiency or cost of the system....well, that's what we have right now...at least in your example where anyone can hit up the ER for issues.

And I get that what you're proposing is that we care for these people before that and hopefully in the long run the cost of caring for them sooner is less than the cost of caring for them later. I'm not sure I agree with that. What we save in costs we potentially lose in timeliness or quality as there are suddenly millions more people proactively taking the finite available time of the health care professionals.

If we're just going to 'adjust the sliders' and raise one while lowering another, then I'm not sure there's a better combination of settings then what we have. (yes, this is zero-sum thinking, but no one has offered anything else)

I *am* offering something else....a better outcome for everyone, the individual and society. Simply by investing in a healthier, more productive populace. Businesses get lower premiums, people live longer and have longer work-lives, make more money over their lifespan, pay more taxes. I can't see where anyone loses...it's just primary prevention, it sure isn't rocket surgery (or socialism, whatever the heck that means these days, LOL).

But to do that would surely cost more money and put additional burden on the system. There's a tradeoff...and I'm just not convinced the new positives outweigh the new negatives.

I know its an absurdly simple point, but does it mean anything that the WHO ranks Canada's health care system as better than the US's (PDF)? And while the WHO's study has generated expected criticism, those critics have been answered by a peer-reviewed medical journal:

We identified 38 studies comparing populations of patients in Canadaand the United States. Studies addressed diverse problems, includingcancer, coronary artery disease, chronic medical illnesses and surgicalprocedures. Of 10 studies that included extensive statisticaladjustment and enrolled broad populations, 5 favoured Canada, 2favoured the United States, and 3 showed equivalent or mixed results.Of 28 studies that failed one of these criteria, 9 favoured Canada, 3favoured the United States, and 16 showed equivalent or mixed results.Overall, results for mortality favoured Canada (relative risk 0.95, 95%confidence interval 0.92-0.98, p= 0.002) but were very heterogeneous,and we failed to find convincing explanations for this heterogeneity.The only condition in which results consistently favoured one countrywas end-stage renal disease, in which Canadian patients fared better.

So, while the results are not surprisingly somewhat mixed, the system in Canada quite clearly is at least as good as that in the US. Its actually better, but knowing that its at least as good, yet costs less, should be enough for even the most staunch opposition, right? I mean, if we're not going to rely on quantitative analysis, what's the correct measure?

That's not even close to being a solid quantitative analysis of the issue.

The only condition in which results consistently favoured one country was end-stage renal disease, in which Canadian patients fared better.

It's not the part that was bolded in your quote, but I think it sums up that study pretty well.

I'm not saying one system is better than the other. I'm really just asking for someone to explain how Canada's or another system is better. That is, without stating again that it's because we love people and the grass is greener on the other side of the border. ;)

I know it's been said it would cost less. I'm not convinced of that, though, because cost isn't fixed when it comes to health care. It very much depends on the choices made for care. So how can the system be changed without opening the door to a change in the way that choices/decisions are made about care?

Carrie M. said:
That's not even close to being a solid quantitative analysis of the issue.

How is it not? And if its not, what would be? Are we refusing to believe studies because we're not convinced they're 110% infallible?

I'm not saying one system is better than the other. I'm really just asking for someone to explain how Canada's or another system is better.

Canada's system is as good or better than the US's because:

It costs less per person.

It has significantly lower overhead.

People receive equally good health care.

People live longer there.

I know it's been said it would cost less. I'm not convinced of that, though, because cost isn't fixed when it comes to health care.

You're not convinced, even though people receive similar care there and pay less for it? What am I missing?

rollergator said:
I *am* offering something else....a better outcome for everyone, the individual and society. Simply by investing in a healthier, more productive populace. Businesses get lower premiums, people live longer and have longer work-lives, make more money over their lifespan, pay more taxes. I can't see where anyone loses...it's just primary prevention, it sure isn't rocket surgery (or socialism, whatever the heck that means these days, LOL).

Aren't some insurance companies and businesses already trying to lower costs by promoting a better lifestyle and wellness? For example, the company I work for, our insurance will pay a portion of a gym membership. Other businesses I've been to have been doing the "biggest loser" contest. I don't know the exact details but I'd imagine that insurance companies would lower premiums when covering a group of employees that practice a better lifestyle.

It isn't the end all be all solution, but I have seen a trend where wellness and prevention is being pushed. Which is something that I don't see much of a difference in whether we have universal health or not.

My biggest issue is the cost of the system. This will do nothing to help our current financial status. In fact it's projected that another $1 - $2 trillion of debt would be added by 2020 just by health care costs alone. Now with Gonch's concern over the level of care everyone would get I would wonder if this solution would be worth it.

I'm still in the boat that something needs to be changed with our health care system, but I don't think something this costly is it.

djDaemon said:How is it not? And if its not, what would be? Are we refusing to believe studies because we're not convinced they're 110% infallible?

Because it doesn't explain all of the parameters of the study. It was a summation that didn't offer the detail of how cases were chosen, what variables were included, and whether a similar test would provide similar results.

What would be more convincing is a study that includes all of that information. If this one did, that data was not provided.

No, 110% is not possible. But there is a % of statistical relevance that would make a study more reliable.

