Renovated Hall of Presidents previewed by passholders at Magic Kingdom

We interrupt this conversation on economics and statistics to point out that Yesterland has added the "George W. Bush" version of the Presidents show, including a complete transcript of GWB's speech in the attraction. Worth a look:

http://www.yesterland.com/presidents.html

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

That makes no sense. For it to matter you'd have to compare Canada before and after and show the benefits of the system being implemented and then show how the same would work here. You can't just say, "Canada has shown neither to be true." - they've shown neither to be true compared to what?

Anyone want to dig up real unbiased numbers on the before and after of Canadian health care? It'd be a start.

This concerns me:

In the US as of August 2008 - Average ER wait time nears 1 hour

"The average time that hospital emergency rooms patients wait to see a doctor has grown from about 38 minutes to almost an hour over the past decade, according to new federal statistics released yesterday."

While in Canada as of June 2009 - Health wait times require action now, docs say

"Patients are also facing long delays when they go the emergency department, the WTA said, waiting an average of nine hours to be seen and treated and for patients who needed to be admitted, the average wait time was nearly 24 hours."

And I never even mentioned Aunt Betty's 14 month wait. :)

The second article also mentions:

"-For cancer patients, the study found that the median wait time for radiation therapy was almost seven weeks...

-Patients with major depression are waiting almost six weeks to start treatment with a psychiatrist."

No sir, I don't like it.

rollergator said:
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.

Cool the results are solid. But what do the results say again?

Overall, results for mortality favoured Canada but were very heterogeneous,and we failed to find convincing explanations for this heterogeneity.The only condition in which results consistently favoured one country was end-stage renal disease, in which Canadian patients fared better.

That's not real convincing. That's one step shy of sheepishly saying, "Ummmmm, it was kinda better."

5 favoured Canada, 2 favoured the United States, and 3 showed equivalent or mixed results.

And this 50/50 split in the "Canda's system is better" trial doesn't exactly inspire the need for change either.

And if I include the other part of that:

Of 28 studies that failed one of these criteria, 9 favoured Canada, 3favoured the United States, and 16 showed equivalent or mixed results.

I'm even less enamoured by the 32% win rate.

All that study says to me is that the Canadian system isn't markedly better than the US's.

I just don't understand how it's possible to slip millions and millions of uncovered people into the system and not have it cost more or create burden in the short term. Or not radically change what care we get in the long term. I keep coming back to one idea - I'm just not convinced the new positives outweigh the new negatives.

Lord Gonchar said:

That makes no sense. For it to matter you'd have to compare Canada before and after and show the benefits of the system being implemented and then show how the same would work here. You can't just say, "Canada has shown neither to be true." - they've shown neither to be true compared to what?

Fine - it makes no sense. At all. And as such, should be totally dismissed. Got it.

This concerns me...

I'll do you one better:

According to a report out this week, the average total waiting time ina U.S. emergency room in 2008 was four hours and three minutes, a27-minute increase in nationwide average wait times since 2002.

...

The recession is one chief reason for the increase, according to the American College of Emergency Physicians. In a survey in January of more than 1,700 emergency doctors, 66 percentsaid they'd seen an increase in the number of patients in theiremergency rooms over the preceding six months. Most of the physicians-- 83 percent -- reported seeing patients who'd lost their jobs andhealth insurance and delayed medical care.

"Some of these people come to the ER because they've been turned awayby their primary care physician, because they've lost their insurance,"said Dr. Angela Gardner, incoming president of the physicians group."Sometimes they've delayed care because they have no insurance and endup with a much more serious condition."

Interesting. :)

While in Canada...

By most accounts, Canada's wait times are a symptom of inadequate supply. Here in the US, we already have the supply, and our increasing demand is a result of a lack of universal health care.

The second article also mentions:

"-For cancer patients, the study found that the median wait time for radiation therapy was almost seven weeks...

-Patients with major depression are waiting almost six weeks to start treatment with a psychiatrist."

No sir, I don't like it.

Neither do I, because its a BS statistic. The median is NOT the arithmetic mean, and is pretty much useless in the way you're trying to present it. Let's assume there are 10 patients, 9 of which recieve their radiation therapy immediately, and the last person (perhaps because they're not in real danger) has to wait 14 weeks. That would give you a median time of 7 weeks, but its most certainly not indicative of a typical, or average, wait time, which would be 1.4 weeks. Ten days doesn't sound all that bad compared to 7 weeks.