Canada's system is as good or better than the US's because:

It costs less per person.

It has significantly lower overhead.

People receive equally good health care.

People live longer there.

Costs less per person based on what comparison? We can't even get a reasonable cost per person assessment for people seeking care within one system. If you and I had the same ailment, it is quite possible the cost to treat it will be different for both of us.

You're not convinced, even though people receive similar care there and pay less for it? What am I missing?

You missed the very next sentence in my quote, apparently. I am not convinced because cost is very much dependent on the decisions made for care. When we change who makes the decisions for the course of treatment in our system, do you really think there won't be a change in both the cost and the courses of care?

Carrie M. said:

Because it doesn't explain all of the parameters of the study. It was a summation that didn't offer the detail of how cases were chosen, what variables were included, and whether a similar test would provide similar results.

It doesn't?

Interested readers can obtain the detailed protocol for this reviewfrom the corresponding author. In brief, the formal search includedpapers and abstracts published up to the end of 2002. The process wasstandard for systematic reviews: definition of eligibility criteria; abroad search identifying possibly eligible titles and abstracts;selection of titles and abstracts that might possibly be eligible;selection of eligible reports from review of full documents; andabstraction of descriptive information, validity, and outcome data.

Eligibility Criteria
We included published and unpublished prospective or retrospectiveobservational studies comparing health outcomes (mortality ormorbidity) in Canada and the United States for patients of any age withthe same diagnosis. We excluded randomized trials, studies thatidentified the patients on the basis of the occurrence of one of theadverse health outcomes of interest, and national disease-specificmortality studies that failed to define the population at risk (thatis, those with the disease of interest). For instance, we excludedstudies of national rates of death from cancers because lower mortalitymay be due either to a lower incidence of cancer or to better care forthose with the disease.

The review process required many methodological decisions not fullyanticipated in the initial protocol. These included issues regardingeligibility. For instance, we considered whether or not to considerlow-birth-weight a disease. We decided not to do so because it has awide variety of social and medical causes with associated differencesin prognosis. On the other hand, we decided to include studies of theoutcomes of pregnancy because we considered that prenatal andobstetrical care were potentially important types of care that we couldlegitimately assess. We discussed whether to include studies thatevaluated critically ill patients with an array of diagnoses. Wedecided to do so on the basis that acute illness severity scores arevery powerful predictors of outcome across a range of critically illpopulations.

Only members of our team who were both blinded to the results of thestudies in question and had expertise in the clinical issue at handparticipated in these decisions.

Sorry for the absurdly long quote.

The study then goes on to explain how it identified, screened and selected the studies.

What would be more convincing is a study that includes all of that information. If this one did, that data was not provided.

I'm not sure exactly what you're looking for, but I get the impression you're sort of nit-picking here. Of course, its more likely that I'm missing something, as your analyses are always pretty spot-on.

No, 110% is not possible. But there is a % of statistical relevance that would make a study more reliable.

Its been a long time since my last stats class. What does the "confidence interval" refer to? The CI for this study is given as 95%

Costs less per person based on what comparison? We can't even get a reasonable cost per person assessment for people seeking care within one system. If you and I had the same ailment, it is quite possible the cost to treat it will be different for both of us.

Well, most of what I come across lists the US as spending 15% GDP on health care, per capita, while Canada spends 10%. I've yet to see anything that suggests the opposite is true. So, unless we're to assume that Canadians are a different species and as such are subject to completely different ailments, is this not a relatively accurate comparison?

You missed the very next sentence in my quote, apparently. I am not convinced because cost is very much dependent on the decisions made for care. When we change who makes the decisions for the course of treatment in our system, do you really think there won't be a change in both the cost and the courses of care?

Why do you assume that there will be negative outcomes in both cost and course, when Canada has shown neither to be true?

HeyIsntThatRob? said:

rollergator said:I *am* offering something else....a better outcome for everyone, the individual and society. Simply by investing in a healthier, more productive populace. Businesses get lower premiums, people live longer and have longer work-lives, make more money over their lifespan, pay more taxes. I can't see where anyone loses...it's just primary prevention, it sure isn't rocket surgery (or socialism, whatever the heck that means these days, LOL).

Aren't some insurance companies and businesses already trying to lower costs by promoting a better lifestyle and wellness? For example, the company I work for, our insurance will pay a portion of a gym membership. Other businesses I've been to have been doing the "biggest loser" contest. I don't know the exact details but I'd imagine that insurance companies would lower premiums when covering a group of employees that practice a better lifestyle.

So here's what I don't understand - if businesses and insurance companies are "pushing wellness", are we supposed to believe it's out of the goodness of their hearts? It's not. They're doing it because it saves them money in the longer term - ROI, baby. So much so that even after adjusting for the "time value of money" (i.e., interest accruals), it still is cheaper to pay now for health rather than to pay later for illness/disease. If businesses have come to recognize that wellness is cheaper, shouldn't our government (eventually) come to the same realization?

edited to add: Confidence Interval refers to the idea that x% of the time (almost always 95%), data points will fall within the range of values given. So if you get both highest and lowest values of less than one with a 95% confidence interval, your hypothesis is in all likelihood spot-on.