Cool the results are solid. But what do the results say again?

...

That's not real convincing. That's one step shy of sheepishly saying, "Ummmmm, it was kinda better."

So? You keep ignoring that their system costs far less than ours, both in terms of operational costs (efficiency) and per capita costs.

5 favoured Canada, 2 favoured the United States, and 3 showed equivalent or mixed results.

And this 50/50 split in the "Canda's system is better" trial doesn't exactly inspire the need for change either.

That's not a 50/50 split. Its a 71.4/28.6 split, favoring Canada having the better system.

Of 28 studies that failed one of these criteria, 9 favoured Canada, 3favoured the United States, and 16 showed equivalent or mixed results.

I'm even less enamoured by the 32% win rate.

Try 75% - 9 of the 12 non-ties favor Canada.

I just don't understand how it's possible to slip millions and millions of uncovered people into the system and not have it cost more or create burden in the short term. Or not radically change what care we get in the long term. I keep coming back to one idea - I'm just not convinced the new positives outweigh the new negatives.

Perhaps if you stopped using "fuzzy math", it would be easier to convince you. :)

Dj, I have to confess. I completely missed the second link in your post. All I saw was the table of comparisons and the summary you quoted. I can completely see why you thought I was being ridiculous. :)

Having said that, though, I still say after looking over the study that I don't think it's a very solid statistical reference for deciding to adapt Canada's system over our own. There are just too many variables that weren't considered.

djDaemon said:

For instance, we excluded studies of national rates of death from cancers because lower mortality may be due either to a lower incidence of cancer or to better care for those with the disease.

This one causes me to scratch my head. Cancer is a very expensive disease to treat and to screen for in terms of preventative care. Leaving it out is problematic to me. Not to mention the latter part of that sentence "lower mortality may be due... to better care for those with the disease." Isn't that the entire point? I really don't understand that.

The review process required many methodological decisions not fully anticipated in the initial protocol. These included issues regarding eligibility. For instance, we considered whether or not to consider low-birth-weight a disease. We decided not to do so because it has a wide variety of social and medical causes with associated differences in prognosis. On the other hand, we decided to include studies of the outcomes of pregnancy because we considered that prenatal and obstetrical care were potentially important types of care that we could legitimately assess.

Again, not understanding the distinction associated with the cause for the care. Low-birth-weight babies need medical attention. Disease or not, that costs money.

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%

Definitely missed the importance of this stat because I didn't see the entire study. I read this to be the statistical reference associated with the comparison of mortality rates, which as it turns out is the study they did... not of the entire health care system.

I just don't see a study about mortality being broad enough to make decisions about the overall system of health care. There is a lot of health care cost associated with preventive care.

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?

My point is that costs aren't fixed, so taking overall costs and dividing by total population isn't a fair representation of costs per person moving forward. I will concede I could be looking at that all wrong.

As I see it, it also depends on the types of spending taking place in each country and/or what the spending is for. If Canadians have fewer higher priced diseases (so to speak) than the US or if they conduct fewer prescreening tests or if their technology is less advanced or if their doctors make less money... all of those things will impact the overall cost.

Doesn't that statement leave you with the idea that this study wasn't really all that conclusion about which system is "better"? It states that Canada's may be better, but the differences are not consistent.

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

I haven't seen any evidence that Canada has shown neither to be true.

Carrie M. said:
Dj, I have to confess. I completely missed the second link in your post. All I saw was the table of comparisons and the summary you quoted. I can completely see why you thought I was being ridiculous. :)

Thank goodness. I thought I had finally gone completely crazy. :)

Having said that, though, I still say after looking over the study that I don't think it's a very solid statistical reference for deciding to adapt Canada's system over our own. There are just too many variables that weren't considered.

I don't necessarily disagree, and I don't think that we should adopt Canada's system, as it were. I do think their successes pave the way for the US to adopt a universal system, just as their failures pave the way as well.

This one causes me to scratch my head. Cancer is a very expensive disease to treat and to screen for in terms of preventative care. Leaving it out is problematic to me. Not to mention the latter part of that sentence "lower mortality may be due... to better care for those with the disease." Isn't that the entire point? I really don't understand that.

Yeah I'll give you that - I don't understand it either.

Again, not understanding the distinction associated with the cause for the care. Low-birth-weight babies need medical attention. Disease or not, that costs money.

Also true, but I have to say that I'm not well-versed in medical conditions, terminology and the like. Perhaps I put too much trust in doctors to do the right thing, with regard to the study.

My point is that costs aren't fixed, so taking overall costs and dividing by total population isn't a fair representation of costs per person moving forward. I will concede I could be looking at that all wrong.

Well, I don't know if there's an easier/better way to look at it, in the context of analyzing the efficiency of the systems.

Doesn't that statement leave you with the idea that this study wasn't really all that conclusion about which system is "better"? It states that Canada's may be better, but the differences are not consistent.

I don't know, because the quote didn't find its way into your post (and I don't have time to go back, as my work da- errr, because I'm about to leave this PC).

Not sure why or how we decided that Canada was "the becnhmark" to judge by...but anyhow, after remembering that it was a 60 Minutes-ish news show I saw (that I referenced earlier), I decided to Google and track down some nation-by-nation info that might provide a BROADER comparison than the simplified "US v Canada" idea we've been discussing. Wish I could post a table, but since I can't, I'm recommending the first table down from here - specifically to give the additional information of how a wider variety of countries "stack up". http://tinyurl.com/d57wmd

-Patients with major depression are waiting almost six weeks to start treatment with a psychiatrist."

I would be surprised if the wait time in the States was less. Maureen's calendar is booked solid into September at this point, at both her private practice (patients with insurance or paying out of pocket) and the county clinic (those with sufficiently poor financial conditions to be on public health-care assistance).

Interpretation: Available studies suggest that health outcomes may be superior in patients cared for in Canada versus the United States, but differences are not consistent.

Dj, here is the quote that was omitted in my last post. I don't know why when I copy and paste, the pasted material appears blank when I submit.

djDaemon said:

The median is NOT the arithmetic mean, and is pretty much useless in the way you're trying to present it. Let's assume there are 10 patients, 9 of which recieve their radiation therapy immediately, and the last person (perhaps because they're not in real danger) has to wait 14 weeks. That would give you a median time of 7 weeks, but its most certainly not indicative of a typical, or average, wait time, which would be 1.4 weeks. Ten days doesn't sound all that bad compared to 7 weeks.

I think (and by 'think' I mean 'you do') got something mixed up there. In your example the median is immediate care and the average is 1.4 weeks.

The fact that the number mentioned in that article isa median number means half the people waited longer than 7 weeks and half less. We can't find the average (or arithmetic mean) without knowing how many people and how long each waited.

Perhaps if you stopped using "fuzzy math", it would be easier to convince you. :)

Fuzzy math is better than incorrect math. ;)

That's not a 50/50 split. Its a 71.4/28.6 split, favoring Canada having the better system.

5 out of ten favored Canada. 2 the US and 3 equal or mixed.

50% of the time the US is equal to or better than Canada. That also means 50% of the time Canada is worse than or equal to the US.

Try 75% - 9 of the 12 non-ties favor Canada.

But overall 19 of the 28 put the US equal to or better than Canada. That's almost 67.8% of the time.

In both cases you just can't ignore some of the data.

That's not to say being better isn't worth it. Just that Canada's isn't much better. And again, is that improvement worth the costs?

rollergator said:
Not sure why or how we decided that Canada was "the becnhmark" to judge by...

Me either. I've said several times I understand health care in the US is broken, but Canada's doesn't seem much better, if any, and it certainly doesn't sound like the answer to the US's problems.

Fuzzy math is better than incorrect math

As an engineering professor, I'm afraid I'm going to have to lay the smackdown on you for suggesting this. Incorrect is incorrect. If the bridge "almost didn't collapse" it's still pretty bad.

Ha!

Sorry, Professor. I like to look at it as "partially collapsing" :)

My attempt at returning the jab aside, I'm assuming my understanding of medians, averages and figuring percentages is pretty solid then?

Can I have a gold star?

^^True...to a degree. It might just be the economist in me coming to the surface (again), but in the real world, "fuzzy" is really the best you ever get in terms of having enough good and accurate data with which to make billion-dollar decisions (or trillion-dollar decisions in this case). The real world is far too complex, and resembles a peach more than a nectarine. Nectarines indeed taste better, and you don't get peach-fuzz in your mouth...but they're hard to find in nature, because dominant genetics are the evolutionary standard.

You never have "all the facts" to make policy decisions, you gather as much relelvant and useful information as you can within the constraints of time and money, then you pretty much have to "take your best guess". Everything we do involves some degree of "fuzzy math" - or else I'd be riding Rockit at universal tomorrow. ;)

...and yes, Gonch gets his gold star for basic stats... :)

rollergator said:
Not sure why or how we decided that Canada was "the becnhmark" to judge by...

I think because it's been the only model provided as an example of an alternative. I hear people want change, but I'm not clear on what shape that change is supposed to take, except that coverage for all is desired.

I think change is necessary, too. I just don't know whether that change involves an entirely different model.

The animatronic presidents look fake...

Oh, sorry. What are we talking about?

:)

The animatronic presidents look fake...

[ObDisneyGeek]No, they just don't photograph well[/ObDisneyGeek]

Carrie M. said:I think change is necessary, too. I just don't know whether that change involves an entirely different model.

That;s why I supplied the link above....to give a wider view of "models currently available". personally, the BEST plan probably involves a conglomeration/aggregation of the best features of various existing models - and maybe some stuff that no one has tried. One thing is pretty certain in MY mind at least - the system we have IS, in fact, broken.

rollergator said:
One thing is pretty certain in MY mind at least - the system we have IS, in fact, broken.

Mine too.

But I also fear that every system is broken in some way. And even if we could move from our system to one less broken, is it worth any possible downside to doing so?

Honestly, that's where my mind is right now, too. I don't see the merit in observing other models and trying to adapt them for ourselves. We need to assess our needs and what our system is doing for us (and not doing for us) and make adjustments as necessary.

Why does that involve comparisons with other countries?

You're getting the coveted double quote again, Gator. :)

rollergator said:
Wish I could post a table, but since I can't, I'm recommending the first table down from here - specifically to give the additional information of how a wider variety of countries "stack up". http://tinyurl.com/d57wmd

That's cool and all, but it seems to lack any idea of degree of seperation. Rank alone doesn't tell much of the story.

If someone has $101 and a handful of people have $100 and change and I only have $99 - I'd be ranked dead last, but there'd be no meaningful difference in what any of us could buy with our money.

The only place that info exists on that chart is the cost line. We spend a lot more.

I also found this interesting:

"Compared with the other five countries, the U.S. fares best on provision and receipt of preventive care, a dimension of 'right care'"

being as preventive care seems to be the cornerstone of long term cost reduction in your eyes. According to your link, that's one of the things we do better than the rest.

It also says:

"The findings indicate room for improvement across all of the countries..."

Exactly my suspicions.

Carrie M. said:Honestly, that's where my mind is right now, too. I don't see the merit in observing other models and trying to adapt them for ourselves. We need to assess our needs and what our system is doing for us (and not doing for us) and make adjustments as necessary. Why does that involve comparisons with other countries?

I don't think the answer is in "adapting their models for ourselves". I do think the answer involves investigating the other models and applying the best of what works elsewhere to our "Frankenstein model". We're still a unique country, with unique demgraphics and experience, and what would work best for us is unlikely to have been implemented lock, stock, and barrel anywhere else.

I am interested in the notion that we fare best in preventive care, because that is FAR from what we've been told in Public Health classes. My suspicion is that these rankings are "opinion-based surveys" where individuals are asked to rank 1-to-5, Likert-wise, how they perceive their care in the various areas. Given longer life expectancies and better overall health indicators (heart disease, obesity, etc.) in the other countries listed, I'm hard-pressed to believe the rankings *I* linked to are based on those types of objective measures. In other words, mea culpa, I need to track down better statistics that actually back up MY argument... ;)

One last edit since we're discussing this at home: Aunt Betty is the healthcare equivalent of Joe the Plumber on taxes. Anecdotal evidence makes for really poor science. The numbers tell the story, a story often distorts the truth. Of course, Joe didn't even let the truth distort his opinion, LOL...